023 Chapter 2 Background 2.3 Impact of ageism on older adults Ageism has serious consequences for older adults’ health and wellbeing. There is consistent and compelling evidence in the literature (which includes longitudinal, cross-cultural, and laboratory studies) demonstrating that ageism can affect people’s health in profound ways. Being exposed to, or having, negative perceptions about ageing have been linked to adverse health outcomes, such as poor physical and psychological health, delayed recovery from disability, decreased memory performance, reduced quality of life and wellbeing, even earlier death.45 Moreover, perceiving older adults as needing protection and treating them in a way that undermines their autonomy or independence – no matter how well-intentioned – can reduce feelings of self-efficacy and competence in older adults.46 One of the most damaging things about ageism is that negative stereotypes about ageing affect not only people’s perceptions of older adults and behaviours towards them, but also how older individuals view themselves and their behaviour. Internalised ageism occurs when negative beliefs about older age become self-directed over time and operate unconsciously. Attributes associated with the ‘typical old person’ tend to become incorporated into the elderly person’s current and future self-views.47 Research shows that internalised ageism can become a self-fulfilling prophecy, in which older adults view themselves in stereotypical ways and act accordingly.48 For example, older adults with internalised negative expectations of the ageing process may not seek treatment for health issues or engage in preventive health behaviours, due to their belief that ageing naturally results in deteriorations in health. This could lead to a more rapid decline in their health than older adults who do engage in healthcare-seeking and preventive behaviours. In contrast, having positive perceptions about older age has been found to be associated with a host of positive health outcomes, including: reduced risk of conditions, such as dementia, cognitive impairment, diabetes, stroke, and heart disease; better functional health; psychological wellbeing; and increased longevity.49 2.4 Ageism among aged care and community workers Aged care and community workers often have close and ongoing interactions with older adults. This makes ageism among this population a particularly serious concern, as it has the potential to directly affect the health, wellbeing, and quality of life of the older adults they support. The Royal Commission into Aged Care Quality and Safety acknowledged the dangers associated with workers’ assumptions about old age and the ageing process.50 It was recognised, for example, that negative assumptions about the ageing process may contribute to older people’s health issues being overlooked and attributed to ‘old age’, while assumptions relating to cognitive decline may lead to social exclusion and disrespectful treatment of older adults. Despite this, much of the focus of the aged care sector has been around the structural defects, regulatory gaps, and institutional practices, while micro (personal) factors, such as ageist attitudes and behaviours by workers, have received comparatively less attention.51