Ageism directed to older adults in health services: A scoping review

a scoping review of primary studies in English, Spanish and Portuguese, without time delimitation and collected from 14 databases. Selection of the titles, abstracts and full text was in charge of two independent and blinded reviewers, totaling a corpus comprised by 41 articles. Data extraction was performed by pairs. The data were presented in narrative summaries and charts.

Results:

the ageism expressions are understood at the interpersonal level through images and attitudes that depreciate, devalue life and delegitimize older adults’ needs, as well as at the institutional level, which confers barriers to accessing health services, generating non-assistance and neglect. The coping measures consist of educational interventions and expansion of communication channels between aged people, health professionals and managers.

Conclusion:

the results may make health professionals vigilant for care/neglect guided by age bias and sensitive for coping with ageism by obtaining diverse scientific knowledge. The analysis of the phenomenon in the Unified Health System context constitutes a knowledge gap, as well as the implicit ageism expressions.

Descriptors:
Ageism; Aged; Health Services; Aging; Health Personnel; Review

Highlights:

(1) Ageism expressions involve interpersonal and institutional relationships.

(2) Ageism directed to older adults permeates from diagnosis to treatment.

(3) The coping measures comprise educational actions and also scientific research studies.

(4) It is necessary to recognize the presence of ageism in health services.

(5) It is necessary to recognize care/neglect practices guided by age bias.

Information source

Search strategy

PubMed

((“Ageism”[MeSH Terms] OR “Age Discrimination” [All Fields] OR “Age discriminations”[All Fields] OR (“Ageism”[MeSH Terms] OR “Ageism” [All Fields])) AND (“Aged” [MeSH Terms] OR (“Aged” [MeSH Terms] OR “Aged” [All Fields]) OR (“older” [All Fields] OR “olders” [All Fields]) OR “elder*”[All Fields] OR (“senior” [All Fields] OR “seniorities” [All Fields] OR “seniority” [All Fields] OR “seniors” [All Fields]) OR “geriatr*”[All Fields]) AND (“Health”[MeSH Terms] OR (“Health”[MeSH Terms] OR “Health”[All Fields] OR “healths”[All Fields] OR “healthful”[All Fields] OR “healthfulness” [All Fields] OR “healths” [All Fields]))) Filters: Aged 65+ years old, 80 and over: 80+ years old, Middle-Aged: 45-64 years old.

CINAHL^*

MH “ageism” OR TI ( ageism or “age discrimination” or “age bias” or “age stereotype” OR “age prejudice” ) OR AB ( ageism or “age discrimination” or “age bias” or “age stereotype” OR “age prejudice”) AND MH aged OR TI ( aged OR elderly OR senior OR “older people” OR geriatric OR elder* ) OR AB ( aged or elderly or senior or “older people” or geriatric OR elder* ) AND MH Health OR TI ( health OR “health services” OR “Health Care Services” OR “Public Health Service” ) OR AB ( health OR “health services” OR “Health Care Services” OR “Public Health Service” ) AND (Restrict by SubjectAge: - aged, 80 & over Restrict by SubjectAge: - middle-aged: 45-64 years old Restrict by SubjectAge: - aged: 65+ years old) AND (Restrict by academic journals)

