Ageism has been described as "thinking or believing in a negative manner about the process of becoming old or about old people" (Doty, 1987, p. 213). Society's attitudes and beliefs about aging are culturally embedded and can have a profound effect on how people view themselves and others who are aging. Unfortunately, negative stereotypes about aging are still quite prevalent (Rowe & Kahn, 1987). Health care providers are not immune to these insidious stereotypes. This article reviews a number of ageism stereotypes in society generally and in the health care field. The aim is to demonstrate that ageism can negatively affect health care providers' professional training and service delivery and, ultimately, their clients' behavior and health outcomes.
For many years service providers used the World Health Organization (WHO, 1947) definition of health: "Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease" (p. 16). This concept of health was a radical departure from the traditional model that saw health only as the absence of disease. WHO recognized that psychosocial well-being is an important component of health. However, health remained an abstract concept and, therefore, an ideal difficult to achieve. More recently, Achieving Health for All (Health and Welfare Canada, 1986) defined health in terms of "quality of life" and included in the definition the opportunity to make choices and to gain satisfaction from living despite functional limitations. This document suggested that health is a dynamic process of interaction between communities and individuals. Health involves freedom of choice: Communities (including health care providers) and individuals choose to take deliberate action to make the changes necessary for healthy aging.
Unfortunately, ageism can often affect the choices people are presented with and the decisions they make about those choices. If people believe that some of the "inevitable deterioration" of aging is preventable, they are likely to be more active in their own self-care. If health care providers believe that elderly people are valuable, equal members of society, then this belief should be reflected in professional training and service provision. Consequently, confronting ageism by enhancing positive beliefs about aging is a vital component of health promotion training and programming.
EFFECT OF AGEISM ON FACTORS IN AGING
Traditionally, aging has been viewed as a continual process of decline. Unfortunately, this stereotyping results in systematic discrimination that devalues senior citizens and frequently denies them equality (Butler, 1987).
In his review of the attitudes toward aging shown by humor, Palmore (1986) found that elderly people were often portrayed negatively. The humor tended to focus on physical and mental losses, as well as on decreases in sexual attractiveness and drive. Jokes about older women tended to be more negative than those about older men.
In North American culture, employability is often viewed as a primary measure of one's ability to contribute meaningfully to society and as a source of self-identity and self-esteem (Moody, 1988). Botwinck (1984) reviewed the literature on the effects of ageism on employment. He found that although age was not an important factor in the evaluation of work competence, older age was given as one of the reasons for poor applicant quality if the person was not hired. When a younger applicant was not hired, lack of effort or inability was given as the reason.
Snyder and Barrett (1988) reviewed 272 federal court cases dealing with age discrimination and employment filed between 1970 and 1986. Sixty-five percent were decided in favor of the employer. The researchers found a number of problems with how these cases were decided. First, there was frequent use of generalities about the differences between older and younger workers' abilities, despite the fact that there was no documented evidence of consistent group differences in actual job performance. …