Note: This is a précis of an article originally published in National Geriatrics Interest Group (Vol. 3, Issue 1, 2015), and the full article can be read there.
“Bed-blocker” and “silver tsunami” have become common terms to describe the elderly. The term bed-blocker1 was coined by health-care professionals to describe older adults who are medically well enough to be discharged but remain in an acute hospital bed for other reasons; “silver tsunami” warns of the negative impacts of the aging workforce.2
The terms are symptomatic of an underlying view of older persons as burdensome – one of two forms of ageism found by the Ontario Human Rights Commission during its consultation on ageism.3 The other form is the structuring of services and systems such that the needs of older adults are not fulfilled.
Discriminatory language is disempowering and hurtful. The OHRC gives an example of a law professor telling his class that “those who speak English with a ‘foreign’ accent do not make ‘good lawyers’.”3 The commission says this discriminatory statement may be enough to create a “poisoned environment” for students in the class who speak English with an accent.3 In the same way, terms such as bed-blockers, silver tsunami and “successful aging” may establish a poisoned environment for seniors.
Calling older patients who remain in hospital for non-acute medical reasons bed-blockers though they may still need care and attention4 suggests acutely ill patients are more deserving of attention and funding than those needing long-term care. It places blame on the patients themselves for not being discharged.
The silver tsunami or the grey tsunami equates the impact of that aging population to a natural disaster that strikes without warning.5 But the impact of the aging baby boomer generation was predicted and has been well documented.5 Furthermore, there is research showing that increases in inflation and technology costs will create a greater burden on the economic system than aging workers.6 Regardless, older adults have a right, as recognized by the United Nations Principle for Older Persons, to be treated with the same high quality care and the same dignity as younger patients.7 As such, it is unethical to do anything, including using discriminatory language, which would diminish their dignity.
Even the more benign concept of “successful aging” confers a value judgment. The idea of successful aging describes physical and psychosocial well-being into old age8 but the term presupposes its opposite.8 The term also implies that success is a product of individual choice and effort, which leads to negative judgments on the everyday older adult who fails to achieve this success.
Media reports commonly present an “apocalyptic view of demographic trends and an assumption of intergenerational conflict for scarce resources”9 which fuel fears and resentment towards older adults for creating unsustainable increases in health care and pension costs.9 The World Health Organization’s Missing Voices Report reveals that ageism and disrespect are major forms of elder abuse that occur globally.10 The report participants felt that while disrespect is linked to verbal and emotional abuse, it is more pervasive as a poor social attitude.10
Moreover, the two forms of ageism identified by the OHRC are interrelated. In 2010-11, Ontario spent 34.7 per cent of its health-care budget on operation of hospitals, as compared to 13.7 per cent on community care and long-term care homes combined.11 A lack of accessible and appropriate long-term care in turn results in the longer stays of older persons in acute care beds.
Many cultures deeply respect their elders for their experience, contributions and wisdom. However, we tend to equate youth with technology, innovation, and the future, while aging is associated with disability, vulnerability and decline.9 The OHRC suggests several methods to combat ageism including:
- Acknowledging of the contributions older persons as active participants in society as employees and employers, volunteers, consumers, citizens, and individuals holding great life experience.
- Public awareness campaigns using written and audio-visual media to combat the negative stereotypes and ageist attitudes about older persons. These campaigns can also be used to reach out to those suffering from ageism and empowering them to respond.
- Initiatives in the education system involving intergenerational interaction to break down barriers between generations and combat ageism from an early age before the formation of negative attitudes.3
Bed-blockers, silver tsunami and successful aging are discriminatory terms used by the public and media that portray the presence of ageism in our youth-centered society. These attitudes stem from the value our society places in youth and the lack of value in aging. This fundamental belief has caused a systematic ageist structuring of systems and services to favour the young.3
About the Author
Selynne Guo is a second-year MD candidate at the University of Toronto.
Footnotes
1 Maley J. Court evicts NHS 'bed blocker'. 2006.
2 Schumpeter. The silver tsunami. 2010. IMDb . Silver Tsunami (2014 film). 2014.
3 Ontario Human Rights Commission. Ageism.
4 Styrborn K, Thorslund M. Delayed discharge of elderly hospital patients--a study of bed-blockers in a health care district in Sweden. Scandinavian Journal of Social Medicine 1993;21(4):272-80.
5 Roos N, Hirst N. Silver tsunami to break the health system’s bank?
6 Canadian Health Services Research Foundation. Myth: The ageing population is to blame for uncontrollable health care costs. Journal of Health Services Research & Policy 2011; 16 (4): 252-53.
7 Office of the High Commission for Human Rights. United Nations Principles for Older Persons. 1991.
8 Martin P, Kelly N, Kahana B, Kahana E, Willcox BJ, Willcox DC, Poon LW. Defining Successful Aging: A Tangible or Elusive Concept? The Gerontologist 2015; 55 (1): 14-25
9 Law Commission of Ontario. A Framework for the Law as It Affects Older Adults: Advancing Substantive Equality for Older Persons through Law, Policy and Practice, Final Report. Toronto, 2012.
10 WHO/INPEA . Missing Voices: views of older persons on elder abuse. Geneva, World Health Organization, 2002.
11 Ontario Ministry of Finance. 2012. Chapter 5: Health.