Exploring Ageism in Healthcare Towards Older Adults

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adult gerontology acute care

The World Health Organization (WHO) estimates that half of people are ageist towards older adults. Ageism refers to stereotypes, prejudice, and discrimination against people based on their age. It exists everywhere, from our vocabulary and relationships to institutions and systems.

The population of aging adults continues to grow in the United States, highlighting the prevalence of ageism in healthcare. Between 2022 and 2050, the U.S. Census Bureau expects the number of Americans ages 65 and older to increase by 47%, rising from 17% to 23% of the total population. Working to eliminate ageism will ensure our healthcare system helps older adults achieve optimal health and well-being.

Keep reading for an overview of how older adults experience ageism in healthcare and the health effects of ageism. Plus, discover what healthcare professionals can do to alleviate the problem, including the critical role of adult-gerontology acute care nurse practitioners (AGACNP).

What Is Ageism in Healthcare?

Approximately 1 in 5 Americans over age 50 experience ageism in healthcare. Ageism towards older adults is common but often subtle. It is based on misconceptions about them having certain characteristics, such as:

  • Depression
  • Loneliness
  • Apathy
  • Immobility
  • Cognitive decline
  • Anger
  • Stubbornness

These stereotypes lead to overt and implicit ageism. Sometimes, older patients experience intentional ageism, like a healthcare provider refusing treatment based solely on age. People can also be ageist without awareness. Consider a healthcare provider who forgoes conversations about preventative care with older patients.

How Can Healthcare Providers Address Ageism in Healthcare?

Healthcare providers are vital to addressing ageism because they are the primary point of contact for patients in the healthcare system.

The first step is to look inward to understand ageist practices and work to dismantle them. When healthcare providers become conscious of beliefs and biases about age, they can begin to interrupt any ageist tendencies they might have.

Education is also essential. Healthcare providers working with older patients should grow their understanding of the physiological, psychological, and social aspects of aging. Staying current on evidence-based practices in adult care challenges ageist thinking, ensuring providers provide appropriate, individualized care.

Here are a few examples of how the learning gained through self-reflection and education can help healthcare providers avoid perpetuating ageism in healthcare.

Overtreatment and Undertreatment

Ageism in healthcare can manifest as the overtreatment or undertreatment of older patients. Healthcare providers who make assumptions about health based on age alone can subject older patients to unnecessary or inadequate interventions.

For example, undertreatment is when healthcare providers dismiss treatable concerns, such as joint pain, as “normal” parts of aging. Without treatment, the joint pain could worsen over time and lessen mobility. Overtreatment is providing interventions that aren’t beneficial to the patient, like aggressive chemotherapy for an older patient who communicates their preference for palliative care.

Healthcare providers who rely on evidence-based practices rather than assumptions foster effective and respectful treatment. They develop treatments based on each patient’s unique health status, goals, and preferences rather than age alone, mitigating the risk of over- or under-treating them.

Ageist Communication

Ageist communication is rooted in stereotypes and prejudice that undervalue the competence and autonomy of older adults. When working with an older patient, healthcare providers may:

  • Oversimplify their explanations
  • Interrupt
  • Avoid eye contact
  • Direct questions and decision-making to caregivers
  • Discourage technology use
  • Use terms of endearment
  • Use a high-pitched voice

Some health professionals use elderspeak to comfort older patients and help them better understand complex health information. However, research shows that it makes older adults feel incompetent and disrespected.

Healthcare providers build trust with older patients when they communicate openly and respectfully, enabling them to express their concerns and receive appropriate care. It’s vital to avoid simplifying speech or explanations based on age, refer to the patient by name, make eye contact, and speak to patients rather than caregivers to engage them in their care.

Exclusion from Clinical Trials

Excluding older adults from clinical trials is another example of ageism in healthcare.

Among clinical trials published in leading medical journals between 1998 and 2015, 30% had an upper age limit, and 90% didn’t justify it. Some clinical trials for COVID-19 vaccines did not include older adults, even though the virus disproportionately affects them.

