us. Welcome to the Geriatric Rehab Community member May session. Our theme is ageism in geriatric rehabilitation, practical approaches to tackle them. What is ageism? Ageism is discrimination against individuals or groups based on their age. The term was first coined in 1969 by Robert Neal Butler to describe discrimination against seniors that was patterned in the path of sexism and racism. So I'm not going to give you all the details of that. My role here is as the chair of the community to introduce our speakers. We have a great session and great speakers for this event. And our speakers are as follows. And this is our agenda here, but I will give you the introduction of speakers here. And our first eminent speaker is Ashton Applewhite. She's a writer and an activist from Brooklyn, New York. A leading spokesperson for the movement to raise awareness of ageism and to dismantle it. And I think this is our responsibility as well. She is starting and it's our responsibility at every angle in healthcare field. An internationally recognized expert on ageism, Ashton Applewhite is the author of This Chair Rocks, A Manifesto Against Ageism. It's a fantastic book. Those of you who do not know about this book, please note, it is a book that you must buy and read it. She's a co-founder of the old school anti-ageism clearinghouse. There you go. Ashton speaks widely at venues that have included the TED main stage and the United Nations and is at the forefront of the movement to raise awareness all across, if not here, across the globe. And she is trying to help us how we can dismantle it. In 2022, the decade of healthy aging, a United Nations and WHO collaboration named Ms. Ashton one of the healthy aging 50, the 50 leaders transforming the world to be a better place to grow older. What an honor. Congratulations. Ashton's work also extends into ableism and today she will address that as well. I liked what she said in TED talks. Let's end ageism. I think on, I speak on behalf of our community, the geriatric rehab community and the AAPMM members and repeating her slogan, let's end this ageism and please join me to thank her for initiating this. She's a visionary who can address how to tackle one of the most persistent biases of our day. People are getting older all across the globe and what better time than to start this and then move it forward. Today, we are very fortunate to have Ashton Applewhite speak on still kicking, confronting ageism and ableism. Our next participant is Hilary Siemens. Everybody knows Hilary. She will be moderating a conversation with Ms. Applewhite with questions and answers. Hilary Siemens, MD, FAA, PMR. As a primary care geriatrician and physiatrist, she has practiced medicine in various settings. She cared for older adults with few active medical problems, those with multiple medical problems, and those requiring palliative care and hospice care. So, she has a wide spectrum of care that she has provided so far. A longstanding AAPMNR member, she currently is the principal Siemens patient care communications LLC. She will probably introduce a little bit of that in her time. The teamwork with colleagues enabled her to participate in multiple issues, appreciate multiple issues, including ageism, confronting patients, care partners, families, and healthcare providers. Dr. Siemens will moderate the conversation, which will give us a lot more information that we try to extrapolate from her. Now, our second speaker is Hannah Bashian. Okay, I'm just not going to read my slides. I'm just going to project it for the audience. Dr. Bashian is a geropsychologist who graduated with a PhD in counseling psychology from Lehigh University, where her research focused on the impact of ageism across the lifespan. Her thesis examined how ageism and health status intersected to impact how individuals view older adults. Her dissertation was entitled The Impact of Ageism, Aging Anxiety, and Health Focus of Control on Middle-Aged Adults and Their Health Outcomes and Their Health Behaviors. This work explored the impact of ageist attitudes, before it was ageism, now it's attitudes towards ageism, on middle-aged adults and their engagement in health behaviors. She completed her pre-doctoral internship and post-doctoral fellowship at VA Boston, specializing in geropsychology. She is currently working as an advanced fellow in geriatrics at the New England GRECC. Dr. Bashian is co-founder and head of the ageism committee in VA Boston. She's working with a group of psychotherapy folks focused on combating ageism attitudes in older adults. I like the word combating. We are trying to eliminate it, but elimination comes after combating. Dr. Bashian is also working with older veterans in an inpatient medical setting and is currently conducting research around adopting psychological interventions for veterans with complex medical and cognitive comorbidities that naturally occur along with age. Dr. Bashian is a clinician experienced in care and in the issues relating to ageism. She's well-equipped to address practical considerations for this session's audience. She will be speaking on the impact of ageism in older adults, cognitive and physical health, and their health behaviors. It's not just cognitive and physical health, but their health behaviors. Without further delay, I would like to invite our speakers to the podium. I invite Ms. Ashton Applewhite to take the session to begin. Hello, everyone. Thank you for joining us tonight. It is a pleasure to be here. I will start by invoking this strange period in history when the main pandemic is behind us. But one thing COVID did, which is so relevant to your work, is bring age and aging out of the corners right into the middle of the room. It exposed the effects of systemic racism even more starkly, I would say. The fact that existing structural inequalities put people at greater risk than age alone. That concept is intersectionality, a clumsy word for an idea that Kimberly Crenshaw and other Black feminists came up with. The idea that different forms of oppression and aspects of identity inform and reinforce each other. That is the reason that Black and Latinx and Indigenous people, no matter how old, died of COVID at much higher rates than White people. The risk factor isn't race. It's racism, bias, not biology. What other prejudices come to mind when we think about vulnerability? Race, obviously, ethnicity, gender and sexual orientation, class sometimes, which all too often are missing, age and ability, ageism and ableism. You already heard the dictionary definition of ageism from Dr. Paduri. The dictionary definition of ableism is prejudice and discrimination against people with disabilities instead of on the basis of age. Both these forms of bias are upheld by the notion that being non-disabled is normal, quote unquote, and that leading meaningful, desirable lives means staying youthful, able-bodied and able-minded. I'm talking about them because I'm old and my body doesn't work as well as it used to. I'm talking about ageism and ableism because not enough people are yet. I'm talking about ageism and ableism because everyone is old or future old. Unless you die young, you will experience disability, even temporarily. No one gets a pass. It doesn't take much head scratching to figure out that most of our apprehension about aging is actually about how our minds or bodies might change as we move through life. That's not ageism. It's ableism. Plenty of young people live with disability. Plenty of olders do not. Why is it important to distinguish between ageism and ableism? Because we need to understand what we're up against if we're going to combat it like Dr. Paduri is urging us to do. We are being ageist any time we assign value to someone on the basis of how old we think they are, ableist when we assign value to them on the basis of how we assume their minds or bodies function, and we're being ageist and ableist, and we all are at some of the time, when we attribute capacity or incapacity to someone based on their age. Everyone is ageist. Everyone is ableist. No judgment. But we can't challenge bias unless we're aware of it. Attitudes start to form in early childhood around these things, just like attitudes towards race and gender, how awful it is to grow old, how tragic it is to encounter disability, and unless we stop to challenge them, they become part of our identity, largely unconsciously, and this distorts our sense of self and our place in the world. That is internalized bias. Older people, like the ones you work with, can be the most biased of all, which is kind of counterintuitive, but it's true, because we have had a lifetime to absorb these messages, and most of us haven't stopped to challenge them. Internalized bias is the reason so many of us try to pass for younger, or attempt to conceal a disability, or are offended by the polite offer of a seat on the bus. All these behaviors are ageist or ableist. Again, we all do them. No judgment. But we can't challenge bias unless we know we're doing it, right? Unless we're aware of it, and these behaviors are not good for us, because