Reference	Authors	Title	Year	Objectives	Methods	Language
⁽ ¹³13. Grant PT, Henry JM, McNaughton GW. The management of elderly blunt trauma victims in Scotland: evidence of ageism? Injury. 2000;31(7):519-28. https://doi.org/10.1016/s0020-1383(00)00038-3 https://doi.org/10.1016/s0020-1383(00)00... ⁾	Grant PT, Henry JM, McNaughton GW.	The management of elderly blunt trauma victims in Scotland: evidence of ageism?	2000	To determine the in-hospital mortality of traumatized aged patients. To analyze the main characteristics of its management; to see whether these traumatized patients were treated less aggressively than their younger peers.	A prospective study with data collected by Scottish Trauma Audit Group, in Scotland.	English
⁽ ¹⁴14. Uncapher H, Areán PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48(2):188-92. https://doi.org/10.1111/j.1532-5415.2000.tb03910.x https://doi.org/10.1111/j.1532-5415.2000... ⁾	Uncapher H, Areán PA.	Physicians are less willing to treat suicidal ideation in older patients.	2000	To determine whether there is age bias among primary care physicians when contemplating the treatment of suicidal patients.	A quantitative study with primary care physicians in San Francisco, United States.	English
⁽ ¹⁵15. Bouman WP, Arcelus J. Are psychiatrists guilty of “ageism” when it comes to taking a sexual history? Int J Geriatr Psychiatry. 2001;16(1):27-31. https://doi.org/10.1002/1099-1166(200101)16:1%3c27::AID-GPS267%3e3.0.CO;2-S https://doi.org/10.1002/1099-1166(200101... ⁾	Bouman WP, Arcelus J.	Are psychiatrists guilty of “ageism” when it comes to taking a sexual history?	2001	To determine the current perceived practice of consulting psychiatrists regarding their patients’ sexual history and management of sexual dysfunction.	A quantitative study with aged people and psychiatrists in hospitals from Sheffield, Nottingham, Leicester and Birmingham, England.	English
⁽ ¹⁶16. Kennelly C, Bowling A. Suffering in deference: a focus group study of older cardiac patients’ preferences for treatment and perceptions of risk. Qual Health Care. 2001;10(Suppl 1):i23-8. https://doi.org/10.1136/qhc.0100023 https://doi.org/10.1136/qhc.0100023... ⁾	Kennelly C, Bowling A.	Suffering in deference: a focus group study of older cardiac patients’ preferences for treatment and perceptions of risk.	2001	To explore older adults’ health care experiences in relation to their medical condition (ischemic heart disease), their understanding of health risks, treatment preferences, and the impact of the treatments on their quality of life.	A qualitative study carried out in London with people over 56 years of age and diagnosed with ischemic heart disease.	English
⁽ ¹⁷17. Austin D, Russell EM. Is There Ageism in Oncology? Scott Med J. 2003;48(1):17-20. https://doi.org/10.1177/003693300304800105 https://doi.org/10.1177/0036933003048001... ⁾	Austin D, Russell EM.	Is There Ageism in Oncology?	2003	To determine whether age-related differences in hospital management of cancer patients were or were not clinically justifiable.	A quantitative study with cancer patients in a colorectal cancer treatment hospital from Scotland.	English
⁽ ¹⁸18. Fischer LR, Wei F, Solberg LI, Rush WA, Heinrich RL. Treatment of elderly and other adult patients for depression in primary care. J Am Geriatr Soc. 2003;51(11):1554-62. https://doi.org/10.1046/j.1532-5415.2003.51506.x https://doi.org/10.1046/j.1532-5415.2003... ⁾	Fischer LR, Wei F, Solberg LI, Rush WA, Heinrich RL.	Treatment of elderly and other adult patients for depression in primary care.	2003	To determine whether depression is treated differently in older and younger patients in primary care clinics.	A quantitative study with adults diagnosed with depression treated at primary care clinics in the Midwest Region of the United States.	English
⁽ ¹⁹19. Peake MD, Thompson S, Lowe D, Pearson MG. Ageism in the management of lung cancer. Age Ageing. 2003;32(2):171-7. https://doi.org/10.1093/ageing/32.2.171 https://doi.org/10.1093/ageing/32.2.171... ⁾	Peake MD, Thompson S, Lowe D, Pearson MG.	Ageism in the management of lung cancer.	2003	To study the impact of age on the survival of patients with lung cancer.	A quantitative study with people admitted to 48 hospitals in the United Kingdom.	English
⁽ ²⁰20. Williams D, Bennett K, Feely J. Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care. Br J Clin Pharmacol. 2003;55(6):604-8. https://doi.org/10.1046/j.1365-2125.2003.01795.x https://doi.org/10.1046/j.1365-2125.2003... ⁾	Williams D, Bennett K, Feely J.	Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care.	2003	To determine whether there is gender or age bias in prescribing important secondary preventive therapies for ischemic heart disease in primary care.	A quantitative study of patients with ischemic heart disease in the East Region of the General Medical Services scheme from Ireland.	English
⁽ ²¹21. Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD. Older stroke patients in Europe: stroke care and determinants of outcome. Age Ageing. 2004;33(6):618-24. https://doi.org/10.1093/ageing/afh219 https://doi.org/10.1093/ageing/afh219... ⁾	Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD.	Older stroke patients in Europe: stroke care and determinants of outcome.	2004	To estimate the care structure and process. To identify independent factors associated with three-month mortality and functional outcomes in patients aged over 75 years old.	A quantitative study carried out with stroke victims in 13 hospitals from 10 European countries.	English
⁽ ²²22. Van Delden JJ, Vrakking AM, Van Der Heide A, Van Der Maas PJ. Medical decision making in scarcity situations. J Med Ethics. 2004;30(2):207-11. https://doi.org/10.1136/jme.2003.003681 https://doi.org/10.1136/jme.2003.003681... ⁾	Van Delden JJ, Vrakking AM, Van Der Heide A, Van Der Maas PJ.	Medical decision making in scarcity situations.	2004	To explore the clinicians’ views on several topics that have emerged in the debate over the allocation of scarce resources with a particular focus on the role of age and to compare the, with the policymakers’ views.	A qualitative study with oncologists, cardiologists and nursing-home physicians in the Southwest region of the Netherlands.	English
⁽ ²³23. Gunderson A, Tomkowiak J, Menachemi N, Brooks R. Rural physicians’ attitudes toward the elderly: evidence of ageism? Qual Manag Health Care. 2005;14(3):167-76. https://doi.org/10.1097/00019514-200507000-00006 https://doi.org/10.1097/00019514-2005070... ⁾	Gunderson A, Tomkowiak J, Menachemi N, Brooks R.	Rural physicians’ attitudes toward the elderly: evidence of ageism?	2005	To examine the perceptions and attitudes of rural Florida physicians who routinely provide care to older adults.	A qualitative study carried out with physicians who care for aged people living in rural areas in Florida, United States.	English
⁽ ²⁴24. Finger RP, Ali M, Earnest J, Nirmalan PK. Cataract surgery in Andhra Pradesh state, India: an investigation into uptake following outreach screening camps. Ophthalmic Epidemiol. 2007;14(6):327-32. https://doi.org/10.1080/01658100701486814 https://doi.org/10.1080/0165810070148681... ⁾	Finger RP, Ali M, Earnest J, Nirmalan PK.	Cataract surgery in Andhra Pradesh state, India: an investigation into uptake following outreach screening camps.	2007	To analyze the decision-making processes that lead to accepting cataract surgery services offered during outreach screening camps, investigated in people with cataracts in India.	An exploratory and qualitative study with cataract patients from two eye hospitals in Hyderabad, India.	English
⁽ ²⁵25. Manthorpe J, Clough R, Cornes M, Bright L, Moriarty J, Iliffe S. Four years on: The impact of the National Service Framework for Older People on the experiences, expectations and views of older people. Age Ageing. 2007;36(5):501-7. https://doi.org/10.1093/ageing/afm078 https://doi.org/10.1093/ageing/afm078... ⁾	Manthorpe J, Clough R, Cornes M, Bright L, Moriarty J, Iliffe S.	Four years on: the impact of the National Service Framework for Older People on the experiences, expectations and views of older people.	2007	To evaluate the impact of the National Framework of Services for Older Adults on aged people’s experiences and expectations.	A qualitative study carried out with aged people and their caregivers who use health services in England.	English
⁽ ²⁶26. Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe KH, Kirkevold M, et al. In quest of justice? Clinical prioritisation in healthcare for the aged. J Med Ethics. 2008;34(4):230-5. https://doi.org/10.1136/jme.2006.018531 https://doi.org/10.1136/jme.2006.018531... ⁾	Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe KH, Kirkevold M, et al.	In quest of justice? Clinical prioritisation in healthcare for the aged.	2008	To explore which criteria, values and other relevant considerations are important in clinical priorities in health services for aged patients.	A qualitative study with physicians and nurses who care for aged people in public hospitals and nursing homes in different parts of Norway.	English
