“No, I Am Not Demented”

Source: Sarablatter / Pixabay

Recently, my husband was admitted to a hospital with pneumonia and a blood clot. A lifelong lawyer with a respect for the importance of details, he had learned to be his patient advocate while navigating the healthcare system.

Yet, again and again, he found aides, nurses, and even doctors not hearing him. Although he was always treated with kindness and respect, some interactions went like this:

"I need to take my cancer medication with dinner," he insisted.

"You’ll get your pills at ten o’clock," the nurse repeated.

“Could you please read the label? I take these pills twice a day, with food. I take them with breakfast and dinner.”

“No, the orders are to give them to you at ten o’clock.”

As he used reason, then joking, then tears, even anger, the nurse could only see the frail figure lying helpless in the hospital bed equipped with rails, like those a child might have to keep from falling onto the floor. His chart said he was 83 years old. As one of his doctors later pointed out, the nurse might have assumed he was demented.

“Everyday ageism” is so prevalent a problem in the United States that the American Society on Aging proclaimed October 7 “Ageism Awareness Day.” It's a time to promote awareness of all the stereotypes people hold about older adults and the negative impact such beliefs have on individual, group, and institutional wellness. Their Ageism and Culture Advisory Council has published an informative ageism factsheet.

Examining the impact of attitudes towards aging is not new. Psychiatrist Robert Butler founded the scientific study of gerontology in the 1960s. With it came increased accuracy in understanding what Americans experience as the decades pass.

Better observation of the aging process allowed scholars to identify normative changes over time, aspects of experience such as education, ethnic and racial background, social relationships, religious commitment, involvement, or trauma that influence those changes.

We now know that perceptions of older people form automatically as young children are exposed to elders and messages in the environment about them. Often, grandparents provide the earliest template of what being “old” means.

Children generalize their concepts, forming unconscious biases, as they observe older adults and representations of them. These biases, or “scripts” for how life unfolds, are fused with emotions. Resulting expectations shape behavior.

Jean Piaget first described these processes from the perspective of developmental psychology. Decades later, Silvan Tomkins wrote four dense volumes exploring their impact on adult cognition, emotions, and behavior.

In short, we tend to take in the information we are exposed to, weigh heavily on what is most personally meaningful, and use it as a lens that filters expectations. We then assume that the new material matches our assumptions.

As a founding father of psychology, William James, pointed out, it is the brain’s way of making meaning out of the “blooming and buzzing confusion” of a baby's sensory and motor experiences.

Source: silviarita/Pixabay

A 2022 survey, the Michigan National Poll of Healthy Aging, collected responses from 2,048 adults, scientifically selected to reflect the diversity of the American population aged 50 to 65 and 66 to 80. They completed the Everyday Ageism Scale that measured their exposure to ageist messages, ageism expressed in their interpersonal interactions, and “internalized” ageism (personal beliefs about growing older). Almost all participants (93.4 percent) reported regularly experiencing at least one of the 10 forms of ageism listed on the scale.

Responses powerfully predicted all four outcome measures: physical well-being — self-rated health and number of chronic illnesses — and mental health — self-perceptions and depressive symptoms. Given the size and design of the sample, a large number of potential confounders (e.g., sex, socioeconomic status (SES), even region of the U.S.) could be examined and controlled for.

Ageism exposure was highest in the over-65 group, those with lower SES, those in rural (vs. metropolitan) areas, and those with higher exposure to media.

Because of studies like this, the damaging impact that negative beliefs about aging can have on mental and physical well-being has been well-documented. Yale psychologist Becca Levy has shown that erroneous and destructive perceptions can be consciously changed. Her latest book, Breaking the Age Code, explores the why and hows of updating beliefs.

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As Levy shows us, negative perceptions of aging can evolve, especially when challenged by information that does not fit the stereotype. My husband’s doctor listened to his frustration and understood the negative impact stereotyping has on our health. She noted that the staff members who did not see my husband as the intelligent, educated, and articulate man he is had not modified their notion of “old” and what went with it.

As a psychologist, perhaps my strongest advice to students and patients has been, “Do not make assumptions.” Encounter each new experience on its own. Allow yourself to see the world from multiple points of view, with what Buddhists call “a baby’s mind.” Ask, “What is this person trying to tell me?” especially when their communications become increasingly insistent.

An 80-year-old friend with a rare lung disease severely limiting her activities and options underwent the rigorous process of getting her dog credentialed as a certified support animal. Recently, she reserved a flight and was told she could not bring her small dog in the cabin since “therapy” dogs were no longer permitted as service animals.

Her needs, her efforts, and her quiet insistence got her nowhere. Finally, she reached a supervisor, who told her to reframe her request by emphasizing the beneficial physical impact of having her dog in her arms: specific physical functions like lowering her blood pressure, breathing rate, and inflammation. She was heard.

When will older people stop being treated as invisible? Or are their requests treated as offensive attempts to undermine an efficient (and computer-monitored) system? When will young people, especially in service industries, see others—especially older adults—as individuals with unique qualities deserving to be acknowledged and, if possible, honored?

Copyright 2023 Roni Beth Tower