 Hello everyone, my name is Jane Katten and I'm the CEO at AgeWell. I'd like to welcome you to our show, Aging Matters. I'd also like to thank our sponsors, MVP Healthcare, for making our show possible each month. As you may know, AgeWell is the largest area agency on aging in the state of Vermont. We serve four counties, Franklin, Grand Isle, Chittenden, and Addison. Our clients are over the age of 60 or under the age of 60 with a disability on long-term care Medicaid. So our goal is to make sure that we wrap around them with services that allow them to stay healthy and independent in the setting of their choice. Every month on Aging Matters we like to find topics of interest to all of us as we age so that we can learn more about how to navigate aging to AgeWell. Today on our show I'm delighted to introduce and welcome Dr. Regina Kep, who specializes in the aging process and the care of older adults and their families, with an emphasis on working with minority older adults. She's a clinical psychologist and the founder and director of the Center for Mental Health and Aging. Today we're going to be discussing the impacts of ageism on the physical and mental health of older adults. And it's really actually great timing to welcome Dr. Kep, because the month of May we are recognizing two different initiatives, two awareness months. The first one is Mental Health Awareness Month, and the second is Older Americans Month. And Older Americans Month is celebrated every year in the month of May, and this year the theme is Aging Unbound. So today on our show we'll be learning about diverse aging experiences and how we can combat stereotypes, especially with the help of Dr. Kep, who I would love to welcome again to our show. Thank you so much for being here with us today. Thank you for having me. Dr. Kep, before we dive into some questions and explore more about ageism and how we should think about that as we get older, could you start and tell us a little bit about your background, your experience, and the Center for Mental Health and Aging? Sure. Well, thank you so much for having me. I'm delighted to be here. So I'm a board-certified clinical psychologist and a Jero psychologist, so that means that I specialize with older adults and older families. And I'm an educator, so I, through the Center for Mental Health and Aging, we provide public education for older adults and families about mental health and aging, what's typical, what's not typical, and we provide education for professionals. And so that's, I'm delighted to be here and provide some education to your constituents with CCTV. Thank you so much. That's awesome. And we're so happy you're here, especially as we think about aging and how we can all benefit, you know, to think about how older adults can remain engaged and independent and included. So let's dive into our topic. I have a few questions for you to start us off. First of all, Dr. Kep, could you define the various types of ageism? Sure. I'll start by just defining ageism in general. So ageism is bias and discrimination based on age. It can include stereotypes or exclusion from activities like working or groups, things like that, based on age. And so that in a nutshell is sort of ageism, bias and discrimination based on age. And so there are different ways that that manifests or plays out. So there can be structural ageism and individual ageism. So structural ageism is kind of like what I described maybe being left out of healthcare. You've seen maybe research studies where we're looking for participants from 18 to 65, but if you're over 65, we're not going to be studying diabetes in your age group, right? So research studies will often have a cap at 65 or whatever that age cap is. And then as a result, many older adults are not included in research or healthcare studies or psychology studies, lots of different studies. So that's an example of structural ageism. Also older adults being denied access to work or age discrimination in the workplace. That's an example of structural ageism. And then there's like internalized ageism. Sorry if I hit that mic. Then there's internalized ageism. And that's where we integrate messages over our lifespan about what it means to grow older and how people view growing older. And then we internalize those messages and carry them with us. And if we start believing them, they have an incredible impact on our lives. And we're going to get into that today about how that does impact our life. And so some of the ways that this plays out are there's one example is hostile ageism. So you know because you are with age well that financial exploitation of older adults is a concern. And so that's an example of hostile ageism. So when older adults are exploited financially or physically or whatever it is, that's an example of hostile ageism. There's also something that's commonly used now, or maybe people have heard of it. It's called the silver tsunami. And this is the concept of the baby boomer population aging. And so between 2011 and 2030, 10,000 Americans turn 65 every day. And that surge in aging is called, you know, that's the baby boomers. Some people use the term to describe that as silver tsunami. And the reason it's ageist is because if we think about what a tsunami is, a tsunami is a natural disaster that depletes us of resources and causes all sorts of havoc and requires, you know, cleanup squads. And we're going to lose all of our resources. And it's a casualty, right? It results in casualties. So the idea that the aging population is going to deplete us is an idea that's very ageist in and of itself. And so this idea of silver tsunami is an ageist one. And that was pretty hostile ageism. Then there's invisible ageism. And people experience this a lot when maybe you go to a party or a gathering and you're overlooked if you're an older adult in the room. Or during the COVID-19 pandemic, many older adults were contributing to child care for maybe they had middle-aged children and all the day care is closed and their grandchildren, their children still had to work. And their grandchildren needed care. Many older adults were stepping in to provide child care. But that wasn't in the news very often. And so that's just one small example of contributions that older adults make that are overlooked