Ageism and Age Discrimination in the Family: Applying an Intergenerational Critical Consciousness Approach

Abstract

Ageism and negative age stereotypes can be expressed unconsciously and consciously through microaggressions in interpersonal interactions, through social and cultural institutional messaging, and through exposure to and encounters with systems of law, government, employment and healthcare. The negative impact of age stereotypes on older adults has been well documented, yet the experience of older adults and ageism within the family has been understudied. This paper reviews theories and evidence on the manifestations of ageism and age discrimination, drawing from an ecological framework emphasizing the importance of structural systems, and then focuses on ageism in the family. A clinical case example illustrates this process and is analyzed through the lens of critical consciousness theory. The paper concludes with the implications for research, theory development and clinical practice.

Full text

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Clinical Social Work Journal
ISSN 0091-1674
Clin Soc Work J
DOI 10.1007/s10615-020-00753-0
Ageism and Age Discrimination in the
Family: Applying an Intergenerational
Critical Consciousness Approach
Stacey Gordon

1 23
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Clinical Social Work Journal
https://doi.org/10.1007/s10615-020-00753-0
ORIGINAL PAPER
Ageism andAge Discrimination intheFamily: Applying
anIntergenerational Critical Consciousness Approach
StaceyGordon1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Ageism and negative age stereotypes can be expressed unconsciously and consciously through microaggressions in interper-
sonal interactions, through social and cultural institutional messaging, and through exposure to and encounters with systems
of law, government, employment and healthcare. The negative impact of age stereotypes on older adults has been well docu-
mented, yet the experience of older adults and ageism within the family has been understudied. This paper reviews theories
and evidence on the manifestations of ageism and age discrimination, drawing from an ecological framework emphasizing
the importance of structural systems, and then focuses on ageism in the family. A clinical case example illustrates this process
and is analyzed through the lens of critical consciousness theory. The paper concludes with the implications for research,
theory development and clinical practice.
Keywords Productive aging· Family caregiving· Ageism
Introduction
Ageism and ageist attitudes have been shown to have nega-
tive behavioral, psychological and cognitive consequences
for older adults (Levy 2000, Levy 2003, 2009; Levy and
Banjali 2002; Levy etal. 2011). Scholars increasingly view
the problem of ageism with concern (Bennett and Eckman
1973; Palmore 1982; Polizzi and Millikin 2002a, b), espe-
cially in light of current demographic trends indicating an
unprecedented growth of the older adult population in the
U. S. (U.S. Census Bureau 2000). By the year 2030, one in
every five Americans will be age 65 or older (U.S. Census
Bureau 2000). “Ageism is a systematic stereotyping of and
discrimination against people because they are old”, and
harms all of society by creating rifts between people and in
communities (Butler 1969, 1989 p. 139). Ageism is struc-
tural, and permeates society from macro-level systems such
as laws and policies affecting access to work for older adults
(Gonzales etal. 2015a, b; Morrow-Howell etal. 2015), to
micro-level healthcare decisions that negatively affect older
adults with an excessive cost to society (Levy etal. 2018). In
addition, ageism significantly impedes opportunities for pro-
ductive aging (Gonzales etal. 2015a, b). Negative age atti-
tudes lead to microaggressions, subtle or explicit insults that
are commonly aimed at older adults and are produced by the
ageism embedded in macro-structural systems. Federal, state
and local policies can serve to bolster the dynamic between
the dominant and subordinate groups, and this dynamic can
shape healthcare, the workplace, communities and inter-
personal interactions between colleagues, friends and fam-
ily members (Marchiondo etal. 2017; Estes and DiCarlo
2019). Ageism within families has not yet been well stud-
ied; however, there are significant clinical implications to
understanding ageism for the wellbeing of older adults and
families. This paper takes the position that the problem of
ageism in the family can be understood through the lens of
larger social structural forces and provides theory, research
and a case example to illustrate the problem and explore the
use of critical consciousness therapy techniques as promis-
ing strategy to address ageism in the family.
