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June 24, 2020

Unconscious bias

In my last blog What do you expect at your age? I explored the structural ageism that exists in our society and the negative impact of this on older people. In fields such as healthcare and government policy making, there is evidence of ageist attitudes affecting treatment and policy decisions, with wide-reaching and serious implications for older people.

I am interested to learn where ageist beliefs originate, what form they take and how we can begin to tackle them.

In her book ‘Sway’, Pragya Agarwal describes ageism as a ‘hidden bias in our society’. By this she means “biases that exist without our conscious knowledge, the ones that manifest themselves in our actions and reactions often without us realising it.” (1)

We all carry these implicit biases with us, collected as we move through life as we take on social norms – from our parents, the media, politicians and others – and hold them at the subconscious level. They affect the way we act and react, how we treat people and the decisions we make. When we meet someone new, it takes ‘less than a second for age based social categorisations to take place’(1).

So what are the commonly held ‘age-based biases’ that exist within our society?

In a global study, carried out by Ipsos Mori, it was revealed… “People’s associations with ageing are overwhelmingly negative…. Research from the US, UK and Europe suggests that older people are likely to be stereotyped as frail, ill and dependent, and having low social status.”(2)

A report into ‘Ageism in Britain’ by Age Concern in 2006 found that ‘Older people are stereotyped as warm, friendly and moral but incompetent and incapable.’(3)

Within health and social care settings “stereotypes tend to be even more negative, focusing on death, physical and cognitive decline…Getting old is often seen as a process of increasingly bad health.”(4)

Clearly, not all age based associations are negative. In the Ipsos Mori survey, the most frequently selected words associated with old age, alongside ‘frail’ and ‘lonely’, are ‘wise’ and ‘respected’. (2)

These two stereotypes are often forged together in our perceptions of what older people are like… “frail but wise, lonely but respected – creating a ‘doddering, but dear’ archetype, which is damaging. This means that we’re more likely to pity and patronise older people, and deny them power and influence.(2)

It does not take a huge leap to see how these biases play out in the day to day encounters older people have. In a report ‘That Age Old Question’, the Royal Society for Public Health explains the impact of unconscious bias in health and care settings:

“Overall, health professionals make decisions about and interact with older adults every day, and when they are not aware of how these decisions are infected by implicit age biases, the harmful effects for those older adults will go unrecognised.” (5)

The language we use (frail, vulnerable, elderly) and the thoughts and feelings we hold (incapable, friendly, incompetent) about older people affect how we treat them, both as individuals on a day to day basis, and as citizens within our society.

As Ashton Applewhite explains in her book ‘This Chair Rocks’:

“…if we diminish our regard for the senior members of our society verbally, we are likely to do the same when it comes to the way we frame policy – removing their dignity and sense of agency in condescending generalisations that assume vulnerability and dependence…(6)

How do move beyond this, to start to break down some of these stereotypes and tackle age based biases?

Agarwal describes how tackling unconscious bias can be difficult as “we are reluctant to re-evaluate our beliefs and like to believe that we are all egalitarian and carry no biases”. But it is possible to tackle these biases if our awareness is raised and we are willing to explore and understand how… “we put up walls between ‘us and ‘them’ before we even realise we are doing so”. (1)

Agarwal describes the interaction between the activation of a stereotype (switching it ‘on’) which is unconscious and the application of the stereotype (taking an action) which is conscious.

“We need time, intention and adequate cognitive capacity and resources to be aware of the activation of stereotypes and then to significantly reduce the application of any stereotypical beliefs on others around us.”

So one of the solutions lies in awareness raising leading to increased understanding, this involves investing in staff training and support.

Agarwal believes… “that by addressing the biases at the individualistic level, we can begin to understand the societal and structural inequities and injustices” (1)

This resonates with the recommendations by the Royal Society of Public Health, who advocate the following:

Training for healthcare professionals on the effects of ageism in clinical and care settings which should apply to all professionals routinely interacting with older individuals in health and care settings, and will:

1. make healthcare professionals aware of the different ways that ageism can take root in healthcare settings, and how it can affect patient-carer interactions negatively through ageist language and patronising communication;

2. make healthcare professionals aware of how implicitly held negative age stereotypes can affect diagnosis and treatment of older patients, and understand how to avoid this so as to ensure fair access to treatment;

3. train healthcare professionals so they are aware of the ways in which self-stereotyping and stereotype threat can impact on the behaviours, rehabilitation, and physical and cognitive performances of older patients.(5)

Unconscious bias plays a major role in reducing the health and wellbeing of older people, and denying them a voice. By increasing awareness, identifying and acknowledging these hidden biases, we can all play a part in eradicating ageism.

Sarah Prescott
Friendly Communities Officer, Time to Shine

(1) Sway: Unravelling unconscious bias (Pragya Agarwal, Bloomsbury, 2020)

(2) The Perennials: the future of ageing (Ipsos Mori Thinks)

(3) Ageism in Britain 2006 (Age Concern, 2008)

(4) Doddery but Dear (Centre for Ageing Better, 2020)

(5) That Age Old Question (Royal Society for Public Health, 2018)

(6) This Chair Rocks: A Manifesto Against Ageism (Ashton Applewhite, Melville House UK, 2019)