Navigating Ageism: Self-Reflection, Bias, and Better Care for Older Adults

In this episode, CLIME Associate Director Kate Mulligan speaks with Dr. Douglas Lane, a board-certified clinical and geropsychologist and Clinical Professor at the University of Washington School of Medicine, about the subtle and overt ways ageism shows up in healthcare.

Drawing on decades of experience working with older adults, Dr. Lane discusses how age-related assumptions affect clinical decision-making, communication, and trainee development. He and Kate explore provider reactions to aging, how transference and countertransference influence care, and practical approaches to building age-inclusive, dignity-centered clinical environments. The conversation also touches on healthy aging, modeling age-awareness for learners, and steps healthcare systems can take to better support older adults.

Transcript

Amanda Garza: Welcome to CLIMEcast, today we're talking about ageism and healthcare, how assumptions about age shape clinical interactions, and what we can do to create more respectful age-inclusive care. Our guest today is Dr. Douglas Lane, a board-certified clinical and geropsychologist and clinical professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine.

Dr. Lane has been a clinician educator in older adult care since 2006, training learners across medicine, psychiatry, psychology, nursing, chaplaincy, and social work. He has also held national leadership roles in geropsychology, including serving as president of the Society for Clinical geropsychology and is a member of the American Board of Geropsychology.

In this episode, Dr. Lane brings a seasoned clinician educator's perspective to how ageism shows up in everyday practice and how we can better support the dignity and wellbeing of older adults. 

Let's join Clime Associate Director Kate Mulligan, as she speaks with Dr. Lane about recognizing ageism and clinical care and fostering more age-inclusive environments.

Kate Mulligan: Welcome, Doug, thanks for joining us today. I'm really excited to talk about ageism in medicine and how to go about combating that. Before we get started on that, I'd love it if you could share with our listeners a little bit about yourself and how your interest in ageism and especially ageism and medicine evolved.

Doug Lane: Sure, so I really appreciate the chance to be here it's a privilege. So my name is Doug Lane. I am a geriatric psychologist and clinical psychologist. It's sort of the medical equivalent of being a family physician with a subspecialty in older adults. I work in practice in Tacoma, I also am a clinical professor in the Department of Psychiatry at the medical school at UW.  I serve on the board of directors for the Frank Toby Jones Elder Living Facility here in Tacoma, and recently retired, well, I guess not so recently, about a year ago. I worked in the geriatric medicine service for VA Puget Sound for a number of years. I originally came into working with older people on a fundamental level through a sense of connection with the older members of my family who in a large part raised me.

And a lot of people that I've spoken with or students that I've trained who work with older people will tell similar stories that their real most fundamental interest came from interactions with older members of their family. It's that personal interaction that really drives a lot of the interest.

That's absolutely it, and that's one of the things that we know about dealing with ageism is that one of the best antidotes is contact. And of course in our society, we like to warehouse the old people. We do, I remember working in a long-term care facility and a psychiatry fellow who was rotating through the facility as part of his training who was from Korea, and he commented to me, just off the cuff, we were talking one day, that it still caught him off guard. That such places even really existed because it was so foreign for him that we have these places where we put our older members of our community.

Kate Mulligan: Right, it's sort of personally interesting to me that where I live, there's at least three aged care living facilities within, I don’t know, 10 blocks of my place, and they keep building them. So it's kind sobering to think how many people there are who need help. And it is. It is. Yeah. Thank you for sharing that. It's lovely to hear about people's personal experiences. I'm wondering if we could start very simply and personally for providers, and you're clearly one of the more experienced ones, what is unique on a personal level about caring for older people?

Doug Lane: That's an excellent question, most fundamentally, it comes down to this, as a provider, I've worked with any number of people over the years, who had cancer, heart disease things that hopefully I won't ever have to confront. Working with older people I am working with something that with any luck, I will confront for many years. With any luck, I will get to know what it's like to be 90 years old. So it means working with something that we, ourselves will experience, and so that can activate a lot of feelings within us as a provider, and if we're not aware of those feelings, they can sort of come out without necessarily our awareness in our interactions with older people.

