As people live longer and healthier, nurse training needs to respond to avoid ageist attitudes – The Conversation

Report on Ageism in New Zealand’s Healthcare System and its Implications for Sustainable Development Goals

Introduction: Demographic Trends and the Imperative for SDG Alignment

An analysis of New Zealand’s demographic data reveals a significant increase in life expectancy over the past five decades, a trend that underscores progress in public health and medical technology. However, this demographic shift presents challenges to achieving Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. The increase in longevity is accompanied by a higher prevalence of multiple chronic conditions and disabilities in the older population. This report examines ageism as a critical barrier to providing equitable and effective healthcare, thereby hindering progress towards key SDGs, including SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 10 (Reduced Inequalities).

Ageism as a Barrier to SDG 3: Good Health and Well-being

Impact on Health Outcomes for Older Adults

Age-based discrimination within the healthcare sector directly undermines the core principles of SDG 3. Evidence indicates that ageist assumptions made by health professionals lead to significant negative health outcomes for older individuals. These consequences include:

• The dismissal of genuine medical symptoms as inevitable consequences of “normal ageing.”
• Systematic under-treatment of older people, which elevates the risk of disease progression.
• A higher incidence of missed diagnoses and flawed clinical decisions based on age rather than individual health status.
• Inequitable access to services, where inclusion criteria for treatments or trials are set to exclude individuals over a certain age, such as 65.

Systemic Challenges in Health Education: An Obstacle to SDG 4 and SDG 10

Deficiencies in Nursing Education Curricula

A national review of New Zealand’s nursing programmes highlights how health professional education can perpetuate ageism, failing to align with SDG 4’s mandate for quality, inclusive education. The findings identify several key issues:

1. Stereotypical Learning Materials: Case studies frequently overemphasize negative aspects of ageing, such as dementia, falls, and end-of-life care, while neglecting to represent active ageing, resilience, and the agency of older adults.
2. Reinforcement of Negative Narratives: Clinical placements in aged residential care are often scheduled in the first year of study, implicitly suggesting the work is basic and less complex than other specialities.
3. Limited Clinical Exposure: By allocating most students to facilities housing the frailest segment of the older population, the curriculum reinforces a homogeneous and dependent view of older adults, missing opportunities to teach health promotion for the majority who live actively and independently.

Workforce Implications and Student Perceptions

The educational environment shapes the attitudes and career choices of the future healthcare workforce. Student reflections reveal systemic problems that conflict with the principles of SDG 8 (Decent Work and Economic Growth):

• Systemic Failures: Students observed understaffing, inadequate pay, and overwhelming workloads in aged residential care, describing the environment as a “conveyor belt life” that stripped residents of their identity.
• Career Stigma: A perception exists that starting a career in aged care could render a graduate “unemployable” in other nursing fields, discouraging skilled professionals from entering the sector.

Ageism as a Social Determinant of Health and a Driver of Inequality (SDG 10)

Intersectionality and Compounded Disadvantage

Ageism is an emerging social determinant of health that threatens to widen existing health disparities, directly contravening the objective of SDG 10 (Reduced Inequalities). There is a significant risk that age-based discrimination will compound the health inequities already experienced by vulnerable populations as they age, including:

• Māori
• Pacific people
• Rainbow communities

Failing to address ageism in healthcare risks leaving these groups further behind, undermining the universal pledge of the Sustainable Development Goals.

Recommendations for an SDG-Compliant Framework

Reforming Health Education to Align with SDG 4

To address ageism at its source, immediate reforms in health professional education are required. These actions will help build a workforce capable of meeting the needs of an ageing population.

• Develop and integrate learning materials and case studies that reflect the full spectrum of ageing, including health, activity, and resilience.
• Diversify clinical placements to expose students to older adults in a variety of settings, promoting a holistic understanding of later life.
• Foster inter-generational connections and empathy-building exercises within curricula to dismantle ageist stereotypes.

