How Does Ageism & Age Discrimination Affect Older Adults' Health

(Podcast #059)

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Do you use metaphors about children to describe an older adults behavior? That's ageist? Do you use comments like, Oh, I'm having a senior moment. That's ageist. So ageism is pretty pervasive in our culture, and it's hard to detect. So just these little examples are priming your brain to be more aware. So I'm glad that you're here. And I'm glad that you're listening. And I'm going to challenge you to do some other things to develop awareness of your own ageist attitudes. And we all have them I have them too. I have to work through mine daily.

I'm Dr. Regina Koepp. I'm a clinical geropsychologist, which means that I'm a psychologist who specializes with older adults and families. And this is the psychology of aging podcast, your go to resource for Mental Health and Aging.

Today, I want to talk about ageism, and how ageism affects the mental health and physical health of older adults.

This is an essential topic, actually, and one that we don't talk enough about. I know COVID-19 has had a huge impact on older adults. It's a pandemic that is disproportionately affecting the physical health of older adults. But let me say the other pandemic disproportionately affecting older adults, is ageism. In 2020, researchers found that ageism cost the United States $63 billion in one year, and in one year, resulted in more than 17 million cases of the most expensive health and mental health conditions like heart disease, dementia, cancer, diabetes, mental health concerns like depression, anxiety, and so many other conditions as well.


What is ageism?

So what is ageism? The American Psychological Association committee on aging, defines ageism as stereotyping and discrimination against individuals or groups based on their age. It can include prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs. So that's called structural ageism. Ageism can take on many forms. There are three strains of ageism that I particularly appreciate in terms of describing ageism. And I'm going to describe the three now.

One of these types of ageism, is hostile ageism. And this is the most overt type of ageism, it shows up in physical, financial and verbal abuse. It also you might have heard a term called the silver tsunami, that's a pretty ageist, a term that's used to describe the baby boomer population, flooding society and depleting us of all of our resources. It kind of reminds me of like Paul Revere kind of writing through Boston, saying the aged are coming the aged or coming. So during COVID, there was a hashtag called Boomer Remover that was used across social media platforms. And that's an example of hostile ageism.

The second is neglectful ageism. And this is a variation of ageism, that overlooks the contributions of older adults and makes them invisible, so it doesn't really see them. Let me give you an example of neglectful ageism, you know, overlooking the contributions that older adults make, and not seeing older adults. During COVID a lot of my neighbors and a dear friend of mine, were actually providing child care so that their adult children could continue to work when all of the daycares were closed. Society was not necessarily writing news articles on the older adults who were providing child care to their grandchildren. They were writing news articles often on isolating the elderly, which is the next point. Benevolent ageism.

Benevolent ageism is a compassionate but paternalistic point of view that groups older adults together as one, uniformly frail and vulnerable population that needs protection. So, the challenge with this benevolent, ageism is that it's like a wolf in sheep's clothing. The intention is good, it's benevolent, but the impact could be harmful. So one of the examples of this was I would be driving during the pandemic, to an outpatient mental health clinic where I worked with older adults and their families, during this time it was all telehealth. But I had I was going into the clinic to do the telehealth. And I would drive under a freeway sign that would say, maybe from the Department of Transportation. I don't know who put the sign up there, but it was a legitimate you know, huge traffic sign on the freeway and it would say Coronavirus, isolate the elderly. So let's break that down Coronavirus. We know what's harmful, isolate the elderly. So the intention was good. Let's make sure that older adults are protected. But the impact was harmful. Because when we isolate older adults, this causes another type of harm. It also is making the assumption that all older adults are frail and vulnerable, which they're not imagine older adults span from 65 to 122. That's almost 60 years. That's the largest age group ever and in development, right and human development. So close to 60 years. And within that all types of ability and vulnerability. And so this one statement to isolate the elderly. When does somebody become elderly? Does elderly include illness or age alone? I'm happy to report though that the sign changed a few months later to Coronavirus protect the vulnerable. And that's actually something I could get behind. Or I could drive underneath without cringing anyway. Let me also say that ageism exists, both in society and within each of us. And here's how it plays out.

Just a minute ago, I mentioned structural ageism. So structural ageism is essentially the phenomenon of ageism being prevalent in systems and structures in society. Like in the healthcare system, and workplaces churches, it could include older adults being denied access to health care, of course, you're in pain, you're old. What can I do about it? I hear in mental health care quite a lot, oh, the person has dementia, there's nothing I can do to help them. I can't do therapy with them, which is wrong. It could also include having resources to medical services being rationed due to age. And we saw that many people questioning that during the COVID COVID. situation. Many, many people were questioning like medical providers, you know, who if we are short on intubation resources, who gets intubated? Who gets breathing supports? Do we do it based on age exclusion from clinical trials, so we'll only provide clinical trials for people between the ages of 18 and 65. And limited work opportunities for older adults. I was meeting with a woman in her 50s, who was sharing with me, you know, I think I might have to stay in this job until I retire because I think I wouldn't be able to get another job because of workplace discrimination.

