AGE BIAS IN STROKE REHABILITATION - EFFECTS ON ADULT STATUS

Loss of adult status is a potential threat throughout the course of adult life. Rehabilitation has not focused on older people, in part, because American cultural beliefs about aging suggest that little can be done medically for those who are old. The case of stroke illustrates conflicts that occur in applying the rehabilitation ethos to older people. Because recovery from a stroke is seldom complete, and because older people who have strokes may have other chronic illnesses and long-standing impairments that precede the stroke, the case of stroke raises questions about how existing rehabilitation practices and policies affect adult status in old age. Based on six years of research with 214 stroke patients and practitioners who cared for them, findings indicate that rehabilitation therapists differentiate patients into two categories: rehabilitation candidates or geriatric care patients. A three-part process is described: (1) the split rehabilitation therapists perceived between providing rehabilitation versus giving geriatric care; (2) the differential treatment of patients categorized as rehabilitation candidates or geriatric care, and (3) patients' response to treatment. It is concluded that widespread negative attitudes about aging in the United States affect assumptions about the rehabilitation of those who are old and extend to illnesses that are associated with old age, such as stroke. As a condition that exemplifies such attitudes, stroke reflects ageism that has been institutionalized in the rehabilitation system's rules and regulations about progress in rehabilitation and perpetuated in the everyday, hands-on practice of rehabilitation with those who are old. Such policies are primarily intended to limit the use of federal and private insurance resources, and it is therefore suggested that rehabilitation policies pose a threat to adult status for the majority of older people.