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Hailey ODonnell & Jonathan Stamler

Thunder Bay, ON, P0W1L0

(807)275-8303 &
Sept. 3, 2014
Ministry of Health and Long-Term Care
11th Floor, Hepburn Block
80 Grosvenor Street
Toronto, Ontario M7A 2C4
Dear Hon Dipika Damerla,

We are currently enrolled in the 4th year of BScN Nursing at Lakehead University and are
writing influentially independent. We have received education on geriatric care and normal ageing
changes. This education has increased our awareness of the detrimental impact of ageist beliefs and
myths of older adult care. Through this awareness we reflected on our experiences and observed
that some healthcare providers explicitly and implicitly direct their care in accordance to these
ageist beliefs. Both nursing and medical scholars agree on the necessity of having educated
healthcare providers (Boltz, 2012; Sinha, 2013). The false beliefs that many pathological
conditions are actually due to normal ageing changes have appalling implications for client care and
quality of life (Brown, Kother, & Wielandt, 2011). Such misconceptions are innumerable; however,
three common erroneous beliefs that will be identified in this letter for the sake of demonstration
are the belief that pain, urinary incontinence, and constipation are all consequences of ageing.
"Without continued investment in healthcare professionals' education, the vision of high quality,
guideline-driven, evidence-based health care will never come to fruitition,"(Fletcher, 2007).
Pain is widespread: 80-85% of persons older than 65 will experience pain due to a
significant health problem at some point in time (Miller, 2012)."If chronic pain is inadequately
treated, there may be deleterious effects that are far reaching, including decreased energy, difficulty
concentrating, serious loss of sleep, depression, physical disability, and impaired quality of life,"
(Bernhofer, Sorrell, 2012). Considering the high prevalence and effects of pain, pain control and
alleviation is a key factor in preserving quality of life in older adults (Cwajda-Biaasik, Szewczyk,
Mocicka, & Cierzniakowska, 2012). However, due to the lack of education and ageist assumptions,
many health care providers hold the false belief that older adults have a higher pain tolerance, that
people with dementia don't have pain, and that older adults cannot tolerate opiates (Miller, 2012).
Like all ageist presumptions, these beliefs will alter quality of life. Through continuous education
healthcare providers may provide high quality, guideline-driven, evidence-based health care, and
may abolish this presumption so that proper pain control may be maintained (Fletcher, 2007; Sinha,

According to the International Continence Society (ICS), urinary incontinence is the

involuntary leakage of urine. Urinary incontinence can negatively impact quality of life by leading
to falls, injury, skin conditions, urinary tract infections, eventual loss of ability to perform activities
required to be independent, and it may even alter an individuals self-concept (Keilman, 2010). As
a result, clients may become socially isolated (Baum, 2006). Failure to recognize that urinary
incontinence is not a normal ageing change and that it is a significant nursing issue acts as a barrier
to health care providers from investigating and treating the actual cause (2010). Again, from our
own experience, we have witnessed that the presumption of urinary incontinence being a normal
ageing change results in: the condition merely being managed through the use of costly health care
resources, such as the use of Attends and catheters instead of it being treated and potentially
Deconditioning is not indicative of ageing, rather it is a common, preventable process
following a period of inactivity or bed rest that results in muscle wasting and decreased functional
ability (Gillis, MacDonald, MacIsaac, 2008, p. 547). Victims of deconditioning may become unable
to perform activities of daily living independently, they may lose opportunities to engage socially,
and they may experience an impaired body image and self-concept; thereby, significantly altering
quality of life (Eliopoulos, 2010). "This decline in functional ability results in increased length of
stay, higher hospital costs, and increased risk of temporary or permanent institutionalization for
patients who were able to live at home prior to the admission," (Raj, Munir, Ball, Carr, 2007). Early
detection and prevention of deconditioning is acknowledged as a hallmark of quality practice
(Gillis, MacDonald, MacIsaac, 2008). Deconditioning can occur in as little as two days; therefore,
it is especially problematic that it is often unrecognized and untreated by many uninformed
healthcare providers (2008). The consequences of deconditioning a catastrophic and costly (ie.
prolonged wound healing, risk of respiratory infections); therefore, it is paramount that healthcare
providers are aware of this issue. Activities as simple as ambulation and range of motion exercises
can significantly reduce the prevalence of deconditioning.
Given the risks attributable to ageist misconceptions impacting older adults, we urge you to
provide funding for continuous educational initiatives and advocate for a change in health-care
regulations that will demand mandatory participation in such educational initiatives for all
healthcare workers (ie. personal support workers, nurses, physicians, ect). This would ensure that
current healthcare workers and students entering the healthcare system are adequately prepared to
provide high quality, guideline-driven, and evidence-based health care (Fletcher, 2007; Sinha,
2013). Without a clear understanding of normal ageing changes, clients can unfortunately suffer
Thank you for your time and appreciation concerning this crucial issue.

Jon & Hailey

Baum, N. (2006). Urinary Incontinence in the Geriatric Patient. Clinical Geriatrics, 14(4).
Retrieved August 2, 2013, from

Bernhofer,, E. I., & Sorrell, J. M. (2012). Chronic Pain in Older Adults. Aging Matters, 50(1), 1923. Retrieved August 2, 2013, from the CINAHL database.
Brown, C. A., Kother, D. J., & Wielandt, T. M. (2011). A critical review of interventions addressing
ageist attitudes in healthcare professional education. Canadian Journal of Occupational
Therapy, 78(5), 282-293. Retrieved August 2, 2013, from the CINAHL database.
Cwajda-Biaasik, J., Szewczyk,, M. T., Moscicka, P., & Cierzniakowska, K. (2012). The locus
of pain control in patients with lower limb ulcerations. Journal of Clinical Nursing, 21,
3346-3351. Retrieved August 2, 2013, from the CINAHL database.
Eliopoulos, C. (2010). Gerontological nursing (8th ed.). Philadelphia: Lippincott Williams &
Fletcher, M. (2007). Continuing education for healthcare professionals: time to prove its worth.
Primary Care Respiratory Journal, 16(3), 188-190. Retrieved August 2, 2013, from the
CINAHL database.
Gillis, A., MacDonald, B., & MacIsaac, A. (2008). Nurses' knowledge, attitudes, and confidence
regarding preventing and treating deconditioning in older adults. Journal of Continuing
Education in Nursing, 39(12), 547-554. Retrieved August 2, 2013, from the CINAHL
Keilman, L. J., & Dunn, K. S. (2010). Knowledge, Attitudes, and Perceptions of Advanced Practice
Nurses Regarding Urinary Incontinence in Older Adult Women. Research and Theory for
Nursing Practice: An International Journal, 24(4), 260-279. Retrieved August 2, 2013,
from the CINAHL database.
Miller, C. A. (2012). Nursing for wellness in older adults (6th ed.). Philadelphia: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
Sinha, S. K. (2013). Living longer, living well highlights and key recommendations from the report
submitted to the Minister of Health and Long-Term Care and the Minister Responsible for
Seniors on recommendations to inform a seniors strategy for Ontario. Toronto, Ont.:
[Ontario Ministry of Health and Long-Term Care].