Ageism: The Last Frontier
Ageism starts when we are tiny. Children as young as three can tell old people from others. Unlike being born into the same race, class or nationality, ageism is in acategory all its own. We are not confronted with how to cope with it until we are old ourselves, and our parents are gone. Often they were also brainwashed into believing that being older was awful, something to fear. Despite enormous improvements in diet health and medicine, ageism is at an all time high. Teenagers are using botox. Let’s turn this unimaginative, stale, and boring mindset upside down!Ageism is one of the last socially acceptable prejudices. Psychologists are working to change that Psychologists are examining the age discrimination that pervades American culture and helping people to reimagine healthier relationships with their older selves. By Kirsten WeirDate created: March 1, 2023 11 min read This is taken from the APA Monitor: Closing in on a prejudice that has been normalized.Vol. 54 No. 2Print version: page 36 Older Adults and AgingRacism, Bias, and Discriminatio
From “antiaging” face creams to wisecracking birthday cards about getting older to “OK, boomer” memes, the message is clear: Being old is something to avoid. Never mind that, if we have the good fortune to live a long life, inaccurate stereotypes about aging will harm all of us.
Ageism is defined as discrimination against older people because of negative and inaccurate stereotypes—and it’s so ingrained in our culture that we often don’t even notice. Most organizations now have diversity, equity, and inclusion (DEI) departments to tackle issues such as racism and gender bias. Even in those departments, age bias is seldom on the radar. “Ageism is this odd ‘-ism’ in that it’s still socially acceptable in many ways,” said Joann Montepare, PhD, director of the RoseMary B. Fuss Center for Research on Aging and Intergenerational Studies at Lasell University in Newton, Massachusetts, and past president of APA’s Division 20 (Adult Development and Aging).
It is clear, however, that ageism has a host of negative effects, for people’s physical and mental well-being and society as a whole. What’s more, the negative stereotypes that fuel ageism often get aging all wrong. “When we say aging isn’t all negative, it’s not that we are putting on rose-colored lenses. This is based on rigorous science,” said Manfred Diehl, PhD, a professor of human development and family studies at Colorado State University who studies healthy aging.
Researchers and activists, including many psychologists, are drawing on that science to reframe attitudes toward aging. In 2020, APA adopted a new Resolution on Ageism (PDF, 127KB) that recognizes age as a risk factor for discrimination, encourages more emphasis on aging in psychology training, and advances a more productive public narrative about the benefits of longer life spans. “The question is, what can we do as individuals and also as a society to promote more positive aging?” See Video Here
Aging stereotypes, busted
Ageism is a stubborn prejudice. People of all ages show bias against older adults, though the way they express it changes over the life span. Among younger people, the preference for other young adults is more explicit. In older adults, that preference becomes more implicit (Chopik, W. J., & Giasson, H. L., Gerontologist, Vol. 57, Suppl. 2, 2017).
Either way, the attitudes that underlie age bias are often rooted in falsehoods. While it is true that the risk of some chronic diseases and dementia increases with age, most older adults maintain quite good health and cognitive functioning. “Aging is a very diverse process, and there are great differences between individuals,” Diehl added. “Things usually aren’t as bleak as most people expect.”
Becca Levy, PhD, a professor of epidemiology at Yale School of Public Health and of psychology at Yale University, works to chip away at age stereotypes with a fact-checking approach for public awareness. In her recent book, Breaking the Age Code: How Your Beliefs About Aging Determine How Long and Well You Live, she took aim at more than a dozen beliefs about getting older. “In every case, I found information that not only contradicted the negative stereotype but also highlighted a strength that comes with aging,” she said. Take the stereotype that people become less creative as they get older. Researching her book, Levy found a host of examples of artists and musicians who became more creative and more generative later in life.
Levy also upends the stereotype that all types of cognitive abilities inevitably worsen with age. It’s true that some cognitive skills, such as reaction times, tend to slow a bit over time. But other functions remain robust and even improve. One study of older adults, for instance, showed they were better than middle-age adults at orienting their attention and ignoring distractions (Veríssimo, J., et al., Nature Human Behaviour, Vol. 6, No. 1, 2022).
