Bias and Ageism in Healthcare

The American Psychological Association’s recent apology for its history of racism is part of a national reckoning on race, an insistence that racism be studied in clinical psychology training programs, and demand that the programs become antiracist. Clinical training programs should identify and revise policies that inadvertently promote inequities, exclusions, and conformities on their own turfs.

Of course, this effort is sometimes co-opted by those who would use the prosocial movement to cover their agendas of hatred and power, but by and large, there is widespread agreement in psychology about this reckoning.

With ageism, it’s a different story. A systematic review (Saif-Ur-Rahman et al., 2021) of ageism in healthcare found that bias against the elderly is a major contributor to adverse health outcomes in that population.

Nemiroff (2022) offered a host of good ideas about how to address ageism in medical education. Missing from that list was addressing ageism as it occurs within healthcare educational environments, not with respect to patients but concerning aging teachers and supervisors. This post calls for psychology programs to monitor and address their internal ageist practices.

Ageism is fairly unusual among forms of unfair discrimination because there are some bases, in fact, for differences based on age (Fox et al., in press). On the plus side, aging faculty members in clinical psychology, compared to younger faculty members, tend on average to be more expert, more experienced, more secure in their supervisory authority, and less taken with the next new thing.

They are also more likely to have tenure (a promise of career-long employment), and tenure empowers them to resist sweeping and untested changes to the curriculum. Consequently, older faculty members are unsurprisingly often treated with envy, resentment, and frustration over behaviors directly linked to their aging.

The thought plagues every movement that things would be better if only certain people could be eliminated. This fantasy interferes with empathy, wonder, and curiosity, the cornerstones of real engagement. Having a subset of people who are slow to fall into line awakens this fantasy. The older they are, the more likely they have lived through other movements that did more damage asserting the righteousness of their causes than good in effecting change.

One lesson many people need to learn about race is that many things are race-based that seem at first glance not to be. Thus, for example, race can lead to oppression, leading to anger. When a Black person is angry, it’s a good idea to be even slower than usual in inferring a character trait.

Students who resist the party line in a classroom have to be engaged with critical thinking, but when they are Black, there may be more to their resistance than simple skepticism. This, in general, is what is meant by those who say that color-blindness can foster racism because color-blindness (in these examples) can lead to misreading anger and skepticism as character traits.

Older people can also be angry and skeptical, not because of their character, but because they don’t like being treated as if they are over the hill when they are at the height of their powers. Their processing speed may not be what it used to be, but their pattern recognition just keeps getting better.

They may have come to cherish their hard-earned discoveries as to where most effectively to put their energies for social change, and they may resent incursions on the spaces they have learned to focus on.

They may have seen social initiatives come and go and feel more circumspect about the latest ones. Younger people may jump on the latest bandwagon because they don’t have a forty- or fifty-year stake in doing things the way they know works for them.

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In contemporary training programs, it is likely to be the elderly who insist on retaining control of their classroom and supervision spaces, who think the only truly empirically-supported treatments are those based on a strong working alliance, and who just want to be left alone to teach and supervise as they see fit (having developed ideas about what works for them). They are likely to be treated as obstacles, a form of institutional ageism.

Rooting out systemic ageism in healthcare training programs is where the effort should start to root out systemic ageism in healthcare. No amount of teaching can overcome the experience of being trained in a program that is itself systemically ageist.