they're rooted in shame about something that shouldn't be shameful. Internalized bias is the reason so many olders refuse to use walkers or wheelchairs, even when it means never leaving home. I've heard those stories. I'm sure you have worked with those people, and cognitive impairment is even more stigmatized. It is scary to think about the physical and cognitive impairment that might await us, right? This stuff runs so deep that we tend to act as though old people aren't going to become disabled, and disabled people don't grow old. And an ageist and ableist culture allows us to do that. Of course, disability and aging are different, just as it's different to age with a disability than it is to age into disability. But they also overlap in ways that are really important to learn from and build on. Because otherwise, we rule out collective advocacy, and we reinforce dual stigma. I may need help getting around, but at least I'm not in a wheelchair. And then from the other side, I may be disabled, but at least I'm not old. That's how prejudice works. It frames the other group, what we want to think of as other, at least, as alien, as lesser than ourselves. But olders and people with disabilities are not other. They are us or future us. What are some other ways ageism and ableism affect us? They segregate us. Discrimination sanctions segregation and isolation. And the most important component of a good old age is having a solid social network. Having a good doctor helps. But age segregation impoverishes us all, young and old alike, because it cuts us off from most of humanity. Ageism and ableism pit us against each other, which is a time-honored tactic, divide and conquer, used to distract people who might otherwise join forces to challenge the status quo. This us-or-them logic always pops up around health care. I know you've encountered it the way it did terrifyingly at the outset of the pandemic when ventilators were in short supply. Basing health policy on age discriminates not only against people over that age who are fit and healthy, but against younger people who are at risk because of an underlying condition or disability. It is not ethical or legal to allocate resources by race or by sex, and doing it according to age or ability is equally unacceptable, period. Ageism and ableism also create barriers to employment. At any age, disabled people are much less likely to be employed than their non-disabled peers, and this disparity reflects stereotypes, those assumptions about capacity and performance. As for age, older workers are key to economic growth, and yet we bump up against rampant age discrimination. This is illegal, it's punitive, and it's costly. If we push back and demand accessibility and flexibility, which older workers need, all workers benefit, including students and carers and anyone trying to make a living in a heartless gig economy. And most importantly in this context, ageism and ableism harm our health. These persistent biases in medicine mean less treatment, worse treatment, often no treatment at all. Chronic illness is only one type of disability, yet people with disabilities are four times as likely to describe their health as fair or poor, a situation that reflects economic, environmental, and social disadvantages, right, that's that idea of intersectionality again. Internalized bias matters too, a lot. A growing body of fascinating evidence shows that attitudes towards aging affect how our minds and bodies function at the cellular level. People who associate later life with growth and purpose, not just as everything's going to go to hell, walk faster, heal quicker, and live longer, a whopping seven and a half years longer on average. Ageist myths and stereotypes also affect cognition. People with an accurate view of aging, fact rather than fear-based that is, are less likely to develop Alzheimer's, even if they have the gene that predisposes them to the disease. Most of this work is done by Becca Levy, who has a fabulous book called Breaking the Age Code. Her latest study shows that people, that having more positive or accurate age beliefs can reverse mild cognitive impairment. And I also love pointing out that this is why the World Health Organization, not the World Old People Organization, launched two years ago a global campaign to combat ageism, because they realized that the biggest obstacle to living healthy lives, as well as long lives, is ageism between our ears and in the world around us. Ageism and ableism harm us all individually and collectively in all kinds of ways that we're just beginning to wake up to. They make your work harder, because a society that doesn't value its older and disabled members doesn't value the people who work with us. When there's no ramp, or we can't hear the speaker, or we can't open the damn jar, we tend to think I should have known better, I should have been stronger, better prepared, maybe stayed home. We tend to blame ourselves instead of blaming the ageism and ableism that make these natural transitions shameful, and the discrimination that makes them acceptable. It is not the wheelchair that makes life so much harder for wheelchair users, it's the stairs between them and where they want to go. It's not dark skin that makes life harder for Black or Brown people, it's racism, and it is not the passage of time that makes growing older so much harder than it has to be. It is ageism. Quote, somewhere on the edge of consciousness, there is what I call a mythical norm, which each one of us within our hearts knows, that is not me, wrote poet and activist Audre Lorde. In Western culture, this norm is usually defined as white, thin, male, young, cisgender, straight, and abled, and prejudice works to the advantage of people who have more of those traits, and to shame and silence people who do not. There is no ideal. There is no norm. Systemic discrimination is a formidable obstacle, but it is real, which makes it a lot easier to tackle than something non-existent. The imaginary failings that these systems created and need us to believe in, right, and we're in charge of our ideas, not them. We are not broken. We are not special. We are not lesser. Prejudice is not about how our bodies work or what they look like. It's about what people in power want those things to mean. We live under capitalism, which sorts us according to our social and economic usefulness, quote unquote, and how closely we conform to that mythical norm or ideal. In ageland, those are the successful agers, people who go to great lengths to try and look and move like younger versions of themselves, because under this scenario, to age is to fail. In cripland, they're the supercrips, people who compensate for their disability in some extraordinary way, because again, under this scenario, disability is something to be overcome. In a culture obsessed with youth and speed, it's not surprising that so many of us grossly underestimate the quality of life of older and disabled people. And those are two increasingly overlapping circles on the Venn diagram of life, right? But from the inside, the experience is different. A geriatrician at Johns Hopkins, which I think is where Hillary went to school, put it in a way that really struck with me. He had a mantra that the appearance of the bull changes when you enter the ring. It looks different to the matador, right, than to the spectator. The sight of an old woman hunched over a walker used to make me mutter, it's embarrassing, but true, put me out of my misery if I ever get like that. And now I mutter just as fervently, the bull looks different. I am not saying that being old or having a disability is easy. We're all worried about some aspect of it, running out of money, ending up alone, not having someone to care for us. And those fears are legitimate. But our fears are way out of proportion to the reality and the stories we hear are of triumphs and tragedies. And what never dawns on most of us is that the experience of reaching old age or living with or adapting to disability can be better or worse depending on the culture in which it takes place. Changing the culture is a tall order, but culture is fluid. Look how much progress we've made on gay and trans rights in just a few decades. At gender, look how we used to think of it as a binary, male or female in my childhood. It's high time to ditch the old young binary too and all the rest, mobile, immobile, able, disabled, dependent, independent. No one is independent ever. From life to death, we are interdependent. Dismantling ageism and ableism require nothing less than mass movements like the 20th century one that catalyzed a mass shift of awareness for women around the world. We have a lot to learn from the activists who in the 1970s and 80s, reframed the way we see disability. They changed it from a personal problem, a medical issue into a social problem, bingo. And then demanded integration, access and equal rights. A mandate of the disability justice movement is to stand in solidarity with other marginalized groups. The way the Black Panthers did in 1977 by bringing supplies and cooked