The Concept ofAgeism
Ageism refers to “the stereotyping and discrimination of
people due to their chronological age or a perception that
they are old, or elderly” (Butler 1969, p. 234). Ageism
* Stacey Gordon
stacey.gordon@nyu.edu
1 NYU Silver School ofSocial Work, NewYork, NY, USA
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towards older adults is generally conceptualized as consist-
ing of three interrelated components: affective, behavioral
and cognitive. The affective component consists of feelings
such as contempt for older adults or fears about the vulnera-
bility inherent in the later years of life (Butler 2010). A sense
of loathing younger people may feel toward older adults can
be another manifestation of ageism, and serves to dehuman-
ize older adults and deny them their rights to resources and
participation in civil society (Estes and DiCarlo 2019). The
behavioral component of ageism consists of age-based dis-
crimination (Posthuma etal. 2012; Marchiondo etal. 2016).
Butler compares age-based discrimination with the system-
atic discrimination against people based on race or gender.
These forms of discrimination occur commonly and serve to
prohibit or disallow certain people or groups from participat-
ing fully in society (1975). Age-based discrimination has
been frequently documented, though it is often thought to
be less offensive or damaging than other forms of prejudice
such as racism or sexism (Deal etal. 2010; Levy and Banjali
2002; Marchiondo etal. 2016). Cognitive ageism refers to
attitudes, schemas and stereotypes held about older adults
that inform communication and interaction between older
and younger individuals (Cuddy and Fiske 2002; Eagly and
Chaiken 1993; Iversen etal. 2009; Levy 2001; Levy and
Banjali 2002).
Theoretical Frameworks: The Ecological
Framework
The ecological framework situates multiple levels of influ-
ence on behavior and organizes these levels from macro to
micro, emphasizing the interrelatedness and reciprocity of
influence across levels (Bronfenbrenner 1979). The frame-
work emphasizes that the life of an older adult is embed-
ded in a dynamic context of influences, as the older adult
adapts to the confluence of macro-, meso- and micro- and
chronological-level forces (Lawton and Nahemow 1973).
Ageism and ageist policies and laws can have a negative
influence on an older adult’s quality of life, overall function-
ing and well-being. Applying the ecological framework to
age discrimination helps to develop an understanding of the
pathways through which structural or ideological conditions
and forces, regulatory policies and programs, community-
level supports, as well as relational and individual processes
impact older adults (Norris etal. 2013).
The ecological framework contextualizes reciprocal
relationships between aging and human development in
the home, family, community and work. It provides a lens
through which clinicians can examine the intergenerational
relationships between adult children as caregivers and aging
parents as care recipients (Schiamberg and Gans 1999,
2000). Use of the ecological framework in a clinical setting
allows the clinician to see the context in which ageism and
age discrimination occurs amidst the stressors and resilience
factors influencing family behavior (Norris etal. 2013). Fur-
ther, an ecological framework both provides a perspective
from which to develop appropriate interventions, and helps
the clinician develop a better understanding of the intergen-
erational factors influencing quality of life of older adults
(Schiamberg and Gans 2000; Norris etal. 2013).
Structural Ageism
Viewed from an ecological framework, structural ageism is
a process by which macro-level structural factors principally
drive and reproduce ageist thoughts, feelings and behaviors
at lower meso- and micro-levels. These macro-level influ-
ences include the system of policies, laws, societal attitudes,
language and culture that shape institutional practices, as
well as cultural representations that then reinforce ways that
ageism and age-based discrimination are perpetuated (Estes
and DiCarlo 2019; Ageism in America report). As with sex-
ism and racism, “there is a significant structural component
to ageism that is not captured by ideology alone” (McMullin
and Marshall 2001, p. 113). Structural forces bring to bear
the history of policy and laws and how this history creates
and shapes messaging, which shapes communities and influ-
ences families (Estes and DiCarlo 2019). The workplace and
healthcare settings are two notable places where structural
ageism can be seen.
