Critically examine the effects of ageism on older people, particularly how ageism within health policy and practice impacts on their care. Using evidence, discuss methods that might be used to reduce ageism and improve their care.
AGEISM, HEALTH CARE AND POLICY PERSPECTIVE: PRATICAL STEPS TO IMPROVE HEALTH CARE FOR OLD PEOPLE.
INTRODUCTION
“A woman in her fifties was getting changed in the locker room of the local YMCA, when her friend’s 26-year-old daughter entered the changing area. “What are you doing here?” the younger woman asked with surprise. “Well, the same thing you are” was the reply” (Cousins 2005).
The field of gerontology has attracted substantial research, and various arguments have emerged in the course of this: issues about the attitudes of proponents of ageism; ageism as a socio-cultural construct; ageism as a psychological construct; ageism as determined by health status; ageism as a tool for racism or gender marginalisation.
Professional literature has, however, depicted ageism as dependent on attitudes and knowledge of health and social workers. (Kane 2002).
The concept of Ageism is therefore prone to prejudice, and elderly people are victims of discrimination in the process of seeking health care, looking for a job and many are forced to retire from service thereby creating stereotypes of mental acuity and competence. (Martens et al 2004). In fact, some who may possible be ageist have suggested that the aged are not more deserving attention nor particularly useful to the society in comparison to the young, and such assumptions can be put to practice when resources for treatments are scarce. (Kane 2002)
Perceptions of health and social practitioners towards ageism, however, depend on their idiosyncrasies, personal experiences, socio-cultural background, and religious affiliation, and age, to mention but a few factors.
The aforementioned possible creates an image of an in-group and out-group schism in society and the world at large. Elders in the context of this paper are therefore perceived as out-group due to the stereotyping and prejudice meted to them by health and social care officials.
The paper seeks to demystify the concept of ageism and adopt a theoretical framework to explain the prejudice and stereotyping associated with old age, and the paper will also examine policy areas and practices of health care delivery to the elderly. It will, from the theoretical position, argue for methods and ways of reducing the stigma attached to being old or aged. Drawing from the wealth of empirical studies the paper will seek to clarify and demystify the contending issues associated with ageism and suggest ways of best managing this growing problem.
Taken from The Anti-Ageism Taskforce at The International Longevity Center.
CONCEPTUAL CLARIFICATION AND THEORETICAL FRAMEWORK
Having disclosed the prejudice associated with ageism at the beginning of this research, it is worthwhile to attempt to demystify the concept itself. Ageism as a concept has undergone several literature submissions and research. ‘Ageism’ as a word was, it seems, first used in the United States by Butler. (Bytheway & Johnson 1990) Ageism is enshrined within institutions with de facto discrimination in the workplace, health care, language and the mass media.(The Anti-Ageism Taskforce) Ageism is a social attitude, constructed in such a way as to discriminate against the elderly rather as people of different races and nations are stereotyped for either being a cheat, smart, lazy or easy going. (Canada Network for the Prevention of Elder Abuse). Butler however gave an all encompassing meaning of the term when he submitted that “ageism can be perceived as a systematic stereotyping of and discrimination due to old age, just as racism and sexism makes use of skin colour and gender to define boundaries. Old people are categorized as rigid in thought and manner, fragile, old fashioned.” (Butler 1999, p139).
Ageism can also take the form of stereotyping older people as frail, disabled and dependant, which might be enforced by myths and culture.
Bytheway and Johnson further opined that the most prevalent way of defining ageism is through expressions as with as sexism and racism – the distinction is in terms of variables you identify with each of the terms: for instance sexism is associated with gender, racism is associated with ethnicity and ageism is associated to age.
Ageism is also the transformation of the human organism that makes the probability of survival reduced.
Additionally, it is clear that ageism is also a socio-cultural and psychological construct.
In order to deal with the complexity of the discussion, the paper therefore takes a theoretical step to explain the imminent stereotyping related to ageism; the in-group and out-group feelings and the old age psyche.
