Running head: ELIMINATING AGEISM IN NURSES 1

Eliminating Ageism in Nurses

Sydonie Stock
Ferris State University


ELIMINATING AGEISM IN NURSES 2

Abstract
Ageism is defined as negative attitudes and generalized stereotypes applied to people based on
age (De la Rue, 2003). Negative attitudes could be due to cultural influences that affect all areas
of life, from media to employment (Cerna, Morley, Ninh, & Unice, 2013), or the more narrow
culture within the hospital setting (De la Rue, 2003; Nilsson, Lindkvist, Rasmussen, &
Edvardsson, 2012). Expanded education on the ageing process and increased positive exposure
to older people could improve nurse attitude (Heise, Johnsen, Himes, &Wing, 2012; Liu,
Norman & While, 2012). Learning how to communicate appropriately with older patients and
recognizing their values and opinions could improve patient care and decrease strain experienced
when caring for older patients.


ELIMINATING AGEISM IN NURSES 3

Eliminating Ageism in Nurses
As the last of the Baby Boomers quickly approach retirement age, there will be a drastic
increase in the amount of older adults. The next fifteen years will show those aged 65 and older
numbering 72.1 million people in the United States (Heise, Johnsen, Himes, &Wing, 2012).
This increase in the older population will likely cause an increase in older aged healthcare
patients. Even if the nurse has not specialized in geriatrics, nurses in all patient care areas may
have interactions with the older population as patients in units from medical/surgical to
cardiac/thoracic, or as visitors to pediatric patients (Heise et al., 2012).
This aging population becomes an issue for nursing when the nurses negative attitude
toward the older person, or ageism, leads to inferior care. Ageism may be positive, patronizing
and assuming cognitive or physical limitations, or negative, sarcastic and hurtful comments
about age and the effect aging has on a body (Kagan, 2014). Both types of ageism impact the
patients care (De la Rue, 2003; Hanson, 2014; Kagan, 2014; Nilsson, Lindkvist, Rasmussen, &
Edvardsson, 2012). The United States society holds little respect for the older populations, and
this culture invades the healthcare field (Cerna, Morley, Ninh, & Unice, 2013; De la Rue, 2003;
Hanson, 2014; Stone & McMinn, 2014). Ageism is so prevalent that the Department of Health
made procedures to prevent discrimination based on age (Hanson, 2014). An effective means of
combating ageism is through education about the aging process and positive exposure to older
adults (Heise et al, 2012; Liu, Norman & While, 2012). Increased knowledge and a positive
attitude may enable a nurse to identify moments during care when ageist thoughts or patronizing
actions and words impede care. This awareness could change the way the nurse is caring for the
older patient and improve the quality of care given. The purpose of this paper is to analyze the
ELIMINATING AGEISM IN NURSES 4

problem of ageism in the nursing field and suggest changes that could decrease the occurrence in
practice.
Theory
Joyce Travelbees Human-to-Human Relationship Model proposes that the act of nursing
requires a relationship be formed between the patient and nurse (Travelbee's Human to Human
Relationship Model, 2013). This relationship is built through five phases: (1) the meeting, (2)
identifying individual personalities, (3) empathy, (4) sympathy, and (5) understanding. The
nurse may fall back on ageist thoughts and behaviors if these five phases are not followed.
A communication theory used in eliminating ageism is Communication Accommodation
Theory. This theory suggests that, when people are in a conversation together, the language,
tone, or pitch used will adapt so the message may be more readily understood by the other person
(Giles, Coupland, & Coupland, 1991). Older adults may have communication impairments such
as hearing loss, vision loss, or a decrease in cognitive ability (Hanson, 2014). Not all older
adults have these deficits and the nurse and any health care provider should accommodate
communication accordingly.
Healthcare Environment
Ageism is not simply a healthcare problem. Blame should not be placed solely on the
nurse that overlooks an older patients requests because this behavior stems from a deeper
problem outside that nurses control. Cerna et al. (2013) identifies several aspects of American
culture as a source of ageism: employment, media, and culture.
Younger people are hired into positions more often than older and some companies have
stated that managerial positions are preferably filled by someone less than 40 years old (Cerna et
al., 2013). The stereotype that older people are less adaptable, stuck in their ways, or old
ELIMINATING AGEISM IN NURSES 5

