What do you expect at your age?
Ageism, like all types of discrimination, works on a number of levels. Individual people are ageist, and the structures within society are ageist too. These ‘structures’ include the procedures and policies of society's institutions (such as government, hospitals, schools), and the actions of people within them. How resources are distributed, rights and opportunities, and the culture and beliefs of society are all part of the structures which maintain inequality.
Earlier this year my 83 year old mum was diagnosed with a serious health condition. Prior to diagnosis she had several appointments with her GP due to symptoms she was experiencing. Over a number of weeks these new and worrying symptoms were dismissed as ‘just something that happens when we get older’. I know from speaking to others that my mum’s experiences are not unique.
“No ailment should ever be written off as an ‘old age’ ailment” says gerontologist Mark Lachs “Treating patients based on their age means you can miss very significant, treatable situations.” (1)
Age bias happens widely in medical settings, as the Yale School of Public Health found in the largest examination to date of the health consequences of ageism. Evidence of denied access to health care treatments was found in 85% of all studies:
“….ageism adversely affected whether or not older patients received medical treatment and, if they received the treatment, the duration, frequency, and appropriateness of the treatment provided.” (2)
Older people are also treated differently when seeking help for mental health conditions. They are more likely to be offered medication than talking therapies, as a report published by Public Health England in Yorkshire and Humber reveals:
“...there are inequalities in access to services; older adults are less likely to have access to talking therapies and those aged over 75 are six times as likely to be on tranquillisers.” (3)
This is despite evidence that older people who are referred to talking therapies are more likely to attend and that clinical improvement increases with age. (3)
And in social care settings too... “negative attitudes to ageing can affect the quality of interactions between older adults and social care workers”. (4)
Ageism affects access to services, how services are designed and delivered, and often results in the exclusion of the voice of older people. As the World Health Organisation explains:
“Ageism imposes barriers to the development of good policies on ageing and health as it influences the way problems are framed, the questions that are asked and the solutions that are offered. In this context, age is often understood as sufficient justification for treating people unequally and limiting their opportunities for meaningful contribution.” (5)
In the government’s response to the Covid-19 crisis, we can see ‘institutionalised ageism’ in the initial blanket use of a chronological age category to determine who is most vulnerable. This approach was criticised by the British Society of Gerontology:
“As a population group, it is wrong and overly simplistic to regard people who are aged 70 and above as being vulnerable, a burden, or presenting risks to other people.” (6)
Professor Thomas Scharf in his lecture on Ageism and age stereotyping during COVID-19, explains how expertise in ageing is lacking in the government’s scientific advisory group and more generally:
“If you look around government you’d struggle to find anyone with knowledge or expertise on ageing, one example of an institutionalised form of ageism.”
Studies into how health research is carried out provide evidence of how older people are actively excluded from taking part, even in studies of conditions that affect older people more:
"...older persons were excluded from trials in cardiology, internal medicine, nephrology, neurology, preventive medicine, psychiatry, rheumatology, oncology, and urology ...using an international registry of Parkinson’s disease clinical trials, researchers found 49.0% of the clinical trials excluded older persons, even though this disease is more prevalent in later life." (7)
Whilst ageism is apparent in many of the services and institutions which are there to support older people, it is important to reflect on why this is the case and how we can improve things. Why are older people not referred to talking therapies at the same rate as younger people? Why are symptoms that are investigated in younger people, frequently written off as ‘just old age’ in older people? Why are lockdown restrictions based on age seen as acceptable when restrictions based on other demographic factors (race, gender) are not? What are the assumptions being made, usually unconsciously, behind these decisions? I’ll explore these questions and some of the solutions being offered in my next blog on ‘unconscious bias’.
Friendly Communities Officer, Time to Shine
(1) Maureen Mackey, “Ageism in Medicine: How it appears, Why it can Hurt you” AARP Bulletin, 18.11.10
(2) Harmful effects of ageism on older persons' health found in 45 countries (Michael Greenwood, Yale News, January 2020)
(3) Health Needs Assessment Older people’s mental health in Yorkshire and the Humber (Alison Iliff, PHE Yorkshire and Humber Centre, 2020)
(4) That Age Old Question (RSPH, 2018)
(5) A global campaign to combat ageism (Bulletin of the World Health Organisation, March 2018)
(6) Covid-19 - statement (British Society of Gerontology)
(7) Global reach of ageism on older persons' health: a systematic review (PLOS ONE, January 2020)