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When It Comes to Older Adults: Language Matters
“Watch your thoughts, for your thoughts become your words. Watch your words, for your words become your actions." —Unknown
Although this proverb may be ancient, our understanding of its implications is still surprisingly new, especially when we consider it in light of our values as a nation.
We believe, for example, that a just society like ours should strive to treat everyone as equals. Yet, from the vantage point of geriatrics and long-term care (LTC), we also recognize in a unique way that society tends to marginalize older adults and minimize our abilities to contribute to our communities as we age. There are a number of social, cultural, and systemic factors contributing to the perpetuation of this marginalization; one of the ways this happens is through our words—when they fail to acknowledge older adults and caregivers as equals—which then translates into actions that perpetuate the same.
For several years now, the American Geriatrics Society (AGS) has been working with partners through the Leaders of Aging Organizations (LAO) and the FrameWorks Institute on a project to explore why and how that can change.1,2 It is a project aimed at “reframing aging,” reclaiming the social narrative behind our work serving older adults, and so challenging society to think about, talk about, and act upon aging in a different light.2,3
What have we learned? Well, first and foremost, that language matters. It matters so much, in fact, that colleagues at Geriatric Nursing (GN), the Journal of the American Geriatrics Society (JAGS), and the Journal of Gerontological Nursing (JGN) have all announced important changes to their manuscript submission standards addressing word choice at the heart of how we think about and care for older men and women.2 We at Annals of Long-Term Care: Clinical Care and Aging® are proud to join this movement—not only across the pages of our own publication but also across geriatrics and LTC research writ large. As our brother and sister publications have highlighted in their recent announcements—and as we now reinforce—language matters in our research, and it matters to the future we hope that research will build.2 That is why tools like those from the LAO and FrameWorks Institute are so important, and that is why we are working with partners like the AGS to reinforce why we see this guidance as critical to how we write, speak, and act on behalf of older adults.
Language as a Barrier
In this era of instant public access to scientific research, more refined guidance on the language we use in our manuscripts acknowledges a simple but sometimes overlooked truth: certain terms do not sit well with the public—in fact, some terms may even do more harm than good.2,3 Through anthropological studies and social science research, the LAO has found that language has been a significant barrier to educating the general public and policymakers on the advances we have made in health care and aging services (Figure 1).2,3 Despite years of progress in our own understanding of aging as geriatrics and LTC experts, the public is still mired in a “swamp” that treats aging as:
- Someone else’s problem. People tend to focus on “the aged” as an otherized group.3
- Undesirable. The public associates aging almost exclusively with decline and deterioration.3
- An inescapable decline. For most, “fading away” is tied to a strong sense of inevitability around “breaking down” as a central aspect of growing old.3
- Isolated. A majority of the public perceives old age not only as an outside obstacle but also as a personal or familial problem, not a challenge that society shares.3
- Fatalistic. Intimately tied to these perceptions are fears of decline, depression, and dependence.3 Such fears not only imbue aging with dread but also impede support for policies and solutions that actually address the challenges (and opportunities) associated with age.3
- Out of sight and out of mind. Fear and misperceptions ultimately fuel a lack of attention to older adult health.3 But keeping aging “off the radar” does little to remedy impediments to health as we grow older.3
In light of these findings, we are joining our peer publications in encouraging authors to “use the term ‘older adult’ when describing individuals age 65 and older,” and to “provide a specific age range (eg, ‘older adults between the ages of 75 and 85’) when describing their research or making recommendations about patient care or the health of the population.”2
Further still, we want to work with our authors and readers to end the use of terminology like “the aged,” “elder(s),” “the elderly,” and “seniors”—language specifically cited by the LAO and the FrameWorks Institute for bringing more baggage than benefits to our conversations about research. We at Annals of Long-Term Care hope you will join us in adopting these changes when preparing and submitting manuscripts.
More details about this change can be found in our “Author Guidelines” on the Annals of Long-Term Care website (https://www.managedhealthcareconnect.com/content/author-guidelines). To reiterate what we and our colleagues at GN, JAGS, and JGN believe: this is a change that transcends merely aligning with our peer publications. It is a change reinforcing the idea that language really does matter—and that is true regardless of who, where, or why we may be reporting on geriatrics expertise.
Over the next few years, the AGS will be sharing additional resources on other changes we all can make—beyond word choice—to frame research in ways that resonate with the public. Annals of Long-Term Care is committed to making sure such resources reach LTC leaders. For example, the LAO already has released a collection of tools to help advocates like our authors and readers drive a more productive narrative about the benefits of an increase in the average lifespan. These tools are available for free at https://www.frameworksinstitute.org/toolkits/aging/. They also were discussed during a symposium at the AGS 2017 Annual Scientific Meeting, with a corresponding slide set available for free from GeriatricsCareOnline.org.
It is important to note that these tools are not a panacea for manuscript writing. While you will not find “turnkey” phrases that will revolutionize how you position your work, you will find examples and guidelines that can help you—with practice and over time—continue to work more intentionally to advance the conversation about LTC in the United States. Sharing and telling a common story is part of what it takes for a movement to drive major and meaningful change—change embracing that language matters.
References
1. Lundebjerg NE, Trucil DT, Hammond EC, Applegate WB. When it comes to older adults, language matters: Journal of the American Geriatrics Society adopts modified American Medical Association style. J Am Geriatr Soc. 2017;65(7):1386-1388.
2. Lindland E, Fond M, Haydon A, Kendall-Taylor N. Gauging Aging: Mapping the Gaps Between Expert and Public Understandings of Aging in America. Washington, DC: FrameWorks Institute, 2015.
3. FrameWorks Institute. Gaining Momentum: A FrameWorks Communications Toolkit. FrameWorks Institute website. https://www.frameworksinstitute.org/toolkits/aging/. Published April 7, 2017. Accessed July 26, 2017.
