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DOI: http://dx.doi.org/10.46925//rdluz.33.24

Ageism in clinical practice and improving educational

programmes based on anti-ageism principles

Oleg Mikhailovich Kuzminov *

Kirill Ivanovich Prashchayeu **

Olesya Viktorovna Bochko ***

Eleonora Viktorovna Mudrakovskaya ****

Lilia Aleksandrovna Krupenkina *****

Irina Viktorovna Sinitsa ******

ABSTRACT

The purpose of the article is to study the manifestations of ageism in clinical practice, the relationship of

ageism with the presence of senile asthenia and comorbidity in the picture of the disease, substantiation of

the improvement of educational programs based on anti-age approaches. Methodology. To assess the

subjective perception of discrimination, patients of mature, elderly and senile age were examined;

“Questionnaire for Citizens aged 75 and Over”, “Ageism Questionnaire” by E. Palmare was used; the

Charlson polymorbidity index was calculated; to improve the training programs for medical specialists,

their awareness of the main problems of aging was studied. Results. Ageism manifestations were correlated

with the development of senile asthenia and comorbidity in the clinical picture of the disease. It has been

shown that the psychological discomfort of elderly and senile patients associated with ageism increases

with age, which may exceed in importance the immediate health problems in the overall picture of the

disease. The most important manifestation of the subjective perception of bias is the justification by the

attending physician of the disease mainly by the age of the patients, which indirectly implies ignoring other

causes of pathology and reduces the activity of carrying out therapeutic and diagnostic measures. As a result

of the study, the need to improve educational programs for the training of medical specialists was

substantiated, taking into account the gerontological and anti-aging approach.

KEY WORDS: ageism; gerontology; geriatrics; senile asthenia; elderly; aging.

*

Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of Propaedeutics of

Internal Diseases and Clinical Information Technologies Federal State Autonomous Educational Institution of Higher

Education “Belgorod National Research University” Belgorod, Russia. ORCID: http://orcid.org/0000-0001-7086-9420.

E-mail: o-kiselva@mail.ru

*

* Professor in department of Therapy, Geriatrics and Anti-Aging Medicine Academy of Postgraduate Education under

the Federal State Budgetary Unit «Federal Scientific and Clinical Center for Specialized Medical Assistance and

Medical Technologies of the Federal Medical Biological Agency» Moscow, Russia ORCID: 0000-0002-6534-1362

*** Research associate of the Department of clinical gerontology Independent noncommercial organization «Research

Medical Centre «Gerontology» Moscow, Russia ОRCID: http://orcid.org/0000-0002-6940-3495

**** Urologist MEDSI clinic Moscow, Russia ОRCID: http://orcid.org/0000-0001-6054-9749

*

**** Candidate of Medical Sciences, Professor of the Department of Propaedeutics of Internal Diseases and Clinical

Information Technologies Federal State Autonomous Educational Institution of Higher Education «Belgorod National

Research University» Belgorod, Russia ОRCID: http://orcid.org/0000-0003-3299-5877

****** Therapist, head of the therapeutic department Regional State Budgetary Healthcare Institution «City Hospital

№

2 of Belgorod» Belgorod, Russia ОRCID: http://orcid.org/0000-0003-0017-0774

Recibido: 02/02/2021

Aceptado: 05/04/2021

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El ageísmo en la práctica clínica y mejora de los programas

educativos basados en principios anti-ageísmo

RESUMEN

El propósito del artículo es estudiar las manifestaciones de la discriminación por edad en la

práctica clínica, la relación de la discriminación por edad con la presencia de astenia senil y

la comorbilidad en el cuadro de la enfermedad, fundamentación de la mejora de los

programas educativos basados en enfoques anti-edad. Metodología. Para evaluar la

percepción subjetiva de discriminación, se examinaron pacientes en edad madura, anciana y

senil; Se utilizó el “Cuestionario para ciudadanos de 75 y más años”, el “Cuestionario de

discriminación por edad” de E. Palmare; se calculó el índice de polimorbilidad de Charlson;

Para mejorar los programas de formación de médicos especialistas, se estudió su

conocimiento de los principales problemas del envejecimiento. Resultados. Las

manifestaciones por edad se correlacionaron con el desarrollo de astenia senil y

comorbilidad en el cuadro clínico de la enfermedad. Se ha demostrado que el malestar

psicológico de los pacientes ancianos y seniles asociado a la discriminación por edad

aumenta con la edad, lo que puede superar en importancia a los problemas de salud

inmediatos en el cuadro general de la enfermedad. La manifestación más importante de la

percepción subjetiva de sesgo es la justificación por parte del médico tratante de la

enfermedad principalmente por la edad de los pacientes, lo que indirectamente implica

ignorar otras causas de patología y reduce la actividad de realizar medidas terapéuticas y

diagnósticas. Como resultado del estudio, se fundamentó la necesidad de mejorar los

programas educativos para la formación de médicos especialistas, teniendo en cuenta el

enfoque gerontológico y antienvejecimiento.

