The Fundamentals of Ageism

Mary Lou Ciolfi, JD, MS

University of Maine Center on Aging

Consortium for Aging Policy Research and Analysis


Even though the term ageism was coined over 50 years ago by Robert Butler, a physician, author, and tireless advocate for older people, many of us still do not fully understand what ageism is and what it looks like in daily life. We are unconsciously and unintentionally behaving in demeaning and dehumanizing ways toward older people, including our own aging selves.

This chapter will explain the basics of ageism and offer insight into how detrimental it is to our individual and collective health and wellbeing. It will provide resources for how you can become more aware of your ageist attitudes and how you can take steps to be less ageist!

In 2021, the World Health Organization's Global Report on Ageism reminded us that 1 in 2 people around the world are ageist against older people.

Definition of Ageism

The definition of ageism has changed a bit over the past 50+ years, but the essential elements are the same and they apply to older people as well as to younger people. All of us have inherent value and worthiness regardless of our age or any other attribute that places us in a particular social or identity group (e.g., race, gender, income, religion, sexual identity, geography). Let's all get better at refraining from evaluating an individual's abilities, qualifications, or value based on chronological age. 

Robert Butler, MD

Robert Butler, a physician, author, and advocate for older adults coined the term ageism in 1969 in an interview with Carl Bernstein about a housing development in Baltimore that was opposed by the locals. Bernstein thought the opposition was about race, but Butler's view was that it was about the age of the prospective tenants -- it was the result of ageism.

Butler's definition of ageism is:

The systematic stereotyping of and discrimination against older people because they are old

Watch this short video to hear specific examples of stereotyping, bias and prejudice, and discrimination in our day-to-day conversations and encounters.

Internalized

When we have that feeling that because we are older we can't do certain things, or our opinions don't matter, or we are less valued, or we don't look good any more -- we have internalized society's negative views about aging and older people. It is challenging to change this "script" in our heads, but we can learn (see section below on Avoiding Ageist Language).

interpersonal

Ageist attitudes often show up in interactions between people. This might be obvious ageist remarks such as disparaging comments (e.g., older drivers are a menace), or age-related jokes. Or it can be more subtle such as being annoyed at older people for some reason, such as when they need extra time to complete a task. Notice when you express frustration at older people and ask yourself if you would direct this same frustration at a younger person.

Photo source: https://www.psychologytoday.com/us/blog/evidence-based-living/201901/the-evidence-on-age-discrimination-in-the-workplace

Institutional

Negative attitudes about aging have been around so long that most of our institutions and systems - healthcare, finance, education, transportation - were created without considering the needs of older people. From structural aspects (e.g., shared rooms in nursing homes) to processes (e.g., rarely including older adults in research studies), much of modern society remains inhospitable or inaccessible to older adults. We must adapt as best we can instead of being able to rely on systems adapting to our changing needs.

Ageism in Daily Life

Ageist behavior shows up in both obvious and unsuspecting ways in our daily lives. It is more prevalent than many people realize. Recognizing ageism - in ourselves and in others - takes awareness and vigilance, and sometimes requires courage to speak up. Try to be vigilant, but also recognize that norms of behavior are changing rapidly and that can be confusing.

The University of Michigan's National Poll on Healthy Aging

In 2020, the National Poll on Healthy Aging focused on everyday ageism. The survey findings revealed that the vast majority of older adults experience some form of ageist behavior in daily life, the bulk of which is "exposure to ageist messages". Take a minute to think about the types of messages you see and hear -- in your own head, in the headlines, in advertising, in greeting cards. When you watch for it, you realize how pervasive ageist attitudes really are.

Unwanted help

Often people assume that older adults need help and provide it without being asked. This often causes older adults to feel demeaned and less competent. Just because someone is older or uses an assistive device (e.g., cane, wheelchair) does not automatically mean they need or want assistance from others.

Workplace discrimination

Often older people are passed over for jobs because of their age (even though this may not be legal under our civil rights laws). When they are hired, they are often perceived as inflexible, technologically inept, and out-of-touch, making them feel unworthy and undervalued.

inaccessible spaces

Many public and private spaces are inaccessible to older people. A well known example is the inaccessibility of small dental operatories for older adults who are in a wheelchair or have limited mobility. The lack of space for lift devices and the unavailability of adaptive dental chairs impede access to oral health for many older adults.

The Impact of Ageism

Many studies over the past 20 years have demonstrated that ageist attitudes and beliefs are harmful to our own health and wellness. And yet, it has been challenging to convince government and organizational leaders to learn about ageism and take meaningful steps to address it---even though doing so would, according to the research, improve health and save our health care system a lot of money.