⁽ ²⁷27. Hudelson P, Kolly V, Perneger T. Patients’ perceptions of discrimination during hospitalization. Health Expect. 2010;13(1):24-32. https://doi.org/10.1111/j.1369-7625.2009.00577.x https://doi.org/10.1111/j.1369-7625.2009... ⁾	Hudelson P, Kolly V, Perneger T.	Patients’ perceptions of discrimination during hospitalization.	2010	To identify sources of perceived discrimination during hospitalization and to examine the relationship of perceived discrimination with patient and hospital characteristics, and with patient care ratings.	A quantitative study with adults assisted in hospitals belonging to the University of Geneva, Switzerland.	English
⁽ ²⁸28. Mitford E, Reay R, McCabe K, Paxton R, Turkington D. Ageism in first episode psychosis. Int J Geriatr Psychiatry. 2010;25(11):1112-8. https://doi.org/10.1002/gps.2437 https://doi.org/10.1002/gps.2437... ⁾	Mitford E, Reay R, McCabe K, Paxton R, Turkington D.	Ageism in first episode psychosis.	2010	To compare the incidence, diagnosis groups and hospitalization of two different age groups with first-episode psychosis.	A quantitative study using the PACE (Population-Adjusted Clinical Epidemiology) database in Northumberland, United Kingdom.	English
⁽ ²⁹29. Protière C, Viens P, Rousseau F, Moatti JP. Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy? Crit Rev Oncol Hematol. 2010;75(2):138-50. https://doi.org/10.1016/j.critrevonc.2009.09.007 https://doi.org/10.1016/j.critrevonc.200... ⁾	Protière C, Viens P, Rousseau F, Moatti JP.	Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy?	2010	To identify relevant characteristics of physicians, such as their sociodemographic characteristics, experience, knowledge of geriatric testing, “practice style effects” and belief in the effectiveness of the various adjuvant treatments available.	A quantitative study with oncologists and radiotherapists who treat people with breast cancer, in hospitals from France.	English
⁽ ³⁰30. Clarke LH, Bennett EV, Korotchenko A. Negotiating vulnerabilities: how older adults with multiple chronic conditions interact with physicians. Can J Aging. 2014;33(1):26-37. https://doi.org/10.1017/s0714980813000597 https://doi.org/10.1017/s071498081300059... ⁾	Clarke LH, Bennett EV, Korotchenko A.	Negotiating vulnerabilities: how older adults with multiple chronic conditions interact with physicians.	2014	To understand how aged people perceived and experienced the care provided by their primary care physicians.	A qualitative study with women and men with chronic diseases who use health services in Canada.	English
⁽ ³¹31. Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br J Cancer. 2014;111:1843-51. https://doi.org/10.1038/bjc.2014.472 https://doi.org/10.1038/bjc.2014.472... ⁾	Forrest L, Adams J, White M, Rubin G.	Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study.	2014	To investigate the factors (socioeconomic status, age, gender, histology, comorbidity, year of diagnosis, stage and performance status) that may influence the likelihood of referral to post-primary care, diagnosis and treatment within the target times.	A quantitative study with people diagnosed with lung cancer, obtained from the Northern and Yorkshire Cancer Registry and Information Service, in England.	English
⁽ ³²32. Polat U, Karadaǧ A, Ulger Z, Demir N. Nurses’ and physicians’ perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey. Contemp Nurse. 2014;48(1):88-97. https://doi.org/10.5172/conu.2014.48.1.88 https://doi.org/10.5172/conu.2014.48.1.8... ⁾	Polat U, Karadaǧ A, Ulger Z, Demir N.	Nurses’ and physicians’ perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey.	2014	To determine the perceptions of old age and the prevalence of aging among nurses and physicians.	A quantitative study with nurses and physicians in the medical and surgical clinics of a university hospital from Turkey.	English
⁽ ³³33. Skirbekk H, Nortvedt P. Inadequate treatment for elderly patients: professional norms and tight budgets could cause “ageism” in hospitals. Health Care Anal. 2014;22(2):192-201. https://doi.org/10.1007/s10728-012-0207-2 https://doi.org/10.1007/s10728-012-0207-... ⁾	Skirbekk H, Nortvedt P.	Inadequate treatment for elderly patients: professional norms and tight budgets could cause “ageism” in hospitals.	2014	To analyze ethical care considerations among health professionals when treating and prioritizing aged patients in Norway.	A qualitative study with physicians and nurses from general hospitals in Norway.	English
⁽ ³⁴34. Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, et al. Ageism among physicians, nurses, and social workers: findings from a qualitative study. Eur J Ageing. 2016;14(1):39-48. https://doi.org/10.1007/s10433-016-0389-9 https://doi.org/10.1007/s10433-016-0389-... ⁾	Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, et al.	Ageism among physicians, nurses, and social workers: findings from a qualitative study.	2016	To investigate ageism among health professionals in therapeutic settings in Israel.	A qualitative study with 76 nurses specialized in Oncology, at a specialized center from in Israel.	English
⁽ ³⁵35. Davis T, Teaster PB, Thornton A, Watkins JF, Alexander L, Zanjani F. Primary Care Providers’ HIV Prevention Practices Among Older Adults. J Appl Gerontol. 2016;35(12):1325-42. https://doi.org/10.1177/0733464815574093 https://doi.org/10.1177/0733464815574093... ⁾	Davis T, Teaster PB, Thornton A, Watkins JF, Alexander L, Zanjani F.	Primary Care Providers’ HIV Prevention Practices Among Older Adults.	2016	To understand the HIV^* prevention practices of providers and primary care among older adults. To understand the factors that affect provision of HIV education materials to older adults and HIV screening practices by the providers.	A qualitative study carried out with physicians and nurses who care for patients over 50 years of age in primary health care, in the state of Kentucky, United States.	English
⁽ ³⁶36. Schroyen S, Missotten P, Jerusalem G, Gilles C, Adam S. Ageism and caring attitudes among nurses in oncology. Int Psychogeriatr. 2016;28(5):749-57. https://doi.org/10.1017/s1041610215001970 https://doi.org/10.1017/s104161021500197... ⁾	Schroyen S, Missotten P, Jerusalem G, Gilles C, Adam S.	Ageism and caring attitudes among nurses in oncology.	2016	To replicate the results of previous studies that reported differential support of medical treatment according to patient age in a different population of health professionals (nurses instead of physicians). To determine whether support for expensive immunotherapy, adjuvant chemotherapy, or breast reconstruction is related to age bias among nurses.	A qualitative study carried out with nurses specialized in Oncology and working in different units of the Sart Tilman Liège University Hospital, Belgium.	English
⁽ ³⁷37. Taverner T, Baumbusch J, Taipale P. Normalization of Neglect: A Grounded Theory of RNs’ Experiences as Family Caregivers of Hospitalized Seniors. Can J Aging. 2016;35(2):215-28. https://doi.org/10.1017/s0714980816000179 https://doi.org/10.1017/s071498081600017... ⁾	Taverner T, Baumbusch J, Taipale P.	Normalization of Neglect: A Grounded Theory of RNs’ Experiences as Family Caregivers of Hospitalized Seniors.	2016	To develop a theory about the Nursing care performance, as described by caregivers of aged people in the intensive care sector.	A qualitative study with aged women and caregivers recruited from two large hospitals in British Columbia.	English
⁽ ³⁸38. Demetriadou E, Kokkinou M, Metaxas G, Kyriakides E, Kyprianou T. Psychological support for families of ICU patients: longitudinal documentation of the service. Psychol Health Med. 2017;22(6):736-43. https://doi.org/10.1080/13548506.2016.1231922 https://doi.org/10.1080/13548506.2016.12... ⁾	Demetriadou E, Kokkinou M, Metaxas G, Kyriakides E, Kyprianou T.	Psychological support for families of ICU patients: longitudinal documentation of the service.	2017	To evaluate and describe the need for psychological support for relatives of patients admitted to the ICU^†, for the period between 2011 and 2014. To identify the health professionals’ perception regarding the need for psychological support.	A qualitative study carried out based on the documentation of psychological assistance to relatives of patients admitted to the ICU from 2011 to 2014 in Cyprus.	English
⁽ ³⁹39. Di Rosa M, Chiatti C, Rimland JM, Capasso M, Scandali VM, Prospero E, et al. Ageism and surgical treatment of breast cancer in Italian hospitals. Aging Clin Exp Res. 2018;30(2):139-44. https://doi.org/10.1007/s40520-017-0757-0 https://doi.org/10.1007/s40520-017-0757-... ⁾	Di Rosa M, Chiatti C, Rimland JM, Capasso M, Scandali VM, Prospero E, et al.	Ageism and surgical treatment of breast cancer in Italian hospitals.	2018	To assess whether the patient’s age is a factor that influences the type of surgical treatment for breast cancer in Italy. To assess the existence and characteristics of possible regional differences in the type of surgical treatment for breast cancer.	A retrospective study based on national hospital discharge records, in Italy.	English
⁽ ⁴⁰40. Forti P, Maioli F, Magni E, Ragazzoni L, Piperno R, Zoli M, et al. Risk of Exclusion From Stroke Rehabilitation in the Oldest Old. Arch Phys Med Rehabil. 2018;99(3):477-83. https://doi.org/10.1016/j.apmr.2017.08.469 https://doi.org/10.1016/j.apmr.2017.08.4... ⁾	Forti P, Maioli F, Magni E, Ragazzoni L, Piperno R, Zoli M, et al.	Risk of Exclusion From Stroke Rehabilitation in the Oldest Old.	2018	To investigate whether older age ≥ 85 (years old) is an independent predictor of exclusion from stroke rehabilitation.	A retrospective cohort study carried out with aged people diagnosed with stroke, in an Italian hospital.	English
