Age discrimination is widespread in health care, the media, the workplace and the marketplace, according to a study released earlier this year by the International Longevity Center-USA, an aging-issues think tank in New York City. A majority of older adults polled reported that they'd been ignored or experienced insensitivity, impatience and condescension from others based solely on their age.

The outcome can be more than just an embarrassing situation. Research shows that individuals receiving this treatment often end up with debilitating lowered self-esteem and self-confidence, as well as sub-standard health care.

ILC-USA's research shows that more than a third of physicians erroneously consider high blood pressure to be a normal part of aging and do not treat the condition in their older patients. Forty percent of older people fail to receive vaccines for flu and pneumonia and 90 percent of people age 65 and over do not receive screening tests for bone density, colorectal and prostate cancer, and glaucoma.

''We all experience times when we feel as if health-care providers, retail clerks, family members or a spouse isn't listening to us,'' says Erica DeFrancesco, occupational therapist at Masonic Healthcare Center in Wallingford, Conn., who offers workshops in assertiveness training for older adults. ''In many cases, that feeling is real and seniors aren't sure what to do.''

Too often, experts say, elderly people respond with passivity or anger.
''We often see situations where adult children are over-involved in a parent's life and decisions. The elder doesn't want to hurt anyone's feelings or say the wrong thing, so they end up saying nothing or getting angry,'' says DeFrancesco. ''In today's health-care situation, patients may only have a few minutes with their doctor and not feel comfortable asking for more time. Assertiveness training offers communication tips and techniques to help seniors handle difficult situations in a more positive manner.''

Many of the ideas associated with assertiveness training were introduced by psychologist Manuel J. Smith in his best-selling book, ''When I Say No, I Feel Guilty,'' published in 1975. The book, which has sold more than 2 million copies, is based on Smith's ''Bill of Assertive Rights,'' including the following:

• You have the right to offer no reasons or excuses for justifying your behavior.
• You have the right to change your mind.
• You have the right to make mistakes -- and be responsible for them.
• You have the right to say, ''I don't know.''
• You have the right to say, ''I don't understand.''

Assertiveness training has been used in the workplace and the military, as part of addiction recovery programs, in treatment for depression and other mental illnesses and in elementary schools to help kids learn how to stand up to schoolyard bullies. DeFrancesco says key aspects of the training are helping people identify situations, evaluate their feelings and needs and recognize what role they play in the circumstance and what they would like as a resolution. They learn to differentiate between assertiveness and aggression, to identify priorities, to make ''I'' statements and become aware of body language.

''Assertiveness training empowers people. It doesn't guarantee you'll get the outcome you want, but it helps you feel more in control,'' says DeFrancesco. ''At the start of the workshop, I ask participants, 'Who are you hurting most by not speaking up?' By the end of the session, they've learned it's themselves.''

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