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The Ageism Problem in Healthcare

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.

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What fact brings us closest to a world without ageism?

I’m spending two months in the Bay Area this winter, making myself at home in the western outpost of the Home for Superior Women (read the book!), getting to know my four left coast grandchildren better, and being a Fellow at the Institute for the Future in Palo Alto. One of the signs in the institute’s big storefront windows features this quote from futurist Jim Dator: “Any useful statement about the future should at first seem ridiculous.”

How’s this for a useful statement about the future? “Thinking all older people are the same will be as absurd as thinking all younger people are the same.” It’s from an animation made by EveryAGE Counts, Australia’s terrific national anti-ageism campaign, asking us to imagine a world without ageism. Because we age at different rates—physically, cognitively, and socially—the longer we live, the more different from one another we become. This fact takes a lot of people by surprise, but it’s anything but ridiculous. It’s science: in nerdspeak, heterogeneity is the defining characteristic of old age.

If there’s one age stereotype about olders I wish I could banish, it would be that “the elderly” belong to some homogenous group when nothing could be further from the truth. All stereotypes are ignorant and wrong, of course, but this one—the mother of them all, so to speak, when it comes to aging—is particularly damaging and misinformed. As I put it in my TED talk, “We tend to think of everyone in a retirement home as the same age—“old”—when they can span four decades. Would you ever think that way about people between age 15 and age 55?” Yet youngers are far more alike.  The older the person, the less their age tells us about what they’re interested in or capable of.

If I could choose one fact about aging to plant in every head, it would be this one: the longer we live, the more different from each other we become.

That heterogeneity is of course the source of many headaches, making it incredibly difficult to calibrate pension and retirement eligibility fairly, for example.  What if the key to equitable solutions were to take age out of the equation? Peg financial assistance to socioeconomic status, for example, and support with caregiving to physical and cognitive capacity—not age.  Of course people will always game the system, social change is slow, and policy is a blunt instrument, but it’s worth thinking about. While you’re at it, spread the word: the longer we live, the more different from each other we become.

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“At your age” is the new “Girls don’t.” We don’t have to listen to that either.

This guest post is by Shannon West, a 68-year-old fitness professional working to empower older women to see their potential, and a music blogger who believes older musicians are often the ones on the cutting edge. This is her spin on a viral social media post that struck her as suggesting that older women should resign themselves to the fact that their best days were over, so she “took a shot.” Shannon lives in Jacksonville, FL, and can be reached at  ShannonWest0201 [at] gmail [dot] com.

To all my female friends who have passed our cultural expiration date which by now I think is…like…25. (see Amy Schumer’s brilliant “Last F***able Day” video). We get told we are at that age where we see wrinkles and are destined to have saggy muscles and put on extra body fat. We read it in a women’s magazine see it on TV so it must be true. Right? We see cute 25-year-olds, especially in movies, TV shows, and other media, because there are so few multidimensional roles for older women. So we reminisce, because we have been told that our 20s are the last decade in our lives where we can be attractive, fashionable, and adventurous. We have been told that the synonym for vibrant, engaged, forward thinking, healthy, adventurous, empowered, and creative is “young” even though those qualities are actually available to everybody. We hear that we should consider qualities like wisdom and experience the lesser cards we are dealt as we drift into invisibility, even though both are valuable and some of us are still a long way from getting the “wisdom” part down, although our life experiences have definitely given us a sense of accomplishment, perspective, and confidence in our ability to navigate the messy unpredictability that life brings.

Many of us see ourselves as warriors in the quiet and survivors. It’s time to let go of the quiet and engage our warrior spirit in the act of questioning everything our youth-obsessed culture has told us about growing older and actively seeking change on both a personal and political level. It is time to ask why we feel bad about getting older and why we see our growth and years of experience as a process of decline and increasing limitations. Who made these rules? Who said we had to live under them? Should we honor the wishes of advertising agencies and the “anti-aging” industry that create and exploit our fear of aging into a multibillion dollar industry? Should we take as truth research that says we must become sedentary and rapidly decline at a specific birthday when it was conducted in a previous century on older adults whose life experiences were so different from ours today?