And then there's individual ageism. And this is an ageism, that's described by the stereotype embodiment theory. And this theory suggests that we internalize stereotypes about older adults throughout our lifespan, and that when we believe ageist stereotypes about ourselves, that they can have a significant impact on our physical health and our mental health as we age. And that's what we're going to get into now.


How does ageism affect older adults' physical health?

How do these negative beliefs about ourselves in impact our physical and mental health as we age so let's start with physical health. So ageism is linked to cardiovascular events. So for example, there was a study where people who held more negative stereotypes at age 30 were significantly more likely to experience a cardiovascular event over the next 38 years. In another study, people with more negative age stereotypes were twice as likely to have a cardiovascular event after the age of 60.

Ageism is also linked to Alzheimer's disease. So in one study, people with negative age stereotypes had three times the rate of hippocampal volume decline than people with positive age stereotypes. They also had significantly greater accumulation of plaques and tangles. That's a big deal. Okay, this next one is going to blow your mind among people with the Alzheimer's gene so only people with Alzheimer's Gene were studied, and those with positive age beliefs were almost 50% less likely to develop dementia than those with negative age beliefs. Let me say that again. among people who had the apoe e for gene, also known as the Alzheimer's gene, those with positive age beliefs were close to 50% less likely to develop dementia than those with negative age beliefs. And here's another important statistic. Ageism affects longevity. Researchers found that those with a positive view of aging live seven and a half years longer than those with a negative view of aging. Whoa.


How does ageism affect older adults' mental health?

So how does ageism affect mental health? In a study looking at how ageist beliefs affected the mental health care of older adults, researchers found that when older adults accepted ageist stereotypes, they were significantly more likely to experience anxiety, post traumatic stress disorder and suicidal thoughts. But when people fully resisted negative age stereotypes, they had significantly lower rates of anxiety, post traumatic stress disorder and suicidal thoughts. And this is how, let me give you some examples of how ageism plays out in mental health care. Anecdotally that I see in my clinic. I might hear older adults say, well, what's the point of getting treatment for depression? Or what's the point of taking medications? I'm going to die anyway? Or what's the point? Let me just die more quickly. So I'm not a burden on other people. And this is when there's no imminent death happening. Just ageism, you can see how harmful ageism is imagine the level of hope and imagine a belief in our ability to recover. If, if we hold these thoughts, our ability to recover is going to be pretty low if we don't believe we can get better.

And let me remind you, mental health conditions are highly treatable among older adults, like for depression at the same rates as younger adults. Let me give another example of how ages and plays out related to mental health care. But this time from a structural ageism kind of perspective. So in in 2017, there was a study looking at how older adults with suicidal ideation were treated in an emergency room. And researchers found that older adults were significantly less likely to receive a mental health evaluation, or be discharged with referral information for mental health care, compared to younger adults. And this is staggering, because let me tell you, older adults have the highest suicide rate than any other age group. I'll be interviewing an aging and suicide expert in a couple of weeks. And we'll be talking about that. But this is staggering. That's an example of structural ageism. Older adults in this particular study, weren't getting a mental health evaluation when they had suicidal thoughts in the ER, and weren't getting referral information at the same rates as younger adults. All right.


What can we do about ageism? 

So what can we do about ageism? So now that we can all agree that ageism is bad, don't do it? What can we do about it? So the first is to be self aware. And so it's great that you're here. And it's great that you're listening? My hope is that this little conversation will help you to just be more aware, when ages thoughts pop into your head? Do you use metaphors about children to describe an older adults behavior? That's ajuste? Do you use comments like oh, I'm having a senior moment. That's ajust. So ageism is pretty pervasive in our culture, and it's hard to detect. So just these little examples are priming your brain to be more aware. So I'm glad that you're here. And I'm glad that you're listening. And I'm going to challenge you to do some other things to develop awareness of your own ageist attitudes. So and we all have them, I have them too, I have to work through mine daily.

So start by engaging in a self reflective practice where you learn about yourself, and what might contribute to your own ages, thoughts and beliefs. You could do this by taking an assumptions test like the Harvard implicit associations test, and, and discover your own unconscious bias as it relates to older adults. You could even do these different Association tests related to different race identity. So if you want to see if you have bias, as it relates to black adults or Latinx, adults or LGBTQ folks,you could discover your own unconscious bias, I would love for the Harvard implicit associations test to do some intersectional identities. That would be super cool. But I don't think they've done that yet. You know, just a minute ago, I was talking about older adults being seen as all, alike, all older adults are frail, all older adults are ill. And of course, that's not true. And something similar happens that the image of older adults that we have in our minds, tends to be of one race, or one gender. And I want to remind you that older adults are diverse and have lots of intersecting identities. So if there is an older adult with other minority identities, they might experience higher rates of stigma and discrimination. So ageism, interacts with other stigmatized identities, like race and gender identity, our ability, and sexual orientation. And it can create a phenomenon of like what we call double jeopardy, triple jeopardy, and so on. So that means that the more minority identities a person holds the higher level of bias and discrimination and stress they might experience with their minority identities. So remember that older adults are diverse and have intersecting identities. And as part of remembering this is to challenge yourself to be culturally curious and culturally humble.

