Ageism: What's in a word?
The increased longevity of the world's population is one of the great success stories of modern times. But paradoxically instead of celebrating the fact that we might all reasonably expect to live longer, the growth in the number of older people is often seen as ‘a problem’. This is particularly so in the case of welfare provision, where older people are frequently viewed as making excessive demands on the available resources.
True, older people are the major users of health and social care, accounting for some 40% of health service spending, and 50% of the social care budget, in the UK (Department of Health 2001). But, as has been noted, ‘too often the financial commitment to older people in these core public services has not been translated into a cultural or institutional focus on the needs of older people’ (Department of Health 2001). The suggestion is that despite the good intentions of staff, their efforts have been thwarted by systems and organizational boundaries that on occasion result in ‘poor, unresponsive, insensitive, and in the worst cases, discriminatory services’ (Department of Health 2001).
Greater recognition of this situation has resulted in the UK government's launch of policy documents (in England, the National Service Framework for Older People, Department of Health 2001) which have at their core the goal of ‘rooting out’ age discrimination in health and social care. Such a focus on the institutional manifestations of ageism is to be welcomed. But ageism is a complex phenomenon and to target the institutional issues alone is not sufficient.
Palmore (2001 ) suggests that, along with racism and sexism, ageism is one of the three great ‘isms’ of our time. However, he also asserts that ageism differs from sexism and racism in two important ways:
- • ultimately, if we live long enough, we are all potentially liable to be treated in an ageist fashion;
- • ageism is often less obvious and more subtle in its manifestations than either racism or sexism.
Because of the subtle nature of ageism Palmore (2001) contends that ‘nobody knows how much there is or what features it takes’. Conceptually he identifies two broad components: prejudice and discrimination. Prejudice has its roots in the way that older people are stereotyped, for example in our humour or the media, resulting in negative attitudes. This is primarily a cognitive process. Discrimination, on the other hand, results from actions, either personal or institutional, that result in older people being treated differently, for example, being denied access to certain types of health care. As noted above, the main explicit aim of the UK policy initiatives to protect the interests of older people is to ‘root out’ age-related discrimination and thus ensure that older people enjoy fair and equitable access to all forms of health care. A laudable aim and a significant challenge. But what of prejudice?
Measuring ‘improved access’ is relatively straightforward but tackling prejudice, and influencing the way that people think or feel, rather than act, is far more difficult to achieve. As Palmore (2001) notes, we are not yet fully aware of the various forms that ageism may take, and there is certainly a need to probe more deeply into its nature and source (Cohen 2001). This is particularly important because, as Levy (2001) argues, ageism often acts implicitly and without conscious awareness on the part of the perpetrator, so that ‘every socialized individual who has internalized the age stereotypes of their culture is likely to engage in implicit ageism’. Consequently even those who express manifestly positive views about older people can be guilty of prejudice.
As someone who regularly reviews articles about older people for a wide range of journals, ‘implicit ageism’ is something that I experience on an all too regular basis. One particularly obvious manifestation is the use of the phrase ‘the elderly’ in numerous submitted articles and papers which otherwise are intended to promote a positive, or at least an enlightened, view on the needs of older people.
‘What's in a word?' I hear you say: surely if the major sentiments are positive one can overlook occasional use of the phrase ‘the elderly’. I have to fundamentally disagree. As Wilkin & Hughes (1986) rightly pointed out, anything that suggests older people are primarily part of a group – and the phrase ‘the elderly’ certainly does that – keeps alive the myth of homogeneity amongst the older members of our society. [Observant readers, by the way, will spot the irony in the title of Wilkin and Hughes' piece.]
Some while ago I laid out similar arguments about the use of the word ‘geriatric’ (Nolan 1994) and at the time suggested that:
…the way we use words, and the meanings we ascribe to them, is basic to our understanding of the world in which we live. Words colour our interactions with others, and a misunderstanding can often cause offence where none was intended.'
I would maintain that such an assertion is equally true today. As Norman (1984) so eloquently notes ‘words create stereotypes of behaviour and identity which have a powerful effect on those who use them and on those who are labelled by them’. If indeed ageism, and particularly prejudice, is subtle and takes various forms, then I believe that use of the phrase ‘the elderly’ is implicitly ageist and therefore should not be sanctioned as part of normal discourse. I suspect that most people who use the term ‘the elderly’ are not aware of its ageist connotations, and would profess to hold only positive perceptions of older people. This of course reflects the insidious nature of prejudice.
In the UK, as in other countries, governments are at last beginning to tackle the more obvious manifestations of ageism in health and social care. But the battle needs to be waged on several fronts if the war is to be won. We also must begin to recognize and meet head on ageism in all of its forms, for:
…to eradicate ageism we need to become aware of not only the blatant forms of ageism, but also its more subtle forms that operate within us all, regardless of age or explicit views about equality. Levy (2001)
Consigning the term ‘the elderly’ to the linguistic waste bin would be a small but important step in the right direction. It would do us credit as nurses to take an active lead on this…and what better place to start than in JAN?