The Commonwealth of Massachusetts’ action plan for creating an age-friendly state includes reframing aging as one of six goals. The plan seeks to “change the conversation about aging from a ‘challenge’ to an ‘asset,’ increase literacy about issues related to aging, and eliminate ageist images and expressions in language across social, print and other media.” The state adopted the action plan in 2018 and submits annual progress reports.
Robin Lipson, deputy secretary of the Executive Office of Elder Affairs (EOEA), remembers traveling around the state five years ago to hear older residents’ concerns and challenges. “We heard a lot about ageism, and about how language can diminish people’s abilities and create assumptions about what people can do and can’t do,” Lipson says. “We continued conversations with partners, including what was then Tufts Health Plan Foundation about seeing this as an opportunity to reframe the conversation and change the language around aging.”
“Ageist stereotypes and implicit and unconscious biases can have a negative impact on health,” says Alrie McNiff Daniels, director of communications and stakeholder engagement for Point32Health Foundation (newly formed when Harvard Pilgrim Health Care Foundation and Tufts Health Plan Foundation combined). “To change pervasive misperceptions about aging and older people, we need to talk about ageism with people of all ages. This project will raise awareness among college students and help them understand how entrenched ageist attitudes influence our behavior in a variety of settings.”
Point32Health Foundation is funding UMass Boston gerontologists to develop and test a reframing aging curriculum for university students. The project is part of the Foundation’s five-year commitment to support the state’s age-friendly action plan. Educating college students is an opportunity to “ change the conversation with several generations to come,” says Lipson.
“Our goal is to create an interactive, integrated module that will be piloted within health professions programs such as nursing, social work, gerontology, and others,” says Caitlin Coyle, PHD, research fellow and adjunct assistant professor of gerontology at UMass Boston. “We want to familiarize students with ageism and its implications for health, teach them how to recognize ageism and the implications of implicit biases, and introduce strategies for reframing their own language so that they can spread those messages forward in their fields of study and professions.”
Coyle and her team are testing the relevance of the course contents this spring with small groups of nursing students and faculty at UMass Boston and other institutions. They will offer the training program in the fall of 2022 with undergraduate nursing students and master’s level Management of Aging Services students at UMass Boston.
“Our undergraduates will be the future nurses of tomorrow,” says Suha Bailout, PhD, RN, a member of the reframing aging project team and an assistant professor of nursing. Ballout directs UMass Boston’s Traditional Nursing Program, which enrolls 900 undergraduates. It’s important to reach all nursing students, she says, regardless of which specialties they may plan to join. “When nurses graduate, they are generalists. Nothing in their licensure stops them from changing specialties. Realistically, a lot of them will work in adult health, and they will interface with older adults throughout their career.”
The new curriculum combines an asynchronous online module with interactive activities. “We have been working on our nursing curriculum, including focusing more on older adults and aging, but we haven’t done justice to the content yet,” Ballout says. “This project represents a new way of delivering course content, likely one of the better ways by having experts put the content together. We want a module that is interactive and we can integrate into our curriculum, and students can integrate the learning outcomes into their practice.”
The question of outcomes intrigues the gerontology researchers, who will be building evaluation follow-ups into the training module. Does reframing how they perceive and talk about aging and older adults merely raise health professionals’ awareness of aging issues, or could it result in better health outcomes?
“The literature review doesn’t show a lot of evidence that suggests better outcomes,” says Coyle. Agrees team member Jan Mutchler, PhD, director of UMass Boston’s Gerontology Institute, “It’s an open question so far about how much the language we use to describe aging and older adults shapes our mindset and behaviors. We are looking at biases and perspective, with a heavy focus on language. By changing language, you can change your perspective.”
The impact of the reframing aging training can spread wider than the workplace, Ballout notes. “We’re not only educating nurses for their jobs. Nurses become resources for their families and their communities. We’re giving them language that helps them serve as a resource about working with older adults.”
The project funders hope the course can be replicated at other institutions. “We think there will be a benefit to sharing this curriculum beyond the health professions,” says Daniels. “But we’ll pilot it with these students and go from there.”