Journal of Clinical Geropsychology

, Volume 8, Issue 1, pp 1–12 | Cite as

Ageism in Mental Health and Health Care: A Critical Review

  • Claire Robb
  • Hongbin Chen
  • William E. Haley


Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.

ageism barriers to treatment health care age bias mental health service delivery 


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  1. Adelman, R. D., and Albert, R. C. (1987). Medical students attitudes toward the elderly: A critical review of the literature. Gerontol. Geriatr. Edu. 7: 141–155.Google Scholar
  2. Adelman, R. D., Fields, S. D., and Jutagir, R. (1992). Geriatric education, Part II: The effect of a well elderly program on medical student attitudes toward geriatric patients. J. Am. Geriatr. Soc. 40: 970–973.Google Scholar
  3. Beisecker, A. E., Helmig, L., Graham, D., and Moore, W. P. (1994). Attitudes of oncologists, oncology nurses, and patients from a women's clinic regarding medical decision making for older and younger breast cancer patients. Gerontologist 34: 505–512.Google Scholar
  4. Beisecker, A. E., Murden, R. A., Moore, W. P., Graham, D., and Nelmig, L. (1996). Attitudes of medical students and primary care physicians regarding input of older and younger patients in medical decisions. Med. Care 34: 126–137.Google Scholar
  5. Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., Lipsitz, L., Steel, K., and Mor, V. (1998). Management of pain in elderly patients with cancer. J. Am. Med. Assoc. 279: 1877–1882.Google Scholar
  6. Boult, C., Boult, L., and Kane, R. L. (1995). How effective is geriatrics? A review of the evidence. In Katz, P. R., Kane, R. L., and Mezey, M. D. (eds.), Quality Care in Geriatric Settings. Springer Publishing, New York, pp. 87–115.Google Scholar
  7. Butler, R. N. (1975). Psychiatry and the elderly: An overview. Am. J. Psychiatry 132: 893–900.Google Scholar
  8. Butler, R. N., and Lewis, M. I. (1973). General treatment principles. In Aging & Mental Health: Positive Psychological Approaches, The C.V. Mosby Company, St. Louis, pp. 123–142.Google Scholar
  9. Butler, R. N., and Sulliman, L. G. (1969). Ageism: Another form of bigotry. Gerontologist 9: 243–246.Google Scholar
  10. Callahan, D. (1987). Setting Limits: Medical Goals in an Aging Society, Simon and Schuster, New York.Google Scholar
  11. Chu, J., Diehr, P., Feigl, P., Glaefke, G., Begg, C., Glicksman, A., and Ford, L. (1987). The effect of age on the care of women with breast cancer in community hospitals. J. Gerontol. 42: 185–190.Google Scholar
  12. Coccaro, E. F., and Miles, A. M. (1984). The attitudinal impact of training in gerontology/geriatrics in medical school: A review of the literature and perspective. J. Am. Geriatr. Soc. 32: 762–768.Google Scholar
  13. Dye, C. J. (1978). Psychologists' role in the provision of mental health care for the elderly. Prof. Psychol. 9: 38–49.Google Scholar
  14. Ford, C. V., and Sbordone, R. J. (1980). Attitudes of psychiatrists toward elderly patients. Am. J. Psychiatry 137: 571–575.Google Scholar
  15. Garfinkel, R. (1975). The reluctant therapist 1975. Gerontologist 15: 136–137.Google Scholar
  16. Ganz, D. A., Lama, G. A., Orav, E. J., Goldman, L., Guiterrez, P. R., and Mangione, C. M. (1999). Age-related differences in management of heart disease: A study of cardiac medication use in an older cohort. J. Am. Geriatr. Soc. 47: 145–150.Google Scholar
  17. Gatz, M., and Pearson, C. G. (1988). Ageism revised and the provision of psychological services. Am. Psychol. 43: 184–188.Google Scholar
  18. Goodwin, J. S. (1998). Factors affecting the diagnosis and treatment of older persons with cancer. In Balducci, L., Lyman, G. H., and Ershler, W. B. (eds.).Google Scholar