⁽ ⁴¹41. Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257. https://doi.org/10.1186/s12877-018-0941-x https://doi.org/10.1186/s12877-018-0941-... ⁾	Kiplagat J, Huschke S.	HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya.	2018	It describes HIV testing experiences of older adults living with HIV, and how their age shaped their interaction and treatment received during HIV testing and diagnosis.	A qualitative study conducted with HIV-infected people aged ≥ 50 years old using rural and urban clinic services in western Kenya.	English
⁽ ⁴²42. Schatz E, Seeley J, Negin J, Mugisha J. They ‘don’t cure old age’: Older Ugandans’ delays to health-care access. Ageing Soc. 2018;38(11):2197-217. https://doi.org/10.1017/S0144686X17000502 https://doi.org/10.1017/S0144686X1700050... ⁾	Schatz, E, Seeley, J, Negin, J, Mugisha J.	They ‘don’t cure old age’: Older Ugandans’ delays to health-care access.	2018	To examine the factors that cause older Ugandans to delay accessing health care.	A qualitative study with aged people in the Kalungu district, rural southwestern Uganda.	English
⁽ ⁴³43. Schroyen S, Adam S, Marquet M, Jerusalem G, Thiel S, Giraudet AL, et al. Communication of healthcare professionals: Is there ageism? Eur J Cancer Care. 2018;27(1). https://doi.org/10.1111/ecc.12780 https://doi.org/10.1111/ecc.12780... ⁾	Schroyen S, Adam S, Marquet M, Jerusalem G, Thiel S, Giraudet AL, et al.	Communication of healthcare professionals: Is there ageism?	2018	To observe whether characteristics of older adults’ speech (positive or negative) are more frequent in professionals with a negative view of aging.	A qualitative study with physicians from the city of Liège, Belgium.	English
⁽ ⁴⁴44. Wiel E, Di Pompéo C, Segal N, Luc G, Marc JB, Vanderstraeten C, et al. Age discrimination in out-of-hospital cardiac arrest care: a case-control study. Eur J Cardiovasc Nurs. 2018;17(6):505-12. https://doi.org/10.1177/1474515117746329 https://doi.org/10.1177/1474515117746329... ⁾	Wiel E, Di Pompéo C, Segal N, Luc G, Marc JB, Vanderstraeten C, et al.	Age discrimination in out-of-hospital cardiac arrest care: a case-control study.	2018	To compare out-of-hospital cardiac arrest care and outcomes among young patients.	A quantitative study with data from adults with cancer, extracted from the French national cardiac arrest registry, in France.	English
⁽ ⁴⁵45. Dobrowolska B, Jędrzejkiewicz B, Pilewska-Kozak A, Zarzycka D, Ślusarska B, Deluga A, et al. Age discrimination in healthcare institutions perceived by seniors and students. Nurs Ethics. 2019;26(2):443-59. https://doi.org/10.1177/0969733017718392 https://doi.org/10.1177/0969733017718392... ⁾	Dobrowolska B, Jędrzejkiewicz B, Pilewska-Kozak A, Zarzycka D, Ślusarska B, Deluga A, et al.	Age discrimination in healthcare institutions perceived by seniors and students.	2019	To explore age-based discrimination in health institutions perceived by older adults and medical and nursing students.	A multi-method study with 65-year-olds attending the University of Old Age in eastern Poland.	English
⁽ ⁴⁶46. Shin DW, Park K, Jeong A, Yang HK, Kim SY, Cho M, et al. Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey. J Geriatr Oncol. 2019;10(3):459-64. https://doi.org/10.1016/j.jgo.2018.09.006 https://doi.org/10.1016/j.jgo.2018.09.00... ⁾	Shin DW, Park K, Jeong A, Yang HK, Kim SY, Cho M, et al.	Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey.	2019	To understand the view of aged patients themselves in relation to their care in terms of their relationship with age. To determine: 1) Whether older adults and their caregivers believe that aged patients should be provided the same care level as younger cancer patients; 2) Whether aged patients experienced any age-based discrimination during their cancer treatment.	A quantitative research study conducted with aged people with cancer and their caregivers who participated in the National Cancer Center and another ten regional cancer centers in Korea.	English
⁽ ⁴⁷47. Heyman N, Osman I, Ben Natan M. Ageist attitudes among healthcare professionals and older patients in a geriatric rehabilitation facility and their association with patients’ satisfaction with care. Int J Older People Nurs. 2020;15(2):e12307. https://doi.org/10.1111/opn.12307 https://doi.org/10.1111/opn.12307... ⁾	Heyman N, Osman I, Ben Natan M.	Ageist attitudes among healthcare professionals and older patients in a geriatric rehabilitation facility and their association with patients’ satisfaction with care.	2020	To explore the prevalence of age attitudes (based on the specific age group) in older adults admitted to geriatric rehabilitation, as well as the association between satisfaction with care and age attitudes. To estimate whether there is an association between patient satisfaction with care and age attitudes among health professionals working in the rehabilitation unit. To explore the prevalence of age attitudes among health professionals.	A quantitative study with health professionals and aged people, in a rehabilitation department of a geriatric medical center located in Mid-North Israel.	English
⁽ ⁴⁸48. Kessler EM, Blachetta C. Age cues in patients’ descriptions influence treatment atitudes. Aging Ment Health. 2020;24(1):193-6. https://doi.org/10.1080/13607863.2018.1515889 https://doi.org/10.1080/13607863.2018.15... ⁾	Kessler EM, Blachetta C.	Age cues in patients’ descriptions influence treatment attitudes.	2020	To investigate how age cues in the psychotherapeutic context influence health professionals’ treatment attitudes.	A quantitative study with psychotherapists from the Behavioral Therapy Association in Progress, Germany.	English
⁽ ⁴⁹49. Lee J, Yu H, Cho HH, Kim M, Yang S. Ageism between Medical and Preliminary Medical Persons in Korea. Ann Geriatr Med Res. 2020;24(1):41-9. https://doi.org/10.4235/agmr.19.0043 https://doi.org/10.4235/agmr.19.0043... ⁾	Lee J, Yu H, Cho HH, Kim M, Yang S.	Ageism between Medical and Preliminary Medical Persons in Korea.	2020	To analyze trends in ageism among health professionals and medical students in the Republic of Korea.	A quantitative study with health professionals and aged people, conducted in the Republic of Korea.	English
⁽ ⁵⁰50. Motsohi T, Namane M, Anele AC, Abbas M, Kalula SZ. Older persons’ experience with health care at two primary level clinics in Cape Town, South Africa: a qualitative assessment. BJGP Open. 2020;4(3):bjgpopen20X101048. https://doi.org/10.3399/bjgpopen20X101048 https://doi.org/10.3399/bjgpopen20X10104... ⁾	Motsohi T, Namane M, Anele AC, Abbas M, Kalula SZ.	Older persons’ experience with health care at two primary level clinics in Cape Town, South Africa: a qualitative assessment.	2020	To evaluate how older adults experience health care provision in two primary care clinics; and to identify perceived gaps in health care for aged people.	A qualitative study with aged people in two primary care units from the suburbs of Cape Town, South Africa.	English
⁽ ⁵¹51. Rababa M, Hammouri AM, Hweidi IM, Ellis JL. Association of nurses’ level of knowledge and attitudes to ageism toward older adults: Cross-sectional study. Nurs Health Sci. 2020;22(3):593-601. https://doi.org/10.1111/nhs.12701 https://doi.org/10.1111/nhs.12701... ⁾	Rababa M, Hammouri AM, Hweidi IM, Ellis JL.	Association of Nurses’ Level of Knowledge and Attitudes to Ageism Toward Older Adults: Cross-sectional Study.	2020	To examine how the sociodemographic and professional characteristics of nurses in Jordan correlate with their levels of knowledge, attitudes and age in relation to older adults.	A descriptive, correlational and cross-sectional study carried out with nurses who work at a public hospital and a university hospital in Irbid, northern Jordan.	English
⁽ ⁵²52. Tomioka S, Rosenberg M, Fushimi K, Matsuda S. An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan. BMC Health Serv Res. 2020;20(1):830. https://doi.org/10.1186/s12913-020-05690-9 https://doi.org/10.1186/s12913-020-05690... ⁾	Tomioka S, Rosenberg M, Fushimi K, Matsuda S.	An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan.	2020	To assess whether dementia status is associated with poorer care by examining the association of the patient’s dementia status with the likelihood of undergoing surgery and waiting time until hip fracture surgery in acute care hospitals in Japan.	A quantitative study with victims of closed hip fracture, whose data were extracted from the Diagnosis Procedure Combination database in Japan.	English
⁽ ⁵³53. Hwang EH, Kim KH. Quality of Gerontological Nursing and Ageism: What Factors Influence on Nurses’ Ageism in South Korea? Int J Environ Res Public Health. 2021;18(8):4091. https://doi.org/10.3390/ijerph18084091 https://doi.org/10.3390/ijerph18084091... ⁾	Hwang EH, Kim KH.	Quality of Gerontological Nursing and Ageism: What Factors Influence on Nurses’ Ageism in South Korea?	2021	To identify the factors that influence nurses’ ageist attitudes	A quantitative study with nurses from two general hospitals in a provincial town from South Korea.	English