And to give a specific example of that, if I'm working with an older person, which probably am by virtue of what I do and what we do as, as healthcare providers, um, who has some significant illness. That's probably why they're seeing us in the first place. But that can affect me over time as I see more and more of that and activate any fears that I have in myself about growing older and about my own mortality. Uh, and if I'm not careful, that can come out, for example, in a defensiveness, in contacts with the patient. A protectiveness where I keep myself at a distance from them without even realizing it. It can absolutely undergird some of the ageism that we're talking about in terms of my clinical decision making, maybe informing some of that, that sense of fatalism for example. So that's I think, a primary issue. It also plays out on the other side as well though. So if I am very positively inclined towards older people, which is not a bad thing, but ageism sometimes works on the positive end of that, of the spectrum as well. So if I have a lot of stereotyped positive and even infantalized view, uh, of older people, that can lead me to, again, react to them differently emotionally and make different clinical decisions.

So as a psychologist, I may not be able to imagine or even conceptualize that sweet old man or that that sweet little lady was seriously suicidal last night. It really reflects the importance of self-reflective practice. I would say self-reflective practice is a good antidote to what rightfully can be referred to as implicit bias. In this case, our implicit bias as providers about older people and about working with older people. In medical education there's also a related term, the unwritten curriculum and implicit bias as preceptors, for example, if we're not careful about recognizing our own implicit bias in dealing with that, it can become part of the unwritten curriculum for our students at all levels of training.

So speaking about our reaction to older people, it's important to know who this older person might remind us of our own template for interacting with older people and how that might affect things.

So for example, it may feel like, and it has for me before, feel like I am taking care of a grandparent of mine because this person kind of reminds me of, of my elder relative. And again, I have to be aware of that because that can influence how I interact with the person. It might, as a psychologist, for example, it might make me uncomfortable asking about things that I need to know about.

For example, symptoms of depression. Suicidal thinking for a medical provider, it might make them uncomfortable asking questions that seem very personal, but that they need to ask like bowel habits, you know, and are those things going okay? But thinking about our reaction to the patient again, is really only half the equation.

Older people will react to us and our role as providers, and again, to model this for our trainees is to be able to accept that. And work with that and contain that. Common reactions I've had, uh, and, and these are decreasing as I'm aging myself, but older people, again, from their standpoint, I kind of am the same age as maybe one of their grandchildren or one of their adult children, and they feel the sort of sense of protectiveness, which can lead them to then shield me from information that I otherwise would need to know.

Because they, again, it feels like telling this to my grandson and that just feels awkward to tell them just how depressed I am, for example, 

Kate Mulligan: I'm guessing, Doug, that you have a little script for when you recognize that you wanna share that.

Doug Lane: I do. And if I get a sense that this is going on, or sometimes I don't even have to have a sense, sometimes a person will say, this feels funny. Telling you this, so it's, it's overt. I will say I understand that. I think that's a good way to start anything. I understand that, that validation. Can you tell me a little more about your concern?

Can, can give you some more data to let you know where to go from there. Just know that I'm one of your doctors, I'm one of your healthcare providers, and whatever you tell me, I'm gonna help you with. We're gonna work on it together. I'm a provider. I'm not gonna be overwhelmed. I'm not gonna be surprised or shocked.

You tell me and we'll figure it out together. So just a lot of quietly trying to differentiate my role from who I am from like a grandchild versus them seeing me more as a healthcare provider. So some of the countertransference from older people can be especially hard. They can be summed up in the sentence, you're young and you're healthy, and I'm not.

So it can be almost an angry reaction or an envious reaction or a sense of you don't really get it. You're young, you're healthy, and I'm not. And how could you possibly understand this? Almost a bitterness. Uh, not necessarily at the individual provider for who they are, but just the fact that I'm sitting with a person who's young, got their life ahead of them, doesn't have chronic pain, doesn't have COPD, can leave the house, and I, I can't, it's an exercise sometimes I've used with trainees to say, especially on like, on their first day on rotation is to say, so let's, let's reflect on how you got to this room today.

