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Gerontology

Prof.Dr.Veronika Ospina-Kammerer

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Vulnerability and a Lack of Empathy or Compassion add up to

AGEISM

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Keine Sorge – keine Angst

Wir sprechen Deutsch!

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Are you prejudiced?

Do you say “aaawww, isn’t she cute?” when you see an older woman doing something a younger person might do (e.g., having fun, kissing a man)?

Do you think older people aren’t appealing because of their physical appearance (e.g., loose skin, wrinkles, gray hair, weight around the middle)?

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Are you prejudiced?

Do you think all old people are wise?

Are you uncomfortable talking to elders?

When you talk to older people do you look them in the eye?

Are elders all “old people” to you or can you see each as an individual?

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Beliefs about Aging and Older People

The Social Construction of AgingYouth, speed, production ($) are American

idealsPhysical and mental weakness are stigmatized

feel ashamed or embarrassed when weak, ill, or need help

You have done something WRONG if you become ill or old or poorBlame the Victim

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Beliefs about Aging and Older People

The Social Construction of AgingValues underlie attitudes and stigma

Survivor of the fittest • (I [behavior or attitude] and am alive/well and Mr. X didn’t so

he became old/ ill/died• Control, control, control

Do not believe that uncontrollable forces or chance has anything to do with becoming old or ill

Belief in simple cause and effect relationships• e.g., She got cancer because she did/did not [behavior or

attitude]

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Robert Butler on Ageism

In the 1960s, Robert Butler coined the phrase ageism, which he defined as:

"A process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this with skin color and gender. Old people are categorized as senile, rigid in thought and manner, old-fashioned in morality and skills . . . . Ageism allows the younger generations to see older people as different from themselves; thus they subtly cease to identify with their elders as human beings . . . ."

(See R. Butler, Why Survive? Being Old in America, 1975 - item no. 71 of this bibliography.)

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Ageism

Ageism can be coupled with other forms of oppression

sexism, racism, beautyism… a powerful combination

It all adds up to the beliefs that –AGING is badAGING is uglyAGING is to be avoidedAGING is a social and economic crisisWe need to FIGHT AGING

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Ageism

“A man's face is his autobiography. A woman's face is her work of fiction.”

Oscar Wilde

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AGEISM & SEXISM The Double StandardThe men shown here are the plastic surgeons – note they haven’t been touched up.

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What? We’re Prejudiced? Are you?

Lots and lots and lots of examples in daily life…

ConversationsJokesTelevisionBirthday cardsNewspaperMagazinesMusic lyrics

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Ageism and the MediaSubtle? NOT!

Music http://music.msn.com/music/features/bandsofthelivingdead

Is music only for the young?Rockers and rappers who are in their

40s, 50s, and 60s are referred to as “living dead” -- Writer states they “refuse to die”

Old men rockers are one thing but old women?

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Ageism and the MediaSubtle? NOT!

Prejudice and discrimination on TVLess than 2% of prime time television characters are

65% Majority of film and TV writers are white men under 40Only 1/3 of older characters on prime time TV are

women70% of older men and 80%+ of older women on TV are

portrayed disrespectfully, treated with little if any courtesy, and looked at as “bad”

Examples from Ageism in America: Status Reports of Ageism in America by The Anti-Ageism Taskforce at The International Longevity

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The Truth About AgingThe truth is that most older people are more

vulnerable due to losses Physical losses

May not be able to walk, drive, grocery shop, clean house, talk on telephone, see instructions or watch television, etc.

Social lossesLoss of parents, spouse, siblings, friendsCoupled with physical, income, and cognitive, may lose ability to get to

and enjoy social activities Income losses

Retirement Cognitive losses

Some processing changes and memory loss are normal

And sadly enough, some people prey on older people’s vulnerability

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Age Discrimination & Health Care 60% of adults aged 65+ do not receive

recommended preventive services40% do not receive flu and pneumonia vaccines

Only 10% of elders receive screening tests forBone densityColorectal and prostate cancerGlaucoma Despite the fact that the average age of colorectal cancer

patients is 70, more than 70% of prostate cancer is diagnosed in men 65+, and people over 60 are 6 times more likely to have glaucoma

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Age Discrimination & Health CareChemotherapy is underused in the treatment of

breast cancer patients aged 65+ even though survival could improve with many

Older patients are significantly underrepresented in clinical trials for all types of cancer but notably in trials for breast cancer

Older persons are the biggest users of prescription drugs, yet 40% of clinical trials between 1991 and 2000 excluded older persons

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Race and Gender Discrimination in Health Care

The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization

Article in The New England Journal of Medicine, 2/25/99

By Schulman, Berlin, Harless, Kerner, Sistrunk, Gersh, Dube, Taleghani, Burke, Williams, Eisenberg, & Escarce

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Background

There are sex and race differences in terms of the prevalence of heart disease, heart attack, and death from heart attack in mid and later life in particular. African Americans and women are more likely to

die from heart disease and heart attack and also have higher rates of hypertension.

