If you've ever caught yourself thinking, "my client's just set in his ways. He's not going to change because he's old" or "therapy isn't as effective for older adults." Then this episode is for you. Because today we are unpacking the hidden biases that even the most seasoned therapists sometimes hold.

So what is ageism? Ageism includes stereotypes, which is how we think, prejudice, which is how we feel, and discrimination, how we act toward others or even ourselves. Based on age. It disproportionately affects older adults. So while we can experience ageism throughout our life, like young adults will often talk about experiencing ageism in the workplace, like being treated differently because they're on the younger side.

However, the The difference is, is that young adults, even though they might experience ageism, especially in the workplace, will age out of an age vulnerable, or a targeted age group, and move into age privilege. Whereas the older we get, the more at risk we are for experiencing ageism, and the more harmful the ageist beliefs on our mental and physical health and I'll share some research on this.

There are different types of ageism. There's structural ageism, which can manifest as denial of access to health care, or having resources like medical services or mental health care rationed due to age. There's exclusion from clinical trials and research studies. Imagine research studies that say, we're looking for participants ages 18 to 64, right? Often. Participants 65 and older are not included in research studies and clinical trials, unless you're looking at dementia disorders. And often there are limited work opportunities.

Even in mental health care, we see ageism in the form of professionals or mental health providers not interested in working with older adults. And sometimes they'll say, I just don't have the training to work with older adults. And that's fair because there's structural ageism even in our training programs and graduate training programs, many do not address the mental health needs of older adults. So why would mental health providers then provide care?

Medicare reimbursement is significantly lower for mental health care than private insurers. And so that also keeps mental health professionals from providing mental health care to older adults by accepting Medicare. And that's because Medicare doesn't reimbursed as well as other insurers.

And for many years. In fact, until 2024, about 40 percent of the mental health workforce couldn't even bill Medicare. So only licensed clinical social workers and psychologists could bill Medicare, not LMFTs or LPCs or LMHCs. And so this is changing. But it's not changing fast enough and still Medicare reimbursement needs to get on board with supporting mental health providers in providing care to older adults. So those are some examples of structural ageism.

There's also individual ageism. This is where we internalize ageist ideas and beliefs into our psyche and then believe them.

I want to introduce you to Becca Levy, who is a public health researcher, the premier researcher on ageism. She's at Yale, and she has done countless studies on the impact of ageism.

She developed a theory called the Stereotype embodiment theory related to ageism, and she suggests that stereotypes like ageism are internalized across the lifespan. So we start to hear ageist ideas about older people very early in toddlerhood children when three years old hear discriminatory terms based on age and these ideas, they come inside and then they operate unconsciously within us and then become internalized and have a significant impact on our health and well being. This impact is especially significant when we become the age that those stereotypes. are about and so it's called the stereotype embodiment theory. And this is where we internalize the beliefs across our lifespan and They operate unconsciously and we start to believe them and then we begin to embody them and then they have a negative impact on us. And so I'm going to share some of Dr.

Levy's research with you today to demonstrate how we embody the negative ageist ideas and how that harms us. So let's look at some of the research.

In 2020, Dr. Levy and her colleagues published a study that looked at 422 international studies related to ageism. And I'm going to look at my computer to tell you what they found so I get it right. They found that in 85 percent of the studies, ageism, was linked to older people being denied access to healthcare treatments.

They also found that in 95 percent of these studies, ageism affected mental health conditions like depression, including increased depressive symptoms over time.

And so let me just ask you if you haven't seen the previous episodes: true or false, depression is normal with aging. The answer is false. Depression is not a normal part of aging. I'll link to other depression resources in the show notes.

Ageism often has us look at aging as a time of loss and despair and decline when in fact, that is not the whole story. There are losses and there can be decline. However, there is also joy and resilience and relationships. There's even research that looks at well being across the lifespan, and I'm going to show you what that research shows now. So here is the U curve of well being. And so years ago, researchers looked at who has the highest rates of well being, and they found that well being is highest earlier in our lives and later in our lives. And that's why they call it the U curve, because you can see the U here. And so This idea that older adulthood is filled with despair and loss and decline and filled with limitations is It's not the whole picture, the whole picture is that older adult can include loss and decline and despair, and it can also include well being, joy and relationships and happiness, and there's also research that shows that the closer we get to the end of our life, the more Older people are able to embrace the meaning of life and a sense of purpose.

And as we see here, well being that we don't become more fearful of death. And as we approach the end of our life, we become less fearful of death. And we put more significant weight on things that are meaningful to us. So this is the U curve of well being and. It's something we need to be paying more attention to rather than all the negative associations we place on aging.

