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Challenging My Reflection in the Mirror and My Thoughts on Ageism

I am a "millennial snowflake" psychiatrist hitting middle age with all its crises and needs.

As Apo Whang-Od appeared on the cover of Vogue Philippines at the age of 106, I believe that we do enjoy talking about living a long and healthy life. But are we really prepared to reshuffle our stereotypes about age?

Today, we live in a stressful, anxious, and extremely polarised society that triggers generational conflicts. These generational conflicts were never more apparent than there were at the beginning of the COVID-19 pandemic. The long and intense debates on sacrificing the young generation to save the older adults at that time motivated me to write a blog on ageism. Today, we might say those were all unnecessary debates as the pandemic affected us all. And like in every serious conflict, words like "zoomers", "snowflakes", and "boomers" aggravate the clashes and disagreement between groups.

What is ageism?

According to Word Health Organisation (WHO), "Ageism refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age". This definition emphasises that ageism can be institutional, interpersonal, and self-inflicted (self-directed).

Institutional ageism can be seen as related to interpersonal ageism and implies introducing most of the ageist principles in our laws, decisions, different organisations, and institutions, including the health system. Interpersonal ageism occurs during the interpersonal relationship between two or more individuals. Self-directed ageism can be an internalisation of institutional and interpersonal ageist principles.

In 2021, the World Health Organisation (WHO) published its Global Report on Ageism, which summarises the current research and evidence on ageism. It proposes solutions and recommendations to reduce ageism in healthcare, the workplace and other institutions.

Our stereotypes, prejudices and discrimination actions influence our relationships with ourselves and others: adapted from WHO Global Report on ageism

How does this affect younger adults?

Generation Z (born between mid-1990 and 2010) is also called the iGeneration because of their easier and more regular access to electronic devices. The young generation born in developed countries is more educated and uses more social media to get news. There is greater difficulty finding a job as many graduated in a society affected economically by, most recently, the pandemic and the war in Ukraine. In a world where depression is a major cause of disability, and suicide is "the fourth leading cause of death among 15 and 29 year olds" (according to the World Health Organisation), the younger generation tends to be more aware of mental health conditions.
Time Magazine cover from May 2013

Ageism against younger adults is less studied compared to ageism against older adults. In a European study, the European Social Survey from 2008–2009, 55% of the interviewed young adults between 15 and 24 years of age experienced interpersonal ageism, such as being disrespectfully addressed (ignored and patronised) and 41% reported being insulted and abused.

Several studies have highlighted the effects of different forms of discrimination (ageism, sexism, racism) on mental health. In a more recent longitudinal study from the USA, in a population of young adults from 18 to 28 years of age, ageism was amongst one of the most prevalent forms of discrimination, and it was associated with increased substance use, high psychological distress, and diagnosis of psychiatric disorders.

How does this affect older adults?

The population of older adults is increasing all over the world. The 2021 census in the UK shows that there are 11.1 million adults over 65 years of age in the UK, which is more than one-sixth of the total estimated population of 67 million; meanwhile, the British population aged over 90 years of age is more than half a million. Moreover, by 2015 it was estimated that roughly two-thirds of the global population aged over 60 lived in low- and middle-income countries.

According to the WHO global report on ageism from 2021, one in two adults holds ageist attitudes towards older adults.

We do see a demographic change, and it is a challenge to reduce the mortality from non-communicable diseases, including psychiatric disorders. More research and public health policies are focused on addressing modifiable risk factors and health factors to improve people’s health and well-being.

As mental health professionals, we strive to offer our patients the best care. However, when we encounter older adults, our own stereotypes related to age can affect the professional relationship. Studies suggest that mental health professionals lack adequate training to diagnose and work with older adults with psychiatric disorders. In addition, older adults are often excluded from clinical trials for new psychotherapeutic drugs and receive less psychotherapy treatment. For example, in a high-income country like Sweden with an increasingly ageing population, the need for developing old age psychiatry is certainly acknowledged, but it is unfortunately often under-prioritised.

During the COVID-19 pandemic, I met older adults in relatively good health who expressed their concerns and disappointment on how they feel excluded from a digitalised society. These stories made me think about ageism against older adults and the development of all these digital technologies. Digital technologies have advanced extremely rapidly in the last few years. Although these technologies have been mainly designed to be used by the younger generations, the determination of older adults to adapt to the new challenges in society is sometimes remarkable. This was even more impressive during the pandemic lockdowns. At that time, many older adults started to use modern technology to stay in touch with their loved ones and even communicate with their healthcare professionals.

But I have also heard different stories about when older adults feel excluded from society or dependent on their families, as they are not able to master all these techniques, such as online banking, ordering food online, and booking appointments with healthcare services. I do hope that the future will bring us a more age-friendly digital world.
Hilma af Klint The ten largest no 9, Old Age , 1907

Insights on self-inflicted ageism

As I get older, I can see the difference between my real age and the age I feel like I have (my "subjective age"). For me, the discrepancy between these two different ages is the way towards self-inflicted ageism, which seems very difficult to handle. I read a study on ageing satisfaction, or one individual self-perception of their own ageing, which suggest that ageing satisfaction is associated with better physical and mental health.

New physical and mental changes, new opportunities, friendships, and challenges are ahead. Every day, I learn to embrace my age with confidence.


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