meals to the over 100 disabled protesters who occupied a government office for almost a month to demand action on a law that paved the way for the ADA, right, the Americans with Disability Act. Quote, speak up not only for your own disability, but for invisible disabilities and disabled people of color as well, urges activist Alice Wong, the author of Disability Visibility. Speak up too for older people with disabilities. The intersection of ageism and ableism is where many of our darkest fears reside. Illness, incontinence, indignity. It is also where we encounter in direct proportion to those fears, the potential for personal liberation and collective activism. Quoting Audre Lorde again, there is no such thing as a single issue struggle because we don't lead single issue lives. We can't dismantle ageism without dismantling ableism and racism and sexism and homophobia and all the rest. Disability has been used throughout history to justify unequal treatment, not just of disabled people and older people who aged into disability, but of African-Americans, of women, right? Hysteria, minority groups, and immigrants. If we want a more equitable world, we have to support every struggle for equal rights. And that can feel like a heavy lift, but here's another way to think of it. Just as different forms of oppression intersect and inform each other, so do different forms of activism. Activism is intersectional too. When we confront any form of prejudice, we chip away at the fear and ignorance that underlie them all, right? I mean, even if you just say one little correction to a friend or suggest a different way of saying something that isn't biased, that sticks with them and that goes out in the world. All of us lucky enough to grow old, a privilege denied to many black, brown, and disabled people will age into impairment of some kind. People age well not by avoiding chronic illness and disability, but by adapting to them with the help of professionals like you. These are powerful generative processes that unite us all and inform what it means to be human. We're as diverse as it gets, all races, all genders, all backgrounds, and of course, each of those variable shapes are unique circumstances and our reaction to them. My friend Peter says, I'm not blind the way anyone else is blind. I'm not 70 the way anyone else is 70. And the longer we live, the more different from one another we become. We tend to be uncomfortable with difference, think we need to ignore it or paper it over. And that's why people say things like, I don't see you as disabled or I'm colorblind, you're ageless. Instead, we need to acknowledge and embrace our differences and tap into what they can offer. Delight, surprise, perspective, and power when we come together across those things. There are billions of us, at least one out of three people on the planet has a disability, half of us are no longer young, our numbers are growing, medical advances mean more disabled people are reaching adulthood and beyond, a new wave of COVID survivors in the millions are facing disability for the first time and all over the world, people are living longer. Population aging is a permanent global demographic trend and a triumph of public health. We're not gonna make the most of those longer lives without confronting ageism and ableism in the world around us and it starts between our ears. We have to accept and ideally embrace the bodies we were born with and the way they change over time. We do not have to accept being discriminated against because of it. Let's join forces. Thank you for your time. Fantastic, Ms. Applewhite, wow. Just such inspiring words and all you've brought in some research and new ways of thinking about it. Can't thank you enough for spending this time with us. As for the ageist self-talk, I'll just share with the group, when I turned 40, I found my first gray hair. I was a little bit of a gray-haired girl. I found my first gray hair. I kid you not, I said, oh my God, I'm getting old. But many of you might, in addition to Ms. Applewhite's books, a friend of mine gave me Betty Friedan's The Fountain of Age, which rose my awareness that there's ageism everywhere and it helped reshape things. So people, we all think of your ageist self-talk as start pushing back and bringing serious change. Now, I'm gonna ask you, what motivated you to really start this journey? Because I think you also were interviewing 80-year-olds who continued to work, got all that started. Yeah, yeah, that was how it started. I mean, it started because I looked in the mirror in my mid-50s and went, oh, this getting old thing, it's happening to me. I think it's really hard to imagine getting older. We age slowly. I think part of that is conditioned in all the ways I just talked about, but part of it is just human. And I realized I was really apprehensive about it and that's like the free-floating way. So I'm nerdy. And so I started to research longevity and I started interviewing people over 80 who work in hindsight, because that was safe. They were in the world in this way that clearly they hadn't lost any scary loss of capacity. I was nowhere, I didn't hear the word ableism probably for another decade. But from talking to them, I'm glad I had that experience because they were enjoying the ages they were. And I also realized so quickly, I mean, so early into my research within, I feels like weeks, but certainly months, that my ideas about aging and long life were way off base or not nuanced enough or flat out wrong. So I just got a bee in my bonnet about why did we only hear one side of the story? Scary stuff is real, right? But why don't we ever hear the full story? And the answer, it was very clear early on, was bias, internalized and structural bias. Okay. Now something else personally you can tell us is we've heard about Dr. Robert Butler, the founding director of the National Institute on Aging. And in preparing for this, I realized he got a Pulitzer Prize for his book. Get this. The title was, "'Why Survive?' Being Old in America." I remember reading that years ago. Now, I think you actually met Dr. Butler. What was that like? Oh my goodness. It's funny. I'm not, I have like, I don't have many like totems up here, but I keep this picture of him over my desk. He was lovely. And I was lucky enough to work with him, meet him. He at the time was running the International Longevity Center here in New York. I had no credentials. I had no institutional affiliations. And you can tell when you're on the outside, you can tell something about the people in institutions that don't hold that against you. And he was very much one of them. He welcomed me there and to a journalism thing, et cetera. And I interviewed him as one of the people over 80 who work. And he gave me the most beautiful, gentle course corrections, because I wanted to know, you know, it's the very American, very capitalist driven notion that we need to be productive. It's sort of behind this whole keeping busy, which is also very gendered. Like God forbid a woman should stop like, you know, working, cleaning up after people for two seconds. And he said, if you get up in the morning and you put your shoes on, you're being productive. And it just really, I was, I didn't, had no idea how important a correction it was, but it stuck with me. He was a humanist and a fantastic person. And I dedicated my book to him and feel very lucky indeed that I got to meet him. Thank you. Thank you for that. Next. And by the way, audience, I have you all in gallery view. So if you have a question, you can raise your hand with the emojis there or type questions in the chat. I'll put in my email a little later. And so if we don't have a chance to answer everybody's questions, put them in the chat and we'll try and get to them after this session. Okay, next question. You established in 2018 an incredible nonprofit advocacy website and institution called Old School Anti-Ageism Clearinghouse, which provides an incredible amount of free, easily accessible educational materials and activist motivational work. Did this old school, is that partly why you got this phenomenal award from WHO and the United Nations as being one of 50 leaders in the globe to be transforming the world so it's a better place to age? I have to say, well, that, you know, that was just an amazing honor. Part of me was like, okay, I can like go home now because I can't think of a greater honor or, you know, a more, words fail. I don't know if, I mean, they wrote a fantastic biography of me and they said that my book did really catalyze a global conversation about ageism. And they, we have, we, so the organization, which is three people, so anytime I say we, I'm referring to me and my two co-creators of the Old School Clearinghouse, which we started because I thought, you know, the anti-ageism movement is new. Wouldn't it be fantastic if the women's movement had sort of a one-stop shopping, except everything is free except the books, for, you know, the go-to place, for the best, you know, the best webinars, the best podcasts, the best infographics that help explain what