The Everyday Ageism Scale: Development and Evaluation

The Impact of Ageism and Pain on Pandemic-Related Stress in Older Adults: A Structural Equation Modeling and Mediation Analysis

Although research has linked ageism and pain to increased stress in older adults, their influence on stress within the context of pandemics has not been adequately examined. Our objective was to investigate relationships among pain, ageism, and pandemic-related stress in older adults using structural equation modeling (SEM) and mediation analysis. We hypothesized that pain would exert a direct and/or indirect influence on pandemic-related stress, and ageism a direct influence. Data were collected from 486 North American older adults in January 2024. Participants completed measures of pain, ageism, and pandemic-related stress. SEM and mediation analyses yielded evidence suggesting ageism and pain influence pandemic-related stress, although ageism mediated pain's impact on pandemic-related stress. This study underscores how pain and ageism can impact older adults' psychological well-being during pandemics. Findings highlight a potential need for public health interventions to address ageism and pain during future waves of COVID-19 or other global health crises.

Psychometric Properties of Instruments Assessing Ageism: A Systematic Review

INTRODUCTION

The global population is experiencing a significant increase in the number of older people, highlighting the need to maintain both physical and mental health among this cohort and to promote healthy ageing. One critical area that has been insufficiently explored is the prevalence and scope of ageism and its assessment. Therefore, the present review evaluated the psychometric properties of instruments designed to assess ageism against older people.

METHODS

To locate relevant instruments, a search was conducted using seven databases comprising MEDLINE, PubMed, Embase, PsycINFO, Web of Science, ScienceDirect and Scopus. The review utilised the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist to assess the methodological quality of the studies identified, ensuring a thorough evaluation of relevant literature.

RESULTS

From an initial pool of 338,180 outputs, 20 studies were deemed suitable for inclusion. These studies addressed various aspects of ageism, with eight focusing on self-directed ageism and 12 on attitudes towards older individuals. The review found that while 18 studies tested internal consistency, only three assessed cross-cultural validity. None of the studies achieved a high methodological quality rating concerning content validity based on the COSMIN criteria.

CONCLUSIONS

These findings suggest a significant gap in the development of reliable and comprehensive psychometric instruments for assessing ageism, indicating a need for further refinement of these instruments.

IMPLICATIONS FOR PRACTICE

This systematic review equips healthcare policymakers with evidence to advance the development of more robust ageism measurement tools. Additionally, the results underscore the need for researchers to conduct more thorough validation and evaluation of ageism instruments that address its multidimensional nature, thereby enhancing the quality of future gerontological research.

IMPLICATIONS FOR PRACTICE

This systematic review equips healthcare policymakers with evidence to advance the development of more robust ageism measurement tools. Additionally, the results underscore the need for researchers to conduct more thorough validation and evaluation of ageism instruments that address its multidimensional nature, thereby enhancing the quality of future gerontological research.

Rapid review to inform the selection of a set of brief set of universal indicators for use in large-scale cross-national ageism research

OBJECTIVES

Ageism occurs across the world, with negative consequences for individuals and societies. In 2016, WHO received a mandate from its Member States to lead the global campaign to combat ageism. To monitor, evaluate, and build evidence for reducing ageism, the availability of a brief, reliable and valid set of indicators of ageism experiences that can be used globally is essential.

METHOD

Building on previous reviews, the current review examines existing measures of ageism with a specific focus on suitability for meeting this need. Given the urgent need for indicators in the context of the global campaign to combat ageism, a rapid review methodology was adopted.

RESULTS

Results suggested that no measure met all desired criteria; however, the WHO ageism experiences scale was the most promising of available measures due to its focus on ageism as a multi-dimensional construct encompassing stereotypes, prejudices, and discrimination and self-directed, interpersonal, and institutional elements and the explicit consideration of cross-cultural universality in its development. Other promising measures included ESS Round 4 items along with its CIS and VQ variants, the Everyday Ageism Scale, the Perceived Ageism Questionnaire (PAQ), and the Ageism Survey.

CONCLUSION

Further cross-setting validation of this scale is recommended.

