ashok-krishnaswamiI recently spoke at a local research conference on the topic of Geriatric Cardiology. My first slide was titled “Language Matters”.1    It referred to an editorial where Ms. Nancy Lundebjerg and her coauthors pointed out that the words and phrases chosen to describe older adults, either emanating from conscious or unconscious thoughts, will likely lead to certain actions. In fact, they note that the language currently used has been “an obstacle to convey to the public and policymakers the advances that have been made in healthcare and aging services.”

Furthermore, the language we choose may lead to certain biases that we develop against older adults, the possible beginnings of ageism. Ageism is an “ism”, unlike the other two, that can potentially affect all of us. Although it can be overt it is often unintentional. It refers to the discrimination against older adults “based on negative or inaccurate stereotypes”. To combat these negative or inaccurate stereotypes we must first be aware of them. I am referring to:

  • Words that have become grounded in our day to day thoughts, conversations, and actions.
  • Words that create a false imagery of aging as being only fatalistic.
  • Words or phrases that convey that this is someone else’s problem.
  • Words that editorialize the actual data in a negative manner.
  • Words such as “elderly”, or “seniors”.
  • Phrases such as “silver tsunami”, “tidal wave of aged persons or seniors”

The next step is to change our vocabulary. Some specific recommendations that were made were to:

  1. Use neutral words such as older people, older adults, older Americans (when describing persons aged 65 years and older).
  2. Be inclusive using words such as “we and us.”
    • Avoid the use of words like “aged, elder, elderly, seniors as these often have specific connotations, individual biases and negative imagery.
      • I have often attempted in my clinical encounter notes to go as far as separating the concept of chronological and physiological age by stating: “This is a female of chronological age of 85 years who has no significant cognitive disturbances, a firm social support and has intact instrumental activities of daily living and activities of daily living who presents for further management of her (name disease here).” This goes even a step further and attempts to separate the preconceived imagery based on individual biases when just stating a chronological age.
  3. Use phrases such as: “Older adults are living longer and healthier lives”.
    • Avoid the use of phrases such as “tidal wave,” “tsunami,” and similar catastrophic terms for the growing population of older adults. These phrases serve only to detract from the message and don’t point to the specific facts needed to solve the problem.
  4. In research setting use statements such as: “Our study has demonstrated that older adults had a higher incidence of a certain disease” and “We hypothesize that this is perhaps due to inadequate access to key health resources”. Then suggest improvements that can be made to completely or partially offset the problem. Explain the rationale for the finding in a positivist attitude rather than avoiding it or referring to it in a fatalistic manner.

“Language Mattersis an excellent, timely, factual, editorial that I am sure the entire geriatric and geriatric cardiology community embrace. However, a more important goal should be to disseminate this topic to our non-geriatric inclined colleagues to change the current culture and proudly display the advances that have been made in healthcare and aging services.

For further information please read the entire article that is freely available at

Other important resources in this area of appropriate language and older adults:

Lundebjerg NE, Trucil DE, Hammond EC, Applegate WB. When It Comes to Older Adults, Language Matters: Journal of the American Geriatrics Society Adopts Modified American Medical Association Style. J Am Geriatr Soc. 2017;65(7):1386-1388.


By: Ashok Krishnaswami, MD, MAS

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