Ageism and other forms of stigma

From Chapter 1: Introduction in Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

In North American society, most of our attention and resources are focused on younger people while older people tend to be marginalized and undervalued. Older adults may experience prejudice, stereotyping and discrimination simply because they are perceived or defined as “old” (American Psychological Association, 2004). They may be treated as invisible or worthless or seen as a drain on society.

The term ageism refers to attitudes about older people and their abilities. Age discrimination is a consequence of ageist attitudes. Ageism affects the individual and also the availability and design of programs and services, which may result in the absence of community resources to meet the needs of older adults. Services designed for adults in general may not recognize or accommodate older people’s needs and issues, while services that are specific to older adults are often scarce and underfunded. Intentional and unintentional discrimination against older adults is commonplace in many service delivery areas (Ontario Human Rights Commission, 2001).

Stigma affects people of all ages with substance use, mental health and gambling problems. Stigma refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward others. The impact of negative staff attitudes or behaviour, whether purposeful or unconscious, can adversely affect the services and care that people receive. Older adults have had many years to absorb this stigma, shame and loss of self-worth, and they may have come to believe that the many forms of discrimination they may experience in later life are warranted (Baker, 2006). When ageism is added to the mix, the burden of the stigma of having a substance use, mental health or gambling problem is multiplied (Centre for Addiction and Mental Health, 2005).

Ageism and other forms of stigma create barriers

Certain attitudes and expectations can undermine the response of people working with older adults. Services might be withheld or denied when service providers or the policies of their agencies deem older adults to be:

• taking up space that should go to “more deserving” patients or clients
• unable to qualify for certain services (e.g., home care, personal support, mental health or addiction services) until they get help for their mental health, substance use or gambling problem
• inflexible and unable to change
• non-compliant when they refuse services that they feel are not appropriate to their needs or that do not match their priorities.

Older people with substance use problems can be caught in a “revolving door” of going to emergency, being bounced between medical and social services or being denied services. They may be shunned and shamed (e.g., referred to as an alcoholic or a drunk), treated as invisible and ignored, or given less latitude and treated with less respect than other people. Older people with mental illness often receive poor quality treatment and care. They may be marginalized within systems, “warehoused” outside the health care system or institutionalized unnecessarily. They may also experience poor quality of life and material and financial inequity (World Health Organization and World Psychiatric Association, 2002). People with dementia may be written off as being unable to enjoy any aspect of life; depression can be judged as mere laziness. How gambling problems might develop in later life may be hard for some service providers to understand; the person may be seen as foolish or greedy and deserving of whatever happens to him or her, rather than as someone who needs help.

Older adults may internalize society’s ageist attitude and feel further shame about their mental health, substance use and gambling problems. Ageism and other forms of stigma lower self-esteem and prevent older adults from seeking or receiving help from appropriate services. Older adults may avoid seeking help because they:

• don’t see themselves as having a problem
• feel they should be able to deal with their own problems and not ask for help
• may not know that help is available or know where to find it
• feel ashamed and want to hide their problems
• want to protect their family’s reputation
• fear repercussions (e.g., legal problems, being placed in a home)
• have experienced disrespect from service providers
• find few or no services targeted at older adults in their area
• feel hopeless that the situation can be improved
• don’t see themselves as deserving help.

• Print Bookmark