Older adults are major consumers of health care. Within the context of an ageing society, their presence in the health care system will continue to grow. Ageist stereotypes and discrimination against older adults have an impact on the health and well-being of older citizens and are potential barriers to health equality. This chapter addresses ageism at different levels of the health care setting with a review of empirical research and health care policy. At the micro (personal) level, manifestations of ageism include attitudes toward older adults among physicians, nurses, and other health care professionals. Ageist communication styles used with older patients, age-biased clinical decision-making regarding diagnostics and treatments, and self-directed ageism in older patients are also discussed. Macro-level (institutional or structural) aspects of ageism are then examined, as reflected in health care reimbursement structures, participation of older adults in clinical trials, institutional policies governing care, and the lack of emphasis on geriatric-specific training for health care professionals. The chapter closes with an integration of the findings and a discussion of the challenges in identifying and reducing ageism in this setting. Conclusions are drawn and recommendations for future research and practice are made.

Though it is generally acknowledged that older adults are underserved in the area of mental health services, the impact of ageist stereotypes on mental health diagnosis and access to care, and on the provision of psychotherapy to older adults, has not been extensively studied. This chapter reviews the sparse literature on ageism and mental health services with the goals of examining current practice related to the assessment of mental health problems and barriers to optimal therapy of older adults from the social perspective of ageism. The chapter begins with a review of literature pertaining to attitudes of mental health clinicians towards psychotherapy of older adults, and focuses on possible contributing factors to the development of ageist attitudes among clinicians. Subsequently, we discuss older adults’ negative attitudes toward ageing, psychiatric diagnosis and psychotherapy, which may affect patients’ interpersonal encounters with a psychotherapist. We also address challenges and problems in the assessment and diagnosis of older mental health patients, and raise the possibility that ageist attitudes may be responsible for some of these issues. Finally, we discuss common difficulties in providing therapy to older adults with mental health problems and review different therapy approaches with older adults. Here again, we discuss the possibility that ageist attitudes might play a role in difficulties with the adaptation of these therapeutic methods for older adults. The chapter concludes with a discussion of possible prevention strategies to address ageist attitudes in mental health settings and makes recommendations regarding future research in this understudied area.

Objectives: The purpose of the present study was to validate the Apathy Evaluation Scale, self-rated version (AES-S), and assess the severity of apathy in a cognitively healthy middle-aged cohort at risk for Alzheimer’s disease (AD). Method: Three hundred and sixteen middle-aged adults were selected to represent a subset of the Wisconsin Alzheimer’s Disease Research Center Clinical Core: the Investigating Memory in People At-risk, Causes and Treatments cohort. Results: An exploratory factor analysis (EFA) with varimax rotation identified 3 subscales: apathy, disinterest, and social withdrawal factors. Confirmatory factor analysis confirmed the EFA findings. Results indicated acceptable convergent and discriminant validity. The AES-S is a reliable instrument to quantify apathy in cognitively healthy middle-aged individuals at risk for AD. Discussion: This study demonstrates the AES-S is a psychometrically sound measurement tool for assessing levels of apathy in a cognitively healthy middle-aged cohort at risk for AD.