Journal of Social Issues, Vol. 72, No. 1, 2016, pp.

86--104
doi: 10.1111/josi.12157

Ageism can be Hazardous to Women’s Health:

Ageism, Sexism, and Stereotypes of Older Women
in the Healthcare System
∗
Joan C. Chrisler , Angela Barney, and Brigida Palatino
Connecticut College

Women tend to live longer than men, and thus typically have more interactions
with the healthcare system in old age than men do. Ageism and stereotypes of
older people in general can have an important impact on elders’ physical and
mental health and well-being. For example, internalized negative stereotypes can
produce self-fulfilling prophecies through stereotype embodiment and contribute
to weakness and dependency. Ageist beliefs and stereotypes can interfere with
health care seeking as well as with diagnosis and treatment recommendations;
they can, for example, contribute to gender disparities in the health care of older
adults if older women are perceived as too frail to undergo aggressive treatments.
Ageism also results in disrespectful treatment of older patients, which is commu-
nicated through baby talk and other forms of infantilization or the shrugging off of
patients’ complaints and concerns as “just old age.” Intersectional identities can
result in a cumulative burden for older women patients who may have a history
of disrespectful treatment for other reasons (e.g., sexism, racism, bias against
lesbians). Reduction of ageism and sexism and promotion of more realistic and
diverse views of older women could improve doctor–patient relationships, facili-
tate adherence to treatment regimens, and reduce disparities in health and health
care.

Women make up the majority of elders, and their percentage of that popu-
lation group increases with age. There are 82 men for every 100 women in the
“young-old” group (ages 65–74), 65 men for every 100 women in the “old” group
(ages 75–84), and 41 men for every 100 women in the “old-old” group (ages 85
and over) (http://transgenerational.org/aging/demographics.htm). Yet, despite the

∗ Correspondence concerning this article should be addressed to Joan C. Chrisler, Depart-

ment of Psychology, Connecticut College, New London, CT 06320. Tel.: 1-860-439-2336 [e-mail:
[email protected]].
86

C 2016 The Society for the Psychological Study of Social Issues
Ageism can be Hazardous to Women’s Health 87

numerical prominence of older women, there has been little interaction between
the fields of women’s studies and gerontology (Bookwala, 2015; Calasanti &
Slevin, 2001, 2006); social and health psychologists also have paid less attention
than is needed to older women’s issues (Freixas, Luque, & Reina, 2012; Sugar,
Anstee, Desrochers, & Jambor, 2002), despite the potential for ageism and sexism
to intertwine and impact older women’s health and well-being. Because of the
paucity of literature concerning ageism, sexism, and women’s health, we discuss
research and theory about elders in general and speculate about its impact on
women, and we discuss the available research about older women and subgroups
of older women (e.g., women of color, lesbians). We conclude with a call for
additional research on older women’s health and suggest policy recommendations
to improve older women’s health and well-being.

Ageism and the Double Standard of Aging

Evidence of ageism is all around us in popular culture, public policy debates,

and both popular and professional discourse. For example, public policy debates
about (and media coverage of) the increasing numbers of elders frame living longer
as a social problem; comments are made about deadwood, “old farts,” the “burden”
of aging, and “greedy geezers,” as younger people see elders as an “unproductive”
drain on resources (Gullette, 2004). Politicians have attempted to turn young
adults against elders by warning about “the gray tsunami” that will deplete funding
for pensions and programs such as Social Security and Medicare in the United
States, leaving nothing behind for generations that follow. Jokes about “old timer’s
disease” and “senior moments” suggest that all elders have cognitive deficits. The
medicalization of aging (aka “longevity medicine”; Calasanti & Slevin, 2001,
2006) has produced “antiaging” products and cosmetic procedures and surgeries
designed to erase evidence of age so that people can “pass” as younger than they
are (Ostenson, 2008). Euphemisms for elders are also common; “senior citizens,”
“golden agers,” and “pensioners” are used by many, and elders are typically
referred to as “aging” or “older” rather than “old.” Of course, everyone alive is
aging, and we are all older than we were yesterday, yet those terms, although not
appropriately descriptive, are preferred to the more accurate term “old,” which too
clearly denotes a stigmatized condition. Further evidence of ageism is distancing
from elders (North & Fiske, 2012), as younger people prefer to avoid too much
physical and social contact with elders and often emphasize differences between
themselves and elders. Public policy that encourages the development of special
social spaces (e.g., “senior centers”) and housing (e.g., “senior living”) facilitates
distancing. Internalized ageism may also be reflected in distancing behaviors (e.g.,
attempts to pass as younger). Consider the first author’s 89-year-old mother, who
regularly refers to an acquaintance of her same age, as “the old man,” whereas she
88 Chrisler, Barney, and Palatino