The underrepresentation of older adults in clinical research means some interventions need more evidence for safe, effective use in this patient population.

Healthcare professionals can work with others to ensure age-inclusive research practices. Collaborating with providers specializing in adult care, researchers, and ethics committees can help dismantle biases that lead to unfair age limits in clinical studies. Healthcare providers can also educate older patients about clinical research and encourage them to participate, if appropriate.

How Can Healthcare Institutions Address Ageism in Healthcare?

Healthcare institutions are also essential in eliminating ageism. According to WHO, three of the most effective strategies are policy and law, education, and intergenerational interventions. Healthcare institutions that engage in these areas support inclusive, compassionate, and evidence-based healthcare for older adults.

Here are a few examples of what healthcare institutions can do:

  • Collaborative Care: Older adults need age-friendly healthcare systems that embrace their autonomy while integrating caregivers and providers specializing in their care. Collaborative care addresses the complex and unique needs of older patients, improving access and quality.
  • Education and Training: Healthcare institutions must ensure professionals have adequate education and training in caring for older adults. For example, colleges and universities must ensure healthcare students participate in hands-on experiences with older patients. Research shows that the earlier medical students interact with older patients, the more likely they will maintain better attitudes about them.
  • Policy and Legal Reform: Healthcare institutions ensure equitable access to quality healthcare by promoting age-inclusive policies and laws. They should address structural barriers to care, including older adults in clinical research and advocating for insurance options that address their needs.

What Are the Effects of Ageism on Older Patients?

The consequences of ageism harm the health and well-being of older adults. The World Health Organization reports that ageism towards older adults is associated with:

  • Poorer physical and mental health
  • Increased social isolation and loneliness
  • Greater financial insecurity
  • Decreased quality of life
  • Premature death

Ageism undermines the efficiency and effectiveness of healthcare for older adults. It reduces healthcare access and quality while raising healthcare costs. Fortunately, the coordinated efforts of healthcare providers and institutions can help alleviate this.

Healthcare Access

Ageism can overlap other forms of bias and disadvantage. An older adult may experience discrimination based on their age as well as gender, race, or socioeconomic status.

The possibility of facing multiple forms of discrimination can discourage older adults from seeking healthcare. Research shows that older adults who perceive certain health issues as “normal” aging, like depression, fatigue, and chronic pain, often skip seeking medical attention.

Older patients may also avoid seeking care if they have experienced ageism in interactions with their healthcare providers.

Though ageism against older patients creates barriers to care, healthcare providers who foster equitable, inclusive practices help ensure access.

Healthcare Quality

The health effects of ageism include poor outcomes for older adults. Ageism reduces healthcare quality by not prioritizing their best interests.

The undertreatment of older patients results in inadequate care or missed or delayed diagnoses. Patients can experience preventable complications and disease progression when health conditions go unmanaged. On the other hand, overtreatment exposes older patients to the risks and complications of unnecessary or overly aggressive care.

Additionally, misconceptions that drive ageism can turn into reality as a result of ageist attitudes and behaviors. For example, treating older adults based on the assumption they have poor physical and mental health can lead to that outcome.

All of these scenarios negatively impact older patients’ health and well-being. However, anti-ageist healthcare providers improve healthcare quality by prioritizing patient-centered care that addresses each individual’s needs.

Healthcare Costs

Another effect of ageism on older adults is higher healthcare costs. In 2020, the one-year cost of ageism in the United States was $63 billion. Ageism accounted for one of every seven dollars spent on the eight most expensive health conditions.

Ageism raises healthcare costs through preventable complications and inefficiency. Undertreatment can delay care, resulting in hospitalization or emergency services. Unnecessary treatments and procedures add costs associated with complications and rehabilitation. Overtreatment also inflates healthcare spending by consuming these unnecessary resources.

Healthcare providers who address ageism improve healthcare outcomes and costs, reducing unnecessary spending while promoting cost-effective, high-quality care.

