GerontologyA Training Resource By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T
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Ageism Part 1
Ageism Impact in Mental Health Services to Older Adults
What is Ageism?
Ageism was described as social stigma associated with old age or older people—which has deleterious effects on older adults’ physical health, psychological well-being, and self-perception (Fullen, 2018)
In 2017, the American Psychological Association published: Guidelines for psychological practice with older adults. This was based on Principle E of the APA Ethics Code (APA, 2002a, 2010a) which urged psychologists to respect the rights, dignity, and welfare of all people and eliminate the effect of cultural and sociodemographic stereotypes and biases (including ageism) on their work. In addition, the APA Council of Representatives passed a resolution opposing ageism and committing the Association to its elimination as a matter of APA policy. (APA, 2002c)
Ageism, a term first coined by R. N. Butler (1969), refers to prejudice toward, stereotyping of, and/or discrimination against people simply because they are perceived or defined as “old”. Ageism has been evident among most health care provider groups, including marriage and family therapists, social workers, clinical psychology graduate students, and health care providers to adults with Alzheimer’s disease. Attitudes toward older men and women differ in a manner that reflects the convergence of sexism and ageism and differentially impact older adults based on gender. For example, cultural standards of beauty may be magnified for older women and create pressure on them to maintain a certain body and appearance consistent with a youthful image). Ageist biases can foster a higher recall of negative traits regarding older persons than of positive ones and encourage discriminatory practices
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Ageism Stereotypes
Ageist attitudes can take multiple forms, sometimes discreet and often without intentional malice.
Even persons with severe dementia respond with behavioral resistance when spoken to in an infantilizing.way
There are many inaccurate stereotypes of older adults that can contribute to negative biases and affect the delivery of psychological services. For example, stereotypes include the views that:
- with age inevitably comes dementia
- older adults have high rates of mental illness, particularly depression
- older adults are inefficient in the workplace
- most older adults are frail and ill
- older adults are socially isolated
- older adults have no interest in sex or intimacy
- older adults are inflexible and stubborn.
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Those stereotypes are not accurate
Ageist attitudes can take multiple forms, sometimes discreet and often without intentional malice.
Even persons with severe dementia respond with behavioral resistance when spoken to in an infantilizing.
There are many inaccurate stereotypes of older adults that can contribute to negative biases and affect the delivery of psychological services. For example, stereotypes include the views that:
- with age inevitably comes dementia
- older adults have high rates of mental illness, particularly depression
- older adults are inefficient in the workplace
- most older adults are frail and ill
- older adults are socially isolated
- older adults have no interest in sex or intimacy
- older adults are inflexible and stubborn.
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Impact of Ageism on Therapists
Negative stereotypes can become self-fulfilling prophecies and adversely affect health care providers’ attitudes and behaviors toward older adult clients.
For example, stereotypes can lead health care providers to:
- misdiagnose disorders
- inappropriately lower their expectations for the improvement of older adult clients (so-called “therapeutic nihilism”
- delay preventive actions and treatment
Providers may also misattribute older adults’ report of treatable depressive symptoms (e.g., lethargy, decreased appetite, anhedonia) to aspects of normative aging
Some therapists unfamiliar with facts about aging may assume that older adults are too old to change or are less likely than younger adults to benefit from psychosocial therapies.
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Causes of Ageism
What may seem like discriminatory behavior by some health providers toward older adults may be more a function of lack of familiarity with aging issues than discrimination based solely on age
For example:
- many therapists still believe that with aging, those with schizophrenia do not show symptom improvement.
- However, research on older adults with schizophrenia reveals that positive symptoms of schizophrenia do abate with age.
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Monitor Therapist Response to older adults
Therapists may benefit from considering their own responses to working with older adults.
Some health professionals may avoid serving older adults because such work evokes discomfort related to their own aging or relationships with parents or other older family members.
Additionally, working with older adults can:
- increase professionals’ awareness of their own mortality
- raise fears about their own future aging processes
- and/or highlight discomfort discussing issues of death and dying
It is not uncommon for therapists to take a paternalistic role with older adult patients who manifest significant functional limitations, even if the limitations are unrelated to their abilities to benefit from interventions.
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Therapist need to AVOID Agist behaviors
Therapist’s Paternalistic attitudes and behavior can potentially:
- compromise the therapeutic relationship
- affect cognitive and physical performance
- and reinforce dependency
Seemingly positive stereotypes about older adults (e.g., that they are “cute,” “childlike,” or “grandparentlike”) are often overlooked in discussions of age-related biases. However, they can also adversely affect assessment of, therapeutic processes with, and clinical outcomes with older adults.
