Ethical considerations in elderly patients with acute coronary syndrome.

Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients' decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process.

Ageism in the COVID-19 pandemic: age-based discrimination in triage decisions and beyond.

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.

Ageism in COVID-Related Newspaper Coverage: The First Month of a Pandemic.

OBJECTIVES: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic. METHOD: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers. RESULTS: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life. DISCUSSION: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media.

Ageism as a Modifying Influence on COVID-19 Health Beliefs and Intention to Social Distance.

Objectives: Commentaries have suggested that initial emphasis on the higher susceptibility and mortality rates of older adults to COVID-19 has instigated ageism within the public discourse and policy decisions. Using the health belief model, the current study examined ageism in interaction with other factors influencing intention to social distance. Methods: Threat of contracting COVID-19, benefits and barriers to social distancing, benevolent and hostile ageism, and intention to social distance were examined in 960 adults (M = 37.81 years, SD = 11.65). Results: Benevolent and hostile ageism were significant moderators for both perceived threat and barriers on intent to social distance; hostile ageism also moderated benefits on intent to social distance. Discussion: The current study demonstrates how ageism influences behavior during a pandemic. With initial reports of COVID-19 presenting older adults as a homogenous group, ageism negatively interacted with intention to social distance and may place older adults at greater risk.

Aging Narratives Over 210 Years (1810-2019).

OBJECTIVES: The World Health Organization launched a recent global campaign to combat ageism, citing its ubiquity and insidious threat to health. The historical context that promoted this pernicious threat is understudied, and such studies lay the critical foundation for designing societal-level campaigns to combat it. We analyzed the trend and content of aging narratives over 210 years across multiple genres-newspaper, magazines, fiction, nonfiction books-and modeled the predictors of the observed trend. METHOD: A 600-million-word dataset was created from the Corpus of Historical American English and the Corpus of Contemporary American English to form the largest structured historical corpus with over 150,000 texts from multiple genres. Computational linguistics and statistical techniques were applied to study the trend, content, and predictors of aging narratives. RESULTS: Aging narratives have become more negative, in a linear fashion (p = .003), over 210 years. There are distinct shifts: From uplifting narratives of heroism and kinship in the 1800s to darker tones of illness, death, and burden in the 1900s across newspapers, magazines, and nonfiction books. Fiction defied this trend by portraying older adults positively through romantic courtship and war heroism. Significant predictors of ageism over 210 years are the medicalization of aging, loss of status, warmth, competence, and social ostracism. DISCUSSION: Though it is unrealistic to reverse the course of ageism, its declining trajectory can be ameliorated. Our unprecedented study lay the groundwork for a societal-level campaign to tackle ageism. The need to act is more pressing given the Covid-19 pandemic where older adults are constantly portrayed as vulnerable.

Reflexiones éticas en torno a las medidas tomadas en las residencias durante la pandemia / Ethical reflections on the measures taken in nursing homes during pandemic

La pandemia por Covid-19 ha afectado especialmente a los mayores que viven en residencias desde su aparición. Para frenar sus efectos devastadores las autoridades sanitarias pusieron en marcha numerosos protocolos y medidas que han podido vulnerar la debida ética asistencial. El asilamiento social de los ancianos de las residencias, el confinamiento en las habitaciones, el cribado en la derivación de los pacientes mayores a los hospitales, y a las unidades de cuidados intensivos han hecho tanto daño como beneficio. En el presente trabajo se plantean diversas líneas reflexivas en torno a la eticidad de cada una de las medidas adoptadas. También acerca del papel de los comités de ética en la vigilancia y supervisión de todos los procesos asistenciales en las residencias

The Covid-19 pandemic has particularly affected older people living in nursing homes since its onset. To curb its devastating effects, the health authorities have put in place numerous protocols and measures that have been able to violate the proper ethics of care. The social isolation of the elderly from the nursing homes, the confinement in the rooms, the screening in the referral of the elderly patients to the hospitals, and to intensives cares units have done both harm and benefit. In the present work, several reflexive lines are proposed around the ethicity of each of the measures adopted. Also about the role of ethics commit-tees in the monitoring and supervision of all care processes in residences

COVID-19: Pandemic Risk, Resilience and Possibilities for Aging Research.

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic," which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts - from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

African Conceptions of Age-Based Moral Standing: Anchoring Values to Regional Realities.

Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low-income, less industrialized countries of the global South, using sub-Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in high-income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world.

