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The United Nations Decade of Healthy Ageing (2021–2030) has identified ageism as a global obstacle that curtails older persons’ opportunities to contribute to society, realize their full potential, and lead a fulfilling life. The World Health Organization (WHO) established the Global Campaign to Combat Ageism (http://bit.ly/combatageism) to build a world for all ages by changing the way we think, feel, and act about age and aging. To provide evidence-based support for the Global Campaign to Combat Ageism, the WHO, in collaboration with other United Nations agencies, released the landmark “Global Report on Ageism” in 2021 (http://bit.ly/ageismreport). Recently, the U.S. National Academy of Medicine’s Global Roadmap for Healthy Longevity reinforced the need to address ageism and identified training, education, and new social infrastructure that values and enables the contribution of older adults as critical steps to promoting healthy longevity and as one of the core missions of health care systems and society as a whole. As demonstrated in robust literature, ageism is widespread and has damaging effects. Ageism is in our institutions, our relationships, and ourselves. Pervasive ageism in health care is particularly distructive since it negatively affects healthy survival and trajectories of health and well-being of older persons and curtails individuals’ capacity to contribute to societal goals. For example, in spite of the massive growth in the number and percentage of older persons in the population and the rising prevalence of those affected by multimorbidity and disability, the care of older patients remains unsatisfactory and the medical practice relies mostly on a standalone (single) disease approach. Thus, tackling ageism in health care may benefit not only each of us but society at large. In this context, an international board of geriatrics experts convened an international working group to discuss ageism in health care. In this article, we describe the effects of ageism on health and social care. We then propose actions that, through education and policies, can help to reduce ageism and promote healthy longevity. For a long time, the medical approach to health focused on the diagnosis, management, and cure of single diseases. At a time when the proportion of older persons in the population was low and longevity was rare, middle-aged individuals with single, usually acute, diseases accounted for most of the patients seeking health care. The common, general paradigm was to treat each disease at the time of clinical emergence, prescribing therapy and sending patients home to heal or die. The mantra “one patient—one problem” has survived for hundreds of years. This approach ignored patients with multiple conditions, frailty, and disability, considering these problems “normal consequences of aging,” “too complex,” and “unlikely to respond to care.” Until the last few decades, this approach was not yet amended by the evidence that prevention of diseases, health promotion, and productive employment matter into the oldest ages. With the aging of the population and a substantial reduction in mortality in older age, there has been a switch in the profile of patients accessing clinical services. These patients, indeed, are mostly affected by multiple chronic medical conditions that adversely affect their physical and cognitive function. To date, health care systems have only partially responded to the extensive transformation of population health, including the introduction of geriatrics as a medical specialty. The overarching mission of medical care remains rooted in the cure of a single disease, a strategy that conflicts with the already large and growing older population and the emergence of new patterns of morbidity and expanded health outcomes that require new models of care. Ageism is a substantial obstacle to both valuing and investing in health and social care that matches the needs and opportunities for the health of our aging population. Thus, it has become pressing to address the ageism that permeates medical care today, to adequately respond to the health needs and preferences of older persons. Ageism is defined as “the stereotypes (how we think), prejudice (how we feel), and discrimination (how we act) directed toward others or oneself based on age.” The demographic imperative of longevity and aging has led to an unprecedented expansion of the older population that is affected by chronic conditions and disabilities, making older people major health care users. This gradual transition now requires a profound and global transformation of the organization of health care for the individual as well as population-focused approaches to achieve healthy longevity. This will require the education of the health care and public health workforce and demands a stronger involvement of all providers who contribute to care, including social workers and informal caregivers. The literature supports a shift of health care systems toward integrated person-centered health and social care teams, who receive professional education on the appropriate care of older adults with varying combinations of conditions, life circumstances, and health priorities. Population health approaches need to incorporate goals for disease prevention and health promotion for older adults. Unfortunately, although the aging of the population is occurring globally, the specific needs of older persons are only recognized in a limited number of health care organizations and the university curricula of a few countries (institutional ageism). The scope of this document is to point to actions that should be implemented now to minimize the adverse impact of ageism in health care and the unmet opportunities to prevent ill health in aging. Addressing ageism may require an initial investment but should eventually lead to substantial resource savings by avoiding unwanted illness or unhelpful care and aligning health care goals and care to the subjective preferences of each older adult. This transformation may involve the integration of less expensive and more generalizable rehabilitative, palliative, and social care rather than managing each medical condition separately. We focus the discussion on a few urgent topics that we believe are critical and describe distinct manifestations of ageism in health care, public health, and their possible consequences. We also propose possible short-term and long-term solutions. The universal undervaluing of older people permeates our culture and is at the root of ageism in health care. Ageism can also be internalized and eventually