Adults Aged 75+ Happy in Conventional Dwelling or Independent Living Facility but Associated With Thriving and Ageism

This study aimed to compare levels of happiness of older women and men living in conventional dwellings (CD) and independent living facilities (ILF), and examine happiness' associations with thriving, social participation, community integration and ageism (self-directed and discrimination). A cross-sectional survey was conducted with a random sample of 509 older adults in CD and 470 in ILF in Quebec, Canada. Participants' mean age was 82.22 ± 5.35, and two-thirds were women. Levels of happiness were similar in both sexes and settings. Greater happiness was associated with greater thriving for all (β = 0.28-1.48), social participation for women in CD (β = 0.67), community integration in CD (β = 0.42 for women and 1.18 for men), and reduced ageism, i.e., discrimination for women in CD (β = -1.02) and men in ILF (β = -0.28), and self-directed for men in CD (β = -0.21). The findings demonstrate that happiness was associated with factors related to the living environment and could be enhanced through targeted interventions.

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.

Assessing the relationship between mental health and AUDIT score among older sexual and gender minorities

INTRODUCTION

Alcohol use, and its relationship with mental health outcomes, remains a public health priority. Yet, little research has focused on this association among aging sexual and gender minority (SGM) populations with even less dedicated to the unique issues of those aging with HIV, a gap we begin to fill here.

METHODS

Data for this analysis originated from the Columbus Healthy Aging Project (CHAP), a cross-sectional survey among adults ≥50 years who reside in the Columbus, Ohio. Multivariable linear regression models were utilized to assess the relationship between alcohol use (via AUDIT score) and several mental health outcomes (e.g., depression, anxiety, perceived stress, and sexual orientation microaggressions), adjusting for demographic characteristics and other risk factors. Models were assessed for moderation by self-reported HIV status.

RESULTS

Among the entire sample (N = 787), mean perceived stress score was 18.2 (SD = 5.5), mean anxiety score was 9.1 (5.9), and mean depression score was 9.9 (SD = 6.7). 32 (7.4%) self-reported as PLWH. Among those reporting any alcohol use, mean AUDIT score use was 10.5 (SD = 10.9). Each of the mental health outcome measures were positively associated with AUDIT score. Meanwhile, there was significant moderation of each of the mental health outcome measures by HIV status, suggesting a stronger association with AUDIT score in each case.

CONCLUSION

Our results suggest that there are broad stressors impacting alcohol use not only among older SGM broadly but in particular among PLWH. Although a diverse set of results, these data highlight the need for more research on alcohol use among aging SGM populations, particularly PLWH and those identifying as a different gender identity.

Age-Related Microaggressions: Their Frequency, Emotional Impact, and Relationship to Negative Affect

Age-related microaggressions are forms of ageist discrimination that occur in day-to-day interactions. This study aimed to validate the findings of a previous study, to identify common age-related microaggressions, and determine how affect influences emotional reactions to microaggressions. Using an online survey, participants (n = 200) were asked about their experience with age-related microaggressions, their affect, and their physical health. Participants were familiar with these microaggressions 53% of the time and had negative reactions to 43% of these microaggressions. The frequency of negative reactions to microaggressions was significantly correlated with scores of negative affect (r = .34, P < .001) and with ratings of perceived physical health (r = -.32, P = .002). The results of the study provide further insight into the topography of, and how older adults experience microaggressions. This information should be used as an educational tool to reduce the prevalence of ageism.

Disparities in depression and anxiety related to sexual orientation and gender identity among older adults: The role of age discrimination

Objectives

Sexual and gender minority (SGM) older adults report poorer mental health than their cisgender-heterosexual peers. Age discrimination may be a mechanism underlying these disparities. The current study examined whether SGM older adults reported more age discrimination and, in turn, higher depression and anxiety, compared to cisgender-heterosexual older adults.

Methods

As part of a larger study, 744 older adults (aged ≥ 50; M = 58.4, SD = 6.23) completed an online survey in September 2021. The survey included measures of depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7), and age discrimination (an adapted version of the Everyday Discrimination Scale). The sample included five sexual orientation and gender identity (SOGI) groups: cisgender sexual minority men (25.3%), cisgender sexual minority women (21.6%), cisgender-heterosexual men (19.8%), cisgender-heterosexual women (18.5%), and gender minorities (14.8%). We tested the indirect effects of SOGI group on depression and anxiety through age discrimination.

Results

Compared to cisgender-heterosexual men and women, all three SGM groups reported more age discrimination which, in turn, was associated with higher depression and anxiety. Further, compared to cisgender-heterosexual women, cisgender-heterosexual men reported more age discrimination which, in turn, was associated with higher depression and anxiety. All indirect effects were significant.

Conclusion

Age discrimination may be a mechanism underlying the mental health disparities affecting SGM older adults and a promising intervention target.

