What can nurses do to stop ageism in healthcare settings?

The World Health Organization reports that ageism is associated with poorer physical and mental health for older adults. This guide addresses what can nurses do to stop ageism in healthcare settings by providing practical, evidence-based actions and strategies to foster a culture of respect and equality.

Quick Summary

Nurses can combat ageism through ongoing education, promoting patient-centered care, improving communication techniques, and acting as patient and systemic advocates to challenge biases and discriminatory practices in healthcare settings.

Key Points

• Self-Reflect: Recognize and challenge personal biases and stereotypes about aging to ensure they do not influence patient care.

• Communicate Effectively: Avoid using 'elderspeak' and instead use respectful, clear language, speaking directly to the patient rather than their caregiver.

• Practice Person-Centered Care: Develop care plans based on each patient's individual needs, preferences, and goals, not on age-related assumptions.

• Advocate for Autonomy: Empower older patients by involving them in decision-making and ensuring their wishes and rights are protected.

• Seek Geriatric Education: Pursue ongoing training and education in gerontology to better understand the complexities of aging and evidence-based practices.

• Challenge Systemic Biases: Actively work to address ageist practices and policies within your healthcare institution and advocate for change.

• Assess Comprehensively: Investigate and address patient symptoms thoroughly rather than dismissing them as an unavoidable part of 'old age'.

Understanding Ageism and Its Detrimental Effects

Ageism, or discrimination based on age, is a pervasive issue in healthcare that profoundly impacts the well-being of older adults. It manifests in many forms, from subtle biases to explicit discriminatory practices, and can lead to a range of negative health outcomes. Examples include undertreatment, where healthcare providers dismiss treatable concerns as 'normal' parts of aging, or the use of patronizing 'elderspeak' that devalues a patient's competence. As nurses, it is crucial to recognize these behaviors and understand their harm to patient trust, health quality, and overall care.

The Power of Self-Reflection and Education

One of the most effective tools a nurse has is self-awareness. Unconscious biases about aging can hinder a nurse's ability to provide the best care. These stereotypes, absorbed throughout life, can lead to assumptions about an older patient's capabilities, health literacy, or emotional state.

Practical Steps for Self-Awareness:

• Regular Reflection: Take time to consider personal attitudes and beliefs about aging. Challenge assumptions that older adults are fragile, resistant to change, or technologically inept.
• Ongoing Education: Seek out continuing education focused on gerontology. Formal training in geriatric care is proven to improve nurses' knowledge and attitudes towards older adults.
• Intergenerational Collaboration: Engage in conversations with colleagues from different generations to collaboratively fight ageism and share perspectives.

Enhancing Communication and Fostering Trust

Communication is the foundation of the nurse-patient relationship. Ageist communication, such as elderspeak, undermines trust and can lead to misunderstanding and poor care decisions.

Effective Communication Strategies:

• Use Respectful Language: Address patients by their name (e.g., 'Mr. Smith' or 'Ms. Jones') instead of using condescending terms like 'honey' or 'dear'.
• Speak Directly to the Patient: When a caregiver is present, always address the patient first. This honors their autonomy and encourages them to participate in their care decisions.
• Simplify Without Patronizing: Use plain language and avoid medical jargon, but never oversimplify explanations. Use visual aids or written instructions to reinforce key points.
• Active Listening: Give patients your undivided attention, allowing them ample time to speak without interruption. Patients often have valuable insight into their own health that can be missed when a provider is rushed.

Championing Person-Centered Care

Person-centered care shifts the focus from treating a condition to caring for the whole person with their unique needs and preferences. For older adults, this is essential for counteracting age-based assumptions.

• Individualized Care Plans: Treat each patient as an individual. An individualized approach addresses their specific health status, goals, and life experiences, rather than relying on age-related stereotypes.
• Encourage Shared Decision-Making: Ensure older adults are active participants in their treatment plans. This respects their autonomy and empowers them to make choices aligned with their values.
• Assess for Psychosocial Needs: Recognize that social isolation, loneliness, and mental health issues are not a normal part of aging but are exacerbated by ageism. Screen for these issues and provide referrals to community resources.

