Dr. Arun S. Rao: Ageism: "If you are not already part of a group disadvantaged by prejudice, just wait a couple of decades--you will be."

Changing the Narrative's 2023 Banner on "Imagine a World Without Ageism" https://changingthenarrativeco.org

July 21, 2025

Hello, my name is Dr. Arun Rao, and I serve as an Advisor to the Dementia Society.

In June 2025, I presented a workshop on Ageism and Healthcare at the Center for Modern Aging, Princeton's (https://cmaprinceton.org) Inaugural Symposium on Aging. One of the sources I used in preparing for the presentation included this quote, and I think it's a very profound thought. Ageism, which is stereotyping, prejudice, and discrimination based solely on a person's age, affects ALL of us- regardless of skin color, gender, background, social status, sexual orientation, etc. In fact, it can contribute to all those other issues used to discriminate against people. But whether we like it or not, we will likely all face an ageist comment or action in our lives.

And the healthcare system is rampant with ageist beliefs.

As a geriatrician, one of my goals in life is to look beyond chronological age and respect the individual patient in front of me as one individual person - an older adult with their unique background, history, abilities, and priorities.

Soooooooo, let's talk about ageism and how we can hopefully combat it.

The basic definition, as I mentioned above, was initially coined by the pioneering geriatrician Dr. Robert Butler in 1969.

It is estimated to cost society about $63 BILLION due to its negative impacts on health, healthcare access, & healthcare delivery.

There are 3 basic types of ageism:

• Institutional- these are laws, policies, societal norms, & practices that restrict access and systematically disadvantage people based on their age.

  • The shortage of geriatricians in the United States is due to inadequate reimbursement for doctors specializing in this field.

  • The underrepresentation of older adults in medical & scientific research often means that studies generally do not focus on conditions that become more common as we age.

  • Medical trainees get more exposure to OB/Gyn or pediatrics than to geriatrics, even though most physicians will treat older adults rather than younger ones.

    
    

• Interpersonal- comes up during interactions between people.

  • Providers attributing symptoms & complaints to aging rather than considering the possibility of an underlying disease.

  • Elderspeak- infantilizing, dismissive, & demeaning way we speak to older adults:

    • Making the assumption that you should automatically use a louder voice, slow your speech, & repeat yourself when speaking with an older adult. Yes, it might help, but it can be insulting if not needed

    • Using phrases such as "Honey," "Sweetie," "Dear"

    • Calling older adults "cute"

  • The conversation with the medical professional (e.g., the doctor) ignores the patient in the room and talks with their care partner, rather than including the patient.

    
    

• Self-directed- biases & beliefs that are internalized. These internalized beliefs can be the most damaging.

  • Feeling that cognitive decline and symptoms are inevitable due to age, so why bother saying anything

  • By not speaking up, the person and/or their care partner delays evaluation and possible meaningful interventions

How does ageism impact healthcare? My belief is:

• Reduces longevity

• Poor quality of life

• Leads to patients being more likely to describe their health as "poor."

• Worsens physical illness - missed or delayed diagnoses

• Slower recovery from an illness or disability

• Undertreatment or overtreatment

• Increased ER visits & hospitalizations

• Patient less likely to seek care out of fear of being belittled/dismissed

• Depression & anxiety

• Further cognitive impairment

• Increased social isolation & loneliness

As an example, a study at The Johns Hopkins School of Medicine showed that when given a patient's age alone, medical students were more likely to treat pneumonia "aggressively" in a 10-year-old girl than in an 85-year-old woman.

So, how can we combat this issue?

We (providers and their patients) should accept aging as a natural process with "pros & cons" and understand what constitutes normal aging vs. abnormal aging.

We should also be mindful of our own biases and challenge them.

We should recognize the diversity of the population of older adults, in essence, "When you've seen one 85-year-old, you've seen one 85-year-old."

We need more opportunities for intergenerational exposure. Such exposure has actually been shown to reduce ageism and ageist beliefs.

A great resource is the organization Changing the Narrative- https://changingthenarrativeco.org

They have many resources to help you understand how to equip yourself to feel empowered, speak up, and know the facts about ageism and aging.

And, of course, if you ever want a physician advocate to help you navigate the healthcare system, look to your local... GERIATRICIAN!

Information for this post comes from Laura A. Robbins, an ageism expert and former Program Office for The John A. Hartford Foundation in Generations: Journal of the American Society on Aging, Vol. 39, No. 3, Ageism in America: Reframing the Issues and Impacts (Fall 2015), pp. 17-21.

Dr. Arun S. Rao, a fellowship-trained & board-certified geriatrician with over 20 years of experience, is the founder & CEO of Geriatrics Planning & Solutions, Inc., a direct-pay house call service for older adults that provides medical care management and consultations. Dr. Rao is a member of the Advisory Council at the Dementia Society of America.

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