ageism is and what we can do about it. So I'd never dreamed, of course, it would be the colossal amount of work or ongoing thing it has become. And we have bigger plans. We plan to transition into the Old School Center for Age Equity. So if any of you have millions of dollars that you wanna throw our way, don't hesitate to get in touch. But I love it when people say, gee, how do you know there is a movement against ageism? And I say, when we started Old School, we didn't even have a campaign section. And now it's one of our fastest growing, right? There's over 30 campaigns around the world devoted to this. We also host weekly meetups, go to the events section, open to all every Wednesday. And we also create our own resources, which you can, you know, hire my colleagues to give it. I don't do that. They're better at it. Or we make everything free, DIY, all the contents available, because, you know, you've got to have an open source mentality if you wanna support a movement. Fantastic. And for those who are interested, I've just put the website in the chat and we'll include that in maybe an article in the FIDS. So, great. Thank you for that. The Academy sponsored a Grand Rounds that people can call in on ageism that I heard. And however, what was interesting is in that Grand Rounds, it rather reflected insufficient focus on the Academy's younger members. And I'm wondering if you've heard that in other contexts, I will comment in the medical culture, I can maybe understand where that sometimes comes from because of our hierarchical nature in the past, things are changing. But have you run into other situations where the term ageism refers to challenges that younger people face? That's a great question, Hilary. Thanks for asking it. I haven't. I was in the hospital for two nights, gosh, it must've been about 15 years ago for a kidney infection that came out of the blue. And I do remember looking around and it seemed like everyone around the bed was about 12. And I was like, oh, and I know enough to say, I'm sure they're incredibly qualified, which of course they were, but it was that moment of, oh, geez. So none of us are immune. Ageism is any judgment on the basis of age, right? Including you are too young. For women in particular, in the workforce in particular, we are never the right age. First, we're too cute and sexy to be taken seriously. Then in the workforce, we're too fertile. Then we're not cute or fertile anymore and the story's over, right? I mean, so ageism really does cast a shadow across our entire lives. Aging is gendered so that men experience less of it earlier, but it bites men too sooner or later, right? And so I think it's really important. And of course, in a youth obsessed society, older people bear the brunt of it. There's no comparison. But when we talk about it as an old person problem, that's what prejudice does, right? Oh, why are we spending money on all these old people who are gonna die soon or whatever? It's to pretend as though old people don't have young people who care about them, right? Or that families aren't connected. We are systems. Anything that impoverishes financially or emotionally or socially, this massive percentage of the population impoverishes us all, right? It's not good for them in the workforce if young people can't get a foothold because people think they couldn't possibly know what they're talking. And can I make a medical analogy here? Just not to- Of course, go for it. One of the, a thing you hear a lot is about people's like, what's your biological age? Because, right? Have you all heard that term? And you all know more about biology than I do for sure, but it was a young medical student that we worked with to create, we old school, to create, we do conversation guides and we have one called Ageist Racist, who me? How do ageism and racism intersect? We have another one, Ageist Sexist, who me? So, and she has now about, she's now becoming a resident, I believe. And she said, she wrote a piece, which I thought was so smart. She said, the reason I Ashton don't like that language is because it smacks of age denial. You are as old as the number of times you have circled the sun. And to say, yes, but I have the pancreas of an eight-year-old, so what, right? It doesn't matter, you are the age you are. She had a better way of putting it, which I hadn't thought of, but is obvious in hindsight. Your body is a system. Yes, some of organ systems may function better than others, but I may have a heart disease and someone else my age has a perfectly fantastic heart and something, some other part of their body works less well. The point is you cannot take out some aspect of your physiological function and say, oh, it's younger because that smacks of ageism, right? And intertwined and ableism in some way, I can't figure out. Maybe Hannah, over to you on that one, ha ha. Oh, thank you. Thank you so very much. And with that, we encourage everyone to take a look at Ashton's website and her books, her TED Talks, all wonderful material. Thank you so very, very, very much. My pleasure. Thank you, both of you, Ashton and Hilary. It was a pleasure to hear the fantastic initiative and the ideas and also the movement that is going in the right direction. I am very happy that you both were able to enlighten the geriatric rehab community, especially on ageism. Geriatrics is, you know, we are all aging. And that's where I think this topic belongs. But I think there is a lot to be said about educating the younger folks about ageism. Thank you. Now I think we can move on to Hannah. Great, thank you. Hard act to follow, let me tell you. I do this presentation a lot, but the moment I was told that Ashton was going to be the other presenter, I was like, oh no, I got to work even harder now. So very excited to be here today, really quite an honor. So I will be talking about ageism in the geriatric rehab setting and providing some advice for clinicians. I'm going to take more of a kind of researchy approach to this. I'm a psychologist, a geropsychologist, as was mentioned. I work at the VA hospital. And I actually work in an acute rehab setting where I work a lot with a lot of different people, a lot of different medical providers. So I'm really excited to be talking to you all today. I have no disclosures to note. So for today, what I'm going to talk about is sort of going a little bit more in depth of the different forms of ageism because it's not straightforward, discuss the impact of ageism in our health care system, discuss ageism and cognition, and then discuss some ways to combat ageism for yourself and for others. So Ashton really spoke a lot about ageism and ableism. And I think that's such an important piece to talk about because when I'm going to move forward, really, a lot of this is going to be intersecting. It's hard to really piece them apart. But I'm going to go a lot further into ageism today. So ageism is like other isms, not straightforward, not simple. It can be overt, obvious, or it can be implicit. So overt ageism, also known as hostile ageism, is really more of this typical thought when you think of this negative view of aging. It's really these views that aging is bad, that older adults are not worthy of attention. It's really kind of things that we sort of hear, and you kind of know that's not the greatest thing to say out loud. You might think it, but you know it's not good to say out loud. What we see a lot more, at least in my experience in health care, is this benevolent form of ageism or implicit ageism. So benevolent ageism, I often compare it to benevolent sexism, where it's seen as like, oh, you're so nice to women, or you're so nice to older adults, when in fact what you're doing is incredibly condescending and actually pretty infantilizing. So benevolent ageism is really seeing older adults as incompetent but cute or warm. So it's seeing it as an older adult that's not really able to do too much, but they're nice, they're cute. And a really common example of this is elder speak. So elder speak is simply that idea of describing an older adult as cute or adorable. This is something I see quite a lot in healthcare actually, is we'll get a new patient in and they are an older, often have some form of a disability as well. And there's this discussion about them and they're nice and they're always described as, oh, but he's so cute, he's such a cute guy. And it's very, very infantilizing. It really demonstrates how you think of the person and it's really, really harmful. Another example of elder speak is speaking loudly or slowly to an older adult without having any information to support your need to do that. This is something I'm absolutely guilty of. I'll walk into a room, start screaming at the older adult and they'll go, why are you screaming at me? And it's a great reminder that I'm making an assumption that because you're old, you obviously have to be hard of hearing. And there's nothing wrong with being hard of hearing, but it's not great that I'm assuming you are. Just like anything else, we shouldn't make these assumptions about people. But with aging, we tend