3 Attitudes to working with older people

• To consider your own attitudes to old age

• To analyse the attitudes of society and healthcare professionals to old age

• To explore the impact of these attitudes on older people and evaluate strategies to overcome negative attitudes and stereotypes that you may encounter in practice

Introduction

Society has many stereotypes of old age and older people. On the whole they tend to be negative. This chapter gives you the opportunity to consider your own views about older people and some of the stereotypes that people in Western societies hold about them. We consider how health and social care for older people will be affected if professionals working in these fields believe these stereotypes. We ask you to consider your own attitudes to working with older people. We also ask you to reflect on your own experiences and in so doing explore how you can develop your own practice in a way that is informed and how people working with older people can help to dispel some of these negative stereotypes.

Activity

Think about the term ‘old age’. List ten things that you think of when hearing this term.

Now think about somebody you know who you consider to be old. List ten things of note about them.

Compare your two lists. How are they different?

Consider which list is the most positive – the first or the second. The extent to which the second list is negative or positive will probably depend upon whether or not you like the person that you have in mind – but, assuming you do, it is likely that this list will be more positive than the former.

When you were thinking about an older person during this activity, how old were they? What do you consider to be ‘old age’? You could compare your answers and ideas with other students and consider whether old age is absolute or a shifting concept – depending on your own age and experiences! If at all possible, compare you answers to these questions to a student from a different cultural background to you. How are you answers different to each other?

Societal attitudes to older people

It is widely believed that negative attitudes to older people exist both within Western society and within nursing. Henderson et al (2008) refer to this as ageism – a process of systematic stereotyping and discrimination against older people. According to Cann (2009), the starting point is that we tend to generalise about older people, viewing 20 million people as a ‘unitary group with identical circumstances and personalities’. Indeed, part of the endemic ageism of Western society lies in our readiness to conceptualise a group we call ‘older people’ and treat them as a homogeneous blob’ (Cann 2009:40). Henderson et al (2008) develop this, suggesting that older people also tend be viewed as being separate from the mainstream and belonging to another time, i.e. being out of touch and not really full members of society.

The Research on Age Discrimination Project (2007) develops these arguments further by considering the experiences of minority groups within the ageing population. They found that some older women described an experience of becoming invisible with old age – that younger people appeared to look through them as if they were not there. In addition, as the UK is becomes an increasingly multicultural society, the number of older people from ethic minorities is increasing. Many people who migrated to the UK from places as diverse as Pakistan and the Caribbean in the 1950s and 1960s experienced a country that was overtly racist and may have experienced discrimination over many years (Holland & Hogg 2010).

The Research on Age Discrimination Project (2007) questions whether this leaves them better able to cope with ageism or if it leaves older people from ethnic minority groups more vulnerable due to experiences of multiple discrimination – age, race and (where appropriate) gender.

A further group of older people for whom discrimination might be compounded are people who are not heterosexual. Older gay men, in particular, will have grown up in an era when they were both discriminated and legislated against. While legislation has clearly changed, it can be argued that discrimination still remains while service planners often overlook the presence and needs of the older lesbian, gay, bisexual and transgendered population, meaning that formal health and social care services might offer an alien environment to a significant minority within the older age group.

Wallace (2008) has identified a list of common stereotypes that society in the Western world holds regarding older people. These are listed in Box 3.1.

Box 3.1 Common stereotypes held in Western societies about older people

Older adults are of little benefit to society

Older adults are a drain on society’s resources

Older adults are cranky and disagreeable

You can’t teach old dogs new tricks

Older adults are all demented

Depression is a normal response to the many losses older adults experience with ageing

Older adults are no longer interested in sex

Older adults smell

The secret to successful ageing is to choose your parents wisely

Because older adults are closer to death, they are ready to die and don’t require any special consideration at end of life

(Wallace 2008)

Activity

Review the list of myths of old age identified by Wallace (2008). For each myth:

Consider where they might come from, i.e. is there any truth in them?

If health and social care professionals believed them, how would this impact on the quality of care offered to older people?

Have you heard any of these stereotypes being used and, if so, in what context?

Are there any arguments that might refute these myths and how might you challenge these stereotypes?

With the last question of this activity in mind, in the following section of this chapter we discuss each of these statements in turn. At the end of the section you may wish to return to your own notes and consider if you would need to make any amendments to these in light of the discussion.