Ageism intheWorkplace
Given estimates that by 2020 one in four U.S. workers will
be age 55 or older (Hayutin etal. 2013) and one in three
U.K. workers will be over age 50 (Department for Work and
Pensions 2013), the prevalence of and tolerance for ageism
is concerning, as more workers may become targets. In a
report based on unemployment rates and duration of unem-
ployment, Miller (1966) found that when older workers lose
their jobs, they have more difficulty finding new jobs when
compared with younger workers. Older workers show higher
unemployment rates and longer durations of unemployment
(Miller 1966; Neumark 2009).
Significant evidence shows workplace inequities, where
employers and others, exhibit stereotyping of older adults,
resulting in negative attitudes about older workers (Cuddy
etal. 2005; Posthuma and Campion 2009; Marchiondo etal.
2016). Negative age stereotypes held by employers, manag-
ers and employees in the workplace include beliefs that older
workers have a lower level of competence, decreased per-
formance capacity, (Krings etal. 2011; Loretto and White
2006), limited physical and mental capacity to perform at
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work (Finkelstein etal. 2013; Karpinska etal. 2013; Loretto
etal. 2013), and inflexibility and resistance to change (Chiu
etal. 2001; Redman and Snape 2002).
Management decisions based on negative beliefs that
older workers are less competent or more difficult to train
in the use of technology can result in age discrimination
in the workplace (Posthuma and Campion 2009). Negative
age stereotypes also influence managers’ subjective deci-
sion-making in hiring and job performance evaluations of
older workers (Sterns and Alexander 1988; Posthuma etal.
2012). These stereotypes result in less frequent hiring of
older workers, failure to select older workers for training, or
targeting older workers for layoffs (Posthuma etal. 2012).
The Workplace Age Discrimination Scale (WADS) is a
tool designed to measure the perceptions of workers’ overt
and covert discriminatory experiences (Marchiondo etal.
2016). As the researchers note,” perceived age discrimina-
tion within the workplace is associated with higher rates of
depression, compromised self-rated health, job dissatisfac-
tion and an increased motivation to retire earlier” (Gonzales
etal. 2019a, b; Marchiondo etal. 2016; Marchiondo etal.
2017 p. 2). Further, the negative consequences of perceived
age discrimination are related to a deterioration of mental
health, lower self-rated health and the hastening of physi-
cal health problems and and a decrease in job satisfaction
(Marchiondo etal. 2017).
Ageism inHealthcare
Specific medical concerns related to age are generally
addressed by physicians specializing in geriatric medicine.
The lack of access many older adults have to geriatric physi-
cians is a fundamental challenge in the healthcare of older
adults. The principles guiding geriatric medicine, such as
patient-centered care, management of chronic illness, and
attention to a patient’s goals and functioning, are those at the
forefront of care for all people (Tinetti 2016). However, the
number of physicians choosing to specialize in geriatrics is
far below demand of the burgeoning older adult population
(Kane 2002). As a group, geriatricians have not been con-
sistently strong champions of the case for geriatric medicine,
and themselves have professed ageist attitudes about their
specialty. “Rather than promoting the benefits of working
with the older adult population, geriatricians accentuate and
lament careers focused on caring for older adults as burden-
some and financially unattractive. Every year we publicize
the number of unfilled geriatric fellowship slots. Then we
wonder why trainees don’t want to join our club” (Tinetti
2016, p. 1401). Financial reimbursement for time spent in
office with older adults is low, and Kane and Kane (2005)
argue that ageism is the reason that geriatrics pays relatively
poorly compared to other medical specialties. Cost and
medical effectiveness of the geriatric assessment has been
demonstrated, yet geriatric assessment is poorly reimbursed
under Medicare to the point that such activities must be sub-
sidized by other more cost-effective procedures. Medicare
payments are heavily biased toward such procedures (Hsiao
etal. 1988).
A dearth of geriatric physicians means that older adults
seeking geriatric primary care and geriatric psychiatric care
are often seen by physicians who lack an understanding of
the aging process and who believe that continual decline is
inevitable. In many cases this leads to a disease-manage-
ment focused approach rather than a proactive supportive
approach, and can result in such problems as polypharmacy,
whereby older adults with multiple comorbidities are pro-
vided redundant prescriptions or medications that interact
negatively with one another, leading to the development of
more serious yet avoidable conditions (Hajjar etal. 2007).