PALABRAS CLAVE: Ageísmo; gerontología; geriatría; astenia senil; anciano;

envejecimiento.

Introduction

The aging of the population is a worldwide tendency of increasing life expectancy in

developed countries, including Russia. According to the UN, the share of elderly and older

people in these countries will increase from 20% of the population in 2015 to 25% in 2025

and to 30% in 2050.

The problem of geriatric care is multidisciplinary and requires improving the

provision of medical, social, psychological and other types of care (Ilnitskiy and Proshchaev,

2013; Kolpina, 2017; Miklyaeva, 2009a; Tkacheva et al., 2017).

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Ageism is one of the social problems in geriatrics. Ageism is discrimination of a

person on the basis of age based on stereotypes or prejudice towards him (Puchkov and

Afanasyeva, 2011; Startseva and Ilnitskiy, 2018; Butler, 1999; Meisner, 2012; Sargent-Cox,

2017; Wyman et al., 2018). Ageism can manifest itself in the dislike of older people by young

people in the form of indifference, disrespect, ridicule, unwillingness to cooperate and

listen, as well as disgust, cruelty and even violence against the elderly. At the same time, the

objects of ageism can be distinguished, for example, patients of healthcare institutions, its

subjects, in particular, medical personnel (Kolpina, 2015; Kolpina et al., 2015; Eymard and

Douglas, 2012; Liu et al., 2012; Granadillo et al, 2015).

The subjective perception of ageism in elderly and senile patients has a negative

effect on both their psychological state and somatic status, in particular on the

neuroendocrine system. Ageism contributes to the development of depression, dementia

and cardiovascular pathology in elderly and senile people (Gaynor et al., 2014; Makris et al.,

2015; Theofanidis, 2015; Thiem et al., 2011). Aggravates the course of gerontological

syndromes, in particular senile asthenia. Senile asthenia is a geriatric syndrome

characterized by an age-associated decrease in the physiological reserve and functions of

many body systems, leading to increased vulnerability of the elderly person's body to the

effects of endo- and exogenous factors (Ilnitskiy and Proshchaev, 2013; Tkacheva, 2018;

Tkacheva et al., 2017; Kotter-Gruhn, 2015). The syndrome of senile asthenia is closely

associated with other geriatric syndromes, as well as with the presence of comorbidity

(multiple pathology in one patient) (Lazebnik et al., 2015; Charlson et al., 1987; Thiem et al.,

2011).

Traditionally, the issues of ageism have been considered in the most detail by

specialist psychologists and sociologists (Miklyaeva, 2009b; Kotter-Gruhn, 2015; Palmore,

001; Voss et al., 2018). However, the inclusion of these issues in educational programs for

2

the training of medical specialists of clinical direction is relevant for creating a "safe

environment" for elderly and senile people, as well as increasing the degree of empathy of all

health workers towards elderly and senile people.

The significance and dynamics of the subjective perception of ageism in therapeutic

patients in different age groups are investigated in order to achieve the goal. Manifestations

of ageism were correlated with the development of senile asthenia and comorbidity in the

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clinical picture of the disease. We examined gerontological knowledge and ageism in

undergraduate clinical students before and after educational programmes based on geriatric

and anti-ageism approaches.

1

. Materials and methods

0 patients (54 women and 36 men) of mature, elderly and senile age (50 ... 90 years),

9

hospitalized in the city clinical hospital No. 2 of the city of Belgorod, were examined to

assess the subjective perception of discrimination. Patients with leading therapeutic,

cardiological and neurological pathology were included. The exclusion criterion was a

general severe somatic condition. The likelihood of senile asthenia was investigated using

the "Questionnaire for citizens aged 75 and over" (Tkacheva, 2018; Tkacheva et al., 2017),

polymorbidity was assessed using the Charlson index (Charlson et al., 1987). The subjective

level of edgism was studied using the "Ageism Questionnaire" by E. Palmore (Palmore,

2001), which allows to measure the subjective perception of a person's discrimination.

