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Age Discrimination
Goals
• Elicit self reflection about own perceptions of older
persons
• Define age discrimination broadly
• Examine types ...
Examining your own beliefs about
older persons
Activity
• List ten words to describe the elderly in general
• Describe your relationship with an older individual.
• Thin...
Defining Age Discrimination
A process of systematic stereotyping, prejudicial
attitudes and direct or indirect discrimination
against people because t...
What is Ageism
Labor: Failure to hire or promote qualified
older persons
Care: Absence of appropriate care of older
person...
Classifying Ageism
Types of Ageism
Personal
Ageism
Bias
against persons
or groups
based on their
older age.
• Exclusion/ig
noring older
perso...
Examples of Age Discrimination
Direct
Systematic
Policy
Access
Social/cultural
Physician attitudes
Think Twice About Stereotypes
Stereotypes
• like all stereotypes, the stereotype of a typical
older person exaggerates the importance of a
few character...
Stereotypes
• 64% of adults >65 report no limitation in
major activity
• Only 20% report they need assistance with
basic d...
What do you expect at your age?
• Attributing ageing to physical decline assumes
that age itself is the cause of decline w...
Stereotypes
• memory loss and dementia are not natural
byproducts of aging
– people who continue to learn and regularly
ex...
Activity Discussion
How is age discrimination
different than other
forms of discrimination?
Examine the social and economic
history that produced current
naturalized beliefs about the elderly
Naturalization of
the social role of the elderly
Rooted in Historical and
Economic Context:
• The Printing Press
• The Ind...
Cross Cultural Perspective
• American sentiment
• Old age as a negative time- decline in physical attributes, mental acuit...
Cross Cultural Perspective
• Americans of Chinese, Japanese, and Korean
descent, researchers found that Korean
Americans a...
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Ageing

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  • These cues are prevalent because, as distinct from other forms of prejudice and discrimination (e.g., racism and sexism), ageism does not tend to be proscribed by political correctness. Initially, these cues may be thwarted by a state of denial, but their prevalence tends to overcome resistance (Levy & Banaji, 2002). Unlike those who have been stigmatized since birth and consequentl may acquire coping strategies from their subgroup, individuals tend to enter old age unprepared to resist negativeage stereotypes.
  • Journal of Social Issues, Vol. 61, No. 2, 2005, pp. 207--221Ageism: Prejudice Against Our Feared Future SelfTodd d nelson 2005
  • Exclusion or ignoring older persons based on stereotypic assumptions· Physical abuse· Stereotypes about older persons and old age
  • Have students list some they can think ofanti-aging products
  • List some negative stereotypes Despondent, shrew, recluse, nosy neighbor, bag lady, vulnerable, severely impaired, crotchety, rude, depressed
  • senile old man with a long beard and ear horn and the timid and unthreatening “granny” sitting inthe corner with her knitting.
  • 64 percent of adults 65+ report no limitation in major activities,18 and only 20 percentreport that they need assistance with basic daily activities.19 Rates of disability continue todecline for persons 65 and older
  • 64 percent of adults 65+ report no limitation in major activities,18 and only 20 percentreport that they need assistance with basic daily activities.19 Rates of disability continue todecline for persons 65 and older
  • These cues are prevalent because, as distinct from other forms of prejudice and discrimination (e.g., racism and sexism), ageism does not tend to be proscribed by political correctness. Initially, these cues may be thwarted by a state of denial, but their prevalence tends to overcome resistance (Levy & Banaji, 2002). Unlike those who have been stigmatized since birth and consequentl may acquire coping strategies from their subgroup, individuals tend to enter old age unprepared to resist negativeage stereotypes.Paradoxically the people who lIKE old people are more likely to engage in over accomodatinglnaguage
  • Ageism is Rooted in Historical and Economic ContextBrief anthropological context: the changing role of the elderly The invention of the printing press (loss of role in oral history)The Industrial Revolution (mobility from home, loss of land ownership) Concurrent advances in medical technology and life expectancy Naturalization of uselessness (based on social/economic context and subsequent value judgments) stereotypes of older persons as physically, mentally, and emotionally unfit, miserly, and incapable of providing aesthetic beauty to the world, reinforce the belief that they lack the ability to be active or involved in the community. The myth that older persons add little or no value to the community has led some to the misguided conclusion that they deserve minimal services, for if they contribute nothing they are deserving of nothing.
  • In the absence of comprehensive national health insurance and pension systems, employersconfront high costs that increase as workers grow older, discouraging employersfrom hiring and retaining older workers.2. In the absence of adequate lifelong continuing education that encourages and supportsenhancement of job skills and development of new skills that keep pace with the jobmarket, it is difficult for older workers to acquire the skills employers seek.3. In the absence of an effective national health promotion and disease prevention program,and a modest investment in biomedical and behavioral research, conditions suchas frailty and dementia among older people result in avoidance and uneasiness about oldage, reinforcing stereotypes.
