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While there is existing literature on medical ethics and geriatric care, this paper offers a unique perspective by examining the specific ethical challenges and obligations faced by pharmacists caring for older people. It provides a comprehensive ethical framework tailored to this specialized area of pharmacy practice. The findings and recommendations presented in this paper have significant implications for enhancing patient-centered, ethically grounded care for older people in pharmacy settings. It offers practical guidance for navigating complex ethical dilemmas and upholding the highest standards of care for this vulnerable population.

Ageism in healthcare has received increased attention in recent years, but literature focusing on how it affects individuals living with rare diseases remains scant. The rare disease population already faces obstacles when navigating health systems, and ageism has the potential to exacerbate existing health inequities. We conducted a systematic review of peer-reviewed and gray literature on health inequities in rare disease populations, seeking to identify publications that reported primary or secondary data on the equitable or inequitable treatment of these populations, or that discussed related regulatory, moral, or philosophical issues. Our aims were to understand how health inequities in these populations arise, how they are justified from societal points of view, how they manifest themselves in laws and regulations, and what effects they have on health care access and health outcomes. We retrieved information from 63 publications, which we inductively synthesized into five categories: ethical discussions, societal preferences, regulations, access to care, and health outcomes. Integrating insights from these categories, we developed an Ethical Spectrum and Resource Allocation Framework, which explains the emergence of equity issues and how they are manifested in health systems. By providing a better understanding of the root causes of health inequities, particularly among older adults, the framework can inform health policymaking, improving access to care and health outcomes for rare disease patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients' decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process., Competing Interests: The authors declare no conflict of interest. Manuel Martínez-Sellés is serving as one of the Guest editors of this journal. We declare that Manuel Martínez-Sellés had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Peter A. McCullough., (© 2022 The Author(s). Published by IMR Press.)

Objectives: The World Health Organization launched a recent global campaign to combat ageism, citing its ubiquity and insidious threat to health. The historical context that promoted this pernicious threat is understudied, and such studies lay the critical foundation for designing societal-level campaigns to combat it. We analyzed the trend and content of aging narratives over 210 years across multiple genres-newspaper, magazines, fiction, nonfiction books-and modeled the predictors of the observed trend., Method: A 600-million-word dataset was created from the Corpus of Historical American English and the Corpus of Contemporary American English to form the largest structured historical corpus with over 150,000 texts from multiple genres. Computational linguistics and statistical techniques were applied to study the trend, content, and predictors of aging narratives., Results: Aging narratives have become more negative, in a linear fashion (p = .003), over 210 years. There are distinct shifts: From uplifting narratives of heroism and kinship in the 1800s to darker tones of illness, death, and burden in the 1900s across newspapers, magazines, and nonfiction books. Fiction defied this trend by portraying older adults positively through romantic courtship and war heroism. Significant predictors of ageism over 210 years are the medicalization of aging, loss of status, warmth, competence, and social ostracism., Discussion: Though it is unrealistic to reverse the course of ageism, its declining trajectory can be ameliorated. Our unprecedented study lay the groundwork for a societal-level campaign to tackle ageism. The need to act is more pressing given the Covid-19 pandemic where older adults are constantly portrayed as vulnerable., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objectives: Media sources have consistently described older adults as a medically vulnerable population during the coronavirus disease 2019 (COVID-19) pandemic, yet a lack of concern over their health and safety has resulted in dismissal and devaluation. This unprecedented situation highlights ongoing societal ageism and its manifestations in public discourse. This analysis asks how national news sources performed explicit and implicit ageism during the first month of the pandemic., Method: Using content and critical discourse analysis methods, we analyzed 287 articles concerning older adults and COVID-19 published between March 11 and April 10, 2020, in 4 major U.S.-based newspapers., Results: Findings indicate that while ageism was rarely discussed explicitly, ageist bias was evident in implicit reporting patterns (e.g., frequent use of the term "elderly," portrayals of older adults as "vulnerable"). Infection and death rates and institutionalized care were among the most commonly reported topics, providing a limited portrait of aging during the pandemic. The older "survivor" narrative offers a positive alternative by suggesting exceptional examples of resilience and grit. However, the survivor narrative may also implicitly place blame on those unable to survive or thrive in later life., Discussion: This study provides insight for policy makers, researchers, and practitioners exploring societal perceptions of older adults and how these perceptions are disseminated and maintained by the media., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Commentaries have suggested that initial emphasis on the higher susceptibility and mortality rates of older adults to COVID-19 has instigated ageism within the public discourse and policy decisions. Using the health belief model, the current study examined ageism in interaction with other factors influencing intention to social distance. Methods: Threat of contracting COVID-19, benefits and barriers to social distancing, benevolent and hostile ageism, and intention to social distance were examined in 960 adults ( M = 37.81 years, SD = 11.65). Results: Benevolent and hostile ageism were significant moderators for both perceived threat and barriers on intent to social distance; hostile ageism also moderated benefits on intent to social distance. Discussion: The current study demonstrates how ageism influences behavior during a pandemic. With initial reports of COVID-19 presenting older adults as a homogenous group, ageism negatively interacted with intention to social distance and may place older adults at greater risk.

