UNDER THE MICROSCOPE

Ageism is defined as stereotyping, prejudice, and discrimination against people on the basis of their age (WHO 2017). It is a fairly recent concept, coined in 1969 by Robert Neil Butler to describe  discrimination against seniors, patterned after the concept of sexism and racism. This topic was inspired by a query in one of my medical chat groups on who can qualify to donate blood. First and foremost is the age limit: no one below 18 or above 65 years of age is “qualified” to donate blood. The first is understandable, since we need informed consent for someone to donate blood. But even that is qualified by the provision that a parent can consent provided the person below 18 satisfies height, weight, and health requirements. There is no such qualification for the senior donor, though we  know former president Fidel Ramos donated blood throughout most of his senior life up to his 80s. This has profound implications for our blood program in that we already have a dearth of blood donors. Blood donor hesitancy is rampant especially among men, as women in general seem more willing to endure the pain of a large-bore needle, which pales in comparison to the pains of childbirth. We have a large and growing senior population some of whom are healthy enough to donate blood. But they are not allowed to. I challenged this stereotyping when, at the height of the pandemic in mid-2020, I volunteered to donate blood at the Philippine Childrens Medical Center, and due to the severe lack of donors (nobody dared leave their homes, much less go to a hospital when Covid was rapidly spreading), I was allowed to donate. It didn’t hurt that I was formerly the chief of the laboratory there, having retired four years earlier, and they know that I try to keep healthy. But in other circumstances, I would have been dismissed outright as unfit to donate blood due to my age (then 69), period. This is ageism at its worst,  considering one to be unfit simply because of age. It implies that all aged individuals are not fit and healthy, notwithstanding the fact that one can stay fit and able well up into the 70s and 80s. This bias carries over into the work environment as well, with the retirement age pegged at 65 in government service and even at 60  in private companies including hospitals. Institutional ageism is prevalent and should be more openly discussed for changes in national and institutional policies to occur. In health care, ageism leads to less care, attention, and treatment of older people, according to one study. However, in the local setting, where older people are accorded more respect, that may not apply. Our healthcare workers show more attention and care for the elderly and infirm due to our innate caring nature -this explains why our nurses are very much in demand around the world.  In our higher-end hospitals, we immediately tag older folk with “Fall Risk” stickers to make everyone aware to be on guard lest they suffer an unnecessary accident within the hospital premises. Unfortunately,  older persons can also imbibe the ageist belief (internalized ageism) and consider themselves as innately sickly and weak, which leads to their being less likely to look after their own health. Thus, they do not maintain good health habits, such as healthy eating and exercise, and in turn setting up a vicious cycle. High fall risk is due to our bad eating habits and inactivity. Seniors need to be responsible for their own well-being. We should strive to be as healthy as we can by being proactive about our welfare. Weight gain is not inevitable even though our metabolism  slows down as we age. It can be countered by eating less but higher quality food. If we eat less calories than our basal metabolic rate (BMR), we will not gain weight. We can actually lose weight by eating less than our BMR. Exercise is essential in both maintaining our muscle mass and avoiding sarcopenia (loss of muscle mass) and preventing osteoporosis (loss of bone mass). Both sarcopenia and osteoporosis lead to poor motor coordination that can lead to high risks of falls and bone fractures, which  lead to increased mortality among the elderly. There is a common misperception that older folks should only do cardio exercises. Strength-training is necessary to promote retention of muscle and bone mass. It doesn’t have to be heavy weights but can be light dumbbells or body-weight exercises. There you go, folks. We are not automatically weak or sickly due to our age. We are what we eat and do. Stay active and eat wisely. Live longer and more independent lives into your seventies and beyond. It is not too late to start. Combat ageism for your own sake.