Monthly Archives: April 2016

The Intersection of Ageism and Health Status

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Shannon Patterson, M.Ed.

By Shannon Patterson, M.Ed.

Dr. Robert Butler first used the term “ageism” in 1969 to describe a type of bigotry displayed by middle-aged adults toward older adults in a public housing setting; later, it was defined as “a process of systematic stereotyping of and discrimination against people because they are old” (Butler, 1975). Ageism is referred to as the third great ism within the United States, following racism and sexism. It differs from the other “isms” in that: 1) everyone may become a target of ageism if they live long enough, and 2) people often deny, or are unaware of their ageist attitudes because it is a newer and more subtle concept (Palmore, 2004). Further, the multiple dimensions of ageism make it easier for us to unknowingly engage in behaviors that may threaten the autonomy of the older adults with whom we work.

We are largely familiar with the concept of ageism and research demonstrating the detrimental influence it has on both the mental and physical health of older adults. However, fewer of us may be aware of the ways in which our clients’ health statuses may interact with their age to produce bias in the counseling relationship. “Healthism” (Gekoski & Knox, 1990) is a term used to describe negative attitudes and stereotypes toward individuals in poor health or with visible chronic health conditions. Research indicates that bias toward an individual’s visible health status may accompany and even amplify ageism to produce ageist attitudes and behaviors toward older adults within the context of a counseling relationship (Messier, 1998; Patterson & Caskie, 2015). As clinicians who are taught to conceptualize our clients using a multicultural framework, we would label this as intersectionality.

The early introduction of the concept of intersectionality within my graduate program contributed to my understanding of the unique ways in which older adults may be oppressed by their visible health status and gender. For instance, I learned that older women are more likely to be the target of patronizing talk in long-term care settings, and that this may be further exacerbated by a visible chronic health condition or “frailty” (Nussbaum, Pitts, Huber, Krieger, & Ohs, 2005). My experience working as a certified nursing assistant (CNA) prior to my graduate training exposed me to this communication style. As my self-awareness grew during my time as a counseling psychology trainee in a nursing home, I noticed my own communication tendencies. For example, my voice became louder and slower when interacting with older adults, regardless of whether or not I knew they were hearing impaired. I also observed the language and voice intonation that nursing home employees used when talking to residents with severe visible health conditions.Why hello there, young lady; hi sweetie!” I began to realize that the actions in which I engaged without hesitation as a CNA—such as, offering to do tasks for my clients with visible chronic health conditions to save time for both of us—maintained the efficiency of my previous routine, but inadvertently decreased my respect for their autonomy. Further, as a novice trainee, my positive ageist attitudes (i.e., “They’re older, so they’re wiser—who am I to question their belief?”) often prevented me from challenging my clients.

Those of us who have served older adults in other capacities must be aware of the ways that these experiences may shape our own negative and positive biases in addition to influencing the way we conduct psychotherapy.  As professionals who choose to work with older adults, we are not likely offenders for traditional displays of negative ageist attitudes and behaviors; however, the intersection our clients’ physical health vulnerabilities and advancing age may increase the likelihood of us displaying more subtle behaviors that hinder our clients’ self-efficacy, self-esteem, and personal growth.  As counseling psychologists, we are uniquely prepared to address this dynamic in our psychotherapy sessions and at the systemic level within the organizations in which we work and study.  Our age and, quite possibly, our health statuses are demographic variables that change over our lifetime. We are fortunate to be members of a profession that encourages us to reflect on the ways in which our changing demographics can positively influence the therapeutic process and our clinical presence.


  • Butler, R.N (1969). Ageism: Another form of bigotry. The Gerontologist, 9, 243-246.
  • Butler R.N. (1975). Why survive? Being old in America. Harper & Row, New York.
  • Gekoski, W.L., & Knox, J. (1990). Ageism or Healthism? Perceptions based on age and health status. Journal of Aging and Health, 2(1), 15-27.
  • Messier, S.H. (1998). Ageism and healthism in diagnosis and prognosis by practicing psychologists: An analogue study. Dissertation Abstracts International: Section B: The Sciences and Engineering, 58(9-B).
  • Nussbaum, J. F., Pitts, M. J., Huber, F. N., Krieger, J. L. R., & Ohs, J. E. (2005). Ageism and ageist language across the life span: Intimate relationships and non-intimate interactions. Journal of Social Issues, 61(2), 287–305. doi:10.1111/j.1540-4560.2005.00406.x
  • Palmore, E.B. (2004). Research note: Ageism in Canada and the United States. Journal of Cross-Cultural Gerontology, 19, 41-46.
  • Patterson, S., & Caskie, G. (2015). Client Health Status as a Moderator of Relations between Trainee Personal Characteristics, Ageism, and Clinical Bias.  Paper presented at the 2015 Gerontological Society of America’s Annual Scientific Meeting, Orlando, FL.

About the Author

Shannon Patterson is a counseling psychology doctoral candidate at Lehigh University and alumna of University of Wisconsin-Madison.  She will be completing her pre-doctoral internship in Health Psychology at the Phoenix VA Health Care System during the 2016-2017 training year. Shannon currently serves as the student representative for Psychologists in Long-Term Care (PLTC), and looks forward to continuing to unite her interests in Geropsychology and Health Psychology in professional practice.

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