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future., (© 2021. Springer Nature Switzerland AG.)

The COVID-19 global crisis is reshaping Canadian society in unexpected and profound ways. The significantly higher morbidity and mortality risks by age suggest that this is largely a "gero-pandemic," which has thrust the field of aging onto center stage. This editorial emphasizes that vulnerable older adults are also those most affected by COVID-19 in terms of infection risk, negative health effects, and the potential deleterious outcomes on a range of social, psychological, and economic contexts - from ageism to social isolation. We also contend that the pathogenic analysis of this pandemic needs to be balanced with a salutogenic approach that examines the positive adaptation of people, systems and society, termed COVID-19 resilience. This begs the question: how and why do some older adults and communities adapt and thrive better than others? This examination will lead to the identification and response to research and data gaps, challenges, and innovative opportunities as we plan for a future in which COVID-19 has become another endemic infection in the growing list of emerging and re-emerging pathogens.

Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low-income, less industrialized countries of the global South, using sub-Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in high-income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world., (© 2020 The Hastings Center.)

Objective: This study addresses older employees' trajectories of perceived workplace age discrimination, and the long-term associations among perceived age discrimination and older workers' mental and self-rated health, job satisfaction, and likelihood of working past retirement age. We evaluate the strength and vulnerability integration (SAVI) model., Method: Three waves of data from employed participants were drawn from the Health and Retirement Study (N = 3,957). Latent growth modeling was used to assess relationships between the slopes and the intercepts of the variables, thereby assessing longitudinal and cross-sectional associations., Results: Perceived workplace age discrimination tends to increase with age, although notable variance exists. The initial status of perceived age discrimination relates to the baseline statuses of depression, self-rated health, job satisfaction, and likelihood of working past retirement age in the expected directions. Over time, perceived age discrimination predicts lower job satisfaction and self-rated health, as well as elevated depressive symptoms, but not likelihood of working past retirement age., Discussion: This study provides empirical support for the SAVI model and uncovers the "wear and tear" effects of perceived workplace age discrimination on older workers' mental and overall health. We deliberate on social policies that may reduce age discrimination, thereby promoting older employees' health and ability to work longer., (© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: With our rapidly aging population, it is critical to understand biases toward older people and what can be done to reduce ageism. Intergenerational contact can improve attitudes towards older people, but the effect of inclusion of outgroups in the self (IOS) in the context of intergenerational contact remains unexplored. In addition, stereotypes of warmth and incompetence may be affected differently by contact experiences and have different roles in effecting change in ageist attitudes., Method: In this study, we modeled the relationships between intergenerational contact, IOS, and stereotypes of warmth and incompetence in predicting attitudes towards older adults in a young community sample (n = 302; 18-30-year olds)., Results: We found that positive contact with one older adult reduced incompetence stereotypes both directly and through an increase in IOS, and both the increase in IOS and the decrease in incompetence stereotypes predicted better attitudes towards older adults. Incompetence stereotypes were a stronger predictor of age-related attitudes than warmth stereotypes., Discussion: This suggests that interventions aimed at improving ageist attitudes through intergenerational contact should focus primarily on disconfirming incompetence stereotypes instead of merely increasing warmth perceptions, which could be done in part by increasing cognitive overlap with older adults., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Evidence suggests that agist biases may operate implicitly (i.e., automatically and unconsciously) to affect discriminatory attitudes and behaviors toward older adults. However, few studies have tested the malleability of implicit age bias. The present study tests the effect of a framing intervention on implicit age bias in a nationally representative sample of American adults., Method: Participants (N = 767) were randomly assigned to read 1 of 3 framed messages, to an unframed message about aging, or to a control