Ageism expressions directed to older adults in health services

Less diagnostic research

Unquestioned sexual history in the psychiatric evaluation of aged men⁽¹⁶16. Kennelly C, Bowling A. Suffering in deference: a focus group study of older cardiac patients’ preferences for treatment and perceptions of risk. Qual Health Care. 2001;10(Suppl 1):i23-8. https://doi.org/10.1136/qhc.0100023
https://doi.org/10.1136/qhc.0100023... ⁾.

Reduced histological verification rates⁽¹⁷17. Austin D, Russell EM. Is There Ageism in Oncology? Scott Med J. 2003;48(1):17-20. https://doi.org/10.1177/003693300304800105
https://doi.org/10.1177/0036933003048001... ⁾.

Brief anamnesis⁽¹⁸18. Fischer LR, Wei F, Solberg LI, Rush WA, Heinrich RL. Treatment of elderly and other adult patients for depression in primary care. J Am Geriatr Soc. 2003;51(11):1554-62. https://doi.org/10.1046/j.1532-5415.2003.51506.x
https://doi.org/10.1046/j.1532-5415.2003... ⁾.

Inadequate diagnostic investigations⁽²¹21. Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD. Older stroke patients in Europe: stroke care and determinants of outcome. Age Ageing. 2004;33(6):618-24. https://doi.org/10.1093/ageing/afh219
https://doi.org/10.1093/ageing/afh219... ⁾.

Restricted access to treatments

Fewer curative surgeries and chemotherapy⁽¹⁷17. Austin D, Russell EM. Is There Ageism in Oncology? Scott Med J. 2003;48(1):17-20. https://doi.org/10.1177/003693300304800105
https://doi.org/10.1177/0036933003048001... ⁾.

Lower probability to receive statin, b-blocker or aspirin and other potentially beneficial treatments⁽²⁰20. Williams D, Bennett K, Feely J. Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care. Br J Clin Pharmacol. 2003;55(6):604-8. https://doi.org/10.1046/j.1365-2125.2003.01795.x
https://doi.org/10.1046/j.1365-2125.2003... ^,²⁹29. Protière C, Viens P, Rousseau F, Moatti JP. Prescribers’ attitudes toward elderly breast cancer patients. Discrimination or empathy? Crit Rev Oncol Hematol. 2010;75(2):138-50. https://doi.org/10.1016/j.critrevonc.2009.09.007
https://doi.org/10.1016/j.critrevonc.200... ⁾.

Inadequate treatment for sexual dysfunction⁽²¹21. Bhalla A, Grieve R, Tilling K, Rudd AG, Wolfe CD. Older stroke patients in Europe: stroke care and determinants of outcome. Age Ageing. 2004;33(6):618-24. https://doi.org/10.1093/ageing/afh219
https://doi.org/10.1093/ageing/afh219... ⁾.

Lower probability to receive timely cancer treatment. Unjustified delays⁽³¹31. Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br J Cancer. 2014;111:1843-51. https://doi.org/10.1038/bjc.2014.472
https://doi.org/10.1038/bjc.2014.472... ⁾.

Omission of information about disease status and treatment options⁽⁴⁶46. Shin DW, Park K, Jeong A, Yang HK, Kim SY, Cho M, et al. Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey. J Geriatr Oncol. 2019;10(3):459-64. https://doi.org/10.1016/j.jgo.2018.09.006
https://doi.org/10.1016/j.jgo.2018.09.00... ^,⁴⁹49. Lee J, Yu H, Cho HH, Kim M, Yang S. Ageism between Medical and Preliminary Medical Persons in Korea. Ann Geriatr Med Res. 2020;24(1):41-9. https://doi.org/10.4235/agmr.19.0043
https://doi.org/10.4235/agmr.19.0043... ⁾.

Reduction of surgical interventions

Lower probability to receive treatment (surgery, radiotherapy, chemotherapy) of any kind⁽¹⁹19. Peake MD, Thompson S, Lowe D, Pearson MG. Ageism in the management of lung cancer. Age Ageing. 2003;32(2):171-7. https://doi.org/10.1093/ageing/32.2.171
https://doi.org/10.1093/ageing/32.2.171... ⁾.

Lower probability to access resources made available for cataract surgery⁽²⁴24. Finger RP, Ali M, Earnest J, Nirmalan PK. Cataract surgery in Andhra Pradesh state, India: an investigation into uptake following outreach screening camps. Ophthalmic Epidemiol. 2007;14(6):327-32. https://doi.org/10.1080/01658100701486814
https://doi.org/10.1080/0165810070148681... ⁾.

Lower probability of breast reconstruction and less incentive to undergo immunotherapy⁽³⁶36. Schroyen S, Missotten P, Jerusalem G, Gilles C, Adam S. Ageism and caring attitudes among nurses in oncology. Int Psychogeriatr. 2016;28(5):749-57. https://doi.org/10.1017/s1041610215001970
https://doi.org/10.1017/s104161021500197... ⁾.

Few conservative surgeries, regardless of the clinical severity of breast cancer⁽³⁹39. Di Rosa M, Chiatti C, Rimland JM, Capasso M, Scandali VM, Prospero E, et al. Ageism and surgical treatment of breast cancer in Italian hospitals. Aging Clin Exp Res. 2018;30(2):139-44. https://doi.org/10.1007/s40520-017-0757-0
https://doi.org/10.1007/s40520-017-0757-... ⁾.

People aged between 80 and 90 years old are less likely to be operated on when compared to patients aged between 65 and 79 years old⁽⁵²52. Tomioka S, Rosenberg M, Fushimi K, Matsuda S. An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan. BMC Health Serv Res. 2020;20(1):830. https://doi.org/10.1186/s12913-020-05690-9
https://doi.org/10.1186/s12913-020-05690... ⁾.

Use of inappropriate language

Condescending and childish language⁽³⁴34. Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, et al. Ageism among physicians, nurses, and social workers: findings from a qualitative study. Eur J Ageing. 2016;14(1):39-48. https://doi.org/10.1007/s10433-016-0389-9
https://doi.org/10.1007/s10433-016-0389-... ^,³⁷37. Taverner T, Baumbusch J, Taipale P. Normalization of Neglect: A Grounded Theory of RNs’ Experiences as Family Caregivers of Hospitalized Seniors. Can J Aging. 2016;35(2):215-28. https://doi.org/10.1017/s0714980816000179
https://doi.org/10.1017/s071498081600017... ⁾.

Aged people were ignored and shunned, and privacy was not guaranteed⁽³⁷37. Taverner T, Baumbusch J, Taipale P. Normalization of Neglect: A Grounded Theory of RNs’ Experiences as Family Caregivers of Hospitalized Seniors. Can J Aging. 2016;35(2):215-28. https://doi.org/10.1017/s0714980816000179
https://doi.org/10.1017/s071498081600017... ⁾.

Instructions in inaccessible language, inhibiting older adults’ participation⁽⁴¹41. Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257. https://doi.org/10.1186/s12877-018-0941-x
https://doi.org/10.1186/s12877-018-0941-... ⁾.

Very short statements that express negative characteristics⁽⁴³43. Schroyen S, Adam S, Marquet M, Jerusalem G, Thiel S, Giraudet AL, et al. Communication of healthcare professionals: Is there ageism? Eur J Cancer Care. 2018;27(1). https://doi.org/10.1111/ecc.12780
https://doi.org/10.1111/ecc.12780... ⁾.

Low access to health services and resources

Lower probability to be screened to an Emergency Department resuscitation room⁽¹³13. Grant PT, Henry JM, McNaughton GW. The management of elderly blunt trauma victims in Scotland: evidence of ageism? Injury. 2000;31(7):519-28. https://doi.org/10.1016/s0020-1383(00)00038-3
https://doi.org/10.1016/s0020-1383(00)00... ⁾.

Health professionals less willing to treat aged people with suicidal ideation⁽¹⁴14. Uncapher H, Areán PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48(2):188-92. https://doi.org/10.1111/j.1532-5415.2000.tb03910.x
https://doi.org/10.1111/j.1532-5415.2000... ⁾.

Limited access to organs for transplantation due to age⁽²²22. Van Delden JJ, Vrakking AM, Van Der Heide A, Van Der Maas PJ. Medical decision making in scarcity situations. J Med Ethics. 2004;30(2):207-11. https://doi.org/10.1136/jme.2003.003681
https://doi.org/10.1136/jme.2003.003681... ⁾.

Aged people experiencing psychosis without access to relevant services, guidelines and funding⁽²⁸28. Mitford E, Reay R, McCabe K, Paxton R, Turkington D. Ageism in first episode psychosis. Int J Geriatr Psychiatry. 2010;25(11):1112-8. https://doi.org/10.1002/gps.2437
https://doi.org/10.1002/gps.2437... ⁾.

Low probability of accessing rehabilitation services⁽³⁴34. Ben-Harush A, Shiovitz-Ezra S, Doron I, Alon S, Leibovitz A, Golander H, et al. Ageism among physicians, nurses, and social workers: findings from a qualitative study. Eur J Ageing. 2016;14(1):39-48. https://doi.org/10.1007/s10433-016-0389-9
https://doi.org/10.1007/s10433-016-0389-... ^,⁴⁰40. Forti P, Maioli F, Magni E, Ragazzoni L, Piperno R, Zoli M, et al. Risk of Exclusion From Stroke Rehabilitation in the Oldest Old. Arch Phys Med Rehabil. 2018;99(3):477-83. https://doi.org/10.1016/j.apmr.2017.08.469
https://doi.org/10.1016/j.apmr.2017.08.4... ⁾.

Inadequate care

Aged people feel that they do not access the same care, resources and guidance as younger individuals⁽¹⁶16. Kennelly C, Bowling A. Suffering in deference: a focus group study of older cardiac patients’ preferences for treatment and perceptions of risk. Qual Health Care. 2001;10(Suppl 1):i23-8. https://doi.org/10.1136/qhc.0100023
https://doi.org/10.1136/qhc.0100023... ^,¹⁸18. Fischer LR, Wei F, Solberg LI, Rush WA, Heinrich RL. Treatment of elderly and other adult patients for depression in primary care. J Am Geriatr Soc. 2003;51(11):1554-62. https://doi.org/10.1046/j.1532-5415.2003.51506.x
https://doi.org/10.1046/j.1532-5415.2003... ^,²⁷27. Hudelson P, Kolly V, Perneger T. Patients’ perceptions of discrimination during hospitalization. Health Expect. 2010;13(1):24-32. https://doi.org/10.1111/j.1369-7625.2009.00577.x
https://doi.org/10.1111/j.1369-7625.2009... ^,⁴⁶46. Shin DW, Park K, Jeong A, Yang HK, Kim SY, Cho M, et al. Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey. J Geriatr Oncol. 2019;10(3):459-64. https://doi.org/10.1016/j.jgo.2018.09.006
https://doi.org/10.1016/j.jgo.2018.09.00... ⁾.

Suicide risk is not assessed⁽¹⁸18. Fischer LR, Wei F, Solberg LI, Rush WA, Heinrich RL. Treatment of elderly and other adult patients for depression in primary care. J Am Geriatr Soc. 2003;51(11):1554-62. https://doi.org/10.1046/j.1532-5415.2003.51506.x
https://doi.org/10.1046/j.1532-5415.2003... ⁾.

Inattention to older adults’ needs⁽²⁶26. Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe KH, Kirkevold M, et al. In quest of justice? Clinical prioritisation in healthcare for the aged. J Med Ethics. 2008;34(4):230-5. https://doi.org/10.1136/jme.2006.018531
https://doi.org/10.1136/jme.2006.018531... ⁾.

Perception of incomplete, uncomprehending medical care and discriminatory practices during interactions between physicians and aged people⁽³⁰30. Clarke LH, Bennett EV, Korotchenko A. Negotiating vulnerabilities: how older adults with multiple chronic conditions interact with physicians. Can J Aging. 2014;33(1):26-37. https://doi.org/10.1017/s0714980813000597
https://doi.org/10.1017/s071498081300059... ⁾.

Aged people with no cure possibility through medical treatment are also less prioritized in basic Nursing care⁽³³33. Skirbekk H, Nortvedt P. Inadequate treatment for elderly patients: professional norms and tight budgets could cause “ageism” in hospitals. Health Care Anal. 2014;22(2):192-201. https://doi.org/10.1007/s10728-012-0207-2
https://doi.org/10.1007/s10728-012-0207-... ⁾.

Rushed service during clinical consultation⁽⁴¹41. Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257. https://doi.org/10.1186/s12877-018-0941-x
https://doi.org/10.1186/s12877-018-0941-... ⁾.

Aged people receive less intensive care during cardiac arrest when compared to younger groups⁽⁴⁴44. Wiel E, Di Pompéo C, Segal N, Luc G, Marc JB, Vanderstraeten C, et al. Age discrimination in out-of-hospital cardiac arrest care: a case-control study. Eur J Cardiovasc Nurs. 2018;17(6):505-12. https://doi.org/10.1177/1474515117746329
https://doi.org/10.1177/1474515117746329... ⁾.

Lack of investment in care and lack of consideration related to the holistic needs and contextual challenges faced by older adults⁽⁵⁰50. Motsohi T, Namane M, Anele AC, Abbas M, Kalula SZ. Older persons’ experience with health care at two primary level clinics in Cape Town, South Africa: a qualitative assessment. BJGP Open. 2020;4(3):bjgpopen20X101048. https://doi.org/10.3399/bjgpopen20X101048
https://doi.org/10.3399/bjgpopen20X10104... ⁾.

Inattention to family members

Aged people’s relatives receive less psychological support, regardless of prognosis⁽³⁸38. Demetriadou E, Kokkinou M, Metaxas G, Kyriakides E, Kyprianou T. Psychological support for families of ICU patients: longitudinal documentation of the service. Psychol Health Med. 2017;22(6):736-43. https://doi.org/10.1080/13548506.2016.1231922
https://doi.org/10.1080/13548506.2016.12... ⁾.

Anti-aging behaviors

Negative and anti-aging attitudes on the part of employees towards old age⁽²⁵25. Manthorpe J, Clough R, Cornes M, Bright L, Moriarty J, Iliffe S. Four years on: The impact of the National Service Framework for Older People on the experiences, expectations and views of older people. Age Ageing. 2007;36(5):501-7. https://doi.org/10.1093/ageing/afm078
https://doi.org/10.1093/ageing/afm078... ⁾.

Social devaluation⁽³⁰30. Clarke LH, Bennett EV, Korotchenko A. Negotiating vulnerabilities: how older adults with multiple chronic conditions interact with physicians. Can J Aging. 2014;33(1):26-37. https://doi.org/10.1017/s0714980813000597
https://doi.org/10.1017/s071498081300059... ⁾.

Embarrassment in caring for aged men with a sexually transmitted infection⁽⁴¹41. Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257. https://doi.org/10.1186/s12877-018-0941-x
https://doi.org/10.1186/s12877-018-0941-... ⁾.

Aged men, older adults and people with lower schooling levels felt discriminated against because of their age in clinics and hospitals⁽⁴⁵45. Dobrowolska B, Jędrzejkiewicz B, Pilewska-Kozak A, Zarzycka D, Ślusarska B, Deluga A, et al. Age discrimination in healthcare institutions perceived by seniors and students. Nurs Ethics. 2019;26(2):443-59. https://doi.org/10.1177/0969733017718392
https://doi.org/10.1177/0969733017718392... ⁾.

Jewish health professionals showed more anti-aging attitudes than Arabs, even those who specialize in the field⁽⁴⁷47. Heyman N, Osman I, Ben Natan M. Ageist attitudes among healthcare professionals and older patients in a geriatric rehabilitation facility and their association with patients’ satisfaction with care. Int J Older People Nurs. 2020;15(2):e12307. https://doi.org/10.1111/opn.12307
https://doi.org/10.1111/opn.12307... ⁾.

Older nurses reported high frequency of negative age-related behaviors in everyday life⁽⁵¹51. Rababa M, Hammouri AM, Hweidi IM, Ellis JL. Association of nurses’ level of knowledge and attitudes to ageism toward older adults: Cross-sectional study. Nurs Health Sci. 2020;22(3):593-601. https://doi.org/10.1111/nhs.12701
https://doi.org/10.1111/nhs.12701... ⁾.

General hospital nurses have anxiety and fear of old age⁽⁵³53. Hwang EH, Kim KH. Quality of Gerontological Nursing and Ageism: What Factors Influence on Nurses’ Ageism in South Korea? Int J Environ Res Public Health. 2021;18(8):4091. https://doi.org/10.3390/ijerph18084091
https://doi.org/10.3390/ijerph18084091... ⁾.

Beliefs and stereotypes

Health professionals are more likely to feel that suicidal ideation in older adults is normal and not to use therapeutic strategies⁽¹⁴14. Uncapher H, Areán PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48(2):188-92. https://doi.org/10.1111/j.1532-5415.2000.tb03910.x
https://doi.org/10.1111/j.1532-5415.2000... ⁾.

Rural physicians have a negative perception of people over 85 years old, regardless of all the information about health status and functional and cognitive capacity⁽²³23. Gunderson A, Tomkowiak J, Menachemi N, Brooks R. Rural physicians’ attitudes toward the elderly: evidence of ageism? Qual Manag Health Care. 2005;14(3):167-76. https://doi.org/10.1097/00019514-200507000-00006
https://doi.org/10.1097/00019514-2005070... ⁾.

Perception of aged people as weak and sick, with diminished mental abilities, intolerant and inflexible, disabled and difficult to adhere to treatments⁽³²32. Polat U, Karadaǧ A, Ulger Z, Demir N. Nurses’ and physicians’ perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey. Contemp Nurse. 2014;48(1):88-97. https://doi.org/10.5172/conu.2014.48.1.88
https://doi.org/10.5172/conu.2014.48.1.8... ⁾.

Beliefs that aged people are less sexually active and are uncomfortable talking about sex⁽³⁵35. Davis T, Teaster PB, Thornton A, Watkins JF, Alexander L, Zanjani F. Primary Care Providers’ HIV Prevention Practices Among Older Adults. J Appl Gerontol. 2016;35(12):1325-42. https://doi.org/10.1177/0733464815574093
https://doi.org/10.1177/0733464815574093... ⁾.

Negative affect towards aged people, less interest in treating them, perception that treatments are not successful and have worse prognosis⁽⁴⁸48. Kessler EM, Blachetta C. Age cues in patients’ descriptions influence treatment atitudes. Aging Ment Health. 2020;24(1):193-6. https://doi.org/10.1080/13607863.2018.1515889
https://doi.org/10.1080/13607863.2018.15... ⁾.

Violent approach

Aged people were treated as objects and responsibility for their care was transferred to the family⁽³⁷37. Taverner T, Baumbusch J, Taipale P. Normalization of Neglect: A Grounded Theory of RNs’ Experiences as Family Caregivers of Hospitalized Seniors. Can J Aging. 2016;35(2):215-28. https://doi.org/10.1017/s0714980816000179
https://doi.org/10.1017/s071498081600017... ⁾.

Health professionals yelled at, were rude to and accused aged people of wasting their time and taking medications that should be intended for younger individuals; they criticized for not listening and understanding the guidelines, not following the protocols and considering the illegitimate complaints; older adults were disrespected, devalued and labeled as uncooperative and unintelligent⁽⁴²42. Schatz E, Seeley J, Negin J, Mugisha J. They ‘don’t cure old age’: Older Ugandans’ delays to health-care access. Ageing Soc. 2018;38(11):2197-217. https://doi.org/10.1017/S0144686X17000502
https://doi.org/10.1017/S0144686X1700050... ⁾.

Coping measures against ageism directed to older adults in health services

Improve communication between aged people and medical team⁽¹⁶16. Kennelly C, Bowling A. Suffering in deference: a focus group study of older cardiac patients’ preferences for treatment and perceptions of risk. Qual Health Care. 2001;10(Suppl 1):i23-8. https://doi.org/10.1136/qhc.0100023
https://doi.org/10.1136/qhc.0100023... ⁾.

