Ageism: What It Is and How to Fight It

As a member of not only the Gerontological Society of America, but also the APTA's Academy of Geriatric Physical Therapy, I feel that I have a unique outlook on the aging process. At my current job, the majority of my patients are considered to be "older adults," with many of them pushing 100 years old. As an active component of the GSA and AGPT, I feel that I have a different perspective on my patient population than many of my contemporaries do. Without connection to professional societies, it is easy to develop poor clinical habits, but the worst habit of all to adapt is to discriminate against someone for their age. The level of discrimination that I am talking about is subtle and pervasive in our health care system. This isn't an out right "We don't serve your kind here" but an almost unnoticeable adjustment in clinical care for our older adults. This veil of discrimination is part of a larger problem called ageism, and as health care professionals it is easy to fall into line with the social attitudes many people have about aging. But as healthcare providers, we should also act as change agents for our patients who are older adults to change not only their attitudes about aging, but also to convey to our co-workers that ageist tendencies are unethical  and downright illegal even in the simplest of forms.

Here are a few questions to ask yourself to make sure you aren't harboring ageist tendencies:

1. Am I adjusting my treatment parameters because of their impairments, or because of their age? I have heard it time and time again from coworkers in multiple settings about how old someone is and how they need a "break" because of it. I'm sorry, but that patient is here to work. If they are not capable of participating in therapy at this time than you either need to adjust what you are doing or consider an alternate plan of care that is appropriate for their deficits, not their age. 
2. Are you avoiding more difficult activities because of the patient's age, or because they truly aren't ready for it physically? I have heard clinicians across the spectrum complain and whine that cannot do a certain activity with a patient because of their age, but that is ageism. Now, saying that someone is not ready to do an activity because of their muscle weakness, or endurance limitations is much more solid and objective clinical reasoning. 
3. Are you using age as an excuse for not rendering services? There is also the idea that if someone is older, debilitated, and has a care-giver that they do not need to learn how to do for themselves... and this is WRONG. Whether the patient opts to do an activity with or without the care taker is their prerogative, but your prerogative is to at least give them the option to be able to do it on their own. This decreases caregiver burden/burnout and empowers your patient with an increased level of independence, however small the task may be. 

Should we consider age as a factor when evaluating our patients? Sure. But it should be used as only a single piece in the complex puzzle that is the care of our patients. Age should not serve as a giant stamp on our patient's foreheads, warning all who come into contact with them that they can't handle physical therapy. Here are a few ways that it is respectful and clinically relevant to our practice as physical therapists to include age in our plan of care:

1. Aging comes with certain comorbidities that should be addressed, but remember that many of those comorbidities (osteoporosis, osteoarthritis, etc) can also occur in much younger populations if all conditions are right. You don't get these issues because you are old, you get them because body processes aren't working appropriately. This doesn't mean that you aren't more likely to develop them as you age, but it also doesn't mean that you will automatically have them either. 
2. Older adults could have different values and goals than their younger contemporaries in the clinic, but there is also the possibility that they don't! I have met older adults who can be staunch republicans and in the next bed have a raving democrat for a roommate! Values and goals are relevant to the experiences that the person undergoes as they develop their sense of self. A suffragette will have vastly different ideals that someone who grew up on a plantation in the south. 
3. Using age to stratify for outcome measures is not only appropriate, but statistically supported. Many of our outcome measures for older adults are stratified by age groups, so it is appropriate to utilize these numbers based on these delineations in order to best identify how our patients compare to healthy individuals. This allows us to promote evidence-based practice and goal setting to return our patients to their prior level of function. 
4. Finally, it is important to celebrate the triumphs of our older adult patients without quantifying the statement by age. When a patient demonstrates a task well, don't say, "well that is pretty good for someone your age" because it is no different than saying "Not bad for a girl." If the second phrase angers you, then the first one should as well. 

Above all, please remember: Being "old" is not a disease. Age is not a clinical impairment. Let's empower our patients instead of stigmatizing them! 

Protecting Your Profession: Standing Up for Physical Therapy Is the Same Thing as Standing Up for your Patients

Education is perhaps the most powerful tool we have in our arsenal. We use it to help patients understand their condition and the importance of their treatment, but how consistent are we in educating them on our field as a sovereign entity? As a physical therapist, it is easy to forget that not everyone knows what we do or how we relate to other healthcare providers. Occasionally I get a question about our field that I think to myself "Are you kidding me? How dumb can you be?" However, after taking a step back, I realize that not everyone has the exposure to our field as those of us who actually live and breathe the profession. Below are some of the questions/interactions I have had:

"When will you go back to school to get your nursing degree and move up in the world?"

Doctor: Give them a walker.

Me: They aren't safe to use one at home. I am not prescribing one.

Doctor: Well I want them to have one. 

Me: Okay then, you prescribe it. 

Doctor: I need you to write in your note that they are safe to use it. I'm the doctor. 

Me: And I am a Doctor of PT. Now that that is cleared up, back to our issue: they are going to fall with the walker, so if you would like to be liable for the lawsuit, be my guest. 

"Aren't you just a glorified massage therapist? The doctor said all you do is massage?" 

Initially these questions made me angry as I felt personally offended, but now they make me angry because I realize that we still have a long way to educate the general public on our services. So many ailments can be treated with physical therapy and people aren't gaining access to our services simply because they don't know about them.

Not only are we not doing a good job on educating the public, but we are also not doing enough to educate other healthcare professionals on what we do. I still meet OTs that make snide comments that we "go for walks for no reason" and doctors that are shocked we can improve lung perfusion with breathing exercises as I wean patients off of supplemental oxygen. While some comments are made in jest, we should treat them as serious as intentional transgressions against our field's character. If we aggressively treat this issue, then we will be seen as a serious field and the symptom of the pain associated with poorly educated members of society with quickly diminish.

I recommend rehearsing a monologue in order to calmly respond to these prompts. Having your elevator spiel ready at a moment's notice is handy for reacting to these issues. Educating our patients, fellow healthcare workers, and society at large is our greatest weapons for managing these changes in our systems. If people knew just how beneficial and widespread our services are, there would be no question about the necessity of them. We could survive any reform or shifting care paradigm because we would be in demand like never before. It is up to use to ensure the future of our field, and education is our secret weapon.