How to Avoid Ageist Language in Aging Research? An Overview and Guidelines

KEYWORDS:

• Ageist
• ageism
• aging
• language
• guidelines

Introduction

Language carries and conveys meaning that feeds assumptions and judgments. However, ageist language is problematic because it perpetuates prejudice (affect), stereotyping (cognition), and discrimination (behavior) against people based on their age. Ageism and ageist language are significant problems in society. Of particular interest in this article is the widespread use of ageist language in research on aging and the need for guidelines to mitigate it.

Generally speaking, research on aging intends to improve the quality of life for older people. However, this well-meaning intention may be futile if ageist language continues to be used. The United Nations Committee on Economic, Social, and Cultural Rights (1995) has rejected the term “elderly” in preference for “older persons.” However, a search on Google Scholar for the term “elderly” in the titles of articles published between 2000 and 2020 returns more than 140,000 results, and a search for the term anywhere within articles returns more than 2,000,000 results. These observations highlight the prevalence of ageist language in the literature.

Thus, in this article, we suggest guidelines for and provide exemplars of age-related language in two areas: language describing older people and language describing activities. In doing so, we hope to address the problem of ageist language and to promote dignified and respectful language use in commentaries and studies on aging. This is in line with the World Health Organization (2021) decade plan of action for combating ageism, in conjunction with the United Nations Decade of Healthy Aging (2021–2030).

Language describing older people

When referring to a person or a group of people over 60 years of age, we encourage using “older person” and “older people,” respectively. The “-er” suffix makes the adjective “old” inoffensive because everyone is older than someone. “Older adult” and “older adults” are also acceptable substitutes for the same reason. The terms “adult” and “adults” are acceptable because they signify biological maturity, whereas the terms “person” and “people” exemplify dignity as human beings. Other terms such as “elder,” “experienced,” “seasoned,” and “senior” can also be used to describe older people respectfully.

When describing the condition of an older person or a group of older people, we encourage using “person-first language” by placing that person or group of people at the front of the descriptive phrase, not at the end. For example, use “a person who has paraplegia” instead of “a paraplegic person” and “a person who has diabetes” rather than “a diabetic person” or “diabetic.”

We also encourage exploring new ways to develop and use respectful language when describing older people. For example, the descriptor “dementia” could be recognized as “the shift in cognitive abilities of how a person experiences the world” or, in short, “changing cognition.” If any of us were to lose a leg, we would learn how to navigate life without it. The same understanding can be extended to dementia. So, instead of using “dementia residents,” “dementia patients,” or even “people with dementia,” one should use “people experiencing cognitive changes” or “people experiencing changing cognitive abilities.” In this regard, we can avoid referring to a person who “suffers from dementia,” which presumes that the experience is negative when, in fact, it could be positive, especially when people can live with this condition and experience life happily and meaningfully.

The label “patient” is overused both in research (e.g., aging studies) and in practice (e.g., professionals working in or surveying nursing homes). The meaning of “patient” is that things (e.g., medical treatments) are performed on the person, putting that person into a passive position. The international culture change movement has as a premise – “put the person before the task.” Thus, we advocate avoiding the term “patient” unless a very medical situation is being referred to in which person-first language would be used instead (e.g., “people receiving medical care or treatment”). Similarly, the label “resident” in assisted living homes is passé – people are people no matter where they live (e.g., use “people living in retirement homes”). As often as possible, refer to the older adult as a “person” or – also very powerfully – an “individual.”

When referring to people in a research project, it is acceptable to refer to them as “participants,” as this word conveys a sense of inclusiveness and independence. Alternatively, if the participant is a “caregiver,” use this term instead of “loved one,” as they may be a professional or friend, not necessarily a spouse, significant other, or relative. However, if a genuine family member is meant, say that. “Care partner” is also acceptable, as this term denotes shared responsibilities in care, which is part and parcel of living normally.

We also wish to highlight that people are not “placed” (or “put”) anywhere. Only “things” get placed or put (e.g., on a shelf), and, thus, words that convey such meaning should be avoided. Similarly, people are not “admitted” and “discharged” from the homes they live in – instead, they “move in” and “move out,” or they “go/come for a stay” (e.g., rehabilitation guests).

“Noncompliant” is a judgmental label; we ask that “(non)compliance” (e.g., with the use of an adaptive device or with a physician’s orders) not be used. Older adults and their preferences are to be respected; “noncompliant” does not honor a person’s agency, choice, or ability to choose. Any use of “difficult” should also be avoided. The same can be said for “behavioral issues or symptoms,” which is overused. To avoid using such terms to describe older people, describe what is meant instead: for example, “when engaging in …, older people find it challenging to … .” An important part of using person-first language is avoiding labeling, and it is thus best to simply describe what is meant, respectfully. For example, instead of “agitation” or “agitated behaviors,” a more precise description is preferable (e.g., “when engaging in …, older people felt uncomfortable with … ”).

