Ageism in Healthcare: Impact on Older Adults and How Providers Can Confront Their Biases
9 min read Discussion: Ageism and the care of older adults
Due to the increasing percentage of older adult clients in the U.S., it is imperative that healthcare providers assess and confront their own attitudes and perceptions toward older adults.
In your initial post, address the following:
- Describe ageism and its impact on societal views of older adult clients.
- Explain how ageism can influence the healthcare provisions of older adult clients.
- As a healthcare provider, how can one best assess and confront attitudes, perceptions, behaviors, and biases toward older adults?
Why ageism matters now
The United States is aging rapidly. In 2024, 61.2 million Americans were aged 65 and older, a 13% increase since 2020, and older adults now outnumber children in 11 states and nearly 45% of U.S. counties. The national median age reached a record 39.1 years (U.S. Census Bureau, 2025). Older adults are the largest users of hospitals, primary care and long-term care, so nearly every nurse and healthcare provider cares for them. How providers think about aging directly affects the quality of that care.
1. What is ageism and how does it affect societal views of older adults?
Ageism is stereotyping (how we think), prejudice (how we feel) and discrimination (how we act) toward people based on their age (World Health Organization [WHO], 2021). The term was coined by gerontologist Robert Butler in 1969. Ageism can affect any age group, but older adults are its most common target. The WHO estimates that one in every two people worldwide holds ageist attitudes toward older people (WHO, 2021).
Laws, rules and practices that disadvantage people by age, such as age limits for treatment or exclusion from clinical trials
Ageism in interactions: patronizing talk, ignoring the older person and speaking to family instead
Older adults internalize negative stereotypes: “I’m too old to exercise” or “pain is just part of getting old”
Conscious beliefs and actions, such as openly saying older workers are less capable
Unconscious attitudes that influence behavior without awareness
Seemingly kind but harmful: overprotection, doing everything for the person, “sweetie” or “dear”
Impact on societal views
- Negative stereotypes: older adults are often portrayed as frail, forgetful, dependent, unproductive, resistant to change or a “burden” on health and social systems. In reality, most older adults live independently, and many continue to work, volunteer and care for others.
- Media and culture: anti-aging advertising frames aging as something to fight, and older people are underrepresented or portrayed as comic or pitiable figures.
- Everyday ageism: in a national U.S. poll, 93% of adults aged 50–80 reported regularly experiencing some form of everyday ageism, such as messages that aging is unattractive or assumptions about their abilities, and more frequent ageism was linked to worse physical and mental health (Allen et al., 2022).
- Social and economic exclusion: ageism contributes to employment discrimination, social isolation and loneliness, and to older people’s voices being left out of decisions that affect them.
- Effects on older adults themselves: internalized ageism shapes how people age. Older adults with more positive self-perceptions of aging lived on average 7.5 years longer than those with negative self-perceptions (Levy et al., 2002).
2. How ageism influences healthcare for older adults
Ageism is a documented threat to health. A systematic review of studies from 45 countries found that ageism led to significantly worse health outcomes in 95.5% of studies examining its effect on health, including poorer mental health, shorter life expectancy and slower recovery from illness, and that age-based denial of care occurred in most studies that examined it (Chang et al., 2020). In the U.S., ageism was estimated to cost $63 billion in one year in excess spending on eight common health conditions (Levy et al., 2020).
| Area of care | How ageism shows up | Consequence |
|---|---|---|
| Assessment and diagnosis | Symptoms dismissed as “normal aging,” such as fatigue, confusion, pain, falls, incontinence or depression | Missed or delayed diagnosis of treatable conditions such as delirium, infection, depression and hearing loss |
| Treatment decisions | Age, rather than functional status and goals, used to decide treatment; less aggressive care for cancer, cardiac disease or rehabilitation | Under-treatment and avoidable decline |
| Over-treatment | Polypharmacy and inappropriate medications without review; overuse of sedatives or restraints | Falls, delirium and adverse drug events |
| Communication | Elderspeak: slow, loud, simplified speech and terms such as “honey”; talking to family instead of the patient | Loss of dignity; reduced participation; elderspeak is associated with resistance to care in people with dementia |
| Autonomy and consent | Assuming incapacity because of age; excluding the person from decisions | Violates respect for autonomy; care that does not match the person’s values |
| Prevention and health promotion | Less counseling on exercise, smoking cessation, sexual health or mental health because “it’s too late” | Missed chances to improve health and quality of life |
| Research and systems | Exclusion of older adults from clinical trials; limited geriatric training and workforce | Weak evidence for treatments commonly used in older adults |
| Self-directed ageism | Older patients under-report symptoms or avoid care, believing problems are inevitable | Delayed care seeking and poorer outcomes |
3. How providers can assess and confront their own ageist attitudes
Step 1: Assess your attitudes and knowledge
- Self-reflection: what words come to mind when you think of “old”? What experiences with older relatives or patients shape your views? Do you find caring for older adults less rewarding, and why?
- Implicit bias testing: the Age Implicit Association Test (IAT) from Project Implicit reveals unconscious preferences for younger over older people.
- Validated attitude scales: the Fraboni Scale of Ageism and Kogan’s Attitudes Toward Old People Scale measure explicit attitudes.