Estigma y discriminación en personas con VIH/SIDA, un desafío ético para los profesionales sanitrios / Stigma and discrimination in people with HIV/AIDS, an ethical challenge for health professionals / Estigma i discriminació en persones amb VIH/SIDA, un desafiament ètic per als professionals sanitaris

Este artículo tiene como propósito reflexionar sobre la situación de estigma y discriminación que afecta a personas con VIH/SIDA. Esto constituye una vulneración a los derechos fundamentales de estas personas y una barrera en el avance hacia la eliminación de la enfermedad. Ya que estudios realizados en diferentes países dan cuenta que las personas en esta condición se sienten discriminadas por la sociedad, y por los profesionales de la salud. Este es uno de los aspectos que ha dificultado el acceso al tratamiento, su adhesión, y educación para el cambio de conducta en los grupos de riesgo

This article aims to reflect on the situation of stigma and discrimination affecting people with HIV/AIDS. This constitutes a violation of the fundamental rights of these people and a barrier to progress towards the elimination of the disease. Studies carried out in different countries show that people in this condition feel discriminated against by society and by health professionals. This is one of the aspects that has hindered access to treatment, adherence, and behaviour change education in at-risk groups

Aquest article té com a propòsit reflexionar sobre la situació d'estigma i discriminació que afecta a persones amb VIH/SIDA. Això constitueix una vulneració dels drets fonamentals d'aquestes persones i una barrera en l'avanç cap a l'eliminació de la malaltia. Estudis realitzats en diferents països exposen que les persones en aquesta condició se senten discriminades per la societat i pels professionals de la salut. Aquest és un dels aspectes que ha dificultat l'accés al tractament, l'adhesió al mateix, i educació per al canvi de conducta en el grups de risc

Long-Term Effects of Age Discrimination on Mental Health: The Role of Perceived Financial Strain.

OBJECTIVES: This study examines the role of work-related perceived age discrimination on women's mental health over the life course and tests whether financial strain mediates this relationship. METHODS: Using the National Longitudinal Survey of Mature Women (1967-2003), we employ nested growth curve models to evaluate whether perceived age discrimination at work influences women's depressive symptoms and life satisfaction and whether perceived financial strain mediates this relationship. RESULTS: Women who experienced age discrimination had greater overall depressive symptoms but not after controlling for financial strain. We found evidence that age discrimination affected financial strain, which, in turn, increased women's depressive symptoms. Women who reported age discrimination had lower odds of being in higher categories of overall life satisfaction; financial strain partially mediated the relationship but age discrimination remained a significant predictor. DISCUSSION: Despite legal protection, age discrimination at work is frequent and has significant effects on women's mental health over the life course. Financial strain partially mediates this relationship, pointing to financial implications of perceived age discrimination for women and their families. Our findings have important policy and workplace implications, calling attention to ageism as a potent stressor for working women's mental health beyond those tied to sex or race.

Trajectories of Perceived Workplace Age Discrimination and Long-Term Associations With Mental, Self-Rated, and Occupational Health.

OBJECTIVE: This study addresses older employees' trajectories of perceived workplace age discrimination, and the long-term associations among perceived age discrimination and older workers' mental and self-rated health, job satisfaction, and likelihood of working past retirement age. We evaluate the strength and vulnerability integration (SAVI) model. METHOD: Three waves of data from employed participants were drawn from the Health and Retirement Study (N = 3,957). Latent growth modeling was used to assess relationships between the slopes and the intercepts of the variables, thereby assessing longitudinal and cross-sectional associations. RESULTS: Perceived workplace age discrimination tends to increase with age, although notable variance exists. The initial status of perceived age discrimination relates to the baseline statuses of depression, self-rated health, job satisfaction, and likelihood of working past retirement age in the expected directions. Over time, perceived age discrimination predicts lower job satisfaction and self-rated health, as well as elevated depressive symptoms, but not likelihood of working past retirement age. DISCUSSION: This study provides empirical support for the SAVI model and uncovers the "wear and tear" effects of perceived workplace age discrimination on older workers' mental and overall health. We deliberate on social policies that may reduce age discrimination, thereby promoting older employees' health and ability to work longer.

Intergenerational Contact Predicts Attitudes Toward Older Adults Through Inclusion of the Outgroup in the Self.

OBJECTIVES: With our rapidly aging population, it is critical to understand biases toward older people and what can be done to reduce ageism. Intergenerational contact can improve attitudes towards older people, but the effect of inclusion of outgroups in the self (IOS) in the context of intergenerational contact remains unexplored. In addition, stereotypes of warmth and incompetence may be affected differently by contact experiences and have different roles in effecting change in ageist attitudes. METHOD: In this study, we modeled the relationships between intergenerational contact, IOS, and stereotypes of warmth and incompetence in predicting attitudes towards older adults in a young community sample (n = 302; 18-30-year olds). RESULTS: We found that positive contact with one older adult reduced incompetence stereotypes both directly and through an increase in IOS, and both the increase in IOS and the decrease in incompetence stereotypes predicted better attitudes towards older adults. Incompetence stereotypes were a stronger predictor of age-related attitudes than warmth stereotypes. DISCUSSION: This suggests that interventions aimed at improving ageist attitudes through intergenerational contact should focus primarily on disconfirming incompetence stereotypes instead of merely increasing warmth perceptions, which could be done in part by increasing cognitive overlap with older adults.

