Ageism in Mental Health and Health Care: A Critical Review

Abstract

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.

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REFERENCES

  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.).

  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.

  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 

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Robb, C., Chen, H. & Haley, W.E. Ageism in Mental Health and Health Care: A Critical Review. Journal of Clinical Geropsychology 8, 1–12 (2002). https://doi.org/10.1023/A:1013013322947

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