Let me also say that even when people live with mental health conditions, rates of resilience can be very high as well.

So it's not that if you're living with a mental health condition, you don't have well being or you don't have resilience. People living with mental health conditions have high rates of resilience. There was a research study done, I think, across five universities during COVID 19 prior to the COVID 19 vaccine. There was a researcher at UCLA, Helen Labretsky, who collaborated with other large universities in the United States and Canada, and found that Even older adults who were enrolled in mental health care at the time of the COVID 19 shutdown, they found that those older adults demonstrated high rates of resilience.

And she was quoted as saying at that time, we were so surprised at this because by all intents and purposes these older adults were deemed the most vulnerable, so older during COVID 19 prior to the vaccine, people were physically very vulnerable to illness and sadly, death. And yet, the people, older adults who participated in this study, who had pre existing depression, showed high rates of resilience during COVID 19.

So it's not that if you're living with a mental health condition, you also, you lose resilience. Their study showed that even living with a mental health condition, people are whole, vibrant human beings capable of resilience, and I just love that study and that research.

We also see ageism in mental health care in terms of, we heard earlier many mental health providers not getting education or training to, to serve older adults, but also to not even know what's Typical with aging or not typical with aging and so don't have the tools to identify and then recommend mental health care for older adults, so that also interferes with older adults getting the mental health care that they need.

My goal with this program and the Psychology of Aging videocast and podcast is to make sure that you do have the tools to meet the mental health needs of older adults and including our continuing education programs. Which you can access on demand get instant access at any time.

All right, there's also the way that ageism plays out in mental health care is this idea that older adults won't benefit from mental health care because "They're rigid and won't change" I talk about this a lot because this stereotype is so ingrained in us. In fact, older adults do benefit from mental health care. Studies over and over again demonstrate that. And when we don't treat mental health conditions like depression, anxiety, the risk for dementia is significantly higher.

But when we do treat them, The risk for dementia decreases and it's not only dementia that's implicated here, it's other chronic health conditions, it's hospital stays, family strain, caregiving strain, and the risk for suicide and needless suffering. We can address and treat these mental health concerns among older adults.

here's one thing that often happens too, is that ageism is often conflated with ableism, which is bias and discrimination based on ability, and this often happens with older adults who experience experience dementia disorders or have a dementia diagnosis.

And I'll hear many mental health providers say to me, "but the person has dementia. There's nothing I can do to help them". And in fact, that is false. There is so much as mental health providers and therapists. There is so much that you can do to help a person and their family living with dementia and so depression is treatable for people with cognitive impairment and without cognitive impairment Among older age groups and so even adults with dementia benefit from treatment for depression and might look a little different.

You might need some training to address it or help to bridge the family to better care, but there's a lot you can do. And so if you want to learn more about addressing memory loss and your therapy practice, I have a great resource for you. I have a 10 minute video and a workbook on five expert strategies for addressing memory loss in therapy. Simply go to www.mentalhealthandaging.com/clarity. then watch it and use it and use it and share it with your friends.

Now that we've talked a little bit about conflating ageism with ableism we also will say, well, older adults are frail or need help or have dementia or are senile. Like these are all very ageist terms, but they're also very ableist terms terms. We're conflating age with disability, but then we're degrading disability, which is also not cool. And not Ethical or helpful or compassionate or anti ableist and so why this is so important is that when people hold multiple minoritized identities or stigmatized or identities that are discriminated against, like older age, like BIPOC identity, black, indigenous, people of color identity, LGBTQIA plus identity. Socioeconomic status or social class. And what happens is that when people hold multiple minoritized identities, the experience of stress, it's called minority stress, accumulates to create compounded disadvantages for people. And these are not just social disadvantages which are extreme and need to be addressed.

This is also physical health and mental health disadvantages. Meaning that people with multiple minoritized identities face greater risk for poorer health outcomes. Like. Earlier age of death, dementia disorders, and so much more. And so, there's a lot we need to be doing to address ageism, ableism, racism, sexism, LGTBQIA plus phobia.

We need to be doing more to create pro aging, pro BIPOC, pro fill in the blank communities. And healing spaces.

Here's another reason why this is so important by 2030, there will be more older adults, then more people 65 and older than children under the age of 18. But did you know that by 2030, the older white population will increase by 39%. Whereas older BIPOC population will increase by 89%.