What Is the Role of AGACNPs in Addressing Ageism?

AGACNPs are uniquely positioned to alleviate ageism in healthcare because they are committed to improving health outcomes for all adults. The role inherently challenges ageism because it prioritizes equitable, evidence-based care.

While their education has focused attention on older adults, AGACNPs treat the complex chronic, acute, and critical care needs of all adult patients. They provide multifaceted treatment and monitoring to stabilize patients, prevent complications, maximize health, or provide palliative care. For AGACNPs, no patient is “too old” to benefit from healthcare intervention or recover from complex health conditions.

There are many differences between the  FNP vs. AGACNP role, one being prevalence. While 65% of new graduate nurse practitioners (NPs) are certified in family care, fewer than 13% are certified in adult acute care. Registered nurses interested in advanced practice nursing can help close the gap by becoming AGACNPs.

AGACNPs combat ageism by providing patient-centered care, collaborating with patients and their caregivers, and coordinating with other healthcare professionals.

Discover more NP statistics you should know.

Patient-Centered Care

AGACNPs address ageism through their patient-centered approach. They prioritize the needs and preferences of each patient instead of making assumptions about their health based on age.

AGACNPs provide care to older adults that:

  • Differentiates between normal and abnormal changes in development and aging based on scientific knowledge. 
  • Integrates evidence-based interventions and considers the risks and benefits of treatment.
  • Helps patients regain and maintain age-specific physiologic and psychological stability that reflects their goals of care.

Their patient-centered care ensures positive outcomes through inclusive, evidence-based treatment.

Patient Collaboration

AGACNPs advocate for and facilitate patient engagement in healthcare decision-making and treatment. Collaborating with older patients honors their autonomy while challenging the stereotype that they cannot understand or make decisions about their care.

AGACNPs educate patients and their caregivers about how normal development and aging can occur alongside mental and physical health challenges. They communicate with clarity and compassion, empowering patients and their caregivers to express their preferences and opinions. 

Collaborating with patients allows AGACNPs to align care with what matters most to them.

Interdisciplinary Coordination

AGACNPs address ageism in healthcare by coordinating with other healthcare professionals, including social workers, physical therapists, and physicians. They provide guidance, consultation, and mentorship about the acute and critical care of adults.

This interdisciplinary collaboration improves health outcomes for older patients by ensuring interventions and decisions are based on evidence, not stereotypes. It also ensures patients receive comprehensive, individualized care.

Bridge Gaps in Complex Acute Care for Adults with a Doctor of Nursing Practice from Baylor University

As the population of aging adults continues to grow, so does the need for healthcare professionals who can provide them with effective, compassionate care. BSN-prepared RNs who want to provide higher levels of nursing care can do so by leading quality improvement in the health of adults and older adults as AGACNPs.

Baylor University offers a Doctor of Nursing Practice - Adult-Gerontology Acute Care Nurse Practitioner track (DNP - AGACNP) that prepares actively practicing BSN-prepared registered nurses to provide acute care for the entire adult spectrum. The program is accredited by the Commission on Collegiate Nursing Education (CCNE) and ranked by U.S. News & World Report.

The DNP is a terminal degree that equips nurses for leadership amid the constantly changing demands of the U.S. healthcare system. One of the reasons why NPs should pursue a DNP is that it may become the new standard for entry-level advanced practice registered nurses (APRNs). Earning your DNP helps future-proof your career as a qualified nurse leader.

Baylor University's Louise Herrington School of Nursing provides students with a competitively robust education through the integration of faith and academic excellence. You can expect the same level of quality education through the online format.

As an online DNP-AGACNP student at Baylor, you will prepare to deliver timely care to diverse and vulnerable populations of individuals aged 18 years and older. You will gain advanced knowledge and build on clinical competencies in acute care environments, gaining preparation at the highest level of nursing practice.

Learn more about Baylor’s DNP-AGACNP program track to get started.

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