message unrelated to aging. Framed messages emphasized (a) the contributions of older adults to society; (b) aging as a process of accumulating wisdom and energy; and (c) mechanisms through which prejudice against older adults operates. Participants subsequently completed an aging implicit association test (IAT) to assess implicit bias., Results: Relative to the control condition, participants in the 3 framed message conditions displayed lower implicit age bias. No differences were observed between participants in the control condition and those who read the unframed message., Discussion: Findings indicate that reframing messages about aging can decrease implicit bias against older adults. This study highlights ways for communicators to promote a positive understanding of the aging process, thereby mitigating sources of implicit prejudice., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study investigated the perceived acceptability of benevolent and hostile ageist behaviors targeting older adults and whether the acceptability varied depending on the age of the perceiver and the relationship between the person engaging in the ageist behavior and the recipient of the ageist behavior., Method: Young, middle-aged, and older adult participants rated the acceptability of 13 benevolent and 17 hostile ageist behaviors targeting older adults for five different relationship types: younger family members, same-age family members, familiar service workers, unfamiliar service workers, and friends., Results: Participants, regardless of age, rated benevolent ageism to be more acceptable than hostile ageism. Young adults were more accepting of hostile ageist acts than middle-aged and older adults were. However, overall acceptability of hostile ageist acts was low. Familiarity with the perpetrator also affected perceptions of the acceptability of ageist acts., Discussion: Perceptions of the acceptability of ageism targeting older adults differed as a function of participant age, ageism type, and relationship type. Findings are discussed in light of social identity theory and intergroup contact theory., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: This study examines the role of work-related perceived age discrimination on women's mental health over the life course and tests whether financial strain mediates this relationship., Methods: Using the National Longitudinal Survey of Mature Women (1967-2003), we employ nested growth curve models to evaluate whether perceived age discrimination at work influences women's depressive symptoms and life satisfaction and whether perceived financial strain mediates this relationship., Results: Women who experienced age discrimination had greater overall depressive symptoms but not after controlling for financial strain. We found evidence that age discrimination affected financial strain, which, in turn, increased women's depressive symptoms. Women who reported age discrimination had lower odds of being in higher categories of overall life satisfaction; financial strain partially mediated the relationship but age discrimination remained a significant predictor., Discussion: Despite legal protection, age discrimination at work is frequent and has significant effects on women's mental health over the life course. Financial strain partially mediates this relationship, pointing to financial implications of perceived age discrimination for women and their families. Our findings have important policy and workplace implications, calling attention to ageism as a potent stressor for working women's mental health beyond those tied to sex or race., (© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

This article provides an integrative presentation regarding ageism within the professional culture of gerontological research by examining the operationalization of subjective age, a construct most commonly assessed by asking an individual to report how "old" they feel. According to the life span perspective [Baltes, P. B. (1987). Theoretical propositions of lifespan developmental psychology: On the dynamics between growth and decline. Developmental Psychology, 23, 611-626] and the life course perspective [Elder Jr, G. H. (1975). Age differentiation and the life course. Annual Review of Sociology, 1(1), 165-190.], growing older represents a complex, multidirectional process that encompasses maintenance, growth and decline as well as cultural factors that influence development. Viewing the construct of subjective age from these perspectives casts doubt on the validity of its operationalization. This article argues that operationalizing subjective age in this manner contributes to the dominant societal view of aging as decline by perpetuating the use of the term "old" as an undesirable state. As well, we purport that as gerontological researchers and scholars our professional code of ethics requires us to examine the unintentional communication and perpetuation of ageism by focusing attention on our own use of language.

