Discrimination Based on Age: The Special Case of the Institutionalized Aged

  • William M. Altman
  • Patricia A. Parmelee


The title of this chapter is something of a misnomer, because we are concerned not with discrimination per se but with the junctures (or, all too often, the disjunctures) among medical, legal, and psychological perspectives on aging and the elderly. In focusing on nursing home residents, we shall deal with negative attitudes toward and stereotypes of the elderly that may color their treatment in such settings. But the problem goes beyond ageism to encompass prevailing social attitudes about life, death, and the course that each should ideally take.


Decisional Capacity Health Care Decision American Geriatrics Society Make Health Care Decision Forced Relocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexander, G., & Lewin, T. (1972). The aged and the need for surrogate management. New York: Syracuse University Press.Google Scholar
  2. Altman, I., & Rogoff, B. (1987). World views in psychology: Trait, interactional, organismic and transactional perspectives. In D. Stokols & I. Altman (Eds.), Handbook of environmental psychology (pp. 7–40). New York: John Wiley.Google Scholar
  3. Altman, W.M. (1986). Involuntary relocation of elderly people: A legal and public policy analysis. Unpublished manuscript.Google Scholar
  4. American Bar Association (1989). Recommendations of the National Guardianship Symposium. American Bar Association Commission of the Disabled, Commission on Legal Problems of the Elderly, and Section on Real Property, Probate and Trust. Report to the House of Delegates Recommendation. Washington DC: Author.Google Scholar
  5. Andrews, L.B. (1984). Informed consent statutes and the decisionmaking process. Journal of Legal Medicine, 5(2), 163–217.PubMedCrossRefGoogle Scholar
  6. Angell, M. (1984). Respecting the autonomy of competent patients. New England Journal of Medicine, 310, 115–116.CrossRefGoogle Scholar
  7. Appelbaum, P.S., Lidz, C.W., & Meisel, A. (1987). Informed consent: Legal theory and clinical practice. New York: Oxford University Press.Google Scholar
  8. Application of President and Directors of Georgetown College, 331 F.2d 1000, 1017 (1963) (Burger, J., Dissenting from denial of rehearing en banc).Google Scholar
  9. Archea, J., & Margulis, S.T., (1979). Environmental research inputs to policy and design programs: The case of preparation for involuntary relocation of the institutionalized aged. In T.O. Byerts, S.C. Howell, & L.A. Pastalan (Eds.), Environmental context of aging: Lifestyles, environment quality, and living arrangements (pp. 217–228). New York: Garland.Google Scholar
  10. Arizona Rev. Stat. Ann. &36–542(b) (1986).Google Scholar
  11. Avorn, J., & Langer, E. (1982). Induced disability in nursing homes patients: A controlled trial. Journal of the American Geriatrics Society, 29, 397–400.Google Scholar
  12. Axilbund, M.T. (1979). Substituted judgment f or the disabled: Report of an inquiry into limited guardianship, public guardianship and adult protective services in six states. Washington DC: American Bar Association Commission on the Mentally Disabled.Google Scholar
  13. Baltes, M.M., & Reisenzein, R. (1986). The social word in long-term care institutions: Psychosocial control toward dependency? In M.M. Baltes & P.B. Baltes (Eds.), The psychology of control and aging (pp. 315–343). Hillsdale, NJ: Erlbaum.Google Scholar
  14. Baron, C.H., & Saks, M.J. (Eds.) (1978). The use/nonuse/misuse of applied social research in courts. Cambridge, MA: Apt Books.Google Scholar
