Increasing life expectancy has led to several challenges due to population ageing. One of these challenges, which has not yet received adequate attention, is the intersection of ageing, old age, and disability. This statement may come as a surprise to some, particularly from within an ageist context where old age is often associated with disability. However, there is a significant gap in dialogue between disciplines centred on ageing and those focused on disability. Although both fields have undergone substantial development, they are largely parallel endeavours that do not engage in interdisciplinary research. That notwithstanding, the Oxford Institute of Population Ageing conducted a series of seminars on ageing and disability, which represents a significant step forward in fostering the necessary interdisciplinary interaction. This blog shares the same goal.
To address this issue, it is essential to recognise that there are individuals who live with a disability before reaching old age. In contrast, others may experience disabilities for the first time during later life. Both groups, therefore, have unique characteristics requiring careful analysis that considers their similarities and differences.
Historically, gerontology has failed to acknowledge individuals ageing with a pre-existing disability and eventually reaching old age. This group is often rendered invisible because it falls within the disciplinary boundary separating those dedicated to the study of old age and ageing from those who are focused on disability. Furthermore, a major criticism of gerontology is that its engagement with disability-based topics solely focuses on dementia, which neglects a far broader spectrum of disabilities experienced by people throughout their lives.
In order to understand these difficulties, it is pertinent to delve into the origins of the intersection of ageing and disability through the lenses of ageism and ableism. Ageism largely consists of social representations concerning age that have detrimental effects on older adults. This concept includes stereotypes (cognitive dimensions), prejudice (affective dimensions), and discrimination (behavioural dimensions). As I previously alluded to in the case of dementia, some of the most prevalent ageist ideas associate old age with deterioration, particularly in terms of cognitive impairment, frailty, dependency, and incompetence. These representations perpetuate the misconception that older adults resemble children and should be treated accordingly. Here, a focus on assistance is predominant and rather than embracing a rights-based approach that recognises all older persons as individuals in their own right, regardless of whether they have a disability, they are lumped together as in some way less deserving than their younger counterparts. It is important to note that these ideas are constructs and are neither universally applicable nor accurate. Furthermore, ageism can and often does harm older adults’ quality of life due to the effects of discrimination. It can also lead to the internalisation of these ideas throughout the life course, which can result in older adults believing, and acting, as if they were in some way deficient.
Similarly, ableism is related to stereotypes, prejudices, and discrimination against persons with disabilities. These ideas are based on placing certain abilities over others and ultimately considering persons with disabilities as less competent; entrenching the view that disability is undesirable. Ageism, similar to ableism, has a detrimental impact on the quality of life of persons with disabilities, as it hinders their access to healthcare services, education, and employment.
It is essential to recognise that when persons with disabilities reach old age, these two forms of discrimination intersect and exacerbate each other, increasing their vulnerability to discrimination. Additionally, when other forms of discrimination, such as racism and sexism, come into play, the likelihood of discrimination increases even further. For instance, Temple et al. (2021) conducted a study on discrimination against older adults with mental health conditions, revealing that for each type of discrimination reported, a person was 1.3 times more likely to encounter barriers in accessing healthcare services.
When considering the interplay of these forms of discrimination, it becomes clear that ageist ideas are closely linked to ableist representations. This connection includes the fear of ageing, which is very often associated with inevitable dependency and deterioration. In their study, Gendron et al. (2023) showed that there was a significant relationship between internalised ageism and fear of cognitive and physical disability. Moreover, relational ageism, which refers to concerns about being judged by others due to age, was associated with fear of physical, cognitive, and sensory disabilities.
Recent debates have raised questions regarding the distinction between ageism and ableism. Van der Horst and Vickerstaff (2021) proposed that many ideas categorised as ageism can also be considered ableism. For instance, denying work opportunities to older adults based on the assumption that their age might lead to sensory problems that could hinder their performance is an ableist idea.
These studies compel us to consider the significance of distinguishing between ageism and ableism, recognising that some ageist notions are rooted in ableism. This suggestion also relates to critiques pertaining to the concept of 'successful aging', as it can inadvertently promote the notion that we must age without disability and maintain youthfulness. Consequently, the pursuit of successful ageing can lead to stigmatisation and discrimination against persons with disabilities, particularly those older adults with disabilities who do not meet the criteria for ‘success’.
The adverse consequences of ageism and ableism compel us to consider potential solutions to these issues, with particular regard to their intersectionality. The WHO’s Global Report on Ageism (2021) proposes three key avenues for combating ageism: 1) implementing policies and laws that promote ageism reduction, ensuring equality and non-discrimination based on age; 2) conducting educational interventions on old age and ageing issues; and 3) implementing intergenerational contact interventions. These proposals are further supported by a systematic review that focuses on interventions aimed at reducing ageism. In this review, educational activities and intergenerational initiatives were found to be the most effective and cost-efficient ways of reducing ageism.
Considering the material contained in this blog post, it is essential to develop anti-ageist initiatives that address the issue of ableism. This approach should adopt a life course perspective, not only focusing on older adults with disabilities but also on people with disabilities who are ageing and will reach old age. Consequently, it is crucial that: 1) policies and laws promote the reduction of ageism and ableism, with a focus on eradicating all forms of discrimination related to age and disability; 2) educational interventions on ageing include a life course perspective that acknowledges the intersection of ageing and disability; and 3) intergenerational contact interventions incorporate older adults with disabilities and people with disabilities of all ages.
It is important to note that not all older adults have disabilities, and not all persons with disabilities are older adults. Therefore, the proposals contained herein emphasise the significance of intersectionality while taking great care not to perpetuate ageist and ableist ideas.
About the Author
Javiera Rosell is an academic visitor at the Oxford Institute of Population Ageing. She is a Professor of Psychology at the Pontificia Universidad Católica de Chile (PUC) and a member of the Center for Age and Aging Studies at the same university. Also, she is a postdoctoral researcher at the Millennium Institute for Care Research (MICARE).
Opinions of the blogger is their own and not endorsed by the Institute
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