Federal Register / Vol. 89, No. 248 / Friday, December 27, 2024 / Notices 105605 

change and will not be modified to 

remove personal or business 

information including confidential, 

contact, or other identifying 

information. Comments should not 

include any information such as 

confidential information that would not 

be appropriate for public disclosure. 

Comments regarding each of these 

applications must be received at the 

Reserve Bank indicated or the offices of 

the Board of Governors, Ann E. 

Misback, Secretary of the Board, 20th 

Street and Constitution Avenue NW, 

Washington, DC 20551–0001, not later 

than January 13, 2025. 

A. Federal Reserve Bank of Chicago 

(Colette A. Fried, Assistant Vice 

President) 230 South LaSalle Street, 

Chicago, Illinois 60690–1414. 

Comments can also be sent 

electronically to 

Comments.applications@chi.frb.org: 

1. Robert M. Kahn and Kristin Kahn, 

both of Newton, Iowa; Michael S. 

Albright and Mollie Albright, both of 

Sioux City, Iowa; and Megan Kahn, 

Basalt, Colorado; to join the Kahn 

Family Control Group, a group acting in 

concert, to retain voting shares of 

United Iowa Bancshares Inc., and 

thereby indirectly retain voting shares of 

FNNB Bank, both of Newton, Iowa. 

Board of Governors of the Federal Reserve 

System. 

Michele Taylor Fennell, 

Associate Secretary of the Board. 

[FR Doc. 2024–31073 Filed 12–26–24; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Request for Information Regarding the 

Impact of Ageism in Healthcare 

AGENCY: Agency for Healthcare Research 

and Quality, Department of Health and 

Human Services. 

ACTION: Notice of request for 

information about the impact of ageism 

in healthcare and methods and 

strategies to address ageism in 

healthcare delivery. 

SUMMARY: The Agency for Healthcare 

Research and Quality (AHRQ) is seeking 

information from the public to 

understand the impacts of ageism on 

healthcare quality, including aspects 

related to safety, timeliness, patientcenteredness, equitable distribution, 

and care outcomes. How does the effect 

of ageism differ across different 

population groups? We are interested in 

identifying efforts and innovative 

strategies and programs that address and 

mitigate ageism to optimize older 

adults’ health. 

DATES: Comments must be submitted on 

or before March 15, 2025. AHRQ will 

not respond individually to responders 

but will consider all comments 

submitted by the deadline. 

ADDRESSES: Submissions should follow 

the Submission Instructions below. We 

prefer that information be submitted 

electronically on the submission 

website. Email submissions may also be 

sent to ecareplan@ahrq.hhs.gov. 

FOR FURTHER INFORMATION CONTACT: Jose 

Plascencia Jimenez, 

Jose.Plascenciajimenez@ahrq.hhs.gov. 

Telephone 301–427–1364. 

SUPPLEMENTARY INFORMATION: The 

Agency for Healthcare Research and 

Quality (AHRQ) is seeking information 

from the public to understand the 

effects of ageism on healthcare services 

and outcomes. Notably, the AHRQ seeks 

any evidence, insights, or perspectives 

on the impact of ageism on care delivery 

and quality to identify barriers and 

explore opportunities to address agerelated biases. Responses will inform 

future research priorities and studies, 

policies, and initiatives to improve the 

quality and outcomes of care for older 

adults. 

For this RFI, ageism is defined as 

stereotypes, prejudice, and 

discrimination directed towards other 

people or oneself based on age.1 While 

ageism is often subtle, it is woven into 

our workforce, healthcare systems, and 

everyday interactions. Ageism 

undermines older adults and their 

contributions to our communities. 

Research shows that 81 percent of 

adults aged 50–80 report experiencing 

internal ageism, 65 percent are exposed 

to ageist messages, and 45 percent face 

ageism in interpersonal interactions.2

These statistics demonstrate how 

ingrained ageism is in our society. 