  15. Bedell, S.E., & Delbanco, T.L. (1984). Choices about cardiopulmonary resuscitation in the hospital: When do physicians talk with patients? New England Journal of Medicine, 310, 1089–1093.PubMedCrossRefGoogle Scholar
  16. Bell v. Thornburgh, 491 Pa. 263, 420 A.2d 443 (1980), opinion on remand, 422 A.2d 738 (1980).Google Scholar
  17. Besdine, R. (1983). Decisions to withhold treatment from nursing home residents. Journal of the American Geriatrics Society, 31, 602–606.PubMedGoogle Scholar
  18. Blessed, J., Tomlinson, B.E., & Roth, M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral graymatter of elderly subjects. British Journal of Psychiatry, 114, 797–811.PubMedCrossRefGoogle Scholar
  19. Bouvia v. Superior Court, 170 Cal. App.3d 1127, 225 Cal. Rptr. 297 (1986).Google Scholar
  20. Bracco v. Lackner, 462 F. Supp. 436 (N.D.Cal. 1978).Google Scholar
  21. Brakel, S., Parry, J., & Weiner, B. (1985). The mentally disabled and the law (3rd ed.). Chicago: The American Bar Foundation.Google Scholar
  22. Brower, H.T. (1981). Social organization and nurses’ attitudes toward older persons. Journal of Gerontological Nursing, 7, 293–298.PubMedGoogle Scholar
  23. Capron, A.M. (1974). Informed consent in catastrophic disease research and treatment. University of Pennsylvania Law Review, 123, 340–438.PubMedCrossRefGoogle Scholar
  24. Carstensen, L., & Whitbourne, S. (1978, November). Variations in locus of control and morale by institutional totality in an elderly sample. Paper presented at the annual meeting of the Gerontological Society of America, Dallas.Google Scholar
  25. Cassileth, B., Zupkis, R., Sutton-Smith, K., & March, V. (1980). Informed consent—Why are its goals imperfectly realized? New England Journal of Medicine, 302, 896–900.PubMedCrossRefGoogle Scholar
  26. Coccaro, E.F., & Miles, A.M. (1984). The atti-tudinal impact of training in gerontology/geriatrics in medical school: A review of the literature and prospective. Journal of the American Geriatrics Society, 32, 762–768.PubMedGoogle Scholar
  27. Coffman, T.L. (1981). Relocation and survival of institutionalized aged: A reexamination of the evidence. Gerontologist, 21, 483–500.CrossRefGoogle Scholar
  28. Cohen, E.S. (1981). Legal issues in “transfer trauma” and their impact. Gerontologist, 21, 520–522.CrossRefGoogle Scholar
  29. Cohen, E.S. (1985). Autonomy and paternalism: Two goals in conflict. Law, Medicine and Health Care, 13(A), 145–150.Google Scholar
  30. Cohen, E.S. (1987). Legislative and educational alternatives to a judicial remedy for the transfer trauma dilemma. American Journal of Law and Medicine, 11(A), 405–432.Google Scholar
  31. Comment (1970). Restructuring informed consent: Legal therapy for the doctor patient relationship. Yale Law Journal, 79, 1533–1576.CrossRefGoogle Scholar
  32. Cruzan v. Harmon, 760 S.W.2d 408 (Mo. 1988), No. 88–1503, U.S. Supreme Court (1989, July 17).Google Scholar
  33. Ennis, B., & Litwack, T. (1974). Psychiatry and the presumption of expertise: Flipping coins in the courtroom. California Law Review, 62, 693–752.CrossRefGoogle Scholar
  34. Evans, A.L., & Brody, B.A. (1985). The do-not-resuscitate order in teaching hospitals. Journal of the American Medical Association, 253, 2236–2239.PubMedCrossRefGoogle Scholar
  35. Flicker, C. (1988). Neuropsychological evaluation of treatment effects in the elderly: A critique of tests in current use. Psychopharmacological Bulletin, 24, 535–556.Google Scholar