applied to oneself (self-directed ageism). In particular, older people may internalize the stereotype that older age is a period of inevitable disease and decline, a thought process that can impose barriers to engaging in health-promoting behaviors and accessing health and social care at an older age. All aspects of health care, from education to acute and long-term care, along with population-level prevention, remain outdated and inadequate to meet the expanding needs of the aging population, and ageism in health care is unlikely to be solved until endemic ageism is addressed. Older adults who internalize ageism experience worsening of physical and cognitive health and a shorter life expectancy than older adults with positive aging beliefs. Persons with negative aging stereotypes may disengage from healthy behaviors, such as taking prescribed medication, participating in physical activities, or following a healthy diet, because they will not see the potential gain from such behavior. Older people may also refuse to access health and social care services, because they believe that they do not deserve equal access and social care service or there is an associated stigma. Education about aging and ageism in the general population, including in the current population of older people, is required to dismantle existing misconceptions to promote healthy behaviors across the life course and to reinforce that every person has the same value regardless of age. Interventions that support positive aging beliefs are available that have been shown to improve aging perceptions and health, and these interventions should be broadly disseminated and supported. Aging is ignored in curricula across educational programs for different health and social care providers. There is too little awareness that healthy aging is strongly influenced by the choices that we make over the whole life span. The lack of opportunities to learn about the aging process and older people in general can leave cultural norms unchallenged and result in negative attitudes against older patients. Most health and social care workers have not received educational opportunities around aging and older people and are therefore unprepared to respond to the preferences and health care and prevention needs of the older patients that they will eventually treat. Policies should be developed and implemented to ensure that aging becomes an integral part of any educational curriculum for health and social care professionals. Health and social care providers should also have the opportunity to participate in intergenerational activities involving older people, as this engagement has been demonstrated to effectively reduce ageism. Despite strong evidence that exposures and behaviors in early life can affect the aging process, as well as one’s health and function in later life, and that prevention and health promotion are effective into the oldest ages, aging is still widely considered a natural decay process that cannot be modified. Investment in health care is mostly directed to disease treatment, that is, care of diseases when they become clinically evident, rather than on prevention or health promotion over the life course. Progress in medical care has, therefore, mostly extended the length of life characterized by disease, with little effect on health expectancy and healthy longevity. Prioritizing preventive medicine and public health earlier in life and over the life course will increase the probability of living a longer and healthier life for all. The main purpose of health care should be not only to cure diseases, but rather to postpone the onset of diseases, frailty, and disability. Health care is primarily focused on diagnosing and managing individual diseases following guidelines based on evidence generated in younger adults with few medical conditions. Ageism might result in mis- or overtreatment, that is, the provision of a treatment intervention that is based on disease-specific evidence generated in younger adults and extrapolated to older adults. This disease-based decision-making results in interventions that may not be beneficial and may even be harmful and burdensome to older adults and does not address what matters most to them. For example, the exclusive focus on the treatment of individual diseases may lead to the adverse effects of polypharmacy, potentially harmful interventions, and unnecessary hospitalizations as individual diseases mount up and one’s overall function and preferences are ignored. In addition to acquiring and using therapeutic evidence on functional, symptom-based, and quality-of-life outcomes in older adults with multiple conditions, care should focus on identifying the specific health outcome goals of older adults and implementing realistic care aligned with meeting these goals. Treatment should be decided in collaboration with the patient and in the context of their comorbidity, functional capacity, social support, and living environment. Clinical decision-making does not adequately consider alternatives of care that may better align with subjective priorities and preferences of older patients, including the decision to withhold treatment to avoid iatrogenic harm. For example, function, frailty, and disability are often appropriate primary targets of interventions, but older people may not be involved in the development of a care plan with these goals in mind. Treatment choices are offered to older people and their caregivers without informing them of other possible choices goals and choices that may better match subjective priorities and preferences. Poor adherence might occur as a consequence of the limited involvement of older persons in treatment decision-making. Identifying the health outcome goals of each individual using a person-centered care approach and providing a comprehensive explanation of the consequence(s) of alternative therapeutic choices to allow shared decision making should become an integral component of medical education and practice. This is particularly important for older patients who are often affected by complex health problems not amenable to a “cure.” Quaternary prevention (“primum non nocere”), including deprescribing when appropriate, and patient-reported outcomes and experiences (PROMs and PREMs) should receive proper attention in medical and paramedical education. Caregivers should be involved in clinical decision making, as appropriate, taking into consideration the preferences and priorities of those they care for. Ageism leads to an age-based, unjustified, and discriminatory exclusion of older patients from treatment that can be life saving or essential to preserve