Ageism and Professional Training in Aging: Who Will Be There to Help?

For students and trainees, practice in aging is a hard sell. More than a generadon ago -in the heyday of peace and love, the Beatles, and flower children-the preeminent gerontologist Robert Butler (1969) coined the term ageism, defining it simply as another form of bigotry (see the article by Butler, this issue). The manifestations of ageism can be seen in any number of discriminatory behaviors that reflect the negative stereotyping of older adults, and these behaviors induce systematic disadvantages. Even over-idealization of people based on advanced age can be viewed as a form of ageism; this distinction between something (or someone) being "antique" and something being just plain "old" often has less to do with actual age than with attributed value. Not all old people are wise, kind, or spiritually evolved. Indeed, most things and people, as appraised by society, lose value when they become old. Unfortunately such a perspective is endemic in far too many walks of life. Most people, including healthcare professionals, are more familiar with pathological aging than with healthy aging and tend to generalize and project their expectation of pathology. Ageism is thus the composite of stereotypical beliefs and attitudes held about a group of people based upon their advanced age. Sad to say, today manifestations of ageism are apparent in the education and training of professionals who provide health services to older adults and in the reluctance of potential providers to undertake specialized training to address the situation. Regrettably, ageism also appears to have become an export commodity. Countries and cultures that have historically embraced the traditional values of respect and honor of their elders have increasingly turned to the West as a model of all things good and desirable. The prevalent desire for immediate gratification and the nearly instant obsolescence (of products and people) seen in today's culture have whittled away at esteem of the elderly. The ascendance of narcissism has contributed to a culture of "me-centeredness"; detached from the ethic for the good of all and the primacy of tenure. The whole concept of anti-aging is less about achieving the best possible old age than about extending youth until it meets death, thereby avoiding old age all together. So, the question is, If old age is avoidable, why choose to devote one's professional life to it? A conflict is now emerging into cultural prominence. Though our collective consciousness has been raised to conform to standards of political correctness, and we honestly want to be sensitive to others and respect individual differences, we increasingly rely on the quick hit, on surface rather than depth, and ultimately on the collective rather than the individual as we chart a course of action. How does this development apply to ageism, or, for that matter, to any prejudice against other groups? In these times of multitasking, increasing speed, and loss of boundaries, the process of stereotyping groups and making generalizations helps us to avoid the time-consuming and effortful task of coming to know a person as an individual rather than as an exemplar of a group. Attitudes and behaviors that are preformed and pre-packaged enable us to run on automatic. Necessary though they might be, these propensities also fuel less desirable traits and predispositions. Expressions of ageism can range from subtle to overt, and they affect individuals and systems, both formal and informal. Public policies, which reflect societal attitudes, affect the access to care and delivery of services. The government has of late become more attentive to the role of ageism in the workplace and supports legal protection of older workers. However, ageism as it is manifested in healthcare is comparatively invisible and receives less attention. I am not referring here to the fiscal aspects of healthcare, but rather to the education and training of professionals who provide health services to older adults. …