  36. Francis, L.P. (1988). The evanescence of living wills. Journal of Contemporary Law, 14, 27–51.Google Scholar
  37. Frolik, L. (1981). Plenary guardianship: An analysis, a critique and a proposal for reform. Arizona Law Review, 23, 599–660.Google Scholar
  38. Halper, P. (1980). The double-edged sword: Paternalism as a policy in the problems of aging. Millbank Memorial Fund Quarterly, 58, 472–499.CrossRefGoogle Scholar
  39. High, D.W. (1988). All in the family: Extended autonomy and expectations in surrogate health care decision-making. Gerontologist, 2#(Supp.), 46–52.Google Scholar
  40. Horowitz, M.J., & Schulz, R. (1984). Institutional relocation and its impact on mortality, morbidity, and psychosocial status. In A. Baum, S.E. Taylor, & J.E. Singer (Eds.), Handbook of psychology and health: Vol. 4. Social psychological aspects of health (pp. 319–343).Google Scholar
  41. Hillsdale, N.J.: Erlbaum. Hortsman, P. (1975). Protective services for the elderly: The limits of parens patriae. Missouri Law Review, 40, 216–278.Google Scholar
  42. Idaho Code Ann., Chap. 43, &39–4302 (Michie 1985).Google Scholar
  43. In re Coburn, 165 Cal. 202, 131 P. 352 (1913). In re Farrell 529 A.2d 404 (N.J. 1987).Google Scholar
  44. In re Harris, 477 A.2d 724 (D.C. 1984).Google Scholar
  45. In re Ingram, 102 Wash.2d, 827, 689 P.2d 1363 (1984).Google Scholar
  46. In re Schiller, 372 A.2d 360 (N.J. Super. 1977).Google Scholar
  47. In re Siegal’s Estate, 69 Pa. Sup. Ct. 425, 82 A.2d 309 (1951).Google Scholar
  48. In the matter of Claire C. Conroy, 98 N.J. 321, 486 A.2d 209 (1985).Google Scholar
  49. In the matter of Karen Quinlan, 79 N.J. 10, 335 A.2d 647 (1976).Google Scholar
  50. Kapp, M.B. (1985). Adult protective services: The attorney’s role. Florida Bar Journal, 59(10), 23 – 28.Google Scholar
  51. Kapp, M.B., & Bigot, A. (1985). Geriatrics and the law: Patient rights and professional responsibilities. New York: Springer.Google Scholar
  52. Katz, J. (1977). Informed consent—a fairy tale? Law’s vision. University of Pittsburgh Law Review, 39, 131-HA. Kayser-Jones, J., &Google Scholar
  53. Kapp, M.B. (1989). Advocacy for the mentally impaired elderly: A case study analysis. American Journal of Law and Medicine, 14(4), 353–376.PubMedGoogle Scholar
  54. Klein v. Califano, 586 F.2d 250, 3d Cir. (1978).Google Scholar
  55. Kramer, N.A., & Jarvik, L.F. (1979). Assessment of intellectual changes in the elderly. In A. Raskin & L.F. Jarvik (Eds.), Psychiatric symptoms and cognitive loss in the elderly (pp. 221–272). New York: Hemisphere.Google Scholar
  56. Kuypers, J.A., & Bengtson, V.L. (1973). Social breakdown and competence. Human Development, 16, 181–201.PubMedCrossRefGoogle Scholar
  57. Lane v. Candura, 376 N.E.2d 1232, Mass. App. (1978).Google Scholar
  58. Langer, E.J., & Avorn, J. (1982). Impact of the psychosocial environment of the elderly on behavioral and health outcomes. In R.D. Chellis, J.F. Seagle Jr., & B.M. Seagle (Eds.), Congregate housing for older people (pp. 15–25). Lexington, MA: Lexington Books.Google Scholar
  59. Lawton, M.P. (1989). Behavior-relevant ecological factors. In K.W. Schaie & C. Schooler (Eds.), Social structure an aging: Psychological processes (pp. 57–78). Hillsdale, NJ: Erlbaum.Google Scholar
  60. LaZalla v. State of Minnesota, 366 N.W.2d 395 (Minn. App. 1985).Google Scholar
  61. Levy, M.R., Lambe, M.E., & Shear, C.L. (1984). Do-not-resuscitate orders in a county hospital. Western Journal of Medicine, 140, 111–113.PubMedGoogle Scholar