They'll say, well, I don't. I came in the front door, took the elevator, came up. Here I am, and I'll say, so let's imagine and predict that the majority of the people you'll be working with, for example, in a long-term care nursing facility, can't do that. That what you just did is to exercise a privilege that the majority of the people in this building don't have.

And to frame that up. And if someone wants to do this, I've never required this, but if someone was interested and said, yeah, I'd like to try this, spend a day in a wheelchair. I had one fellow one day described it in a, in a very colorful way, and this was his way of coping, was to use little humor. But he said, you know what, it's like you, you look at the world from the, from the belly button view.

Everybody I interact with, I'm either looking up or I'm looking at their belly button. And I thought, yeah, that's very true. 

Kate Mulligan: Thank you. That's so, that's really powerful. You mentioned when we were talking earlier that ageism is the last, how did you put it? The last sanctioned oppressive practice? 

Doug Lane: Yeah it's a way of talking about it very frankly and very bluntly, which sometimes is the best way to talk about it, is just to say what it is, which is the last, one of the last few socially sanctioned prejudices in our society. 

Kate Mulligan: So that might be a good, uh, stepping point to the next question that I had, which is how would you define, what's your working definition of ageism? How do you define ageism and where did the term come from? 

Doug Lane: Sure, yeah. It's an interesting history. Uh, the term actually originated was coined by Dr. Robert Butler, who was a physician in 1969, and the fact that he was writing about this in 1969 during the Civil Rights movement is not, I don't think, an accident.

It was part of recognizing all, all of the different ways in which there are oppressive dynamics in our society. We marginalized different groups of people and so he took a very important opening, um, to say our, our society is evolving and we need to remember older people and how we treat them as part of this evolution.

So for a lot of us, I would wager 1969 is not that long ago as we think about it. So it's, uh, a relatively new term. I define it in very concrete terms, so biased or stereotyped views of older people, either in the positive direction as I mentioned, or the negative direction, versus being able to see them as like any other person with their own strengths, vulnerabilities, and conceptualizing them as a whole person.

Kate Mulligan: Great, Thank you! I've heard ageism described as bias against your future self, which, which I think is really appropriate, although it's so hard to imagine yourself, your future self without self-reflective practice as you mentioned. 

Doug Lane: Absolutely, and it's a, I think it's a point for us as educators to to know, I mean, going back to that notion of my experiences as a clinician and working with older people personally, if I'm not aware of that, that can become an issue implicitly in our interactions.

Younger providers can experience a bit of a whiplash because they're not probably at a point in their life where they're even considering knowing their older self and who that person might be. I mean, if they're in their late twenties or thirties, they're thinking about very different things. Um, but especially working with older people, they might go to work each morning at eight o'clock and spend nine or 10 hours in the world of people who were 80 and 90 and preparing for death and everything that goes with that, and then go home in the evening and switch back to being late twenties, early thirties. And so in a way, it, you can think of it as a phase shift for, for nine or 10 hours a day. They're propelled forward in time to a different developmental phase in the overall arc of human development. Um, and that can take its toll. Um, especially on younger providers, so it's something that we as, as, again, preceptors, educators should keep an eye on how our younger trainees are doing.

Kate Mulligan: Oh, that's great. I, I hadn't even thought about that. That's a really poignant comment, and I can't imagine there would be light. I deal with students all day long, and the oldest one is probably not much older than 40. 

Doug Lane: Right, right. Yeah. 

Kate Mulligan: I'm the old person in the room for sure. So I'm guessing that there are a lot of variations on ageism and how it expresses.

Would you like to elaborate on that for us? 

Doug Lane: Absolutely. And there's a, an article JAMA Online that is maybe two years old, but they took a very large survey of just those, I think three important areas to think about. The first one they were assessing, asking. Interviewing people about their experiences of, of these kind of key areas of ageism.

And one of them were societal messages, so larger messages from the world around them, you know, in the form of TV, commercials, magazine articles. I mean the, the, you know, the stuff that we come across in our day-to-day lives. The second was interactions with people in which ages, comments might be made. Um, or ageist references and, and not even necessarily with, uh, with any ill intent and especially some of the interactions on the positive end of ageism often occur from a good place. In other words, the person who's doing it may think they're doing the right thing and not realize the effect of it. But then the third area was direct ageism. So being the direct target of ageist, you know, ageist policies, ageist behavior on the, on the part of other people.