fashioned may be to blame for this trend (Cerna et al., 2013). This practice is so common in the
United States that more than 20,000 age discrimination lawsuits are filed each year. However, it
is not only the workforce at fault. Media portrays aging as a bad thing, something to avoid
(Cerna et al., 2013) and advances in technology aids this image with anti-aging procedures, such
as Botox and facelifts (Heise et al., 2012). Older adults are generally stereotyped in
advertisements and on television or movies, if they are portrayed at all (Cerna et al., 2013).
Ignoring the older adult is a form of ageism (Cerna et al., 2013). But media alone is not
responsible for the attitudes of employers or healthcare providers. The culture in the United
States today is one that promotes ageist ideas (Cerna et al., 2013; Hanson, 2014; Stone &
McMinn, 2014). The strain of an older population is described as the problem of aging
societies (Stone & McMinn, 2014, p. 433). This implies that it is the older persons fault,
simply for living past a certain age. Cerna et al. (2013) compared American culture to that of
Vietnam, Native Americans, and Korean cultures. In each of these the older generation lives
with the younger and is respected, their role changes from earner to caring for grandchildren or
other children in the area. Because grandparents may not live with their children and
grandchildren in the United States, this caregiver role may not be offered or available, and the
respect for elders that other cultures grow up with may be denied to the children of the U. S. All
aspects of ageism in society could play a role in healthcare and may be to blame for the nurses
inattention.
The healthcare system also plays a part in the nurses attitude toward older patients.
Nilsson et al. (2012) found that healthcare providers had increased negativity if the older patient
had a cognitive impairment, if there is a disproportionate amount of cognitively impaired older
adult patients, and if the nurse was young. There is also a positive correlation between increased
ELIMINATING AGEISM IN NURSES 6

strain in caring for older patients and increased negativity. These findings may indicate areas of
need to be addressed.
Since ageism is a personal opinion about someone based on age, the largest challenge
associated with removing ageism from nursing care is changing the way nurses think about the
older population. To make this change, nurses in all fields of care, nurse educators, nursing
students, professors in schools of nursing, administrators in schools of nursing, and clinical
preceptors must be involved. Managers, supervisors, and administrators should work to avoid
ageism because if authority figures do not respect the older adult, those under them will follow
suit (De la Rue, 2003). There are several assumptions found to be at the core of ageism that
must be identified to change the nurses thoughts. The idea that older people are a drain on
society (De la Rue, 2003; Liu et al., 2012; Hanson, 2014; Stone & McMinn, 2014) may be a
factor. The stereotypical image of an older adult, frail and weak, hard of hearing, poor vision,
and dementia or cognitive impairment (Hanson, 2014; Stone & McMinn, 2014), may play a role
in an individuals views. An individuals assumptions should be identified in order to avoid
unintentional ageism.
Inferences, Implications, and Complications
The research found regarding ageism in nursing care were from several countries. This
implies that ageism is not only a problem in the United States, but all over the world. Kagan
(2012) and Cerna et al. (2013) wrote their articles about the U. S. Heise et al. (2012) studied this
problem in the United States and developed recommendations to change the way nursing
students viewed the older adult. De la Rue (2003) also worked with nursing students, but in
Australia. Nilsson et al. (2012) studied established nurses in Australian hospitals. Stone and
McMinns (2014) editorial addressed several cultures around the world including the Chinese,
Japanese, and Taiwanese. Hanson (2014) conducted a systematic review including research
ELIMINATING AGEISM IN NURSES 7

from around the world, while Liu et al. (2012) focused their systematic review on research
written in English or Chinese.
A logical interpretation of the data found is the decline in respect toward the older adult
might lead to patronization and the assumption that the older population as a whole cannot care
for themselves. Nurses could be influenced by culture, media, and the environment and this
influence may lead to unconscious ageist beliefs and behaviors. It could be inferred that western
cultures, including the United States, are more biased against age than cultures where the older
generation live with and help raise the younger. Anti-aging societies value youth which could
lead to ageism in the form of ignoring or stereotyping older people in the media. Nurses might
find ageism in the workforce as the older adult may be seen as unadaptable. The nurse could
have this same opinion regarding an older patients life style and health choices. Older adults
may be pushed to the side, the aging process avoided or downplayed. Nursing schools that
downplay the ageing process may not be providing adequate education, which could lead to a
negative attitude toward the older adult. Negative attitude feeds ageist ideas and may result in
either positive ageism or negative ageism. Any type of ageism could negatively affect nursing
care and patient outcome.
If the problem of ageism in nursing continues to be ignored, patient satisfaction from the
increasing older population could decrease. According to Jaspen (2013), private and government
insurance may incorporate patient satisfaction into healthcare reimbursement. If the large older
population is not satisfied with care, reimbursement could decrease, causing the hospital to lose
money when caring for this age group.
It is nearly impossible for a nurse to avoid working with older adults, either as patients or
visitors. Increased education on the aging process and on older adults could improve care and
ELIMINATING AGEISM IN NURSES 8