  62. Lewis, M.A., Cretin, S., & Kane, R.L. (1985). The natural history of nursing home patients. Gerontologist, 25, 382–388.PubMedCrossRefGoogle Scholar
  63. Lexington Management Corporation v. Missouri Department of social Services, 656 F.Supp. 36 (M.D. Missouri, 1986).Google Scholar
  64. Lo, B., McLeod, G.A., & Saika, G. (1986). Patient attitudes to discussing life-sustaining treatment. Archives of Internal Medicine, 146, 1613–1615.PubMedCrossRefGoogle Scholar
  65. Lowenthal, M.F. (1977). Toward a sociological theory of change in adulthood and old age. In J.E. Birren & K.W. Schaie (Eds.), Handbook of the psychology of aging. New York: Van Nostrand Reinhold.Google Scholar
  66. Marriner, W.K., & McArdle, P.A. (1985). Consent forms, readability, and comprehension: The need for new assessment tools. Law, Medicine & Health Care, 68–74.Google Scholar
  67. McConnel, C.E. (1984). A note on the lifetime risk of nursing home residency. Gerontologist, 24, 193–198.PubMedCrossRefGoogle Scholar
  68. McPherson v. Ellis, 287 S.E.2d 892, N.C. (1982).Google Scholar
  69. Miles, S.H. & Ryden, M.B. (1985). Limited treatment policies in long-term care facilities. Journal of the American Geriatrics Society, 33, 707–711.PubMedGoogle Scholar
  70. Miss. Code Ann. & 41–41–3, Suppl. (1985).Google Scholar
  71. Modzierz, G.J., & Schlesinger, S.E. (1986). Do not resuscitate policies in Midwestern hospitals: A five-state survey. Health Services Research, 20, 949–960.Google Scholar
  72. Morrow, J., Gootnick, J., & Schmale, A. (1978). A simple technique for increasing cancer patients’ knowledge of informed consent to treatment. Cancer, 42, 793–799.PubMedCrossRefGoogle Scholar
  73. Müller v. Oregon, 208 U.S. 412 (1908).Google Scholar
  74. National Center for Health Statistics (1987). Use of nursing homes by the elderly: Preliminary data from the 1985 National Nursing Home Survey. Advance Data from Vital and Health Statistics, No. 135. (DHHS Pub. No. PHS87–1250.) Hyattsville, MD: Public Health Service.Google Scholar
  75. Newfield House v. Mass. Dept. of Pub. Welfare, 651 F.2d 32, 1st Cir. (1981).Google Scholar
  76. New Hampshire Rev. Stat. Ann. &464-A: (7), (11) (1983).Google Scholar
  77. Nolan, B.S. (1984). Functional evaluation of the elderly in guardianship proceedings. Law, Medicine and Health Care, 72(5), 210–218.Google Scholar
  78. O’Bannon v. Town Court Nursing Center, Inc., 447 U.S. 773 (1980).Google Scholar
  79. Ohio Rev. Code Ann. &2111.06, Page Suppl. (1983).Google Scholar
  80. Parmelee, P.A., Katz, I.R., & Lawton, M.P. (1989). Depression among institutionalized aged: Assessment and prevalence estimation. Journal of Gerontology, 44, M22–M29.PubMedCrossRefGoogle Scholar
  81. Parmelee, P.A., & Lawton, M.P. (1990). Design of special environments for the aged. In J.E. Birren (Ed.), Handbook of the psychology of aging (3rd ed., pp. 464–488). New York: Academic Press.Google Scholar
  82. Perry, C.B., & Applegate, W.B. (1985). Medical paternalism and patient self-determination. Journal of the American Geriatrics Society, 33, 353–359.PubMedGoogle Scholar
  83. Peterson, C., & Seligman, M.E.P. (1984). Causal explanations as a risk factor for depression: Theory and evidence. Psychological Review, 91,Google Scholar
  84. Piper, A.I., & Langer, E.J. (1986). Aging and mindful control. In M.M. Baltes & P.B. Baltes (Eds.), The psychology of control and aging (pp. 71–89). Hillsdale, NJ: Erlbaum.Google Scholar
  85. President’s Commission for the Study of Ethical Problems in Medicine and Biomed ical and Behavioral Research (1982). Making health care decisions: The ethical and legal implications of informed consent in the patient-practitioner relationship. Washington DC: U.S. Government Printing Office.Google Scholar
