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Age Discrimination, Eppur Si Muove (Yet It Moves)

2016; Wiley; Volume: 64; Issue: 2 Linguagem: Inglês

10.1111/jgs.13949

1532-5415

Rocío Fernández Ballesteros, Antonio Bustillos, Carmen Huici Casal, Jose M.l Ribera Casado,

Insurance, Mortality, Demography, Risk Management

Journal of the American Geriatrics SocietyVolume 64, Issue 2 p. 453-455 Letters to the EditorFree Access Age Discrimination, Eppur Si Muove (Yet It Moves)† Rocío Fernández-Ballesteros PhD, Rocío Fernández-Ballesteros PhD Department of Psychobiology and Health, Autonomus University of Madrid, Madrid, SpainSearch for more papers by this authorAntonio Bustillos PhD, Antonio Bustillos PhD Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, SpainSearch for more papers by this authorCarmen Huici Casal PhD, Carmen Huici Casal PhD Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, SpainSearch for more papers by this authorJose M.l Ribera Casado MDr, Jose M.l Ribera Casado MDr Geriatric Service, Hospital Clinico San Carlos, Complutense University of Madrid, Madrid, SpainSearch for more papers by this author Rocío Fernández-Ballesteros PhD, Rocío Fernández-Ballesteros PhD Department of Psychobiology and Health, Autonomus University of Madrid, Madrid, SpainSearch for more papers by this authorAntonio Bustillos PhD, Antonio Bustillos PhD Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, SpainSearch for more papers by this authorCarmen Huici Casal PhD, Carmen Huici Casal PhD Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia, Madrid, SpainSearch for more papers by this authorJose M.l Ribera Casado MDr, Jose M.l Ribera Casado MDr Geriatric Service, Hospital Clinico San Carlos, Complutense University of Madrid, Madrid, SpainSearch for more papers by this author First published: 18 February 2016 https://doi.org/10.1111/jgs.13949Citations: 4 †Eppur si muove is the phrase attributed to the Italian astronomer and philosopher Galileo Galilei (1564–1642) in 1633 after the Inquisition forced him to recant his heliocenter theory, which claims that the earth moves around the sun. Under pressure, he supposedly added, sotto voce, "E pur si muove" (or in some versions "Eppur si muove"). AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL To the Editor: Around the world, ageism and age discrimination have been strongly combated over the last decades. In the European Union (EU), national well-being policies ensure a universal public health system for all citizens.1 Moreover, the Fundamental Rights of the European Union, Article 21–1, states: "any discrimination based on any ground such as … age … shall be prohibited" [emphasis added], and Art 35 refers to health care, declaring: "A high level of human health protection shall be ensured in the definition and implementation of all the Union's policies and activities." Accordingly, the Spanish Constitution (1998), Article 14, states: "Spaniards…cannot be discriminated against…for any condition," and the General Health Law (Law 14/1986), Article 1.2, affirms that "all Spaniards, and foreigners with residence in the national territory, have the right to health care and protection." Following the European Observatory on Health Systems and Policies,2 the public and universal Spanish Health Care System was ranked as one of the best in Europe. Recently, the Spanish legal system has been under scrutiny with respect to age discrimination in the field of health and social care and services. With the exception of mandatory retirement (only in the public sector), Spanish laws seem to be free of ageism,3 but are older Spaniards truly are free of age discrimination? Contrary to other constructs in the field, such as age stereotyping (sociocognitive) or prejudice (emotional–attitudinal), discrimination may be operationalized through observable events, as a large variety of research from preventive medicine to palliative care shows.4 The current focused on a set of age discrimination events, asking members of the Spanish Society of Geriatrics and Gerontologists whether these events are observed in common practice. First, after interviews with health and social services, a 28-item questionnaire asking for the occurrence (yes/no) of direct and indirect discrimination situations5 in health and social care settings was developed. Direct, or blatant, ageism is when health or social practices are unavailable to people of a certain age (e.g., breast cancer prevention campaign after 70), and indirect, or subtle, ageism refers to when older adults have lower priority or have limitations in accessing certain health or social services. The questionnaire also asked about ageist behaviors, defined as verbal or overt behaviors indicated by special forms of addressing older adults. The questionnaire was administered anonymously online. Participants were 174 Spanish Society of Geriatrics and Gerontologists members (mean age 45.7 ± 