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The Surprising Social Determinant You’re Likely Overlooking: Ageism

A surprising factor might be to blame for worse health outcomes in older individuals: ageism in healthcare settings.

A surprising factor might be to blame for worse health outcomes in older individuals: ageism in healthcare settings.

That’s the salient finding of a recent systematic review conducted by E-Shien Chang, MA, a Ph.D. candidate in the Department of Social and Behavioral Sciences at the Yale School of Public Health, published in PLOS ONE. In 95.5% of the 422 studies included in the research, ageism led to significantly worse health outcomes. Moreover, researchers observed the negative effects of ageism in healthcare in all 45 countries and 25 years studied in the review.

What Is Ageism in Healthcare?

Chang defines it as how a patient’s age may influence health professionals’ decision-making. This decision-making is independent of the patient’s prognosis, preference, or likelihood to reap benefits from available treatments. While ageism affects patients of all ages — for example, HCPs may act on stereotypes associated with young and middle-aged people — but Chang’s study focused on ageism’s health impacts on older people.

“Some characteristics of ageism in healthcare may be the way providers speak to older patients,” Chang says. “Ageist speech can manifest in patronizing speeches, or ‘elder speak.’ For instance, the provider’s voice may have a high pitch, slow speed, or simple short sentences because the providers are associating older patients with age stereotypes, rather than patients’ individual competencies.”

Chang notes that in many studies included in the review, older patients were less likely to receive specific treatments than younger patients. “These results coincided with studies based on a patient's medical records,” she says. “Other examples [of ageism] include being dismissive to older patients’ wishes or concerns because they are old.”

Nurses’ own age biases come into play, as well, Chang explains. “Several studies in our review found that nurses with more positive age stereotypes were more likely to provide more support to older patients and to encourage older patients to undergo proper treatment, compared with nurses with more negative age stereotypes,” she says.

Another noteworthy finding from the study was that less-developed countries had a higher prevalence of worse ageism-associated health outcomes than more developed countries. Similarly, older adults with a high school degree or less were especially vulnerable. Chang posits that the reason behind these associations is a lack of resources, either at the individual or systemic level.

What Can Healthcare Professionals Do About Ageism?

As a healthcare professional, Chang says you will have the best shot at combating ageism by acknowledging that it’s a problem.

“Ageism is just as pervasive as sexism and racism,” Chang stresses. “As ageism is so deeply ingrained in our culture, simply paying attention to one’s own negative age stereotypes, ageist language, and behaviors when interacting with patients in healthcare settings will be a good start.”

Tips for Communicating With Older Adults

Here are some strategies to create a positive connection with an older patient, per Regis College:

  • Introduce yourself. And find out the patient’s name preference.

  • Pay attention to your body language. Sit directly opposite the patient and maintain eye contact. This position commands the patient’s attention and helps them decipher facial cues.

  • Exercise patience. Be willing to repeat yourself. If necessary, speak more slowly and clearly — but only if necessary.

  • Show respect. Understand that older patients may have different opinions from you. Acknowledge and address them, if appropriate.

  • Be an active listener. Nod to show recognition. Ask clarification questions, but don’t interrupt.

  • Get to know the patient. Try to learn about the patient’s living situation, lifestyle, social circles, etc.

  • Recognize sensory challenges. Many older adults struggle with hearing or vision problems. Respond to these without overcompensating.

  • Show empathy. Demonstrate that you understand and relate to your patient’s concerns.

While the benefits of these behaviors may seem obvious, in Chang’s experience, ageism is more insidious than you might think — and it gets even less acknowledgment than racism or sexism.

“We know that ageism is more resistant to change because providers and patients may subscribe to ageist thinking,” she explains. “Providers may think certain symptoms in older patients are a normal part of aging and thus are more dismissive about prescribing treatment.” 

So, next time you screen for the social determinants of health, consider ageism and your own biases.

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