The adverb “still” is another word with potential ageist connotations. For example, “the older person still drives” implies that the older person is not normally able to drive. “Still,” and other similar adverbs, should be avoided.

We also concur with the rejection of the term “elderly” by the United Nations Committee on Economic, Social, and Cultural Rights (1995) because the term is commonly associated with negative aspects of aging, such as dependency and frailty. These connotations are inaccurate and misleading because older people can also remain active, independent, and robust. The term “elderly” inappropriately generalizes older people and thus should not be used. However, the word “elder” is acceptable, as it denotes seniority, which respectfully correlates with greater age and lived experience. That is to say, an “-ly” suffix changes the inoffensive word “elder” to the offensive word “elderly.”

Finally, it goes without saying that unfortunate terms such as “aged,” “demented,” and “senile” should never be used.

Language describing activities

When describing activities, we encourage stating the actual activity rather than using terms such as “activity” and “activities.” These terms can be too general and may carry negative connotations (e.g., contrived group activities in an institution, contrary to aspects of healthy and seamless aging, such as dignity, freedom, and quality of life). In this regard, we opine it is best to approach an “activity” in its most basic form (i.e., as something that one does) and describe it as such: for example, “attending a class, course, or training,” “going for exercise,” or “playing a musical instrument.”

We also encourage focusing on what brings purpose and meaningful engagement into older people’s lives, which may or may not relate to an older person’s definition of “leisure” or “recreation.” Specifically, the line between work and leisure or recreation is not always clear because what is leisure or recreation to some may be work to others or vice versa. Focusing on purpose and meaning can help avoid this issue by directing activity implications toward life satisfaction, living well, and successful aging. So, instead of saying “participation in leisure reading,” say “participation in reading.” The field is also increasingly using terms such as “experience” and “(meaningful) engagement” in place of “activities,” which we encourage.

Avoid using the institutional and outdated term “facility” or “institution.” People live in homes and communities, not facilities or institutions. Therefore, do not use “facility,” “institution,” or their manifestations, such as “skilled nursing facility” or “nursing home institution.” Instead, use “assisted living,” “assisted living home,” “assisted living community,” “nursing home,” “nursing home community,” “retirement home,” or “retirement home community.” Combined with the guidelines above, one should say “older people who live in nursing homes,” not “nursing home residents.” This enables us to keep the focus on people and thereby avoid the trap of labeling people and removing their individuality.

Also, consider not using “program,” as this implies short-term, medical, therapeutic, or clinical intervention. For example, instead of “modified Taekwondo program,” say “modified Taekwondo.” Alternatively, the word “class” could be used, as this is more dignified to the older person (e.g., “a modified Taekwondo class”). Adults take classes, and they take them to learn. The term “class” (instead of “program”) is also more progressive, as the act of learning in an educational class holds potential for sustainability by the people who took part. Using language wisely can help to make this happen. Ideally, we want people to continue to use what they have learned in any class. So, instead of saying “brain games, exercise, music, and reminiscing programs,” say “brain games, exercise, music, and reminiscing classes.” Alternatively, avoid the terms “program” and “class” altogether. The terms we are trying to remove can very often just be avoided: notice that “brain games, exercise, music, and reminiscing” is perfectly fine – in this instance, less is more. If an “adult day program” is being referred to, that is different and a part of the title.

Additionally, consider “community supports” instead of “community programs.” “Opportunities” might also be a substitute for “programs”: for example, use “opportunities that provide … ” or even “classes or events that provide … ” rather than “programs that provide … .” If it is a “pilot” or “pilot project,” say that instead of “program.” Likewise, sometimes “initiative” is what is meant, so say that instead. Simply put, “program” is overused and a hallmark of the institution and should thus be avoided wherever possible.

Similarly, the term “intervention” is being replaced, as it also implies short-term, medical, therapeutic, or clinical intervening. Thus, instead of “cognitive intervention studies,” say “cognitive studies.” The much softer alternative widely used is “approach”: for example, “fall reduction approaches” and “a proactive approach to aging well.”

We also suggest avoiding the terms “therapy” and “therapeutic” (in the context of programs), which have been added to many things to elevate their importance in the medical or clinical world – this is known as “scientism.” However, most older people living in a nursing home do not want that. Medical or clinical care is a part of living, and the lives that older people live need to be the focus. If some specific therapy is being referred to, such as “physical therapy,” then this term makes sense; otherwise, each older person should decide what is therapeutic to them. Older people do things all the time that end up being therapeutic to them, but they do not necessarily call these things “therapeutic.” They may take walks, do art, and love their animals, yet these get called “physical therapy,” “art therapy,” and “pet therapy,” respectively, from the medical or institutional perspective. This focus on therapy portrays older people as being sick and therefore in need of therapy, taking real life out of the picture. Instead, what we should really be focusing on is real life for real people. Thus, instead of “ … can be an effective therapeutic program,” say “ … can be effective” and state why it was effective (e.g., what improved).

