Journal of Gerontological Nursing ( IF 1.3 ) Pub Date : 2022-05-01 , DOI: 10.3928/00989134-20220404-02 Sarah McKiddy 1 , Basia Belza 1 , Janet Primomo 2
Introduction
Words matter. This is an increasingly relevant phrase, sentiment, and value. Words, indeed, matter because they are the vessels through which we convey ideas, operationalize concepts, and ultimately absorb meanings. The potency and mileage of words traverse beyond print and speech because we live in a world with -isms, defined as “a form of doctrine, theory, or practice having, or claiming to have, a distinctive character or relation: chiefly used disparagingly” (Oxford English Dictionary, 2021b). Per this definition, -isms are overarching narratives based on construed, relational properties bearing a biased tenor. Due to the proliferation and iterative nature of words and meanings, foundational definitions were selected. Ageism will specifically be addressed in this editorial, but we would be remiss to not recognize the intersectionality and dynamism of concurrent–isms, for example, racism and sexism. Ageism is defined by the Oxford English Dictionary (2021a) as “prejudice or discrimination on the grounds of a person's age.” By fueling discriminatory impulses and seizing the narrative based on an individual's age, ageism legitimizes and reinforces these prejudices and stereotypes. Ageism shares many attributes with other -isms, but it also has unique properties and entanglements in need of further crystallization and exploration.
Ageism is perplexing when understanding that everyone ages and many are surrounded by loved ones who are considered “older adults.” Where is the disconnect and how do we make age-inclusive terminology the norm? We represent different experiences related to aging and, for the purposes of this editorial, we will focus on ageism toward adults aged ≥65 years. We also acknowledge that we have largely been describing ageism and narratives on aging from a Western point of view. Individuals of all ages have a stake in promoting the human dignity and rights of all age groups. We realize more profoundly that thinking about it is not enough; writing about it is not enough; we need to listen to those experiencing the stigmas of ageism and act. Through this editorial, we (a) challenge the existing terminology used for individuals who are in the older demographic, and (b) provide strategies to eliminate ageism.
Updates on the Evidence of Ageism
Aging, as a shared experience, has the inherent capacity to connect us. Terminology associated with the aging experience, such as “elderly,” adds undue distance to this shared journey. Berridge and Hooyman (2021) contemplate if “elderly” is more of an abstract term that no one identifies with rather than a term that has any credence, accuracy, or relevance to any age group. Beyond this described distance is the overgeneralization and subsequent isolation based on the sprouting perceptions growing from the insidious weed of discrimination. This is not to say that transitions, clinical conditions, and age-related changes need to be suppressed or re-branded. Rather, this is a call to end the use of antiquated and limiting labels “other-ing” populations and thereby reducing the richness and validity of individual identities. By acknowledging the power of words, there is also the realization that words do not exist in a fixed state. And neither do the meanings we form, twist, reframe, and weave throughout time. As health care professionals and researchers, we have a social mandate to reflect and act on evolving language to eradicate stigmas, confront inequities, and improve the lives of all.
In Chang et al.'s (2020) systematic review examining how structural and individual ageism influence health on a global scale, the authors found that ageism led to significantly worse health outcomes in 95.5% of the included studies and 74% of the associations between ageism and health. Moreover, the studies reported effects of ageism across all 45 countries, 11 health domains, and age, sex, and ethnicity, providing a glimpse into the widespread and pervasive nature of ageism (Chang et al., 2020). Ageism is connected to poorer health outcomes in that the fear-driven mindset becomes self-fulfilling in limiting an individual's expectations of health status and quality of life (Marques et al., 2020). Furthermore, ageism is linked to a decreased life expectancy of up to 7.5 years, delayed recovery related to disabilities in older age, and overall lowered mental and physical health outcomes (World Health Organization, 2021).
Bowman and Lim (2021) discuss person-first language and the limiting or reducing qualities of common terms and phrases used in health care and medical research. Figure 1 illustrates how moving from words conveying ownership and adding distance can be transformed into individual-first communication.
Shifting from “my older patient” to “individual.” Adapted from Bowman & Lim (2021).