  19. Greene, M. G., Adelman, R. D., Charon, R., and Hoffman, S. (1986). Ageism in the medical encounter: An exploratory study of doctor–patient relationship. Lang. Commun. 6: 113–124.Google Scholar
  20. Greene, M. G., Hoffman, S., Charon, R., and Adelman, R. D. (1987). Psychosocial concerns in the medical encounter: A comparison of interactions of doctors with their old and young patients. Gerontologist 27: 164–168.Google Scholar
  21. Greenfield, S., Clanco, D. M., Elashoff, R. M., and Adelman, R. D. (1987). Patterns of care related to breast cancer patients. JAMA 257: 2766–2770.Google Scholar
  22. Gutmann, D. (1981). Training in the clinical psychology of aging: Observations and recommendations. In Santos, J. F., and VandenBos, G. R. (eds.), Psychology and the Older Adult: Challenges for Training in the 1980s, The American Psychological Association, Washington, DC, pp. 97–107.Google Scholar
  23. Hatfield, A. B. (1999). Barriers to serving older adults with a psychiatric disability. Psychiatr. Rehab. J. 22: 270–276.Google Scholar
  24. Herrick, C. A. (1997). Stigma and ageism: Compounding influences in making an accurate mental health assessment. Nurs. Forum 32: 21–26.Google Scholar
  25. Intrieri, R. C., Kelly, J. A., Brown, M. M., and Castilla, C. (1993). Improving medical students' attitudes towards and skills with the elderly. Gerontologist 33: 373–378.Google Scholar
  26. James, J. W., and Haley, W. E. (1995). Age and health bias in practicing clinical psychologists. Psychol. Aging 10: 610–616.Google Scholar
  27. Kaplan, S. H., Greenfield, S., and Ware, J. E. (1989). Assessing the effects of physician–patient interactions on the outcomes of chronic disease. Med. Care 27: S110–S127.Google Scholar
  28. Kastenbaum, R. (1964). The reluctant therapist. In Kasternbaum, R. (ed.), New Thoughts on Old Age, Springer. New York, pp. 139–145.Google Scholar
  29. Katz, I. R. (1999). Expanding the place of geriatric mental health within health systems: Integrated care, prevention, and rehabilitation. Gerontologist 39: 626–630.Google Scholar
  30. Kimmel, D. C. (1988). Ageism, psychology, and public policy. Am. Psychol. 43: 175–178.Google Scholar
  31. Knight, B. (1986). Therapists' attitudes as explanation of underservice of elderly in mental health: Testing an old hypothesis. Int. J. Aging Hum. Dev. 22: 261–269.Google Scholar
  32. Knight, B. G., Santos, J., Teri, L., and Lawton, M. P. (1995). Introduction: The development of training in clinical geropsychology. In Knight, B. G., Teri, L., Wohlford, P., and Santos, J. (eds.), Mental Health Services for Older Adults, American Psychological Association, Washington, DC, pp. 1–8.Google Scholar
  33. Krumholz, H. M., Radford, M. J., Wang, Y., Chen, J., Heiat, A., and Marciniak, T. A. (1998). National use and effectiveness of B-blockers for the treatment of elderly patients after acute myocardial infarction. J. Am. Med. Assoc. 280: 623–629.Google Scholar
  34. Levinsky, N. G., Ash, A. S., Yu, W., and Moskowitz, M. A. (1999). Patterns of use of common major procedures in medical care of older adults. J. Am. Geriatr. Soc. 47: 553–558.Google Scholar
  35. McCormick, W. C., Inui, T. S., and Roter, D. L. (1996). Interventions in physician-elderly patient interactions. Res. Aging 18: 103–136.Google Scholar
  36. Mckinlay, J. B., Burns, R. B., Durante, R., Feldman, H. A., Freund, K. M., Harrow, B. S., Irish, J. T., Kasten, L. E., and Moskowitz, M. A. (1997). Patient, physician and presentational influences on clinical decision making for breast cancer: Results from a factoral experiment. J. Eval. Clin. Pract. 3: 23–57.Google Scholar
  37. Newcomb, P. A., and Carbone, P. P. (1993). Cancer treatment and age: Patient perspectives. J. Natl. Cancer Inst. 85: 1580–1584.Google Scholar
