{"id":34133,"date":"2015-05-07T16:00:16","date_gmt":"2015-05-07T15:00:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=34133"},"modified":"2015-05-12T16:22:09","modified_gmt":"2015-05-12T15:22:09","slug":"david-oliver-minding-our-language-around-care-for-older-people","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/07\/david-oliver-minding-our-language-around-care-for-older-people\/","title":{"rendered":"David Oliver: Minding our language around care for older people and why it matters"},"content":{"rendered":"

\"david_oliver_2015\"<\/a>I love to plough through the newspapers, with radio or TV news on in the background. My enjoyment can be punctured by annoyances. Recurring candidates for this personal \u201croom 101\u201d are ageist language and attitudes. Comparing 2015 with my youth, I\u2019ve seen a welcome sea change in the language deemed acceptable regarding race, sexuality, or disability\u2014whether in the street or in the media. Yet ageist terminology remains far from taboo.<\/p>\n

Older people are occasionally vilified, often mocked, and usually patronised. In media representations they are either invisible (\u201cout of sight out of mind\u201d when it comes to, for instance, care home residents or the housebound); portrayed as vulnerable and victims; or \u201callowed in\u201d if they are \u201cspritely\u201d or \u201cgood for their age.\u201d As for demeaning language? It\u2019s often used unwittingly or with kindly intentions. But it embodies and shapes values and attitudes and, in turn, the services we provide.<\/p>\n

I\u2019ve lost count of the number of times I\u2019ve seen older people marooned in acute hospitals and awaiting step down services referred to as \u201cbed blockers\u201d\u2014most recently in the Independent<\/em><\/a>. The story highlighted a key issue: the effect of cuts to social and community health services. But the terminology paints older people as a nuisance or threat to our system, \u201cblocking\u201d our beds from use by more deserving folk\u2014as if they have any control over their predicament. Besides which, on leaving hospital they would still require funded care, so \u201cbed blockers\u201d sets one public service against another.<\/p>\n

Equally self-defeating are campaigns by the Daily Mail<\/em> and Telegraph<\/em> on \u201cDignity<\/a>\u201d or \u201cJustice<\/a>\u201d for \u201cThe Elderly.\u201d Although the former, in particular, delights in scandal, sensation, and solution free stories, these campaigns do espouse the worthy cause of better care for older people, however unhelpful the tone. \u201cThe Elderly,\u201d by contrast, lumps all from 65 to 100 in one amorphous (vulnerable, dependent, and invisible) mass\u2014despite many people retaining independence and control well into older age. But then our media often falsely polarise depictions of ageing\u2014either accompanying stories with depictions of wrinkled hands and walking aids or \u201callowing\u201d depictions of older people who still manage to look and act young.<\/p>\n

Then we have catastrophising language on population ageing: the \u201cticking timebomb,\u201d \u201cgrey tsunami<\/a>,\u201d or \u201cgrowing burden\u201d threatening the very viability of our public services. Demographic change is a legitimate cause for concern, but economies can grow; people staying well for longer may retire later; and older people can make a net contribution through work, volunteering, caring, grandparenting, and spending. We don\u2019t need to stoke intergenerational conflict.<\/p>\n

\"older_people_media_2\"<\/a>
\u00a9 Australian Human Rights Commission. Taken from this report: https:\/\/www.humanrights.gov.au\/publications\/fact-or-fiction-stereotypes-older-australians-research-report-2013\/chapter-4-role-and<\/figcaption><\/figure>\n

News media reflect societal values as much as shaping them. Sadly, the attitudes of some clinical staff can mirror them. This needs to change, given that any clinician training this year will be doing so with the youngest cohort of patients we\u2019ll ever see and the care of older people with complex needs will be the main job for most of us. If journalists need to check their ageist language, then so do we.<\/p>\n

There\u2019s already a tacit hierarchy<\/a> of prestige within<\/a> the clinical professions<\/a>. It favours single conditions affecting younger people and amenable to heroic, high tech cures over care and support to help older people with multiple long term conditions, frailty, or dementia live well with them. It\u2019s also challenging and hard work. This is clearly reflected in staffing\/patient ratios and recruitment.<\/p>\n

Language plays its part here too. Clinicians<\/a> aren\u2019t immune from using ageist terms, such as \u201cbed blocker<\/a>\u201d or \u201csocial work medicine.\u201d I\u2019ve heard worse, although I haven\u2019t heard terms like \u201ccrumble\u201d or \u201cGOMER\u201d\u00a0for a while<\/a>.<\/p>\n

But I\u2019ve repeatedly witnessed frail older people with medical problems that can and should be addressed being written off as having \u201cacopia\u201d or \u201csocial admissions<\/a>.\u201d\u00a0Patients being referred to as \u201cbed 18\u201d or \u201cthe stroke in bed 18\u201d\u2014driven partly by exaggerated fears about confidentiality and anonymity, but then seeping into custom and practice. Older people with impaired cognition or communication being labelled as a \u201cpoor historian,\u201d when it\u2019s surely the clinician who’s the history taker. (Do we call 3 year old paediatric patients \u201cpoor historians?\u201d) Patients assessed as having \u201cfailed\u201d their occupational therapy assessments, betraying total ignorance of the principles behind planning care transitions or support. People with reversible delirium or disabling dementia labelled as \u201cpleasantly confused.\u201d I could go on with this list but you get the picture.<\/p>\n

Finally, as if tainted by association, I\u2019ve heard disparaging language used about services for older people and in effect those who work in them. I\u2019ve spent 26 years as a coalface doctor so I live with and love the gallows humour in clinical teams\u2014I\u2019m not a killjoy. But referring to specialist teams as \u201celderly scare\u201d or saying patients are \u201cwaiting for Geris\u201d demeans the teams. It also absolves staff from doing their best for these patients, instead letting them assume that complex needs and especially rehab, discharge planning, and community interfaces are someone else\u2019s job and not \u201cproper medicine.\u201d<\/p>\n

Readers, this really isn\u2019t a question of over-sensitivity and \u201cpolitical correctness gone mad.\u201d The words we use colour the way we think and the way we practice. It really is time to mind our language.<\/p>\n

David Oliver<\/strong> is a consultant physician in geriatrics and general medicine, president of the British Geriatrics Society, senior visiting fellow at the King\u2019s Fund, and a visiting professor of medicine for older people at City University London.<\/em><\/p>\n

Competing interests: None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"

I love to plough through the newspapers, with radio or TV news on in the background. My enjoyment can be punctured by annoyances. Recurring candidates for this personal \u201croom 101\u201d […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5759,263],"tags":[],"class_list":["post-34133","post","type-post","status-publish","format-standard","hentry","category-david-oliver","category-global-health"],"yoast_head":"\nDavid Oliver: Minding our language around care for older people and why it matters - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2015\/05\/07\/david-oliver-minding-our-language-around-care-for-older-people\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"David Oliver: Minding our language around care for older people and why it matters - The BMJ\" \/>\n<meta property=\"og:description\" content=\"I love to plough through the newspapers, with radio or TV news on in the background. 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