Differences and Disparities in Ageism Affecting Older US Adults: A Review

How Are Dehumanizing Perceptions of Homelessness Associated With Age?

BACKGROUND AND OBJECTIVES

Increasing numbers of unhoused older individuals in the United States underscores the urgency for tailored services and support. Previous studies demonstrate prevalent negative attitudes and dehumanizing perceptions toward unhoused people. Additionally, past research highlights the influence of ageism and dehumanization on the care older adults receive. However, limited work addresses the layered dehumanization faced by unhoused aging individuals. This study investigated how dehumanizing perceptions of homelessness were associated with age.

RESEARCH DESIGN AND METHODS

In this experimental study, participants (N = 399; Mage = 23) were randomly assigned to scenarios depicting unhoused individuals who were discernibly either older or younger. Participants were prompted with different empathy tasks and assessed on dehumanization levels.

RESULTS

Results revealed older unhoused individuals faced significantly higher levels of dehumanization compared to their younger counterparts. Findings also indicated that older participants and male participants demonstrated stronger dehumanization toward unhoused adults.

DISCUSSION AND IMPLICATIONS

Dehumanization may be intensified for unhoused aging individuals due to their intersecting identities. In turn, this may affect willingness to provide care and the quality of services offered, impacting care settings, medical facilities, and policies focused on homelessness. This research sheds light on the complexities of dehumanization, emphasizing the urgency to address these linked biases to create more inclusive and supportive environments for unhoused aging individuals.

Black-White Differences Related to Ageism and Health: Evidence from the Experiences of Aging in Society Project

BACKGROUND

Age-based stereotypes, prejudices, and discrimination (ageism) are implicated in poor health, yet it is unclear if all groups of older adults experience the same amounts, types, and outcomes of ageism.

METHODS

This exploratory study investigated differences in ageism and health among Black and White USA adults ages 50 + who participated in the Experiences of Aging in Society project (2021-2023) (N = 131; 78% female, 46% Black, mean age 70). We compared amounts and types of self-reported ageism by race using three measures: Everyday Ageism Scale, Expectations Regarding Aging Survey, and Everyday Discrimination Scale when attributed to age. We identified racial differences in associations between ageism and the number of chronic health conditions participants had using z-tests of racially-stratified regression parameters.

RESULTS

Black and White older adults generally reported comparable amounts of ageism across measures. Everyday ageism was associated with more chronic conditions at comparable levels by race, though findings suggested race-specific patterns in the most influential types: Black adults-age discrimination and White adults-internalized ageism. Positive expectations of aging and everyday discrimination attributed to age were associated with the health of White but not Black adults; only the former demonstrated significant race differences.

CONCLUSION

While Black and White older adults may report comparable exposure to ageism, race may contribute to divergent mechanisms of risk and health consequences. Findings endorse the Everyday Ageism Scale for ageism-health research including Black adults and all measures for exclusively White samples. Interventions promoting older adult health may benefit from attending to similarities and differences at the intersection of ageism and race.

Taking an age-period-cohort perspective to assess changes in the incidence of self-perceptions of aging over time

Self-perceptions of aging (SPA) are defined as an evaluation of one's own aging. SPA can be positive (e.g., perceiving no change or improvement with age) or negative (e.g., perceived self-decline with age). We disentangle age, period, and cohort effects (e.g., attributed to a) individual differences associated with the passage of one's chronological age, b) circumstances affecting all in the same way, or c) circumstances differentially affecting groups of people born at a particular time, respectively) associated with changes in SPA over time. We relied on data from the Health and Retirement Survey collected between 2008 and 2020, consisting of 42,346 observations of individuals over the age of 50. We found a decline in the incidence of positive SPA after the age of 65 and an increase in the incidence of negative SPA, starting at 50. The effects of age on the incidence of negative and positive SPA varied somewhat across gender and ethnicity. We identified a strong linear trend suggesting a decline in negative SPA over time for Whites and Latinos. We also found a slight non-linear cohort effect in cohorts of Black men born between 1950 and 1955 and women born after 1955, with a higher relative risk of reporting negative SPA compared to other cohorts. For positive SPA, we did not identify linear or non-linear period or cohort effects. Clinically, the findings point to the susceptibility of older persons to lesser positive SPA and more negative SPA with age, thus highlighting a need for differential interventions.