does not think of herself as an “old woman.” She also firmly believes that “a lady
never tells her age.”
Why should a lady avoid revealing her age? A double standard of aging
(Deutsch, Zalenski, & Clark, 1986; Sontag, 1979) has been described in which
signs of aging (e.g., gray hair, facial lines) are seen as making men look distin-
guished, wise, and experienced, whereas they merely make women look “old.”
Studies done in the United States show that women are perceived as old at earlier
ages than men are (Hummert, Gartska, & Shaner, 1997; Kite & Wagner, 2002).
Ageism and sexism join hands as midlife and older women are judged more
harshly than men of the same age for their looks and behavior (e.g., refusal to “act
their age”). Hollywood actresses age out of lead roles decades earlier than actors
do (Lemish & Muhlbauer, 2012), and even powerful politicians are judged more
or less negatively depending on their gender. Hillary Clinton is a case in point. In
2007, radio commentator Rush Limbaugh predicted that then U.S. Senator Clinton
would not win the presidency because people would not want to “watch a woman
get older before their eyes” (Dowd, 2007). In 2014 her critics said that she is
too old to run again for the presidency, although those same critics had no con-
cerns about Ronald Reagan’s or John McCain’s age when they ran for president
(Tomasky, 2013). The more negative portrayal of older women than older men in
popular culture (including the greater number of jokes about old women; Crawford
& Unger, 2004; Lemish & Muhlbauer, 2012) and the greater pressure on women
than on men to hide signs of aging (Dingman, Otte, & Foster, 2012; e.g., hair
dye, “antiaging” skin cream, botox) may result in older women being ashamed
of their age (Holstein, 2006) and more sensitive to age-related microaggressions
(i.e., brief, sometimes ambiguous actions that communicate a derogatory view of
a particular social group and make the individual targets of the action feel inferior;
Heintz, DeMucha, Deguzman, & Softa, 2013).
Frequent exposure to ageist prejudice and discrimination can constitute a form
of minority stress. Elders are not often classified as “minorities,” perhaps because
there has been a great deal of emphasis in recent years on their growing numbers in
the population. However, the marginalization and degradation that elders as a group
experience in youth-oriented countries (e.g., the United States and other Western or
Westernized nations) suggests that the concept of minority stress may be relevant
to them and deserves investigation by researchers. This is important because stress
reduces immune system functioning and is known to be a contributor to the onset
(and the worsening) of some chronic illnesses (Taylor, 2012); public health experts
are especially concerned about stress effects on the health of vulnerable people
(e.g., children, elders, low-income individuals). The majority of elders are women,
and the older the population segment, the greater the gender imbalance (Gullette,
2004). Although stress related to ageism usually does not start before age 50, older
women have a lifetime of exposure to stress related to frequent (or occasional)
sexism. Older women of color have a lifetime of experience with racism, older
Ageism can be Hazardous to Women’s Health 89

sexual minority women have long experience with homophobia, and transgender
elders have experience with transphobia. A recent study (Sabik, 2013) of African
American and European American women in their 60s showed that subjective
ratings of their health were related to their perceptions of age discrimination; the
more discrimination they perceived, the lower their ratings of both their physical
health and their psychological well-being. Interviews with older lesbians indicate
frequent experiences of homophobia, heterosexism, and ageism (Averett, Yoon,
& Jenkins, 2013) in the healthcare system and elsewhere.
The perceived unfairness model (Jackson, Kubzansky, & Wright, 2006,
p. 21) proposes that experiencing discrimination or prejudice oneself, or observ-
ing it directed at a member of a group to whom one has an emotional attachment,
sets off “a cascade of psychological and physiological processes” that, with re-
peated episodes, can produce or contribute to negative health outcomes. Unfairness
arouses hostility, and research has shown direct effects of hostility on cardiovas-
cular and pulmonary functioning (Jackson, Kubzansky, Cohen, Jacobs, & Wright,
2007; Kubzansky et al., 2006). More frequent experiences of sexism and racism
have been shown to predict more health problems (Kloniff & Landrine, 1995;
Landrine & Klonoff, 1996; Moody, Brown, Matthews, & Bromberger, 2014), and
a recent study (Page-Gould, Mendoza-Denton, & Mendes, 2014) showed that the
more sensitive people of color are to race-based rejection, the more stress-related
symptoms they report. It is likely that perceived unfairness related to ageism would
have similar effects. Of course, older women, especially older ethnic or sexual mi-
nority women, have more and different kinds of opportunities to experience bias;
thus, they may face a greater cumulative burden of the stress effects of unfairness.