Therapists are encouraged to develop more realistic perceptions of the capabilities and strengths as well as vulnerabilities of this segment of the population.
To reduce biases that can impede their work with older adults, it is important for therapists to examine their attitudes toward aging and older adults and (since some biases may constitute “blind spots”) to seek consultation from colleagues or others, preferably those experienced in working with older adults.
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Providing Non-ageist Integrated Care For An Aging Population
SAMHSA reported in 2016 that the number of Americans aged 65 and older increased by 25% from 2003 to 2013 and the next 25 years promised another 50% increase.
- From 2018 to 2038 the number of Americans aged 85 and older is expected to more than double from 6 million to 14.6 million,
- Nearly one in five older adults have one or more mental health or substance use conditions under the umbrella term, “behavioral health”.
- About 16 percent of women and 11 percent of men aged 65 and older experience symptoms of depression
- The majority of older adults’ behavioral health issues are identified and treated in primary care settings instead of specialty behavioral health settings
(SAMHSA, 2016)
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Older adults are distinct from other populations in keyways
1. Complex chronic health conditions. Older adults are more likely than any other age group to have complex chronic health conditions, including mental health conditions, substance use disorders and cognitive impairments. About two-thirds of older adults have two or more chronic conditions.
2. Drug use and abuse. Older adults receive a high proportion of prescription drugs in the U.S. due to increased likelihood of being prescribed long-term and multiple medications. Improper use is common, whether because of cognitive decline or attempting to save money by using their medications sparingly or taking another person’s remaining medications. Additionally, commonly prescribed medications – opioids for pain and benzodiazepines used to treat anxiety and sleep disorders – are addictive and can increase the risk of falls and memory/retention issues affecting up to 17 percent of older adults
3. Co-morbid health conditions, age-related changes in drug metabolism; potential interactions with prescribed drugs, over-the-counter medications, dietary supplements and alcohol; and cognitive decline make drug misuse a special concern.
4. Health disparities. Life expectancy and overall health have improved for most Americans in recent years, but factors related to economic status, race, sexual orientation, gender identity and rural status, as well as limited access to adequate housing and transportation services, keep many older adults from benefiting from these gains.
5. Safety concerns. Individuals become more frail as they age and their risk of falls and injury increases. One in every three adults aged 65 or older falls each year and falls are the leading cause of both fatal and nonfatal injuries for older adults
6. Loss is common. Some older adults may experience loss. Loss of spouses, friends, physical functioning, independence, routine and sense of purpose affects overall health, including mental health and substance use. Health care providers and older adults often mistake depression for a natural response to aging. This can lead providers to not screen for or treat depression and older adults to not seek help.
7. Elder abuse. Elder abuse is a serious problem, with an estimated 8 to 10 percent of older adults experiencing abuse, not including financial exploitation. Other estimates found that between one and two million older adults are mistreated each year, while only 27 percent of hospital emergency departments have elder abuse protocols (compared with 75 percent for child abuse).
8. Negative attitudes and discrimination toward people with behavioral health concerns. These attitudes can be a barrier for all age groups. Generational and cultural differences may be a barrier to identifying concerns, treatment follow-through and active engagement in behavioral health treatment
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It is imperative that therapists who work with older adults be aware of the impact of ageism and work to correct any faulty thinking that comes out in their work with this population.
References on Ageism Related to Therapists working with Older Adults
American Psychological Association. (2002a). Ethical principles of psychologists and code of conduct. American Psychologist, 57(12), 1060–1073. doi:10.1037/0003-066X.57.12.1060
American Psychological Association. (2002c). Guidelines on multicultural education, training research, practice, and organizational change for psychologists. Retrieved from: http://www.apa.org/pi/oema/resources/ policy/multicultural-guidelines.aspx
American Psychological Association. (2010a). Ethical principles of psychologists and code of conduct including 2010 amendments. Retrieved from http://www.apa.org/ethics/code/index.aspx
American Psychological Association (2014). Guidelines for psychological practice with older adults. American Psychologist, 69(1), 34–65. DOI: 10.1037/a0035063
Butler, R. N. (1969). Ageism: Another form of bigotry. The Gerontologist, 9, 243–246
Fullen, M. C. (2018). Ageism and the Counseling Profession: Causes, Consequences, and Methods for Counteraction. The Professional Counselor (8)2, 104-114 http://tpcjournal.nbcc.org doi:10.15241/mcf.8.2.104
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Aegism Part 2
The Fighters Against Ageism
Let’s Dismantle Ageism Examples
Ask yourself:
1. What was the last thing you said or thought you were too old for?
2. What is the biggest misconception people have about you based on age?
3. What is the biggest misconception people have about you based on age?
Then ask yourself:
4. “What is the intent of this statement?”