improve nurse attitude toward the older patients. If the nurse is able to recognize and avoid
ageism, patient satisfaction could increase along with hospital reimbursement.
Recommendations
The American Nurses Association (2010), or ANA, developed standards of practice for
all nurses to follow ensuring quality and safety of care. ANA standard 7, ethics, sates that the
nurse acts in a way that promotes patient autonomy, dignity, rights, values, and beliefs (p. 47).
Following this standard, the nurse should not assume a cognitive deficit solely based on age.
Stone and McMinn (2014) suggest that if there is an assumption of mental impairment based on
age, the nurse is more likely to ignore the patients wishes and treat the patient paternalistically.
The QSEN Institute, quality and safety education for nursing, developed six pre-licensure
competencies which are then broken down into knowledge, skills, and attitudes (QSEN Institute,
2014). The first of these is patient-centered care, which states under attitudes that the nurse
should respect the patient and encourage the patient to verbalize values and wishes (QSEN
Institute, 2014). To improve quality of care, nurses should avoid talking down to the patient
while acknowledging and including the patients desires in the care plan. As Kagan (2014)
discussed, healthcare professionals often limit the care options for an older patient. If the patient
in Kagans story had been given treatment options, options that might have been presented to a
younger patient, she may have felt more satisfied with the care provided.
Standard 8, education, requires the nurse to gain and maintain knowledge related to
caring for the patient population (American Nurses Association, 2010). As the population ages,
it is the nurses duty and responsibility to gain the knowledge needed to care for the older
patients. Heise et al. (2012) found that a change in student nurses attitude depended on the type
of exposure to the older adult. If the interaction was positive, as with a healthy older person, the
ELIMINATING AGEISM IN NURSES 9

students attitude became more positive. Conversely, if the students interaction was perceived to
be negative, as in a nursing home, the attitude remained negative. Heise et al. (2012) also found
varying methods of educating students on older adult health. Some nursing schools offer a
gerontology course at the beginning while others provide it at the end of the program. When the
class is at the beginning of the nursing program, there is a fear that the older adult content will be
downplayed as it is revisited in the following courses. Nilsson et al. (2012) also suggested
education plays a role in positive attitudes. De la Rue (2003) insists that nursing courses not
only educate students on the aging process, but also on ageism and methods to combat ageism in
their future practice. These are important aspects of educating future nurses that should be taken
into consideration. If the older adult content is downplayed in the courses, the nurse may not
have the knowledge needed to care for that population. If the older adult clinical experience is
negative, the student might be biased against the older adult patient. Further research should be
conducted to determine the most effective means of education on older adults. Without the
proper education on older adults, their safety could be compromised by seeking medical aid.
Standard 11, communication, states that the nurse recognizes personal communication
styles and that of the patient and family (American Nurses Association, 2010). Ageism is often
revealed in the language used; geriatric, elderly, aged, and even senior (Stone & McMinn, 2014).
These terms convey the image of infirm, fragile, dysfunction, and disability (Stone & McMinn,
2014). De la Rue (2003) found that two concerns nursing students identified were inappropriate
communication and taking away the patients autonomy through patronizing behaviors, cultural
insensitivity, and making decisions for the patient, among others. Kagan (2012) introduces the
idea that the older patient may be ageist toward him or herself, making statements about being
too old to do something, and that this self-stereotyping can decrease health. Communication is a
ELIMINATING AGEISM IN NURSES 10

vital part of nursing care, and the way a nurse communicates with patients may influence the
quality of care provided. The second competency from the QSEN Institute (2014), teamwork
and collaboration, includes in the nurses skills the ability to adapt communication style to meet
the needs of the situation and the health care team. The patient and family should be considered
an integral part of the healthcare team, according to the attitude requirements (QSEN Institute,
2014). The nurse could increase quality of care by including the patient and family in making
health care decisions. This process might be enhanced by improved communication skills
between the nurse and the older patient.
Conclusion
Nurses have a responsibility to give each patient the best care possible (American Nurses
Association, 2010). If ageism plays a role, quality of care will decrease (De la Rue, 2003;
Hanson, 2014; Kagan, 2014; Nilsson et al., 2012). Although society as a whole should work
toward this goal, eliminating ageism in the nursing profession should start with improved
education of the aging process along with increased positive clinical exposure to older adults
(Heise et al., 2012; Nilsson et al., 2012; De la Rue, 2003). Improved communication means
adapting styles to accommodate the other person (Giles et al., 1991) and should be practiced to
improve the skill. Nurses should improve the relationship with the older patients by respecting
their values and beliefs and including them in health care decisions (American Nurses
Association, 2010). Nurses should not assume a cognitive impairment, frailty, or illness just
because of age, doing so is having an agist attitude. The profession of nursing is centered on
caring (American Nurses Association, 2010). Eliminating ideas and habits that limit and
diminish care should be a priority.

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