Abstract:
The world has experienced an unprecedented increase in average life expectancy and population aging—a revolution in longevity that brings both opportunities and challenges. And for many older adults, aging brings impairments that cannot be avoided. As such, society must deal with a new demographic reality, yet the response is hindered by ageism and ableism, and the risks and indignities are greatest for those who live where those “isms” intersect. This article discusses ageism and ableism, the steps to take to address each of them, and suggests what advocates for older and disabled persons can learn from one another.
Key Words:
ableism, advocacy, ageism, elder’s rights, disability, discrimination
As of 2015, the number of adults older than age 60 was 906 million worldwide, representing 12.3% of the world population, and the United Nations (UN) has projected that by 2050, 1 in 6 people in the world will be older than age 65 (Population Division, 2019).
Not all older persons are disabled, nor is disability limited to older people, but the intersectionality of age and disability is an area of focus that will only grow in importance in years to come. The proportion of people with disabilities worldwide has been reliably estimated to be around 1 in 6, and according to a UN report from 2018, more than 46% of older persons worldwide have an impairment (250 million experience moderate to significant impairments; Population Division, 2018). Also, older adults represent the majority of the population of persons with disabilities (Population Division, 2018, p. 48).
The world has experienced an unprecedented increase in average life expectancy and population aging, a revolution in longevity bringing opportunities and challenges that will be influenced and impeded by ageism. According to the World Health Organization (WHO; 2021):
“Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) directed towards people on the basis of their age. It can be institutional, interpersonal or self-directed. Institutional ageism refers to the laws, rules, social norms, policies and practices of institutions that unfairly restrict opportunities and systematically disadvantage individuals because of their age. Interpersonal ageism arises in interactions between two or more individuals, while self-directed ageism occurs when ageism is internalized and turned against oneself.”
The Impact of Structural Ageism
All the levels of ageism mentioned above are important to understand; however, elders’ rights movements correctly focus a good deal of attention on institutional ageism, often called “structural ageism.”
According to Becca Levy (2022), “[s]tructural, or institutional, ageism is not only one of the most potent forms of bias that exists today, but also one of the least acknowledged.” She quoted a 2021 report by the WHO that concluded, “Often people fail to recognize the existence of such institutional ageism because the rules, norms and practices of the institution are long-standing, have become ritualized and are seen as normal.”
Ryan Backer and Iggy Chang (2022) explained that ageism at the structural level operates in the form of discriminatory social policies. These are macro-level policies and practices, such as reliance upon the concept of “dependency ratios,” which discriminate against or restrict resources and opportunities for older persons while promulgating unsupported stereotypes that older persons do not contribute to the economy. And prejudicial norms against older persons propagated by societal institutions “can also include age-based biases of individuals who are part of these larger societal institutions, such as policy makers or health care providers” (Backer & Chang, 20220, pp. 48–49).
Backer and Chang (2022) noted that structural ageism impacts the lives of older persons in a number of ways beyond the well-documented injurious health effects, including unjustified exclusion from day-to-day activities of life, creation of a hostile and invalidating social environment, and promulgation of negative age beliefs among older persons themselves that ultimately lead to adverse health, behavioral, and quality of life outcomes.
Backer and Chang also pointed out that ageism often works side by side with ableism, making it difficult to distinguish between the two. Ableism has been defined by the Center for Disability Rights (n.d.) as “a set of beliefs or practices that devalue and discriminate against people with physical, intellectual, or psychiatric disabilities and often rests on the assumption that disabled people need to be ‘fixed’ in one form or the other.”
‘Ageism often works side by side with ableism, making it difficult to distinguish between the two.’
The Law Commission of Ontario (2023) described ableism as: “a belief system, analogous to racism, sexism, or ageism, that sees persons with disabilities as being less worthy of respect and consideration, less able to contribute and participate, and of less inherent value than others” (p. 100).
An article in Medical News Today (Villines, 2021) noted that examples of ableism range from blatant hostility and aggression to less obvious everyday interactions. At the individual level this can include: asking someone what is “wrong” with them; saying, “you don’t look disabled,” as though this is a compliment; viewing a person with a disability as inspirational for doing typical things, such as having a career; assuming a physical disability is a product of laziness or lack of exercise; using public facilities such as parking spaces or toilets that are for people with disabilities; questioning whether a person’s disability is real; using ableist language (“dumb” and “lame”); and misusing words in ways that trivialize impairments (e.g., “I am so OCD.”).
In addition to the personal insults that people with disabilities must endure alongside constant exclusion and underestimation, they also must cope with and attempt to overcome structural ableism.