The characteristics of ageism are related to sexism, discrimination and prejudice. In the light of this it shows that a sense of identity is formed, in the process stigmatizing the members of the out-group. (Aged people) The question remains: why then does this prejudice and discrimination persist? In view of the aforementioned, I will apply two theories that firmly explain the rationale behind the whole issue. The terror management theory and the Social Identity theory could be used in analysing the impact of ageism on the elderly.
The Terror management theory (TMT) posits that the inevitability of death acts as a terror to human value and existence and as such a construction of cultural worldview to convince us that human beings are not vulnerable to complete annihilation is created to add meaning to life. (Martens et al 2004).
TMT and other researches on mortality submit that ageism exists due to the fact that elderly people are associated with imminent loss and death. Social exclusion and distancing behaviours therefore serve as a crucial product of ageism. (Dozois 2006)
Social Identity Theory, however, posits a person has not one self but several selves that correspond to elongating the circles of group membership. The theory however asserts that group membership creates in-group self –categorization which further favours the in-group at the expense of the out-group. After categorization individuals or groups seeks the supremacy of their in-group uniqueness through some valued dimension. (University of Twente,TCW) This can be likened to the distribution of public goods in a club mode. The out-group is always left out and discriminated against.
Group identity is used to maintain positive self identity which leads to in-group and out-group schism. The impact of identity formation and the division that flows from it will be the next subject of discussion.
THE EFFECTS OF THE OUT-GROUP PHENOMENON: AGEISM IN REVIEW
The human drive to the issue of mortality paves the way for people to perceive elderly people as threatening because they serve as reminders of the inevitability of death. Theorizing and researching has disclosed that distancing or disparaging of the elderly is a consistent phenomenon due to the qualities of being old. (Martens et al 2004)
From this stems a need to reassess the effects of ageism on older people. The imminent use of stereotypes underlies the general scope of this section. Ageism is the composite of these generalizations which makes use of beliefs and attitudes mainly associated with age as the most important variable. The belief or attitudinal system however creates the context in which positive or negative stereotypes can flourish . (Dozois 2006)
A division of the different impacts associated with ageism is divided into several factors such as, the sociological factor, the physical factor, the emotional factors, and cognitive factors. (Grant 1996)
Dozois (2006) disclosed that negative stereotypes associated with elderly people are; illness, impotency, ugliness, mental decline, mental illness, uselessness, isolation, poverty, depression.
Many of the aforementioned are mainly associated with older women than men. The first impact ageism has as a concept and practice established is the sociological perception which facilitates isolation of the elderly. A survey of 84 people within the age range of 60 and above disclosed that almost 80 per cent of the respondents experiencing ageism had memory or physical impairments due to their age. (Dittmann 2003)
The 2001 survey by Duke University’s Erdman Palmore further confirms the societal and print media construct: the most frequent type of ageism reported by 58 percent of respondents was a joke against the elderly. The survey however states that 31 percent were ignored or not taking serious due to their age. (ibid Dittmann)
The impact of negative stereotyping is damaging to old people because this might shorten their lives. A longitudinal study by Levy of six hundred and sixty people who were fifty years and older, shows that those with more positive self – perceptions of aging lived 7.5 years longer than those with negative self –perceptions of aging. This suggests that if the society at large can create a better picture of the elderly then more might enjoy a longer life span. (ibid Dittmann)
The role of the mass media in constructing and promoting ageism and discrimination against the old people can be evidenced in the submission of Levy “age stereotypes are often internalized at a young age before they become relevant to people”. (ibid Dittmann) Doris Roberts (the Emmy award winning actress in her seventies) in a testimony before the Senate in the USA disclosed that “the old people are perceived as dependent, helpless, unproductive and demanding rather than deserving”. (ibid Dittmann) The Status report on ageism in America claims that “2 percent of prime television characters are 65 or older, although this group of people comprises 12.7 of the population”. The report also discloses the Medias view concerning aging, that the anti-aging industry perpetuates a culture that views ageing as undesirable and a bad thing due to the increase in anti-ageing products which earn up to $45.5 billion in 2004, and annual records forecast a growth of $72 million by 2009. (Status Reports on Ageism in America)
The media, therefore, in the process of socialization educates the young in an arguably damaging way which eventually leads to another vicious cycle: this is a sociological impact of ageism on old people. The commonsense motive of stereotypes depicts a constructed space that operates then legitimatizes behaviours. The idea that young people are future potentials for productivity makes older people upon retirement viewed as non-productive. (Reeve &Angus 2006) This is a narrow focus on the perspective of productivity and economic potentials linked with capital investment. In this process older people as well as people with disabilities are marginalized as unproductive and dependent; this therefore creates a firm impression that not ageism alone is a variable for this out-group identity.