And what was startling to me was the rate, at which people talked about experiencing these different areas. And something like 94%, I believe 93 or 94%. Of people endorsed having experienced some of these [00:18:00] things. 

Kate Mulligan: Do you remember what the age of the population was?

Doug Lane: About? Yeah, they started in the mid fifties, which I thought was interesting because we talk about ageism coming in from the outside, but then there's also a concept of internalized ageism, which is how I then begin to experience myself.

Based on these ideas and sometimes the harshest ages messages I've encountered were coming from inside of the older person to themself. So I thought it was interesting that they started in the fifties because I think it's an age when our sense of ourself as an older person is just beginning to form.

Kate Mulligan: Thank you. Just a note to our listeners, we'll make sure that we attach some of these references that you're alluding to in the episode notes, and there'll be a lot of helpful information there. I know there's some fantastic podcasts and things as well on ageism and how to combat that. We talked a little bit about how ageism can show up in your practice or with [00:19:00] providers. Can we step back again and talk about the effects of ageism overall? 

Doug Lane: Sure, there's a large literature on it, so I'll just kind of put it in a, in a peanut shell. Um, we know that it affects people, in terms of medical outcomes, especially, for example, the internalized ageism can affect me and how willing I am maybe to accept rehabilitative physical therapy, if I believe, what's the point? You know, I'm on a downhill slide anyway. Why am I gonna put myself out for this even though my physician or medical provider may be saying this could really help you if I don't buy that. So my health behavior can change as a result of this.

Folks are at higher risk for mental health complications as a result of ageism, and as we know, mental health affects physical health and vice versa. The two are unavoidably woven together. It can also damage relational health, what's referred to as relational health. So my relationships with, for example, my daughter, my wife, my friends, uh.

Things along those lines, and it can damage existential health, which is my sense of purpose and my sense of meaning, how I find hope in my life. All of those things can be damaged by ageism that can affect me on a larger level. It can tumble all the way down to, you know, the clinic, for example. It can affect my decision whether to elect, do not resuscitate status or not.

For example, if I don't see myself as having much of a point in this world as an older person, why wouldn't I be DNR? Do not resuscitate. Even though I might have many important relationships that could be meaningful for me if I believe those people that don't, don't see me as having much of a [00:21:00] purpose, or I don't see myself as having much of a purpose, I might make decisions that I wouldn't otherwise make.

Kate Mulligan: It's interesting hearing you talk because for every point that you make, there's somewhat, in my friend group exemplifies exactly what you're saying. So it's kind of heading close to the bone here. But let me let you continue with how ageism can show up. 

Doug Lane: So the thing that I especially listen for and, and working with an older person, as you know, as a patient.

Is any signs of internalized ageism? I'm a big believer in one way, combating ageism by ourselves as clinicians and teaching our students to also look for the resiliency factors. In this person, what's keeping them going? What's getting 'em out bed in the morning? What's getting 'em through the hard stuff?

Where are they finding the good times? If I'm hearing internalized ageist messages and my attitude towards myself as an older person, that, [00:22:00] that tips me off to potentially the presence of, this is gonna sound funny, but the, the presence of an absence some resiliency factors. 

Kate Mulligan: I guess I'd have to ask, like I would've thought that internalized ageism would've been so prevalent that you might be better off focusing on exactly what you said, looking for the resilience as opposed, 'cause everybody in western society I think is steeped in internalized ageism.

Doug Lane:Yeah, it is very common and I, I encourage people to treat the assessment of resiliency, the presence of any, you know, damaging toxic attitudes. Treat that as just like we would assess blood pressure or, uh, balance and gait or any other clinical issue. Because again, with older people we know there's gonna be some medical issues, but that's only half the the of the equation.

What are the resiliencies or what's getting in the way of the resiliency, like internalized ageism? 

Kate Mulligan: Okay. Now, previous discussions we've talked about stereotype threat and how that can show up. 

