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Attitudes
There has been increasing awareness in the past decade that ageism and age discrimination are important issues for those who work in the health and social services. The 2001 National Service Framework for Older People included a commitment to 'rooting out' age discrimination in health and social care. However, the 2006 review of progress found that progress to improve health and social care for older people had been impeded by 'deep cultural attitudes to ageing'.
This illustrates the disadvantages which can still result from the 'warm but incompetent' stereotype including:
- poor standards of care on general hospital wards
- poorly managed discharges from hospitals
- being repeatedly moved from one ward to another for non-clinical reasons
- being cared for in mixed-sex bays or wards
- meals being taken away before older people could eat them due to a lack of support at meal times
(Health Care Commission, Commission for Social Care Inspection, and the Audit Commission, 2006)
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Attitudes
Ageism can also be found among some older people. A recent comprehensive survey of ageism in the UK was carried out. What did the results reveal rearding older people who found that older people who ‘self-stereotype’?
- Suffer with health problems.
- Attribute their problems to the ageing process and therefore not seek medical assistance.
Their awareness of the negative stereotypes may lead some other older people to:
- Minimise their health problems as a way of denying negative stereotypes.
- Be reluctant to visit medical professionals because of perceived ageism in the system.
It is important that those working in the health and social services do not reinforce any negative attitudes to ageing held by older patients and service users, and that they are also prepared to challenge ageist and discriminatory practices.
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Attitudes
To consider this issue of staff attitudes and practices further read the following case study.
‘Donald, age 89, has recently moved into a home for older people. His mobility is restricted and he is beginning to experience memory impairment and is sometimes confused. When he receives his post he finds that it has been opened and read. He is distressed and angry. Staff say that it is normal practice, particularly for people with memory impairments. They may miss important information contained in their post.’
(Source: Crawford and Walker, 2004, p.4)
Which of the following statements match your view of the situation:
- The staff are justified in opening his post because they are protecting his interests.
- People who may be confused are incapable of expressing their views
- The staff actions reflect a ‘warm but incompetent’ stereotype which is intrusive and disrespectful.
- Donald, and people like him, are being denied their rights and opportunities to make choices for themselves.
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Attitudes
The correct answers are:
- The staff actions reflect a ‘warm but incompetent’ stereotype which is intrusive and disrespectful.
- Donald, and people like him, are being denied their rights and opportunities to make choices for themselves.
The staff may be well-intentioned but they appear to assume that people with memory problems are incapable of expressing their views. Donald should be consulted about what he wants in this and other areas of his life.
Ageist attitudes by staff are the most frequently reported aspect of age discrimination (Levenson, 2003).
Read the following transcript and note down different kinds of ageist practice which are illustrated.
‘Two doctors were examining my x-rays within my hearing (unbeknown to them). One said to the other: “How old is she? Does she need to use her arm a lot at work?” I was then asked: “How do you feel about leaving it as it is? I replied: “What would you do if it was your arm?” He immediately decided to remove the plaster and re-set my wrist. I dread to think what would have happened if I had not overheard the ageist discussion about the x-rays. I did make a complaint to the hospital.’
(Help the Aged, 2004, p.20)
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Attitudes
Suggested answer:
Here is a list of the most common ageist attitudes and assumptions.
- all older people are similar in their needs, regardless of their health, social circumstances, age, race, gender, disability and personal values and preferences.
- older people are incapable of understanding and therefore unable to participate in decisions about their own treatment and care.
- older people are less valuable members of society than people of working age
- older people do not need to be in peak health
- health problems are ‘just your age’.
- older people are not interested in preventive health measures
- older people will (or will not) want specific treatments or services, so need not be asked.
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Direct and indirect discrimination
You have looked at some staff attitudes and related behaviours. Like ageism, age discrimination in health and social care can also result from institutionalised policies and practices. It may take direct or indirect forms (Levenson, 2003; Roberts, Robinson and Seymour, 2002).
Direct age discrimination
This occurs when people are treated differently or denied services because of their chronological age (e.g. age-related criteria for intensive care beds).
Indirect age discrimination
This happens where a service or practice has no explicit age bias, but there is still a disproportionate impact on a particular age group who are thereby disadvantaged. (e.g. difficult physical access to buildings, or clinics held in places poorly served by transport: factors which can adversely affect everyone, but particularly older people)
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Direct and indirect discrimination
Read the list of examples of discrimination against older people in the health and social services. Using the definition and examples given earlier decide whether it is direct discrimination or indirect discrimination.
- A liaison psychiatry service which has a policy of only catering for under 65s
- Age related criteria for specific services such as stroke, rehabilitation, etc.
