Ageism Revisited

My long-established patient—an active, retired professional in her 70s with few health problems—provides feedback to me during a recent wellness visit. She states that the staff in my practice had treated her condescendingly and disrespectfully, seemingly because of her age. I am surprised to hear this because my staff members are especially professional and several have experience caring for older relatives. An increasing number of older patients are being seen in my practice, and this feedback is concerning to me. How can I improve staff communication skills with older patients?

Between the 2010 and 2020 censuses, the U.S. population 65 years and older increased from 40.3 million to 55.8 million and now represents almost 17% of the U.S. population.¹ This nearly 40% increase was more than double the increase from 2000 to 2010 (15%) and is attributed to the influx of the baby boomer population (i.e., individuals born between 1946 and 1964).¹ This population currently accounts for approximately 60% of the older population; this number will increase as the rest of the cohort ages, simultaneously growing with a racially diverse aging population.¹ In many medical practices, older adults already comprise a large proportion of the patient population.² Best serving the health needs of these patients requires an intentional approach to the care of older individuals, free of ageist assumptions.

Ageism refers to a pattern of prejudice, discrimination, and marginalization that is strongly associated with multiple negative effects on the physical and mental health of older individuals.^3–5 Ageism can take many forms, verbally or with body language, ranging from overt mistreatment and abuse to the conveyance of condescension or even dislike. Although much attention has been given to overt abuse of older people, more than 90% of individuals 50 years or older report experiencing ageism routinely or even every day, predominantly in the form of language and behaviors that convey hostility, a lack of value, or narrow stereotypes of older adults.⁶ These repeated negative interactions may be subtle or not intentionally discriminatory but are nevertheless strongly associated with poor physical and mental health in older adults.⁶ Women, members of minority populations, and patients with perceived impairments or disabilities are at increased risk of all forms of ageism and its multiple negative effects on overall health.^6–8

Even well-intentioned health care professionals can inadvertently convey ageism. Common examples of disrespectful behavior include asking for information from companions rather than the patient and discussing symptoms in front of patients while ignoring them. This dismissive conduct conveys the assumption that all older adults have cognitive deficits. Other examples include patronizing behavior, baby talk, and excessive reassurance.^6,9,10

Several organizations and multiple publications provide guidance on communicating appropriately with older patients and their families or caretakers. Some resources include the local chapter of the AARP, the Area Agency on Aging, and other advocacy organizations for older individuals.³ Some of these recommendations, however, may be insufficiently aligned with the expectations and behaviors of older patients, specifically baby boomers.¹¹ The aging population is a large and heterogeneous group with myriad individual life experiences and diverse health care needs and priorities.^11–14 Among this group, many older adults value independence, autonomy, wellness, and positive physical appearance.