Ageist behavior by physicians and other healthcare
professionals has been well documented. Such behaviors
include: reports of physicians minimizing concerns of
older adults, and ascribing them only to their age and not
to actual medical conditions (Greene etal. 1989; Adelman
etal. 2000; Williams etal. 2007; Ambady etal. 2002); a
lower likelihood of physicians using preventive methods to
treat either medical or psychiatric problems (Cobbs etal.
1999; Greenfield etal. 1987; Adelman etal. 2000); use of
derogatory names when speaking about older patients, and
spending less time listening to older patients (Adelman etal.
2000; Ambady etal. 2002); and physicians considering older
patients difficult and less pleasant to deal with (Adelman
etal. 1991, 2000).
Ageist bias has been identified particularly in cancer
screening, diagnosis and treatment. Studies reveal that
although more than 55% of all cancers and over two thirds of
all cancer mortalities occur in the 65-plus age group, older
adults are less frequently diagnosed at an early stage, even
when standard screening procedures exist. In addition, older
adults are underrepresented in clinical cancer drug trials, and
are less likely to be informed of such trials by their physi-
cians and to receive treatments that are considered definitive
or potentially curative (Townsley etal. 2005; Turner etal.
1999; Goodwin etal. 1988).
Ageism intheFamily
For many older adults, family relationships are their longest
surviving connections and family relationships often “act as
a buffer against negative self-views and negative mental and
physical health outcomes in older persons” (Nelson 2016 p.
278). Knowing that a supportive family member is present,
reliable and consistent whether close by or afar, can have a
positive impact on an older adult’s attitude and expectations
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about their own mental and physical health and can also
provide older adults with a sense of hope and control of their
future aging trajectory (Nelson 2016; Ramirez and Palacio-
Espinoza 2016).
In contrast to the abundance of evidence of the positive
impact of family support for older adults, very little attention
has been given to the issue of ageism and age discrimination
in families. Ageism and ageist attitudes, rooted in both posi-
tive and negative stereotypes, can have a significant impact
on older adults and their family relationships (Palmore
1999). Positive ageism in the family might take the form
of family members calling grandma “cute”, speaking to her
slowly and in a tone of voice with which adults would nor-
mally address a child, or grabbing her hand at a crosswalk
to ensure that she crosses the street safely (Chonody 2016).
These stereotypes and behaviors appear to be compassion-
ate, but they are often paternalistic in nature and serve to
support behaviors that place older adults as needy and child-
like. These behaviors are detrimental as they cause older
adults to question their own capabilities and strengths and
lower self-esteem (Kemper etal. 1995; Gendron etal. 2016).
Negative ageism takes the form of well-intentioned family
members who portray older adults as less capable of making
decisions for themselves and fail to afford them privileges of
adulthood, solely because of their age. (Estes and DiCarlo
2019). Often, these families are not aware that their atten-
tion to older relatives can be viewed as ageist and support a
limited view of older adulthood. “Even though at face value
these behaviors appear to be deferential to age, they have
the potential to undermine the status and treatment of older
persons in society” (Cherry and Palmore 2008, p. 857).
Microaggressions
The term “microaggression” is a particularly useful concept
to advance our understanding of ageism in the family as
it focuses on discrimination at the interpersonal level, and
refers to an “everyday verbal, non-verbal or environmental
slight, snub or insult” directed at a target person or persons
who are members of an oppressed group (Sue 2010, p. 5,
2004; Sue etal. 2018). Microaggressions can be insidious,
slight or subtle, and may be intentionally made to marginal-
ize people or make them feel inferior (Sue 2004, p. 5). Such
statements may “invalidate group identity, demean some-
one on a personal level or communicate that they are lesser
human beings, and suggest they do not belong to the major-
ity group” (Sue 2010, p. 3).