Normalize Aging; Dismantle Ageism; Strategies for Nursing
It is time to disrupt the norms that perpetuate ageism and any form of divisive language (Fick & Lundebjerg, 2017). Words generalizing based on assumptions and reinforcing inequities need to be recognized, confronted, and obliterated. Normalizing the phenomenon of aging by dismantling stigmas has positive implications on an individual's health and is a step toward confronting other iterations of biases. To move beyond an ideal and resolutely chisel away at its dissolution, the following four suggestions for addressing ageism are proposed:
| ▪ | Take ownership of our words by removing our ownership of individuals: As Figure 1 indicates, pause and reflect on how we are framing an individual and our relationship to the individual: what bookended words or standalone terms are we using that decrease the autonomy and independence of an individual? Also consider the verbs we use for an individual we deem to be “older” and reflect on what this might diminish or inaccurately suggest. | ||||
| ▪ | Model age-inclusive language: When someone uses generalizations or derogatory terms, such as “silver tsunami” or “over the hill,” help redirect to openly reflect on why this is unacceptable, harmful language. Seemingly innocuous jokes targeted at specific age groups are still a symptom of the larger problem that is ageist language. | ||||
| ▪ | Debunk ageism myths: Read and feature more literature on the joys of aging, focusing on the growth, learning, creativity, and contributions offered by the aging experience. | ||||
| ▪ | Engage and campaign: Engage in more conversations on the aging experience with family, friends, colleagues, and community members and seek opportunities for intergenerational interactions and relationship building. Build on these experiences by initiating communication campaigns to increase understanding and knowledge of aging for the media, policymakers, legislators, and education and service providers. | ||||
Our current portrait of ageism could be replaced by painting a new portrait of the aging experience: one that reconciles individuality with inclusivity and illuminates the growth that comes with aging. It should be recognized that aging is unfortunately a privilege influenced and shaped by social determinants of health. In re-framing aging initiatives, we need to be mindful of how to discuss biases related to aging without painting a picture of aging that excludes and ignores the reality of health disparities and inequities. To more fully realize the ableism associated with ageism, we need to build evidence from different cultures and bridge understandings to create an inclusive and global lens.
Sarah McKiddy, de Tornyay Center
Pre-doctoral Scholar
PhD Student
School of Nursing
University of Washington
Seattle, Washington
Basia Belza, PhD, RN, FAAN, FGSA
Aljoya Endowed Professor in Aging
School of Nursing
University of Washington
Seattle, Washington
Janet Primomo, PhD, RN
Associate Professor Emeritus
University of Washington Tacoma
Tacoma, Washington
- Berridge C., & Hooyman N. (2020). The consequences of ageist language are upon us. Journal of Gerontological Social Work, 63(6–7), 508–512.
10.1080/01634372.2020.1764688 PMID:32458755 Crossref Medline, Google Scholar - Bowman C., & Lim W. M. (2021). How to avoid ageist language in aging research? An overview and guidelines. Activities, Adaptation and Aging, 45(4), 269–275.
10.1080/01924788.2021.1992712 Crossref, Google Scholar - Chang E. S., Kannoth S., Levy S., Wang S. Y., Lee J. E., & Levy B. R. (2020). Global reach of ageism on older persons' health: A systematic review. PLoS One, 15(1), e0220857
10.1371/journal.pone.0220857 PMID:31940338 Crossref Medline, Google Scholar - Fick D. M., & Lundebjerg N. (2017). When it comes to older adults, language matters. Journal of Gerontological Nursing, 43(9), 2–4.
