Tackling the Ageism We Wage Against Ourselves

Abstract

To paraphrase the now classic British film, Love Actually (https://www.imdb.com/title/tt0314331/), ageism is within and all around us. You might guffaw at my cultural reference, but I urge you to stop and reflect. How often do we hear ‘I'm too old for…’ or ‘Ignore me, I'm having a senior moment’? We might even utter these platitudes ourselves. As nurses, we hear these critical self-appraisals more than most. Such exclamations punctuate our everyday clinical practice, research and education as well as likely filtering into our home lives. Rarely is this sort of self-appraisal of ageing and being older positive. We don't hear things like ‘I'm too old to bow to peer pressure or social convention. I'm going to do what I wish to!’ nearly as often as we contend with the self-directed discrimination that is commonplace today. The ageism we wage against ourselves is harsh, harmful and costly.

Self-directed ageism—what is sometimes incompletely labelled age-related self-stereotyping—trends toward the negative. It appears to arise in self-concept, health behaviours, lifestyle choices and healthcare decisions at some indeterminate point in adulthood, likely in later mid-life but possibly earlier. We really do not know much about this process. The need for research into the intrapersonal and social onset and persistence of insidious representations of ageing and being older in our beliefs, thoughts and actions remains unmet. Professions and industries like healthcare often even codify this consequential form of ageism with policies and practices. Consider how many guidelines take effect or address people at the age of 60 or 65 but without rationale beyond chronological age.

We learn early in childhood to attach chronological age to our identities and most aspects of daily life. After childhood, the word old applied to people, as opposed to objects, commonly characterizes sentiments of decline and loss in vernacular English. Old becomes synonymous with weakness, lethargy, fatigue and discomfort. ‘I'm feeling so old today!’ is a popular example heard across most English-speaking societies. Our socially acquired understanding of old paints personal and social images of ageing with layers of negative connotations. What results thwarts health, function and well-being for individuals, families and communities, promoting societal health inequities. Sadly, self-directed ageism goes largely unnoticed or is blatantly ignored by most of us. Worse yet, it is blindly accepted by older people as a code for their identity and way of being in later life.

As we approach the end of the United Nations Decade of Healthy Ageing (https://www.decadeofhealthyageing.org/), we gerontological nurses must refresh our knowledge of ageism, especially that which we direct inward, and develop a forward thinking research agenda to help secure the aim of this global initiative. The World Health Organization (WHO) reminds us that ageism is how we think or form stereotypes, how we feel or are prejudiced, and how we act or discriminate against others and ourselves based on age or perceptions of it (Officer and de la Fuente-Núñez 2018; WHO 2021). The WHO's estimate of the prevalence of ageism underscores its pervasiveness today. Moreover, the WHO—supported by a compelling body of scientific evidence—indicates that ageism, including that we direct against ourselves, damages health and well-being even when those thoughts, feelings and actions are apparently positively intended but substantively negative.

Gerontological nurses frequently hear older people express their own stereotypes, prejudices and discrimination simultaneously towards themselves and others. Each one of us hears and sees people in our clinical and educational practices, research and daily lives living out ageism against themselves and others. Who among us has not heard ‘Oh, but I couldn't be seen with those people! They're old!’ from a person whom we consider to be older? We hear this sort of comparison as often as we hear comments about being too old that refer only to the self. The appellation of older here may be a result of comparing characteristics of others like perceived age, appearance and social roles like being retired or a grandparent with what we see in ourselves. Some evidence suggests that this comparative thought—called views on ageing—that lies behind the downward social comparison may offer benefits by identifying oneself as not old (de Paula Couto et al. 2025). Potential benefits stem from motivations we find in that identity of not old. But the comparison still requires a negative understanding of ageing and being old, possibly outweighing potential benefits over time. Thus the ironic smile that such a statement might elicit from some of us glosses over a phenomenon that deserves far more investigation than we gerontological nurses are giving it.

Paradoxically, ageism is the form of stereotyping, prejudice and discrimination that we direct at both our current and our future selves. In expressing it, the damage we cause to ourselves and to others cascades into our shared future. In an era where health equity is intensively studied and threats to it challenged by individuals and institutions alike, ageism against ourselves and others remains largely accepted, embraced and even structurally reinforced. Just why ageism remains unchallenged may feel mysterious. But this acceptance of ageism must result from complex sociocultural constructions that research can help trace. As ageism persists, implicit endorsement of it makes the existential conundrum of whether we should wish for a long, well-lived life or dread what later life may bring a reality of daily life. The world needs us to advance our research to make this conundrum an historical artifact.

We gerontological nurses are immersed in ageism at work, in our homes and throughout our communities. Some of the ageism happening within and around us we see, but much of it we do not. As a result, we must challenge our scientific stance on this highly prevalent phenomenon, exhorting ourselves to do better. We cannot afford to believe that ageism is a problem of the young or is one that lies outside the realm of healthcare if we are to remain true to nursing's salutogenic focus on health, function and well-being. Many nurse investigators have documented ageism held by nursing students and, less often, by nurses themselves. The findings from these studies typically conclude with calls for education about ageism and promotion of careers in gerontological nursing. Rarely do we study ageism expressed by people towards themselves, indeed towards ourselves. Nor do we typically trial interventions that help dismantle this scourge. That gap in our specialty's research limits our capacity to work with people to improve their health, function and well-being by overcoming the ageism that they—and by extension, we—direct inwardly.