The marginalizing impact of ageism however undermines the traditional importance of self reliance, which brings in the point of dependency. Reeve and Angus (2006) reveal that resistance to community caregivers as a way of avoiding the threat of nursing home entry.
The crux of the matter is self reliance paves way dependency in later life which might lead to the process and new concept of ageing well.
Organizational age discrimination is a fundamental part of stereotyping related to ageism. Several research studies have tried to explain the theoretical rationale behind older workers discrimination. Positive stereotypes such as the idea that older workers are reliable and loyal do not seem to conquer the pervasive discriminatory remarks that they are resistant to change, new technology and training. (Riach 2007) Such work place or organizational discrimination is depicted by the status reports on ageism in America; for instance the National General Social Survey reports that perceived discrimination due to age increased from 6.0 to 8.4 percent for workers overall, from 11.6 percent to 16.9 percent for workers 65 and older within the period of 1977 to 2002.(Status report of Ageism in America) The 2004 U.S Equal Employment Opportunity Commission (EEOC) further ruled that employers can deny health benefits to retirees at age 65 without necessarily violating age discrimination laws.
Ageism however in the annals of research has produced a new breed which is “new ageism”; a reconceptualization of ageism in the era of globalization and Liberalism. (Riach 2007)
It relies heavily on inequality and is tagged as a new form of “symbolic racism”.
New ageism therefore paves way for the individual to maintain a status quo of egalitarianism and on the other hand to promote inclusion as a prerequisite to enjoying inclusion thereby justifying difference and schism. Here, arguably, lies the strength of the duo theoretical framework which is Terror management theory and Social Identity Theory. Grant (1996) however validates the theories by categorizing the impact of ageism based on relevant factors which in the course of analysis we have discussed. The next issue will be to focus on the impacts of health policies and health care with regards to to ageism.
AGEISM, HEALTH CARE PRACTICE AND HEALTH POLICY PERSPECTIVE
An early look at President Bush’s FY 2006 budget shows a freeze in funding levels for some of the major existing programs that provide funding for elder abuse prevention and adult protective services.( Status Reports of Ageism in America)
Many people including health practitioners and policy makers have confused the ageing process with the disease process. Grant (1996) submitted that the belief that persistent decline is unavoidable and leads to symptoms or disease management rather than ways to improve and promote health.
The Canadian data submits that anxiolytic consumption more than doubles within the range of 65 years age and above and hypnotic medication use triples. The fact emerging from the following is that emergency department visits by elders are medication related. (Alliance for Aging Research, 2003; Grant, 1996).
Ageism in health care is treated with a stereotyping mindset; the following evidence from surveys, research and studies further heighten the need to address this issue immediately.
A 2003 study of hospitalizations and mortality among Medicare beneficiaries with chronic heart failure reveals that of 122,360 patients subject to inevitable hospitalization, 50 percent of the cases were preventable. (Alliance for Aging Research, 2003; Grant, 1996).
Rohan et al. (1994) depicts the rationale or probability of health practitioners to diagnose senile dementia rather than depression on the basis of age. Several studies have however revealed how ageism has been construed in a negative way in health practitioner’s interaction with older patients. Research however submits that health practitioners are less engaged, respectful, less supportive and less egalitarian when it comes to attending to older patients, provide less detailed information to aging patients, provide information to the family rather than the patient and are less likely to spend time on a differential diagnosis. (Dozois 2006).