Sue (2010) proposes that microaggressions fall into three
different categories: microassaults, which are often uncon-
scious and convey rudeness and insensitivity toward a per-
son because of their heritage, microinsults, which are often
conscious and are explicitly derogatory verbal or non-verbal
attacks with the intention of causing harm to a person, and
microinvalidations, which are often unconscious and cause
a person to question their own thoughts, feelings or experi-
ences. The concept of microaggressions was first employed
by Pierce (1974), and has only recently been employed in the
literature on older adults by Sue (2010) for example, when
referring to “elderspeak” (p. 113), or the use of a microag-
gressive label such as “sweetie” that belittles or infantilizes
an older adult.
Ageism in the family can be seen in the form of microag-
gressions such as a remark a family member might make
about the older adult rendering their less than adequate
competence or capability in performing certain tasks due to
their age (e. g. in using technology, seeing or hearing well,
remembering details or performing a job). Sometimes it can
be difficult to discern the difference between a microaggres-
sion toward an older adult in the family and a statement of
concern about them. Generally, a statement of concern about
a family member is about the person’s well-being and has the
person’s overall functioning in mind. A concern focused on
the health, or behavior of a family member can be followed
up by a visit to a physician, to have the issue of concern
evaluated. A microaggression about age is not meant to be
followed up with any clarification or action; rather, it is an
opinion statement about the older adult and has little or no
positive benefit to the older adult. The following case exam-
ple illustrates how ageism in the form of microaggressions
manifest in the micro-level system within a family.
Mr. Franco: ACase Study
A case study is a useful tool to illustrate examples of behav-
ior discussed in this paper. The author presents this fictional
case study, one based on several similar cases from their
clinical social work practice (Strong etal. 2018).
Mr. Franco is a 76year-old middle-class Italian American
man in good health, living on his own in an apartment in
New York City, where he has lived for 45years. He has been
divorced for 25years and maintains an active life, volunteer-
ing in a neighborhood school, and working part-time at a
local bookstore. He has two adult children: a 43year-old son
AJ, who lives uptown, and a 53year-old daughter Amanda,
who lives in a suburb of New Jersey, an approximately
45-min car ride from her father. Mr. Franco has developed
close connections with his neighbors, people of all ages. He
considers many of them close friends and socializes with
them about every other week. He is particularly close with
one neighbor, and this young man has a spare set of keys to
Mr. Franco’s apartment.
On a recent walk home from his part-time work, Mr.
Franco stopped at the grocery store to purchase some food.
Carrying his two medium-sized grocery bags home from the
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store, he became distracted by several dogs playing across
the street and did not see a cracked area of the sidewalk. Mr.
Franco tripped on the sidewalk and fell in front of his apart-
ment building. He later reported that this particular area of
raised sidewalk was a well-known problem, and it had been
slated for improvement the following week. The doorman of
the building confirmed that Mr. Franco was not the first per-
son to trip in that spot. As Mr. Franco’s neighbors were leav-
ing the building, they saw him fall and called 911, waiting
with him until an ambulance arrived. Mr. Franco was met by
paramedics and was rushed to the hospital in an ambulance.
Mr. Franco’s adult children met him at the hospital and
stayed with him while the doctor conducted a thorough
examination, taking an X-ray of his knee and a CT scan of
his brain. His children requested the brain CT scan as they
were concerned that Mr. Franco might have hit his head
when he fell. Mr. Franco reported his knee was in pain, and
badly bruised. The X-ray showed he had no broken bones,
and the CT scan indicated nothing unusual. After many
hours of tests and observation, Mr. Franco was discharged
from the emergency room, and both AJ and Amanda accom-
panied their father home in a taxi. When they arrived, they
found that Mr. Franco’s neighbors had left his two bags of
groceries right outside his door. The three family members
entered the apartment, prepared and ate a meal together. The
adult children then left their father just before he was ready
to go to bed. The next morning AJ called Mr. Franco to
check on him and informed him that he and Amanda and
their spouses would be coming over to see him that evening
and would bring dinner. After dinner ended, AJ announced
that “it was time to have a talk” with Mr. Franco, who agreed
to sit and engage in conversation. AJ began by saying that
he and Amanda and their spouses were very worried about
their father, and that they had decided it was time for Mr.