Achieving Health Equity in an Ageing Population (SDG 3 & SDG 10)

A comprehensive approach is necessary to ensure that healthcare systems are equitable and responsive. Tackling ageism is a critical first step toward preparing a healthcare workforce that can uphold the principles of the SDGs for all New Zealanders, regardless of age.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights issues that are directly connected to several Sustainable Development Goals (SDGs). The analysis points to the following SDGs being the most relevant:

• SDG 3: Good Health and Well-being: The core of the article focuses on healthcare for an aging population, including life expectancy, chronic conditions, quality of care, and the challenges within the healthcare system, such as ageism leading to misdiagnosis and under-treatment.
• SDG 4: Quality Education: A significant portion of the article is dedicated to the education of health professionals, particularly nurses. It critiques how current educational programs, case studies, and clinical placements can perpetuate ageist stereotypes and inadequately prepare the future workforce.
• SDG 8: Decent Work and Economic Growth: The article touches upon the working conditions of nurses and carers in aged residential care. It mentions issues like inadequate pay, understaffing, overwhelming workloads, and career stigma, which are all relevant to the goal of decent work.
• SDG 10: Reduced Inequalities: The central theme of the article is ageism, which is a form of discrimination that leads to health inequalities. The text explicitly states that ageism results in “limited access to services” and can “compound existing health inequities as Māori, Pacific people and rainbow communities grow older.”

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

SDG 3: Good Health and Well-being

• Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article connects to this target by highlighting how ageism leads to under-treatment and missed diagnoses of genuine symptoms in older people, which can worsen chronic conditions and negatively impact well-being.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… The article points to failures in achieving this target for older adults, stating that “Inequalities occur where there is limited access to services or inclusion criteria are set to exclude people over 65.”
• Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce… The article’s discussion of understaffing, low pay, and career stigma in aged care directly relates to the challenges of recruiting, training, and retaining a sufficient and well-supported health workforce.

SDG 4: Quality Education

• Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for… human rights… and appreciation of cultural diversity. The article argues for reforming health professional education to eliminate ageist stereotypes and equip students with the skills to provide non-discriminatory care, thereby promoting the human rights of older people and appreciating the diversity of the aging experience.

SDG 8: Decent Work and Economic Growth

• Target 8.5: By 2030, achieve full and productive employment and decent work for all… and equal pay for work of equal value. The student comment that people in aged residential care “do not get paid what they are worth” directly addresses the issue of fair compensation and decent work.
• Target 8.8: Protect labour rights and promote safe and secure working environments for all workers… The description of aged care staff being “constantly understaffed making the workload insurmountable and overwhelming” points to a failure to provide a safe and secure working environment.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age… The article’s entire focus on tackling ageism in healthcare is an effort to promote the inclusion and fair treatment of people regardless of their age.
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory… practices. The article identifies ageism as a discriminatory practice within healthcare that leads to unequal outcomes, such as “missed diagnoses” and under-treatment, and calls for its elimination starting with education.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article mentions or implies several indicators that could be used to measure progress:

Indicators for SDG 3

• Life Expectancy: The article explicitly states that male life expectancy in New Zealand increased from 68 in 1970 to over 80 today. This is a direct measure of population health.
• Health Worker Density and Distribution: The mention of aged care facilities being “constantly understaffed” implies that the density and distribution of the nursing workforce is an indicator of the system’s capacity to provide quality care.
• Prevalence of Age-Based Discrimination in Healthcare: The article cites a WHO report where “nearly 60% of health professionals admitted to making age-based (or ageist) assumptions.” This percentage serves as a direct indicator of ageism within the health system.

Indicators for SDG 4

• Content of Educational Curricula: The critique of case studies that “favoured information about older people with dementia, falls or end of life care” implies that an analysis of curriculum content can be an indicator of whether education is balanced and non-discriminatory.
• Student Attitudes and Career Choices: The student’s comment about fearing that working in aged care “would make me unemployable in other areas” is an indicator of the stigma associated with the field, which is shaped by the educational experience. Tracking student attitudes and career choices post-graduation could measure the effectiveness of educational reforms.

Indicators for SDG 8

• Wage Levels in the Care Sector: The statement that nurses and carers “do not get paid what they are worth” points to wage levels relative to other sectors as an indicator of decent work.
• Staff-to-Patient Ratios: The description of an “insurmountable and overwhelming” workload due to understaffing implies that staff-to-patient ratios in aged care facilities are a key indicator of working conditions.

Indicators for SDG 10

• Reports of Discrimination Based on Age: The article’s central theme of ageism and the WHO statistic on health professionals’ assumptions serve as an indicator for measuring discrimination.
• Health Outcomes Disaggregated by Age and Ethnicity: The warning that ageism may “compound existing health inequities as Māori, Pacific people… grow older” implies that tracking health outcomes (like diagnosis rates or treatment access) and disaggregating the data by age and ethnicity is a necessary indicator to monitor and reduce these inequalities.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article. In this table, list the Sustainable Development Goals (SDGs), their corresponding targets, and the specific indicators identified in the article.

Source: theconversation.com