to do this. Another thing that Ashton writes in her book that her movement is for older, is to use the term older. And I will definitely argue, we should not be using the word elderly to describe our older adult population. It really demonstrates this view of older adults as frail, as sickly, and it tends to not be the best word choice. So just something to think about. And as you can see on my slide, I do have this photo of the OK Boomer. I don't know if others have heard of this, but it's this new sort of trend. I guess it's not super new anymore, but we're really seeing a political movement with the onset of COVID, where we started making those overt, hostile ageism more OK. So this whole movement of an older adult having a viewpoint, and it's easily shut down by the phrase OK Boomer. So we're really seeing, although we are seeing a huge movement towards ageism and talking more about it, we're also seeing, unfortunately, the other side of the coin, people being more open about their ageist attitudes. So ageism refers to multiple things. Ageism refers to how we think about our own aging process as well as others getting older. It's how we feel about the aging process as well as others, and how we act. So our behaviors and thoughts and feelings towards the aging process and towards others' aging processes. So as you can see, ageism really refers to how we view ourselves and others. And Ashton really talked a lot about this internalized ageism, and I'm also going to go into that as well, because I think that is really fundamental when thinking about ageism. So discrimination against older adults occur across many different settings. It is absolutely completely prevalent. It is almost everywhere. We see it in the employment space. We see it within our own household. So this isn't something we might not think about, but we place more value on certain family members. We treat certain family members differently. We value opinions more of certain family members. So you might see it within your own household. We see it constantly in the media, both in the anti-aging movement. So seeing all these advertisements of, you know, how to look younger, get rid of your wrinkles, things that just simply happen as aging are seen as problematic, are seen as you've done something wrong, even though what's happening is you're simply getting older. You haven't died. Congratulations. And then on the other side, in movies and television, older adults are either used for humor or they're completely erased. And instead, an older adult is played by someone who's two years older or younger than their child. So we really see it in the media quite a bit. And then we see it in healthcare. And because of the audience I have today, I'm gonna go a little bit more in depth with the healthcare piece. So ageism in healthcare is incredibly prevalent and it happens in many different ways. So this was mentioned already, but what we know is that we attribute or misattribute pathology to aging. So you might have someone come to you and they say, oh, my leg hurts. And you'll go, oh, well, you know what? You're 65. That's what happens when you're old. I've seen standup comedians have that as one of their lines, that they hit a certain age and their health is just what they are. When in fact, maybe there was something you could do, but you have unfortunately ignored it because you were only focused on the person's age. On the flip side, we pathologize aging in a lot of ways as well. We over-pathologize it. We try to cure things that are just normal parts of aging. And if we didn't keep trying to put a Band-Aid on it, we might actually make some really positive improvements. It also can occur in our interactions with staff members and patients. This is something I am guilty of, and it happens quite a bit, especially on an inpatient setting. So if you're going to an inpatient room, you're going with another provider, the older adult is sitting in the room and who are you talking to? You're talking to the provider about the older adult, ignoring them completely. And so that really demonstrates, you don't see them as meaningfully part of this conversation. You're talking about them while they're in the space. And that really demonstrates our ageist attitudes or ageism. It also might occur in that we focus on talking to the healthcare proxy and not include the older adult. Even with cognitive impairment, you want to bring in an older adult to the conversation. And I think we're so often get comfortable with, well, he doesn't know. He's a poor historian. I'm going to talk to the daughter. And fine, talk to the daughter, but also talk to the older adult. And then we also see it in treatment options. So I'll talk a little bit more about this, but we do see the treatment options are often offered at lower frequencies for older adults. So as I mentioned, this is incredibly widespread. In one study, it was found that one in every 17 adults over the age of 50 experienced frequent healthcare discrimination. And I think something that's actually really important to point out with ageism is, it doesn't actually matter what your age is. It matters how people view you. And I think that's often where ageism and ableism intersect is we picture an older adult to look a certain way. And that's when the person experiences that ageism. So I think it's important to note that we often think of old age as 65 and up, but that doesn't really matter when we're having this conversation. It's not like you hit 65, now you're getting ageist attitudes directed at you. It really can happen at any point in kind of throughout your life. And to go a little further with this idea that ageism has been found to impact the treatment offered to patients, there's some really interesting studies that have essentially done different vignettes to describe patients and seeing how different providers would recommend treatment. So this one study looked at how you would recommend treatment in oncology for a person with breast cancer. So what they found was that a young patient was more likely to be recommended breast conservation therapy compared to an older patient who was recommended a modified radical mastectomy. I think this is a great example of intersectionality and ageism on both ends of the spectrum. So we really see some sexism and ageism going on where we assume a younger woman's breasts are valuable. They need to be, we need to figure out a way to conserve them at all costs. An older woman, well, they're not sexual anymore. They're essentially asexual. They don't need their breasts anymore. Let's do this radical mastectomy. So I think this is a really good example of how ageism can really impact the treatment we offer people. We also see it in a lot of different settings. So we see it in stroke treatment. I'm sure a lot of people here have worked with people who've had a stroke. Maybe ask yourself the next time, am I treating this person differently due to their age? Because research has found that older individuals who have had a stroke will not be provided the same level of rehabilitation compared to younger individuals with stroke. We see in the way we treat sleep. We see in women's health, in STI and STD treatment, we often under-diagnose it, even though older adults actually are a very high risk population for having an STI. We see in the mental health field. I'm a general psychologist and I am always the person in the room saying, well, what about age? What about the person age? Or saying this person can still benefit from treatment. Why are we just assuming that depression is part of getting old? When in fact, what we know is that depression gets less when we're in a older age. We do not see high rates of depression. And then we see it in life-sustaining treatments, making assumptions of what people want without actually having the conversation. Perceptions of age can lead to internalized ageism. This was mentioned a little bit by Ashton. An internalized ageism is something I'm incredibly passionate about as I work with older adults and I see the ramifications of internalized ageism on these individuals' own health outcomes. Internalized ageism is essentially the idea that throughout life you're being told, hey, getting old sucks, and now you're old and you're like, oh, well, I guess it's going to suck to be me. And this is really what we see. And it has some really negative outcomes. So internalized ageism is related to worse cognitive health, worse mental health. So people who have more negative views of getting older have actually higher rates of depression, higher rates of anxiety. We see actually a higher risk of mortality. As Ashton mentioned, people who have more negative views of getting older die at a significantly higher rate of death sooner than those who have positive views of aging. They're less likely to seek out treatment and they engage in less healthy behaviors. And I like to take a health locus of control perspective when thinking about why this relationship exists. So when we think about health locus of control, it's how much control do I feel I have? Do I have an