  • http://www.telegraph.co.uk/health/3256340/Talking-down-to-the-elderly-is-bad-for-their-health-medical-study-finds.htmlveraccommodation becoming overly polite, speaking louder and slower, exaggerating their intonation, and talking in simple sentences (Giles, Fox,Harwood, & Williams, 1994). identical. These speech styles derive from our stereotypes about olderpersons as almost child-like in their level of cognitive functioning and dependencyon younger adults.Some older adults find this comforting when they are very sick or very ill but some people talk to the elderly like this indiscriminanatlyPeople who ‘like’ older adults tend to do this more
  • Levy, B. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6), 332-336
  • Attitudes and views toward aging are introduced during preschool yearsattitudes. In today’s mobile society,with families moving away from older relatives, children may not have an opportunity to experience“grandparenting” and never have had the opportunity to relate to an older personParentsmay perpetuate this virtual and actual distance between grandchildren and grandparents by notmaking an effort to visit and communicate regularly in a meaningful way.3 Fear of aging and itsaccompanying illness can also engender ageism in a family. Caring for an aging parent can be a frigthening experience
  • Risk in this is that
  • Older participantswere subliminally exposed to the primes and, afterbeing presented with scenarios describing a potentially fatalillness, were asked if they would choose a life-prolongingmedical intervention, even when it resulted in two types of costs:losing their savings and extensive care by family members.Those in the positive-age-stereotype group tended to accept thelife-prolonging intervention, while those in the negative-agestereotypegroup tended to reject it (Levy, Ashman, & Dror,2000).
  • Aging is often viewed as a personality homogenizer, as though at some point people lose their individuality and fall into a single category: the elderly. Yet when we look at our own lives, we see many differences -- large and small -- between ourselves and our peers. These individual traits don't disappear when people turn 65 (or 75, or 85). Subsequent stereotypes harder to id, groups self identify, groups havent had long time to learn resistance mechanism and self advocate,
  • (Levy & Myers, 2004)Levy, Hausdorff, Hencke, & Wei, 2000herefore, ifthesympatheticbranchoftheautonomicnervoussystemishighlyaroused, thensweatglandactivity will also increase, which in turn increasesskinconductance. In thisway, skinconductancecanbeusedas a measureof emotional andsympatheticresponses.The older person on the receiving end of this demeaning communication often ends up with a reduced sense of self, lower self-esteem, and perceptions of low self-competence, which enforces existing stereotypes (ageism in america)
  • Levy,Slade, & Kasl,2002; Levy, Slade,Kunkel, & Kasl, 2002
  • Encyclopedia of AgeismErdman B. Palmore
  • Negative ageist stereotypes may also explain why older patients receive less medical information from physicians than do younger patients, and the increasing unwillingness of general internists and family physicians to provide primary care services to the older population
  • Ageism in america
  • Older persons who have higher cognitive and social functioning regard secondary baby talk as disrespectful, condescending, and humiliatingConnotes dependency, mental disability,
  • Transcript of "Ageing"

    1. 1. Age Discrimination
    2. 2. Goals • Elicit self reflection about own perceptions of older persons • Define age discrimination broadly • Examine types of age discrimination in healthcare • Context: Examine the social and economic history that produced current naturalized beliefs about the elderly – How older people embody stereotypes--> medical relevance • Educate about the medical relevance of discriminatory behavior • Explore physician role in age discrimination and ways to improve attitudes
    3. 3. Examining your own beliefs about older persons
    4. 4. Activity • List ten words to describe the elderly in general • Describe your relationship with an older individual. • Think of the last conversation you had with an older person- how did you talk to them, what did you talk about? • What are some of the major barriers that the elderly face in day to day living? What are some solutions to these barriers? • How should healthcare prioritize the elderly? • Do you know of how any other culture perceives death? How might that change their attitude towards the elderly?