We're becoming a more diversified society, which is fabulous. And by 2050, it's projected that BIPOC individuals, remember BIPOC standss for black, indigenous, and people of color. Will comprise more than 42 percent of the population 65 and older. And so we need to be working toward anti ageism and anti racism and anti oppression in all of its forms to create healthy aging for everybody.

And if that's not enough of a statistic for you, I want to share another graph that shows the experience of discrimination based on race when seeking health care. So I'm going to share my screen and show you a graph from the Alzheimer's Association, which Of late has been doing a great job demonstrating the impact of racism on the health and well being and risk for dementia among BIPOC individuals.

So in this graph from the Alzheimer's Association report from 2021, they show the percentage of U. S. adults who have experienced racial or ethnic discrimination when seeking health care. And you'll see the mint is from time to time, and the purple on the bar is regularly. And so you see that black Americans identify that close to 50 percent of black Americans surveyed reported that either regularly or from time to time, they are experiencing discrimination when seeking health care, and then Native Americans, Hispanic Americans, Asian Americans, and white Americans.

And here's why this is so important, mental health providers are seen as part of the health system and BIPOC individuals have also experienced significant discrimination when seeking mental health care. And so we have a lot of work to do in repairing the experiences of discrimination for BIPOC individuals, and also for creating more age inclusive, culturally inclusive, Racial and ethnically inclusive spaces.

So if you're working in higher education and graduate programs, what are your recruitment efforts in recruiting BIPOC students, LGTBQIA plus students age diverse students, et cetera.

So how do we do better? So how do we address our ageism? And some of the principles to address our ageism can also be applied to addressing our racism or sexism or LGBTQIA plus phobia. So here are some ways to address ageism.

One is to identify and evaluate your own biases. Do you look at older adults dancing and think they're so cute? Or your older patient who's not making progress in therapy and think it's because they're old?

One example of ageism there is to infantilize older people by calling them cute or to attribute lack of change to age. Of course, people don't change because they're older, people don't change because change is hard. Most people struggle with change.

The second is to engage in perspective taking, you know, this idea of walking a mile in somebody else's shoes. This takes a lot of curiosity and Creativity to do this in your mind and and also it takes the ability to identify if you're projecting your own fear or dread or ideas of what it means to grow older in the experience of perspective taking and so beyond perspective taking I like this idea that I call shifting your focus and so this means shifting from the way that you look at older people.

So, if I am spending a lot of time with older adults in the hospital setting or at end of life, that's not the experience of most older adults. Most older adults are not in the hospital and not at end of life. And so, if my world and exposure to older people is mostly that, then I have to remind myself to, to broaden my lens, to zoom out and look around for older adults who are thriving in the community.

That's one way to shift your focus.

Another way to shift your focus is to look at older adults who defy the stereotype, the counter stereotype. And so, if you're on Instagram, this could be older adults who are working out, weightlifting, running having healthy relationships with their children.

Being totally independent, even while using assistive devices, thriving, being joyful, even when getting medical care. These ideas of older adults who are defying the stereotype, counter the stereotype. These are two ways to shift your focus when it comes to changing your perspective around. What it means to age.

In mental health care. Our older clients are also riddled with these messages about aging as well. They also have had a lifetime of internalizing negative messages about aging. And so in psychotherapy or in your work with older adults, it can help to remind older adults of resiliency. Like, for example, 90 percent of older adults have experienced a traumatic event and 50 percent of them experience post traumatic growth and probably all of them have some resilience.

And so you can focus on also highlighting resiliencies and growth. In spite of, or because of, the hardship. Also, one of the psychotherapies that's evidence based for working with older adults is solution focused or problem focused psychotherapy. Where you work with the older person on identifying where else did they have challenges in their life, and what tools did they have within themselves to solve the problems, and move through those challenges. And then how can you use that now at this, challenging time in your life if you're working in psychotherapy through a challenge. And so, there are ways to do that, to incorporate anti ageist perspectives in your therapy practice as well. And then, when you hear people say, what can I do with them, they're X age, or what can I do with them, they have dementia, you can challenge that thinking.

Those are some ways to challenge your ageist ideas, and we all have them. So you're not a bad person if you have them, you're a human if you have them, because we're all socialized to be ageist and have ageist ideas. But we don't all take the next step to challenging the ageist ideas and creating more inclusive communities where People feel safe and that they have a sense of belonging. And so I invite you to take that next step. I also have a continuing education course where I dive deeper into the research on the impact of ageism on physical and mental health and what you can do to change it. I'll put a link to it in the show notes

My goal is to equip you with tools and resources to meet the mental health needs of older adults. Because it is only with your help that we can meet the mental health needs of older adults.

So thank you for being here and doing your part.