The COVID-19 pandemic has drawn attention to the negative affect of ageist beliefs on the health outcomes of people at both ends of the age spectrum—those who are young and those who are old. The WHO Global Report on Ageism, released in March of 2021, identified aging as one of the 4 action areas of focus for the “Decade of Healthy Aging” (2021-2030).1 Despite estimates that 1 in 2 people worldwide carries ageist attitudes toward older people, ageism remains a relatively unstudied subject, particularly in the US.1 The existing data come from Europe, where 1 in every 3 people report experiencing ageism, with the most frequent reports coming from the younger population, aged 15 to 24 years.1,2

Among older adults, ageism is more documented. Before the pandemic, 25% of all patients seen in emergency care settings were older adults, and it was estimated that 20% of the American population would be over the age of 65 by the year 2030.3 Older people are admitted to the hospital more frequently and repeatedly, and once there, they are more likely to die or have long-term morbidity and functional decline.3 During the first months of the pandemic, it was consistently reported that older patients with COVID, particularly those with comorbid conditions, carried a higher peak of viral load and, and also had significantly higher mortality rates from the infection than younger adults.4 And yet, emergency department healthcare practitioners received no specific training in geriatric care up to that point.3

In general, ageism shortens lifespan and reduces quality of life.2 The WHO Report also found that ageist attitudes in healthcare contribute to poor outcomes in physical and mental health, slows recovery from disabling injury and illness, and increases cognitive decline.2


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A review by Mikton, et al2 (contributors to the WHO report) found 2 weaknesses to the report: the first was a disproportionate focus on higher-income European countries that provided data and the second was an emphasis on ageism directed at older people over that which targets younger people. This was in part because of a lack of information about ageist treatment of younger populations, as the majority of studies have been in older people.5 The studies that did look at young people mainly included college populations, in which  participants reported feeling patronized when interacting with older adults. The settings of ageism varied between older and younger people as well; younger people reported ageism most frequently related to the employment application process, while ageism towards older people often occurs in healthcare settings.1,2

Clinical decision making is also negatively affected. A study by Ben-Harush6 noted that clinicians tend to favor treating younger patients vs those who are very old. In studies that compared healthcare attitudes by age groups, most showed younger patients were given preference over very old patients in treatments such as HIV antiretroviral therapies, and in selection for heart transplantation, as well as in giving treatment to comatose patients. Younger patients are also much more likely to be perceived as needing psychosocial support. 6

How Ageism Manifests in Healthcare

An evaluation of the qualitative biases of healthcare professionals toward the aged found 3 negative patterns: in their interactions with older patients, communications, and in the failure to provide appropriate levels of care.6 Studies dating back to the late 1990s showed a history of physicians showing less respect, optimism, and patience with older patients, and involving them in care decisions less frequently.6

Perceptions of young or old patients as being frail and unable to fully undertake self-care are commonly held in healthcare, regardless of the reality. Younger patients with physical or mental health challenges are frequently mislabeled as “disabled,” while very old patients are met with perceptions that they are frail, weak, or lacking full mental capacity.7

Ageism often figured into the selection of diagnostic procedures for older patients, as physicians showed a reluctance to use more invasive therapies, and referred them for surgery at lower rates, despite good recovery rates. As people age, exposure to ageism increases, creating a chronic pattern of stressors that may in turn contribute to a higher risk for chronic disease and a greater mortality.7

Steps to Reverse Ageism

According to the WHO Global Report on Ageism, changes need to come from 3 areas: policy and law, education, and intergenerational contact interventions.1 The WHO report further lays out 3 recommendations designed to combat institutional ageism in healthcare via these 3 strategic areas. The first is the investment in strategies that can effectively prevent and respond to ageism; the second is to actively fund research and facilitate the acquisition of better data targeting ageism and methods to reduce it; and the third is to encourage a movement toward changing the narrative around aging.1,2

A white paper written in 2018 by Ringer and colleagues about ageism in emergency care stated, “new models of care and collaboration are essential to provide safe and effective care for older ED patients. If EM physicians are to be agents, not just objects, of the inevitable transformations of EM resulting from an aging population, it is essential that future members of the specialty are educated to be innovators and change leaders.4

The goal of the WHO Global initiative is to heighten awareness and create meaningful directions toward changing the way people think, feel and act towards age and ageing. The report states, “To prevent harm, reduce injustice and foster intergenerational solidarity we need to reduce ageism against people of all ages.1

References

1. Global report on ageism. World Health Organization. Geneva, Switzerland. https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/global-report-on-ageism (Accessed 4/29/21).

2. Mikton C, de la Fuente-Núñez V, Officer A, Krug E. Ageism: a social determinant of health that has come of age. Lancet. 2021;397(10282):1333-1334. doi: 10.1016/S0140-6736(21)00524-9

3. Ringer T, Dougherty M, McQuown C,et al; Academy of Geriatric Emergency Medicine. White Paper-Geriatric Emergency Medicine Education: Current State, Challenges, and Recommendations to Enhance the Emergency Care of Older Adults. AEM Educ Train. 2018 Nov 12;2(Suppl Suppl 1):S5-S16. doi: 10.1002/aet2.10205

4. Vellas C, Delobel P, de Souto Barreto P, Izopet J. COVID-19, Virology and Geroscience: A Perspective. J Nutr Health Aging. 2020;24:685-691. doi: 10.1007/s12603-020-1416-2

5. de la Fuente-Núñez V, Cohn-Schwartz E, Roy S, Ayalon L. Scoping Review on Ageism against Younger Populations. Int J Environ Res Public Health. 2021;18:3988. doi: 10.3390/ijerph18083988

6. Ben-Harush A, Shiovitz-Ezra S, Doron I, et al. Ageism among physicians, nurses, and social workers: findings from a qualitative study. Eur J Ageing. 2016;14:39-48. doi: 10.1007/s10433-016-0389-9

7. Allen JO. Ageism as a Risk Factor for Chronic Disease. Gerontologist. Epub 2015 Jan 23.  2016;56:610-4. doi: 10.1093/geront/gnu158

This article originally appeared on Dermatology Advisor