“Dementia-appropriate” or “age-appropriate” clump people together and thereby patronize individuals and take away individuality. Approaches to descriptions should always be customized to the person, the individual. Our suggestion is to always remain focused on the individual, as staying individualized better resonates with a specific older person than the more general “[any term]-appropriate.”

Similarly, whenever the term “time” is used in the description of an activity (e.g., “bath time,” “snack time,” and “leisure time”), it rings as if children were being talked to and may be patronizing to older people. We are calling this out and encourage all to avoid this usage. It is much more dignified to describe things as they are: for example, “reading” is more precise and dignified than “leisure time.”

Verbs such as “allow,” “let,” or “permit” are – unintentionally, of course – pejorative and patronizing and should therefore be avoided. Prominence should be given to honoring, supporting, and giving opportunity. For example, instead of saying “the Taekwondo program allowed them to interact,” say “the Taekwondo class offered the opportunity to interact.” Instead of “letting them experience something new,” say “creating opportunities for them to experience something new.” Instead of “the facility allows residents to have pets,” say “the home/community supports those who live there to have pets/animals.”

Finally, the COVID-19 pandemic has presented new implications for the way we describe activities. While public health organizations popularized the term “social distancing” in the early days of the pandemic, society swiftly responded by putting forth “physical distancing” to capture the actual intended meaning: the truth of the matter was indeed physical distancing – six feet in fact – not social distancing. More importantly, the pandemic has taught us the importance of socializing, and, thus, we ought to desperately hold onto “social,” even in language. Additionally, instead of saying “virtual,” which actually means not physically existing but made by software to appear so, say “online” (e.g., “online exercise,” “online meeting,” and “online visit”); likewise, use “restricted” instead of “isolate.” Similarly, notice how strong and unnecessary the word “lockdown” is – we are not being locked down physically with a lock; instead, say “ … asked to quarantine or stay home.”

Concluding remarks

To this end, please join us in returning to normal language and nomenclature. For instance, there is no reason to use “air quotes” when referencing normalcy:

Participants were given season tickets, enjoyed public music, attended receptions with fellow community members, and shared support in a “normal” social setting.

Normal is what we are espousing in this article – normal is what is needed. The international culture change movement promotes rampant normalcy, so, of all things, normalcy needs no air quotes.

We conclude with a summary that highlights beautiful (normal) outcomes by showing first a “before” (discouraged) exemplar:

Participation in a Taekwondo intervention activity program can increase confidence, enjoyment, and the experience of physical improvement, and, in this way, it may positively affect the overall mental health of nursing home residents.

and an “after” (encouraged) exemplar:

Participation in Taekwondo can increase confidence, enjoyment, and the experience of physical improvement, and, in this way, it may positively affect the overall mental health of older people living in nursing homes.

To members of the scholarly community: the terms “program” and “intervention” may be used if needed for systematic reviews of the literature. However, whenever using these old words, please join us in advocating for and using new words simultaneously. Consider such a dialogue of shifting language in the discussion and future research agenda sections of literature reviews.

As co-editors-in-chief of Activities, Adaptations & Aging: An International Journal of Dignified and Purposeful Living for Older Adults, we encourage a shift in language in both professional and societal practice and in future applied and scholarly research.

Suggested reading

Bowman, C., Ronch, J., & Madjaroff, G. (2016). The power of language to create culture. Pioneer Network. Retrieved from https://www.pioneernetwork.net/wp-content/uploads/2016/10/The-Power-of-Language-to-Create-Culture.pdf (accessed September 21, 2021).

Disability is Natural. (2021). New ways of thinking and revolutionary common sense. https://www.disabilityisnatural.com/ (accessed September 21, 2021).

Language of Caring. (2021). Language of caring. Retrieved from https://languageofcaring.org/ (accessed September 21, 2021).

Power, A. (2021). Dr. Al Power. https://www.alpower.net/ (accessed September 21, 2021).

Pioneer Network. (2021). Culture change fundamentals. Retrieved from https://www.pioneernetwork.net/resource-categories/culture-change-fundamentals/ (accessed September 21, 2021).

The Eden Alternative. (2021). Words make worlds. Retrieved from https://www.edenalt.org/resources/words-make-worlds/ (accessed September 21, 2021).

Disclosure statement

No potential conflict of interest was reported by the author(s).