function and/or quality of life. Older people also experience discrimination in their access to preventive measures, such as mammography screening. Older patients, based on their chronological age, are less likely to be eligible to receive intensive care or complex medical and surgical treatment, regardless of the severity of their baseline condition, or their level of intrinsic capacity. Considerations about biological age and function and individual health goals and care preferences, instead of chronological age, should guide treatment goals and choices (see also Point “Clinical Ageism: Focus on Isolated Treatment of Individual Diseases Using Evidence Not Applicable to Older Adults”) and allocation of treatment resources to the geriatric population. Legislation should be devised and appropriately implemented to ensure that health care rationing by age is prohibited. High-quality and dignified end-of-life care should be guaranteed when appropriate. Older patients in general and particularly those with multiple physical and mental conditions and disabilities are often excluded from clinical trials that test the effectiveness and safety of pharmacological and nonpharmacological interventions. This fact is even true for trials testing interventions for conditions that are more prevalent in older age. If data are collected on older people, they may not be age disaggregated, being instead buried in a single age group of over 60 or 65 years of age and hiding the enormous diversity among older individuals. This undermines the validity of the results for most older adults; moreover, there is broad underinvestment in bio-gerontological aging research. Validation of the efficacy and safety of treatments often does not apply to older patients, especially those with clinical and social complexity. Additionally, tools that can be used on a large scale for risk stratification are lacking, preventing older people from the possibility of receiving proper prognostic assessment and getting access to specific care and clinical pathways. Older patients should be included in clinical trials aimed to test interventions that may become beneficial to them. Policies could be generated to promote and ensure adequate representation of older people in research. Data should be more extensively stratified by age and health status measures and require functional, symptoms, and quality-of-life outcomes in addition to disease-specific outcomes and survival. More research is needed to develop new study designs (e.g., pragmatic trials) and outcomes that enable a more inclusive participation regardless of age and comorbid conditions. There is a lack of communication and connection between the different settings and the health and social care professionals that provide care for the same person, especially for older persons with cognitive impairment who cannot advocate for themselves. A lack of integration and continuity between medical and social care, including informal care, increases the risk of inadequate medical management of older patients with multiple chronic diseases, cognitive impairment, polypharmacy, frailty, and/or disability. Such a lack of integration and communication may result in adverse health outcomes, inappropriate polypharmacy and drug interactions, redundancy of diagnostic and therapeutic interventions, and multiple readmissions to different care facilities. There is a need for integrated and coordinated health and social care networks to promote more comprehensive and effective assistance. Geriatric medicine may play a pivotal role in the oversight of this process, favoring connections and integration between specialized settings (e.g., by designing, overseeing, and coordinating a care plan from acute care, to subintensive care, to and then to long-term care and primary care services. is well that acute medical problems in older patients often a of health and function, often to a decision for from the older people with acute problems are not for and For example, an is that older patients are often for more in than younger patients. problems that could have been and become and medical conditions that the health and functional trajectories of the patient (e.g., can into with home and expanded role of primary and care, a better integration of services, the of a for the and the of a for of social and support can minimize the of to the cannot be older patients should receive attention and care to avoid of health conditions. older patients should be of clinical because of their risk of Health care often do not to the needs of older patients, such as those that early and are to patients and in rather than allow them to in physical and that can promote and prevent such as and The inadequate of health care lead to a of (e.g., and acute of physical and cognitive function that could have been they more and health care should that the care of older patients, for example, with and promoting early and Ageism is to health care Older patients often have limited access to health care, they may lack and they may not be to an alternative of care. Older adults may be more likely to in health care, as they may experience multiple and health and social and may need to long to access care. This is particularly the in countries with universal health and care is mostly at and These affect the health, quality of life, and survival in older to younger regardless of their health to health care should be guaranteed to older people, especially those with disability, frailty, social and should health, health, and other usually the public health care to health care should be and for older persons. Ageism in health care in misconceptions about older individuals’ to and are for younger adults. the of is a main of communication between individuals and the health care At the same time, there is a risk that used in medicine and public health or new of ageism clinical and decision-making tools will be based on research data from clinical trials in older particularly those with multimorbidity or functional excluded or on clinical data that lack the functional outcomes of to older adults and the individual health priorities of older adults. The of and often to consider the specific needs of older being in and with complex that are not for people with or of existing may also be negatively affected by inadequate training, social support, or limited Older adults are the of health care and to access to and care. The inappropriate of and clinical decision-making tools will likely the inappropriate care of older adults as in the of this “Clinical Ageism: Focus on Isolated Tre
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