Another thing that you could do is speak out against ageism, when you see it happening. It's so ingrained in us and in our culture, but many people aren't even aware of how their language and behaviors negatively portray older adults. And I like what Ashton Applewhite says, I interviewed her last year in September. And she says, The thing about ageism, that is so remarkable is that the discrimination and bias that we and judgment we have against older adults, is basically against our own future selves. That's pretty powerful.

So another thing that you can do is to shift your focus. And this means to try to see things with a new lens, and shift away from the stereotype. So you might do this by shifting your focus from a stereotypical view of older adults, to a counter stereotype. And this is where you put a picture in your mind of older adults who are the opposite of the stereotype. Or to look at the fuller picture. So for example, even though older adults were indeed disproportionately impacted physically, by the covid 19 pandemic, they also demonstrated the highest coping and resilience rates than any other age group, and the lowest levels of mental health concerns compared to other age groups.

Another way to go about this is to shift how you interact with older adults. So if you realize that you're only around older adults who are sick, or at the end of their life, then and so if you're caregiving, and really in meshed and immersed with illness and loss, which is very painful, and that's your only exposure, or your primary exposure to older adults, then I would encourage you to take a step back, and, and look out and try to identify other older adults in your community who are at a different stage in their older adulthood, who are healthier, who are thriving, and look for examples of other older adults who are not sick or at the end of their life. And this is especially important for caregivers, because I often hear caregivers say, it's hard for me, I'm caring for my mom with dementia. And it's hard for me to imagine that I won't get it to, because that's all I see. That's my model. That's my example for aging. And so if that's you, I would encourage you to step back and look around, broaden your lens, widen your focus and look for other older adults who are thriving. Because even though you're caring for a person who is biologically related to you, it doesn't mean that you will have that same illness, it doesn't mean that you will have that same aging course.

Remember that study, the one that looked at our beliefs about aging, when we have an Alzheimer's gene. And people with the Alzheimer's gene, the gene who had positive views of aging, or 50% less likely to develop dementia. There is a lot you can do to prevent dementia. And there's a lot that you can do to shift your focus around aging from a negative view of aging to a positive one. You're worth it and your older adulthood is worth it. And I'm sure deep down the person that you're caring for once that for you too. And wants that for your own older adulthood, we don't talk enough about Mental Health and Aging in society. We also have beliefs about aging that are not true. There are lots of myths about aging out there about mental health and aging out there. Like there's a myth that it's normal to have depression, that it's normal to be anxious that it's normal to have dementia, anxiety, depression, dementia are not normal parts of aging. But if we believe that they are, we are not going to detect when we see signs and symptoms, and we're not going to help older adults get access to care. And we know that when older adults get access to care for mental health conditions, they do better.

Here's what happens when older adults have depression, anxiety and don't get access to mental health care. Their medical illnesses get worse. They use more medications for medical problems. They have more frequent hospitalizations, they stay longer in the hospital, they have more ER visits, their caregivers have higher rates of stress, and their risk for suicide increases. But we could do something about this just by shifting our view about aging and ageism. Just by getting familiar with what's typical among older adults, and not typical, we can help older adults improve their quality of life. And let me tell you, older adults benefit from mental health care at almost the same rates as younger adults, and indeed at the same rates when we're talking about depression. Let me tell you ways that ageism and ableism intersect back to this idea that Oh, the person has dementia, there's nothing I can do. Of course, there is so much we can do to help families and older adults living with dementia. When a person is newly diagnosed with dementia, they may likely have depression or anxiety at the same time that actually is treatable. Their risk for suicide goes up. And we can help with that. And as the dementia process as the dementia illness progresses, we can help families manage care so that the families are building their resilience factors in caregiving. So that families are connected to additional resources that they might not know about, so that caregivers get support. Because when caregivers get support, they have more to give. There's so much we can do.



Introducing the Center for Mental Health and Aging


So I have been working tirelessly over the last several months to build the Center for Mental Health and Aging, so that you have a place that you can go to online for the mental health care of older adults. Our mission is to improve mental health care for older adults by providing education like to help you understand what's typical with aging, what's not typical when to be concerned, especially as it relates to Mental Health and Aging, and then to get you access to mental health providers. Because one of the most significant reasons that older adults do not get the mental health care that they need is because lack of access to mental health providers. And so we want to change that we want to be sure that any older adult who needs mental health care can get it. You can learn more at



Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults?

Are you a licensed therapist, psychiatrist or neuropsychologist who specializes with older adults? I would love for you to have a profile in the Mental Health and Aging provider directory. I would love for you to join me in the movement to make mental health care for older adults and caregivers easier to find. Together we'll build the largest geriatric and the only geriatric mental health provider directory in the nation. Let's make it easier for older families to get the mental health care that they need. By helping them get access to you to be the first to know when this provider directory is available. Go To and that will take you to download a guide which is the five must know facts when you're working with older adults. If you go if you go there and download that guide, you will be the first to know when the provider directory is available. And I cannot wait until the Center for Mental Health and Aging is launched. I'm counting down the days. I cannot wait. So head on over to my website and you'll be the first to know let's make it easier for older families to get the mental health care they need by helping them get access to you.


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