We need to actively combat ageism and age stereotyping, first by looking inward and seeing how we are affected personally. Is what we are being told really our personal truth? Are we being pressured to limit our vision of who we are? Then we have to actively challenge ageism everywhere—in the workplace, in our relationships, in what we are told about how we dress and how we “should” wear our hair, in how we take care of our bodies, in how we move through the world. We may choose to ease into elderhood in the traditional way or we may choose to run an Ultra at 65. The path you choose is the path that is fine for you. It is the ability to create and walk our own path instead of being forced onto someone else’s idea of what our path should be that matters. We have the skills to do this. We were the ones who grew up with “girls don’t”. We didn’t listen to that. “At your age” is the new “Girls don’t.” We don’t have to listen to that either. Start on Ashton Applewhite’s groundbreaking This Chair Rocks website, and be sure to check out the Resources area.

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OK, people

I’m barely back from a tour of Australia sponsored by EveryAGE Counts, their terrific national anti-ageism campaign. It was fascinating to look from another continent at how views on age and age bias are changing around the world.

While I was in Oz, the #OKBoomer meme broke the internet—ageland’s little corner of it, at least. One accelerant was the use of the phrase in Parliament by a young New Zealand politician, Chloë Swarbrick, to rebut an older colleagues after the man heckled her during a speech about the climate crisis. As Swarbrick explained in a subsequent essay in the Guardian, the remark was an “off-the-cuff, albeit symbolic of the collective exhaustion of multiple generations set to inherit ever-amplifying problems in an ever-diminishing window of time.”

Every generation points fingers at the one that came before it and finds fault with the generation that follows (“kids these days”). But young people are coming of age at a time of profound uncertainty, in anxious times we look for scapegoats, and they do have it harder than their parents did. I was born in 1952, right in the middle of the bulge in the proverbial python. Youngers have many reasons to envy my generation’s extreme demographic good fortune, and it is tempting to frame us as the enemy. The song that started it all described boomers as racist, fascist Trump supporters with bad hair. It’s tempting to rise to that hateful bait—ageism cuts both ways—or to go on the defensive. Then everyone loses, and the planet smolders. Bushfires destroyed millions of acres during my few weeks in Australia.

The old are not the enemy and age is not the issue. As historian Holly Scott pointed out in the Washington Post, the problem with #OKBoomer is that “generational divides distract from deeper questions of power.” And privilege. The issue is inequality, which does not discriminate by age. What stands between us and a more equitable world are the structures and systems that benefit from oppression—racism, sexism, ageism and all the rest—because prejudice pits us against each other in order to maintain the status quo. Like auto workers in the US competing against auto workers in Mexico instead of organizing for better wages, pitting young against old is a time-honored tactic used to divide people who might otherwise unite to change things.

OK, boomers: it’s time to reach across the “generational divide,” itself a myth promoted by the mainstream media. It’s time to really listen to what youngers have to say and figure out how to work together. It’s time to act like ancestors—because the stakes have never been higher.

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The Fruits of Ageism

This guest post is by Barbara Lynn Kail, Associate Professor at Fordham University Graduate School of Social Service. She has taught social welfare policy for over 20 years there.  She also currently collaborates with Perre Tarres Faculty of Social Education and Social Work in Barcelona. This permits her to follow another passion, the antiageism movement and current developments in Spain.  Please send any questions or comments to her at kail@fordham.edu.

Generation Z’ers, could I please have a few minutes of your time. 

I’ve only recently become aware of the term “OK Boomer,” after reading an article in the Style section of the New York Times.

Both our generations seem to be engaging in the worst aspects of ageism. In fact, “ok boomer” seems to have polarized us even further.  One radio host compared it to the n-word, while the New York Post asks why Gen Z hates Boomers.  Is this, as the New York Times says, a declaration of war?