The dominance of the social constructed malaise of ageism is further disclosed by the Report of Ageism in America which states that “thirty five percent of doctors falsely consider an increase in blood pressure as dependent on aging”. Chemotherapy is under utilized in the treatment of breast cancer patients over 65, even though it might increase the chances of survival or elongating the patients’ life span.
Furthermore in the Health policy perspective, in 2005, the U.S Congress ruled out funding for geriatrics education and training in the 2006 Labour –Health and Human Services appropriations bill. The same programme had been earlier funded in 2005 at $31.5 million. (Status Report on Ageism in America)
The discrimination in the practice of health care and health policies are imminent in the discussion and reality of the concept of ageism. However, to emphasize the humanitarian aspect worthy of health and social workers, I would cite a crucial example from the Healthandage.com website, which tells about the case of Alice C whom Levinsky depicted as a 88 year old woman who stopped breathing 3 minutes after reaching an emergency room
But the physician never gave up on her and transferred her to the intensive care; the question that most ageists would ask was the act of humanitarianism worthwhile? One point made clear in this case discloses the old woman did not die but rather resuscitated and enjoyed her life. Wan and Ferraro (1991) opines that before major policy changes are effected to address ageism further a need to evaluate the present policies and reshape them for a more desirable impact is crucial. This takes us to the measures to be taken to reduce the stereotyping associated with ageism.
WAYS TO REDUCE AGEISM AND IMPROVE HEALTH CARE
Ageism in concept and in practice leaves no single individual out: quite simply, if we are lucky enough not to die prematurely, then it awaits us all. The major areas of reducing ageism as a socio-cultural, psychological construction should go through the channels of socialization. A bottom to top approach must be adopted starting from family units to the health sector, institutions and policy makers.
A crucial method is a reference to the Swedish model of Health care services for the elderly as exemplified in the study about age related prioritization in health care. The GAS project (Good Ageing in Skane) in Southern Sweden depicts the need for a combined effort to care for the old people. (Werntoft 2007) From the project the need for paying close attention, care and priority to old people was made central to the success of the project which can be replicated on a regional basis.
Identifying high risk groups for institutionalization is a crucial point to be worked on by policy makers and health professionals. Individuals with high risk should be considered a target for community-based projects. In relation to this, a longitudinal approach to assess the risk differentials is crucial: the three important factors to be considered are the agent, the host and the environment. (Wan and Ferraro 1991).The determinant factor for success in such programmes relies on adequate funding and monitoring.
The psychological, socio-cultural construct can start from the grass roots with municipal governments offering incentives and rewards for teenagers who participate in visits to nursing homes as part of voluntary or community service. Programmes aimed at drawing the young closer to the aged, or ageing people, could play a significant role in breaking down barriers. Such programmes according to Grant (1996) must directly challenge ageing myths, address skill-developing practice and create a supportive milieu for testing new behaviours.
Professional training and research work must be intensified, the study of gerontology and field works must be encouraged, producing more experts in the speciality of healthcare for old people.
Finally, a summary of the ten point strategy of Braithwaite is important in addressing care related matters of ageism. (Braithwaite 2002).
CONCLUSION
Since death is inevitable, and ageing is also inevitable for the growing number of those lucky enough to enjoy long lives, the issues of stereotyping and discrimination associated with ageism must be addressed. From the analysis and use of theoretical positions, it is evident that ageism in practice is largely a socio-cultural and psychological construct. It is therefore important to address the issues by intergenerational cooperation. We should perhaps all, as a society, see the growing number of elderly people as useful members of society rather than a burden, and also remember that quality time and dedication should be given to the elderly partly because they deserve it, and partly because both young and middle aged will one day become old.
REFERENCE
Alliance for Aging Research. (2003). Ageism: How Healthcare Fails the Elderly
http://www.agingresearch.org/brochures/ageism/index.cfm accessed 23rd November, 2008.