Franco to leave his apartment and move into an assisted liv-
ing facility with greater support and supervision, one located
in Amanda’s suburban neighborhood in New Jersey. Amanda
told Mr. Franco that this is what all of her friend’s parents
are doing and this would be “the best option” for Mr. Franco
who “clearly needed more supervision than he was getting”
at home in New York City. Amanda then announced as she
and AJ were leaving, that she had visited a certain facility
with an excellent reputation and had already put down a
deposit to save two different units until Mr. Franco was able
to get to the facility to choose which unit he prefers.
In an attempt to sort out his feelings and communicate
with his children about their demand that he move, Mr.
Franco contacted a social worker and stated that although
he was shocked by his children’s quick rush to move him,
he also felt a good measure of warmth and appreciation over
their concern for him. He later stated that he had begun to
feel angry and disappointed in his children for not discussing
directly with him their plans for his future, and for thinking
that his opinion did not matter or should be overruled. He
reported feeling deeply insulted, misunderstood and belit-
tled, as though he had been made to feel like a child himself
and was being “duped by his kids”, and stated that “right
now, I can’t trust my children to act in my best interest.”
Mr. Franco contrasted his feelings about his children with
the more positive feelings he had towards his friends and
neighbors. He reported that when his friends and neighbors
noticed that he seemed down, they rallied around him, bring-
ing him meals and “cards with nice messages”. They com-
municated to Mr. Franco how much they appreciated his
friendship and how much he added to the building and to
the neighborhood. Mr. Franco declined the invitation to go
and see the assisted living facility and stated that he had no
intention of moving out of his apartment.
Analysis oftheCase ofMr. Franco: Structural
Ageism
The interactions among Mr. Franco and his children,
Amanda and AJ, can be understood from their embedded-
ness in larger macro- and meso-level contexts of structural
ageism. Amanda’s and AJ’s decision to act to secure a place-
ment for Mr. Franco in an assisted living facility without
receiving his prior consent can be placed in the context of
a proliferation of private for-profit assisted living options
in the United States (Grabowski etal. 2012). The growth
of such facilities is, in part, a result of the lack of broad
public commitment to and an attendant lack of allocation
of resources by policy makers to support middle-class older
adults in their own homes and in their communities. Large
gaps exist between funding allocated through the Older
Americans Act, and the critical needs of older adults (Estes
1979), particularly those in the middle class, whose life
expectancy has increased without savings to keep apace.
Private independent and assisted living facility chains can
be viewed as representatives of an “aging-industrial com-
plex”, a shrewd profit-driven solution to fill a void in pub-
licly supported housing for older adults. Large corporations,
driven by their financial bottom-line, operate across multiple
states and are not governed by federal regulations. Each state
asserts its own system of rules and regulations regarding
staffing and environment in private (non-Medicaid) assisted
living facilities (Hodlewsky 2001). These large facility
chains direct their advertising for independent and assisted
living communities toward families like Mr. Franco and his
children in order to effectively populate their facilities. Often
it is the adult children who, influenced by advertising and
without other options, influence their parents to leave their
home. A study by Reinardy and Kane (2003) explored deci-
sion making within families in a move from home to assisted
living. The study indicates that two-thirds of older adults
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were influenced by family members to make the decision to
move to assisted living. While some older adults do choose
to live in an assisted living facility and enjoy their program-
ming and social opportunities, the majority of older adults
prefer to age in place, in their own homes and communities
(Wiles etal. 2012). Amanda and AJ did not explore or con-
sider any of the community options that might assist their
father in aging in his own home, because they did not know
of such programs.
It is common for adult children to present the option
of assisted living out of concern for their parents without
investigating the full scope of services available to age in
place in the community, and the financial commitment and
services available. Looking at the case example through a
meso-level lens, Amanda and AJ failed to consider the com-
munity context and institutions Mr. Franco is involved in
prior to a rush to move him to an unfamiliar assisted living
facility. For example, he works part-time at a local bookstore
and volunteers part-time at a local elementary school. These
organizations value Mr. Franco and his daily contributions.
