Mind Your Language! Promoting the use of age-inclusive language in medical education

Introduction

Some age-related language used by healthcare professionals can be perceived negatively by older people and can harm patient-professional relationships. The British Geriatrics Society (BGS) has published guidance promoting respectful, person-centred language. This two-cycle quality improvement project aimed to evaluate and improve age-related language used within Newcastle University's MBBS programme.

Methods 

Cycle 1 reviewed written materials within the Year 2 curriculum that had particular emphasis on older people's medicine. Ethical approval was therefore not required. We defined older people as those aged ≥65 years or with frailty, multimorbidity or functional impairment.  

Content was evaluated against 2024 BGS guidance, with preferred and non-preferred terminology recorded by frequency and location. Recommended revisions and supporting educational resources were provided to faculty alongside discussion encouraging adoption of recommended language. Cycle 2 reassessed the same materials to examine for changes in language.

Results

Many resources employed recommended terminology, with 79% of terms (293/370) in cycle 1 aligning with BGS guidance. Terms such as “older people” and “multimorbidity” were used instead of the pejorative “the elderly” and “chronically ill.” However, some resources used deficit-focused or diagnosis-first language, such as "frail" and "dementia patient". 

Encouragingly, use of positive terminology such as “people living with dementia” increased in Cycle 2, demonstrating improved person-first language. At conference, illustrative word-clouds will visualise the evolution of terminology use between cycles.

Conclusion 

Aligning terminology with BGS recommendations helped to improve the use of age-inclusive language within our curriculum. Non-preferred terminology was not eradicated entirely, with some terms persisting despite intervention. The key factor that encouraged change was gaining staff support through acknowledging existing optimal language use, rather than simply criticising sub-optimal language. We encourage educators to reflect on language used in their curricula - if we want graduates to speak respectfully about older people, our curricula must model that language.