- Age-related criteria for access to day surgery (rather than assessing individual need and ability to benefit)
- Eligibility criteria that effectively exclude many older poorly sighted people, for example, help with cutting toe nails being restricted to those ‘in clinical need’ only.
- Care packages for older people with a lower cost ceiling across the board than those for younger service users.
- A policy of spending less on training for staff to transfer to the care of the psychogeriatric service, or older people’s team in social services, than on work with other age groups.
- Lower referral rates for investigations or treatments for older people with similar health problems to younger people.
- Palliative care services if they only accept people with cancer, thus excluding older people who may have terminal conditions that are less likely to occur in younger people (e.g. heart failure)
- Early discharge without appropriate support services (many older people live alone).
- Providing a limited range of services to older people in a routine and inflexible way which contrasts with more innovative service development and provision for other age groups
- Institutionalised regimes in hospital wards and homes for older people which contrast with smaller more person-centred regimes for other patients.
- Lack of privacy and denial of dignity in care homes and hospitals where it would be afforded to younger residents and patients
- Transitions between services triggered by chronological age rather than changing individual need and personal circumstances (as can occur with people with mental health problems at age who may be required at age 65
- Restricted access to specialist neurological support which in some areas is funded for under 65s only
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Formal and informal discrimination
It's less improtant that you allocated all of the examples correctly than that in doing this exercise you focussed your attention on the different kinds of discrimination - direct or indirect - in wide range of policite and practices.
Organisational factors also contribute to discrimination and disadvantage, for example:
- Work with older poeple is not seen as attractive, nor is it well rewarded for care workers in residential and nursing homes
- The proportion of staff who are qualified and well trained tends to be lower than with other patient and service user groups
- The helath service is geared towards acute disease intervention rather than to care for chronic conditions
- Joint working and coordination across different service and disciplinary boundaries have proved difficult yet older people's needs oftern require a multi-disciplinary approach
Is age discrimination always unfair? An exception is where positive measures are required for addressing inequalities. For example, free prescriptions are given to children and people aged 60 or over - and there are specialist services for children and adolescents and some older people - as a way of providing effective services for these groups. A similar case can be made for special intervention to ensure the quality of care of mentally ill older people with high levels of dependency. Their needs are relatively expensive to meet and as a group they are unlikely to be attractive to private residential care providers.
Principles of anti-ageist practice
Good practice in work with older people is inherently anti-ageist. Unfortunately, ageist attitudes and policies, inadequate resources and lack of staff training in the needs of older people all conspire to lower the quality of practice. Are there principles that should inform an anti-ageist practice with older people?
Think about the following key words:
- Value and respect
- Listening
- Seeking information
- The older person’s voice
- Choice
- Inter-depenency
- Priortion of service
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Principles of anti-ageist practice
Suggested answer
We would suggest the following:
- Value and respect the individual older person as the adult he or she is. For example, do not demean with epithets like ‘dear’ or using first names' without permission and respect privacy.
- Listen and try to understand what the older person wants.
- Seek information, without being intrusive, about the person’s life: family history, work, interests etc. - as this can help with 2 above and can also assist in forming a relationship.
- Ensure that the older person’s voice is heard, if necessary through an advocate.
- Offer choice.
- Promote inter-dependency. Independence may be a difficult goal for some older people, but inter-dependency – i.e. being able to give emotional support, for example, in return for support given - may be a more realistic aim.
- Prioritising services for the most disadvantaged older people – such as those with severe mental health problems and those in poverty - for example, many older women and black and Asian older people.
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Anti-ageist practice
Discriminatory practice may be embedded within an institutional setting. Read the following statement from a manager of a home for older people.
‘I was inducting a new member of staff who has recently joined us from another home. When I told her that the people who live in this home could get up in the morning whenever they like, she was shocked! At her previous home breakfast was always served at 7.30 a.m. This meant that staff got some residents out of bed at 5 a.m. so that everyone could be ready for breakfast. When asked what was her justification, the member of staff was told it was seen as a way in which the night staff “helped” the day staff – residents were clean and ready for breakfast when the day staff came on duty. Also the cook was able to get on with cooking the lunch”
(Source: Crawford and Walker, 2004, p.12)
How would you challenge this approach?
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Anti-ageist practice
The over-riding issues here would seem to be that of choice and a denial of the rights of people who live in the home in favour of the staff. Whilst all institutions have routines and processes they do not have to support poor practice of this kind. Meeting the needs of everyone in a residential home is no easy task but this kind of practice is oppressive and unacceptable. It conflicts with several of the principles of anti-ageist practice discussed earlier (value and respect; listening to needs and wants; offering choice).
We return briefly to ways of challenging ageism at the end of this learning object but first you can consider something which can be of a consequence of age discrimination – social exclusion.