Stereotypes of Elders

Ageism is based in part on stereotypes about elders, which contain both

positive (e.g., wise, sage, experienced) and negative (e.g., grumpy, lonely, senile)
aspects (Kite & Johnson, 1988). Stereotypes of elders are pervasive in popular cul-
ture and in professional literature, including medical and gerontology textbooks
(Robinson, Briggs, & O’Neill, 2012). In youth-oriented cultures, the negative as-
pects are emphasized, perhaps as a way of distancing younger from older people.
Many negative aspects are related to changes in the body that render it unattractive
(e.g., wrinkled, gray-haired, ugly) or incompetent (e.g., forgetful, passive, weak,
feeble, frail, debilitated, disabled, dependent, ill). Weakness, frailty, passivity, and
dependence are also the aspects of the feminine gender role stereotype, another
point of intersection between ageism and sexism, which might make it easier for
people to perceive older women than older men as incompetent. The stereotype
content model places elders in the pitied group—warm but incompetent (“dodder-
ing but dear”; Cuddy & Fiske, 2004, p. 3), a pattern that is found across cultural
groups and that persists even when attention is drawn to counterexamples (Cuddy,
90 Chrisler, Barney, and Palatino

Norton, & Fiske, 2005). Housewives (Eckes, 2002) and pregnant women (Masser,
Grass, & Nesic, 2007) are also rated warm but incompetent by participants in
social psychology studies, which may make being pitied when they age a more
common experience for women than for men.
Ageist stereotypes can produce negative halo effects (North & Fiske, 2012);
when people are seen as old and unattractive, they may be expected to exhibit
other negative aspects as well (e.g., ill health, inability to understand technology,
depression, anxiety). For example, younger adults who think that it must be awful
to be old expect older adults to be depressed and anxious about aging (Gullette,
2004). As a result, depression is undertreated in elders (Van Egeren, 2004), who are
less likely than younger people to be referred for psychotherapy. Those who believe
that old age and illness are firmly linked (including many elders themselves) may
also be likely to dismiss the complaints and symptoms of elders as “just old age”
rather than schedule a thorough medical examination (Calasanti & Slevin, 2006;
Stewart, Chipperfield, Perry, & Weiner, 2012).
Internalized ageist stereotypes can become self-fulfilling prophecies
(Stewart et al., 2012) and lead to learned helplessness (Cousins, 2000). For ex-
ample, stereotypical beliefs applied to the self can serve as a barrier to health
promotion (Yeom, 2013) if elders believe they are not capable of adherence to
exercise or dietary regimens, or are too forgetful to follow complicated medication
regimens, or believe that their aches and pains or depression are “just old age.”
Public policies that require elders to exhibit “frailty” in order to receive services
influence the way that social workers, medical personnel, and other gatekeepers
see elders (perhaps especially women, as frailty is a better fit with the feminine
gender role), and also the way that elders who want the services see (and por-
tray) themselves (Grenier & Hanley, 2007). In addition, self-stereotyping lowers
people’s self-esteem and self-efficacy; it also causes stress, which depletes psy-
chological resources needed to engage in self-care and adhere to medical regimens
(Rivera & Paredez, 2014).
Stereotype embodiment theory (Levy, 2009) suggests that when internalized
ageist stereotypes are activated through stereotype threat (e.g., a healthcare profes-
sional commenting on a person’s frailty), a microaggression (e.g., an ageist remark
or joke), or other route (e.g., aches and pains, looking at a photograph of a younger
self) people act out (or embody) those stereotypes in self-definitional and self-
fulfilling ways. Laboratory studies have shown that elders primed with positive
(e.g., wise, spry) or negative (e.g., senile, shaky) aspects of the stereotype match
their performance to the prime (Levy, 2000). For example, negative priming has
been shown to lead to worse handwriting (Levy, 2000), poorer performance on a
memory (Desrichard & Kopetz, 2005; Hess, Auman, Colcombe, & Rahhal, 2003)
or math (Abrams, Eller, & Bryant, 2006) test, stronger cardiovascular response
(an indication of stress) when asked to solve verbal puzzles or do arithmetic (Levy,
Hausdorff, Henche, & Wei, 2000), lower willingness to take a risk, lower scores on
Ageism can be Hazardous to Women’s Health 91

a measure of perceived health, higher scores on a measure of loneliness, and more