The awareness of senior students of the medical institute of the National Research

University "BelSU" about the main problems of aging was studied to improve the training

programs for medical specialists in the field of gerontology and geriatrics. A survey was

conducted of 220 people of both sexes (118 women and 102 men) at the age of 21 - 25 years.

We used the original questionnaire "Assessment of the level of ageism in the system of

cross-cutting gerontological education", which included 25 questions about old age and

age: definition of old age; how long does the period of youth last; at what age old age begins;

at what age does old age begin; at what age should men retire; at what age women should

retire; should there be differences between men and women at retirement age; five benefits

of old age; five negative aspects associated with old age; can a person in old age get a new

profession; can an elderly person drive a car; five leading problems (diseases, disorders) in

the health of older people; are there people in your environment (family, friends, neighbors,

etc.) with urinary incontinence; Whether urinary incontinence is an integral part of the

aging process by what signs, as early as possible, to identify urinary incontinence; is it

possible to effectively treat urinary incontinence in old age; what forms of living for older

people do you consider acceptable; if you come to a polyclinic and you have the opportunity

to choose a doctor between 30, 50 and 70 years old, which doctor will you choose; if you

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had the opportunity to choose teachers (for you or your children) between 30, 50 and 70,

what age teacher would you choose; you give way to older people on public transport; how

do you feel about marriages between people with a 20-year age difference; can a nurse call

an elderly patient a grandmother; how many years ahead do you plan your life; do you think

about your old age; are you afraid of your old age? Different points were assigned to the

answer options. Next, the ageism index was calculated. The level of ageism was regarded as

low at an index value of 0-24, as an average level at 25-74, as a high level at 75-100.

2

. Results and discussion

A study of the subjective perception of discrimination in patients undergoing

treatment in a hospital setting showed that 39% of them (35 people) note the presence of a

certain level of ageism in relation to them. Analysis of the structure of specific

manifestations of discrimination according to the “Ageism Questionnaire” by E. Palmare

showed that the overwhelming majority of respondents noted the fact that the doctor

justified the disease in the patient mainly by their age. This indirectly implies ignoring

other reasons and reduces the activity of carrying out medical and diagnostic measures. A

noticeably smaller part of the manifestation of ageism is associated with the bias of medical

personnel in interpersonal contacts with patients. Not a single patient noted gross

violations of medical ethics (Fig. 1).

Figure 2 shows a diagram of the distribution of points of subjective perception of

ageism in the study group of patients according to the E. Palmare questionnaire. It shows a

clear increase in subjective perceptions of discrimination with age.

The study of the age-related dynamics of the subjective perception of ageism, as well

as the dynamics of such gerontological problems as comorbidity of pathology and the

development of senile asthenia (frailty) are presented in Table 1.

Analysis of the table shows that with age there is a progressive increase in the

incidence of all studied gerontological problems. Moreover, comparing them with the initial

level in adulthood, taken as a unit, shows an outrunning increase in the psychological

discomfort of patients associated with ageism (Fig. 3). That is, the problem of social

relations may exceed in importance the immediate health problems in the picture of the

disease among elderly and senile patients.

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Figure 1. Structural diagram of the manifestations of subjective perception of ageism in

patients according to the E. Palmare questionnaire

Figure 2. Diagram of the subjective perception of ageism in points according to the E.

Palmare questionnaire

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DOI: http://dx.doi.org/10.46925//rdluz.33.24

Table 1. The degree of polymorbidity, the likelihood of senile asthenia and the level of

subjective sensation of ageism in patients in different age groups (M±m)

Index

Age

Adult age (n = 27) Elder age (n = 32)

Senile age (n = 31)

80,6±0,61

55,2±1,55

3,3±0,58

67,2±0,61

8,4±1,25

Charlson Index

9,6±0,55

Application form

for citizens aged 75

and over

1,9±0,31

0,3±0,13

2,6±0,22

1,05±0,21

4,2±0,35

1,15±0,31

Ageism level

Figure 3. The relative increase in the level of ageism, comorbidity and the presence of senile

asthenia in different age groups

The data obtained showed the relevance of improving educational programs based

on the gerontological and anti-age approach. In this regard, the level of ageism among

senior students of the medical institute was investigated before and after the development

of gerontological programs. The programs contained four didactic modules: organizing

geriatric care, gerodispensary treatment, emergency geriatrics and orthogeriatrics. At the

same time, they used modern educational technologies in the form of e-learning.