  86. Ratzan, R.M. (1980). “Being old makes you different”: The ethics of research with elderly subjects. Hastings Center Report, 10, 32–42.Google Scholar
  87. Ratzan, R.M. (1985). Technical aspects of obtaining informed consent from persons with senile dementia of the Alzheimer’s type. In V.L. Melnick & N.N. Dubler (Eds.), Alzheimer’s dementia: Dilemmas in clinical research (pp. 123– 139). Clifton, N.J: Humana.CrossRefGoogle Scholar
  88. Regan, J.J. (1981). Protecting the elderly: The new paternalism. Hastings Law Journal, 32, 1111–1132.Google Scholar
  89. Rockhill Care Center v. Harris, 502 F. Supp. 1224, W.D. Missouri (1980).Google Scholar
  90. Rodin, J. (1986). Health, control and aging. In M.M. Baltes & P.B. Baltes (Eds.), The psychology of control and aging (pp. 139–165). Hillsdale, NJ: Erlbaum.Google Scholar
  91. Rosoff, A.J., & Gottlieb, G. (1987). Preserving personal autonomy for the elderly: Competency, guardianship, and Alzheimer’s disease. Journal of Legal Medicine, 8, 1–47.PubMedCrossRefGoogle Scholar
  92. Roth, L., Meisel, A., & Lidz, C. (1977). Tests of competency to consent to treatment. American Journal of Psychiatry, 134, 279–284.PubMedGoogle Scholar
  93. Sales, B.D., Powell, D.M., & VanDuizand, R. (1982). Disabled persons and law: State legislative issues. New York: Plenum.CrossRefGoogle Scholar
  94. Salgo v. Leland Stanford Jr. University Board of Trustees, 154 Cal. App.2d 560, 317 P.2d 170 (1957).Google Scholar
  95. Sard v. Hardy, 379 A.2d 1014 (Md. Ct. App., 1977).Google Scholar
  96. Scholendorff v. Society of New York Hospitals, 21 N.Y. 124, 105 N.D. 92 (1914).Google Scholar
  97. Schwartzburg v. Califano, 453 F. Suppl. 1042 (S.D.N.Y. 1978).Google Scholar
  98. Schulz, R. (1976). Control, predictability, and the institutionalized aged. Journal of Personality and Social Psychology, 33, 563–573.PubMedCrossRefGoogle Scholar
  99. Schulz, R., & Horowitz, M.J. (1983). Meta-analytic biases and problems of validity in the relocation literature: Final comments. Gerontologist, 13, 460–461.CrossRefGoogle Scholar
  100. Scott v. Bradford, 606 P.2d 554 (Oklahoma 1979).Google Scholar
  101. Siu, A.L. (1987). The quality of medical care received by older persons. Journal of the American Geriatrics Society, 35, 1084–1091.PubMedGoogle Scholar
  102. Snow, R.M. & Atwood, K. (1985). Probable death: Perspective of the elderly. Southern Medical Journal, 78, 851–853.PubMedCrossRefGoogle Scholar
  103. Snyder, L. (1988). Artificial feeding and the right to die: The legal issues. Journal of Legal Medicine, 9(3), 349–375.PubMedCrossRefGoogle Scholar
  104. Somervile, M. (1979). Consent to medical care. Ontaiio, Canada: Law Reform Commission of Canada.Google Scholar
  105. Spilerman, S., & Litwak, E. (1982). Reward structures and organizational design. Research on Aging, 4, 43–70.CrossRefGoogle Scholar
  106. Stanley, B., Guido, J., Stanley, M., & Shortell, D. (1984). The elderly patient and informed consent. Journal of the American Medical Association, 252, 1302–1306.PubMedCrossRefGoogle Scholar
  107. Stanley, B., Stanley, M., Guido, J., & Garvin, L. (1988). The functional competency of elderly at risk. Gerontologist, 2#(Suppl.), 53–58.Google Scholar
  108. State Department of Human Resources v. Northern, 563 S.W.2d 197 (Tenn. Ct. App. 1978).Google Scholar
  109. Stokols, D. (1987). Conceptual strategies of environmental psychology. In D. Stokols & I. Altman (Eds.), Handbook of environmental psychology (pp. 41–70). New York: John Wiley.Google Scholar