frequent requests for help (Coudin & Alexopoulos, 2010). Elders with a stronger
internalization of negative stereotypes also report more frequent hospitalizations
(Levy, Slade, Chung, & Gill, 2014) and a more negative assessment of their own
physical health (Ramı́rez & Palacios-Espinosa, 2016) than do those whose view
of aging is more positive. Furthermore, elders who endorsed positive stereotypes
lived longer than their more negative peers (Lev, Slade, Kunkel, & Kasl, 2002; Ng,
Levy, Allore, & Monin, 2016). The results of these studies indicate that negative
stereotypes can actually contribute to dependency, weakness, inability (Coudin
& Alexopoulos, 2010), and perceived ill health in elders (Ramı́rez & Palacios-
Espinosa, 2016), and thereby reinforce those stereotypes and undermine elders’
physical and mental health.

Negative Attitudes toward Elders among Healthcare Professionals

Given that ageism and negative stereotypes of elders are ubiquitous, it is not
surprising that healthcare professionals also exhibit them. Studies of physicians
show that their attitudes are “complex and mixed” (Meisner, 2012, p. 61). That
is, they may express both positive and negative aspects of stereotypes of elders,
and their reasons for not liking to work with elders are also complex. Those
reasons might have to do with distancing, perhaps as a terror management strategy
(Martens, Goldenberg, & Greenberg, 2005), or, in the United States, they might
have more do with economics, given that Medicare reimbursement is less than
physicians get from private insurance for the same services (Meisner, 2012).
Furthermore, physicians are trained to “cure,” and, in general, they prefer to work
with patients who have acute illnesses that can be cured, rather than with patients
who have chronic illnesses that can only be managed (often with mixed success)
(Taylor, 2012). Chronic illnesses are more common among older than younger
people (Taylor, 2012), and elders may have more than one type of chronic illness,
which can make their cases more difficult to manage. Regardless of the reasons for
healthcare professionals’ attitudes and decisions about which patients to welcome
to their practices, elders may be aware (or suspect) that their doctors do not like
to work with older people or are disrespectful or impatient with them. “Leaky”
ageist attitudes can be experienced as microaggresssions, and physicians’ negative
attitudes might make elders hesitate to seek or follow medical advice or even cause
them to cancel appointments.
Physicians’ and medical students’ thoughts about elders are primarily related
to death, disease, and decline in functionality (Chodosh et al., 2000). Their stereo-
types of elders include rigid, religious, irritable, boring, lonely, isolated, asexual,
easily confused, depressed and depressing, needy, frustrating, and nonproductive
(Green, Adelman, Charon, & Hoffman, 1986; Higashi, Tillack, Steinman, Harper,
& Johnston, 2012; Michielutte & Diseker, 1985; Reyes-Ortiz, 1997). There is
92 Chrisler, Barney, and Palatino

some evidence that physicians are more cynical about working with, and more
distrustful of, elders than other types of health professionals are (Montplaisir &
Dufour, 1982 as cited by Meisner, 2012), perhaps because they doubt elders’
willingness or ability to follow “doctor’s orders.” Given a choice, physicians say
they would rather work with younger patients than with older ones (Helton &
Pathman, 2008), and they are most unwilling to work with “old-old” (age 85+)
and frail patients (Chodosh et al., 2000). When physicians do report a mix of both
positive and negative aspects of the stereotype of elders, their responses support
the stereotype content model: Elders are warm and likable, yet frustrating and
difficult because of their incompetence (Higashi et al., 2012). Medical students
seem to like “old people” better than “old patients” (Liu, While, Norman, & Ye,
2012).
Nurses tend to have more positive attitudes toward working with elders than
physicians do (Fisher & Peterson, 1993; Liu et al., 2012). This may be because
the mission of nursing is to “care,” rather than to cure (Bristow, 2012). Therefore,
patients who need (or are believed to need) the most care may be the most
rewarding to nurses. However, a recent study (McKenzie & Brown, 2014) of
nursing students’ interest in working with dementia patients revealed low intention
to choose that path. Reasons why the students did not want to work with dementia
patients include a mix of negative attitudes (e.g., boring, repetitive, inability to
“relate” to the patients) and economics (e.g., lower pay than other specialty areas).
The researchers speculated that terror management theory might also explain the
students’ reluctance to nurse dementia patients, the majority of whom are women
(Vina & Lloret, 2010).
There have been a number of studies of implicit and explicit attitudes to-
ward other marginalized groups, which, of course, intersect with age, although
intersectionality was not considered in the studies. Healthcare professionals have
been shown, for example, to exhibit race bias (e.g., Sabin, Nosek, Greenwald, &
Rivara, 2009; Sabin, Rivara, & Greenwald, 2008), antifat bias (e.g., Sabin, Marini,
& Nosek, 2012; Schwartz, Chambliss, Brownell, Blair, & Billington, 2003), and
bias against sexual minorities (e.g., Lim, Brown, & Kim, 2014; Stevens, 1998).
For example, healthcare professionals endorsed the stereotypes that heavy weight
people are lazy, stupid, and worthless (Schwartz et al., 2003) and that European
Americans are more compliant than African Americans (Sabin et al., 2008); “lazy”
and noncompliant people are less likely to adhere to medical regimens, and thus
are likely to be perceived as less rewarding patients. In a study of elders’ attitudes
toward and experiences with physicians (George & Jackson, 1998), European
Americans were significantly more likely than African Americans to agree that
doctors do their best to allay patients’ worries and always treat them respect-
fully. The researchers also reported that well-educated and urban people have the
most positive attitudes toward physicians and that Black and poor people receive
the worst care in hospitals. Women of color make up the largest proportion of
Ageism can be Hazardous to Women’s Health 93