Getting older affords other benefits. As people age, they tend to become more agreeable and more conscientious. Older adults also tend to be better at regulating their emotions. “These are positive changes that can lead to overall greater social maturity,” Diehl said. “These changes often mean we get along better with others, and we may pay better attention to health or put ourselves in fewer risky situations.”
Such changes may be partly responsible for another observed phenomenon, known as the paradox of aging, said Karl Pillemer, PhD, a sociologist and professor of psychology and gerontology at Cornell University. “Older people tend to report greater happiness and life satisfaction compared to younger people,” he said.
Some researchers have debated the evidence for this so-called happiness curve, a U-shaped trend in which happiness levels are lowest at midlife. But in a recent analysis, economist David Blanchflower took a comprehensive look at data from 145 countries and concluded that, in fact, happiness sinks to a low-water mark in middle age before increasing again through later adulthood (Journal of Population Economics, Vol. 34, No. 2, 2021). Other research suggests that, contrary to popular belief, mental health also improves across the life span (Thomas, M. L., et al., Journal of Clinical Psychiatry, Vol. 77, No. 8, 2016). “This view that old age is all negative decline just doesn’t seem to be the case,” Pillemer said.
How ageism harms
The negative view of late life isn’t just false. It’s also dangerous. “The narrative that age is decline, age is burden, hurts everyone: individuals, families, communities, and society,” said Nancy Morrow-Howell, PhD, a professor of social policy and expert in gerontology at Washington University in St. Louis. “Some older adults do need support, but mostly they’re giving it,” she added. “They make important contributions to the workforce, including paid work as well as volunteering and caregiving. Those contributions to society are a resource, not a luxury.”
Ageism in the workplace affects hiring and promotion decisions. In medical settings, stereotypes associated with aging may influence treatment decisions. People may incorrectly assume older adults are too frail for more aggressive cancer therapies, for instance. In the mental health field, most psychotherapists don’t receive adequate education in geropsychology, and age bias and stereotypes can influence their attitudes and practices. In a chapter on ageism and mental health, evidence revealed that many psychotherapists exhibit a preference against working with older patients, assume less favorable prognoses for older patients, and believe that depression is a natural consequence of older age (Bodner, E., et al., in Contemporary Perspectives on Ageism, Springer, 2018).
Internalized messages about aging also influence a person’s health and well-being—a connection Levy has documented in numerous studies. As a graduate student, she took a research trip to Japan to explore why the Japanese had the longest life spans in the world. “One of the first things I noticed was how differently older people there were treated,” said Levy. “They were celebrated in families, on TV shows, in comic books.”
Today, Levy’s research explores how societal messages about aging impact a person’s health and well-being. Experimental research, longitudinal studies, and cross-cultural comparisons of age-related beliefs all point to one conclusion: “People who take in more negative age beliefs tend to show worse physical, cognitive, and mental health. But the good news is that those who are exposed to or develop more positive age beliefs tend to show benefits in physical, cognitive, and mental health,” she said.
Age-related beliefs affect health in multiple ways, Levy has found. Those who have more negative feelings about getting older are more likely to experience higher levels of stress, which has been linked to many diseases of aging. Also, people who feel fatalistic about getting older may be less likely to engage in healthy behaviors such as staying active or taking prescribed medications.
Together, those mechanisms can have significant impacts on health. In one study, for instance, Levy and her colleagues showed that positive beliefs about aging protect against dementia, even among those with a high-risk gene (PLOS One, Vol. 13, No. 2, 2018). But the effects extend beyond dementia. She has also found that negative self-perceptions of aging are associated with a higher prevalence for all of the eight most expensive health conditions among Americans, which include heart disease, lung disease, diabetes, musculoskeletal disorders, and injuries. She calculated that the cost of ageism in the United States was $63 billion per year—one of every seven dollars spent for those eight conditions (The Gerontologist, Vol. 60, No. 1, 2020).
Challenging ageist stereotypes
Given the stakes, there are good reasons to challenge age-related stereotypes and age bias. Such efforts are beginning to bear fruit. In a systematic review, Pillemer and colleagues found that interventions to reduce ageist stereotypes and prejudice are often effective (Burnes, D., et al., American Journal of Public Health, Vol. 109, No. 8, 2019).
The most effective interventions combine education about aging with efforts to increase intergenerational contact, Pillemer found. “One of the biggest threats to reframing attitudes toward aging lies in the increasing age segregation of American society. We’re in the midst of a dangerous experiment where young people have almost no contact with older people outside of intermittent contacts in their own families,” he said.