Doug Lane: Sure and briefly defined this is essentially the idea that if I closely identify as a member of a group, whatever that group might be, in this case, older people.

And I'm getting a lot of messages that, for example, for. Older people, they get cognitively challenged and probably have some kind of dementia, and that's just what happens when you're old. I'm likely to internalize that and even without even realizing it, but again, just to, and then to underperform or to misinterpret things or over interpret things as a sign of, yep, my cognitive losses, you know, having a senior moment, all those kinds of things.

And not allow myself potentially to function as well as I can. And again, this can tumble all the way down to the clinic. I might underperform on a cognitive screening. I might not try as much. I might, yep. I'm old. I told you, doc, you know, and, and again, not demonstrate my actual functional level. 

Kate Mulligan: Can you gimme a quick tip on how you deal with that in the moment?

If you hear someone actually express that? 

Doug Lane: Absolutely. For example, on a, on a, say a, a cognitive screen, I would be inclined to say, you know, sometimes you have lapses in memory. We all do. So none of us has a perfect memory, and it's not unusual sometimes for people to realize if they really give it a good shot, that their memory is better than they might think because we know that people are actually not the best judge of their memory.

Um, that's why we do these objective sort of tests. So give it a shot. I'm not willing to say that, um, that there's a problem here until we have it on paper. 

Kate Mulligan: Right. Thank you. That's helpful. 

Doug Lane: Yeah. Another way that, that ageism can manifest itself, especially on that sort of overly stereotypically positive end of things is infantilization.

In other words, coming to see the older person as in some ways, like a, like an overgrown child or overgrown adolescent and, and treating them that way. The two most common ways I've seen this manifest in healthcare settings, um, are talking to the person who came to the appointment with the patient rather than the patient themselves.

So, for example, if my daughter brings me to my doctor's appointment, the provider, and again, without even realizing it, there, there's no mal intent here. They don't even realize that it just happens. The provider might find themselves talking more to my daughter than me. And I might be just sitting right here, uh, listening to myself be talked about in the third person.

The other major way I see that manifest is and what's referred to as elder speak. You'll see it happen again. It's not, it's not coming from a place of mal intent. It just happens where the provider will adopt this sort of sing song tone voice that we might use with a child and use terms like sweetie.

Sweetheart. Sweet little old man, cute little old lady. Things like that, you know, again, are infantilizing that insult their dignity coming from a good place, but a place where there's some implicit bias about older people. 

Kate Mulligan: This is really cutting close to the bone. I have to tell you. It's like, woo. 

Doug Lane: It's happened to me. It's happened to all of us. I mean, none, none of us are immune to this. It gets us. 

Kate Mulligan: I also feel as though, among my friend group, getting back to this point of having someone with you at a doctor's appointment or in healthcare situations, sometimes the child takes on a role that you might not have agreed to. It's just one of those things that seems to happen without being self reflective, I guess. 

Doug Lane: Absolutely. And I think if the provider detects which we do that, the person who's come with the patient, so a daughter or wife or whatnot, has some mistaken beliefs, even some ageist beliefs. I think sometimes the, the provider is in a good place to be able to say, you know, I, I'm so glad you're here.

It's clear how much you care about your dad, say for example, or your mom. Um, and it is so important that we have you involved in their care, which is true. It's always great to have supportive people in the older person's life be part of their care, but to then be able to say, you know, I, some things I just wanted to, to point out, to encourage you.

For example is that, um, you know, I think your mom might be more able to do X, Y, Z than you realize. So it's worth giving that a shot, letting her have a, you know, some autonomy there. Good for her wellbeing, be good for her. I like to say a, it'll be good for her soul and help you because that's a little less stress than you have to deal with as a caregiver.

So kind of coaching around some of that can be really helpful. To folks who are caregiving. 

Kate Mulligan: Great. Thank you. I struggle with this idea of age because I feel like there's several stages in there. How do you even define age is, it's obviously not just chronological, but let's leave that for another, another day and maybe think about how you think we can combat ageism in everyday life and in the healthcare environment especially.

I guess one other thing that I'd love to hear from you since we've got you here, is. You must have a few tips on healthy aging. 