Invest in and carry out scientific research studies⁽¹⁵15. Bouman WP, Arcelus J. Are psychiatrists guilty of “ageism” when it comes to taking a sexual history? Int J Geriatr Psychiatry. 2001;16(1):27-31. https://doi.org/10.1002/1099-1166(200101)16:1%3c27::AID-GPS267%3e3.0.CO;2-S
https://doi.org/10.1002/1099-1166(200101... ^,²³23. Gunderson A, Tomkowiak J, Menachemi N, Brooks R. Rural physicians’ attitudes toward the elderly: evidence of ageism? Qual Manag Health Care. 2005;14(3):167-76. https://doi.org/10.1097/00019514-200507000-00006
https://doi.org/10.1097/00019514-2005070... ^,³¹31. Forrest LF, Adams J, White M, Rubin G. Factors associated with timeliness of post-primary care referral, diagnosis and treatment for lung cancer: population-based, data-linkage study. Br J Cancer. 2014;111:1843-51. https://doi.org/10.1038/bjc.2014.472
https://doi.org/10.1038/bjc.2014.472... ^-³²32. Polat U, Karadaǧ A, Ulger Z, Demir N. Nurses’ and physicians’ perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey. Contemp Nurse. 2014;48(1):88-97. https://doi.org/10.5172/conu.2014.48.1.88
https://doi.org/10.5172/conu.2014.48.1.8... ^,⁵¹51. Rababa M, Hammouri AM, Hweidi IM, Ellis JL. Association of nurses’ level of knowledge and attitudes to ageism toward older adults: Cross-sectional study. Nurs Health Sci. 2020;22(3):593-601. https://doi.org/10.1111/nhs.12701
https://doi.org/10.1111/nhs.12701... ⁾.

Train and update scientific knowledge for health professionals⁽¹⁴14. Uncapher H, Areán PA. Physicians are less willing to treat suicidal ideation in older patients. J Am Geriatr Soc. 2000;48(2):188-92. https://doi.org/10.1111/j.1532-5415.2000.tb03910.x
https://doi.org/10.1111/j.1532-5415.2000... ^,³⁰30. Clarke LH, Bennett EV, Korotchenko A. Negotiating vulnerabilities: how older adults with multiple chronic conditions interact with physicians. Can J Aging. 2014;33(1):26-37. https://doi.org/10.1017/s0714980813000597
https://doi.org/10.1017/s071498081300059... ^,³⁵35. Davis T, Teaster PB, Thornton A, Watkins JF, Alexander L, Zanjani F. Primary Care Providers’ HIV Prevention Practices Among Older Adults. J Appl Gerontol. 2016;35(12):1325-42. https://doi.org/10.1177/0733464815574093
https://doi.org/10.1177/0733464815574093... ^-³⁶36. Schroyen S, Missotten P, Jerusalem G, Gilles C, Adam S. Ageism and caring attitudes among nurses in oncology. Int Psychogeriatr. 2016;28(5):749-57. https://doi.org/10.1017/s1041610215001970
https://doi.org/10.1017/s104161021500197... ^,³⁸38. Demetriadou E, Kokkinou M, Metaxas G, Kyriakides E, Kyprianou T. Psychological support for families of ICU patients: longitudinal documentation of the service. Psychol Health Med. 2017;22(6):736-43. https://doi.org/10.1080/13548506.2016.1231922
https://doi.org/10.1080/13548506.2016.12... ^,⁴¹41. Kiplagat J, Huschke S. HIV testing and counselling experiences: a qualitative study of older adults living with HIV in western Kenya. BMC Geriatr. 2018;18(1):257. https://doi.org/10.1186/s12877-018-0941-x
https://doi.org/10.1186/s12877-018-0941-... ^,⁴⁵45. Dobrowolska B, Jędrzejkiewicz B, Pilewska-Kozak A, Zarzycka D, Ślusarska B, Deluga A, et al. Age discrimination in healthcare institutions perceived by seniors and students. Nurs Ethics. 2019;26(2):443-59. https://doi.org/10.1177/0969733017718392
https://doi.org/10.1177/0969733017718392... ^,⁴⁷47. Heyman N, Osman I, Ben Natan M. Ageist attitudes among healthcare professionals and older patients in a geriatric rehabilitation facility and their association with patients’ satisfaction with care. Int J Older People Nurs. 2020;15(2):e12307. https://doi.org/10.1111/opn.12307
https://doi.org/10.1111/opn.12307... ^-⁴⁸48. Kessler EM, Blachetta C. Age cues in patients’ descriptions influence treatment atitudes. Aging Ment Health. 2020;24(1):193-6. https://doi.org/10.1080/13607863.2018.1515889
https://doi.org/10.1080/13607863.2018.15... ^,⁵³53. Hwang EH, Kim KH. Quality of Gerontological Nursing and Ageism: What Factors Influence on Nurses’ Ageism in South Korea? Int J Environ Res Public Health. 2021;18(8):4091. https://doi.org/10.3390/ijerph18084091
https://doi.org/10.3390/ijerph18084091... ⁾.

Listen to citizens and hospital administrators and their perspectives on older adults’ health priorities⁽²⁶26. Pedersen R, Nortvedt P, Nordhaug M, Slettebø A, Grøthe KH, Kirkevold M, et al. In quest of justice? Clinical prioritisation in healthcare for the aged. J Med Ethics. 2008;34(4):230-5. https://doi.org/10.1136/jme.2006.018531
https://doi.org/10.1136/jme.2006.018531... ⁾.

Stimulate the work of physicians and nurses in the Geriatrics and Gerontology areas⁽³²32. Polat U, Karadaǧ A, Ulger Z, Demir N. Nurses’ and physicians’ perceptions of older people and attitudes towards older people: Ageism in a hospital in Turkey. Contemp Nurse. 2014;48(1):88-97. https://doi.org/10.5172/conu.2014.48.1.88
https://doi.org/10.5172/conu.2014.48.1.8... ⁾.

Educate family caregivers, aged people and health professionals to fight against ageism and make decisions based on scientific evidence⁽⁴⁶46. Shin DW, Park K, Jeong A, Yang HK, Kim SY, Cho M, et al. Experience with age discrimination and attitudes toward ageism in older patients with cancer and their caregivers: A nationwide Korean survey. J Geriatr Oncol. 2019;10(3):459-64. https://doi.org/10.1016/j.jgo.2018.09.006
https://doi.org/10.1016/j.jgo.2018.09.00... ⁾.

Conduct campaigns to raise awareness of the aging process and old age⁽⁵⁰50. Motsohi T, Namane M, Anele AC, Abbas M, Kalula SZ. Older persons’ experience with health care at two primary level clinics in Cape Town, South Africa: a qualitative assessment. BJGP Open. 2020;4(3):bjgpopen20X101048. https://doi.org/10.3399/bjgpopen20X101048
https://doi.org/10.3399/bjgpopen20X10104... ^-⁵¹51. Rababa M, Hammouri AM, Hweidi IM, Ellis JL. Association of nurses’ level of knowledge and attitudes to ageism toward older adults: Cross-sectional study. Nurs Health Sci. 2020;22(3):593-601. https://doi.org/10.1111/nhs.12701
https://doi.org/10.1111/nhs.12701... ⁾.

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[1] Corresponding author:
Pricila Oliveira de Araújo E-mail: poaraujos@uefs.br https://orcid.org/0000-0002-7941-9263