Reducing Ageism and Enhancing Social Activism in Middle School: The Use of Diverse Measures of Ageism

The aim of the study was to assess the effectiveness of a short educational intervention to reduce ageism and enhance social activism among adolescents. The study involved a 90-min workshop for 318 Israeli adolescents (aged 11 to 15, 73.9% females). Familiarity with the concept "ageism" and attitudes toward older persons were assessed before and after the intervention. The findings indicate an improved familiarity with the concept "ageism," while adolescents drew upon concepts such as discrimination and racism to define ageism. Following the intervention, a diverse range of age-related stereotypes emerged, signaling a shift toward more positive perceptions, with notable growth in positive age stereotypes, especially among females. Finally, about two-thirds of created memes targeted ageism against older persons, 18.98% promoted an age-inclusive world, and 17.15% addressed ageism toward children and young persons. Implications for reducing ageism in adolescence and for measuring social change in ageism are discussed.

Everyday ageism experienced by community-dwelling older people with frailty

PURPOSE

Ageism encapsulates stereotypes, prejudice and discrimination towards others or oneself based on age. While identified as the most frequent form of discrimination, relatively little work has captured the problem of day-to-day ageism faced by older people with frailty in community settings. The aim of this study therefore was to examine the prevalence of everyday ageism experienced by older people attending hospital-based ambulatory care services, and to clarify its association with measures of quality of life (QOL) and frailty.

METHODS

A consecutive series (n = 100) of patients aged ≥ 70 years attending ambulatory care completed focused interviews. Day-to-day experience of ageism was measured with the everyday ageism scale, QOL was measured with the control autonomy self-realisation pleasure scale.

RESULTS

Just over half of participants reported exposure to ageist messages; over 5/6 reported experiencing ageism in interpersonal interactions and 2/3 held some ageist beliefs themselves. Logistic regression demonstrated that experiencing ageism in interpersonal interactions was associated with a higher likelihood of internalised ageism [Adjusted Odds Ratio 6.02 (95% CI 1.70, 21.34); p = 0.005)]. Both ageism in interpersonal interactions [β = -5.22 (95% CI -9.52, -0.91); p = 0.018] and internalised ageism [β = -5.36 (95% CI -8.75, -1.97); p = 0.002] were associated with significantly lower QOL.

DISCUSSION

This study highlights the striking prevalence of everyday ageism experienced by a cohort of community-dwelling older people with frailty and multimorbidity. In the context of further projected demographic changes in coming decades, with increasingly higher proportions of older people worldwide, these findings highlight an important societal issue that needs to be addressed.

Empathy mitigates the relationship between ageism and subjective age in late life

This study corresponds with a dispute in gerontology literature about whether a younger subjective age acts as a psychological defense for older adults by perceiving themselves as younger in order to dissociate from their age-group or as a marker of good physical health. This cross-sectional study presents a preliminary step to clarify this dispute. We examined the role of emotional empathy (measured by the Multifaceted Empathy Test) as a moderator in the ageism (measured implicitly by the Brief Implicit Association Test) and subjective age (measured on Likert scale) association on a convenience sample of 203 community-dwelling older adults (aged 65-90, M = 74.54, SD = 6.76). It was hypothesized that implicit ageism would be associated with younger subjective age and that this association would be only evident among older adults with lower emotional empathy. Implicit ageism was not associated with younger subjective age. As expected, hierarchical linear regression showed that the connection between higher implicit ageism and a younger subjective age remains significant (p = 0.012) only among participants with lower emotional empathy (∆R2 = 0.022, β = 0.156). Higher emotional empathy was associated with younger subjective age. For older adults who are equipped with the ability to feel others' emotions, the defensive dissociation between self and other perceptions of aging might be unnecessary. Theoretical and methodological implications are discussed.

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.

"It's the not being seen that is most tiresome": Older women, invisibility and social (in)justice