Women and African Americans tend to have greater functional disability due to angina before myocardial infarction as well.

Cardiovascular tests and procedures can help with quality of life and the extension of life.

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Research Question & Methods

Research QuestionDoes the race and sex of a patient independently

influence how physicians manage chest pain?

MethodsActors portrayed male/female white/black older patients

(age 55 and 70) with particular characteristics in scripted interviews about their symptoms

Identical data given to physicians about patients (medical history, results of tests, etc.)

Sample of 720 physicians derived from attendees at two national medical conventions

Computerized survey asked physicians to make recommendations for managing the patient’s chest pain

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Results

Physicians’ mean estimates of the probability of coronary artery disease were lower for women

A sophisticated logistic regression analysis indicated that the odds of women and African American patients being referred for cardiac catheterization was lower than for men or whites Looking at the effect of the double whammy (sexism and

racism), it was found that Black women were significantly less likely to be referred for cardiac catheterization than white men

Some believe that people are most sympathetic to people like themselves; hence, the finding (white male doctors tended to favor or refer white men) Along these lines, one could ask -- Were the female and Black

cardiologists more likely to refer women and African Americans for cardiac catheterization?

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You might ask – but aren’t college-educated younger adults less likely to be prejudiced than others?

And finally, you might ask – aren’t nursing students less likely to be prejudiced?

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Study of Standardized Patients

Nursing studentsWhich patient was ascribed the most

negative characteristics?Which patient was least preferred to work

with?Why?

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Your Beliefs and How They Affect You and Your Treatment of Others

How much control over things do you feel you need to have to be okay, live life as you’d like, and avoid anxiety?

How much control do you think you have over aging and disease?

What impact do you think your notions have on your behavior?

What impact do you think your notions have on the way you view others’ behavior?

What impact to you think your notions have on the way you will treat others who are aging, dealing with health decline, disability, disease, pain and suffering, dying?

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More Examples of Age-Related Vulnerability in Today’s World

Out of sight, out of mind?14,802 persons, mostly

elderly, died in France during a 2003 heat wave

20% of health care providers were gone, most French families were on vacation

Should government have provided? Should people have not vacationed?

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What is Resilience?What is Resilience?

The Resilience of Elders of The Resilience of Elders of ColorColor

The Resilience of Older The Resilience of Older WomenWomen

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Ethnic Minority Distribution of Older PopulationEthnic Minority Distribution of Older Population84.3% of total population 65+ is White and 15.7% 84.3% of total population 65+ is White and 15.7% are ethnic minorities are ethnic minorities (8.1% African American, 5.6% Latinos, (8.1% African American, 5.6% Latinos,

2.4% Asian/Pacific Islanders, 0.4% American Indians)2.4% Asian/Pacific Islanders, 0.4% American Indians)

0

2

4

6

8

10

12

14

16

18

% of ethnic minoritypop 65+

projected % 2050

African Americans

Asian/Pacific Isl

American Indians

Latinos

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Ethnicity and CultureEthnicity and Culture

Know definitions of ethnicity and cultureKnow definitions of ethnicity and culture What is “resiliency?”What is “resiliency?” Why do we even talk about the Why do we even talk about the

resiliency of particular groups?resiliency of particular groups? What social forces impact minority What social forces impact minority

elders’ lives? women’s lives?elders’ lives? women’s lives? What interactions does the book say begin What interactions does the book say begin

to add up and cause stress? to add up and cause stress? Know what the double jeopardy hypothesis Know what the double jeopardy hypothesis

isis

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Issues Common AcrossIssues Common AcrossElders of ColorElders of Color

Cumulative structural disadvantagesCumulative structural disadvantages Low paying jobs, higher poverty rates, Low paying jobs, higher poverty rates,

more single womenmore single women Lower rates of insurance coverageLower rates of insurance coverage Sociocultural (structural and family-Sociocultural (structural and family-

related) barriers to health care and related) barriers to health care and social service usesocial service use

Centrality of family/kinCentrality of family/kin Chronic illness patternsChronic illness patterns

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Social ForcesSocial Forces

How do minority and women elders How do minority and women elders become “resilient?”become “resilient?”

Is the answer to force individuals to Is the answer to force individuals to become resilient or should we become resilient or should we change society?change society?