low-income elders in the United States (Gullette, 2004), thus they are among the
most vulnerable patients.
Results of qualitative research demonstrate that some healthcare professionals
treat elders disrespectfully in ways that suggest that older patients are unworthy of
care. For example, a 39-year-old diabetes patient asked to comment about clinic
staff told Marris (1996): “I’m horrified at the way they speak to older people,
the lack of respect shown . . . You hear somebody yelling at them, ‘You’ve been
eating!’” (p. 162). In a study (Fisher & Peterson, 1993) of surgeons’ attitudes
toward elders, participants said they had heard colleagues refer to old patients as
“goners” (p. 175) and joke about finishing the surgery quickly before the patient
dies. In a particularly egregious example, two surgeons who were about to do a
hip replacement on an older woman realized that the prosthesis they had been
given was not the right size for the patient. They decided to go ahead and insert it,
and one commented, “Well, I don’t think she is going to be doing much dancing
anyway” (p. 178). In an ethnographic study, the researchers (Higashi et al., 2012)
observed a professor and several residents discuss two patients of different ages
who had equally poor prognoses. The physicians expressed sympathy for the
42-year-old patient in visible ways and used the word “tragic” repeatedly (p. 478).
No such concern was expressed for the 84-year-old patient. As one older woman
told researchers, “Sometimes you get the feeling that the doctor is thinking I am 75
and don’t have much time left anyways, so why worry about her — I don’t know if
they really think that, but you certainly get that impression” (Tannebaum, Nasmith,
& Mayo, 2003; p. 8). Another form of disrespectful behavior is depersonalization,
for example, discussing a patient’s case in front of the patient without addressing
the patient. This might happen more often to elders if they are assumed to have
cognitive deficits (Higashi et al., 2012).
Stereotypic assumptions about cognitive deficits and functional decline may
explain elders’ frequent experience of infantilization in medical settings. Elders
may be given assistance they do not need or experience others making decisions
that they could make for themselves. Healthcare professionals may not explain
as much to elders as they do to younger adults, perhaps because they think elders
would not understand; instead they focus more on reassuring elders that they will
be okay (Higashi et al., 2012). Use of simple sentences and elementary vocabulary
with elders is also common, as is baby talk (Taylor, 2012). Baby talk refers to the
use of simple sentences with childish vocabulary, which are spoken in a higher
pitch and brighter tone than usual; adults use this form of language primarily
with very young children and pets. For example, an older patient might be told to
“pop up on the table” so that the doctor can “take a look at your tummy.” Older
women have complained that healthcare professionals treat them as though they
were children by addressing them as “sweetie,” “dearie,” and “young lady” and
by referring to a cooperative or compliant patient as a “good girl” (Cruikshank,
2008; Heintz et al., 2013; Leland, 2008). Some elders might be comforted by
94 Chrisler, Barney, and Palatino

baby talk (Cruikshank, 2008; Nelson, 2005), perhaps especially when they are
feeling anxious or are in pain, however others resent being “talked down to” and
dislike people who address them that way (Ryan, Hamilton, & See, 1994). In
a national survey in the United States (Commission on Women’s Health, 2003),
women of all ages were significantly more likely than men to report dissatisfaction
with their doctors, including that their doctors talked down to them or dismissed
their complaints. Elders who are assumed to have functional deficits might also
be spoken to more slowly and in a loud voice, a form of overaccommodation
that might not be necessary (Nelson, 2005; Van Egern, 2004). Infantilization
and overaccommodation can be experienced by elders as microaggressions that
communicate their low status, which allows others to treat them disrespectfully
and impolitely (Williams, Herman, Gajweski, & Wilson, 2009). A tendency to
infantilize elders might also result in healthcare professionals not taking elders
and their complaints and questions seriously, which could compromise the care
they receive.
North and Fiske (2012) suggested that the mix of attitudes toward and
stereotypes about elders constitute ambivalent ageism, akin to ambivalent sex-
ism. Ageism might be hostile (e.g., beliefs that elders are incompetent, frustrating,
and use too many societal resources) or benevolent (e.g., beliefs that elders are
warm, frail, and need to be cared for gently). Infantilization and baby talk could be
expressions of benevolent ageism. Given that women so often experience benev-
olent sexism and that women are the majority of elders, older women may be
especially likely to be perceived by younger male physicians in a paternalistic
manner. Benevolent sexism (in this case, a desire to protect) has been suggested
as a reason why older women receive less aggressive medical treatment than older
men with similar conditions (Travis, Howerton, & Szymanski, 2012).

Age- and Gender-related Healthcare Disparities

Ageist beliefs (e.g., the growing number of elders is a burden on society)

and stereotypes that all elders are frail, depressed, and cognitively compromised
fuel debates about rationing health care. In an appearance on the U.S. televi-
sion program Morning Joe on September 22, 2014, Ezekiel Emanuel, MD, PhD,
Chair of the Department of Medical Ethics and Health Policy at the University
of Pennsylvania’s Perelman School of Medicine, defended his belief that age
75 is the “perfect age to die.” The well-known bioethicist Daniel Callahan, PhD,
a founder of the Hastings Center and a Senior Scholar at Yale University, has said
that everyone over age 80 should voluntarily refuse medical treatment or be denied
it (Gullette, 2004). Such pronouncements from respected experts constitute hostile
ageism; the statements suggest that all people over 75 or 80 have ill health that re-
quires expensive treatments or that their cognitive and functional decline produces
such a low quality of life that it would not be worth living. That, of course, is not
Ageism can be Hazardous to Women’s Health 95

true, as elders are a diverse group in many ways; for example, Sister Madonna
Buder, known as “the Iron Nun,” who finished the Ironman triathlon at age 82,
and the South African grandmothers’ soccer league are examples of healthy, active
elders (Chrisler & Palatino, in press). Gullette (2004, p. 95) considers discussion
of the expense of medical care for elders “without sympathy for the sufferers” to
be hate speech.
Hostile ageism could result in denial of health care to elders, especially if
the care is expensive, and it could result in coercion of elders into signing do not
resuscitate (DNR) orders (Gullette, 2004). On the other hand, benevolent ageism
(in this case, that elders do not know what is best for them) could result in refusal
to honor DNR requests and coercion of elders to agree to intensive treatment
(e.g., another round of chemotherapy) that they do not want. These matters are
difficult to study, but there is some evidence that White people’s DNR requests,
as well as their requests for intensive medical care, are more likely than Black
people’s requests to be honored (Loggers et al., 2009) and that men’s decisional
capacity and DNR requests are honored more often than women’s (Parks, 2000).
There is also evidence that elders are more likely than other patients to be under-
or overmedicated, especially in regard to pain management (Correa-de-Araujo,
2006; Gullette, 2004).
Just as there are health-related problems that elders are “expected” to have
(e.g., hearing deficits, depression), there are problems that they are not expected
to have. For example, elders are not expected to be alcohol or drug abusers,
and so they are not typically screened for those problems (Van Egeren, 2004).
Many younger adults assume that elders are not sexually active, so they are not
likely to suggest screening for sexually transmitted infections, nor are elders
(especially women) likely to request such screening (Durvasula, 2014). However,
among the most common reasons older women give for low sexual activity is
partner’s health or lack of a partner (McHugh & Interligi, 2015). After the death of a
partner, or after moving into senior housing where potential partners are available,
sexual activity may increase. Older women who are no longer concerned about
avoiding pregnancy may not think about safe sex practices unless they have been
educated by a healthcare professional. Elder abuse is another problem that may go
undetected by healthcare providers who expect elders to be weak and unsteady on
their feet, and thus readily accept explanations that injuries have resulted from falls
(Davidson, DiGiacomo, & McGrath, 2011; De Four, 2012). Older women may not
be asked about caregiving roles they play in their families, which can be stressful
and impact their physical and mental health (Rondon, 2010). Thus, stereotypic
beliefs about elders can result in lack of education, treatment, or prevention of
health problems.
Older patients may receive less aggressive treatment than younger patients
do; for example, they are less likely to be placed on organ transplant lists and
less likely to be enrolled (or even discouraged from enrolling) in clinical trials
96 Chrisler, Barney, and Palatino

of new medications (Ageism in the health care system, 2003; Bowling, 1999;
Correa-de-Araujo, 2006; Gullette, 2004; Wenger, 2012). Furthermore, a number
of gender disparities among elders have been documented by researchers, and
these differences in treatment could be hazardous to older women’s health. Men
receive more thorough medical examinations, more follow-up (Travis et al., 2012),
and more evidence-based medical care (Gochfeld, 2010) than women do, and
they are more likely to receive preventive care (Cameron, Song, Manheim, &
Dunlop, 2010). For example, older women are less likely than older men to get flu
shots, cholesterol screenings, colonoscopies, and carotid endarterectomy for stroke
prevention (Cameron et al., 2010; Correa-de-Araujo, 2006; Donovan & Syngal,
1998). Although women have higher prevalence of knee and hip arthritis and other
forms of joint disease and disability, they are less likely than men to undergo joint
replacement surgery, and they receive replacements later in the disease process
than men do, which means that they suffer longer (Knee joint replacement, n.d.;
Fitzgerald et al., 2004).
Perhaps the greatest gender disparity occurs in the treatment of various forms
of cardiac disease, which is the most common cause of death among both women
and men over the age of 80 (Centers for Disease Control and Prevention, 2011).
Women are less likely than men to receive heart bypass surgery (Travis, 2005;
Travis, Meltzer, & Howerton, 2009 as cited by Travis et al., 2012), cardiac
resynchronization therapy, atrial fibrillation ablation (Wenger, 2012), and cardiac
catheterization (Correa-de-Araujo, 2006) even when their conditions are similar.
Women are also less likely than men to be prescribed beta-blockers, anticoagu-
lants, and daily aspirin (Correa-de-Araujo, 2006), and they are less likely than
men to be referred to a rehabilitation program after a heart attack (Keefe, 2004;
Wegner, 2012). Women may also be disadvantaged in the diagnosis of heart at-
tacks because their symptoms may vary from the prototypical profile of a heart
attack, which is based on men’s symptoms (Travis et al., 2012). Women also tend
to be older than men when they are diagnosed with cardiac disease, thus age and
gender stereotypes may combine to suggest that women are too weak or frail to
withstand the procedures mentioned above (Travis et al., 2012), yet the available
evidence does not support greater risk or less success in women (Wegner, 2012).
Race disparities have also been noted for some of these procedures (e.g., bypass
surgery); European Americans are more likely than African Americans with the
same condition to receive them (Travis, 2005).

Policies and Practices to Reduce Ageism and Improve Women’s Health

Research is needed on age, gender, and other disparities in health and health
care, with attention to intersectionalities. Additional research is also needed on
biases in healthcare decision making, including qualitative studies that ask health-
care professionals to think about how and why they make the decisions they do
about what kinds of treatment their patients should have. Until people realize that
Ageism can be Hazardous to Women’s Health 97

their decisions might be influenced by ageist, sexist, racist, and homophobic be-
liefs and stereotypes, they are unlikely to recognize and challenge their own and
their colleagues biases.
Education is needed for both healthcare professionals and older patients. More
extensive and better quality education in gerontology for all healthcare profession-
als is necessary. That education should include exposure to healthy older adults
(Stewart et al., 2012) and emphasize positive aspects of aging. Students should
be taught that “aging” means both growth and loss for all age groups (Robinson
et al., 2012). Cohort effects on health behavior should also be taught; the young–
old are different from the old–old in many ways, and those differences should be
recognized, as should other forms of diversity (e.g., gender, race/ethnicity, sexual
orientation, social class) that impact the experience of aging. Ageism cannot be
reduced until it is made visible (Sabik, 2013), so it must be included in curricula.
Healthcare providers and students need to be taught about ageism, sexism, and
stereotypes of elders and understand their role in reducing bias and stereotyping
of all kinds (Nemmers, 2004). They should be taught that ageism is unethical and
unacceptable (Bowling, 1999). Better communication skills should also be taught
(Pfeifer, 2014), including respectful ways to interact with people with actual (or
suspected) disabilities (Van Engeren, 2004).
Older people also need education about ageism and stereotypes so that they
can recognize and resist them. Positive self-perceptions can benefit physical health
and well-being (North & Fiske, 2012) and reduce the likelihood of negative
stereotype embodiment. Older women might be especially likely to benefit from
assertiveness training (Adler, McGraw, & McKinlay, 1998) and other forms of
empowerment (e.g., exercise; Chrisler & Palatino, in press). If older women are
unafraid to tell their doctors about their symptoms (Holstein, 2006; Marris, 1996)
and able to insist upon getting the information they want (Tannebaum et al.,
2003), the quality of their healthcare might improve. Elders should be taught to
distinguish between chronic illness and “old age” to avoid self-fulfilling prophecies
and so that they know when to seek medical care. Older women’s health might
benefit if they are taught stress management techniques. Assertiveness and stress
management training could be taught by nurses, health educators, social workers,
or psychologists (O’Brien & Whitbourne, 2015). Professionals might find fruitful
educational partnerships with activists in the Women’s Health Movement (e.g.,
National Women’s Health Network, Black Women’s Health Imperative; Dan,
Jonikas, & Ford, 1994).
Older patients (especially older women) should be included in clinical trials
unless there is a nonage-related reason for exclusion (Bowling, 1999). Clini-
cal guidelines should be developed for screening older patients (including ques-
tions about elder abuse, alcohol and drug use, sexual health, and caregiver stress)
and for evidence-based treatment of various forms of cardiac disease. Current
guidelines might not be applied to older women because of their frequent exclu-
sion from clinical trials. Older women are particularly susceptible to medication
98 Chrisler, Barney, and Palatino

