Infantilizing language is common in the health care industry—emblematic of a larger issue in how the U.S. treats older adults, and particularly older women.
I still remember the first time I heard someone say it. I was a college student and volunteer EMT, hauling a gurney across a nursing home parking lot one humid New Jersey night. My patient, a woman in her 80s, was having a stroke, and paramedics had been dispatched to get an IV into her on the way to the hospital. The medic’s greeting to this woman as I loaded her into the ambulance?
“All right, sweetheart, you just take it easy.”
Maybe that sounds innocuous to you. I get it. “Sweetheart,” “my dear,” “little lady”—these are terms of endearment, after all. And, if you are one of the 54 million Americans over the age of 65 reading this, you may have been addressed this way before. This kind of infantilizing language is common—multiple studies report that talking down to older adults, a majority of whom are women, is endemic to the health care system.
While most would agree this isn’t a crisis on its own—nobody ever died of being called “darling,” and some don’t mind at all—it’s emblematic of a larger issue in how the health care system in the United States treats older adults, and particularly older women. This affects millions of people, as more than half of adults turning 65 today are projected to need long-term medical care in their lifetime.
The consequences are serious.
- Older adults are frequently excluded from research trials and not screened for drug and alcohol abuse or for sexually transmitted infections.
- Signs of elder abuse may also go unnoticed by health care providers who have not been trained to look for them.
- Older women are less likely to receive certain screenings, and they may receive less thorough physical examinations than men of the same age.
- Even pain management is offered to men more frequently and earlier; women in need typically receive it later, thereby suffering longer.
- Most fatal of all, a Yale study found heart attacks and other cardiac issues often present differently in women, and older women are less likely to be correctly diagnosed, receive follow-up preventive therapies even after a heart attack and to receive bypass surgeries. This inequity is compounded for women who are poor, non-white or LGBTQ+.
Given that the Western medical model is cure-focused, the field of gerontology—working with older people who are naturally closer to the end of their lives—is often unappealing to aspiring doctors. Therefore, fewer physicians are specifically trained to work with older adults, let alone enthusiastic about engaging with a group so widely and negatively stereotyped.
And yet, for older adults, experiences of ageism and ageist microaggressions—which have been shown to be acutely stressful for women, perhaps in connection with ageist beauty standards—can trigger a cascade effect of stress responses that can have an ongoing, negative impact on health, including inflammatory effects, depression and heart disease.
That sweltering night in New Jersey, I just as easily could have been the one dismissed as “sweetheart” by the paramedic. In fact, on more than one occasion and due to a bad case of baby-face, I was asked by my patient if I was “old enough to be doing this.”
When I started to experience unnerving neurological symptoms in my mid-20s, I was later told I was “lucky” that my doctor immediately ordered an MRI and issued a diagnosis rather than giving me a condescending pat on the head and suggesting that I “try to relax.” People who are—or are perceived as—very young, female, or both, are also likely to be dismissed by medical professionals or require additional appointments before getting a diagnosis.
Maybe this doesn’t seem connect to my gripe about language. But words matter. The way health care professionals address their patients matters; in those first moments of greeting someone, they are sending a message about how they perceive their relationship to a patient, a relationship informed by status, power, and respect. If you call a 75-year-old woman “sweetheart,” she knows where she stands—and she’s not going to take that sitting down.