    5. 5. Defining Age Discrimination
    6. 6. A process of systematic stereotyping, prejudicial attitudes and direct or indirect discrimination against people because they are old” - Robert Butler “Age prejudice in this country is one of the most socially-condoned and institutionalized forms of prejudice, such that researchers may tend to overlook it as a phenomenon to be studied” -- Nelson 2005
    7. 7. What is Ageism Labor: Failure to hire or promote qualified older persons Care: Absence of appropriate care of older persons in long term care institutions Language: Abusive language (crone, old- fart), condescending/patronizing language (little old lady) Communication: Insensitivity, impatience, incorrect assumptions about cognitive functioning Abuse: Physical, emotional, financial, sexual abuse
    8. 8. Classifying Ageism
    9. 9. Types of Ageism Personal Ageism Bias against persons or groups based on their older age. • Exclusion/ig noring older person based on stereotype • Physical abuse • Stereotype about persons Institutional Ageism Missions, rules, and practices that discriminate against individuals and or groups because of their older age. • Mandatory retirement • Absence of older persons in clinical trials • Devaluing of older persons in cost-benefit analysis Intentional Ageism Practices carried with knowledge of bias: take advantage of the vulnerabilities of older persons. • Marketing and media that use stereotypes of older workers • Targeting older workers in financial scams • Denial of job training based upon age Unintentional ageism Practices in which perpetrators unaware of bias against persons or groups based on their older age • Absence of procedures to assist older persons in their own in emergency • situations (e.g., flood, heat wave) • Lack of built- environment considerations (ramps, elevators, han drails) • Language used in the media
    10. 10. Examples of Age Discrimination Direct Systematic Policy Access Social/cultural Physician attitudes
    11. 11. Think Twice About Stereotypes
    12. 12. Stereotypes • like all stereotypes, the stereotype of a typical older person exaggerates the importance of a few characteristics and the society assumes these characteristics to be true for all older people • Though human body loses resilience with age, the extent to which these physical changes occur varies widely from person to person and stigma associated is often unwarranted
    13. 13. Stereotypes • 64% of adults >65 report no limitation in major activity • Only 20% report they need assistance with basic daily activities • Rates of disability continue to decline
    14. 14. What do you expect at your age? • Attributing ageing to physical decline assumes that age itself is the cause of decline when in fact illness is often the cause – Unwarranted prognostic pessimism – Incorrect or missed diagnosis – Miss past exposures or behavioral factors – Drug interactions can cause dementia/delirium can be missed for ‘normal ageing” – Over medication due to assumption that patients are ‘stuck in their ways’
    15. 15. Stereotypes • memory loss and dementia are not natural byproducts of aging – people who continue to learn and regularly exercise maintain cognitive abilities
    16. 16. Activity Discussion How is age discrimination different than other forms of discrimination?
    17. 17. Examine the social and economic history that produced current naturalized beliefs about the elderly
    18. 18. Naturalization of the social role of the elderly Rooted in Historical and Economic Context: • The Printing Press • The Industrial Revolution • Advances in life expectancy • The nuclear family, nursing homes
    19. 19. Cross Cultural Perspective • American sentiment • Old age as a negative time- decline in physical attributes, mental acuity • Increasing dependence on others Individuality and control over the body • Death as the end of self • Influencing factors: western culture, capitalism, individualistic values • Contrast with a belief system in which • Hugely variable for just for consideration of another mindset: • Ones self has no fixed ending, Spirit lives on (spiritually, reincarnation, etc.)different view of life. • Death is not feared; welcome relief from life’s travels • Death is seen as a passage to a different spiritual existance • Less anxiety about death- old adults revered: special status and power • Intergenerational reciprocity
    20. 20. Cross Cultural Perspective • Americans of Chinese, Japanese, and Korean descent, researchers found that Korean Americans are the “most pious” in supporting older family members. – However, in a separate study, Moon and Benton also learned that older Korean Americans who were victims of elder abuse were more likely to blame themselves and less likely to report the abuse. – Only one-third of those interviewed were aware of an agency to which they could go for help – Parenthetically, a majority of Caucasians were aware of such a resource.
    21. 21. What factors promote ageism? • Absence of adequate national health insurance/pensions systems. • Absence of life long education, job enhancement, training, (reduced skills) • Absence of effective national health promotion and disease prevention • Stereotyping/scapegoating of the elderly
    22. 22. …cute little old lady adorable sweetie darling Verbal Ageism • A self-fulfilling message that older people are incompetent, frail and feeble • Older people exposed to negative stereotypes associated with ageing, reinforced by belittling phrases and condescending attitudes, performed markedly worse in memory and balance tests than peers who were not. You don’t want to upset your family “overly polite, speaking louder and slower Exaggerating their intonation, talking in simple sentences” (Giles, Fox, Harwood, and Williams 1994)
    23. 23. Stereotyping Embodiment Theory • Internalization of Stereotypes Across the Life Span • Unconscious Operation of Age Stereotypes • Salience Gain from Self-Relevance • Utilization of Multiple Pathways – psychological – behavioral – physiological
    24. 24. Internalization of Stereotypes Across the Life Span “When negative age stereotypes are encountered by individuals before they are directed at themselves, there is unlikely to be a felt need to mount defenses against them; hence, susceptibility is maximized.” (Levy 2009) ‘‘Attributes associated with the ‘typical old person’ tend to become incorporated into the elderly person’s current and future self- views’’ (Rothermund, 2005, p. 232).
