In the coming decades, the number of people in the Australian population over the age of 65 is predicted to increase to 23% by the year 2066. The process of physiological ageing is associated with an increase in the presentation of disease pathologies, an increased potential for physical and cognitive deficits and a decrease in health literacy. The ageing of the Australian population presents challenges for the sonography profession including an increasing age gap between the sonographer and their patient as well as increasing complexities in performing ultrasounds on older patients. The natural changes that accompany ageing can create barriers to effective communication between sonographers and their patients. Ageist beliefs can lead to conscious and unconscious bias and unfounded judgements by sonographers decreasing the quality of patient care. To combat the decline in the quality of healthcare that is reported for older patients, sonographers can endeavour to put into place deliberate practical tools and strategies to avoid ageism and improve communication with older patients. Conversely, institutional awareness, education and policies that address age related judgements and bias from older patients towards younger sonographers can foster respectful dialogue, promote understanding and stimulate positive communication across different age groups.