In contemporary society, age is not just a number; it often becomes a barrier that leads to separation and discrimination, particularly in healthcare for the elderly. This phenomenon, known as ageism, stems from the word “age”.

The term ‘ageism’ – coined by Robert Butler in 1969 – refers to a discriminatory, stigmatizing, and disadvantageous attitude towards the elderly based on their age. In healthcare, ageism is particularly prevalent worldwide. It is seen as a social phenomenon that affects the judgment and treatment of older adults, leading to underdiagnosis, overdiagnosis, or inappropriate therapies.

This pervasive issue has serious consequences for the physical and mental health of the elderly. It restricts access to adequate care, raises healthcare costs, increases social isolation, and deteriorates the quality of life for older individuals.

When elderly individuals are deemed “too old and expensive”, they are often denied access to the best and most advanced therapies. This attitude negatively influences healthcare decisions and the elderly’s perception of aging. In fact, those who adopt negative age stereotypes about aging are more likely to develop physical and mental health issues, thereby increasing their risk of mortality.

Ageism is prevalent in the Italian healthcare system, particularly in cases of cardio-cerebrovascular diseases. These conditions affect over 60% of people over 65 and up to 80% of those over 85 – a population group exceeding 2.2 million in Italy. As individuals age, the recommended pharmacological prescriptions and regular check-ups decrease progressively, halving among those over 85. This results in substantial under-treatment in up to 40% of cases.

From these considerations arises the Carta of Florence, the first manifesto against ageism in healthcare. Published in the Official Journal of the European Geriatric Medicine Society (EuGMS), the document, authored by Andrea Ungar and Luigi Ferrucci, proposes 12 concrete actions to combat age-related prejudices and stereotypes in healthcare, thereby improving the quality and longevity of elderly lives. Among these actions, promoting education and raising awareness among the population, especially the elderly, is essential to dispel the false beliefs that consider old age an inevitable period of decline.

Other essential aspects include improving access to medical care, especially for vulnerable individuals such as those with disabilities or socioeconomic disadvantages. Additionally, it is crucial to ensure that elderly people have priority access to emergency rooms and to develop healthcare facilities that cater specifically to their needs. In these settings, elderly patients should have the opportunity not only to rest but also to engage in self-care, participate in rehabilitation, and socialize, which are all vital for a quicker and more effective recovery.

The Carta of Florence emphasizes the importance of personalized therapies and the collaboration between doctor, patient, and caregiver to ensure that treatment options align with the priorities and preferences of elderly patients.

“Although many healthcare providers worldwide strive to offer advanced treatments to the elderly, 40% are excluded from the best care and clinical trials, which negatively impacts their longevity”, said Ungar, who led the development of the manifesto. “We need a fundamental shift in how we care for the elderly. They should not be treated ‘in pieces’, but rather with a holistic approach by geriatricians, who specialize in managing complex health needs.”

The Carta of Florence was presented during the Anti-ageism Alliance: A Global Geriatric Task Force for Older Adults’ Care congress, organized by the Menarini Foundation and sponsored by the Italian Society of Gerontology and Geriatrics (SIGG). Held in Florence on April 5 and 6, the event gathered presidents of major geriatric societies worldwide, representatives from the World Health Organization and the United Nations, ethics experts, and patient association representatives.

This congress provided a platform to discuss and promote the manifesto’s principles, creating a crucial opportunity to drive concrete actions and improve the care and social treatment of the elderly.

Countering ageism means ensuring that no elderly person is left behind and that everyone has access to appropriate therapies. It is crucial to implement the principles of the Carta of Florence, guaranteeing that every individual – regardless of age – receives the necessary and deserved medical care.