Doug Lane: Well, and I'll just, to your earlier point, one of my favorite quotes about aging is from Satchel Paige, the baseball player, who said, how old would you be if you didn't know how old you are?

That's kind of in a nutshell how I like to approach it. A really sort of common toxic manifestation of internalized ageism is, is people my age shouldn't. Sometimes that's legitimate. You know, people who have had a hip replacement and have chronic arthritis and things like that probably should not be bungee jumping.

That would probably be ill-advised, but even that is independent of age. I could be in my fifties and have had to have those issues addressed, and I shouldn't be bungee jumping, but in general, don't define oneself in terms of age. [00:30:00] 

Kate Mulligan: I like that with the first thing out of your mouth, by the way. 

Doug Lane: Oh, yeah. Yeah, because we typically downgrade ourselves. That's what comes from that, keeping ourselves physically healthy. I heard this the other day. I thought it was really nice that the goal of physical exercise as we age, becomes less and less to oriented around aesthetics. I, I wanna look good in the summer for the beach or whatever.

It becomes less and less about that, and more and more about, I exercise today so that I can stay healthy to exercise tomorrow. Because we know that keeping our bodies healthy, eating right, um, getting good sleep, staying physically active in a way that's safe and appropriate for, you know, my medical status, all that basic stuff they taught us in health class in eighth grade still holds not smoking, not misusing alcohol or other substances.

Being a regular customer to our healthcare provider, one of the things I learned in geriatric medicine is that an ounce of prevention is actually worth 10 pounds of cure. So staying on top of chronic medical issues, take our medication if the doctor recommends, uh, physical therapy, go get it, jump on it.

Keeping ourselves, existentially healthy. Keeping up key relationships, keeping up activities that are aligned with the values we live by. If something happens that gets in the way of doing it the way I used to do it, avoiding that sort of psychological rigidity, which says, well then I guess I can't do it anymore, versus saying, well, let's get creative here and think about some other alternatives for getting me into the elementary school so I can keep reading books to the kids at story time.

What are my other options? To get me where I want to go. So attending to existential health and relational health as well, 

Kate Mulligan: and exercising, keeping, exercising your problem solving abilities and expanding them really. 

Doug Lane: Yep. And that's the last piece of it really is, is keeping ourselves intellectually active, cognitively active.

And I think an example of where you see that happening societally is this trend in senior living communities more and more towards having educational opportunities. Full on courses in given things that people can go and they can learn about, you know, American history. And that's all about keeping ourselves cognitively active as well.

Ageism affects people with dementia as much as it affects anybody else. And so everything we're talking about is amplified when it comes to people with dementia doing these things to help. These healthy, aging oriented perspectives, um, they don't go away. Just because a person has Alzheimer's disease, they still help optimize that person's remaining function.

And dementia is a whole other topic. That's why I haven't brought it in. 

Kate Mulligan: Oh, dementia is, oh my gosh. Okay. 

Doug Lane: So giving medical students, residents from all disciplines, um, the opportunity to work with older people. And not just older people who are ill, but older people who are, who are doing all right.

It's important to have both. And the former, of course, is a lot easier to arrange than the latter. The reason they're coming to see us is because they're sick. And if we're not careful, you know, that that sort of selective population can again, fuel our own ageism, our own sort of bias views of things. So having exposure to older people who are, sometimes they use the phrase aging well, can also be just as important.

And then education, understanding these issues of ageism, the need for self-reflective practice around how I'm reacting and how my own thoughts about my own aging are, are activated, and mortality and how those things change as I get older. For example, when my daughter was born, I noticed a big change because now I'm in a new phase of my life and well, now what does this mean? You know, and having to sort of reconfigure. So being aware that that need for self-reflective practice never goes away. And so the, I think of it as a form of exposure meeting older people and also meeting myself as an older person.

Kate Mulligan: I think you talk sometimes about being a model for your colleagues. 

Doug Lane: Yes, absolutely. And I think it's important to think about the kind of model. I think if we come across as essentially saying, listen i'm taken care of with all of this. I know what's going on. I don't do this, but you're doing it. And I wanna point that out to you.