Our research must grow significantly if we are to play a strong part in the Decade of Healthy Ageing and similar campaigns. Long past are the days when evidence that ageism exists suffices to meet clinical and social needs. Documenting ageism in any group, including older people themselves, lacks novelty when we remember that the WHO tells us that virtually half the world's population is ageist. Successfully dismantling ageism requires far stronger scientific aims and application of more robust methods than we commonly employ. We also need research that marries the study of ageism with that focused on ableism given that self-directed ageism frequently focuses on abilities. Moreover, we need research that distinguishes between and among stereotypes, prejudices and discrimination as they operate in daily life and affect health, function and well-being. Currently, what we term negative age-related self-stereotyping focuses on what is thought but less on beliefs and actions. We nurses see the actions whereby older people count themselves out along with the anguish and isolation that the beliefs which support those actions engender. All these phenomena call for our highest quality, most sophisticated research.

The Decade of Healthy Ageing, with its focus on health and social equity, concludes in 2030. Ageism generates critical inequities in health as well as in consequent changes in function and well-being that clearly demand our scientific attention and advocacy. A panoply of social, commercial and environmental drivers of health demonstrably link back to the stereotypes, prejudices and discriminatory acts of ageism. Now is the right time to develop a strong, clearly conceived nursing research agenda for self-directed ageism and its parallels like ableism. Current research lacks our distinctive disciplinary perspective beyond documentation of prevalence. Our specialty lags scientifically in the domain of ageism, thus failing to generate our share of the means to dismantle it. Thus, we cannot fully meet the needs that we nurses are observing across health and social care settings and in our communities.

Developing a research agenda through which gerontological nursing can address self-directed and other forms of ageism is a collaborative enterprise. Nevertheless, some substantive and methodological dimensions are worth laying out here. Considering these broader issues better enables us to come together as a community around a research agenda and the strategy to achieve it. Let's start with acknowledging our own ageism as nurses and people. Everyone is ageing—it's called human development in other contexts—and nurses are no different than anyone else. We nurses, even if we are gerontological specialists, are likely as ageist or more so than the majority of the world's population. With our ageism acknowledged, we can stop studying the extent to which we or our students are ageist and move towards more sophisticated aims and suitable methodologies.

We must particularly contend with our self-directed ageism so that we can more clearly see it in others. Here, we surely need more and better studies that involve just about everyone other than our students. To be fair, we surely have sufficient evidence to create robust age-inclusive and age-friendly nursing and interprofessional curricula. The resources to achieve that objective are not in question. Grappling with our own biases, we become better able to explore age-related biases, particularly those among people who are and will be in our care across health and social care settings. We can then formulate ways to help them replace their existing ageism with age-friendly thoughts, beliefs and actions for themselves and others. Similarly, we can help build age inclusion across institutions and communities. Understanding the ageism that operates in health and social care settings is crucial, too. Institutionalized or structural ageism presents pervasive influences on individuals who interact with those institutions and organizations where such ageism is manifest.

Our research must target the language of ageism and its use in the sociocultural context in our research. English is one of the primary languages of science globally. But clinical nursing exists in the languages of the people and communities in our care. The ageism of English words and phrases is often transmitted through science, its meaning misunderstood in societies where English is not the primary language. Similarly, the ageism of words and phrases in languages other than English calls out for research by gerontological nurses. Likewise, we must connect our research in ageism with cultural and religious conceptions of respect for older people and filial piety. The extent to which these concepts inadvertently drive ageism wielded against oneself remains incompletely described.

The WHO (Officer and de la Fuente-Núñez 2018) points to the necessity of multifaceted responses to successfully combat ageism. Most research conducted within our gerontological nursing community relies on educational initiatives and occasionally employs some intergenerational activities. We infrequently attend to the need to advance policy and law. All these interventions—education, intergenerational activity and policy—can be enhanced through professional activism. Advancing the interventions that we plan to undertake requires reckoning with how we express our activism. We must realize that some older and younger people alike may find stridency in our approach forbidding or displeasing. That must not stop us. Our profession's relational sensibility then becomes vital to our activism, making our science and especially our interventions to dismantle self-directed and other forms of ageism achievable.

We on the IJOPN editorial team want to hear the views of our authors, peer reviewers and readers on ageism. We know we cannot achieve our aim of drawing attention to self-directed ageism and successfully generating a research agenda to combat it and other forms of ageism without thoughtful conversations. Share your thoughts on ageism, tagging IJOPN on LinkedIn (https://www.linkedin.com/company/international-journal-of-older-people-nursingg?trk=public_post_feed-actor-name) and using the hashtag #geronurses. We look forward to reading what you think about self-directed and all other ageism.

The author declares no conflicts of interest.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.