11.0, 63% female); 59% physicians, 19% psychologists, 5.5% social workers, 4.8% nurses, and 12.1% other social and health professionals with a mean 17.2 ± 9.6 years working with older adults. With reference to the three types of items, exploratory factor analysis yielded three main factors accounting for 37.1% of the variance. The first factor was loaded with direct ageism items (14.1%), the second with indirect ageism items (12.4%), and the third factor with ageist behaviors (10.6%). More than two-thirds of the participants reported that more than half of the discrimination situations occurred in their practices. For direct discrimination situations, access limitations to high-cost care units (76%), high-technology evaluation devices (76%), or high-cost surgeries (76%) were reported. Regarding indirect discrimination, nonstrict fulfillment of good practice protocols (64%) and exclusion of preventive programs (smoking, breast cancer; 62%) were most reported. Finally, in ageist paternalistic behaviors reported were when professionals address an older adult as if he or she were a child (diminutive, baby talk, 87%); when a health or social professional is attending an older person accompanied by a relative, usually directing their questions to the relative and even using the third person (he, she) to refer to the present older adult (85%); and in gerontological centers, when older adults' preferences are not taken into consideration in setting up activity schedules without alternatives (84%). These results are in agreement with many others; for example, surveys by Age Concern England5 have identified direct ageism (limiting access to certain services for individuals as a function of their age) and indirect ageism through attitudes of practitioners and that influence decision-making about the type of care provided to older adults and how they are perceived.6-8 From the results of the current study, based on opinions of geriatricians and gerontologists, it can be concluded that direct and indirect discrimination and ageist behaviors are obstinate realities in gerontological and geriatric contexts in Spain and probably in other EU countries. Age discrimination is taking place (Eppur si muove) even when legislation is perfectly antiageist and reinforces egalitarian human rights. The post hoc hypothesis is that negative stereotypes at cultural (society) and contextual (health and social care) levels, as psychosocial processes, are behind such discrimination.9, 10 Much greater efforts must be made in changing ageist psychosocial processes. Acknowledgments The authors would like to thank the Spanish Society of Gerontology and Geriatrics and to those members who answered our questionnaire. Conflict of Interest: There were no identified conflict of interests in this study. The study was supported by Ministry of Innovation Project PSI 2010 17700-EVE. Author Contributions: Fernández-Ballesteros: principal investigator, study design, manuscript preparation. Bustillos: data analysis and interpretation, manuscript preparation. Huici Casal: Preparation of discrimination questionnaire, manuscript preparation. Ribera Casado: acquisition of subjects, manuscript preparation, prepared legislation part of study. Sponsor's Role: The Spanish Agency for Research financed the project but had no research role. References 1Rechel B, Grundy E, Robine JM et al. Ageing in the European Union. Lancet 2013; 381: 1312– 1322. 2Papanicolas I, Smith PC. Health System Performance Comparison. An Agenda for Policy, Information and Research. Berkshire, England: McGraw-Hill Education, World Health Organization, 2013. 3Ribera JM, Bustillos A, Guerra A et al. Se discrimina a las personas mayores en función de la edad? De la legislación a la discriminación informada por el profesional. Are older persons discriminated? From law to professional reports. Rev Esp Geriatr Gerontol 2015. in press. 4Holm S. Ethical issues in geriatric medicine. In: HM Fillit, K Rockwood, K Woodhouse, eds. Brocklehurst Textbook of Geriatric Medicine and Gerontology, 7th Ed. Philadelphia: Saunders Elsevier, 2009, pp 983– 987. 5Adams A, Buckingham CR, Argber S et al. The influence of patient's age on clinical decision-making about coronary heart disease in the USA and the UK. Ageing Soc 2006; 26: 303– 321. 6Salzman B. Myths and realities of aging. Care Management 2006; 7: 141– 150. 7Haug MR, Ory MG. Issues in elderly patient-provider interactions. Res Aging 1987; 9: 3– 44. 8 Eurobarometer 317. Discrimination in the EU in 2009. Special Eurobarometer Report. Brussels, Belgium: European Commission, 2009. 9Levy B. Stereotype embodiment. A psychosocial approach to aging. Curr Direct. Psychol Sci 2009; 18: 332– 336. 10Bustillos A, Fernández-Ballesteros R. Is older adults' functioning affected by stereotypes held by caregivers? GeroPsychol 2013; 4: 1– 7. Citing Literature Volume64, Issue2February 2016Pages 453-455 ReferencesRelatedInformation