You rightly protest that members of my generation are :

  • Destroying the world as we know it with our environmental policies.
  • Using money and power to maintain the status quo and a privileged position.
  • Hurting future generations through selfishness and short-sightedness.
  • Not to be trusted.

In short, we Boomers just don’t “get it.” 

Well, these accusations sound really familiar.  As a Boomer, I vividly recall charging my parents’ generation with :

  • Destroying the world with nuclear bombs and our foreign policy in Viet Nam.  We are on the eve of destruction!
  • Using blatant racism and sexism  to ensure those who had money and  power held on to it…
  • at the expense of our generation and future generations – the Greatest Generation was not so great.
  • Breaking our trust… anyone over thirty!

I too engaged in gross generalizations, and Mom and Dad were never going to “get it.” 

Boomers, at least some of us, may honestly “get” where you Gen Z’ers are coming from.  In many respects your concerns are my concerns and have been since I was a teenager.  Engaging in wholesale characterizations of each generation causes us to miss an opportunity to join forces.  Just for starters – we can offer experience in grass roots organizing and building a social movement;  you have honed the use of social media to a fine art.  Recognizing the destructiveness of ageism could go a long way. Together, we could focus our efforts far more effectively and fight those of any generation who are afraid of change and revel in a status quo that is truly not sustainable.

Please tell me, ok boomer!

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a progressive falls into the trap of scapegoating “the old”

The New York Times devoted much of this week’s Sunday Opinion section to a staggeringly ageist article, “Out With the Old, In With the Young” by Astra Taylor, which blames “young people’s inability to effect change” on a “hoary establishment.” As I’ve explained in the Guardian (How did old people become political enemies of the young?), pitting old against young is wrong-headed for countless reasons.

Seeing the New York Times embrace this line of thinking is distressing; seeing a progressive activist like Taylor fall into the trap is even more so. Most younger lefties, of whom Taylor is among the most eloquent, don’t seem to take ageism seriously, perhaps because they have yet to acknowledge their own internalized bias. As I see it, hitching age to the intersectional sled, so to speak, is critically important if we are to join forces against all the problems facing the planet today.  I’d love to have a public conversation about it.

Here’s my Letter to the Editor:

It’s true that older people have more power and millennials too little. Likewise, men have more power than women, and white people more than people of color. The driver of this inequity, however, is not age, or race, or gender. The fundamental driver is capitalism, which perpetuates itself by privileging one group over another.

Those in power are mostly older, male, and white because they benefit from racism, sexism, patriarchy, and all the other mechanisms that disempower the rest of us. It is not because they’re old. Likewise, their priorities are a function of their privilege and the ideology that sustains it—not their age. Class, gender, and race all predict voting behavior better than age does.

Yes, we should absolutely lower the voting age and further enfranchise younger people, but frame these measures as pro-equity, not anti-old. Prejudice pits us against each other, and ageism is no exception. In a world riven by deep divisions of class, race, and gender, we cannot afford to add age to the mix.

* * *

For a more detailed analysis of Taylor’s “logically flawed and stunningly ageist article,” read this post in Yo, Is This Ageist? by my very smart colleague and policy wonk, Paul Kleyman,

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ageism takes center stage on the International Day of Older Persons

Three years ago I had the honor of addressing the United Nations on the International Day of Older Persons, which is celebrated annually around the world on October 1. In my talk, which I called End Ageism – Or the Rest is Noise, I made a passionate case for confronting ageism in every domain — health, education, employment, and human rights, to name just a few — as a prerequisite to making the most of longer lives.

Three years later, it’s been incredibly exciting to witness individuals and organizations around the world doing exactly that, and see #ExposeAgeism trending on Twitter. Here are just a few examples:

The evidence is everywhere: a global movement to #ExposeAgeism is underway. Australia is leading the way with its EveryAGE Counts campaign, which is bringing me over for a national, three-week tour in November. You’ll find more initiatives in the CAMPAIGNS section of Old School, a clearinghouse of free, vetted anti-ageism resources. YESSSS!

