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it will take them much longer to find a new job compared to younger adults, and they are more likely to receive a pay cut if and when they do find new employment.³¹

      Like any major transition, retirement can significantly impact an older adult's quality of life. Approximately one‐quarter of adults report that their quality of life worsened after retirement. The retirement experience fell short of their expectations for a number of reasons, including boredom, financial worries, or changes in their health status.³² In retirement, older adults should be counselled to participate in social activities, continue to foster connections with friends and family, exercise regularly, and engage in mentally stimulating activities, as all have been positively correlated with increased quality of life and decreased risk of dementia and social isolation.

      The internet and social media

      The use of the internet is becoming a ubiquitous part of life and is rapidly changing among older adults. Research from the Pew Research Center suggests two‐thirds of Americans over 65 utilize the internet.³³ Approximately 4 in 10 older adults own a smartphone, and approximately 30% of the population over 65 utilizes social media regularly. Younger age (i.e. 65–69 years old), higher income, and higher educational attainment are all associated with higher rates of internet usage. As the Baby Boomer population ages and mobile technology continues to become more widely available, it is likely that older adults' engagement with the internet and social media will continue to rise. Barriers to engagement with the internet and technology include a lack of confidence about learning to use new devices and physical handicaps that impede comfort in using handheld devices. A variety of senior centres, libraries, and other community organizations provide educational material and classes specifically for improving senior citizens' technologic literacy.

Internet use can offer many advantages to older adults. For instance, online ordering of goods and services, on‐demand transportation, and online banking can benefit those with impaired mobility. Preliminary studies suggest that using the internet and applications can help older adults manage chronic medical conditions.³⁴ Where available, telehealth allows older adults with limited mobility or who live in rural locations to access primary and speciality care. There is also emerging evidence suggesting that internet use can help combat loneliness and social isolation, although results of studies have been mixed.^35,36 However, older adults are also often preferentially targeted by scammers (see the section ‘Scams and fraud’). Some studies suggest that they may be more susceptible to the spread of misinformation than younger internet users.³⁷ Older adults should be counselled on safe internet use, particularly if they are newly engaging in technology.

      The impact of video and streaming services has been mixed. Patients can and do benefit from high‐quality, educational materials meant to educate them about medical devices, health conditions, or upcoming procedures. However, some self‐proclaimed healthcare gurus on reality television promote questionable or frankly inaccurate medical advice.³⁸ Patients should be sceptical of medical claims made by popular culture figures, particularly claims made outside of the purview of regulating bodies such as the US Food and Drug Administration.

Challenges of ageing

      Older adults are prone to unique challenges and difficulties due to the physiology and societal expectations of ageing. Additionally, challenges common to the human experience impact older adults differently because of myriad factors, such as the accumulation of multiple chronic illnesses, high rates of cognitive impairment and dementia, and a gradual loss of independence.

      Ageism

      In an era of enhanced social awareness, ageism may be one of the last socially acceptable forms of prejudice. Defined as stereotyping, prejudice, or discrimination against people based on their age, ageism is pervasive and takes on many forms. Ageism can be institutionalized in the form of workplace discrimination or an insidious cultural norm that represents older adults as disabled, demented, or undesirable. It even can affect healthcare; providers and patients alike may dismiss disease processes such as delirium and disability as ‘normal ageing’ and miss opportunities for treatment.

      Societal ageist beliefs lead to undervaluing the contributions of older people and providing inadequate resources for them. When older adults are excluded from the workplace due to mandatory retirement ages or other ageist policies, society misses out on critical economic contributions. Additionally, the workplace potentially loses opportunities for wisdom and mentorship by undervaluing experienced senior employees.

Occasionally, in an effort to recognize ageism, the media overcorrects, misrepresenting seniors in an idealistic ‘golden age’ or representing them as ‘cute’, thus unintentionally infantilizing the population. As a society, we should strive for balanced, realistic views of ageing and older adulthood. The Frameworks Institute (www.frameworksinstitute.org) has developed evidence‐based strategies to help individuals and societies combat ageism and improve the global ageing experience. These are summarized in Table 4.1.

      Sensory impairments

      Sensory impairments are common in older adulthood. At least one‐third of older adults have some form of vision impairment, and up to two‐thirds report hearing loss. The causes and treatment of sensory impairment are addressed elsewhere in this book, but it is important to understand how sensory impairments affect older adults' relationships with their surroundings.

Impaired vision can have significant impacts on older adults' quality of life. They have reduced in‐home mobility, reduced ability to drive or navigate public transportation, and increased risk of isolation. Impaired vision particularly affects the ability to engage in leisure activities, and adults with impaired vision report a decline in quality of life related to their leisure time.³⁹ Limitations in self‐care may lead to a loss of independence. For instance, in an Australian study, researchers found that with each line of reduction in presenting visual acuity, there was a 7% increase in the risk of institutionalization.⁴⁰ Vision loss can exacerbate chronic conditions, possibly due to impediments in medication administration and increased risk of falls and fractures. Where available, low‐vision rehabilitation can address the functional deficits accompanying vision loss and should be utilized in addition to standard ophthalmologic care.

Table 4.1 Strategies to combat ageism.

      Source: Based on Frameworks Institute, ‘Reframing Ageing’ (www.frameworksinstitute.org).

Eliminate the ‘othering’ of ageing. Use phrases like ‘When we age …’ or ‘wAs we grow older …’ when discussing processes of ageing.

Reframe ageing. Avoid language like ‘fighting’ or ‘battling’ ageing. Emphasize positive aspects of ageing, including accumulated experience/wisdom and improved life satisfaction. Avoid unrealistic idealism.

Increase awareness of ageism. Use public policy and media to introduce the concept of ageism. Call out examples of ageism when encountered.

Emphasize that social policies influence ageing. Contradict the belief that one's financial and health conditions are solely a result of individual choices. Emphasize how social structures and policies (transportation, housing availability, Social Security) influence ageing.

Appeal to values of justice. Emphasize concrete, systemic examples of ageism such as discrimination and abuse to appeal to societal values of inclusion and equity.

Hearing loss can also have numerous impacts on older adults. Many older adults are not forthcoming about their hearing

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