May 3, 2023
Racism and ageism are serious concerns in health care and society; but when they intersect, the implications multiply substantially. “This is such a complex and multifaceted issue,” said Timothy Farell, MD, speaking on an AMDA On-The-Go podcast, The Intersection of Structural Racism and Ageism.
Host Diane Sanders-Cepeda, DO, CMD, started the program with some brief definitions. Structural racism, she said, is the “ongoing historical and long-term reproduction of the racialized structure of our society through a combination of all forms of racism.” Ageism, she observed, involves attitudes toward older people and about aging, as well as discriminatory practices involving older adults.
Dr. Farrell said, “One fact, at least with ageism, is that it is such an insidious and in some ways invisible ‘ism’ that we often take for granted.” For instance, he referred to the plethora of birthday cards that promote unflattering stereotypes of aging and older people. In health care, ageism is sometimes “baked in,” and that makes it difficult to find out what matters to patients and how to help them. “Factor in racism, and you get the perfect storm,” he noted.
Ramona Rhodes, MD, another guest on the program, explained, “Ageism is an ‘ism’ that people don’t think about or give credence to.” She noted that when she was exploring career opportunities after her residency and she told people she was interested in geriatrics, some said, “You are a glutton for punishment if you are going to care for ‘old people.’” However, she added, “We are learning more about intersectionality as it relates to ageism and racism and the negative outcomes resulting from this.”
Jasmine Travers, ANP, PhD, RN, a third guest, observed that according to the World Health Organization, one in three people globally are ageist, yet people don’t see themselves as such. At the same time, she said, “No one wants to think they are racist, so this makes change harder” to implement and sustain.
“When racism and ageism collide, there are implications for health outcomes,” Dr. Rhodes said. For instance, when older adults think they are being discriminated against or experience racism, this may keep them from pursuing care. At the same time, these individuals are often excluded from research studies that could benefit this population.
Dr. Travers noted, “Think about the number of older adults who can’t access the services to stay in their homes the way they desire.” For example, there isn’t a large availability of assisted living facilities, but even fewer in areas with a higher proportion of Black or Latino residents. There also are barriers when it comes to finances. As a result, people in these areas may find themselves in nursing homes without being included in decisions about their care. “We need to think about the consequences of not being part of your decisions about health care,” Dr. Travers suggested.
Part of ageism is the assumption that older people, particularly from disadvantaged backgrounds, are unable to participate in important decisions. This, said Dr. Farrell, “impacts day-to-day decision-making and things like conversations in the exam room.” He noted that he has had to train students to recognize the importance of something as simple as not addressing older adults by their first name or talking down to them. “This can be deeply distressing and make them feel like their feelings and needs aren’t being considered,” he said.
Dr. Farrell stressed, “We need to focus on getting our own house in order.” This includes education and training and the use and facilitation of best practices. “We reflect the ageism and racism of society, but we have a responsibility to look inward, do better, and make society better as a whole,” he said.
Increasing diversity in health care is key, said Dr. Travers, including in leadership positions. “Organizations should be reflective of the population being served so we can better understand where our blind spots are and where we need to break down policies and practices that enable racism and ageism,” she said.
“I think we need to increase our understanding of how structural ageism and racism intersect,” said Dr. Travers. This means understanding our privileges and how they affect others, she observed: “We need to peel back the layers and be open to how we might be perpetuating structural racism and ageism,” however unintentionally.
Listen to the full podcast and hear more of this insightful and thought-provoking conversation.