    25. 25. Internalization of Stereotypes Across the Life Span At best older persons are portrayed as being sweet, childlike, peaceful, comical, absentminded or befuddled. At worst they are repulsive, feeble, irrational or out of touch with reality. Absentminded and confusedGrumpy and rude
    26. 26. Unconscious Operation of Age Stereotypes Stereotypes activated unconsciously when primed (Levy 2000) Negative age stereotypes Positive Age Stereotype words Priming with word associations Handwriting rated as: senile, shaky, Handwriting rated as: younger, ‘confident’, wise
    27. 27. Unconscious Operation of Age Stereotypes Stereotypes activated unconsciously when primed (Levy 2000) Negative age stereotypes Positive Age Stereotype words Priming and presentation with scenario of potentially fatal illness Reject life prolonging Medical interventions Choose life prolonging medical intervention even when it resulted in two types of costs: losing their savings and extensive care by family members.
    28. 28. Salience Gain from Self-Relevance Artificial demarcation (subjective)  objective legitimization Forced group identification
    29. 29. Utilization of Multiple Pathways Psychological Behavioral Physiological subliminal-age-stereotype priming groups Beliefs Performance Eg. Health problems inevitable part of getting old – regard healthy practices as futile Reduced self efficacy- Taking medication, Healthy lifestyle habits, handwriting exercise,Decision making Systolic Blood Pressure Diastolic Blood Pressure Skin conductance: Sympathetic response Poorer health outcomes Direct stress response
    30. 30. Physical Impact • Poorer health outcomes • Direct stress response • Increase in cardiovascular events • Self care – decreasing activity, poor diet, and not seeking adequate medical treatment – Or: exploit time/money spent on false treatments not FDA approved/regulated- to avoid wrinkles, plastic surgery, fad diets, anti-ageing, etc • 18 percent of all suicide deaths in 2000
    31. 31. Medical relevance of discriminatory behavior
    32. 32. The Association Between Age Stereotype on Cardiovascular Events
    33. 33. Medical Relevance • Participants with more positive self-perceptions of aging at baseline had better functional health over the course of the study and lived an average of 7.5 years longer than those with more negative self-perceptions of aging (Levy, Slade, & Kasl,2002; Levy, Slade,Kunkel, & Kasl, 2002) • German study: Germans followed over a 6-year period, demonstrated that age stereotypes were a significantly better predictor of health than vice versa (Wurm, Tesch-Ro mer, & Tomasik, 2007).
    34. 34. Words Medical Students Use To Describe Patients • Ineffective • Dependent • Unacceptable • Disagreeable • Inactive • Socially undesirable • Socially withdrawn • Emotionally ill • Economically burdensome by acting as a drain on public resources
    35. 35. The Physician and Aging Patient • Physicians: – Many regard the older patient as “depressing, senile, untreatable, or rigid” (Reyes-Ortiz, 1997, p. 831). • Medical Students: – express reluctance to working with older patients present because of belief that they have health concerns that are less amenable to treatment, even with little basis for that assumption other than a stereotype about aging and health issues (Madey & Gomez, 2003). • Mental health personnel: – don’t want to work with older clients because they believe that older people often don’t have any serious psychological issues that merit therapy, and that they are just lonely and want to exploit the therapist as a captive listening ear.
    36. 36. Facts on Med School • 10% of American medical schools requiring course work or rotations in geriatric medicine; • <3% of medical school graduates take elective course in geriatrics • approximately just 7,600 geriatric physicians available for a 35+ million population that is projected to double to 70+ million by 2030.24
    37. 37. Medical Relevance • Autonomy: – Use of condescending language compromises the physician/patient relationship – Infantilizing patients- – shielding elders from confusing or upsetting information- reduces autonomy and self efficacy • Future patients will not accept this behavior: Baby boomer population more educated generation, social activism, entitlement • Proper care: – Disease NOT ageing – Sexual health!
    38. 38. Physician role and improving attitudes • Learning about physiology of aging – as to not conflate age with disease • Promoting autonomy – Older persons who have higher cognitive and social functioning regard secondary baby talk as disrespectful, condescending, and humiliating – Connotes dependency, mental disability
    39. 39. Why Address This Now? – GP ageist attitudes can be a barrier to implementing evidence based guidelines in treating older people – Inaccurate assumptions about the needs and capabilities of older people can lead to ineffective and improper care – Demographic changes necessitate it
    40. 40. Health Care Providers Essential Role
    41. 41. Conclusion and goals for future of healthcare
    42. 42. Goals • National healthcare goals – Develop interventions that will maximize the influence of older individuals’ positive age stereotypes in their everyday life – Reduce age discriminatory behavior by healthcare providers- to improve quality of care and outcomes – Improve upon geriatric education
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