Understanding the Different Forms of Ageism

The World Health Organization (WHO, 2021) defines ageism as stereotypes (what we think about older adults), prejudice (how we feel about older adults), and discrimination directed toward people based on their age (how we act toward older adults). In other words, ageism includes the beliefs we hold about aging, the attitudes we have toward older adults, and the ways those beliefs and attitudes influence our actions. Therefore, it is important to understand the different forms of ageism.

Institutional ageism refers to policies, practices, or systems that limit opportunities or resources based on age. In healthcare, this may include excluding older adults from research studies, restricting access to certain treatments, or assuming that declining function is a normal part of aging rather than a condition that warrants intervention (WHO, 2021; Chang et al., 2020).

Interpersonal ageism occurs during interactions between individuals. Examples include speaking to family members instead of the older adult, assuming a person is unable to learn new skills, or dismissing concerns as simply “getting old” (WHO, 2021).

Self-directed ageism develops when older adults internalize negative societal messages about aging. Over time, individuals may begin to believe that declines in health, participation, or independence are inevitable and stop seeking opportunities to remain active and engaged (Allen et al., 2022; Levy, 2009).

Although these forms of ageism differ, they often interact and reinforce one another, influencing both healthcare experiences and health outcomes.

The Impact of Ageism on Health Outcomes

Research consistently demonstrates that ageism is associated with poorer physical and mental health. In a systematic review of 422 studies, Chang et al. (2020) found significant associations between ageism and adverse outcomes across multiple health domains, including chronic disease, reduced quality of life, poorer mental health, and cognitive decline. Negative beliefs about aging can also influence health outcomes. Allen et al. (2022) found that older adults who viewed physical or emotional health problems as a normal part of aging were more likely to report poorer physical and mental health.

Ageism can influence healthcare decisions in subtle ways. Healthcare providers may unintentionally recommend less intensive interventions or attribute symptoms and functional changes to aging rather than considering potentially treatable conditions. For example, research has shown that older adults may receive less rigorous physical activity recommendations than younger adults with similar health conditions (Eswaran & Meisner, 2022).

The consequences extend beyond physical health. Experiences of age discrimination have been linked to higher rates of depression, anxiety, loneliness, and lower psychological well-being (Caskie et al., 2025; Lyons et al., 2018). Older adults who internalize ageist beliefs may avoid discussing new symptoms with healthcare providers because they assume their concerns are simply part of getting older (Mayo et al., 2022). As a result, treatable conditions may go unaddressed and participation in meaningful occupations may decline.

Ageism can also affect whether older adults seek care in the first place. Caskie et al. (2025) found that many older adults endorsed beliefs that depression, sadness, and emotional distress are simply a normal part of aging. Furthermore, research suggests that positive self-perceptions of aging are associated with better health outcomes, whereas negative perceptions may contribute to poorer physical and mental health (Allen et al., 2022; Nakamura et al., 2022).

When these assumptions go unchallenged, individuals may be less likely to seek treatment or advocate for their needs. Occupational therapy practitioners can play an important role in recognizing these beliefs, educating clients about healthy aging, and supporting participation in occupations that promote physical and mental well-being.

When developing care plans and implementing person-centered interventions, these outcomes matter because ageism may limit participation in meaningful activities by influencing healthcare experiences, expectations, and opportunities for engagement (Allen et al., 2022; Chang et al., 2020; Mayo et al., 2022). When older adults are viewed primarily through a lens of decline, opportunities for independence, choice, participation, and growth may be overlooked.

An OT Lens: Occupation, Participation, and Possibility

Occupational therapy is grounded in the belief that people can continue to participate in meaningful occupations throughout their lifespan. Rather than focusing on chronological age, OT practitioners focus on individual abilities, goals, contexts, and strengths.

Ageism can unintentionally appear within our own interventions. For example, practitioners may set lower expectations for older clients, prioritize safety at the expense of meaningful participation, or assume that learning new skills is unrealistic. While these decisions are often well-intentioned, they can reinforce age-based stereotypes and limit occupational opportunities. OT practitioners should therefore remain aware of how age-based assumptions may influence goal setting, clinical reasoning, and intervention planning.

The Occupational Therapy Practice Framework emphasizes client-centered care, participation, and the right of individuals to engage in meaningful activities regardless of age (AOTA, 2020). This perspective encourages practitioners to ask, “What matters to this person?” rather than, “What can we realistically expect at this age?”

What Occupational Therapy Practitioners Can Do

Recognizing ageism is the first step toward addressing it. OT practitioners can challenge ageism by examining their own assumptions about aging and reflecting on how those beliefs may influence evaluation, goal setting, and intervention planning.

Practitioners can also advocate for strengths-based approaches that highlight abilities rather than limitations. This includes supporting older adults in learning new skills, engaging in meaningful occupations, using technology, pursuing community involvement, and maintaining valued roles.

Education is another important strategy. Research suggests that increasing knowledge about aging and promoting positive intergenerational interactions can reduce ageist attitudes (Levy, 2018). OT practitioners can provide education to clients, families, students, healthcare teams, and community members about typical age-related changes, adaptation, resilience, and occupational potential in later life.

Finally, occupational therapy practitioners can promote positive self-perceptions of aging. Encouraging participation in meaningful activities, fostering self-efficacy, and supporting opportunities for successful engagement can help counteract the negative effects of self-directed ageism. Positive perceptions of aging have been associated with better physical health, greater activity participation, and lower levels of loneliness (Nakamura et al., 2022).

Conclusion

Ageism remains a significant barrier to equitable healthcare and healthy aging. Whether it appears in healthcare systems, interpersonal interactions, or older adults’ own beliefs about aging, ageism can negatively affect physical health, mental well-being, and occupational participation. Occupational therapy offers a valuable perspective by focusing on strengths, meaningful engagement, and person-centered care. By recognizing and challenging ageism within our systems and our own practice, OT practitioners can help create environments where older adults are not defined by their age but are supported in living meaningful and fulfilling lives. Through client-centered interventions, education, advocacy, and the promotion of self-efficacy, occupational therapy practitioners can help older adults maintain participation in the occupations and roles that matter most throughout later life.

References

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Chang, E.-S., Kannoth, S., Levy, S., Wang, S.-Y., Lee, J. E., & Levy, B. R. (2020). Global reach of ageism on older persons’ health: A systematic review. PLOS ONE, 15(1), e0220857. https://doi.org/10.1371/journal.pone.0220857

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Levy, B. R. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6), 332-336. https://doi.org/10.1111/j.1467-8721.2009.01662.x

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Lyons, A., Alba, B., Heywood, W., Fileborn, B., Minichiello, V., Barrett, C., Hinchliff, S., Malta, S., & Dow, B. (2018). Experiences of ageism and the mental health of older adults. Aging & Mental Health, 22(11), 1456-1464. https://doi.org/10.1080/13607863.2017.1364347

Mayo, D. M., Meuser, T. M., Robnett, R. H., Webster, M. E., & Woolard, C. E. (2022). Cross-generational understandings of ageism and its perceived impacts on personal-public health. Journal of Gerontological Social Work, 65(7), 711-727. https://doi.org/10.1080/01634372.2021.2019865

Nakamura, J. S., Hong, J. H., Smith, J., Chopik, W. J., Chen, Y., VanderWeele, T. J., & Kim, E. S. (2022). Associations between satisfaction with aging and health and well-being outcomes among older U.S. adults. JAMA Network Open, 5(2), e2147797. https://doi.org/10.1001/jamanetworkopen.2021.47797

World Health Organization. (2021). Global report on ageism. https://iris.who.int/handle/10665/340208