No Place for Ageism in our Society

PROFESSOR PERMINDER SACHDEV AM | p.sachdev@unsw.edu.au

For the more than 700 million people in the world aged over 65, often considered ‘old’ in our society, 2020 has been a landmark year. The misery wrought by the pandemic has preferentially targeted this age group, with those over 70 being five times more likely to die from COVID-19 than the general population [1].

In countries with uncontrolled infections, older persons have faced discrimination in decisions relating to triage and life-saving interventions. The poor state of our aged care homes was highlighted by the fact that about four-fifths of all deaths due to COVID-19 in Victoria occurred in these homes [2]. Social media has been replete with negative comments toward the elderly, often implying that the lives of older people were somehow less valuable, with the hashtag #BoomerRemover having been used to characterise the pandemic [3]. Not only have lockdowns been particularly stressful for the elderly, rates of elder abuse have also risen in many jurisdictions [4].

The past year has also seen some bright spots. The election of Joe Biden as President of USA at the age of 78 years was one ray of hope. Nearly half the proposed members of his cabinet are in the 60s and 70s. This journey to the presidency has however not been without negative language about older people and the stereotype threat of judging Biden as being cognitively compromised because of his age. Stereotyping and discrimination on the basis of age – ageism – has not been far from the social discourse.

Even as our society is ageing, negative attitudes toward ageing are prevalent and widespread, at least in Western societies.

There is some evidence that ageism is now more prevalent than sexism or racism.

Older individuals are characterised as feeble, cognitively impaired, less creative, rigid in their thinking, old-fashioned in morality, having outdated skills and a burden on society. Manifestations of this stereotypical framework are all around us. While minor memory lapses in a young person are considered to be due to tiredness or stress, those of an older person are attributed to age or even dementia.

Ninety percent of the marketing dollars target people younger than age 50 even though people over 50 are responsible for half the consumer spending.

What is more, advertising for the elderly is frequently negative, targeting incontinence and erectile dysfunction for instance [5]. The youthful appearance is overwhelmingly valued, and the international anti-ageing industry is worth US$260 billion and growing rapidly.

Nowhere is ageism as pervasive and a contributor to injustice and inequality as in the workplace. Even as many governments are working toward extending work lives and have removed mandatory age-based retirement, older workers face discrimination when seeking new work or maintaining employment in times of economic distress. People over the age of 50 experience longer periods of unemployment and are forced to take up lower paying and lower skill jobs [6]. Their employment also tends to be more precarious, being either part-time or contractual [7]. The older worker is frequently seen as rigid and inflexible, not trainable or directable, and lacking in technical proficiency. When it comes to redundancies, voluntary or forced, older workers are generally the first to be approached. Even older workers in influential positions are not spared the seemingly helpful enquiry about their ‘succession planning’, with the implicit suggestion for them to make way for the younger generation.

Ageism is widespread in the healthcare sector. While older people are more likely to be ill and in need of healthcare, they encounter health professionals who frequently have negative attitudes towards the elderly [8]. There is some evidence that during medical training, the attitudes of medical students towards older people become progressively negative and they begin to see them as being chronically unwell [9]. The ugly truth of poor care of the elderly in aged care homes has been of recent focus by the Royal Commission into Aged Care and Safety [10]. The small budgetary allocation for aged care and the low status of aged care workers perpetuate the situation.
Ageing stereotypes not only poison our behaviour towards others, such stereotypes are often internalised by the old persons themselves, affecting their attitudes, aspirations and behaviour. Older people therefore may not expect themselves to be as ‘smart’ or capable or robust, and may indeed perform at below their capability. This compounds their loss and further justifies the discrimination in the eyes of others. It is estimated that older individuals with a negative attitude to ageing live on average 7.5 years less than their positive counterparts.

It does not have to be this way. There are many positive aspects of ageing that are highlighted only infrequently. Not all cognitive abilities decline with age, and some such as vocabulary in fact improve.

The elderly have precious experiential skills and many accumulate wisdom that is difficult to measure but invaluable in many occupational and interpersonal situations. Older individuals also develop the skill of getting to the core of a problem quickly. Older people are in general considered to be more optimistic and happier, although this can vary considerably. Workplaces that recognise these qualities are able to benefit from older workers, while giving them more flexibility and control over their work schedules. The Hollywood portrayal of an older person returning to the workplace as a junior employee in the movie The Intern highlighted some of the positive aspects of the older worker.

There are cultural differences in the attitude towards ageing which influence ageism in different societies. Much has been written on the East-West differences, with the veneration and respect of the older person in Eastern societies stemming out of filial piety and the Confucian attitude to wisdom. Some of this may relate to the extended family structure in traditional societies that provides important nurturing roles for older members and does not divest them of financial power. The evidence for this East-West difference is mixed, but it does provide another way in which ageing can be construed and the elderly can have a positive and enriching role in society and be rewarded for it as well.

Society’s attitudes to ageing can shift with education and example. Social and economic realities are also likely to confront them. The older population is expected to double by mid-century, by which time about one in four individuals in high income countries will be aged 65 or over. This population also has considerable wealth and increasing political clout, and the demographic change will come with greater standing and recognition. However, we cannot wait for natural socioeconomic forces to shape this narrative. Much can and must be done to confront and defeat ageism.

We need a public education campaign to highlight the positive aspects of ageing and break the negative stereotypes, so that we are never too old. As a society, we must recognise the value of good care of the aged so as to benefit from their presence amongst our midst.

Our workplaces must recognize the skills and value of the older worker.

Any tendencies for an intergenerational conflict for research must be checked and replaced with cooperation for the common good. The value of intergenerational families must be revisited in places where they have been lost. As we continue to win battles against sexism and racism, let us not ignore the even bigger blight of ageism. We will be a better people and a richer society for it.

Perminder Sachdev is Scientia Professor of Neuropsychiatry at UNSW Sydney, Co-Director of the Centre for Healthy Brain Ageing (CHeBA), and Clinical Director of the Neuropsychiatric Institute, Prince of Wales Hospital in Sydney. He co-founded CHeBA and has published 5 books, 3 edited books, 57 book chapters and >600 peer-reviewed papers. Professor Sachdev was NSW Scientist of the Year for Biomedical Sciences (2010) and appointed Member of the Order of Australia (2011) for service to medical research in the field of neuropsychiatry.

References:

1. COVID-19 Strategy Update, 14 April 2020. World Health Organization. https://www.who.int/publications-detail/covid-19-strategy-update---14-april-2020
2. Gaze B, Sarmas L. Covid-19, age discrimination and aged care. https://pursuit.unimelb.edu.au/articles/covid-19-age-discrimination-and-aged-care
3. Ayalon L. There is nothing new under the sun: ageism and intergenerational tension in the age of the COVID-19 outbreak. Int Psychogeriatr. 2020;1‐4. Published online April 14, 2020.
4. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5). https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30061-X/fulltext
5. Emsley V. Don’t Underestimate the Market Power of the 50+ Crowd. Harvard business Review, Jan 09, 2020. https://hbr.org/2020/01/dont-underestimate-the-market-power-of-the-50-crowd
6. OECD. (2013). Pensions at a glance, OECD and G20 indicators. Paris, France: OECD Publishing. http://www.oecd.org/pensions/public-pensions/OECDPensionsAtAGlance2013.pdf
7. Phillipson, C. (2012). The future of work and retirement. Human Relations, 66, 143–153. doi:10.1177/0018726712465453.
8. Samra R, Griffiths A, Cox T, Conroy S, Gordon A, Gladman JRF. Medical students’ and doctors’ attitudes towards older patients and their care in hospital settings: A conceptualisation. Age and Ageing 2015; 44: 776–783. https://eprints.bbk.ac.uk/id/eprint/12555/1/12555.pdf
9. De Biasio JC, Parkas V, Soriano RP. Longitudinal assessment of medical student attitudes toward older people. Medical Teacher 2016; 38: 823–828.
10. https://agedcare.royalcommission.gov.au/