Defined by Dr. Robert Butler in the 20th century, ageism is the “systematic stereotyping of and discrimination against older people because they are old, just as racism and sexism accomplishes this with skin color and gender” (1). Family Lifeline (FLL) employs Clinical Social Workers, Program Managers, Community Health & Registered Nurses, a cadre of volunteers, Personal Care Assistants, Certified Nursing Assistants, and Administrative Staff with the shared outcome-driven goal of empowering people at all life stages.
Colleen Wilhelm, the FLL Director of Strategic Partnerships/Programming for Older Adult and Persons with Disabilities, shared that ageism has arisen in her specialized provision of services and some of the steps FLL takes to combat its pervasive effects. Foundationally, the traditional healthcare model tends to focus upon acute care treatment while “treatable conditions are treated but not necessarily in thoughtful and effective ways. Our medicine is so focused on acute care that often chronic diseases we sometimes see are managed this way as well, which doesn’t work” said Wilhelm. Elders may develop syndromes such as cognitive impairment and functional decline, often compounded by a lack of social or financial support. “So much goes into health. I like the World Health Organization (WHO) definition. Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity – from genetics, life history, life choices, access, and info/knowledge etc.” reports Wilhelm (2). Social contacts tend to decrease with age for a variety of reasons, including retirement from work, the death of friends and family, the busyness of adult children or lack of mobility. Regardless of the causes, the consequences of isolation can be alarming and even harmful. Even perceived isolation (the feeling of loneliness) is a struggle for many older people.
Additionally, the prevalence of potentially inappropriate medication (PIM) use is a major risk factor for adverse drug reactions in the elderly (3). PIMs are identified in tools such as the Beers criteria developed by the American Geriatrics Society and available to the general public as well as to prescribing physicians. However, lack of awareness to older adults’ changing physiology and drug tolerance as well as a nationwide shortage of professional specialization in geriatric medicine leads to the overall reported PIM use of one-third each month and more than half over 12 months (4). Says Wilhelm, “I have often seen someone in the 80’s taking the exact same medicine with the exact same dose since they were 60. With changes to the liver, kidneys that naturally occur with age, this seems suspect”.
So how do high PIM prescription rates, focus upon acute care versus treating the entire person and picture of health while living with chronic disease, and isolation among older adults reflect ageism? Because in the health profession, accurate and sensitive discernment between pathological disease and normal changes associated with aging is key. Persistent general misconceptions of older adults as demented, frustrating, uninteresting, and needy can influence health professional career and training focus. Appropriate perceptions of aging in the domains of physical, mental, and cognitive function leads to less medication errors (over or under prescribing). Understanding that poor health is not an inevitable consequence of aging is vital to a provider dismissing a treatable condition as a feature of old age or vice versa.
What are the ways in which FLL is working to transcend ageism? Staff collaborate in a multidisciplinary fashion to administer comprehensive care plans. Wilhelm constantly researches and engages with gerontology professionals such that the specialized Geriatric Social Workers may receive up to date information on changing health policy and breakthrough science. Trained volunteers create strong bonds with home bound seniors through regular visits, which facilitate advocacy and increased emotional/mental health. CNAs and RNs provide services from personal assistance to maintain dignity (hygiene, light housekeeping, shopping) and keep a vigilant eye on health status. In their approach to geriatric services, FLL staff adopt an inter-generational programming model to counsel caregivers and all family members. The strongest method to combat ageism is to incorporate empowerment at all life stages and promote the individual dignity of each senior in all arenas of health, a vision that FLL stands behind firmly.


Written by Melanie Johnson, a member of FLYP (Family Lifeline’s Young Professional Council), she works with older adults in clinical research for neurodegenerative diseases. As a gerontologist, Melanie is committed to community care and resource provision, promoting healthful aging, and disrupting ageism.
References:
(1) Butler, R. N. 1975. Why Survive? : Being Old in America. San Francisco: Harper & Row.
(2) Preamble to the Constitution of the WHO as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the WHO, no. 2, p. 100) and entered into force on 7 Apr 2948.
(3) Jiron, M., Pate, V. et al. 2016. Trends in Prevalence and Determinants of Potentially Inappropriate Prescribing in the United States: 2007-2012. J Am. Geriatric Soc. 2016 Apr; 64 (4): 788-97.
(4) Flood, K.L & Allen, K.R. 2012. ACE Units Improve Complex Patient Management. Today’s Geriatric Medicine. Vol. 6 No. 5 P. 28.