Angus, J, Reeve,P . (2006) Ageism: A Threat to “Aging Well” in the 21st Century , Journal of Applied Gerontology ; 25; 137-151. http://jag.sagepub.com/cgi/content/refs/25/2/137 accessed from Sage Database, 24th November, 2008.
Braithwaite, V. (2002). Reducing Ageism. In Dozois,E (ed) Ageism : A Review of the Literature. http://www.calgaryhealthregion.ca/programs/aging/pdf/ageism_lit_review_final_may2006.pdf accessed 23rd November, 2008.
Bytheway,B ,Johnson,J (1990) On defining ageism, Critical Social Policy ; 10;27- 39.
http://csp.sagepub.com/cgi/content/refs/10/29/27 accessed from Sage Database 23rd November ,2008.
Canadian Network for the Prevention of Elder Abuse, http://www.cnpea.ca/ageism.htm , accessed 23rd November ,2008 .
Cousins, S.O (2005) Report for the active living Coalition for Older Adults. http://www.alcoa.ca/e/pdf/overcoming_ageism.pdf accessed 24th November ,2008.
Dittmann, M , (2003) Fighting ageism , http://www.apa.org/monitor/may03/fighting.html accessed 24th November ,2008.
Dozois,E (2006) Ageism : A Review of the Literature. http://www.calgaryhealthregion.ca/programs/aging/pdf/ageism_lit_review_final_may2006.pdf accessed 23rd November, 2008.
Grant, L.D. (1996). Effects of Ageism on Individual and Health Care Providers’ Responses to Healthy Aging. Health and Social Work. 21 (1), 9-15. accessed from Questia Library 24th November 2008.
HeathandAge.com ; Does ageism affect health Care rationing? http://www.healthandage.com/html/res/healthpolicy/content/page3.htm accessed 24th November ,2008.
Kane,M.N ( 2002) Awareness of ageism ,motivation , and countertransference in the care of elders with Alzheimer’s ,American Journal of Alzheimer’s Disease and Other Dementias ;17;101-109. http://aja.sagepub.com/cgi/content/refs/17/2/101 accessed from Sage Database ,24th November,2008.
Martens,A , Greenberg,J , Schimel ,J and Landau,M.J (2004) Ageism and death : Effects of Mortality Salience and Perceived Similaraity to Elders on reactions to Elderly People. Personal and Social Psychology Bulleting; 30; 1524- 1536. http://psp.sagepub.com/cgi/content/refs/30/12/1524 accessed from Sage Database, 24th November .
Report on Ageism in America, Ageism in America, http://www.ilcusa.org/media/pdfs/Ageism%20in%20America%20-%20The%20ILC%20Report.pdf accessed 23rd November, 2008.
Riach ,K .(2007) ‘Othering’ older worker identity in recruitment. Journal of Human Relations 2007; 60; 1701-1727 . http://hum.sagepub.com/cgi/content/refs/60/11/1701 accessed from Sage Database, 24th November ,2008.
Rohan, E.R., Berkman, B., Walker, S., Holmes, W. (1994). The Geriatric Oncology Patient: Ageism in Social Work Practice. Journal of Gerontological Social Work. 23 (1/2), 201-221.
Wan.T.H, Ferraro, K.F (1991) Assessing the impacts of Community –Based health Care Policies and Programs for Older Adults. Journal of Applied Gerontology ; 10; 35-52. http://jag.sagepub.com/cgi/content/refs/10/1/35 accessed from Sage Database, 24th November, 2008.
TCW; Social Identity Theory, http://www.cw.utwente.nl/theorieenoverzicht/Theory%20clusters/Interpersonal%20Communication%20and%20Relations/Social_Identity_Theory.doc/
accessed 23rd November,2008.
Werntoft,E, Hallberg,I.R, and Edberg,A.K (2007) Older People`s Reasoning About Age-Related Prioritization in Health Care Nursing Ethics ; 14; 399-412. http://nej.sagepub.com/cgi/content/refs/14/3/399 accessed from Sage Database, 24th November, 2008.