Older women experience intersectional discrimination at the nexus of ageism and sexism. This is embodied, women's aging bodies being culturally devalued within youth-privileging cultures and the hyper-sexualization of younger, able-bodied, women. Older women often face the dilemma of attempting to mask the signs of aging or aging "authentically" but encountering heightened stigma, prejudice, and discrimination. Very old women in the fourth age who "fail" to age "successfully" are subject to extreme social exclusion. Many older women speak of experiencing a loss of visibility as they age, however how this occurs, and what it means, has not yet been analyzed in depth. This is an important issue, as recognition-cultural status and visibility-is essential for social justice. This article reports on findings taken from a U.K. survey on experiences of ageism and sexism completed by 158 heterosexual, lesbian, and bisexual women aged 50 to 89. Their perceived invisibility took five forms: (a) being under-seen/mis-seen in the media; (b) being mis-seen as objects of sexual undesirability; (c) being "ignored" in consumer, social, and public spaces; (d) being "grandmotherized," that is, seen only through the lens of (often incorrectly) presumed grandmotherhood; (e) being patronized and erroneously assumed to be incompetent. The findings are compared with Fraser's social justice model. The argument presented is that older women's experiences of nonrecognition and misrecognition are profound sources of social injustice. Both increased visibility and cultural worth are needed for older women to enjoy the benefits of social justice in later life.

Development of the item pool for the 'WHO-ageism scale': conceptualisation, item generation and content validity assessment

OBJECTIVES

ageism harms individuals' health and wellbeing and can be costly to societies. Reliable and valid measures that can quantify ageism are critical for achieving accurate data on its global prevalence, determinants and impacts, and to evaluate the effectiveness of interventions to reduce it. Ageism scales exist; however, none have been demonstrated to validly measure ageism in a manner consistent with consensus definitions of the concept (i.e. as manifested in all of stereotypes, prejudices and discrimination), whilst also quantifying ageism against all groups, from a target and perpetrator perspective, and across diverse country settings. Our objective was to develop an item pool to meet this need.

METHODS

we completed the conceptualisation, item generation and content validity assessment phases of a new World Health Organisation (WHO) WHO-ageism item pool that aims to measure the multi-dimensional nature of ageism. These phases drew on a review of available evidence, an experts' workshop and structured content validity reviews conducted by experts in scale development and ageism drawn from every world region defined by WHO.

RESULTS

our resulting item pool is designed to provide a multi-dimensional measure of ageism against all ages measured from both a perpetration and experienced perspective and that can produce valid and reliable scores within diverse country contexts and comparable scores across these contexts.

CONCLUSIONS

our item pool is the first major step in providing a global and comprehensive measure of ageism. Future phases of research will refine the item pool and establish the statistical psychometric properties of the final tool.

Ageism as a barrier to eliciting what matters: A call for multigenerational action to confront the invisible "-ism"

This editorial comments on the article by Sun et al. in this issue.

The cognitive tenacity of self-directed ageism

Ageism refers to prejudice or discrimination based on a person's age. When ageism is directed at older people, it is unique in two ways: it is socially condoned in a manner that other types of prejudice are not, and the animus is eventually self-directed. Of central interest here is why ageism becomes self-directed in late adulthood, despite its potentially harmful personal costs. We present a cognitive model in which negative ageist beliefs become increasingly accessible and difficult to eliminate owing to broader developmental shifts in mentation. Given that these effects are contingent on our social environment, systemic changes in societal conceptions of age and aging are needed if we are to reduce vulnerability to self-directed ageism.

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

Purpose of Review

This review summarizes findings from quantitative research studies published between 2010 and 2022 providing insight on sociodemographic differences and disparities in ageism among US adults ages 50 and older.

Findings

Across 21 studies, disparities in ageism were more consistently found such that those who were older (57% of studies), with less education (64%), and of lower socioeconomic status (100%) reported more ageism than their counterparts. Amount of ageism did not differ by sex in the majority (71%) of studies. Findings regarding race/ethnicity were mixed. Other possible differences in ageism, assessed in a small number of studies, were patterned by employment characteristics, geographic residence, religiosity, and political affiliation but not by marital or employment status.

Summary

Given that ageism is both common and associated with poor health outcomes, identifying disproportionately affected segments of the older adult population is a necessary prerequisite for developing targeted interventions to reduce negative outcomes linked to ageism and associated health disparities. Evidence within this review suggests that the patterning of ageism may deviate from that typically documented for other social and structural disadvantages. Some groups traditionally considered to be socially marginalized were found to report more ageism while others did not.

Talking really does matter: Lay perspectives from older people on talking about suicide in later life

Background

The cumulative body of research on suicidality in later life describes its unique and complex features in older people when compared with that in other population groups. Yet significant gaps exist in how research informs the further development of suitable interventions. The perspectives of older people are also limited in research findings.

Aims

Therefore, this exploratory study aimed to (1) identify potential barriers and enablers in discussing suicidal thoughts and their expression in later life from the perspectives of lay older people and (2) explore where opportunities might occur in approach, place, relationships, and language with older people to discuss suicidal thoughts and their expression.