Myths concerning ‘old age’

In response to the first question, you may encounter older people for whom some of these myths appear to be true, but you will also encounter people for whom this is not remotely accurate as a description. The tendency to view the older population as a homogeneous group is flawed on two levels. First, old age covers a span of 40 years or more. Some people who are in their 60s will consider themselves (or will be considered) to be old, while there is an ever increasing number of centenarians within the population. Second, Elliott-Smith (2009) points out that, while it may be appropriate to look at a 5-year-old and reach judgements about the extent to which they are typical of 5-year-olds, it is not feasible to do this with 70-year-olds who are likely to have had significantly different life and health events that have contributed towards their current situation, health and outlook.

Currently, in UK society, older people are better educated and healthier than ever. Most live in their own homes with little functional impairment while over one million people of pension age are in employment (Cann 2009) and many others are engaged in voluntary work. It is possible to be old and be considered to be a productive member of society. Looking to the future, Bytheway (2010) points out that the older population in the UK is changing to include more members of the ‘baby boomer’ generation, born in the post-war era. This is a generation that, over the years, has had a tendency to avoid fitting in with predetermined stereotypes and it is unlikely that this trend will stop as they reach old age.

Impact of ageist attitudes on the quality of health care

If nurses believe the common myths about old age that have been identified by Wallace (2008), it is likely that the quality of care offered to older people will be affected. It is probable that older people will be viewed as a drain on resources, asexual, being depressed or demented and not really being a person of value. For the remainder of this chapter, we look at the assumptions identified by Wallace (2008) and consider the implications for older people if the health and social care professionals who are working with them believe these things about them.

1 Older adults are of little benefit to society

We live in a culture where people are expected to both give and receive. This is highlighted in social exchange theory (Beel-Bates et al 2007). When thinking about their relationships, most people tend to feel uncomfortable if they are constantly in a position where they are receiving and unhappy if they are always giving. Numerous studies suggest that this does not change in old age (e.g. Grasser & Craft 2000, Neufeld & Harrison 1995). Where nurses believe that older people have little to contribute, they are unlikely to expect much of them and will probably view them as lesser beings as a result of this – thus having a detrimental impact on the self-esteem of the older person. By contrast, nursing which takes account of the need for people to engage in social exchange will attempt to create occasions where the older person can feel that they are contributing and explicitly value any contributions that the older person makes.

Activity

Think about your meetings in clinical practice with someone that you consider to be old. Make a note of what you think you offer to that person in your interactions with them. Now consider how you benefit from your involvement with the person.

It is likely that you think that the older person benefits from your interventions to meet their physical and psychological needs while you are involved in their care. As a student nurse it is probable that you will be gaining from your work with the individual by learning about their needs and how best to work with them to meet them. In addition, you may be benefitting if they try to help you in your work by making your job easier (perhaps by trying to be as independent as possible or by minimising any demands on you when they can see that you are busy). Also, if you have a good rapport with the individual, it is likely that you benefit from the social contact that you have with them as you work with them.

If you are able to view your interactions with older people as moments where you gain as well as give, and take opportunities to communicate this with them as you work with them, it is likely that you will help to improve the self-esteem of the individual.

2 Older adults are a drain on society’s resources

This assumption offers the reverse perspective of social exchange theory – that, in addition to not offering anything, older people only take – and that the resources they lay claim to are, in effect, wasted. Where nurses believe this, they are likely to take the view that older people are less deserving of the resources that are available and this belief is likely to influence the clinical decisions that they make. In the UK, NHS organisations have been under instruction to eliminate age discrimination since the publication of the National Service Framework for Older People (Department of Health (DoH) 2001). As a result, NHS trusts have reviewed their policies and procedures to ensure that older people are not disadvantaged and that decisions are made based on clinical need rather than patient/client age. However, many decisions are made under the radar of public scrutiny and health and social care professionals need to be meticulous in ensuring that it is clinical need and not the age of the individual that is the deciding factor for any clinical decisions that are made.

Activity

Consider your experiences of nursing practice. Are there any situations where you feel that ‘under the radar’ discriminatory decisions have been made to the disadvantage of older people?

The Research on Age Discrimination Project (2007) has found that covert (and some more overt) forms of age discrimination are difficult to eliminate. They report incidents where GPs fail to refer older people with debilitating depression for further treatment on the basis of age. More overtly, in the UK, breast screening is available to all women on a 3-yearly basis once they reach the age of 50. However, at the age of 70, they are no longer invited to their screening appointment – they have to initiate it themselves.