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Ageism in Mental Health and Health Care: A Critical Review

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Journal of Clinical Geropsychology

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

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Butler, R. N. (1975). Psychiatry and the elderly: An overview. Am. J. Psychiatry 132: 893–900.

    Google Scholar 

  • 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 

  • Butler, R. N., and Sulliman, L. G. (1969). Ageism: Another form of bigotry. Gerontologist 9: 243–246.

    Google Scholar 

  • Callahan, D. (1987). Setting Limits: Medical Goals in an Aging Society, Simon and Schuster, New York.

    Google Scholar 

  • 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 

  • 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 

  • Dye, C. J. (1978). Psychologists' role in the provision of mental health care for the elderly. Prof. Psychol. 9: 38–49.

    Google Scholar 

  • Ford, C. V., and Sbordone, R. J. (1980). Attitudes of psychiatrists toward elderly patients. Am. J. Psychiatry 137: 571–575.

    Google Scholar 

  • Garfinkel, R. (1975). The reluctant therapist 1975. Gerontologist 15: 136–137.

    Google Scholar 

  • 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 

  • Gatz, M., and Pearson, C. G. (1988). Ageism revised and the provision of psychological services. Am. Psychol. 43: 184–188.

    Google Scholar 

  • 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.).

  • 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 

  • 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 

  • 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 

  • 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 

  • Hatfield, A. B. (1999). Barriers to serving older adults with a psychiatric disability. Psychiatr. Rehab. J. 22: 270–276.

    Google Scholar 

  • Herrick, C. A. (1997). Stigma and ageism: Compounding influences in making an accurate mental health assessment. Nurs. Forum 32: 21–26.

    Google Scholar 

  • 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 

  • James, J. W., and Haley, W. E. (1995). Age and health bias in practicing clinical psychologists. Psychol. Aging 10: 610–616.

    Google Scholar 

  • 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 

  • Kastenbaum, R. (1964). The reluctant therapist. In Kasternbaum, R. (ed.), New Thoughts on Old Age, Springer. New York, pp. 139–145.

    Google Scholar 

  • 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 

  • Kimmel, D. C. (1988). Ageism, psychology, and public policy. Am. Psychol. 43: 175–178.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • McCormick, W. C., Inui, T. S., and Roter, D. L. (1996). Interventions in physician-elderly patient interactions. Res. Aging 18: 103–136.

    Google Scholar 

  • 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 

  • Newcomb, P. A., and Carbone, P. P. (1993). Cancer treatment and age: Patient perspectives. J. Natl. Cancer Inst. 85: 1580–1584.

    Google Scholar 

  • 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 

  • Orbach, A. (1994). Psychotherapy in the third age. Br. J. Psychotherapy 11: 221–231.

    Google Scholar 

  • Palmore, E. B. (1990). Ageism: Negative and Positive, Springer, New York.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • Rochon, P. A., and Gurwitz, J. H. (1999). Prescribing for seniors: Neither too much nor too little. JAMA 282: 113–115.

    Google Scholar 

  • Roybal, E. R. (1988). Mental health and aging: The need for an expanded federal response. Am. Psychol. 43: 184–189.

    Google Scholar 

  • 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 

  • Schaie, K. W. (1988). Ageism in psychological research. Am. Psychologist 43: 179–183.

    Google Scholar 

  • Schaie, K. W. (1993). Ageist language in psychological research. Am. Psychol. 48: 49–51.

    Google Scholar 

  • Settin, J. M. (1982). Clinical judgment in geropsychology practice. Psychother. Theor. Res. Pract. 19: 397–404.

    Google Scholar 

  • Shaw, A. B. (1994). In defense of ageism. J. Med. Ethics 20: 188–194.

    Google Scholar 

  • 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 

  • Small, G. W. (1991). Recognition and treatment of depression in the elderly. J. Clin. Psychiatry 52: 11–22.

    Google Scholar 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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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