  110. Taub, H.A., Baker, M., & Sturr, J. (1986). Informed consent for research: Effects of readability, patient age, and education. Journal of the American Geriatrics Society, 34, 601–606.PubMedGoogle Scholar
  111. Thomasma, D.C. (1984). Freedom, dependency, and the care of the very old. Journal of the American Geriatrics Society, 32, 906–914.PubMedGoogle Scholar
  112. Thompson, L.W. (1980). Testing and mnemonic strategies. In L.W. Poon, J.L. Fozard, L.S. Cermak, D. Arenberg, & L.W. Thompson (Eds.), New directions in memory and aging (pp. 367–377). Hillsdale, NJ: Erlbaum.Google Scholar
  113. Timko, C., & Rodin, J. (1985). Staff-patient relationships in nursing homes: Sources of conflict and rehabilitation potential. Rehabilitation Psychology, 30, 93–108.Google Scholar
  114. Turnbull, H.R. (1977). Consent handbook. Washington DC: American Association on Mental Deficiency.Google Scholar
  115. Tymchuk, A.J., Ouslander, J.G., & Rader, N. (1986). Informing the elderly: A comparison of four methods. Journal of the American Geriatrics Society, 34, 818–822.PubMedGoogle Scholar
  116. Tymchuk, A.J., Ouslander, J.G., Rahbar, B., & Fitten, J. (1988). Medical decision-making among elderly people in long-term care. Gerontologist, 25(Suppl.), 59–63.CrossRefGoogle Scholar
  117. Uhlmann, R.F., McDonald, W.J., & Inui, T.S. (1984). Epidemiology of no code orders in an academic hospital. Western Journal of Medicine, 140, 114–116.PubMedGoogle Scholar
  118. Uniform Probate Code, 6th edition, Section 5–103(7) (1982).Google Scholar
  119. Utah Code Ann. &75–1–201 (18) (1978).Google Scholar
  120. Wack, J., & Rodin, J. (1978). Nursing homes for the aged: The human consequences of legislation-shaped environments. Journal of Social Issues, 34, 6–21.CrossRefGoogle Scholar
  121. Wagner, A. (1984). Cardiopulmonary resuscitation in the aged. New England and Journal of Medicine, 310, 1129–1130.CrossRefGoogle Scholar
  122. Waltz, J.R., & Scheuneman, T.W. (1970). Informed consent to therapy. Northwestern University Law Review, 64, 628–650.Google Scholar
  123. Weinstock, R. (1987). Informed consent and competence issues in the elderly. In R.R. Rosner & H.I. Schwartz (Eds.), Geriatric psychiatry and the law (pp. 49–78). New York: Plenum.CrossRefGoogle Scholar
  124. Wetle, T. (1985). Ethical issues in long-term care for the aged. Journal of Geriatric Psychiatry, 18, 63–73.PubMedGoogle Scholar
  125. Williams v. Commonwealth of Pennsylvania, 58 Pa. 1161, 427 A.2d 319 (1981).Google Scholar
  126. Wolk, S., & Telleen, L. (1976). Psychological and social correlates of life satisfaction as a function of residential constraint. Journal of Gerontology, 31, 89–98.PubMedCrossRefGoogle Scholar
  127. Yaretsky v. Blum, 629 F.2d 817 (2d Cir. 1980, rev’d. on other grounds, 457 U.S. 991, 1982).Google Scholar
  128. Younger, S.J., Lewandowski, W., McClish, D.K., Juknialis, B.W., Coulton, C., & Bartlett, E.T. (1985). “Do not resuscitate” orders: Incidence and implications in a medical intensive care unit. Journal of the American Medical Association, 253, 54–57.CrossRefGoogle Scholar
  129. Ziegler, M., & Reid, D. (1983). Correlates of changes in desired control scores and in life-satisfaction scores among elderly persons. International Journal of Aging and Human Development, 76, 135–146.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • William M. Altman
  • Patricia A. Parmelee

There are no affiliations available

Personalised recommendations