  38. Niederehe, G. (1981). Postgraduate training of psychologists for work in aging: Continuing education, retraining, and in-service education. In Santos, J. F., and VandenBos, G. R. (eds.), Psychology and the Older Adult: Challenges for Training in the 1980s, American Psychological Association, Washington, DC, pp. 133–146.Google Scholar
  39. Orbach, A. (1994). Psychotherapy in the third age. Br. J. Psychotherapy 11: 221–231.Google Scholar
  40. Palmore, E. B. (1990). Ageism: Negative and Positive, Springer, New York.Google Scholar
  41. Palmore, E. B. (1997). Sexism and ageism. In Coyle, J. M. (ed.), Handbook on Women and Aging, Greenwood Press, Westport, CT, pp. 3–13.Google Scholar
  42. Radecki, S. E., Kane, R. L., Solomon, D. H., Mendenhall, R. C., and Beck, J. C. (1988). Do physicians spend less time with older patients? J. Am. Geriatr. Soc. 36: 713–718.Google Scholar
  43. Ray, D. C., McKinney, K. A., and Ford, C. V. (1987). Differences in psychologists' ratings of older and younger clients. Gerontologist 27: 82–86.Google Scholar
  44. Redelmeier, D. A., Tan, S. H., and Booth, G. L. (1998). The treatment of unrelated disorders in patients with chronic medical diseases. N. Engl. J. Med. 338: 1516–1520.Google Scholar
  45. Rochon, P. A., and Gurwitz, J. H. (1999). Prescribing for seniors: Neither too much nor too little. JAMA 282: 113–115.Google Scholar
  46. Roybal, E. R. (1988). Mental health and aging: The need for an expanded federal response. Am. Psychol. 43: 184–189.Google Scholar
  47. Samet, J., Junt, W. C., Key, C., Humble, C., and Goodwin, J. S. (1986). Choices of cancer therapy varies with age of patient. J. Am. Med. Assoc. 255: 3385–3390.Google Scholar
  48. Schaie, K. W. (1988). Ageism in psychological research. Am. Psychologist 43: 179–183.Google Scholar
  49. Schaie, K. W. (1993). Ageist language in psychological research. Am. Psychol. 48: 49–51.Google Scholar
  50. Settin, J. M. (1982). Clinical judgment in geropsychology practice. Psychother. Theor. Res. Pract. 19: 397–404.Google Scholar
  51. Shaw, A. B. (1994). In defense of ageism. J. Med. Ethics 20: 188–194.Google Scholar
  52. Silliman, R. A., Guadagnoli, E., Weitberg, A. B., and Mor, V. (1989). Age as a predictor of diagnostic and initial treatment intensity in newly diagnosed breast cancer patients. J. Gerontol. Med. Sci. 44: 46–50.Google Scholar
  53. Small, G. W. (1991). Recognition and treatment of depression in the elderly. J. Clin. Psychiatry 52: 11–22.Google Scholar
  54. Soumerai, S. B., McLaughlin, T. J., Spiegelman, D., Hertzmark, E., Thibault, G., and Goldman, L. (1997). Adverse outcomes of underuse of ¯-blockers in elderly survivors of acute myocardial infarction. J. Am. Med. Assoc. 277: 115–121.Google Scholar
  55. Stenmark, D. E., and Dunn, V. K. (1981). Issues related to the training of geropsychologists. In Santos, J. F., and VandenBos, G. R. (eds.), Psychology and the Older Adult: Challenges for Training in the 1980s, American Psychological Association, Washington, DC, pp. 83–96.Google Scholar
  56. Tarsitani, P., Venturiero, V., Gambassi, G., DiNiro, M. G., Cocchi, A., and Bernabei, R. (1997). Renal failure in older people: A preventable hospital admission and ageism indecision making. J. Am. Geriatr. Soc. 45: 1537–1538.Google Scholar
  57. Turner, N. J., Haward, R. A., Mulley, G. P., and Selby, P. J. (1999). Cancer in old age—is it inadequately investigated and treated? BMJ 319: 309–312.Google Scholar
  58. Whitbourne, S. K., and Hulicka, I. M. (1990). Ageism in undergraduate psychology texts. Am. Psychol. 45: 1127–1136.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Claire Robb
    • 1
  • Hongbin Chen
    • 1
  • William E. Haley
    • 1
  1. 1.Department of GerontologyUniversity of South FloridaTampa

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