external health locus of control, meaning this just happens? Do I have internal health locus of control, meaning I can make a difference? People who have ageist attitudes, who have internalized ageist attitudes, assume that getting older means I'm going to be depressed. Things aren't going to get good. So why would they do anything to try to make themselves healthier? They don't believe that aging is good. So they think this is what is supposed to happen. So they don't seek out treatment. So this is why it's such an important thing that we start talking about it earlier because actually a lot of my work look at middle-aged and we see these relationships still in middle-aged. So this is something that's happening sooner than we really even realize and has lasting impacts. And I did want to talk a little bit about ageism and cognition. So we do know that people who have more negative views of aging have worse cognition. As Ashton mentioned, there's some really great work by Becca Levy. She's like the godfather on all things ageism. She has some great work out there. But she has found that you actually have a higher risk of Alzheimer's disease and dementia as Ashton had mentioned. And positively, if we can make some changes in your views of aging, we can actually maybe make some reversal of that cognitive impairment. However, I also want to take a different angle to this. Not only do I want to think about ageism as its impact on people's cognition, but I want to think about how we view older adults with cognitive impairment. So one, getting dementia is not a normal part of aging. Having some cognitive changes is absolutely part of aging, but somebody with Alzheimer's disease, that's not a normal part of aging. And unfortunately, in our society, people assume it is. They assume that if you're old, you obviously are going to have dementia, but that is absolutely not the case. And for those who have dementia, they're often treated differently. They're often pitied. In a study I conducted, it was shown that there was more compassion for an individual who had Alzheimer's disease compared to somebody with prostate cancer or was a healthy older adult. However, one thing I wish I looked at is are we looking at compassion or are we looking at pity? And that's a very different thing. Earlier, I spoke about that elder speak. And really, all of this goes back to infantilizing, seeing people as someone to pity, but not really seeing them as human. So when we think about cognition, unfortunately, we see a lot of ableism, a lot of isms within this intersection of age and cognition, and we can actually create problems in and of itself. So when we do cognitive screenings, the way we talk to an older adult can actually have an impact on how they test. So we know stereotype threat exists across a lot of different marginalized groups, and age is one of those groups. So I've done neuropsych testing in the past, and I've always wondered, how much is me just going in saying we're testing for Alzheimer's disease, creating half the issue? I know for myself, the moment someone tells me that my blood pressure is going to rise, I'm going to be more nervous. And that is not taken into account. I do also want to talk, kind of shifting gears just a little bit, about why does this exist? And this is not covering all of it. There's a lot of reasons why ageism exists in our society. But two that really speak to me is the stereotype embodiment theory and terror management theory. So the stereotype embodiment theory is actually a work by Becca Levy. And in this, she essentially is talking about that internalized process of ageism. And essentially, she really posits that throughout life, we're being told these stereotypes of aging. And after a while, we become part of this group we've been stereotyping. And we internalize these and the self-stereotype. And we sort of have this self-fulfilling prophecy that ends in these negative health outcomes. Another theory that gives some explanation for ageism towards older adults is terror management theory. So terror management theory really talks about how as human beings, we have this basic desire to survive, but the unique knowledge that we're inevitably going to die one day. And this kind of conflict can create extreme fear, anxiety, or terror. So we create different ways to defend against this. And one of these ways is separating ourselves from thoughts about death and dying and a reminder of death and dying are older adults. And so we treat older adults as differently. We hide them away. We ignore them because we don't want to think about our own death and dying process. And the reason I really like terror management theory is because I have a lot of death anxiety. And when I was in college, I was really afraid of older adults. And I took a lot of classes about older adults and had to go to nursing homes. And I was like terrified. And through that process, I was able to really confront this bias I had and realize that my fear was being kind of scapegoat onto older adults. So I do relate to terror management theory, which is why I think it's the one I bring up, but there's a lot of other theories around why ageism exists. And they all, I think, provide some partial explanation for it. I also would be remiss to not mention intersectionality. Ashton did a really nice job, so I'm not going to go into that too much about this, but I just want to mention that older adults are not a homogenous group. They are just as diverse as any other group. And that diversity is going to increase with the increasing aging population. And I think it's really important to consider intersectionality because that means we're going to see different health outcomes. We have to always be taking a lifespan perspective when we work with older individuals because when we see someone who is a lesbian woman at 75, that means they grew up during a time where maybe it wasn't as safe to be out. Maybe they didn't come out until later in life. And all of these contribute to their health outcomes, health inequities. And I think it's just really important to make sure we're always thinking about that. And so I just bring this up, you could have a total hour on this subject alone, but I just had to bring it up for just a moment. So what can we do about this? So here's some practical ways we can really challenge ageist microaggressions. And I use microaggressions, but this can really be something we do for all kind of over ageist moments as well. So these are strategies that you can use for other isms as well. It doesn't have to just be ageism. But one of the most common ones make the invisible visible. So just name what's being said. When you say to someone, you look great for your age, say out loud, well, what does that mean? Would I not look good if I wasn't this age? You know, kind of try to make it known what they're actually saying. Oh, he's so cute. He's so cute. What do you mean by that? Do you think he's a teddy bear? You know, really make it clear what they're saying. Disarming it is also another strategy. This is simply saying like, oh, ouch. When someone does something that's pretty bad, so someone says something pretty ageist, a good way to go about it is just simply like, oh, it's kind of like a little joking, but it also makes it clear that what they said was not okay. You can also choose to educate the offender so you can educate the individual and normalize it. Ageism is in our society. It is here. We are all ageist. And that is okay as long as we're thinking about it and working on it. So educating individuals about what's going on is really important. And then finally, if all else fails, seek someone else to talk to about this. If you are in a hospital where you're noticing ageism is incredibly rampant, talk to someone. See if you get some in-services on ageism. Start a group about it. Try to find ways to get support because ageism has real, real impacts on older adults' health and well-being, which means it has real impacts on your health and well-being if you're lucky and reach older age. So finally, I just want to say, you know, if you remember anything, try to reduce your use of elder speak. Your patients are not cute. Please do not say it. It hurts me every time I hear someone say, oh my gosh, he's so cute. Try to encourage positive use of aging. Try to reflect if a person was a different age. Ask yourself, would you have asked different questions? Would you have recommended different treatments? Maybe that's what you should be doing, but always ask those questions and then read. I always recommend to read Ashton's book. I swear this was already on my slide. I use this all the time. It's not because she's here. I really recommend reading this book. It has a really great lens about not just why we need to do it, but also acknowledges we're in a capitalist society and talks about the monetary losses that ageism has on our society, which I think is an incredibly important lens to also take. So thank you so much. It's a pleasure talking with you all today. Thank you, Hannah. That was so uplifting to hear in the real world how