Writing in Forbes in 2021, Andrew Pulrang observed, “even after decades of progress against ableism, people with disabilities still face significant barriers to social inclusion, equal opportunity, health and safety, and financial security … [and] … while some of the most visible efforts to continue the fight focus on changing ableist habits and attitudes, the most harmful and persistent barriers disabled people face are still distinctly structural.”
Claudia Mahler, the current UN independent expert on the enjoyment of all human rights by older persons, noted, “ableism, a value system that considers certain characteristics of body and mind as essential to live a life of value, is often conflated with ageism,” and that, “older persons with disabilities may have access to fewer or different services, experience age cut-offs for disability benefits and personal assistance, and face an increased likelihood of institutionalization compared with their younger peers with disabilities” (Mahler, 2021, p. 11).
Mahler (2021) conceded that the biological process of aging includes an increased likelihood of disability; however, she expressed concern that seeing ill health as a symptom of older age instead of as a medical condition that merits treatment leads to older persons being excluded from appropriate healthcare services including preventive screening, surgical treatment, rehabilitation services, and organ transplant.
Catalina Devandas-Aguilar, who from 2014 to 2020 served as the first U.N. special rapporteur on the rights of persons with disabilities, also discussed the intersectionality of aging and disability, noting that “given that the number of persons over the age of 80 years is expected to more than triple by 2050, the correlation between the ageing population and increased rates of disability is very clear” (Devandas-Aguilar, 2019, para. 4).
She wrote that “although ageism and ableism share common roots and consequences, inequality in older age is not the mere result of ableist biases … [and] … ageism—the stereotyping of, and prejudice and discrimination towards, older people and older age—is a distinct form of oppression that affects older persons, including older persons with disabilities.”
According to Devandas-Aguilar (2019), “while disability is increasingly understood as a social construct, inequalities due to old age are predominantly seen as ‘natural’ or ‘inevitable,’ ” which leads to “older persons with disabilities [being] discriminated against and disadvantaged not just because they have a disability, but also because of stereotypes about older people” (para. 7).
Combating Ableism and Ageism
In the January–February 2023 issue of Generations Today, Ashton Applewhite (2023) noted, “The intersection of ageism and ableism is where many of our darkest fears reside. Illness. Incontinence. Indignity.” She added, “it’s also where we encounter—in direct proportion to those fears—the potential for personal liberation and collective activism.”
Indeed, the prescriptions for combating ableism and ageism are strikingly similar and it is clear that activists for people with disabilities and older persons can learn a great deal from one another. For example, the above-referenced article in Medical News Today called for an extensive campaign to combat ableism at the individual and structural levels that would include “learning about disability—what it means and how it affects people … learning about ableism, ableist stereotypes, and the history of disability rights activism … listening to people with disabilities share their experiences … challenging ableism as it happens, for example, by correcting a myth or stopping bullying … giving people with disabilities a platform, or “passing the mic,” instead of speaking for them … advocating for accessibility and inclusivity … [and] … enacting policies or laws that counter ableism” (Villines, 2021).
‘Ageism challenges people who are much younger and appears to be getting worse, no thanks to the wicked turn of tone in the media world.’
At the same time, there is a growing consensus on the key elements of an effective campaign against structural ageism. At the national level, the focus is on identifying and combating discriminatory social policies, prejudicial social norms, and countries, by protecting the economic rights of older persons through pension-reform laws and raising retirement benefits of workers, recognizing and protecting the social rights of older persons through national policies that include healthy aging as a priority policy, protecting the civil rights of older persons by enacting and enforcing laws and policies to prevent discrimination against older workers, and protecting the political rights of older persons through constitutional-level protection against age discrimination (Chang et al., 2021).
In its Global Report on Ageism issued in 2021, the WHO called for policies and laws that address age discrimination and inequality, educational interventions to reduce ageism across all levels and types of education, support for intergenerational contacts between people of different generations, and improving data and research to achieve a better understanding of ageism (pp. xv, xvii–xviii). Issues relating to older persons have been integrated into the generic international human rights framework and emerging regional human rights legal systems and there has been recognition of the fact that the special circumstances of older persons should be taken into consideration when developing social and economic policies.
There also is a growing consensus regarding the need for explicit recognition of the specific rights of older persons in the form of an international convention or treaty that would raise the profile of the issues, serve as a basis for action in different contexts, and empower advocates and members of that group to act. The UN Convention on the Rights of Persons with Disabilities has often been mentioned as a valuable framework for the proposed, but long delayed, UN Convention on the Human Rights of Older Persons.
