Gerontology Prof.Dr.Veronika Ospina-Kammerer

1. GerontologyProf.Dr.Veronika Ospina-Kammerer Prof. Dr. VOK

2. Vulnerability and a Lack of Empathy or Compassion add up to AGEISM Prof. Dr. VOK

3. Keine Sorge – keine Angst • Wir sprechen Deutsch! Prof. Dr. VOK

4. Are you prejudiced? • Do you say “aaawww, isn’t she cute?” when you see an older woman doing something a younger person might do (e.g., having fun, kissing a man)? • Do you think older people aren’t appealing because of their physical appearance (e.g., loose skin, wrinkles, gray hair, weight around the middle)? Prof. Dr. VOK

5. Are you prejudiced? • Do you think all old people are wise? • Are you uncomfortable talking to elders? • When you talk to older people do you look them in the eye? • Are elders all “old people” to you or can you see each as an individual? Prof. Dr. VOK

6. Beliefs about Aging and Older People • The Social Construction of Aging • Youth, speed, production ($) are American ideals • Physical and mental weakness are stigmatized • feel ashamed or embarrassed when weak, ill, or need help • You have done something WRONG if you become ill or old or poor • Blame the Victim Prof. Dr. VOK

7. Beliefs about Aging and Older People • The Social Construction of Aging • Values underlie attitudes and stigma • Survivor of the fittest • (I [behavior or attitude] and am alive/well and Mr. X didn’t so he became old/ ill/died • Control, control, control • Do not believe that uncontrollable forces or chance has anything to do with becoming old or ill • Belief in simple cause and effect relationships • e.g., She got cancer because she did/did not [behavior or attitude] Prof. Dr. VOK

8. Robert Butler on Ageism In the 1960s, Robert Butler coined the phrase ageism, which he defined as: "A process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this with skin color and gender. Old people are categorized as senile, rigid in thought and manner, old-fashioned in morality and skills . . . . Ageism allows the younger generations to see older people as different from themselves; thus they subtly cease to identify with their elders as human beings . . . ." (See R. Butler, Why Survive? Being Old in America, 1975 - item no. 71 of this bibliography.) Prof. Dr. VOK

9. Ageism • Ageism can be coupled with other forms of oppression • sexism, racism, beautyism… a powerful combination • It all adds up to the beliefs that – • AGING is bad • AGING is ugly • AGING is to be avoided • AGING is a social and economic crisis • We need to FIGHT AGING Prof. Dr. VOK

10. Ageism • “A man's face is his autobiography. A woman's face is her work of fiction.” • Oscar Wilde Prof. Dr. VOK

11. AGEISM & SEXISM The Double StandardThe men shown here are the plastic surgeons – note they haven’t been touched up. Prof. Dr. VOK

12. What? We’re Prejudiced? Are you? • Lots and lots and lots of examples in daily life… • Conversations • Jokes • Television • Birthday cards • Newspaper • Magazines • Music lyrics Prof. Dr. VOK

13. Ageism and the MediaSubtle? NOT! • Musichttp://music.msn.com/music/features/bandsofthelivingdead • Is music only for the young? • Rockers and rappers who are in their 40s, 50s, and 60s are referred to as “living dead” -- Writer states they “refuse to die” • Old men rockers are one thing but old women? Prof. Dr. VOK

14. Ageism and the MediaSubtle? NOT! • Prejudice and discrimination on TV • Less than 2% of prime time television characters are 65% • Majority of film and TV writers are white men under 40 • Only 1/3 of older characters on prime time TV are women • 70% of older men and 80%+ of older women on TV are portrayed disrespectfully, treated with little if any courtesy, and looked at as “bad” Examples from Ageism in America: Status Reports of Ageism in America by The Anti-Ageism Taskforce at The International Longevity Prof. Dr. VOK

15. The Truth About Aging • The truth is that most older people are more vulnerable due to losses • Physical losses • May not be able to walk, drive, grocery shop, clean house, talk on telephone, see instructions or watch television, etc. • Social losses • Loss of parents, spouse, siblings, friends • Coupled with physical, income, and cognitive, may lose ability to get to and enjoy social activities • Income losses • Retirement • Cognitive losses • Some processing changes and memory loss arenormal • And sadly enough, some people prey on older people’s vulnerability Prof. Dr. VOK

16. Age Discrimination & Health Care • 60% of adults aged 65+ do not receive recommended preventive services • 40% do not receive flu and pneumonia vaccines • Only 10% of elders receive screening tests for • Bone density • Colorectal and prostate cancer • Glaucoma Despite the fact that the average age of colorectal cancer patients is 70, more than 70% of prostate cancer is diagnosed in men 65+, and people over 60 are 6 times more likely to have glaucoma Prof. Dr. VOK

