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From The Editor

Editor's Message: The Journal as a “Change AGEnt”: Using Language, Framing, and Emphasis to Combat Ageism

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Journal of Geriatric Physical Therapy: July/September 2022 - Volume 45 - Issue 3 - p 115-116
doi: 10.1519/JPT.0000000000000361
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Ageism is infused in how we think about (stereotypes), how we feel about (predjudice), and how we act toward (discrimination) people based on their age.1 Although ageism can be directed at younger people, in this message I use the term to reference thoughts, emotions, and behaviors related to older adults. Ageism exists in society at large, institutions including health care and academia, interpersonal relationships including health care providers and clients, and individuals including older adults. When older adults are also members of other groups that face discrimination based on sex/gender, race/ethnicity, and ability/disability, ageism is compounded.

The negative health consequences of ageism are many, with adverse effects on physical health, mental health, cognitive function, recovery from illness/disability, quality of life, longevity, and health care costs to individuals and society.1 To wit, ageism is very harmful on multiple levels and should be eliminated. The United Nations declared 2021-2030 as the Decade of Healthy Aging and, in collaboration the World Health Organization, identified 10 priorities to improve the health and well-being of older adults worldwide.2 Priority #8 is to implement a global campaign to combat ageism by shifting social norms, ending misconceptions, and dismantling discrimination. Evidence-based strategies to counter ageism do exist and should be implemented. It is well beyond the scope of this message to summarize these strategies, but here I address one strategy of particular relevance to written media, and by extension to this Journal. That strategy is framing.

A “frame” is a conceptual mental structure that shapes the way we see the world.3 For example, the frame for the term “hospital” might include a set of concepts such as ambulance, doctors, nurses, surgery, medications, wheelchair, etc. Language, especially metaphors, can evoke a frame, which triggers related thought patterns and emotions; these influence subsequent decisions and actions. Framing is communicating in a manner intended to activate unspoken ideas and associations that are connected to our values.4 The choices we make about what we say and how we say it affect the attitudes, understanding, and behavior of the listener/reader.

To combat ageism, we need to intentionally and effectively communicate in ways that counter negative stereotypes and create more positive attitudes about aging. Research shows that using negative aging metaphors such as “over the hill” evokes thoughts of inevitable decline and feelings of dread, while positive aging metaphors such as “building momentum” evoke thoughts of force, energy and forward motion, and feelings of hope and possibility.5 The motto of APTA Geriatrics, “Age On!” captures this sense of building momentum.

This Journal adheres to the American Medical Association's AMA Manual of Style (11th Edition), which rejects the use of terms with negative aging connotations such as “aged,” “elder,” “elderly,” “seniors,” and “senior citizens” and recommends the use of neutral terms such as “older individuals,” “older adults,” “older people,” “older population,” etc.6,7 Ideally, these neutral terms should be followed by specific information about the study population, for example, age range, average or median age, etc. Terms that depersonalize, for example, “subjects,” “diabetics,” “patients” (unless the participants are actually hospitalized), “residents,” etc, are also rejected, and the use of person-first language is required, for example, “older women with diabetes,” “community-dwelling older adults,” etc. Language that implies helplessness is likewise avoided (“suffering from arthritis,” “victims of neglect,” etc), with more neutral wording preferred (“diagnosed with arthritis,” “experienced neglect,” etc). Terms that infer subservience to authority such as “noncompliant” should be replaced with wording that reflects mutual respect between equals.

Expert recommendations for framing aging positively from “Gaining Momentum: A FrameWorks Communications Toolkit”8 go even further. Authors should avoid terms that imply that the growing population of older people is a burden, disaster, or catastrophe that cannot be adequately managed (“silver tsunami,” “overwhelming costs,” etc) and use language that affirms the positive aspects of these changing demographics, such as “As Americans live longer and healthier lives, we need to modify....” Language suggesting that aging outcomes are solely the result of individual choices should be replaced with alternative wording that emphasizes the concurrent role of social contexts and social determinants of health and well-being. Lastly, use values rather than just data to demonstrate that the topic of study is a matter deserving attention, and convey the sense that it is feasible to adapt to this population shift and meet the needs of older adults.

While it is imperative to counter the social stereotype that all older adults are frail, forgetful, and functionally limited, on the health care front, clinicians, educators, investigators, and authors must nonetheless be able to talk and write honestly about older adults who are genuinely frail, do have cognitive impairment, or have become functionally dependent. Geriatric health care providers are in fact “especially fitted”9 to serving older people with these conditions. We have to be able to speak and write truthfully about these individuals and groups that exist within the larger older adult population, without reinforcing negative stereotypes and perpetuating ageism. The lived experiences of older adults with disease and disability include loss and, often, sadness and grief about those losses. Recommendations for language and framing that recognizes and respects the realities of these aspects of aging are also needed. What are the best ways to convey that a meaningful life can be lived despite loss of vigor, memory, or independence? That growing older will present new challenges, and older adults deserve expert, person-centered care to support their health, well-being, and quality of life as these challenges arise.

Current recommendations on framing frailty9 are primarily directed toward those advocating for improved policies and programs in the social services context. As a journal editor, I welcome recommendations targeted to clinicians, educators, investigators, and authors. Authors Bowman and Lim10 offer specific suggestions to avoid ageist language in aging research,10 many of which are helpful. Expert guidance on what to say and how to say it within professional health care and academic contexts may improve our ability to clearly convey our values and better combat ageism.

—Leslie K. Allison, Editor

REFERENCES

1. World Health Organization. Global report on ageism: executive summary 2021. Accessed May 7, 2022. https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/global-report-on-ageism
2. Rudnicka E, Napierała P, Podfigurna A, Me˛czekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020;139:6–11. doi:10.1016/j.maturitas.2020.05.018
3. Lakoff G. Don't Think of an Elephant! Know Your Values and Frame the Debate. 1st ed. Chelsea Green Publishing; 2004.
4. Dignam J. Frame the Debate: Insights From Don't Think of an Elephant! Accessed May 7, 2022. https://commonslibrary.org/frame-the-debate-insights-from-dont-thinkof-an-elephant
5. Sweetland J, Volmert A, O'Neil M. Finding the Frame: An Empirical Approach to Reframing Aging and Ageism. FrameWorks Institute; 2017. Accessed May 5, 2022. https://www.frameworksinstitute.org/wp-content/uploads/2020/05/aging_research_report_final_2017.pdf
6. The AMA Manual of Style Committee. Correct and preferred usage. In: AMA Manual of Style: A Guide for Authors and Editors. 11th ed. Oxford University Press; 2020.
7. Lundebjerg NE, Trucil DE, Hammond EC, Applegate WB. When it comes to older adults, language matters: Journal of the American Geriatrics Society adopts modified American Medical Association style. J Am Geriatr Soc. 2017;65(7):1386–1388. doi:10.1111/jgs.14941
8. FrameWorks Institute. Quick start guide. In: Gaining Momentum: A FrameWorks Communications Toolkit. FrameWorks Institute; 2017. Accessed May 6, 2022. https://www.frameworksinstitute.org/wp-content/uploads/2020/05/aging_bp_quickstart.pdf
9. Lynn J. Language matters, so geriatricians should talk of declining health and death. J Am Geriatr Soc. 2017;65(12):2742–2742. doi:10.1111/jgs.15155
10. Bowman C, Lim WM. How to avoid ageist language in aging research? An overview and guidelines. Act Adapt Aging. 2021;45(4):269–275. doi:10.1080/01924788.2021.1992712
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