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High time to challenge ageism and the dominant biomedical view of ageing

The prevalence and impact of ageism in our community, and in the healthcare system, and the tendency to see poor mental health as a ‘normal’ part of ageing were major issues raised at the Mental Health and Ageing summit hosted by Mental Health Victoria in Melbourne earlier this week.

Dr Meg Polacsek, Research Fellow in the Social Gerontology Division at the National Ageing Research Institute, was a panelist at the timely summit, which took place as Royal Commission investigations are underway in Victoria into the mental health system and nationally into the aged care system.

In the post below, Polacsek outlines the need to challenge prevailing misconceptions about age and mental health that can lead to poor diagnosis and management of mental health issues for older people, as well as the need to broaden the discourse on ageing from one that is often focused on loss to one that offers encouragement and inspiration.

Croakey will next week publish a major wrap of discussions from the summit by journalist Marie McInerney who attended the event for the Croakey Conference News Service. This article is published as part of the #MHAgeing coverage.


Meg Polacsek writes:

If you consider that most of us are likely to live to a ripe old age, it’s curious that ageism is still so pervasive in our culture. It seems incongruent that one of the contexts where it is most frequently encountered is in the healthcare sector.

Like racism and sexism, ageism is prejudice or discrimination against a category of people. However, there is a significant difference between racism or sexism, and ageism: unlike a person’s race or gender, anyone may become a target of ageism if they live long enough.

Ageism is inextricably linked with cultural influences. While widespread in many developed societies, old age is still honoured and respected in more traditional cultures, which value inter-dependence and mutual support among individuals. Asian cultures generally hold more positive societal views of ageing than their Western counterparts. In Australia’s Aboriginal and Torres Strait Islander communities, acceptance of ageing as an important part of the cycle of life accords more respect to Elders.

Unfortunately, it is in the interaction between health professionals and older patients that ageism most frequently occurs. There is ample evidence of health professionals patronising older patients, listening less to their views, giving less time to clinical interviews and attributing symptoms to age rather than to treatable conditions. Health professionals often communicate with older adults using “elderspeak”, which is characterised by a patronising tone, slower or louder speech, and simplified sentences.

One area that warrants particular attention is the mental health of older adults. Depression and anxiety are common in older adults. Suicide rates are highest in men and women aged 70 years and over in almost all regions of the world. Australian men aged 80 years and above are most likely to die by suicide than other age groups.

The natural experience of grief at a loss is also often poorly managed in older adults, increasing the risk of complicated grief and depression, and cognitive decline. These difficulties are compounded in vulnerable or diverse populations, including those from culturally and linguistically diverse (CALD) backgrounds, Aboriginal and Torres Strait Island people, those living in rural and remote areas and in older gay, lesbian, bisexual, transgender and intersex people.

Yet there remains a tendency to normalise poor mental health as a ‘normal’ part of ageing.

Ageism remains a major challenge for older adults seeking help for depression or anxiety. Older people frequently encounter difficulties obtaining a diagnosis and appropriate treatment for depression. Assessments and treatment recommendations are often based on the older adult’s chronological age, rather than their personal circumstances, preferences, functional status or other co-morbid conditions.

Ageism is also indicated by the limited mental health treatment options offered to older adults. Low referrals for psychotherapy, for example, may reflect the erroneous belief that older adults are less likely than younger adults to benefit from this therapy.

If we bear in mind that we may all one day be on the receiving end of ageist behaviour, we need to challenge prevailing misconceptions about age and mental health. There are two clear opportunities to make ourselves heard: the Federal Government’s Royal Commission into Aged Care Quality and Safety and the Royal Commission into Victoria’s Mental Health System.

We need improved mental health screening for older adults that mitigates the risk of confusing symptoms with physical illness or decline. Models of care that integrate mental health care into medical care are also urgently needed. Most of all, the common, but erroneous, view of depression and anxiety as normal parts of ageing should be addressed through education and training.

At all levels of health care, the ageist attitude that older adults are less functional or capable of actively participating in optimising their health and quality of life should be addressed. It is important that the health care workforce understands the complexities of ageing with depression, and that contextual factors are considered when supporting an older adult with depression or anxiety. This will require a shift from the dominant biomedical view of ageing towards improved understanding of the personal, social and environmental factors that impact on individuals.

Finally, let’s raise awareness of the constructive strategies used by older adults to manage their mental health and optimise their quality of life, in order to broaden the discourse on ageing from one that is often focused on loss to one that offers encouragement and inspiration.


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