Attitudes about aging

Over 20 years ago, Becca Levy, a researcher at Yale University determined that we could live years longer if we had more positive attitudes about our own aging -- as much as 7.5 years longer! Dr. Levy's research also showed that young people with negative views of aging are twice as likely to experience cardiovascular events 40 years later. 

This research demonstrates the health benefit of having a realistic and positive view of aging. As we will see in the next section, reframing our language and our attitudes can be a prescription for improved wellness.

Graphic credit: https://www.asaging.org/ageism-awareness

Ageism and Healthcare costs

Watch this short video to learn about the high costs of ageism in healthcare. 

As you watch, think about your own healthcare encounters, for yourself or with an older adult. Were there comments or behaviors that made you feel unworthy of medical attention (e.g., "well, you are almost 80 years old, what do you expect?") Do you know anyone who held off getting hearing aids or using a cane because they did not want to appear old? Those are the subtle ways that ageist beliefs influence our health decisions and impact health outcomes.

Avoiding Ageist Language

In the past ten years, the concern about an aging demographic has become a more visible issue. That, in turn, has prompted researchers and communication specialists to find ways we can reframe aging so it is not all negative. In this section, we will see how that works.

Activity: Attitudes toward Aging

First, let's remind ourselves about the long-standing negative associations of growing older, particularly for older women. That will help us understand what language and images we want to change. Below is just a sample of the more obvious ways our culture perpetuates harmful images of aging. 

REframing aging initiative

The National Center to Reframe Aging was created to start a national movement to address ageism. It educates audiences all over the country in how to tell a "complete story" of aging -- one that is not all negative but is real. The education and resources from the Center are based on the innovative research of The FrameWorks Institute. The FrameWorks Institute addresses reframing of many societal issues, including climate, child abuse, care work, and cultural divisions.

Activity: Avoiding Ageist Language

Review the flip cards to get some ideas about how to change your language and the images in your family, organizational, or community messaging. 

Resource: Reframing Aging

As you read through the Reframing Aging Quick Start Guide below and review the other resources available at the National Center to Reframe Aging, be sure to reflect on when you use this outdated language and when you hear others use it. Talk with family, friends, and colleagues about reframed language and anti-ageist ideas. Enlist each other to offer gentle reminders when you fall back on outdated words and phrases. Using updated language takes time and practice.

The National Center to Reframe Aging has many resources to help guide you in shifting your language around aging, the images you choose for communications, and how to frame what you say about anything related to aging. While it may take some practice at first, you will soon catch yourself.

As an example, consider how often we say - or hear others say - something like "I'm too old to learn technology".

Practice reframing it not as something related to aging, but a choice you are making, regardless of your age. You get to decide whether you want to learn something new whether it's technology, learning a new language, or joining a local club! Our age should not dictate the choices available to us. 

Saying "as we age" is a great way to talk about issues we all are likely to face; it will resonate with people of all ages. For instance, saying "we all deserve access to safe, affordable housing as we age" can work to bridge the gap that often exists between younger people and older people.

See more Reframing Aging resources here

Activity: Re-Framing Message

Here is a sample of a poorly framed message and how it can be updated using Reframing Aging principles:

As the adult population of Maine grows, the number of vulnerable seniors is rising and many lower-income individuals who need support turn to group homes.

Here is that same sentence using Reframing Aging principles as set forth in the Quick Start Guide in the chapter:

As more of us age into later life, we need affordable housing options, including options with services for those of us who may need them.

Consider the differences in language, tone, and inclusivity.

None of us are alone in developing our skills around re-framing ageist messages. Visit the Padlet below to share the differences you see in language, tone, and inclusivity between the two messages. Learn from others while you're there! In the Padlet, click on the "+" signs under each category to add your ideas about boundaries.

Ageism Padlet - Click Here to visit and contribute. 

Reflection: Practice Reframing

Now, try your hand at reframing!

More than half of business owners are 55 years or older and the youngest Baby Boomers will reach retirement age in 2030. There's a silver tsunami coming and there will be a mass exodus of baby boomers who are going to all be retiring in the next five to 10 years. That wave is likely to hit rural areas especially hard.

Click here to complete the practice. This is the first of two times you will be asked to share your thoughts during the Ageism chapter. Entering your reflection also records your progress in the chapter. Important: Complete each section before moving on to its corresponding reflection. When you return to the form, you will automatically be taken to where you last left off. 

We developed a few examples of reframed messages that include some elements of a well-framed message. Compare these examples with your own reframed language.  After developing your message, click here to download practice sheet. 

Elderspeak

Elderspeak is the term for the words, tone of voice, and gestures we use with older adults that sounds like baby talk and appears childlike. It is deeply dehumanizing, feels bad to the older person, and denies them their adult personhood. While it is based in expressing care and concern, it has a damaging impact on older people, despite its widespread use.