or not taken into consideration, even that make them media or news stories. And those are examples of invisible ageism. And then there's what's called benevolent ageism. And this one gets tricky, especially for helpers like you and me. And so what benevolent ageism is, is this idea that we want to do something good. Our intention is to do something good for somebody else. But it has the impact of actually harming them. So for example, I was living in another state. I was living in Atlanta when COVID-19 started and I moved to Vermont last summer. And I'm delighted to live in Vermont now. And so I was working at a hospital in an older adult clinic, an outpatient clinic for older adults. And I would drive every day under a freeway sign that read, COVID-19, isolate the elderly. And the idea, this is a benevolent ageist statement. And the idea is that the intention was good. We know that during COVID-19, prior to the vaccine, older adults, people 65 and older, were disproportionately physically impacted by COVID-19. And among hospitalizations and deaths, it was a travesty. And so the intention to protect older adults was a good one. But the way that they went about it with the sign that isolate the elderly first, but isolate older people has the impact of harming people, right? We know isolation kills. And so eventually they changed the sign to coronavirus, protect the vulnerable. And that was a sign that I could get behind or drive underneath without cringing every day. But that's an example of benevolent ageism. We think we're doing good, but it actually has the impact of harming someone. And so this idea of, like, you may have heard of elder speak, where we're talking to an older person, we start talking to them like a child, right? So we're trying to do good. We're trying to be kind and inclusive. But it has the impact of actually harming them. When older adults are spoken to like children, they actually begin to change in front of our eyes that we begin to doubt ourselves. And like, why are people treating me like a child? Am I doing something wrong? And it actually has an impact on the older person. And so that's an example of benevolent ageism. We want them to feel warm and welcome, so we're going to talk to them like a child, but it has the impact of actually harming them. So we're going to stop doing that. Yes, we need to stop doing that. And I had no idea there were different types of ageism. So your examples were just excellent. We also know there are stereotypes that are associated with ageism. So maybe you could tell us a bit more about the most common stereotypes that older adults might experience. Yeah. So some of the ones that irk me the most are, I mean, they're everywhere. I mean, stereotypes about growing older are everywhere. So one common stereotype is older adults are rigid and will never change. And this is really problematic because if we think older people will never change, we're not going to refer them to health care or mental health care or smoking cessation programs. And also it's not true. Older adults are incredibly capable of change. There's misconceptions or stereotypes that as we age it's normal to be depressed or anxious. And that's not true. And the problem with believing that is that when older adults are depressed and anxious, they're not going to get the care that they need to treat the depression and anxiety. And treatment is highly effective. If we believe that older adults are rigid, then even mental health providers or health care providers may have the misconception that if they recommend a treatment that the older person won't follow through anyway because they don't change. But that's not true. And so these stereotypes are so critical that we're aware of so we can start to dismantle them to be sure that people are getting what they need as we grow older. I think other stereotypes are one of my favorites is that older people are no longer interested in intimacy or sexual when that's also not true. There was a huge study a few years ago that surveyed 1,000 people between 65 and 80 and found that the vast majority are still interested in sex during that time of life. And actually that 31% of women and 51% remain sexually active during that stage of life. And so there are these lots of misconceptions, but as a result of this misconception that older adults are no longer sexually active or interested in sex, doctors aren't talking with them about sexual health. And actually one of the byproducts of that, this is not only related to doctors not talking about sex with older adults, but is that STDs have doubled for older adults in the past 10 years. Interesting. Yeah, for people 65 and older. It's chlamydia, gonorrhea, and syphilis have doubled. Wow. Yeah. Wow. So all of these stereotypes are creating situations that can cause harm. That do cause harm. And they do. And you alluded to psychosocial, psychosexual, physiological health issues. Let's talk more about some of those other things you're seeing. You talked about the sexual implications for older adults. What else should we know about? Well, I'd say also that as, you know, if we believe these negative ideas about aging. So other negative ideas are like it's, what's the point of growing old? Like what's the point of this anyway? That's a negative idea about aging. Like there's nothing glorious that happens. Later I have nothing left to offer. Right. So if we believe that to be true, which is, I don't believe that to be true. It's not true. Then we're going to be less likely to do things that care for our health, right? So doctors, if structural ageism, doctors, mental health providers, lots of clinicians and other people in society are going to be less likely to recommend things. And then also the older adult themselves, if they believe these things, is going to be less likely to implement recommendations. And so that can have a major impact on health. And so for mental health, we know that when older adults believe negative stereotypes about aging, they're more likely to have depression, anxiety, have suicidal thoughts, have more trauma, like unmanaged traumatic reactions from maybe historical or current traumatic events. And so we know that it has a major impact. And the same is true for physical health. And so if older adults believe