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  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