much ageism is there that we are blinded, actually. I can give you tons of examples. There was one patient that came to my clinic. He has pain, very bad pain in the middle back. Anybody under 65, you know, they are ready to give them epidurals. But this person at age 80, they think at his age, I don't think we need to do that. Excuse me? His pain is not real. You won't get relief by giving the shot. And tell me why you cannot give it. That's a contraindication. That person was really offended by my questions, but he had no answers for those. That's the irony of it. I think we see that all the time. They are treated differently. Even though the pain mechanism is the same, the person is suffering for God's sake, please do something. And you just want to give them some aspirin or Tylenol. I can understand one thing by not giving them pharmaceuticals because with age, as we know, liver and kidney function is fading, right? So we want to make sure we carefully give them. It's not that we deny them. So I think if you can educate our future generation of residents and younger physicians, you can still treat them, but take precautions. How often do we not give gabapentin to older people? But you can titrate based on the kidney function and other functions, right? We don't do that. I think people who are cognizant of what's going on, the bias against the age, we can educate them, but it should be across the whole healthcare field. I think that's what is the missing piece here. And I think your slides were so hitting on the nail, saying that you are not aware of it, please be aware of it. And I think that's a fantastic advice that you gave to people. And I know quite a few people have not joined us because probably the schedule or the time zones or whatever, but the record message will be there. And I think you're going to be brought back to our sessions again. It is such a powerful message you and Ashton gave to our audience. I think I can't thank you enough. Thank you. And I think we can open up for audience to ask any questions if they have. Please don't be bashful. If you can't ask, you can always put in the chat box and we can address them. I'll start. I don't see any hands up yet. I'll be quick. Either one of you, can you have recommendations of the conversations to have? Like, he's so cute. Hannah, you gave us a few things that we may or may not remember, but I think just giving us words, and it will both teach people, but also they need to learn these different behaviors, myself included. So are you aware, does the old school clearing house have samples of ages, comment and response or Hannah in your work? Thank you. I loved, Hannah used my favorite line, because you can never think of the snappy answer until you've left the room. But of just, what do you mean by that? Because what is less, you don't want to put someone on the defensive, then they're just, the moment is lost. But you want them to think, what did I mean by that? But I really like, you didn't go, oof, but that's what I would say. That's so effective. Just like, oof, because it's an expression of emotion, you're involving the person in it. But it's like, then they have to think, why did she go? We think a lot of times, I meant it as a compliment or that the person didn't mean it. I think the definition of microaggression is small, typically unconscious. We say these things, because we don't yet know any better, but it doesn't let you off the hook. What you want to do is provoke that little. So yes, old school is searchable by topic, search under language, and you'll see lots and lots of examples. And just, what do you mean by that? Another, I don't feel old or what does old feel like? Try and interrogate, like people use old to mean insert bad thing and young mean to insert good thing. What do you, I don't feel old. What do you, my daughter was, she had a birthday, she's in her late thirties and a friend was, they were going onto a bar and she said, I'm too old for that. And my daughter said, you might be too lazy. You might be too smart. You might be too tired, but it's not about age. That's right. Let me say something. I, you know, I encountered quite a few examples. I can't give you all of them because of the time. There was one time a patient came with her daughter. The patient is fully alert, fully. She came in back pain. She has nothing to do with their cognition or any other health condition. The daughter kept telling about her pain. I said, excuse me, can I hear from your mom, what she's going through? No, but in one second, she would let her say, and then take over again. At that point, I had to send her out. You have to find ways to help the old people. I said, you know what, you mind if I need to examine her, can you step out? No, I think mom will be better if I'm here. No, I can trust your mom that she'll be okay. But if she's not okay, I'll call you in. We got to go so circuitously to help these, you know, individuals that can completely take control of their own health. But for some reason, the daughter came with her and then she's taking over. On the other hand, we have a family friend that lives in Buffalo. He's 102 and he's a statistician and he has got 37 PhDs from across the globe, 37. All right. And he's a, my husband is a statistician and he worked for it with him in India for a year. And he, to this day, still sends emails to friends and he still is publishing. So he's a perfect example. Last month, they honored him in India with the highest honor a person can ever get. There's equal and to Nobel prize. For unfortunately, for statistics, there is no Nobel prize, but the Indian community came around and said, this man is 102 and he's still producing. And his book is a Bible. Honestly, everybody follows his book. So they honored him with the highest honor, rather than saying, you know, he's old, let's give it to a younger person. That's wrong attitude. But I felt very proud that A, they honored him, B, he is with it. So it's a, you know, that's the other extreme. And then when the other times when we see people bringing their family, mother or father, and then they not only take over, giving the histories of whatnot, but they also say, you told him to take a hundred milligrams, but I'm giving him 50. Excuse me, he's not better. Are you a doctor? Then why did he come to me? Why did you bring him here? And then the father takes over. That's what I told her, but she won't listen to me. So there is another bias inside the family itself. Even the outsiders can help. So by educating, I guess we can probably do some, you know, education to the people that don't have attitude, you know, about age, but they are practicing it. That's one of the problems. The attitude is different from practice, right? They're practicing. So that's something that we need to take control of. And I wanted to ask Ashton a question. There are about seven things that they describe that we can do to help, you know, combat this. One of them is surround yourself with young people, right? I went to a few parties where people are in their forties. Okay. I'm not 40, I'm past 65. So one of them came and said, you know, your age group. I said, excuse me, what are you referring to? This may not be appropriate for your age group. I said, why not? I play Scrabble. What's wrong with you? Can you beat me in Scrabble? He said, oh, I'm so sorry. I didn't mean that way. So it's there everywhere. I mean, they're in forties and they're going to get to my age at some point, right? I think you did. You did great. I mean, I think it's really, you know, this society is really, really age segregated and making, it's one of the reasons, if we are almost surrounded mostly by people, our own age, our whole life, of course, we think the reason I have like being with them or have things in common with them is because we share an age when in fact age has much less to do with that than we think. But in the absence of evidence to the contrary, of course, that's the default assumption, but making a significantly older or younger friend is in itself an anti-ageist act. So I often suggest that people think of something you like to do like Scrabble and find a mixed age group to do it with. Games are a great example, you know, card games, you know, and then you, you know, you can't go grab someone different age and say, I want to be your friend because you're old or because you're young, but, you know, let's go, you know, birdwatching or book club or whatever the hell it is. And then you have something in common and, you know, so you did great. Thank you. Thank you. You know, something else though, when people don't recognize what they're doing and those people are the ones that are difficult to educate, they're just, I don't know about your experiences, any of you, they're denying the fact that they're doing this. And how do you educate them? And I said, maybe not now, maybe when another person needs to tell them this, that they're doing, you know, some harm by discriminating, you know, older than them. We all need to tell them the more often they hear it in a gentle kind of way. Hannah, how would