- Knowledge tests: Palmore’s Facts on Aging Quiz identifies misconceptions about aging.
- Behavior audit: review your own practice. Do you speak directly to older patients? Use elderspeak? Assume confusion is normal? Ask for feedback from colleagues and patients.
Step 2: Confront and change biased attitudes and behaviors
The WHO (2021) identifies three effective strategies against ageism: education, intergenerational contact and policy and law. Providers can apply all three:
- Education: learn the difference between normal aging and disease, and complete geriatric training. Knowing that delirium, depression and incontinence are not normal parts of aging changes practice immediately.
- Positive contact: spend time with healthy, active older adults, not only those who are acutely ill; seek mentorship from older colleagues; take part in intergenerational programs.
- Person-centered communication: address older adults directly by their preferred name, use normal tone and adult language, allow extra time without rushing, check hearing and vision, and use teach-back.
- Assess function, not age: base decisions on functional status, cognition, goals and preferences, using tools such as comprehensive geriatric assessment, and refer to geriatric specialists when needed.
- Adopt the Age-Friendly Health Systems “4Ms”: focus on What Matters to the person, Medication (deprescribe inappropriate drugs), Mentation (screen for delirium, dementia and depression) and Mobility (keep older adults moving safely) (Institute for Healthcare Improvement [IHI], 2020).
- Speak up: challenge ageist jokes, labels such as “bed blocker” or “frequent flyer,” and age-based decisions in team meetings, respectfully and with evidence.
- Advocate at the system level: support age-friendly policies, inclusion of older adults in research, and adequate staffing and geriatric training.
- Counter self-directed ageism in patients: encourage older adults to report symptoms and set goals, and promote positive views of aging.
Example: replacing ageist practice
| Ageist approach | Age-inclusive approach |
|---|---|
| “Her confusion is just because she’s 88.” | “New confusion in an 88-year-old is not normal; I’ll screen for delirium and look for causes such as infection or medications.” |
| “How are we doing today, sweetie?” (directed to the daughter) | “Good morning, Mrs. Lopez. How are you feeling today?” |
| “He’s too old for physical therapy.” | “What are his goals? Let’s assess his function and refer him to PT.” |
Sample discussion post
Ageism is stereotyping, prejudice and discrimination based on age, and it affects about one in two people worldwide (WHO, 2021). In society, older adults are often viewed as frail, dependent or a burden, even though most live independently and contribute to families and communities. These views are reinforced by media and anti-aging messages, and many older adults internalize them, which can shorten life expectancy (Levy et al., 2002). In healthcare, ageism leads providers to dismiss treatable symptoms as “normal aging,” to under-treat or over-treat based on age rather than function, to use patronizing elderspeak, and to exclude older patients from decisions. Ageism is linked to worse health outcomes in most studies (Chang et al., 2020) and adds billions in healthcare costs (Levy et al., 2020). As a healthcare provider, I can assess my own biases through reflection, the Age Implicit Association Test and tools such as the Fraboni Scale of Ageism and Palmore’s Facts on Aging Quiz. To confront them, I will continue learning about normal aging versus disease, speak directly and respectfully to older patients, base decisions on function and goals rather than age, apply the Age-Friendly 4Ms framework, and challenge ageist language and decisions on my team. Recognizing and addressing ageism is essential to providing safe, dignified care to the growing population of older adults.
Related reading: Protein malnutrition in an older adult and preventing inpatient falls with data.
Conclusion
Ageism shapes how society sees older adults and how healthcare treats them, leading to missed diagnoses, inappropriate treatment, poor communication and worse outcomes. As the older population grows, every healthcare provider has a responsibility to examine their own attitudes. By assessing implicit and explicit biases, learning about aging, building positive contact with older adults, using person-centered and age-friendly care, and speaking up against ageism, providers can ensure older adults receive care that respects their dignity, autonomy and potential.
References
Allen, J. O., Solway, E., Kirch, M., Singer, D., Kullgren, J. T., Moïse, V., & Malani, P. N. (2022). Experiences of everyday ageism and the health of older US adults. JAMA Network Open, 5(6), e2217240. https://doi.org/10.1001/jamanetworkopen.2022.17240
Chang, E.-S., Kannoth, S., Levy, S., Wang, S.-Y., Lee, J. E., & Levy, B. R. (2020). Global reach of ageism on older persons’ health: A systematic review. PLoS ONE, 15(1), e0220857. https://doi.org/10.1371/journal.pone.0220857
Institute for Healthcare Improvement. (2020). Age-Friendly Health Systems: Guide to using the 4Ms in the care of older adults. https://www.ihi.org/initiatives/age-friendly-health-systems
Levy, B. R., Slade, M. D., Chang, E.-S., Kannoth, S., & Wang, S.-Y. (2020). Ageism amplifies cost and prevalence of health conditions. The Gerontologist, 60(1), 174–181. https://doi.org/10.1093/geront/gny131
Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261–270. https://doi.org/10.1037/0022-3514.83.2.261
U.S. Census Bureau. (2025, June 26). Older adults outnumber children in 11 states and nearly half of U.S. counties [Press release]. https://www.census.gov/newsroom/press-releases/2025/older-adults-outnumber-children.html
World Health Organization. (2021). Global report on ageism. https://www.who.int/publications/i/item/9789240016866