Method

We conducted in-depth qualitative individual interviews with 15 people aged 70-89 years. This method helped explore older peoples' own lay perspectives on suicidal thoughts in later life and how these are expressed, and their understanding of where and how people might seek support.

Results

A total of three themes were generated from the dataset: (1) intergenerational and socio-cultural differences in suicide expression, (2) the normalization of suicidal thoughts in later life, and (3) the importance and difficulties of everyday discussion and opportunities to express suicidal thoughts.

Conclusion

Suicidal thoughts and their expression appear commonly and are normalized in later life yet remain taboo and hidden. The participants revealed how such thoughts and behaviors are typically expressed through colloquial or "off-hand" remarks and comments and the importance of authentic listening. The findings highlight the importance of more informal discussions around these topics and how care professionals, practitioners, and providers might frame opportunities for dialogue with people who may want to access support. Further engagement with community-informed participatory research methods in which older people provide their own perspectives and experiences is important in addressing these gaps. There is a need for co-designing in developing screening, assessment, and signposting outside of clinical settings that can be used in everyday caring relationships with people in later life.

Experiences of Everyday Ageism and the Health of Older US Adults

Importance

Major incidents of ageism have been shown to be associated with poorer health and well-being among older adults. Less is known about routine types of age-based discrimination, prejudice, and stereotyping that older adults encounter in their day-to-day lives, known as everyday ageism.

Objective

To examine the prevalence of everyday ageism, group differences and disparities, and associations of everyday ageism with indicators of poor physical and mental health.

Design, Setting, and Participants

This cross-sectional study was conducted using survey data from the December 2019 National Poll on Healthy Aging among a nationally representative household sample of US adults ages 50 to 80 years. Data were analyzed from November 2021 through April 2022.

Exposures

Experiences of everyday ageism were measured using the newly developed multidimensional Everyday Ageism Scale.

Main Outcomes and Measures

Fair or poor physical health, number of chronic health conditions, fair or poor mental health, and depressive symptoms.

Results

Among 2035 adults ages 50 to 80 years (1047 [54.2%] women; 192 Black [10.9%], 178 Hispanic [11.4%], and 1546 White [71.1%]; mean [SD] age, 62.6 [8.0] years [weighted statistics]), most participants (1915 adults [93.4%]) reported regularly experiencing 1 or more forms of everyday ageism. Internalized ageism was reported by 1664 adults (81.2%), ageist messages by 1394 adults (65.2%), and interpersonal ageism by 941 adults (44.9%). Mean Everyday Ageism Scale scores were higher for several sociodemographic groups, including adults ages 65 to 80 years vs those ages 50 to 64 years (11.23 [95% CI, 10.80-11.66] vs 9.55 [95% CI, 9.26-9.84]) and White (10.43 [95% CI, 10.20-10.67]; P < .001) and Hispanic (10.09 [95% CI, 9.31-10.86]; P = .04) adults vs Black adults (9.23 [95% CI, 8.42-10.03]). Higher levels of everyday ageism were associated with increased risk of all 4 negative physical and mental health outcomes examined in regression analyses (with odds ratios [ORs] per additional scale point as high as 1.20 [95% CI, 1.17-1.23] for depressive symptoms and b = 0.039 [95% CI, 0.029-0.048] for chronic health conditions; P values < .001). Internalized ageism was the category associated with the greatest increase in risk of poor outcomes for all health measures (with ORs per additional scale point as high as 1.62 [95% CI, 1.49-1.76] for depressive symptoms and b = 0.063 [95% CI, 0.034-0.092] for chronic health conditions; P values < .001).

Conclusions and Relevance

This study found everyday ageism to be prevalent among US adults ages 50 to 80 years. These findings suggest that commonplace ageist messages, interactions, and beliefs may be harmful to health and that multilevel and multisector efforts may be required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.

Ageist Communication Experienced by Middle-Aged and Older Canadians

Ageism has been well-documented in the United States, but ageism experiences in Canada remain less well-known. To address this gap, in the current research middle-aged and older Canadians completed a conversational interview in which they described their ageism experiences. Their descriptions were coded for life domain, perpetrator, and type of ageist communication. The most common domain in which ageist communication occurred was the public sphere, with perpetrators most often being strangers. Ageist communication most often involved age-based social or physical assumptions about the participant. In combination, these findings detail how ageism manifests in the everyday lives of Canadians and contribute to understanding the nuances of the expression of ageism in North America.