side effects (“appropriate” doses are usually determined by studies of men) so

careful monitoring is needed (Gatz, Harris, & Turk-Charles, 1995); cognitive
side effects (e.g., confusion, fuzzy thinking) can be misdiagnosed as dementia in
women given their increased risk for Alzheimer’s disease. Health promotion cam-
paigns should explicitly include elders (Levy, 2009), as both physical and mental
health can be improved at any age.
Access to healthcare services and the quality of services available are always
political and influenced by policy makers’ priorities and biases (Travis, Gress-
ley, & Adams, 1995). Public policy initiatives are needed to reduce barriers to
healthcare access for low-income rural and inner city dwelling older women, such
as transportation services and home care visits (Dan et al., 1994; Fitzpatrick,
Powe, Cooper, Ives, & Robbin, 2014); these barriers are more often reported in
the United States by older women of color (Fitzpatrick et al., 2014). Given that
the best predictor of older women’s health is how healthy they were when they
were younger (Gatz et al., 1995), it is important to work to reduce health disparities
among people at all ages (e.g., by ensuring access to immunizations, preventa-
tive care, healthy food, safe places to exercise, reproductive health services).
Community-based caregiver respite programs, opportunities to socialize (not just
with other elders, but with people of all ages), and bereavement counseling might
be especially helpful to older women’s mental health and well-being. Many older
women are afraid of falling; both the results of falls and the fear of falling result in
compromised independence (Chrisler, Rossini, & Newton, 2015). Programs that
provide low-cost mobility aids (e.g., walkers, canes, scooters) and teach tai chi
(or other activities that improve balance) will produce changes in older women’s
quality of life (Chrisler et al., 2015). Public policy will always be more effective
if older women are consulted about what services they need and involved in the
design of programs and interventions (Dan et al., 1994).
Advocacy will be necessary to teach policy makers at all levels (from hospital
administrators and insurance company executives to local and national government
agencies) about the needs of elders and to assist in the development of policies
that take the diversity of elders into account (Cummings, 2002). Pensions or social
security benefits sufficient to keep elders out of poverty and healthcare plans
that reduce or eliminate out-of-pocket costs for low-income elders are especially
important to older women (Fitzpatrick et al., 2014). Social justice cannot be
achieved without the efforts of both activists and experts. However, if we commit
to work together on initiatives such as those described here, perhaps ageism will
become less hazardous to women’s health.

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JOAN C. CHRISLER, PhD, is The Class of 1943 Professor of Psychology at

Connecticut College, where she teaches courses on health psychology, social
psychology, and the psychology of women. She has published extensively on the
psychology of women and gender roles, and is especially known for her work on
women’s health, menstruation, weight, and body image. She is a former editor of
Sex Roles and the current editor of Women’s Reproductive Health.

ANGELA BARNEY is an MA candidate in Psychology at Connecticut College.

Her research interests are in personality, social psychology, and women’s health.
She earned a BA in psychology and women’s studies at the State University of
New York, College at Fredonia.

BRIGIDA PALATINO is an MA candidate in Psychology at Connecticut College,

where she also serves as assistant coach of the women’s soccer team. Her research
interests are in gender roles and health behavior. She earned a BA in psychology
and environmental studies at Connecticut College.