you feel about that? Yeah. I mean, I think that, I think that when we have people who engage in a lot of microaggressions or, you know, any type of ism, really, I think it's sort of, you have to make a personal choice of your own self-care as well. So, you know, if you think this person is important, you know, if they're a medical provider, I do think it's almost ethically imperative to confront ageism because of all of the things we know, just like any other ism really. But I think that if they're really not hearing it and it's really impacting them, like that's when you go to that seek external support piece because I do think it is very important and can have really huge impacts. And sometimes we just might not be the person they can hear it from or they need someone in a position of power to tell them it. And I think that that's unfortunate and it's always disappointing when that's the case. And sometimes that's what needs to happen, unfortunately. I have to tell you another small story before we close. I recently bought a house from a 92-year-old woman that lives alone. She doesn't have a bedroom or bathroom on the first floor. She goes up the whole flight of 15 steps. She's still driving and she goes to the gym four times a week driving. When all of this was described to me by my realtor, I said, why do you say that she's 92? And I gave the example of my family friend who is 102 and still publishing it. Oh, no, I didn't mean that, but I just admire her. But the tone of voice didn't come as admiration to me, you know. But at least she recognized the fact that I didn't like that she was emphasizing she's 92. You know, someday they'll be saying that to me. You know, it's not that I want to feel offended, but I think it's their ignorance more than anything else. All right. Any audience questions coming up? I think there is something going on here. Let's see. Yes, Dr. Paul. I think you're on mute. It's in the corner here up here. Okay. Well, I play racquetball. I play with a group that generally ranges from the 20s into their 80s. It's really a lot of fun. And oftentimes, you know, it kind of works out where an older guy will pair up with a younger guy. And it's pretty cool. It's a pretty cool relationship. And, you know, the older guys might be wearing a brace or two, but the younger guys are faster, believe me. And there's a certain reality to it. Yeah. Hey, Paul, I didn't realize you put Paul. I thought your last name is Paul. You're Dr. Friedman, right? I recognize you. Okay, go ahead. My general question is, in conversations with patients, how do you nuance the reality of aging with an understanding that the patient in front of you is different, let's say at age 90, than they were at age 50? I mean, that is a certain reality that has to be accommodated in our thinking and our medical practice. How do you get the nuance? How do you really catch the reality of that person as they are? And we know that, for example, that the Olympic sprinter, Bolt, is not running as fast at age 30, as he did at age 22. That's the reality. And that's the reality for everyone. I would say to that, I think you're absolutely right. And I think Ashton really hit on this when she was speaking. Age comes with changes. That's 100%, no doubt in that. But that doesn't make it bad or something that we have to hate. And it's accommodating for it. So, you know, yeah, Bolt can't run as fast. But you know what, I'm certain he's still running. And I think that's sort of what's important to it is, you know, when you have an 80-year-old person in front of you saying, I used to love this thing. I can't do it anymore. So now I'm doing absolutely nothing. That's when you want to talk about, well, what's going on there? And I think I see that quite a bit as a psychologist, you know, older individuals saying, well, yeah, I've lost so much. And it's true. There have been losses. But you often have to point out, well, there's been losses actually your entire life. And you've overcome them in the past. What can you do now? So I think it's not denying that there are things that happen when you get older. It's how can we still have a good quality of life with these changes? And, you know, I think Ashton also brought up a really great point about wheelchair use. I've had so many individuals whose life quality would improve exponentially if they would be willing to use a wheelchair. But the ageist and ableist society that we've been raised in makes it so, well, I can't be seen in that. If we can all start fighting it, then we're going to see a better quality of life for someone who did have changes as they aged. So I think it's always a nuanced understanding of like, yeah, you know, for example, we won't give the same medications to an older and a younger person. That's okay, as long as you're thinking through why you're making those differences. And it's not only due to the fact that you see them as an old person. So I think that's really where it comes into. It's always just that reflection. And, you know, how can I look at this a little bit differently? You know, I think, you know, racquetball, that is a fast sport. The, you know, the arena or, you know, sprinting, the arena where we see the biggest change is in any kind of extreme athletic effort. Right. And so, I mean, I always say there's only two inevitable bad things about aging. Some part of your body is going to slow down or fall apart. I don't, cognitive decline is not inevitable, but I mean, challenge me if you think, if I have this wrong, but, you know, about 20% of the population stays super sharp. I mean, maybe they lose, you know, a little bit of the tip of the tongue stuff, but some, your body's going to function less well. And we, you know, as a physician age is real, you know, when we pretend it's not happening, we don't do ourselves or our patients, any favors. And I know, you know, that I'll just share an anecdote that I heard from my dentist because of course you can't talk back. And he had been skiing with his family and he shared a chairlift with a 93 year old guy. And he said, what's your secret expecting the guy to say, you know, that he, you know, bench pressed a lot or, you know, had some magic elixir. And he said, don't be an idiot. You can't. And then he did qualify it by saying, you can't ski at 90, the way you skied at 40, he's still skiing, but he's skiing. So I say, you know, we can do the things we love. Usually extreme sports is the one thing people do have to give up on, I think, but versions of them, not the way we did them when we were 40, but there are lots of arenas where we do them better, right? Like, you know, think painting, you know, sex, I would say we get better at it, you know? So it's not a one way slope by any means. You know, aging is physiological, right? That's body. But our thought process is different. Our attitude is different. That doesn't come with age, right? The way you think about other things is not because of your age related, some changes in your brain. The physiology is what is making our body look different. But I think we can make our own assumptions about other, about things that are external to us and how we treat people other than ourselves. And at the same time, as a rehab physician, we all know that if you keep, if you don't use it, you lose it. Like sarcopenia, if you don't work, you know, exercise, and you lose it. And if you don't keep up exercise, you get deconditioned more. So I think you can beat the physiological changes by adding other ammunition, just like exercise and proper diet and, you know, good attitude and having friends. All of this adds to longevity, right? Having friends also is good for longevity. So these factors can change a person's looks and attitude and add to their life. That doesn't mean that they're just living long because of genes. I mean, genes play a role, but I think what else goes on around you makes a difference. Would you agree, Hilary? Are you nodding your head? Very much nodding. And I just want to remind people quickly, put your questions in the chat, because I know we're going to be wrapping up. And while we may not get to them right now, we'll keep track of them. And it's wonderful to see so many people listening in. Thank you, everyone. Thank you all, the presenters and the audience and the moderator, Hilary. It was such a pleasure it was such a pleasure to hear a very interesting topic put in such, you know, easy understanding way for us. And I think we need to spread the word and we need to use the word that's kill the ageism, okay? We need to really make it a point to in every encounter we have at the healthcare field and outside as well. We need to do that. Thank you all. And we are incredibly grateful to you for spending your time with us in the evening and making time to present. Thank you. And on behalf of the community, I'd like to give you a special thanks for everything that you have presented. Thank you.

ageism

older adults

overt ageism

implicit ageism

elder speak

healthcare

cognition

positive age beliefs

internalized ageism

ableism

employment barriers

dismantling ageism