Ageism in Healthcare
Ageism in healthcare refers to “negative or positive stereotypes, prejudice and/or discrimination against (or to the advantage of) health care users on the basis of users’ chronological age or on the basis of a perception of users as being ‘old,’ ‘too old,’ ‘young’ or ‘too young.’ Ageism can be self-directed or other-directed, implicit or explicit and can be expressed on a micro, meso or macro-level” (adapted from São José et al. 2017: 375).
Research on ageism in healthcare expanded significantly at the turn of the millennium, especially over the last decade. The vast majority of the studies were carried out in Europe (mainly in the United Kingdom) and North America (mainly in the United States) and have been mainly concerned with measuring the prevalence of ageism and, to a lesser extent, its manifestations. Two major research objectives have been pursued: (a) to measure and identify ageist practices (discrimination), mostly in treatment and management, and (b) to measure and identify ageist stereotypes not only about older patients in specific but also about older people in general.
There is a predominance of theory-poor studies, and although most studies have mobilized conceptual/general definitions of ageism, these tend to be narrow. The same happens with operational definitions of ageism (definitions that identify the specific components and indicators of ageism), which have privileged certain components of ageism such as behavioral, cognitive, other-directed, explicit, and negative components in detriment of others.
In relation to research design and methods, the studies have been largely quantitative, including (a) studies that used scales of ageism, (b) studies that used surveys, and (c) studies that used other methods of data collection (e.g., case notes and clinical audits). With regard to research settings, there is a clear imbalance in favor of hospitals. In the studies that collected primary data, the research participants were, with some exceptions, the healthcare staff, mostly doctors/physicians. Older patients participated in a minority of studies.
Key Research Findings
There is substantial evidence of discriminatory practices toward older patients and negative stereotypes (held by the healthcare staff) about older patients and older people in general. Only a minority of studies did not identify evidence of ageism (e.g., Hubbard et al. 2003). The evidence of discriminatory practices is found mainly (a) in the manner staff interact with older patients, more specifically in practices such as “elderspeak” (Schroyen et al. 2018) and spending inadequate time listening to older patients (Hansen et al. 2016) and (b) in the access to specialized therapies and services, in which the patients managed in resuscitation rooms who are transferred to neurosurgical care are younger than those who are not (Grant et al. 2000) and the patients that are treated in a stroke unit are younger than those who are not (Rudd et al. 2007). In turn, the evidence of ageist stereotypes about older patients is manifested in beliefs that certain symptoms (e.g., back pain) are related with old age (Makris et al. 2015) and that older patients are not as likely to recover completely from their illnesses as younger patients (Skirbekk and Nortvedt 2014), among others. Finally, the evidence of ageist stereotypes about older people in general was gathered by the use of scales of ageism, in which the “Attitudes Toward Older People Scale” stands out (Kogan 1961).
Future Directions of Research
Future research must pay more attention to the origins and consequences of ageism in healthcare, as well as to interventions aimed to tackle it in practice. With respect to interventions, it is recommended, for example, that new models of intervention to reduce ageism could be tested, such as the recently developed theoretical model called “Positive Education about Aging and Contact Experiences (PEACE)” (Levy 2016). This model focuses on two interconnected factors, namely, education about aging and positive intergenerational contact, and according to its developer is relevant to different settings (including healthcare) and age groups. It is also recommended that future studies engage more systematically with theory and comprehensive definitions of ageism. It is believed that theoretically/conceptually informed research has more heuristic power and is better able to capture the multidimensionality of ageism in healthcare. In this respect, the integration of the study of ageism with the study of aging may be fruitful from a theoretical and conceptual point of view (Levy and Macdonald 2016). Still in relation to theoretical and conceptual aspects, although there are some studies that analyze the combined effect of ageism with other forms of oppression in healthcare, such as sexism (Chrisler et al. 2016), it is suggested that the intersectionality perspective could be mobilized in a more systematic way in future studies. Furthermore, future research must focus on less explored components of ageism, particularly the self-directed and implicit components, which are the most surreptitious and insidious forms of ageism. Looking more systematically at discrimination in diagnosis and clinical trials would also contribute to expand research on the topic.
Developing scales of ageism specifically oriented to older users of healthcare services and diversifying in terms of research design (developing more qualitative studies), research settings (including also primary care settings), research participants (selecting older patients more often), and countries (exploring realities beyond the Anglo-Saxon world) would also contribute to expand research on ageism in healthcare.
- Levy SR (2016) Toward reducing ageism: PEACE (Positive Education about Aging and Contact Experiences) model. The Gerontologist. https://doi.org/10.1093/geront/gnw116
- Schroyen S, Adam S, Marquet M et al (2018) Communication of healthcare professionals: is there ageism? Eur J Cancer Care. https://doi.org/10.1111/ecc