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Assessment of the initial level of gerontological knowledge among students showed

their insufficient level. Only 44.1% of the respondents could correctly indicate the old age,

while 34.1% underestimated this age, and 21.8% overestimated it. Only 22.7% of the

respondents could correctly indicate the period of old age, 59.1% of the respondents

consider this age to be younger and 18.2% - older. 69.7% of the respondents believe that age

matters in the possible choice of a doctor or teacher; this indicates certain manifestations of

ageism (age discrimination). 31.4% of the respondents think about the upcoming old age,

4

9.1% are afraid of it. Among the leading diseases of people of older age groups, 23.8% of

respondents named diseases of the cardiovascular system, 15.2% - the musculoskeletal

system, 10.4% - visual or hearing impairment, 10.1% - dementia (dementia) and 8 , 3% -

digestive disorders. The problem of specific geriatric syndromes ("fall", "muscular

dystrophy", "asthenia", "loss of energy", etc.) was noted by 4.2% of the respondents, which is

only 9th in the priorities.

Average level of ageism: among senior students was 44.2 ± 3.5 points. Assessment of

the level of knowledge gained after mastering educational programs in gerontology showed

a significant improvement in the results of the exit test compared to the introductory one.

A positive moment was a significant decrease in the ageism index. It decreased 2.7 times

from 44.2 ± 5.8 points to 16.2 ± 3.4 points (p <0.05) (Fig. 4).

Figure 4. Decrease in the level of ageism among students after mastering educational

gerontological programs

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Conclusions

The subjective perception of discrimination is important in the clinical picture of the

disease of elderly and senile patients, along with such problems as comorbidity and senile

asthenia.

With increasing age of patients, this problem leads to psychological discomfort and

an increase in dissatisfaction with medical care. When organizing the treatment and

diagnostic process, it is necessary to use a multidisciplinary approach and pay great

attention not only to solving clinical problems, but also to improving the psychological

state of patients.

Taking into account the relevance of the development of gerontological care for the

elderly, it is necessary to improve training programs in this area, aimed at increasing the

level of gerontological knowledge and overcoming ageism.

The systematic inclusion of gerontological educational programs for the training of

medical specialists reduces the level of ageism among healthcare workers and is a necessary

condition for increasing empathy towards elderly and senile patients.

References

Butler, R. N. (1999). Ageism: Another form of bigotry. The Gerontologist, 9, 243-246.

Charlson, M. E., Pompei, P. and Ales, H. L. (1987). A new method of classifying prognostic

comorbidity in longitudinal studies: Development and validation. Journal Chronic Disease,

4

0, 373–383.

Eymard, A. S. and Douglas, D. H. (2012). Ageism among health care providers and

interventions to improve their attitudes toward older adults: an integrative review. Journal

of Gerontological Nursing, 38, 26–35. DOI: 10.3928/00989134-20120307-09

Gaynor, E. J., Geoghegan, S. E. and O’Neill, D. (2014). Ageism in stroke rehabilitation

studies. Age and Ageing, 43 (3), 429–431. DOI: 10.1093/ageing/afu026

Granadillo Sierraalta, L. E., Árraga Barrios de Montiel, M., & Sierraalta Márquez, B. (2015).

Actitud hacia la vejez de estudiantes de Gerontología. Revista De La Universidad Del Zulia, 6

(

15),

43-57.

Recuperado

a

partir

de

https://produccioncientificaluz.org/index.php/rluz/article/view/30968

Ilnitskiy, A. N. and Proshchaev, K. I. (2013). Senile asthenia (frailty) as a concept of modern

gerontology. Gerontology, 1 (1), 408-412.

3

46

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

O. M. Kuzminov et al.// Ageism in clinical practice and improving educational programmes … 338-348

DOI: http://dx.doi.org/10.46925//rdluz.33.24

Kolpina, L. V. (2015). Ageism in servicing senior citizens by health care and social

protection institutions: monograph. Ulyanovsk: Zebra, 128.

Kolpina, L. V. (2017). Social health of the elderly population: the settlement factor.

Management in the XXI century: collection of articles. Collection of articles based on

international scientific-practical conference, Belgorod, 1 nov., NRU BelSU, 216-221.

Kolpina, L. V., Ilyin, A. V. and Shkolina, T. I. (2015). Ageism and the experience of

overcoming it in the practice of health care institutions: an empirical analysis. Modern

problems of science and education, 2-1. Available at: http://science-

education.ru/ru/article/view?id=17852.

