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[Federal Register Volume 89, Number 248 (Friday, December 27, 2024)]
[Notices]
[Pages 105605-105606]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-31074]

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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.

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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, 
patient-centeredness, 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 
[email protected].

FOR FURTHER INFORMATION CONTACT: Jose Plascencia Jimenez, 
[email protected]. 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 age-related 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

[[Page 105606]]

ageism can potentially improve health and functional status, reduce 
costs, and foster intergenerational collaboration among older adults. 
By eliminating age-related 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, post-acute e care, rehabilitative care, and home and community-
based services).
     Researchers and implementers studying ageism or developing 
interventions to implement person-centered 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 decision-makers.
     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 age-related 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]
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