Since he has worked at each of these institutions for over
ten years, he has become a well-known and well-loved com-
munity member, and his knowledge of literature, and skills
with young children are highly valued. If he were to leave his
apartment and move to an assisted living facility, it would
be difficult for him to find equivalent experiences there. As
noted previously, biases against older adults in the workplace
are likely to present difficulties for Mr. Franco in seeking to
secure similar part-time positions if he were to move to an
assisted living facility.
Ageism in the family on the micro-level often manifests in
microaggressions that create inequities and distance between
family members. Age-based microaggressions are covert or
overt manifestations of the marginalization of older adults
and in many cases an unconscious attempt to wrest power
away from them (Sue 2010). Amanda and AJ’s attempts
to assert control over his future was initially perceived by
Mr. Franco as an act of caring and genuine concern of his
children for his well-being. However, over time, when Mr.
Franco felt otherwise and mentioned he did not intend to
move out of his apartment, his daughter became angry. In
an awkward attempt to help their father and assume a role
as caregiver, AJ and Amanda’s microaggressive action was
ultimately viewed by their father as an attempt to take his
power away. This action informed their family dynamic and
reshaped their relationship. Researchers in productive aging
have looked at ageism in the workplace and in healthcare,
but have not yet examined ageism in the family, especially
in the form of microaggressions (Gonzales etal. 2015a, b).
Perpetrators of microaggressions are often unaware of
the insult and the marginalization they convey, and often
are only subtly aware of the damage that can be wrought
by a microaggression (Sue 2010). In the case of Mr.
Franco, who was excluded from the decision-making pro-
cess about his own life, his livelihood, and his home, he
reported that he felt deeply insulted, misunderstood, and
belittled, as though he had been made to feel like a child
himself. Often the intention of a microaggression, or in
this case a microinvalidation, is not immediately perceived
by the receiver of the insult, especially when occurring
in conversation between family members, and when por-
trayed as an expression of concern. Microaggressions and
microinvalidations “allow the expression of biased opin-
ions while freeing the perpetrator of a thin veil of doubt
concerning the intentionality of the action, comment or
behavior” (Van Sluytman 2013, p. 1).
In the case of Mr. Franco, his adult children made a
decision without his permission and announced their
decision to him, in an attempt to get him to do what they
thought was best for him. Whether consciously or uncon-
sciously, Mr. Franco’s children minimized his self-agency
by attempting to assert dominance over him. Even well-
meaning interactions between family members can be per-
ceived as demoralizing by older adults; communicating
excessive care can promote dependence rather than auton-
omy (Nussbaum 2005). Patronizing behavior by a family
member is often excused as a well-intentioned display of
concern rather than recognized as controlling behavior.
Older adults may come to expect family members to pro-
vide social support when needed, and may therefore come
to tolerate family members’ efforts to exercise social con-
trol and dominance (Hummert and Mazloff 2001; Rook
and Ituarte 1999). Mr. Franco, however, perceived his chil-
dren’s attempt to dislodge him from his home as upset-
ting and one he could not consent to, and therefore their
intervention backfired.
Through this experience, Mr. Franco called into ques-
tion fundamental beliefs about his relationships with his
children, thereby distancing himself from his children.
The support he received from his friends and neighbors
helped to boost Mr. Franco’s sense of himself and served
to remind him of his strong connections to his community
and the support he had to remain in his apartment. Numer-
ous studies have examined how implicit ageism negatively
affects older adults. Such negative consequences can begin
with self-doubt, but can further result in “worsening mem-
ory performance, self-efficacy, handwriting and the will to
live” (Levy 2001, p. 579; 1996; 2000; Levy etal. 1999).
However, Nelson has found that the “negative effects of
the negative age-related stereotypes can be mitigated
or even eliminated if older adults perceive a mismatch
between the stereotype and how they perceive themselves
in the future” (Nelson 2016, p. 3). Ultimately Mr. Franco
felt bolstered by his neighbors and friends in the commu-
nity, but still at odds with his children.