Kotter-Gruhn, D. (2015). Changing negative views on aging: implications for intervention

and translational research. Annual Review of Gerontology & Geriatrics, 35, 167. DOI:

https://doi. org/10.1891/0198-8794.35.167

Lazebnik, L. B., Efremov, L. I. and Konev, Yu. V. (2015). Semantic difficulties in

polymorbidity. Clinical gerontology, 3, 44-46.

Liu, Y. E., While, A. E., Norman, I. J. and Ye, W. (2012). Health professionals’ attitudes

toward older people and older patients: A systematic review. Journal of Interprofessional

Care, 26 (5), 397–409. DOI: https://doi. org/10.3109/13561820.2012.702146

Makris, U. E., Higashi, R. T., Marks, E. G., Fraenkel, L., Sale, J. E., Gill, T. M. and Reid, M. C.

(

2015). Ageism, negative attitudes, and competing co-morbidities--why older adults may

not seek care for restricting back pain: A qualitative study. BMC Geriatrics, 15, 39. DOI:

https://doi. org/10.1186/s12877-015-0042-z

Meisner, B. A. (2012). A meta-analysis of positive and negative age stereotype priming

effects on behavior among older adults. Journals of Gerontology: B Psychological and Social

Sciences, 67, 13–17. DOI: 10.1093/geronb/gbr062

Miklyaeva, A. V. (2009a). Age discrimination as a socio-psychological phenomenon:

monograph. St. Petersburg: Rech, 160.

Miklyaeva, A. V. (2009b). Ageism research methods: foreign experience. Bulletin of the

Russian State Pedagogical University named after A.I. Herzen, 100, 148-157.

Palmore, E. (2001). The Ageism Survey: First Findings. The Gerontologist, 41 (5), 572-575.

DOI: https://doi.org/10.1093/geront/41.5.572

Puchkov, P. V. and Afanasyeva, S. V. (2011). Gerontological violence as an intercultural

communication phenomenon in the context of conflict-generating interaction between

generations (macrosociological analysis). Izvestiya of Saratov University, Series “Sociology.

Political science”, 11 (3), 11-14.

Sargent-Cox, K. (2017). Ageism: we are our own worst enemy. International

Psychogeriatrics, 29 (1), 1–8. DOI: 10.1017/S1041610216001939

3

47

REVISTA DE LA UNIVERSIDAD DEL ZULIA. 3ª época. Año 12 N° 33, 2021

O. M. Kuzminov et al.// Ageism in clinical practice and improving educational programmes … 338-348

DOI: http://dx.doi.org/10.46925//rdluz.33.24

Startseva, O. N. and Ilnitskiy, A. N. (2018). Ageism and its overcoming in stationary social

service institutions. Guidelines. Moscow, 42.

Theofanidis, D. (2015). A qualitative study on discrimination and ethical implications in

stroke care in contemporary Greece. Journal of Vascular Nursing, 33 (4), 138–142. DOI:

https://doi.org/10.1016/j.jvn.2015.05.040

Thiem, U., Hinrichs, T., Muller, C.A., Holt-Noreiks, S., Nagl, A., Bucchi, C. et al. (2011).

Prerequisites for a new health care model for elderly people with multiple morbidities:

Results and conclusions from 3 years of research in the PRISCUS consortium. Zeitschrift

für Gerontologie und Geriatrie, 44, 101–112. DOI: https://doi.org/10.1007/s00391-011-0246-6

Tkacheva, O. N. (2018). Clinical guidelines: senile asthenia. Age group: 60 and over.

Moscow, 106.

Tkacheva, O. N., Runikhina, N. K. and Kotovskaya, Yu. V. (2017). Senile asthenia: what

should a primary care physician know about it? Russian Medical Inquiry, 25, 1820–1822.

Voss, P., Bodner, E. and Rothermund, K. (2018). Ageism: The Relationship between Age

Stereotypes and Age Discrimination. In.: L. Ayalon, C. Tesch-Römer (eds.), Contemporary

Perspectives on Ageism, part of the International Perspectives on Aging, vol. 19.

Switzerland: Springer, 11-31. DOI: https://doi.org/10.1007/978-3-319-73820-8

Wyman, M. F., Shiovitz-Ezra, S. and Bengel, J. (2018). Ageism in the Health Care System:

Providers, Patients, and Systems. In.: L. Ayalon, C. Tesch-Römer (eds.), Contemporary

Perspectives on Ageism, part of the International Perspectives on Aging, vol. 19.

Switzerland: Springer, 193-212. DOI: https://doi.org/10.1007/978-3-319-73820-8

3

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