these negative ideas about aging, then they're actually more likely. So there's a researcher out of Yale. Her name is Becca Levy, and I'm just her biggest fan. And so she's like the most prolific researcher that looks at the impact of ageism on health. And what she's found in her research is that when people believe these negative ideas about aging, that they're more likely to, they're at more risk for a heart attack. They're more likely to have a heart attack within like the next 30 years. And they're more likely to have a dementia disorder. So it has a direct correlation, I would say, because it's not causation, but it's correlation. It has a direct correlation to dementia as well and how quickly, even if a person has dementia, that dementia advances. Wow. So huge implications. We have to change the way we think about aging most definitely. Dr. Kep, I've done some reading and there are other considerations when it comes to aging and other identity variables. For example, race or disability or sexual orientation, ethnicity. Can you speak more about those issues as it relates to ageism? Yeah. So another common misconception is that older adults are all alike. And we know older adults are incredibly different from one another. If you look at your own group of friends, you're incredibly different from one another. So in society as a whole, as older adults are aging, our population demographics are shifting. So between now and 2030, the older white population will increase by 39%, where older ethnic minority populations will increase by 89%. So we're actually becoming a more diverse older adult group, which is really exciting. Some of the things to be mindful of as we're looking at intersections of age and ageism, like stereotypes based on age, is that ageism can intersect with other kinds of isms like racism or homophobia or transphobia or sexism. And so when people experience multiple minority identities, like say a person is an older black lesbian woman, that's multiple minority identities, there's a phenomena that happens that's called double, triple, quadruple jeopardy. Wow. And when that happens, that simply means that that person has a greater risk for some health concerns in life. And that's related to lots of things. Like if we experience more discrimination, we have more stress hormones in our body, and that increases our risk for illness. Also, we'll maybe more mistrusting of the healthcare system. The healthcare system may be more discriminatory toward us. Other systems might be more discriminatory toward us, so we don't get the care we need and so on. The other side of this coin though is that is horrible, and we need to be mindful of that, and that's why we're doing some education about that today because we can all combat these isms to make sure that people stay as healthy as possible. But the other side of this coin is that we know that older ethnic minority adults and even LGTBQ older adults have the highest rates of resilience. And so this is something I think that's really important to recognize as well, that we have to be mindful of the impact of isms and harm and discrimination and stereotypes on people. And as we're talking about age and ageism and how that intersects with racism and sexism and queerphobia and all of that, we also have to recognize strengths within these communities and draw on these strengths as well. Oh, that's fantastic. I'm so glad you brought all of that up. So from what you've described, ageism can certainly take a toll on our overall health and wellness. So it must also put a lot of pressure on our healthcare system, right? Yes. And there's a cost to our healthcare system around ageism. Can you speak a little bit more about that? Yes. So this is back to remember structural ageism and internal ageism. So the cost of ageism in the United States. Becca Levy, remember my hero? So out of Yale did a study in 2020 and looked at the cost of ageism in the United States and found that in one year, ageism cost the United States $63 billion. Goodness. Yeah. Because it accounts for, also contributes to, ageism does, 17 million of the most expensive cases of medical cases. So like, or diagnoses like cancers, Alzheimer's, dementia disorders, diabetes, all sorts of health conditions that could be prevented if people, if we were paying attention. Right. Yeah. So my question is, does ageism have an impact on longevity? Yes. So yes is the answer, right? Yes. Yes. So there's good news and bad news here. The good news is that people who have a positive view of aging, Becca Levy's research has found, lives seven and a half years longer and healthier than people with a negative view of aging. So we can do something about it, right? About, we can, well, what I like to say, you know, we're talking about health conditions and aging and also genetics play into health conditions. I don't want to blame people for not believing enough about positive aging, right? Right. People get cancer, people get dementia and they do all the things to prevent it and sometimes bad things happen and that's horrible. The message here is where you can believe, do your part and your part may have tremendous benefits for your own health and longevity. And so, but yes, if we believe that people, if people believe that aging is a wonderful thing and there's something to contribute as we age and that I still have something to learn and my life still has meaning and purpose, then you'll have a better chance of living longer and healthier. That's very encouraging. That's wonderful. So now let's talk about some of the strategies and things you've learned that can help to reduce ageism. Yes. So there's a strategy called the ABC Model. Oh, yes. Right? So A stands for awareness. So the first thing that we have to do is be aware that it's when ageism is happening. And so I'm going to give you an example. Yes. So the other day I was talking to a friend of mine who's in her late 60s and she was telling me, oh, I have to go get a tooth extracted. Oh, right. And she has beautiful teeth. So she had to get a tooth extracted and she made the comment to me, oh, I'm getting old. And I asked her, well, you know, you have all these other teeth in your mouth and they're just as old as the one you're getting extracted. The one she was getting extracted had an