“Tackling ageism will require a new understanding of ageing by all generations” (WHO, 2020).
References
Chang, E-S; Kannoth, S; Levy, S; Wang, S-Y; Lee, JE; Levy, BR. (2020) Global reach of ageism on older persons’ health: A systematic review, PLoS ONE Jan15;15(1):e0220857 doi: 10.1371/journal.pone.0220857
At a glance
Ageism refers to the stereotypes and discrimination towards individuals or groups based on age. Ageism can take many forms, including prejudicial attitudes, discriminatory practices, or institutional policies and practices that perpetuate stereotypical beliefs (WHO, 2020) (Fig 1). This systematic review highlights two different levels of ageism: the structural one, in which institutions reinforce the bias against older persons and the individual one, where older persons take in the negative views of aging of their culture. Both levels can play an important role in affecting the health outcomes of the elderly, and this is the aspect that the article explores. What is already known Chang et al. (Chang, et al., 2020) claim that previous studies on the phenomenon of ageism have focused mainly on the individual dimension, without evaluating the structural sources of ageism or how this phenomenon impacts the health of the elderly person (Sao Jose, Amado, Ilinca, Buttigieg, & Taghizadeh, 2019) (Harris, Krygsman, Waschenko, & Laliberte Rudman, 2018). With the Stereotype Embodiment Theory (SET) (Levy, 2009), Levy explains how three distinct, yet interrelated, components of ageism can impact health: age discrimination (i.e., detrimental treatment of older persons); negative age stereotypes (i.e., negative beliefs about older persons in general); and negative self-perceptions of aging (i.e., negative beliefs held by older persons about their own aging) (Fig 2).
Characteristics of the study
An analysis of 422 publications (both experimental and observational studies), involving an investigation of more than 1,159 possible associations between ageism and health, provided evidence of a correlation between ageism and adverse health effects.
Main results
Ageism was found to adversely impact a broad range of health outcomes among older persons. 95.5% of the 422 studies, which included over 7 million participants and covered a study period of 25 years, demonstrate a correlation between ageism and worse health. Such a correlation was found in all 45 countries and related to 11 health domains. Furthermore, the prevalence of significant findings increased over time (p < .0001).
The 11 health domains identified were (Fig 3):
- Exclusion from health research
- Devalued lives of older persons
- Lack of work opportunities
- Denied access to health services and treatments
- Reduced longevity
- Poor quality-of-life and well-being
- Risky health behaviors • Poor social relationships
- Physical illness • Mental illness
- Cognitive impairment
The health domain most impacted by ageism was denied access to health services and treatments. In 149 studies, health personnel were shown to be more likely to withhold life-sustaining treatments from older patients, as opposed to younger ones, after having checked the patient’s prognosis and treatment preference. The area of research was also impacted, leading to paradoxes such as the exclusion of older persons from clinical trials, even though the disease of interest is more prevalent later in life (e.g., Parkinson’s disease). In the domain related to lack of job opportunities, it was observed how ageism in the workplace predicted worse health, such as increased depressive symptoms, or led to long-term illness. Once employed, seniors have fewer training opportunities and, in some countries (such as the U.S.A. or Britain), employers were significantly more likely to put older workers in positions with lower pay and responsibilities. As for the individual domain, 10 studies demonstrated a correlation between ageism and a shorter lifespan, as older persons with more negative self-perceptions of aging had significantly reduced longevity. Ageism also led to a worse quality of life, fewer relationships, less support and social involvement, as well as risky health-behaviors, such as unhealthy diet, medication noncompliance, drinking and smoking. Ageism can also affect mental health, due to the demonstrated increase in depressive symptoms, and predict worse memory, with an overall functional decline and a devalued life. Additionally, evidence of ageism was found regardless of the characteristics of the targeter (person perpetrating ageism) and target (i.e., age, sex, education, and racial/ethnic group membership). Among targets, those with high-school-or-less education (89.8%) were significantly more likely to be targets of ageism than the more-educated group (70.1%, p < .0001).
Limitations
First, there is concern about the significant heterogeneity of the study outcomes, which did not allow for meta-analysis. Second, qualitative studies were not included in this review. Future reviews could integrate qualitative studies to provide additional insights into the ways in which ageism shapes health.
What’s new?
This is certainly an innovative review, which focuses on an issue that has not yet been systematically investigated. The review highlights the pernicious reach of ageism, occurring simultaneously at the structural and individual level in five continents.
By: Chiara Gallione
References
- Chang, E.-S., Kannoth, S., Levy, S., Wang, S.-Y., Lee, J., & Levy, B. (2020, Jan. 15). Global reach of ageism on older persons’health: A systematic review. PLoS ONE, 15(1), e0220857. doi:https://doi.org/10.1371/
- Harris, K., Krygsman, S., Waschenko, J., & Laliberte Rudman, D. (2018). Ageism and the older worker: a scoping review. Gerontologist, 58, e1–14. Levy, B. (2009).
- Stereotype embodiment: a psychosocial approach to aging. Curr Dir Psychol Sci., 18, 332–36. doi:https://doi.org/10.1111/j.1467-8721.2009.01662.x
- Sao Jose, J., Amado, C., Ilinca, S., Buttigieg, S., & Taghizadeh, L. (2019, Mar. 14). Ageism in health care: a systematic review of operational definitions and inductive conceptualizations. Gerontologist, 59(2), :e98-e108. doi:doi: 10.1093/geront/gnx020.
- WHO. (2020, Nov. 2). Ageing: Ageism. Retrieved Feb. 10, 2021, from World Health Organization: https://www.who.int/westernpacific/news/q-a-detail/ageing-ageism
Glossary
- Health outcomes are changes in health that result from measures or specific health care investments or interventions.
- Stereotype embodiment theory (SET): it is a theoretical model first posited by psychologist Becca Levy to explain the process by which age stereotypes influence the health of older adults.
Edited by Chiara Gallione
