Practice question

What is ageism, how can I recognise it and how can I deal with it in my workplace?

Discrimination against older people can result in inferior standards in services that affect them

Discrimination against older people can result in inferior standards in services that affect them

Picture: iStock

Ageism was first described in 1969 by the American physician Robert Butler as ‘systematic stereotyping or discrimination against people because they are old’.

It can be complex, subtle and fraught with paradoxes.

At a time when increased longevity affords more time to cherish life’s learning and contribute to the lives of others, older people commonly feel marginalised (Jackson et al 2019), thus diminishing their capacity to contribute.

While increasing numbers of older people are a valuable societal resource, they are often viewed as a drain on resources (Cuddy et al 2005). Most of us desire to live as long as possible, but old age is commonly feared.

We are all targets

Ageism differs from sexism or racism in that it is universal – we are all ageing and, if we live long enough, we are all potential targets for ageism. Also, while sexism and racism have become culturally unacceptable, ageism remains widespread (Lievesley 2013, Royal College of Psychiatrists 2018).

Ageism is based on stereotypes. These are fixed, oversimplified images or ideas that typecast, standardise or compartmentalise all individuals into one category – ‘the elderly’.

It manifests as a prejudice – a preconceived opinion that is not based on fact, reason or experience – or as discrimination, when older people are treated less favourably than younger people.

Ageism manifests in many ways and on many levels

Society generally. This occurs through inappropriate humour, insults, name calling or images and media portrayals of older people.

Health and social care services. This is when unequal or unfair treatment is offered on the basis of age, such as non-evidence-based age restrictions (direct discrimination) or services where a policy, condition or practice inadvertently puts older people at a disadvantage, for example in limiting access (indirect discrimination).

Successive reviews by various national organisations have identified widespread ageism in medicine, surgery, optometry, dentistry, critical care and social care, particularly care homes (British Geriatrics Society 2013, Royal College of Surgeons 2015).

One recent example from an NHS doctor highlights that, while 40% of people over 75 have depression, fewer than 4% are referred for talking therapies for which there is good evidence. He wrote: ‘I worked in one clinic dedicated to geriatric mental health where we didn’t have a single psychologist. Antidepressants were our only recourse’ (Pemberton 2019).

Individually. This occurs through the ways in which people think, speak or act, often without conscious awareness. It can manifest in the words they use to describe older people, such as the elderly, demented or bed blockers, as well as acopic, meaning unable to cope.


Dealing with ageism

The first step to dealing with ageism is to recognise it, and a useful starting point is talking to older people about their lives, experiences and priorities. This helps to promote understanding, compassion and empathy.

The more you understand about the diversity of individual lives the more illogical it becomes to objectify people and lump everyone into one group.

Work with older people and their representatives in ways that encourage them to contribute to multiprofessional staff education and to service planning and evaluation.

Prepare your arguments and gather evidence to challenge ageism, such as the fact that chronological age alone is not a sound reflection of biological or social ageing. This makes it an unreliable predictor of outcomes regarding health, disabilities, mortality and quality of life, or of resource requirements.

Illegal under NHS Constitution

Also, age-based discrimination is illegal under equalities legislation and the NHS Constitution, which guarantees that the NHS will provide ‘a comprehensive service to all… irrespective of age… based only on clinical need’ (NHS 2019).

Look for covert ageism that results in inferior service standards for older people or conditions that primarily affect them, such as incontinence. Argue for services focused on people with multiple long-term conditions, because they are the major service users.

Reflect on the beliefs underpinning your own decisions and challenge any inappropriate terminology used by colleagues.

Ageing is inevitable and continuous for us all. My message to the ‘temporarily young’ is that ageism amounts to prejudice against ourselves in the future, and the services we create now will ultimately be the services we inherit.

Hazel Heath is an independent nurse consultant




This article is for subscribers only