infection. Right. And it had an infection for a long time, right? So she needed to have it extracted for a medical reason that didn't have to do with age, that had to do with an infection. And all her other teeth were the same age. Right. So that's awareness. So calling awareness to, oh, is this ageist or is this not? And then begin to question, is this an ageist statement or is it not? And then the B of the ABC Model is to put the blame where it belongs. So is her tooth being extracted, because it's old? No. It's being extracted because it has an infection. Right. And all the other teeth are still intact in her mouth and just as old. Right. Okay. And then the C of the ABC Model is to challenge whenever you see ageism happening. So then to challenge it. Okay. I have to remind myself that I have however many other teeth that are just as old and that I have to check myself when these thoughts come up. And then when you get familiar with that then check other people or inquire. Let's think about that. Is that comment ageist or not? Right. Right. And I think there's a way that we can help each other to have those conversations. Have you got any tips for us to help guide those conversations if we're noticing ageist comments? Yeah. I think it can depend on the relationship that you're calling attention to the ageism in. Yes. So if it's a professional context you might do it in one way. Right. If it's with a spouse or a partner you might do it in another way. So sometimes I'll make a comment like hey let's look at that. What you just said is that really related to age or is it related to something else? Sometimes things are related. You know as we age we are more vulnerable to certain health problems to wear and tear. Right. Our bodies change and that's typical with aging. And so just to get familiar then is this typical with aging? Is this related to aging or is it not? And it's a really helpful way to get curious with yourself and your friends or your colleagues about that. Right. Sometimes I'm in a work meeting and somebody will say something that's ageist and I'll say hey what about that is related to age? Right. What about this situation is related to age? Let's look at that. Oh perfect. So let's focus on what the real issue is and not necessarily how old someone is. That's right. Yeah. And to celebrate if we're lucky I want to be a centenarian is my goal. Yes. I mean if I'm lucky I get to be a centenarian but to celebrate age too rather than to degrade it or to think it's not as valuable. I love that and I think we have to expand our horizons and think about a great life that we can live. In our last few minutes I wanted to just take a moment and talk a little bit more about your Center for Mental Health and Aging. I was on the website today it's absolutely fabulous loaded with resources. Oh my gosh thank you. Just a little bit more about that because I know our viewers will want to maybe explore that or find some resources that could help them learn some more. Oh thank you that means a lot to me. So I created the Center for Mental Health and Aging because I was working in a healthcare system. I was working at the Atlanta VA healthcare system and I was an assistant professor at Emory for a decade I was doing this and colleagues and patients and I was in and out patient mental health clinic for older adults so everybody had to be most of my patients were in their 80s but so what was happening is colleagues with the highest degrees in the hospital patients people would constantly come to me asking me questions about what's typical with aging and not should I be concerned about this and how do I know what do I know about dementia and how can I help them navigate that and is this dementia is this not it is this typical is this not is it normal for my 94 year old mother to be depressed you know she's 94 I don't know I'm looking for answers and so people would come to me and not know what to do and I was one of thousands of professionals in this system but somehow people didn't have this information and I thought well I'm gonna change that I'm gonna make sure one get the mental health care that they need but two to make sure that the public has education and that professionals have education and so so I created the center for mental health and aging and we do three things one is we provide public education provide professional education and we have a national provider directory for mental health providers who specialize with older adults nationally and so it's growing it's new and growing and we actually link to age well throughout the elder care locator yes awesome throughout the United States yes so people can look for their area agency on aging near them awesome well it's a fabulous resource take a moment have a look at it online Dr. Kapp I'd like to thank you so much for being part of our show today I've learned so much and my biggest takeaway is think differently about aging and keep our minds open to how we can embrace aging and not think that it's a negative thing oh yeah to celebrate growing older I mean we will go through adjustments that we need to maybe grieve and transition right but the same thing that's true for ethnic minority and older adults which is the high rates of resilience is true for older adults in general as we age we actually develop more resilience and that's a phenomenon that happens over the course of life it's not just this group of older adults it's every generation that every person that grows old as I grow older I'm a 47 year old woman as I grow older I will gain more resilience and so the idea with aging is to celebrate the beauty and the new learnings and the experiences that come with aging and how you can contribute and find meaning in your own life at whatever stage of life you're in well said thank you so much I so appreciate it well everyone thank you so much for joining us on our show today and if any of you need support if you need resources please reach out to age well we can connect you either through our help line and I'll remind you all of our number it's 1-800-642-5119 or just jump online if you have a computer handy at agewellvt.org we're here to help so thank you for joining us again on aging matters again thanks to Dr. Kepp and we look forward to seeing you next time on our show thank you