Exploring the intersection of structural racism and ageism in healthcare

Timothy W Farrell^{1

2}, William W Hung^{3

4}, Kathleen T Unroe^{5

6}, Teneille R Brown⁷, Christian D Furman⁸, Jane Jih⁹, Reena Karani¹⁰, Paul Mulhausen¹¹, Anna María Nápoles¹², Joseph O Nnodim¹³, Gina Upchurch^{14

15}, Chanel F Whittaker¹⁶, Anna Kim¹⁷, Nancy E Lundebjerg¹⁷, Ramona L Rhodes^{18

19

20}

Affiliations

¹ Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
³ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Geriatric Research, Education and Clinical Center, James J Peters VA Medical Center, New York, New York, USA.
⁵ Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
⁶ Regenstrief Institute, Indiana University Center for Aging Research Indianapolis, Indianapolis, Indiana, USA.
⁷ Center for Law and Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁸ Department of Geriatric Medicine, Department of Geriatric and Palliative Medicine, Trager Institute/Optimal Aging Clinic, University of Louisville, Louisville, Kentucky, USA.
⁹ Division of General Internal Medicine, Multiethnic Health Equity Research Center, Asian American Research Center on Health, University of California, San Francisco, San Francisco, California, USA.
¹⁰ Department of Medical Education, Department of Medicine, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Iowa Total Care, West Des Moines, Iowa, USA.
¹² Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
¹³ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Senior PharmAssist, Durham, North Carolina, USA.
¹⁵ Eshelman School of Pharmacy, Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁶ Department of Practice, Sciences, and Health Outcomes Research (P-SHOR), The Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
¹⁷ American Geriatrics Society, New York, New York, USA.
¹⁸ Central Arkansas Veterans Healthcare System, Geriatric Research Education and Clinical Center, North Little Rock, Arkansas, USA.
¹⁹ Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
²⁰ Division of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

PMID: 36260413
PMCID: PMC9886231
DOI: 10.1111/jgs.18105

Exploring the intersection of structural racism and ageism in healthcare

Timothy W Farrell et al. J Am Geriatr Soc. 2022 Dec.

. 2022 Dec;70(12):3366-3377.

doi: 10.1111/jgs.18105. Epub 2022 Nov 10.

Authors

Affiliations

¹ Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
³ Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
⁴ Geriatric Research, Education and Clinical Center, James J Peters VA Medical Center, New York, New York, USA.
⁵ Department of Medicine, Indiana University, Indianapolis, Indiana, USA.
⁶ Regenstrief Institute, Indiana University Center for Aging Research Indianapolis, Indianapolis, Indiana, USA.
⁷ Center for Law and Biomedical Sciences, University of Utah S.J. Quinney College of Law, Salt Lake City, Utah, USA.
⁸ Department of Geriatric Medicine, Department of Geriatric and Palliative Medicine, Trager Institute/Optimal Aging Clinic, University of Louisville, Louisville, Kentucky, USA.
⁹ Division of General Internal Medicine, Multiethnic Health Equity Research Center, Asian American Research Center on Health, University of California, San Francisco, San Francisco, California, USA.
¹⁰ Department of Medical Education, Department of Medicine, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
¹¹ Iowa Total Care, West Des Moines, Iowa, USA.
¹² Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA.
¹³ Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Senior PharmAssist, Durham, North Carolina, USA.
¹⁵ Eshelman School of Pharmacy, Department of Public Health Leadership, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
¹⁶ Department of Practice, Sciences, and Health Outcomes Research (P-SHOR), The Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Baltimore, Maryland, USA.
¹⁷ American Geriatrics Society, New York, New York, USA.
¹⁸ Central Arkansas Veterans Healthcare System, Geriatric Research Education and Clinical Center, North Little Rock, Arkansas, USA.
¹⁹ Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
²⁰ Division of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

PMID: 36260413
PMCID: PMC9886231
DOI: 10.1111/jgs.18105

Abstract

The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well-documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.

Keywords: ageism; health disparities; intersectionality; racism; social determinants.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

Figures

**FIGURE 1**
Intersection of ageism and racism in healthcare: a double disadvantage

**FIGURE 2**
Social determinants of health

See this image and copyright information in PMC

References

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Exploring the intersection of structural racism and ageism in healthcare

Affiliations

Exploring the intersection of structural racism and ageism in healthcare

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical