The COVID-19 pandemic has caused social workers to take a closer look at their ingrained prejudices when dealing with the aged. Robert N. Butler coined the term “ageism" in 1969 to describe attitudes, practices, and policies that discriminate against older people. Ageism occurs when people face stereotypes, prejudice, or discrimination because of their age. The assumption that all older people are frail and helpless is a common, incorrect stereotype. Prejudice can consist of feelings such as “older people are unpleasant and difficult to deal with.” Discrimination is evident when older adults’ needs aren’t recognized and respected or when they’re treated less favorably than younger people. Social workers who work with the elderly are realizing that even in their minds age is “a category of difference” like race and gender, but unlike race and gender, age positions older adults as a homogenous group with similar needs.

Two Kinds of Ageism

1. Hostile ageism is easy to recognize. For example, dubbing COVID-19 as the “boomer remover” is considered hostile. In health care settings, ageism is defined as age-related discrimination, including explicit age cut-offs for treatment or resource allocation, or implicit age-related biases which limit access or create barriers to health care. At a fundamental level, ageism results in generally poorer health care leading to adverse outcomes and increased mortality. An example would be plans for rationing medical care (“crisis standards of care”) that specify treating younger adults before older adults. Embedded in these standards, now being implemented by hospitals in Idaho and parts of Alaska and Montana, is a value judgment: young peoples’ lives are worth more because they presumably have more years left to live.

Emogene Stamper, 91, of the Bronx in New York City, was sent to an under-resourced nursing home after becoming ill with Covid-19 in March. “It was like a dungeon,” she remembered, “and they didn’t lift a finger to do a thing for me.” The assumption that older people aren’t resilient and can’t recover from illness is implicitly ageist. Stamper’s son fought to have his mother admitted to an inpatient rehabilitation hospital where she could receive intensive therapy. “When I got there, the doctor said to my son, ‘Oh, your mother is 90,’ like he was kind of surprised, and my son said, ‘You don’t know my mother. You don’t know this 90-year-old.’ That lets you know how disposable they feel you are once you become a certain age.”

2. Benevolent ageism refers to assigning protection to people because older age is assumed to identify need.

• Three out of five people see older people as lonely although only one out of eight older people report feeling lonely.
• Disability is also assumed to be common among people age 65 and older but nearly two-thirds of people age 65 and older are reported to have had no disability.
• Doctors assuming older patients who talk slowly are cognitively compromised and unable to relate their medical concerns is another example of benevolent ageism.
• Although social workers campaign against hostile ageism in medical settings, they admit to the ingrained prejudice that leads to benevolent ageism. One social worker we talked to said that benevolent ageism can occur when an older person’s opinions and decisions are disregarded, such as when someone insists an older adult receive home care despite this being against the client’s wishes. This scenario was cited by social workers as an ethical dilemma for care providers, family members, and friends. "Although it can be difficult for clients to accept and understand the benefits of having more help at home and the need for providers to ensure no harm, we also must respect an individual’s right to self-determination."

Social Workers Agree

The unique empathetic response and personal concern that motivates select social workers to specialize in elder care often engenders a streak of benevolent ageism in a well-meaning social worker. "We elder care social workers must constantly remind ourselves that all older people are not needy, infirm, or incompetent. Every time we fall prey to those prejudices, we discount the individual we are trying to help and cause the resistance we so often feel coming off them. This creates a cycle of resistance and what should have been a positive relationship of aid and gratitude sours to a relationship of insistence breeding resistance."

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