17. Age Discrimination & Health Care • Chemotherapy is underused in the treatment of breast cancer patients aged 65+ even though survival could improve with many • Older patients are significantly underrepresented in clinical trials for all types of cancer but notably in trials for breast cancer • Older persons are the biggest users of prescription drugs, yet 40% of clinical trials between 1991 and 2000 excluded older persons Prof. Dr. VOK

18. Race and Gender Discrimination in Health Care The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization Article in The New England Journal of Medicine, 2/25/99 By Schulman, Berlin, Harless, Kerner, Sistrunk, Gersh, Dube, Taleghani, Burke, Williams, Eisenberg, & Escarce Prof. Dr. VOK

19. Background • There are sex and race differences in terms of the prevalence of heart disease, heart attack, and death from heart attack in mid and later life in particular. • African Americans and women are more likely to die from heart disease and heart attack and also have higher rates of hypertension. • Women and African Americans tend to have greater functional disability due to angina before myocardial infarction as well. • Cardiovascular tests and procedures can help with quality of life and the extension of life. Prof. Dr. VOK

20. Research Question & Methods • Research Question • Does the race and sex of a patient independently influence how physicians manage chest pain? • Methods • Actors portrayed male/female white/black older patients (age 55 and 70) with particular characteristics in scripted interviews about their symptoms • Identical data given to physicians about patients (medical history, results of tests, etc.) • Sample of 720 physicians derived from attendees at two national medical conventions • Computerized survey asked physicians to make recommendations for managing the patient’s chest pain Prof. Dr. VOK

21. Results • Physicians’ mean estimates of the probability of coronary artery disease were lower for women • A sophisticated logistic regression analysis indicated that the odds of women and African American patients being referred for cardiac catheterization was lower than for men or whites • Looking at the effect of the double whammy (sexism and racism), it was found that Black women were significantly less likely to be referred for cardiac catheterization than white men • Some believe that people are most sympathetic to people like themselves; hence, the finding (white male doctors tended to favor or refer white men) • Along these lines, one could ask -- Were the female and Black cardiologists more likely to refer women and African Americans for cardiac catheterization? Prof. Dr. VOK

22. You might ask – but aren’t college-educated younger adults less likely to be prejudiced than others? And finally, you might ask – aren’t nursing students less likely to be prejudiced? Prof. Dr. VOK

23. Study of Standardized Patients • Nursing students • Which patient was ascribed the most negative characteristics? • Which patient was least preferred to work with? • Why? Prof. Dr. VOK

24. Your Beliefs and How They Affect You and Your Treatment of Others • How much control over things do you feel you need to have to be okay, live life as you’d like, and avoid anxiety? • How much control do you think you have over aging and disease? • What impact do you think your notions have on your behavior? • What impact do you think your notions have on the way you view others’ behavior? • What impact to you think your notions have on the way you will treat others who are aging, dealing with health decline, disability, disease, pain and suffering, dying? Prof. Dr. VOK

25. More Examples of Age-Related Vulnerability in Today’s World Out of sight, out of mind? • 14,802 persons, mostly elderly, died in France during a 2003 heat wave • 20% of health care providers were gone, most French families were on vacation • Should government have provided? Should people have not vacationed? Prof. Dr. VOK

26. What is Resilience? The Resilience of Elders of Color The Resilience of Older Women Prof. Dr. VOK

27. Ethnic Minority Distribution of Older Population84.3% of total population 65+ is White and 15.7% are ethnic minorities (8.1% African American, 5.6% Latinos, 2.4% Asian/Pacific Islanders, 0.4% American Indians) Prof. Dr. VOK

28. Ethnicity and Culture • Know definitions of ethnicity and culture • What is “resiliency?” • Why do we even talk about the resiliency of particular groups? • What social forces impact minority elders’ lives? women’s lives? • What interactions does the book say begin to add up and cause stress? • Know what the double jeopardy hypothesis is Prof. Dr. VOK

29. Issues Common AcrossElders of Color • Cumulative structural disadvantages • Low paying jobs, higher poverty rates, more single women • Lower rates of insurance coverage • Sociocultural (structural and family-related) barriers to health care and social service use • Centrality of family/kin • Chronic illness patterns Prof. Dr. VOK

30. Social Forces • How do minority and women elders become “resilient?” • Is the answer to force individuals to become resilient or should we change society? Prof. Dr. VOK