That's not necessarily a helpful dynamic. And so I think, coming from a standpoint of, you know what, this, this is just something that we all fall into. I try to watch it, but I fall into it. You know what? Let's, let's do it this way. If I see you fall into it, I'll give you a little nudge. If you see me fall into it, give me a little nudge and we'll just kind of help each other be aware of it more fundamentally, it goes to that environment in education and supervision, whether it's in peer supervision or with supervision of trainees where we try to set a, an environment in which comments, questions are always okay. There's no such thing as well, that's a preceptor. I wouldn't bring anything to him because, you know, he's up here and I'm down there.

Another technique which I shamelessly pirate from a dear colleague down at the VA in Palo Alto is if she hears an ages comment made about a patient, she'll just quietly say, you know, I, I learned something about her the [00:36:00] other day, and she'll bring up some really significant thing that the person did or a, a unique aspect of the person's personality or selfhood.

She told me a really funny joke the other day. I didn't realize what a, what a great sense of humor she has something that says, you know what? I, I, this is what I learned about that person, or This is what I know about that person. Um, uh, and that's also another way I think of, of pushing back a little bit.

When we hear ages, things happen. 

Kate Mulligan: Thank you. Is there anything that we haven't covered that you'd like to cover? 

Doug Lane: We've been talking a lot about, rightfully so, about sort of individual ground level things we can do within ourselves and for our trainees to help combat ageism.

Some of us sometimes have an administrative role in our system. Whatever that might be, department chair, or we might sit on the ethics committee, uh, is another example that can also give us an, an opportunity to identify and, and do what we can to correct systemic ages practices, because ageism certainly it occurs on the ground level, but it also occurs at the systemic level as well. And so we can, look at policies, procedures, all sorts of things and recognize there's a, there's kind of a, an ageist quality to this and we wanna look at that. 

Kate Mulligan: Do you have an example of that? From your personal history, 

Doug Lane: I'm thinking about, for example, a clinic policy where older people, the geriatric service had its own waiting room, separate from the larger waiting room, which multiple other clinics specialties used, so then the, you know, and, and there was no, again, no mal-intent behind it. But looking at it from another perspective, we realized, so what's what's happening here? We're taking our older people and we're shunting them off into their own waiting area. [00:38:00] And we thought it might be helpful because it's closer, people with mobility limits, et cetera.

But you know, every rose has a thorn. And what's the message here? Even unintended, what sort of ageist message are we sending 

Kate Mulligan: and did your awareness of that end up changing the situation? 

Doug Lane: Well, it was a group of us and it got fixed. 

Kate Mulligan: Thanks to you. I encountered something called the four ends in medical trip with older people.

I'm wondering if you could share, 'cause I think I'd like to keep that in mind when I have my visit with my healthcare providers. 

Doug Lane: It. It stands for Mentation mobility medication and what matters. So these are four key areas that in geriatric medicine we try to look at. Some obviously are very practical, like mobility and medication.

But what's important to know is that, these things are not silos. They're all interrelated. So if I'm having mobility problems that could possibly eliminate my opportunities to get out and see friends, uh, or, or go volunteer at the elementary school and read stories like I used to do or see my family, I mean, the things that give my life meaning.

Mobility limits may cut me off from what matters or medication I may have a medication load that at this point doesn't need to be there. We could do some pruning of my medication list, and that might help me optimize, for example, my cognitive functioning and my mentation, as I say, so that it's all interrelated.

So those four Ms, I think are good to think about more as a vegetable soup. A lot of different ingredients that come together to make something bigger than the sum of their parts. 

Kate Mulligan: It's such an interesting metaphor, a food one. Okay. Thank you so much, Doug. That's been really, it's been really lovely to talk to you and I, I know we've only just scratched the surface, but thank you so much for joining us and I hope we can continue the conversation down the line.

Doug Lane: Absolutely. It's my pleasure. Thank you so much for having me.

Amanda Garza: Thank you for listening. We hope you enjoyed this episode of Climb Cast and a special thank you to Dr. Lane for this thoughtful conversation. Don't forget to subscribe so you'll be notified when new episodes are released.