Ageism is social discrimination based on age, most commonly affecting older adults. It can impact patient health outcomes, including physical, mental, social, and financial aspects. As the number of older adults with cancer rapidly increases, oncology nurses must be aware of ageism by starting with their personal and workplace biases.
What Is Ageism?
Ageism refers to stereotypes, prejudice, or discriminatory behaviors toward someone because of their age. This term often refers to older adults, but ageism also can be against other groups. Consider the following examples from the employment sphere:
- 67-year-old Angela was passed over for a promotion because her manager assumed the new role would be too fast-paced and she wouldn’t be able to keep up.
- In team meetings, 22-year-old Jim’s boss Mina continually directs questions about his work project to his older coworker because she assumes Jim isn’t experienced enough to know the answers.
Unfortunately, ageism in health care is a common, well documented problem present in numerous studies. Health care professionals frequently assume older patients are unwilling to receive treatment and are demanding, helpless, or offensive. Providers may only present certain options to older people or recommend less aggressive treatments because of their age. They may consider this a more compassionate choice, even if it results in a lower quality of life or a shortened lifespan. Conversely, younger patients may be presented with overly aggressive treatment options because they are “still young,” disregarding their goals and wishes.
Below are some more common examples of ageism in health care:
- Physicians may dismiss a treatable pathology as “part of the natural aging process.”
- Older adults are often underrepresented in clinical trials.
- Conditions common with aging, such as fatigue, pain, cognitive impairment, and depression, may be undiagnosed and/or undertreated.
What Are Some Strategies to Combat Ageism in Oncology?
As the population of older patients with cancer increases, combining gerontology principles into oncology settings is necessary. An entire discipline of geriatric oncology, or “gero-oncology,” emerged more than 4 decades ago. Several organizations, cancer advocacy groups, and regulatory agencies are focusing on expanding the body of knowledge, education, and clinical practice guidelines to include recommendations specific to older adults. For example, the National Comprehensive Cancer Network® (NCCN) has clinical practice guidelines for older adults. These guidelines provide expert consensus and evidence on various topics, from shared decision-making with older adults, treatment considerations, and managing common side effects to comprehensive geriatric assessment.
A significant barrier to treating older patients is ageism in clinical trials. People aged 65 years or older only represent approximately 40% of clinical trials participation, with only 4% being 80 years or older. In an analysis of 302 clinical trials, participants were, on average, 6.5 years younger than the age of healthy population counterparts. Just as pediatric trials are plentiful, there must be initiatives to address age disparities to improve health equity.
How Can Oncology Nurses Combat Ageism?
The first strategy to combat any bias is a self-assessment or reflection and then an assessment of potential bias in the workplace.
- Recognize Personal Bias. In 1992, the Oncology Nursing Society published its first position paper on cancer and aging. The core of their mandate is for oncology nurses to recognize personal biases toward aging since they have a crucial role in combating ageism. It can be challenging to differentiate ageism from standard clinical procedures. Ask yourself the following questions:
- How do I view patients from a specific age group?
- How can I adapt my care based on the age of my patient?
For example, you may assume an older patient has lower health literacy, even if that may not be true. Or you may assume you know an adolescent’s health goals without a discussion with the patient.
- Address Workplace Ageism. Although it may be uncomfortable, you must also address instances of ageism observed in the workplace. Ageist jokes or comments are unacceptable and can influence a patient’s perception. As an advocate, it is your responsibility to help your team understand ageism and work to mitigate biases toward different age groups.
Oncology nurses’ attitudes toward older patients can significantly affect the quality of nursing. Although there is more focus on caring for older adults in nursing school, it may not be specific to oncology. Addressing ageism in oncology will require integrating geriatric knowledge into cancer care. All oncology nurses must consider age-specific complications of cancer and its treatment to focus on holistic care when making decisions.
Ageism among physicians, nurses, and social workers: findings from a qualitative study
Why ageism in health care is a growing concern
National Comprehensive Cancer Network
We must end ageism in cancer clinical trials
FDA analysis of enrollment of older adults in clinical trials for cancer drug registration: a 10-year experience by the U.S. Food and Drug Administration
Factors associated with age disparities among cancer clinical trial participants