Gerontologists have proposed different concepts for ageing well such as 'successful ageing', 'active ageing', and 'healthy ageing'. These conceptions are primarily focused on maintaining health and preventing disease. But they also raise the questions: what is a good life in old age and how can it be achieved? While medical in origin, these concepts and strategies for ageing well also contain ethical advice for individuals and societies on how to act regarding ageing and old age. This connection between gerontology and ethics is overlooked by both schools of thought. We thus develop this research programme for a systematic geroethics in four steps. First, we analyze 'successful ageing' as put forward by Rowe and Kahn as a paradigmatic example of a gerontological conception of ageing well. Then, in a second step, we move from criticisms within gerontology to an ethical perspective; in particular, we want to clarify the problem of the claim of universal validity of conceptions of the good life. In a third constructive step, we explain how the 'capabilities approach' could be applied in this context as a normative foundation for the implicit normative assumptions of gerontological conceptions of ageing well, such as a particular choice of functionings, the ethical relevance of human agency, and the resulting claims of individuals towards society. Finally, using a concept developed by the German philosopher Ursula Wolf, we systematically develop the different aspects of the connection between ageing well and the theory of the good life in their full complexity and show their interconnectedness., (© 2018 John Wiley & Sons Ltd.)

Purpose: The widespread use of ageist language is generally accepted as commonplace and routine in most cultures and settings. In order to disrupt ageism, we must examine the use of ageist language and sentiments among those on the front line of providing advocacy, services, and policy for older adults; the professional culture of the aging services network. The recorded video segments from the sixth White House Conference on Aging (WHCOA) provided a unique opportunity to examine discourse used by professionals and appointed representatives in the field of aging within a professional sociocultural context., Design and Methods: A qualitative discourse analysis of video recordings was used to analyze the 15 video fragments that comprised the recorded sessions of the 2015 WHCOA., Results: About 26 instances were identified that captured statements expressing personal age, aging or an age-related characteristic negatively in regard to self or other (microageism), and/or statements expressing global negative opinions or beliefs about aging and older adults based on group membership (macroageism). A theoretical pathway was established that represents the dynamic process by which ageist statements were expressed and reinforced (relational ageism)., Implications: Numerous instances of ageism were readily identified as part of a live streamed and publically accessible professional conference attended and presented by representatives of the aging services network. To make meaningful gains in the movement to disrupt ageism and promote optimal aging for all individuals, we must raise awareness of the relational nature, expression, and perpetuation of ageism.

In this article, we sought reconciliation between the "body-as-representation" and the "body-as-experience," that is, how the body is represented in discourse and how the body of older people with cognitive impairment is experienced. We identified four contemporary "technologies" and gave examples of these to show how they influence how older people with cognitive impairment are often represented in acute care settings. We argued that these technologies may be mediated further by discourses of ageism and ableism which can potentiate either the repressive or productive tendencies of these technologies resulting in either positive or negative care experiences for the older person and/or their carer, including nurses. We then provided examples from research of embodied experiences of older people with dementia and of how nurses and other professionals utilized their inter-bodily experiences to inform acts of caring. The specificity and individuality of these experiences were more conducive to positive care experiences. We conclude the article by proposing that the act of caring is one way nurses seek to reconcile the "body-as-representation" with the "body-as-experience" to mitigate the repressive effects of negative ageism and ableism. The act of caring, we argue, is the essence of caring enacted through the provision of person-centred care which evokes nurses to respond appropriately to the older person's "otherness," their "variation of being" while enabling them to enact a continuation of themselves and their own version of normality., (© 2016 John Wiley & Sons Ltd.)