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Consciousness-raising for Ageism while Fighting Other “isms”

This guest post is by Mica Wilson, a marketing and communications professional living in New Rochelle, NY, who has over 30 years of experience in corporate and non-profit organizations. Mica loves to travel around the world gaining perspective on other people’s cultures and struggles, especially those of women and girls. She is currently developing a cross-generational podcast that provides advice and insights for professional women. Please send any questions or comments to Mica at DameTalk4 [at] gmail [dot] com.

On any given day I may experience various forms of prejudice, or “isms”. I am Black, a woman, and looking for a job at 55. I have been inspired to share my personal story after reading Who me, ageist?” A guide to starting a consciousness-raising group around age bias: by Ashton Applewhite. I hope that what I share will motivate those in “power” to join the ageism movement. I define “power”, as those who can make decisions about who they hire, the stories that get told to us through the media, and the policies that are put in place to protect vulnerable and marginalized people. I call out those in power because they have the ability to accelerate change.

Ageism is a unifier because it affects everyone. You face it as a young person when your thoughts and opinions are dismissed because you are “too young” to know anything. Or you may be considered “too old” to add value in the workplace or contribute to society. No matter your sex, race, religion, or sexual identity, you will face ageism. History has shown us there is strength in numbers. The civil rights movement would not have advanced in the same way without the support of non-Black people, and the women’s rights movement was a beneficiary. The ageism movement deserves the same momentum and support.

I must confess, I struggle with focusing on ageism because racism and sexism play such a dominant role in my everyday life. I’m affected by not just my personal experiences, but also by close friend’s experiences, and what I see on TV and read in the news every single day. The stories are rarely positive about people like me. Black man killed by police, Black man arrested then tied to a rope and forced to walk down the street with policemen on horses, Black women make 63 cents to every dollar white men make, there has never been a woman president, NYC has never had a woman mayor, and it goes on and on and on. Every day several stories in the news make me question my value and worth in America. So, when I apply for that job and get no response is it because of my skills, race, sex, or age? It doesn’t help that marketing and communications is considered a “young person’s game”. Whatever the answer is I have to continue living, working, and finding happiness like any other American.

As you get older, your network can make or break you in the job market. To be considered for an opportunity, at minimum you need to know someone who can send your resume directly to HR or a hiring manager. It’s nirvana if you know someone at a senior level who can make the hiring decision or influence it. In this scenario, who gets hurt the most? You got it, Black women. Our network generally does not include enough senior level men or women to help us get that job. When we do know someone, they aren’t always willing to put themselves out there for us. Of course, there are exceptions to that rule. In almost every job I’ve gotten, African-American women and men made sure I was considered for the position. Interestingly enough, they were all in my age group, which I believe speaks to how my support network was limited… Black women and men my age.

It’s important to me that anyone I interact with feels respected and heard. Therefore, when I am around younger people, I make sure our communication is a two-way street. I impart my wisdom to help them avoid some of the minefields I’ve been through. But I also learn from them, whether tech tips, new music, or their perspective on what’s happening in the world today. This allows me to not get stuck in my pre-conceived notions. I’m not a fan of today’s hip-hop, but my nieces introduced me to Lizzo. Yes, while there is some profanity in her music that I prefer not to hear, she is about empowering young women. Her recent call to action was for people to drop the ageism sh**t for the 2020 election. Her lyrics have a powerful message, she speaks out against ageism, she gets it. I have respect for her and I’m now a fan.

I will continue to do my part in the ageism movement. That means where I have influence, I will make sure you are heard and valued no matter how old you happen to be. To that end, I’ve started a podcast where four generations of women including a Millennial and a Gen Z have a seat at the table. Here is my ask to Millennials and Gen Z: join the ageism movement and make sure by the time you reach 50 you have done your part to raise the consciousness of those around you at work and home.  My request to those who are in a decision-making position or participate in the hiring process: ensure that your pool of candidates contains at least one person over 50. If you’re in marketing and communications and the candidate happens to be an African-American woman named Mica Wilson…you just hit the jackpot.