The battle for dignity and realization of civil and human rights is difficult for people with disabilities and older adults, and even harder for those who fall within both groups. The observations of Devandas-Aguilar (2019) are informative:
“The age at which people experience disability influences their sense of identity as well as societal perceptions of them. Those who acquire impairments when older seldom self-identify as persons with disabilities and are more likely to perceive the decline of their physical and cognitive functioning as a “normal” part of ageing. For people who acquired impairments earlier in life and have grown old, older age is a secondary identity; they may therefore have very different expectations about older age.
“These distinct individual experiences and perceptions are also reflected in the ways in which the disability and the aging communities address the intersection between aging and disability. Although both movements are beginning to have increased exchanges, in general they continue to address the situation of older persons with disabilities differently: while the disability rights community often does not adequately reflect the interests and challenges faced by older persons, the older persons’ movement often fails to understand and apply the human rights–based approach to disability. Consequently, older persons with disabilities frequently fall through the cracks” (para. 6).
Regrettably, too many people can truthfully say something like the following about their day-to-day lives: “It’s not age (disability) that stops me, its ageism (ableism).”
While the numbers above use traditional retirement ages, such as 60 or 65, to measure the size of the group that might be vulnerable to ageism, the reality is that ageism challenges people who are much younger and appears to be getting worse. Some of this can be credited to the wicked turn of tone in the media world, even as it becomes clear that the future is a society in which older persons will be a permanent part of demography and society.
I am in my late 60s and ageism has become a daily hurdle for me, even though I like to think I’m in good health and more engaged than ever in my professional interests. The ugliness of ableism has become apparent to me as I help my wife navigate her day-to-day world and, because she is the same age as me, she must put up with the indignities that abound at the intersection of ageism and ableism which, not surprisingly, are far worse for women.
We cannot settle for this. We must do better, and I hope this Generations Journal issue contributes to the cause that should be taken up by and on behalf of older persons with disabilities and those who care for them.
Alan S. Gutterman, PhD, JD, CPG, is the founding director of the Older Persons’ Rights Project in Oakland, CA, author of Ageism and Disability (Older Persons’ Rights Project, 2023), and a member of the Policy Committee of the American Society on Aging.
Photo credit: Shutterstock/WiPhotoHunter
References
Applewhite, A. (2023). Ageist? Ableist? Who, me? Generations Today (January–February 2023). https://generations.asaging.org/ageist-ableist-who-me
Backer, R., & Chang E. (2022, May). “Ageism” in moving toward antibigotry: Collected essays from the Center for Antiracist Research’s antibigotry convening. Boston University Center for Antiracist Research. https://www.bu.edu/antiracism-center/files/2022/06/Moving-Towards-Antibigotry.pdf
Center for Disability Rights. (n.d.). #Ableism [Webpage]. https://cdrnys.org/blog/uncategorized/ableism/
Chang, E.-S., Monin, J. K., Zelterman, D., & Levy, B. R (2021). Impact of structural ageism on greater violence against older persons: a cross-national study of 56 countries. BMJ Open, 11(5). http://dx.doi.org/10.1136/bmjopen-2020-042580
Devandas-Aguilar, C. (2019, July 17). Rights of persons with disabilities: Report of the special rapporteur on the rights of persons with disabilities. Presented to UN General Assembly, 74th session, 17 July 2019. https://documents-dds-ny.un.org/doc/UNDOC/GEN/N19/221/53/PDF/N1922153.pdf?OpenElement
Law Commission of Ontario. (2023). Persons with disabilities: Final report–September 2012. https://www.lco-cdo.org/wp-content/uploads/2012/12/persons-disabilities-final-report.pdf
Levy, B. (2022, Feb. 9). The role of structural ageism in age beliefs and health of older persons. JAMA Network Open, 5(2), e2147802. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788860
Mahler, C. (2021). Report of the Independent Expert on the enjoyment of all human rights by older persons, Claudia Mahler. Presented to UN Human Rights Council, 48th session, 13 September–1 October 2021. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G21/215/63/PDF/G2121563.pdf?OpenElement
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Pulrang, A. (2021, June 14). Fighting ableism is about much more than attitudes and awareness. Forbes.com. https://www.forbes.com/sites/andrewpulrang/2021/06/14/fighting-ableism-is-about-much-more-than-attitudes-and-awareness/?sh=405638b219c0
Villines, Z. (2021, November 8). What is ableism, and what is its impact? Medical News Today. https://www.medicalnewstoday.com/articles/ableism
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