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Clinical Social Work Journal
1 3
Applying aCritical Consciousness Approach
From a clinical standpoint, the challenge in addressing
ageism in the family context, such as in the case of Mr.
Franco, emerges from the fact that the source of such bias
derives from outside the family itself, in the macro-struc-
tural and meso-level influences that shape attitudes and
behaviors towards older family members. Here, the notion
of developing “critical consciousness” can assist the cli-
nician in addressing such a dilemma. Linking the larger
social context to problems found in the family, a critical
consciousness approach links structural ageism deriving
from the macro-system to ageism occurring within the
family. Critical consciousness examines family interac-
tions within their societal context and analyzes how family
members are valued according to identity characteristics.
“Family interactions with patterns of inequality are too
often unacknowledged and unchallenged” (Hernandez
etal. 2005, p. 107).
Developing a critical consciousness in families involves
identifying ageist attitudes, behaviors and cognitions
within each family member and connecting these with
their macro-level origins. In the case of Mr. Franco and
his adult children (and their partners), the clinician might
explore aspects of structural ageism, and encourage them
to engage in a group discussion of how ageism is perpetu-
ated by macro-level structures such as social policies and
the aging industrial complex, that reproduce ageist atti-
tudes and age-discrimination within the family. The clini-
cian might include a discussion of how age is portrayed
in the media, how anti-aging products are sold to keep
people from appearing old, and ask the adult children to
think about how each of them feels in relation to their own
aging. The clinician could then explore the negative conse-
quences of ageism for older adults and for younger people,
presenting facts about the known negative consequences
of ageism. One key point to stress is how significant it is
to their own aging that they come to terms with their own
feelings about older people as they too are aging and will
one day be old like their father.
Another piece of critical consciousness development
would be an analysis of how the adult children made the
decision to impose their own will on their father’s living
arrangements without considering his thoughts or feel-
ings. This might include an exploration of why they might
have thought this would be acceptable, and why they did
not think to discuss with their father, and plan with him.
Anxiety about aging and about caregiving may need to be
explored, since one natural consequence of being an adult
child of an older parent is that at some point the parent will
have care needs. Engaging the adult children in a discus-
sion about concern for their father’s safety is important.
Reframing the adult children’s concern for his safety as a
concern for helping their father figure how he would like to
plan for the future would be empowering for Mr. Franco.
Once a plan is in place, Mr. Franco’s family members can
provide help in the role they have been designated by their
father, according to his wishes.
Conclusion
By using a framework supported by the critical conscious-
ness approach, clinicians can encourage older adults and
family members to examine their own internalized ageism
and the impact of microaggressive interactions with older
adults in the family. Clinicians can further empower family
members by teaching critical gerontological perspectives
that encourage a deepening of their knowledge of structural
ageism and the social construction of age and how societal
expectations of older adults “encourage their dependence on
systems that serve to enrich others, at their own expense”
(Estes and DiCarlo 2019). Supporting the development of
a critical consciousness with respect to ageism can normal-
ize and place in context the challenges and joys of older
adulthood. Promoting such consciousness can also support
the productive aging of older family members in ways that
encourage their inclusion and active contribution in society
(Gonzales etal. 2015a, b). In so doing, clinicians can simul-
taneously support the empowerment, dignity and self-esteem
of older adults, and optimally encourage their aging well and
productively. More needs to be learned about the resilience
of older adults when confronting microaggressions and age-
ism in the family, and it is hoped that growing awareness of
ageism in the family will lead to further theory development
and evidence that promotes more age-inclusive and affirming
clinical practice in the field.
Acknowledgements The author wishes to thank Professor Ernest Gon-
zales for convening the structural ageism research group and for his
mentoring andeditorial guidance in preparation of this article. The
author also wishes to thank Ms. Jenna Abrams and Ms. Sydney Tack
for their research assistance.
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Stacey Gordon is a DSW student at the Silver School of Social Work at
New York University. She also serves as the Program Director of Next
Phase Adult Caregiving and Retirement at the New York University
Work Life. Requests for reprints of this article should be directed to
stacey.gordon@nyu.edu.
Author's personal copy