This guest post is by Brittany Denis, PT, DPT, CPT-RES, a physical therapist, movement coach, and educator who empowers clients through the aging process with mindful movement. She inspires all adults to bring a growth mindset to aging. You can find her writing over or contact her over through her website.
“It was then that I saw what had been right in front of me my entire career: that the experiences of older people in our health care system are indicative of how current medical care is broken for all of us,” -Louise Aronson, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life
The longer I work in healthcare, the more blatant ageism I encounter throughout the system. I’ve had patients who have been told they can’t get stronger because of their age, that they will live in pain forever due to their arthritis, and that they shouldn’t stay active because they might fall. These are all examples of false statements spread by authority figures that cause harm.
And taking it a step further, older adults are discriminated against if they use an assistive device to walk, even by their medical providers. It’s automatically assumed all older adults are hard of hearing, causing people to shout at them. They get called “cute” or are addressed by demeaning names such as “honey” or “sweetie.” Again, all examples of ageist stereotypes being propagated by the very people who should know better.
But, this is a reflection of an issue that’s larger than healthcare. Much of the ageism we encounter within the medical community stems from the ageism that runs rampant throughout society.
The Shortage of Providers for Older Adults
And our first indication of the ageism issue in healthcare is how few providers want to specialize in medicine for older adults. And that translates into poor quality of care for this age group. Older adults are a specialty population in medicine, but not for the reasons most people think.
As Louise Aronson, a gerontologist highlights in her book Elderhood, older adults make up 16% of the population but over 40% of hospitalized adults. Patients over the age of 65 are the group most likely to be harmed by medical care.
According to the American Geriatric Society, it’s estimated that there are almost 3,600 full-time practicing geriatricians. But for adequate care for the 14 million older adults living today, we need at least 20,000 practicing geriatricians. The gap between availability and demand is wide, despite geriatricians reporting the highest job satisfaction among physicians.
In the few years I worked as a physical therapist in a skilled nursing facility, I saw the implications of this day in and day out. The lack of knowledge among healthcare providers about how to properly treat older adults leads to two major issues. Older adults are being over-treated and under-treated at the same time.
As medical providers, we are trained to identify problems and treat them. Which is difficult for problems that don’t have obvious solutions. Medications and surgical interventions are obvious, these are solutions with more guidelines and indications. But this translates into over-medicating older adults.
The solutions that are often most essential and translate into the best outcomes, like access to a community, adequate transportation, physical mobility, and healthy meals are issues that aren’t so easily solved.
So they go overlooked. Most of the solutions for these issues are not even offered because of the difficulty in implementing them and the lack of reimbursement for such services. And this is where this mistreatment of older adults harms all of us. We limit access to the most impactful services, despite their relatively low cost compared to expensive medical treatments. We’ve deemed these issues as too complicated to solve because they are not as simple as prescribing medication.
“Too often old age itself is blamed for realities created by our choices and policies.” -Louise Aronson, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life
The Promotion of Aging Myths Within Healthcare
The second indication of the issue with ageism throughout healthcare is the rampant promotion of aging stereotypes from healthcare providers treating older adults.
At the start of this article, I mentioned examples of false statements spread by healthcare providers to their patients. It’s harmful and untrue to tell someone their strength can’t improve just because they are 80-years-old. The reality is that we start to see strength declines as early as age 30 or 40. Improving strength is a matter of practice and repetition, which can happen at any age.
There isn’t anything about aging that limits us from improving, but we’ve been instilled with the belief that this isn’t true. The truth is that you can build muscle, learn new skills, and continue to grow well into your later years.
Healthcare providers tend to miscalculate risk v. benefit, leading them to tell their older adult patients to limit situations in which they “might fall”. And most of the time this advice is recommended without performing a physical fall screening to identify an at-risk patient before offering advice.
While it’s true that falls do become more common as we age, it has more to do with behavior change that comes along with aging. And that behavior change is often caused by ageist beliefs. We limit our activity a little every year because of some misguided belief that we are “too old to…”.
The truth is that frailty isn’t inevitable. You may develop arthritis as you age, but it doesn’t mean you have to live a life of limited mobility and pain. You might fall, but we all fall at some point. The benefits of staying active outweigh the risk of falling. Your physical health can continue to improve with age so long as you continue to practice. And this is what we should be hearing from our healthcare providers.
What You Can Do
“Unlike other prejudices such as racism and sexism… ageism is unique in targeting our future selves.” –Ashton Applewhite
So where does this leave us? Changes within healthcare are needed at the levels of systems and policy, but change is also dependent on changing individual beliefs. It’s up to all of us to start to change the culture of ageism, not just in healthcare but in all settings.
So here’s where to start.
1. Educate Yourself on Ageism
It’s hard to identify ageism if we don’t understand what is true of aging and what are aging myths. Learn more about changes that come with aging and how aging is viewed in our society.
Reading more about aging and ageism is a good start. I recommend Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life by Louise Aronson, This Chair Rocks: A Manifesto Against Ageism by Ashton Applewhite, and Dynamic Aging by Katy Bowman to challenge your perception of aging.
2. Identify Your Own Aging Bias
Whether or not we want to admit it, we all live with some kind of aging bias. And it’s difficult to shed these misguided beliefs when we live in a society that promotes “anti-aging”.
Start to observe your own thoughts on aging and see if they are in alignment with the reality of aging. Are they mostly positive or negative thoughts? We can’t start to resolve the systemic issues of ageism until we learn to recognize our own ageist beliefs.
3. Create Learning Moments with Others
We can’t solve a problem we aren’t talking about. So it’s important to move the conversation beyond researching, learning, and identifying our own internal beliefs.
It can be difficult, but calmly correct others who are spreading misinformation on aging or ageist beliefs. Most people aren’t aware they are causing harm. Approach these situations carefully and try to help others learn through discussion.
Solving the broader issues of ageism starts at the individual level. Both the young and the old need to be on board because ageism impacts us all. More voices are needed in this space to facilitate change. So learn what you can, identify your own ageist beliefs, and be an advocate for yourself within the healthcare system.