How to be anti-ageist

I vividly recall an initial outpatient encounter with an older adult with Alzheimer’s and her caregiver. I launched into a series of questions for the caregiver that I thought were covering all the bases of providing good care. Were there any changes in her functional status? Were there any new safety risks, such as wandering or forgetting to turn off the stove? Could any medications be contributing to problems with cognition? 

After a few minutes had passed, the patient asked with an incredulous expression and a stern voice, “Would you please look at me to ask me what I think?” 

I learned a powerful lesson that struck to the core about what it means to provide age-friendly care. This was especially impactful since it was imparted not during my formative years as a medical student and resident, but only a few years ago as a seasoned mid-career geriatrician. I learned that despite dedicating my career to the care of older people, I was susceptible to what I call the invisible “ism”—ageism.  

Not only had I directed my gaze and questions to the caregiver, but I’d also dismissed the voice and indeed the entire life experience of my older adult patient and assumed that her younger caregiver would be better able to articulate what matters most to her than the patient herself. 

Ageism means discriminating against a person solely on the basis of their age. Ageism can be overt—like the greeting card section of a store with cards that insult older adults—or more subtle—consider that ageism is rarely considered in well-intentioned equity, diversity, and inclusion initiatives. It’s also one of the few “isms” that’s broadly accepted by society and is therefore pervasive, making it even more important to call attention to ageism so that it can be opposed. 

Ageism shouldn’t be opposed solely on moral grounds. From a health standpoint, it’s been shown that having a positive attitude toward aging results in a life expectancy that is about seven years longer than those with a negative attitude toward aging. Ageism also causes an estimated $63 billion per year in U.S. healthcare costs. Perhaps most importantly, ageism is a barrier to eliciting what matters most to an older adult, thereby possibly leading to care that is undesired by the patient, and less care that is desired by the patient. 

To oppose ageism: 

Ask the patient how they would like to be addressed. Avoid terms such as “sweetie” or “honey” that most older adults will find to be demeaning. Don’t assume that older adults want to be called by their first name. 

Direct your questions to the patient. Then ask the patient’s permission to ask questions of the caregiver. This is best practice even for patients with severe cognitive impairment, who are often able to articulate what matters most to them. 

Advocate for older adults to be included in clinical trials. Otherwise, we’re reduced to guessing whether the results of a clinical trial will be applicable to an older adult. 

Consider the “double disadvantage” of ageism and other “isms.” Older adults experiencing additional “isms” including racism and/or sexism have a double or triple disadvantage. 

Propose anti-ageism campaigns as key components of your health system’s diversity, equity, and inclusion initiatives. Ageism will remain an invisible “ism” if it is not called out. 

Ageism is embedded in American culture to such a great extent that even geriatricians must constantly be on guard to call out ageism in themselves and in others. I implore you to do the same, if only because, as Dr. Laura Mosqueda said, “Ageism is the only “ism” in which we act against our future selves.” Therefore, we all have a deeply personal stake in opposing ageism. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.