Is Ageism Acceptable When it Comes From a Familiar Partner?

OBJECTIVES: This study investigated the perceived acceptability of benevolent and hostile ageist behaviors targeting older adults and whether the acceptability varied depending on the age of the perceiver and the relationship between the person engaging in the ageist behavior and the recipient of the ageist behavior. METHOD: Young, middle-aged, and older adult participants rated the acceptability of 13 benevolent and 17 hostile ageist behaviors targeting older adults for five different relationship types: younger family members, same-age family members, familiar service workers, unfamiliar service workers, and friends. RESULTS: Participants, regardless of age, rated benevolent ageism to be more acceptable than hostile ageism. Young adults were more accepting of hostile ageist acts than middle-aged and older adults were. However, overall acceptability of hostile ageist acts was low. Familiarity with the perpetrator also affected perceptions of the acceptability of ageist acts. DISCUSSION: Perceptions of the acceptability of ageism targeting older adults differed as a function of participant age, ageism type, and relationship type. Findings are discussed in light of social identity theory and intergroup contact theory.

Reframing Aging: Effect of a Short-Term Framing Intervention on Implicit Measures of Age Bias.

OBJECTIVES: Evidence suggests that agist biases may operate implicitly (i.e., automatically and unconsciously) to affect discriminatory attitudes and behaviors toward older adults. However, few studies have tested the malleability of implicit age bias. The present study tests the effect of a framing intervention on implicit age bias in a nationally representative sample of American adults. METHOD: Participants (N = 767) were randomly assigned to read 1 of 3 framed messages, to an unframed message about aging, or to a control message unrelated to aging. Framed messages emphasized (a) the contributions of older adults to society; (b) aging as a process of accumulating wisdom and energy; and (c) mechanisms through which prejudice against older adults operates. Participants subsequently completed an aging implicit association test (IAT) to assess implicit bias. RESULTS: Relative to the control condition, participants in the 3 framed message conditions displayed lower implicit age bias. No differences were observed between participants in the control condition and those who read the unframed message. DISCUSSION: Findings indicate that reframing messages about aging can decrease implicit bias against older adults. This study highlights ways for communicators to promote a positive understanding of the aging process, thereby mitigating sources of implicit prejudice.

"How Old Do You Feel?" The Difficulties and Ethics of Operationalizing Subjective Age.

This article provides an integrative presentation regarding ageism within the professional culture of gerontological research by examining the operationalization of subjective age, a construct most commonly assessed by asking an individual to report how "old" they feel. According to the life span perspective [Baltes, P. B. (1987). Theoretical propositions of lifespan developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611-626] and the life course perspective [Elder Jr, G. H. (1975). Age differentiation and the life course. Annual Review of Sociology, 1(1), 165-190.], growing older represents a complex, multidirectional process that encompasses maintenance, growth and decline as well as cultural factors that influence development. Viewing the construct of subjective age from these perspectives casts doubt on the validity of its operationalization. This article argues that operationalizing subjective age in this manner contributes to the dominant societal view of aging as decline by perpetuating the use of the term "old" as an undesirable state. As well, we purport that as gerontological researchers and scholars our professional code of ethics requires us to examine the unintentional communication and perpetuation of ageism by focusing attention on our own use of language.

Toward a global geroethics - gerontology and the theory of the good human life.

Gerontologists have proposed different concepts for ageing well such as 'successful ageing', 'active ageing', and 'healthy ageing'. These conceptions are primarily focused on maintaining health and preventing disease. But they also raise the questions: what is a good life in old age and how can it be achieved? While medical in origin, these concepts and strategies for ageing well also contain ethical advice for individuals and societies on how to act regarding ageing and old age. This connection between gerontology and ethics is overlooked by both schools of thought. We thus develop this research programme for a systematic geroethics in four steps. First, we analyze 'successful ageing' as put forward by Rowe and Kahn as a paradigmatic example of a gerontological conception of ageing well. Then, in a second step, we move from criticisms within gerontology to an ethical perspective; in particular, we want to clarify the problem of the claim of universal validity of conceptions of the good life. In a third constructive step, we explain how the 'capabilities approach' could be applied in this context as a normative foundation for the implicit normative assumptions of gerontological conceptions of ageing well, such as a particular choice of functionings, the ethical relevance of human agency, and the resulting claims of individuals towards society. Finally, using a concept developed by the German philosopher Ursula Wolf, we systematically develop the different aspects of the connection between ageing well and the theory of the good life in their full complexity and show their interconnectedness.