Ageism within healthcare leads to 

poorer health outcomes, avoidable 

morbidity, and costly preventable 

adverse events.3

Ageism costs our nation an estimated 

$63 billion annually in healthcare 

expenditures.4 In health care, ageism is 

expressed in our social and 

organizational policies, the practices of 

clinicians, and negative assumptions 

held by older adults themselves. At the 

macro level, ageism is complex and 

reflected in healthcare access issues, 

which result in older adults being less 

likely to receive care consistent with 

medical guidelines, payment policies 

that do not adequately reimburse for 

complex care needed for older adults, 

and exclusion or underrepresentation of 

older adults in clinical trials and other 

research. At the micro level, practices 

such as the use of ageist language and 

elder speak, exclusion of older patients 

from care plan conversations, and 

variations in treatment practices due to 

a patient’s age all affect patients’ quality 

of care. Self-directed ageism can also 

lead to adverse outcomes for a patient 

if their beliefs on aging lead them to 

believe that the symptoms they are 

experiencing should be considered a 

‘‘normal’’ part of aging. For example, 

while some cognitive decline is 

expected as we age, memory loss, 

confusion, changes in behavior, and 

inability to complete activities of daily 

living are all signs of changes in 

cognitive ability that need to be 

evaluated by a medical professional. 

Moreover, people who internalize ageist 

societal messages tend to have poorer 

physical, cognitive, and mental health. 

The reverse is also true—individuals 

who internalize positive aging messages 

are likely to exhibit benefits in physical, 

cognitive, and mental health— 

highlighting the need to promote age 

inclusivity. 

AHRQ recognizes that due to 

population aging, the impact of ageism 

on the health and well-being of older 

Americans, their families, caregivers, 

and communities will continue to grow. 

Between 2009 and 2019, the number of 

people in the US aged 65 years and 

older increased 36%, from 39.6 to 54.1 

million, and is projected to reach 94.7 

million people in 2060. Addressing 

ageism is critical as the population ages, 

placing growing demands on healthcare 

systems and highlighting the need for 

policies that ensure compassionate and 

high-quality care for older adults. 

Ageism does not affect all populations 

equally. Some groups of older adults 

may face additional barriers to care. 

Older adults living in rural or 

socioeconomically disadvantaged areas, 

those who have low incomes, or from 

certain racial or ethnic minority groups 

can face additional barriers to care, have 

limited access to resources, confront 

cultural biases, or encounter differential 

health services delivery. People living 

with disabilities may have specific 

needs often forgotten or neglected as 

they age. Women, with a higher life 

expectancy than men, have higher rates 

of chronic illnesses and functional 

impairments with fewer financial 

resources available. Understanding the 

compounded impact of ageism across 

different groups is critical to creating 

comprehensive strategies that ensure 

equitable and inclusive care that 

promotes healthy aging. Mitigating or 

eliminating the biases that encompass 


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105606 Federal Register / Vol. 89, No. 248 / Friday, December 27, 2024 / Notices 

ageism can potentially improve health 

and functional status, reduce costs, and 

foster intergenerational collaboration 

among older adults. By eliminating agerelated biases, older adults may be more 

likely to receive timely and effective 

care, improving health outcomes, 

including functional status, and 

physical and mental well-being, while 

increasing the value of healthcare. 

AHRQ encourages stakeholders to 

contribute their expertise and 

experiences to inform innovative 

approaches to reduce ageism in the 

healthcare system. 

Who Should Respond 

• Clinicians and other health care 

personnel (including community health 

workers, peer support personnel, system 

navigators, and patient advocates) who 

provide services to older adults and 

others at risk for encountering ageism, 

including personnel from across all care 

settings (primary care, specialty care, 

mental and behavioral health, postacute e care, rehabilitative care, and 

home and community-based services). 

• Researchers and implementers 

studying ageism or developing 

interventions to implement personcentered care planning in practice. 

• Clinical professional societies. 

• Payers. 

• Healthcare delivery organizations. 

• People who have experiences 

ageism in health care, their families, and 

caregivers. 

• Patient advocacy groups and 

organizations. 

• Clinical decision support 

developers. 

• Quality and other measure 

developers. 

• Representatives from human service 

agencies and/or community 

organizations with interest or 

experience in addressing ageism. 

• Higher education institutions that 

train clinicians and healthcare 

personnel and/or train those involved in 

community health and education. 

• Clinical and public health decisionmakers. 

• Health technology developers 

focused on improving health outcomes 

among older adults. 

Specific questions of interest to the 

AHRQ include, but are not limited to, 

the following: 

1. What is the scope of ageism in 

health care and its impacts? Can you 

provide specific examples, especially 

those that are wide-spread and/or have 

large impact? 