5. “What is ageist about this statement?”
6. "How can it be reworded so that it is not an ageist statement?”
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Three ways to respond to ageist “compliments”:
1. Respond in kind--repeat the compliment back to them.
2. Cheerfully--show your pride about what they are trying to Compliment
3. Answer with a look of genuine puzzlement, “What do you Mean?”
Sample Compliments (feel free to add your own)
- Have a nice day, Young Lady/Man!
- You’re 35? You’re a baby.
- You can’t be 70-you have such smooth skin!
- She’s 53 years young.
- You look great for your age!
- 80? Oh, that’s not old!
- Oh wow, you still work!
- Are you really 85? But you’re so sharp!
- 60 is the new 40.
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Introducing
OLD SCHOOL - Anti-Ageism Clearinghouse
OLD SCHOOL was established in 2018 this Anti-Ageism organization has the following resources which you can utilize freely in your fight against Ageism in your environment:
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This Chair Rocks
A Book by: Ashton Applewhite (Co-Founder Old School)
In this book you will read that:
- Aging isn’t a problem to be solved. Or a disease to be cured. Or something icky that old people do. It’s how we move through life, and more of us are doing more of it than ever before in human history. What stands between us and making the most of these longer lives?
- Ageism: judging, stereotyping, and discriminating against people on the basis of how old we think they are.
- Solve for ageism and we also address sexism (aging is gendered), ableism (disability is stigmatized), and racism (which denies multitudes the chance to age at all).
Ashton Whitehead says: "So I’ve written a book. I blog about it. I led the team that developed Old School, a clearinghouse of anti-ageism resources. I am the voice of Yo, Is This Ageist? (Go ahead, ask me.) I speak widely. All efforts to help catalyze a grassroots movement to raise awareness of ageism and how to dismantle it."
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Ageism: A Poem
By: Caroline Ryskiewich
Caroline Ryskiewich wrote: "Over the summer, I read Ashton Applewhite's book "This Chair Rocks: A Manifesto Against Ageism" and it rocked my world (pun intended). I've been thinking about ageism pretty much nonstop since then (just ask my poor husband, I talk about it all the time) and as I recently had a birthday myself, felt inspired to write a little ode to ageism. Enjoy!
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Exposing Systemic Ageism
Age discrimination is everywhere.
- As we grow older, we may face stereotyping, prejudice, and discrimination because of our age. - This is ageism.
- Ageism is in our beliefs, institutions and relationships.
- There are even laws that discriminate against older people.
- The COVID-19 pandemic showed us just how deep-rooted ageism is in our societies, and how it is systemic.
- No one action can address all of it.
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Introducing
National Center to Reframe Aging
Led by the Gerontological Society of America
The Message of the National Center to Reframe Aging is The Injustice of Ageism
- Ageism harms us all
- Ageism is discrimination or unjust treatment of older people based on stereotypes.
- ØStarting at an early age, ageism shapes the way we think about ourselves and others as we grow older.
- Underlying ageism is implicit bias – the unconscious attitudes and beliefs that lead to snap judgments about older people.
- Ageism is bad for our health, making us sicker and costing our nation billions in avoidable health care costs.
- Ageism stifles the economy by limiting the participation of older workers, despite their years of experience.
- Ageism is discrimination against older people due to negative and inaccurate stereotypes.
Resource for Reframing aging is at: www.reframingaging.org
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Resources from
National Center to Reframe Aging
Frame of Mind Video Series
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Changing the Conversation on Aging Series
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Handouts for Reframing Aging
1. Quick Start Guide
2. Best Practices Guide
3. Story of Reframing Aging
4. OAM Resource Guide: The National Center to Reframe Aging and SAGE's National Resource Center on LGBTQ+ Aging teamed up to bring resources with this guide on how we can all celebrate our diversity as we age
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ADDENDUM
Mary O’Donnell: Joni Mitchell proves why we should look beyond stereotypes about aging
On March 6th, the local newspaper posted the article by Mary O'Donnell about the impact that Joni Mitchell made at the Grammy's on February 4, 2024.
Read the original Article of February 23, 2024 article:
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The video and article succinctly captured the message contained in this AGEISM section on this site.
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