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With the new Aged Care Act and strengthened Aged Care Quality Standards on the horizon for 2025, now’s a good time to consider the impact ageism can have on the care that older Australians receive. The Act will introduce a new “person-centred” aged care system including a statement of rights and definition of quality aged care, and the draft quality standards place the older person firmly at the centre of the care and supports they receive.
Ageism
Ageism refers to how we think, feel and act towards others or ourselves based on age. Typically, ageism applies to people who are older, but can also impact younger people.
A recent report by the World Health Organisation, found that globally, one in two people are ageist against older people. Ageism is pervasive in Australian society and is evident in institutions like the media, workplaces, legal system, health, disability, and aged care.
Types
Institutional ageism occurs when an institution perpetuates ageism through its actions and policies. This can put up barriers to older people accessing the services or supports they need. The underrepresentation of older people in health research and clinical trials and aged care policies that perpetuate the assumption that all older people are incapacitated and in need of protection,are examples of this.
Interpersonal ageism, occurs in social interactions, and refers to images and attitudes that devalue and delegitimise older people. Telling jokes about getting older fall into this category as does assuming that all older people are deaf, incapable, and disabled.
Internalised ageism occurs when a person internalises ageist beliefs and applies them to themselves. This can take the form of thoughts like “I’m too old to learn how to use my new smartphone” or “nothing can be done about my painful hip, I’m old, I just need to live with it”.
Unconscious bias and older people
Negative views and attitudes towards older people can start early in life. Children as young as three have been found to regard older people as ugly and sick, and associate them with a decline in physical and cognitive capacities, impatience, and bad temper.
Unconscious bias refers to automatic associations and reactions we have when we encounter older people.Instead of maintaining neutrality, we tend to let these biases influence our behavior towards them.
Impacts
The impacts of ageism on older people are broad ranging and may include
- curtailment in the quality and quantity of health care they receive
- reduction in the older person’s health and quality of life
- increased social isolation and loneliness
- restriction in their ability to express their individuality, such as sexual preference and
- increased risk of violence and abuse against them
Ageism can be a barrier to older people receiving the care they deserve. When staff attribute certain signs and symptoms of illness as being a “normal” part of aging, important indicators of illness or deterioration in their health can be missed.
This can be a serious issue for pain management. When staff attribute pain as a consequence of getting older and assume that all older people experience some level of pain, this can result in the older person’s pain not being taken seriously, and even left untreated.
How ageism can manifest
When the rights, needs, dignity, experience, earned wisdom and value of older people are not recognised aged care staff can become impatient and disengaged with them. Staff may be less responsive to the issues raised by the older person and more likely to assume that they are cognitively impaired or have dementia.
Ageist thoughts and bias, even those at an unconscious level, can lead to staff acting in certain ways, they may:
- use elderspeak; a slow paced, exaggerated way of speaking using elevated pitch and volume and simpler vocabulary
- assume that all older people are deaf
- treat older people as though they are invisible or unintelligent, ignore them or speak over the top of them
- take over and do things for them instead of supporting the older person to be as independent as possible
- make ageist jokes that imply that older people are less valuable or less worthy of respect
- disregard the older person’s health concerns, wishes and preferences, particularly if it involves a level of risk
- take advantage of the older person for financial gain
- use someone’s advanced age as justification to undermine, deceive, control, abuse or neglect them
Internalised ageism can lead to older people themselves:
- using derogatory terms to describe themselves like “I’m just a nuisance and useless”
- being less likely to seek support services and healthcare
- being less likely to talk about health issues including mental health issues
- believing they are “too old” to change life-long habits
What can we do?
In an effort to tackle ageism in aged care, consider the following actions:
- Education and training to raise awareness: a study by the Australian Human Rights Commission found that just one education session on ageism resulted in positive sustainable change for workers in aged care and community settings.
- Intergenerational contact: programs that purposefully bring together different generations to share experiences and stories have been found to be an effective way to combat ageism.
- Organisational policy: regular review of policies and procedures should include an audit to check for and remove ageist assumptions and language
- Person-centred approach: working in partnership with older people and their support network,can help them determine their unique health and wellness goals and priorities and create a plan to support goal attainment.
- Risk taking: older people have the right to make their own decisions even if this involves some risk to themselves. Aged care providers and staff have a responsibility to help older people understand these risks and work with them to come up with ways that risks can be minimised. A supported decision-making approach can help older people make choices about their care and optimise their quality of life.
- Adopt an investigative attitude: take all complaints of pain or other health related signs and symptoms seriously and investigate them with the aim of improving or resolving them in line with the older person’s wishes and preferences.
- Supportive perspectives: encourage the older person to adopt positive and supportive perspectives of themselves and help them adopt healthy habits of their choice such as routine exercise
- Challenge ourselves: acknowledge our own ageist thoughts and self-talk when they happen and commit to changing them
- Don’t let it pass: don’t validate an anagist joke with a laugh, by laughing you’re saying that it is OK. It may not be easy to say something, but if it’s safe to do so, challenge the use of ageist language.
- Positive imagery and language: the images and language we use shape the way we think about ageing and older people. Online resources are available to guide you with imagery and language choices to help reduce ageism.
Conclusion
With the scope of ageism expected to expand in the context of a growing aging population in Australia, we all have a responsibility to do what we can to minimise and eliminate ageism in aged care. Raising awareness of ageism and it’s impacts on older Australians and taking the time to consider and implement actions to reduce it, are good places to start.