Elderspeak definition

In this definition, the term overaccommodation means that in conversations with older people we sometimes speak more loudly, more slowly, more simply than is necessary because we assume - without knowing or asking - that older people either cannot hear well, cannot understand complex speech, or require us to make some other adjustment in our communication. When these adjustments are not needed but used anyway, it makes the older person feel demeaned.

In this definition, the term prosody means the rhythm, intonation, or inflection in one's speech. 

Elderspeak looks like:

Elderspeak impacts older adults as follows:

Looking down at an older person is associated with smallness and less importance. We unconsciously associate this gesture with the idea that the caregiver is in a position of power or authority.

Most online images of older people and care providers include touching as an expression of care. This assumes that 1) the older person is okay with this type of touching (many won't be) and 2) touching in this intimate way is appropriate to the relationship (it may not be).

When choosing images for any communication on aging and older people, look for images where the care staff or volunteer is of equal "status" in the photo. In this image there is no perceived hierarchy between the two and no inappropriate touching. 

expressing care for an older person

Watch this short video to learn about the relationship between elderspeak and expressions of care and concern. We do not yet have a paradigm for expressing care to older people and so we usually default to elderspeak.

Activity: Elderspeak

Take this short quiz as a reflection on your own use of elderspeak. Regardless of how you answer, be sure to bring greater awareness to all of your interactions with older people. 

Dignity of Risk

DIGNITY OF RISK is the term we use to recognize that adults of any age have the right to make risky decisions. Since older adults, particularly those with care needs, have long been over-protected in society and denied decision making authority over their own lives, it is especially important to understand this concept and be vigilant about respecting each individual's ongoing right to make life decisions, even those that carry risk to themselves.

What is risk?

Watch this short video on what we mean when we use the term risk. What are the upsides to risk? And why do humans sometimes (often?) choose to do something that involves risk?

What is dignity?

Dignity is a term we use frequently without much thought to its deeper meaning and what it looks like in daily life and decision-making. 

The elements of dignity include: 

Activity: Elements of Dignity

This is not an exhaustive list of the elements of dignity, but it provides a sense of the importance of supporting older adults in the maintenance of our inherent worth as humans and in our ability to make autonomous choice -- to  have agency of our lives, generally and in the fine details of daily life. 

From: The Stanford Encyclopedia of Philosophy

Wrap-up and Reflections

Addressing ageism in an society with a pervasive and longstanding focus on equating youth with positive attributes and aging with negative attributes can be daunting. But ongoing reflection, constant vigilance, and consistent effort will soon result in permanent changes to your language and attitudes. If you feel safe doing so, be brave in speaking up when you see or hear ageist attitudes or behaviors.

🗣️Speak up when you can

It can be difficult or awkward to confront someone who says or does something ageist, particularly if that person is a stranger, or where there is a power or authority imbalance. Do the best you can (and always remember to first assess your personal safety). You can say things like:

💭ongoing personal reflection

Because of our deeply ageist society, we rarely have opportunities to talk openly, frankly, and with humility, about the realities of aging. Once your awareness is heightened, you may start seeing ageism everywhere and you may notice it in your own thoughts and words. Be patient with your progress and reach out to us if you have questions or want additional resources.

Reflection: Ageism

Now, think about your age-friendly work:

 Click here to re-enter the skill chapter form and share your final reflection in this chapter and record your successful completion of the Ageism chapter. Note: Clicking will bring you back to where you left off when you completed your last reflection. When you have finished, please click "submit" to record completion of the Ageism chapter. 

Meet Your Chapter Guide - Mary Lou Ciolfi, JD, MS

Mary Lou Ciolfi, JD, MS, is currently Assistant Director of Policy and Education at the University of Maine Center

on Aging where she conducts research and analysis on various aspects of aging-related policy and long-term care service delivery. She is also Co-Director of the Consortium for Aging Policy Research and Analysis, a partnership between the University of Maine and the University of Southern Maine. Mary Lou is a licensed Maine attorney and practiced law in Brunswick Maine for 17 years before operating a long-term care community for ten years as a residential care administrator. She is an adjunct faculty member at the University of New England and teaches Public Health Law and Public Health Policy. In 2020, Mary Lou completed the Reframing Aging National Facilitators training provided by The Gerontological Society of America, the home of the National Center to Reframe Aging and she frequently presents on ageism and related issues. She received her undergraduate degree from the University of Chicago, her law degree from the University of New Hampshire Franklin Pierce School of Law, and her master’s degree from the University of Southern Maine’s Muskie School of Public Service.

If you have any questions as you are going through the material, please email: lifelong@maine.edu.