Ageism: Care at the Extremes of Life

Introduction

“Ageism,” coined by R. Butler in the 1960s (Butler, 1969), refers to discrimination exhibited towards individuals based on being considered “of an advanced in age” or “old”. However, more recently, the term “age discrimination” has a different focus, representing the arbitrary decisions made about an individual because of their age, (whether “young” or “advanced in age”) (Davies, 2011; Marco et. al., 2001). Ageism and age discrimination are terms used in best practice statements and in literature to define negative or indifferent attitudes towards people because of their age - whether advanced in age or young. (Kydd and Fleming, 2015). Results from the national survey of US adults over age 45 by the American Association of Retired Persons (AARP), in 2017, reported that about 2 out of every 3 workers have experienced or witnessed age discrimination. About 55% of the participants reported that typically, the discrimination started at approximately 50 years of age (Perron, 2018). Despite the ubiquitous nature of age discrimination and strong evidence for its adverse social consequences, many institutions confine responses for tackling ageism typically to discrimination in the workplace (Stypinska and Turek, 2017). Ageism may present in different variations: (i) positive and negative ageism (Iversen et. al., 2009, Palmore 1999), refers to the homogenization of populations based on favorable or unfavorable age-related stereotypes and connotations. (ii) implicit and explicit ageism (Blackburn 2006; Couto and Wentura, 2017; Malinen and Johnston, 2013), where implicit ageism refers to thoughts, feelings, and behaviors toward individuals of a particular age group that exist and operate without conscious awareness or control, implicit ageism also tends to be mostly negative (Levy, 2001; Perdue and Gurtman 1990). On the other hand, explicit ageism relates to conscious actions or thoughts towards a particular age group. (iii) personal and institutional ageism (Bytheway 1995; Palmore 1999; Palmore et. al., 2005). Apart from an individual’s viewpoint and actions related to ageism (personal ageism), institutional ageism may be defined as the laws, rules, social norms, policies, and practices of institutions that unfairly restrict opportunities and systematically disadvantage individuals because of their age. These different variations of ageism may have further subtypes, that can be are distinguished into: (a) interactive ageism (Minichiello et. al., 2000) which involves experiences at the interpersonal level, self-perceptions through interactions with others involves being seen and treated as “old” or “young” in ways which are more obviously defined as age-related; (b) compassionate ageism (Furunes and Mykletun 2010) a subtype of positive ageism, for example being overly compassionate for a particular age group that may can result in perpetuating a stigma/stereotype associated with that age group; (c) gendered ageism (Handy and Davy 2007) associated with ageism related to individuals of a particular gender. It is more prevalent in women and may display intersectionality between ageism and sexism.

It is important for health care clinician trainees to note that with older adults, universal healthcare insurance, such as Medicare (Medicare report, 2016), can be seen as a benefit, but these individuals often experience ageism when they attempt to use the insurance for specific services. Services can be limited or not covered as a systemic effort to reduce costs (Kane and Kane, 2005).