2. How does ageism influence 

healthcare access, quality, safety, and 

outcomes of care? 

3. What is the impact of ageism on 

both the micro and macro levels of 

health care? How does this vary across 

diverse population groups, including 

older adults living in rural or 

socioeconomically disadvantaged areas, 

those with low incomes or from racial 

or ethnic minority groups, or those 

living with disabilities? Between 

women and men? 

4. What is the evidence for 

interventions to address ageism and 

promote age inclusivity in healthcare? 

5. How do age-related stereotypes 

affect clinical decision-making, and 

what steps can be taken to ensure that 

care plans align with older adults’ 

individual needs, preferences, and 

goals? 

6. How does internalized and 

interpersonal ageism impact care 

seeking behavior and health outcomes? 

What strategies are there to address this? 

7. How can healthcare technology, 

such as electronic health records and 

decision-support tools, as well as 

artificial intelligence be designed to 

mitigate ageism rather than reinforce it? 

8. What role could Medicare, 

Medicaid, and private insurers play in 

incentivizing equitable, high-quality 

care for older adults and combating 

systemic ageism? 

9. What are the broader societal 

benefits of reducing ageism in 

healthcare, such as enhanced workforce 

participation of older adults, lower 

healthcare costs, and improved 

intergenerational health? 

10. What are the unique challenges 

and opportunities for addressing ageism 

in healthcare in an aging population and 

increasing healthcare demand? 

11. How can programs advance 

initiatives that reduce ageism in 

healthcare and promote older adults’ 

dignity, autonomy, and well-being? 

12. How can intergenerational 

dialogue and collaboration be fostered 

to challenge stereotypes about aging and 

highlight the contributions of older 

adults to society? 

13. What are the social, cultural, and 

economic factors contributing to ageism 

in healthcare, and how can they be 

addressed through public awareness 

campaigns or policy reforms or other 

strategies? 

14. What roles do education and 

training for healthcare providers play in 

addressing implicit or explicit agerelated biases, and what are the effective 

models for such education, both for 

those currently in training and those 

now in practice? 

AHRQ is interested in all the 

questions listed above. Still, 

respondents are welcome to address as 

many or as few as they choose and to 

address additional areas of interest 

regarding ageism not listed. It is helpful 

to identify the question to which a 

particular answer corresponds. 

This RFI is for planning purposes 

only and should not be construed as a 

policy, solicitation for applications, or 

as an obligation on the part of the 

Government to provide support for any 

ideas in response to it. AHRQ will use 

the information submitted in response 

to this RFI at its discretion and will not 

comment on any respondent’s 

submission. However, responses to this 

RFI may be reflected in future 

solicitation(s) or policies. The 

information provided will be analyzed 

and may appear in reports. Respondents 

will not be identified in any published 

reports. Respondents are advised that 

the Government is not obligated to 

acknowledge receipt of the information 

received or provide feedback to 

respondents concerning any information 

submitted. No proprietary, classified, 

confidential, or sensitive information 

should be included in your response. 

The contents of all submissions will be 

made available to the public upon 

request. Submitted materials must be 

publicly available or able to be made 

public. 

(Authority: Section 902 of the Public Health 

Service Act, 42 U.S.C. 299a.) 

Dated: December 20, 2024. 

Marquita Cullom, 

Associate Director. 

Footnotes 

1. World Health Organization. Global 

Report on Ageism. Geneva: World Health 

Organization; 2021. Global report on ageism 

(who.int). Accessed July 20, 2022. 

2. Allen JO, Solway E, Kirch M, Singer D, 

Kullgren J, Moise V, Malani P. Experiences 

of Everyday Ageism and the Health of Older 

US Adults JAMA Open Network. 2022; 15 

(5): e2217240. 

3. Allen JO. Ageism as a risk factor for 

chronic disease. Gerontologist. 

2016;56(4);610–614. Doi:10.1093/geront/ 

gnw118. 

4. Levy BR, Slade MD, Chang ES, Kannoth 

S, Wang SY. Ageism amplified cost and 

prevalence of health conditions. 

Gerontologist. 2020;60(1): 174–181. 

doi:10.1093/geront/gny131. 

[FR Doc. 2024–31074 Filed 12–26–24; 8:45 am] 

BILLING CODE P 


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