10.3928/00989134-20170811 PMID:28841218 Crossref Medline, Google Scholar - Marques S., Mariano J., Mendonça J., De Tavernier W., Hess M., Naegele L., Peixeiro F., & Martins D. (2020). Determinants of ageism against older adults: A systematic review. International Journal of Environmental Research and Public Health, 17(7), 2560
10.3390/ijerph17072560 PMID:32276489 Crossref Medline, Google Scholar - Oxford English Dictionary. (2021a). Ageism. Oxford University Press. Google Scholar
- Oxford English Dictionary. (2021b). Ism. Oxford University Press. Google Scholar
- World Health Organization. (2021). Ageing: Ageism. https://www.who.int/news-room/questions-and-answers/item/ageing-ageism Google Scholar
中文翻译：
年龄歧视的肖像：值得（超过）一千字
介绍
言语很重要。这是一个越来越相关的短语、情感和价值。文字确实很重要，因为它们是我们传达思想、操作概念并最终吸收意义的容器。文字的效力和里程超越了印刷品和语音，因为我们生活在一个充满主义的世界，定义为“一种具有或声称具有独特特征或关系的学说、理论或实践形式：主要用于贬义”（牛津英语词典，2021b）。根据这个定义，-主义是基于带有偏见的主旨的解释性关系属性的总体叙述。由于单词和含义的扩散和迭代性质，选择了基本定义。这篇社论将专门讨论年龄歧视，但如果我们不承认并发主义的交叉性和活力，例如种族主义和性别歧视，那就太失职了。年龄歧视牛津英语词典 (2021a) 将其定义为“基于个人年龄的偏见或歧视”。通过助长歧视性冲动并抓住基于个人年龄的叙述，年龄歧视使这些偏见和刻板印象合法化并强化。年龄主义与其他主义有许多共同的属性，但也有其独特的性质和纠葛，需要进一步的结晶和探索。
当理解每个人都会变老并且许多人都被被视为“老年人”的亲人所包围时，年龄歧视令人困惑。脱节在哪里，我们如何使包含年龄的术语成为规范？我们代表与老龄化相关的不同经历，就本社论而言，我们将重点关注对 65 岁以上成年人的年龄歧视。我们也承认，我们在很大程度上是从西方的角度描述年龄歧视和关于衰老的叙述。促进所有年龄组的人的尊严和权利与所有年龄段的人都息息相关。我们更深刻地意识到，光想它是不够的；只写它是不够的；我们需要倾听那些遭受年龄歧视污名的人的声音并采取行动。通过这篇社论，
年龄歧视证据的更新
衰老，作为一种共享体验，具有将我们联系在一起的内在能力。与老龄化经历相关的术语，例如“老人”，为这一共享旅程增加了不必要的距离。Berridge 和 Hooyman (2021) 考虑了“老年人”是否更像是一个没有人认同的抽象术语，而不是一个与任何年龄组具有任何可信度、准确性或相关性的术语。超出这个描述的距离是基于从阴险的歧视杂草中萌芽的感知的过度概括和随后的孤立。这并不是说转变、临床状况和与年龄相关的变化需要被压制或重新命名。相反，这是呼吁结束使用过时和限制性标签“其他”人群，从而降低个人身份的丰富性和有效性。通过承认文字的力量，人们也意识到文字并不以固定的状态存在。我们在整个时间中形成、扭曲、重构和编织的意义也不会。作为医疗保健专业人士和研究人员，我们肩负着一项社会使命，即反思不断演变的语言并采取行动，以消除污名、直面不平等并改善所有人的生活。
在 Chang 等人 (2020) 的系统评价中，研究了结构性和个人年龄歧视如何在全球范围内影响健康，作者发现年龄歧视导致 95.5% 的纳入研究和 74% 之间的关联导致健康结果显着恶化年龄歧视和健康。此外，这些研究报告了年龄歧视对所有 45 个国家、11 个健康领域以及年龄、性别和种族的影响，让我们得以一窥年龄歧视的普遍性和普遍性（Chang 等人，2020 年）。年龄歧视与较差的健康结果有关，因为恐惧驱动的心态会自我实现，从而限制个人对健康状况和生活质量的期望（Marques 等人，2020 年）。此外，年龄歧视与高达 7.5 岁的预期寿命缩短、与老年残疾有关的恢复延迟、