Advocating for Patients and Institutional Change

Nurses are crucial patient advocates and have a responsibility to address ageism on both an individual and systemic level. This involves speaking up when ageist behaviors occur and working to reform institutional practices.

Advocacy Tactics:

• Protect Rights and Choices: Intervene when an older patient's rights or wishes are not being respected. This can include communicating with family members or other team members to ensure the patient's voice is heard.
• Confront Ageist Behaviors: Address ageist language or actions from colleagues in a constructive, private manner. Raising awareness is the first step toward changing behavior.
• Influence Policy: Join nursing associations or advocacy groups to push for policies that protect the rights of older adults and prioritize equitable care.
• Promote Geriatric Research: Advocate for the inclusion of older adults in clinical trials to ensure that interventions are based on evidence for all age groups.

Comparison: Age-Friendly vs. Ageist Practices

Aspect	Ageist Practice	Age-Friendly Nursing Practice
Communication	Using condescending 'elderspeak' or speaking only to the family member.	Addressing the patient directly and respectfully, using clear, plain language.
Decision-Making	Making care decisions for the patient, assuming they cannot comprehend their options.	Engaging in shared decision-making, ensuring the patient's preferences are central to the care plan.
Symptom Assessment	Attributing symptoms like fatigue or pain solely to 'old age' without thorough investigation.	Conducting comprehensive assessments to identify underlying, treatable conditions.
Physical Care	Limiting physical activity due to unfounded fears of falling or injury.	Developing personalized physical activity plans that promote mobility and safety.
Professional Development	Viewing gerontology education as secondary or unnecessary.	Participating in ongoing geriatric education and training to stay current on evidence-based practices.

Conclusion: A Commitment to Dignified Care

Combating ageism in healthcare is an ongoing and multifaceted endeavor that begins with the individual nurse. By reflecting on personal biases, honing communication skills, and committing to person-centered care, nurses can create immediate, positive change for their older patients. Beyond the bedside, nurses have a powerful role to play in advocating for systemic reforms that dismantle ageist policies and ensure equitable care for all. This collective action is essential for fostering a healthcare system where every patient is treated with the dignity, respect, and individuality they deserve. For more information on advocacy and geriatric care, consider resources from authoritative organizations such as the American Nurses Association see NursingWorld.org for resources.

Frequently Asked Questions

What is the biggest mistake nurses make when communicating with older patients?

A common mistake is using 'elderspeak'—a simplified, condescending form of communication that can be demeaning to patients and undermine their confidence. It's best to speak respectfully and clearly, treating them as competent adults.

How can a nurse address ageism if they notice it in a colleague?

Address the behavior respectfully and in private. You can point out the specific action or language that was ageist and explain its potential harm. Framing it as an educational opportunity can be more effective than a direct confrontation.

Can ageism affect the physical health of older adults?

Yes, research shows ageism is linked to poorer physical health outcomes, including a higher risk of cardiovascular events, functional decline, and premature death. Dismissing symptoms as 'normal aging' can lead to undertreatment.

How can nurses ensure older patients are included in their own care decisions?

Always involve the patient in discussions about their treatment options, respecting their autonomy and capacity to make informed choices. Actively listen to their preferences and help them understand their options fully.

What role does education play in combating ageism among nurses?

Education helps nurses recognize their own biases and provides them with specific knowledge about the aging process. Structured geriatric training can significantly reduce ageist attitudes and improve the quality of care.

How can nurses advocate for systemic change related to ageism?

Nurses can advocate by promoting age-inclusive institutional policies, pushing for increased geriatric training requirements, and working with professional organizations to influence broader healthcare policies.

What are some signs that a patient is experiencing ageism from a healthcare provider?

Signs include being spoken down to, having their symptoms dismissed, feeling rushed during appointments, being excluded from decision-making, or having conversations directed at a family member instead of them.

Why is patient-centered care particularly important for older adults?

Patient-centered care is vital for older adults because they often have complex and diverse health needs. It prevents blanket assumptions based on age and ensures that treatment aligns with the individual's specific goals and values, leading to better outcomes.