Yet contact alone is not always enough to challenge false ideas about late life. “You often see events that bring young people into nursing homes to give concerts or do activities with older adults, for example. But if young people aren’t prepared for interpreting that experience, they can actually leave with more negative views of aging,” Pillemer added. “It’s important for younger people to interact with older adults who are active and engaged, and also to educate younger people about the aging process.”
To that end, he designed an intergenerational intervention that pairs high school students and older adults for intergenerational wisdom sharing. In a randomized trial, he found that youth who participated showed improvements in their attitudes toward older people and in their sense of life purpose (International Journal of Environmental Research and Public Health, Vol. 19, No. 7, 2022).
[Related: The Reframing Aging Initiative aims to change the narrative around getting older]
Diehl, too, is developing an intervention to change attitudes toward aging. His approach targets middle-age adults in hopes of improving their outlook toward their own aging process. “We want to show people that we have opportunities to shape that process, by choosing what we eat and drink, how physically active we are, and how we manage stress,” he said. His four-week health education program addresses beliefs about self-efficacy in aging and encourages participants to be more physically active—a factor strongly associated with health across the life span. Diehl is still analyzing the results, so he can’t yet say whether the intervention led to measurable changes in physical activity. But in a preliminary analysis, he said, “our data clearly show that the intervention is effective in changing people’s negative attitudes toward their own aging.”
Interventions don’t just improve attitudes for youth and younger adults. In a randomized controlled trial with older adults, Levy found that strengthening positive age beliefs led to more positive self-perceptions of aging, which in turn led to significantly improved physical function (Psychological Science, Vol. 25, No. 12, 2014).
Reframing ageist systems
Looking beyond individual-level interventions, researchers and advocates are also turning their attention to the cultures and systems that perpetuate ageism. Morrow-Howell, for instance, is in talks with her institution’s DEI office to include age as a diversity issue. “Once people start talking about it, they start seeing it. Awareness within organizations is so important,” she said.
She and Montepare are also active with the Age-Friendly University (AFU) program, an initiative to change the culture of higher education to expand opportunities for older adults. (Read more about the AFU program in “Embracing Learners of All Ages,” in the June 2022 Monitor.)
Moving forward, there’s a need to continue studying the factors that support productive aging. “In an increasingly aging society, people have to be willing to do this work,” Pillemer said. “We really need a translational science in aging: We need psychologists to engage in this flow between research and implementation of these ideas in real-world settings,” he added.
Clinical psychologists, too, can do more to address ageism in their own practices. For one thing, they can help patients address their own internalized beliefs about getting older, said Gregory Hinrichsen, PhD, a clinical psychologist and professor in the department of geriatrics at the Icahn School of Medicine at Mount Sinai in New York. “People highly overestimate the problems of later life and underestimate the resilience of later life. We can integrate notions about ageism into clinical practice with older adults,” he said.
Hinrichsen uses cognitive behavioral therapy and interpersonal therapy to help clients challenge the underlying assumptions they have about aging, and to begin to think of aging as a role transition. People often discover they’re treated differently in older age, he said. They might be dismissed or assumed to be incompetent. Often, older adults are addressed in “elderspeak,” a demeaning manner of speech that typically includes a high-pitched voice, speaking more slowly, or using overly familiar terms of endearment like “sweetheart” or “dear.” Clinicians can help people navigate the feelings that come along with being treated differently because they are perceived as “old,” Hinrichsen says. “It’s helpful for people to understand how to handle those challenges.”
In collaboration with Erin Emery-Tiburcio, PhD, ABPP, at Rush University in Chicago and colleagues, Hinrichsen helped develop a continuing-education certification program to teach foundational competencies in adult mental health, offered through the E4 Center of Excellence for Behavioral Health Disparities in Aging. The program helps clinicians better understand the unique presentations of mental health problems in older adults—and, importantly, helps them identify and challenge their own personal and systemic stereotypes of aging.
Though misconceptions and negative beliefs about aging are often deeply entrenched, they are not immutable. Levy, for one, is optimistic that antiageism efforts are gaining ground. “We’re on the verge,” she said, “of a social movement to bring about a more age-just society.”
