At his age it is normal for him to feel bad… ageism in healthcare

The cases in which someone of the third age asks a health professional a question, such as “My leg hurts a lot”, and receives a response in the style of “Sure, man, at your age it is typical” are typical. normal”; or in which psychological help is sought for an elderly relative, and when confessing “My mother is sad”, a response is received in the style of “It is logical, she will not have courage and as old as she is…”

Addressing an elderly person in a higher and slower tone unnecessarily, infantilizing them; underestimating it (“at your age you can’t do this anymore”); maintain a paternalistic attitude towards her at all times… Who has not acted like this or has seen other people doing it? Well, know that you are being the architect or witness of an “ageist” attitude, in this case against the elderly. It is more common than we think, also in healthcare personnel.

On many occasions, we attribute ailments to age that, in reality, are not due to age, but to other causes. It is our prejudices towards the elderly that lead us to wrong conclusions and that we interact with them inappropriately. “In the cases of health management, this attitude can have serious consequences such as underdiagnosis and undertreatment, and that we end up not diagnosing, for example, a tumor or depression, due to not doing the proper tests,” explains Ana Belén Fraile, professor Nursing at the University of the Basque Country (UPV/EHU). “We think it is especially important that health science students, specifically Nursing, be aware of this, because they are the ones who are in continuous contact with patients, many of them older people. If we have ageist stereotypes and prejudices, we run the risk that our behaviors will be too ”, warns Fraile.

The second year of Nursing includes the subject ‘Life Cycle II’; in it the students study geriatrics and gerontology, as well as the specific characteristics of this group. Also in this course, classes are combined with practices in social health centers, where there are elderly people. “We try to make our students aware of how, without thinking about it, we can often fall into negative attitudes towards the elderly, which makes it difficult to exercise effective nursing, and most importantly: learn to avoid it,” explains Fraile.

Batirtze San Martín, professor of Nursing at the same university, investigates how the ‘Life Cycle II’ subject and clinical practices affect students and whether the burden of stereotypes and prejudices they present after having studied it has improved, worsened or is maintained indifferent. An investigation that will be the basis of her thesis and that is being directed by Professor Ana Belén Fraile.

To carry out the research, two study groups were selected: the first, made up of 113 Nursing students, who took the ‘Life Cycle II’ subject and carried out internships in social and health centers, and a second group, with 109 Medicine students, who they did not study this subject, or another similar one, nor did they carry out clinical practices. Although at the beginning of the tests the members of the two participating groups presented a similar level of negative stereotypes and prejudices, at the end of the course, in the Nursing study group a great reduction of their negative stereotypes and prejudices towards people was found. older, while in Medicine students no significant variation was observed.

An attitude with a lot of ‘tradition’

“This is not new, ageism has always existed – recalls San Martín, we have inherited it and instilled it in our daughters and sons without realizing it: when we talk about their grandmothers and grandfathers, for example, and we identify them as fragile and we associate a certain lack of autonomy with them.” “Furthermore, explains Fraile, both the post-war generation and the ‘Baby boom’ generation are people who have suffered very harsh living conditions, are accustomed to austerity and, in matters of health, accept without questioning what the doctor told them. To such an extent, that the daughters and sons came to decide if their elders should be informed about the diseases they had. Regarding the aspect of care, they have been educated in effort and sacrifice and they endure, often without complaining, no matter how you treat them. That no longer happens with later generations, aware of their rights and their autonomy”, both researchers explain.

In the subject ‘Life Cycle II’ much is said about the physical and cognitive changes that occur in the elderly, as well as their deterioration over the years; “We explained to them that this aging process is very heterogeneous,” explains San Martín. In addition, the subject has an ‘aging suit’, with which students can feel first-hand the difficulties that an older person may have in terms of mobility, sight, hearing… “This makes them put themselves in the skin of of his patients from residences and hospitals, says Fraile. They are different dynamics with which they seek to increase their empathy and act accordingly when they are with patients who present difficulties”, adds San Martín.

A very enriching experience

Marta Sastre, Endika Ezquerra, Koldo Berganzo and Patricia Revilla are second-year Nursing students, they are finishing the ‘Life Cycle II’ subject and have already done internships with the elderly in social and health centers. The four agree: “it has been a very enriching experience”.

Berganzo recalls that he was surprised to find himself “with a person aged 87 and over, who has a prodigious memory, better than that of a person of 25”, and assures that “he will have his limitations, but he could help me with the exams! Pharmacology, because it controlled all the pills!”, he jokes.

Revilla, for his part, explains that “during the course they have helped us to see that, just as we have ‘micromachismos’, we also have ‘microageisms’. I had heard about it, like the jokes in which you compare yourself with older people, -‘look at grandma’s bicycle’ or ‘you’re old, you don’t know’-, but we also practice it when we talk about a young person, who suffers and we affirm: ‘what does he know about life, because he is only fifteen years old’. You have to be careful how we speak and how we address others.”

Ezquerra affirms that “I went to the residence with some preconceived ideas, thinking that I would meet elderly and highly dependent people, but then I realized that there are people with such a mind that I would like to be like that at that age.”

“In the end, society instills in you stereotypes of the elderly: that they do not hear, that they do not see well, that they will all be bedridden… explains Marta Sastre; however, when you arrive you see that it has nothing to do with what you thought”.

From left to right: Marta Sastre, Endika Ezquerra, Ana Belén Fraile, Batirtze San Martín and Koldo Berganzo. (Photo: Ibai Biritxinaga / UPV/EHU)

Do these practices help foster empathy with older patients? Ezquerra believes so: “we are supposed to have more empathy with people our age, but I don’t think so, you can feel empathic with much older people. The years are not a barrier that prevents being one, -he assures- it should be a trait that all people have and at all ages, especially in residences and hospitalization ”, where you find very painful situations. “Yes, adds Revilla, that is why in class they emphasize that we must practice therapeutic nursing, without minimizing what the patients feel, when they cry, etc. Older people appreciate it a lot.”

Batirtze has begun the second phase of his thesis and is already working on his second study on students and ageism. Although it has not yet been finalized, some of its results are already progressing: “students who have only had contact with older people through work or volunteering, and not family contact, show a greater propensity to have negative stereotypes and ‘ageist’ prejudices. The United Nations and WHO World Report on Ageism already makes it clear that it is not only a matter of health personnel, but that it is a pending issue that all organizations and people must face”. (Source: UPV/EHU)