Ageism: How Age Discrimination Harms Health

A doctor explains the results of tests to a couple. Tom Werner (Getty Images)

In a consultation, the doctor speaks to the children of his patient – who is also there – to tell them about the care he requires. They address the father condescendingly, in a childish tone indistinguishable from that used with a small child. The situation does not correspond to a concrete reality, but it occurs often, according to Vânia de la Fuente-Núñez, an expert in healthy aging. And it has a name: ageism. It refers to how a person (or oneself) acts, feels and thinks based on their age (which does not have to be advanced). According to many studies, these stereotypes and the prejudices and discrimination they entail directly harm the health of those who suffer from them.

De la Fuente-Núñez, who was responsible for the World Health Organization (WHO) in its campaign against ageism, believes that it is a public health problem, like tobacco. "We can all suffer, because we are all of age. And doing it unconsciously, even believing that the behavior is in favor of the other person, it is not like that, it harms him, "he says in a recent conference organized by the Spanish Society of Epidemiology at the Carlos III Health Institute (ISCIII).

A WHO report on the subject published in 2021, revealed that one in three Europeans have ever felt a victim of ageism. Not only does it occur at profitable ages, young people can also suffer from it. In fact, the first years of working life and those before retirement produce the highest levels among employees. "Some are undervalued because of the lack of experience and others are considered too old," explains De la Fuente. In all age groups, there are more people in Europe who report ageism than sexism or racism, and the group that most accuses it are those between 15 and 24 years old (almost 50%); in the rest, it is around 30% and 35%.

The health of the elderly is, however, the most harmed by ageist behaviors. At least, it is on which there is more scientific evidence. By how they are treated by their environment, medical professionals and themselves. It is what De la Fuente-Núñez calls "self-inflicted ageism" that emerges throughout the life of life. "At the very young age of four we are already aware of the stereotypes that exist related to age in our culture," he explains. From that moment, they are internalized and used to guide feelings and actions towards other people. And, when you reach a certain age, you begin to apply to yourself. They end up being self-fulfilling prophecies.

The expert gives an example of this: "You can internalize a stereotype that an older person, for example, is not creative. When I end up reaching this stage of old age, as I have internalized this stereotype, I act accordingly and maybe I do not pursue a dream I had, such as learning to play an instrument. Those self-fulfilling prophecies have a very negative impact on our health."

It happens that one of the stereotypes around old age is poor health. And although biological age correlates with that indicated by the identity card, it does not always do so decisively. "If you think that it is normal to get sick at a certain age, maybe a person neglects his health when he arrives at it, does not take the medications prescribed, does not stop smoking, or does not do physical activity. Because total, if she is old and she is going to get sick anyway ...", argues Fuente-Núñez.

Ageism also contributes to social isolation and loneliness, which are clearly linked to poorer health and reduced longevity. "This arises by different mechanisms. You may feel unwanted in old age and this can lead to this withdrawal. You can also internalize that old age is a period of loneliness and isolation and act accordingly. And finally, obviously there are laws and practices, such as removing the elderly from their homes to take them to residences, which are usually far from urban centers. "

Often, it is doctors themselves who treat patients differently based on their age, rather than their health. According to the WHO Global Ageism Report, health workers are more likely not to use ventilators, surgery or dialysis as age increases (with no notable differences in health status). This correlation is shown in 85% of the studies that analyzed this association.

Sexual Health and Clinical Trials

Ageism also affects the sexual health of the elderly. A study published in 2017 did a survey with two groups of patients: one made up of 28-year-old patients and another 78-year-old. In both cases it was described that the patient suffered from occasional erectile dysfunction with a clear psychosocial indication. Despite having the same characteristics, most of the elderly were attributed to hormonal changes, while young people were diagnosed with what is known as an anxiety problem related to the fear of not being up to the task in the sexual act. With no other evidence to confirm this, the 78-year-old group received many more prescriptions for hormone therapies.

Diagnoses of sexual diseases are also usually later in older people. This has to do, in De la Fuente's opinion, with the fact that older people never had sex education nor are they the object of campaigns, which often target young people. "If a person is widowed, has relationships, goes to the doctor with a problem, he can assume that there is no sexuality in old age, so he does not ask pertinent questions," he argues. This is leading to delays in the detection and treatment of people with HIV, for example.

One of the biggest paradoxes regarding ageism and health occurs in clinical trials. According to the WHO report, older people are often discarded to participate in them, despite the fact that they are drugs that will be consumed mainly by this age group, as is the case with Parkinson's or those that serve for heart disease. They are discarded both for the simple fact of age and for having multiple pathologies, something that studies try to avoid to minimize confounding factors. "The problem is that these drugs will be taken by people with multiple pathologies, so we should know how they act on them [before approving them]," says De la Fuente.

Ageism is still little studied. In recent years interest in the subject has grown and publications grow exponentially. "Now we know that it can be prevented," says the expert, who affirms that it has a "high price" for people and society: "It can increase the risk of poverty and financial insecurity, has implications for sick leave, days of absence and forced retirement and economically impacts health systems. "

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