Bowman 和 Lim (2021) 讨论了以人为本的语言以及医疗保健和医学研究中使用的常用术语和短语的限制或降低质量。图 1说明了如何从传达所有权和增加距离的词语转变为个人优先的沟通。
从“我的老年患者”转变为“个体”。改编自 Bowman & Lim (2021)。
使老化正常化；消除年龄歧视；护理策略
是时候打破延续年龄歧视和任何形式的分裂语言的规范了（Fick & Lundebjerg，2017 年）。需要承认、面对和消除基于假设和强化不平等的词语。通过消除污名使衰老现象正常化对个人的健康有积极的影响，并且是朝着面对其他反复出现的偏见迈出的一步。为超越理想，坚决铲除理想，针对年龄歧视提出以下四点建议：
| ▪ | 通过消除我们对个人的所有权来掌握我们的话语权：如图1所示，停下来思考一下我们如何构建个人以及我们与个人的关系：我们使用了哪些书尾词或独立术语，这降低了我们的自主性和独立性个人？还要考虑我们对我们认为“年长”的人使用的动词，并思考这可能会减少或不准确地暗示什么。 | ||||
| ▪ | 模型包含年龄的语言：当有人使用泛化或贬义词时，例如“银海啸”或“山上”，有助于重定向以公开反思为什么这是不可接受的有害语言。针对特定年龄段的看似无害的笑话仍然是年龄歧视语言这一更大问题的症状。 | ||||
| ▪ | 揭穿年龄歧视神话：阅读更多关于衰老乐趣的文学作品，重点关注衰老经历所带来的成长、学习、创造力和贡献。 | ||||
| ▪ | 参与和活动：与家人、朋友、同事和社区成员就老龄化经历进行更多对话，并寻求代际互动和建立关系的机会。在这些经验的基础上开展宣传活动，以增加媒体、政策制定者、立法者以及教育和服务提供者对老龄化的理解和知识。 | ||||
我们目前对年龄歧视的描绘可以被描绘衰老经历的新描绘所取代：一张将个性与包容性相协调并照亮伴随衰老而来的成长的描绘。应该认识到，不幸的是，老龄化是一种受健康社会决定因素影响和塑造的特权。在重新制定老龄化倡议时，我们需要注意如何讨论与老龄化相关的偏见，而不是描绘出排除和忽视健康差距和不平等现实的老龄化图景。为了更充分地实现与年龄歧视相关的能力歧视，我们需要从不同文化中建立证据并弥合理解，以创造一个包容性和全球性的视角。
Sarah McKiddy，德托尼中心
博士前学者
博士生
护理学院
华盛顿大学
华盛顿州西雅图
Basia Belza，博士，注册护士，FAAN，FGSA
阿尔霍亚老年学教授
护理学院
华盛顿大学
华盛顿州西雅图
Janet Primomo，博士，注册护士
名誉副教授
华盛顿大学塔科马分校
华盛顿州塔科马
- Berridge C. 和 Hooyman N.（2020 年）。年龄歧视语言的后果在我们身上。老年社会工作杂志，63（6-7），508-512。
10.1080/01634372.2020.1764688 PMID：32458755 Crossref Medline，谷歌学术 - Bowman C. 和 Lim WM（2021 年）。如何在衰老研究中避免使用年龄歧视语言？概述和指南。活动、适应和老龄化，45 (4), 269–275。
10.1080/01924788.2021.1992712 交叉引用，谷歌学术 - Chang ES、Kannoth S.、Levy S.、Wang SY、Lee JE 和 Levy BR（2020 年）。年龄歧视对老年人健康的全球影响：系统评价。公共科学图书馆一号, 15 (1), e0220857
10.1371/journal.pone.0220857 PMID：31940338 Crossref Medline，谷歌学术 - Fick DM 和 Lundebjerg N.（2017 年）。对于老年人来说，语言很重要。老年护理杂志，43（9），2-4。
10.3928/00989134-20170811 PMID：28841218 Crossref Medline，谷歌学术 - Marques S.、Mariano J.、Mendonça J.、De Tavernier W.、Hess M.、Naegele L.、Peixeiro F. 和 Martins D.（2020 年）。针对老年人的年龄歧视的决定因素：系统评价。国际环境研究与公共卫生杂志, 17 (7), 2560
10.3390/ijerph17072560 PMID：32276489 Crossref Medline，谷歌学术 - 牛津英语词典。（2021a）。年龄歧视。牛津大学出版社。谷歌学术
- 牛津英语词典。（2021b）。主义。牛津大学出版社。谷歌学术
- 世界卫生组织。（2021 年）。老化：年龄歧视。https://www.who.int/news-room/questions-and-answers/item/ageing-ageism谷歌学术
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