Consideration of the effects of aging on physicians' practice is crucial to addressing aging clinicians' competence, that is, their ability to practice with reasonable skill and safety. Given physician workforce shortages even in resource abundant countries, the establishment of a compulsory retirement age in the US is impractical and unlikely. Several US hospitals and institutions have sought to address concerns about competence by establishing mandatory age-linked testing and evaluation for physicians. However, these procedures have raised questions regarding age discrimination and test validity., (© 2016 American Medical Association. All Rights Reserved.)

In many societies, the aging of the population is becoming a major problem. This raises difficult issues for ethics and public policy. On what is known as the fair innings view, it is not impermissible to give lower priority to policies that primarily benefit the elderly. Philosophers have tried to justify this view on various grounds. In this article, I look at a consequentialist, a fairness-based, and a contractarian justification. I argue that all of them have implausible implications and fail to correspond to our moral intuitions. I end by outlining a different kind of consequentialist justification that avoids those implications and corresponds better to our considered moral judgments., (© 2014 John Wiley & Sons Ltd.)

Introduction: Cancer societies, research cooperatives, and countless publications have urged the development of clinical trials that facilitate the inclusion of older patients and those with comorbidities. We set out to determine the characteristics of currently recruiting clinical trials with hematological patients to assess their inclusion and exclusion of elderly patients., Methods: The NIH clinical trial registry was searched on July 1, 2013, for currently recruiting phase I, II or III clinical trials with hematological malignancies. Trial characteristics and study objectives were extracted from the registry website., Results: Although 5% of 1,207 included trials focused exclusively on elderly or unfit patients, 69% explicitly or implicitly excluded older patients. Exclusion based on age was seen in 27% of trials, exclusion based on performance status was seen in 16%, and exclusion based on stringent organ function restrictions was noted in 51%. One-third of the studies that excluded older patients based on age allowed inclusion of younger patients with poor performance status; 8% did not place any restrictions on organ function. Over time, there was a shift from exclusion based on age (p value for trend <.001) toward exclusion based on organ function (p = .2). Industry-sponsored studies were least likely to exclude older patients (p < .001)., Conclusion: Notably, 27% of currently recruiting clinical trials for hematological malignancies use age-based exclusion criteria. Although physiological reserves diminish with age, the heterogeneity of the elderly population does not legitimize exclusion based on chronological age alone. Investigators should critically review whether sufficient justification exists for every exclusion criterion before incorporating it in trial protocols., (©AlphaMed Press.)

The literature on patient-physician interactions has largely ignored the perspectives of older adults with multiple morbidities. Featuring in-depth interview data from 16 men and 19 women with an average of six chronic conditions, this study focused on how participants perceived and experienced the care provided by their primary care physicians. Participants suggested that physicians caring for patients with multiple chronic conditions should be thorough, amenable to gate keeping, trustworthy, and open to different decision-making styles. However, many study participants perceived that they received inadequate care due to the personal failings of their physicians, constraints of medical consultations, and societal ageism. Consequently, many of the participants, especially the women, employed various strategies to maximize the care they received and manage their physicians' impressions of them as worthy patients. Our findings suggest that elderly patients with multiple morbidities perceive that their health needs are not being adequately met.

This contribution formulates several key statements concerning a critical gerontology and is intended as a starting point for further thought and discussion from the perspective of critical social sciences. In terms of scientific theory, it follows a concept of normative universalism, distinguishing itself from a mere "science of order", which would be restricted to social self-observation. The assumptions focus on dealing with the social construct of age(ing) under the conditions of modern capitalist societies and on putting age(ing) into context with neo-liberal economic and social politics. This contribution explains some aspects of restructuring the German welfare state into an "activating state", a process accompanied by the casualisation of many older people's life circumstances. Moreover, some cultural perspectives of self-determined life in old age are demonstrated, which invariably should also be seen as a learning task. In this way, the complex interactions between gerontology and social and political practice in terms of praxeological and critical research are covered in their totality. At the same time, critical gerontology is oriented towards what is humanly possible and attempts to identify restrictions to a fulfilling life in old age and to suggest perspectives of how such restrictions can be overcome. The aim is to reflect on our own professional behaviour, to make it more compatible theoretically with critical scientific discourses on ageing and thus contribute to the emancipation of older people from discourses of dominance.