Developing a community advisory board to combat ageism: Process and preliminary outcomes

Ageism - stereotyping, prejudice, and discrimination based on chronological age - is a highly prevalent yet underrecognized form of social discrimination with detrimental effects on healthy aging. Combating ageism is essential for creating an age-friendly society; however, there is no consensus on the optimal approach for doing so. In this manuscript, we posit that community-based participatory research holds promise for addressing and reframing community-level ageism, especially in underserved minoritized communities. To this end, we offer an implementable, adaptable process and model for building community-academic partnerships to combat ageism in diverse communities - using as an example the grassroots anti-ageist work of the University of Minnesota Center for Healthy Aging and Innovation's (CHAI's) Community Advisory Board (CAB). Here, we describe the formation and structure of the CHAI CAB, as well as the development, activities, and preliminary outcomes of its strategic initiative to create a community-led toolkit of resources for combating ageism in diverse cultural communities of the Twin Cities region of Minnesota. We believe our model can be useful for geriatric practitioners and educators to 1) uplift and empower diverse older adults in their communities; 2) promote health equity for underserved populations; and 3) provide rich community-based and experiential learning opportunities for future aging scholars and professionals.

Ageism and lookism as stereotypes of health disparity in intensive care units in Iran: a critical ethnography

BACKGROUND

The intensive care unit presents structural complexities, and the prevailing power imbalance between patients and staff can lead to health disparities. Hence, unveiling the underlying factors that give rise to and reinforce these disparities can contribute to their prevention. This study aims to shed light on the stereotypes linked to ageism and lookism, which perpetuate health disparities within the intensive care unit setting in Iran.

METHODS

This critical ethnographic study employed Carsepkan's approach and was carried out in intensive care units in the west of Iran from 2022 to 2023. The data collection and analysis were conducted through three interconnected stages. In the initial stage, more than 300 h of observations were made at the research site. In the subsequent stage, a horizon analysis was performed. Conversations with 14 informants were conducted in the final stage to enrich the dataset further. Then the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. To verify the validity and reliability of the study, credibility, conformability, dependability, and transferability were all taken into account.

FINDINGS

The ageism and lookism stereotypes emerged from seven main themes; youth-centric; negative ageism; age-friendliness; age-related priority; centered care for pediatric patients and families; appearance-centeredness; and a contradiction between belief and behavior.

CONCLUSION

This critical study showed that ageism and lookism stereotypes permeated the intensive care unit's culture. These stereotypes have the potential to influence equality dynamics, as well as to foster and support health disparity in the intensive care unit.

Aging Stigma and the Health of US Adults Over 65: What Do We Know?

This narrative review assessed the current state of research on aging stigma and health relevant to US adults ages 65 and older. We adopted a stigma framework to highlight aging stigma as a meaningful social construct and the complex ways in which it may be harmful for health. We identified 29 studies of various types (experimental, intervention, cross-sectional quantitative, longitudinal quantitative, and qualitative) published between 2010 and 2023 that investigated relationships between concepts related to aging stigma and health. Aging stigma was associated with poor short- and long-term health outcomes spanning cognition, psychological wellbeing, physical health, and hospitalizations. The premise that aging stigma is harmful to health was moderately well supported, while evidence that health influenced aging stigma was weak. Collectively, studies provided insight into several mechanisms through which aging stigma may affect the health of older US adults, while also highlighting areas for future research. Potential strategies for addressing aging stigma as a public health hazard were discussed.

A phenomenological, intersectional understanding of coping with ageism and racism among older adults

The aim of this qualitative, phenomenological study was to understand how older adults cope with experiences of ageism and racism through an intersectional lens. Twenty adults 60+ residing in the U.S. Mountain West who identified as Black, Hispanic/Latino(a), Asian-American/Pacific Islander, Indigenous, or White participated individually in a one-hour, semi-structured interview. A team of five coders engaged in an inductive coding process through independent coding followed by critical discussion. Peer debriefing enhanced credibility. Nine themes were organized by three umbrella categories: Coping with ageism: 1) distancing via self-determination/defying stereotypes, 2) distancing by helping others; Coping with racism: 3) resistance, 4) exhaustion; Coping with both ageism and racism: 5) increased awareness through aging, 6) healthy lifestyle, 7) education, 8) acceptance/ 'let it go', and 9) avoidance. Novel findings include how older adults may cope with ageism and racism via increased awareness through aging and with ageism specifically by helping peer older adults, although instances of internalized ageism were noted and discussed. The themes exemplify problem-focused (e.g., helping others) and emotion-focused (acceptance), as well as individual (e.g., self-determination) and collective (e.g., resistance) coping strategies. This study can serve as a resource for practitioners in applying a more nuanced understanding of the ways older adults cope with ageism and racism in later life.