To many, "aging" and "old" are considered dirty words. Clinicians should fight ageism.
The report from the ED was met with a moan by the receiving hospitalist: “90-year-old woman S/P fall with multiple fractures of pelvis and sacrum, admitted for pain control and rehab.” After a grueling day, the hospitalist, Dr. K, certainly didn’t want another “gomer” on his service.
I asked to speak with Dr. K, and was met with thinly veiled hostility as I introduced myself: the patient is my mother and I am the physician- daughter. I am also a geriatrician. He had not yet met my mother, and he vented that this might not be an appropriate hospital admission. He would get back to me.
I had just experienced outright ageism: the instant bias and assumptions made about older adults. To many, “aging” and “old” are considered dirty words. There’s no way around it—countless surveys indicate that both words are equated with decay, decline, disease, and death. Senior, elder, geriatric, silvered, golden years? Forget it. Even AARP (formerly the “American Association of Retired People”) banished “retired” from its name (now it stands for “Real Possibilities”).
Aging is a natural, biological process that begins the day we are born. Globally, there are cultures where elders are revered, treated with respect and admiration, and sought out for input on important decisions. For the most part, this is not the case in America.
The influence of ageism is pernicious and pervasive throughout our society. Older adults are often portrayed in the media as useless, bumbling, demented, or incapable of making valuable contributions. Even in hospitals, ageism is rampant, as my mother experienced—and can have direct negative impact on the care received. Rates of iatrogenic complications have been documented to be five times higher in older adults compared with young adults, even after controlling for comorbidity and illness severity.
Two hours later, Dr. K returned with a remarkably different attitude.
“Your mother is incredibly youthful and delightful; I cannot believe she’s 90. She’s really sharp too. Her fall was really devastating; we need to do everything we can to help her get walking and back home.”
Once he got to know my mother, the ageist bias disappeared.
What can we do as healthcare professionals to change attitudes about aging?
1.)Changes start within: be aware of negative attitudes you may have about older adults and reframe awareness.
2.)All older adults have something to teach us: learn about their stories, their lives, their priorities and concerns. Once you get to know the individual, the biases will diminish.
3.)Treat all older adults with dignity and respect; remember they are survivors: do not use their first names without permission, and avoid using terms of endearment (“honey,” “dear”) which can be belittling.
4.)Remember we will all be there someday if we are lucky.
5.)Teach our trainees by example: Your respectful treatment of elders will be apparent to your students and trainees.
A sustained groundswell will be needed to truly change the messaging about aging. Let’s create the change together.