(This post includes material recently published in MindCafe.)
Ageism is a worldwide problem. A literature search of ageism and its impact on older persons’ health (Chang E, 2015) included over seven million participants, comprising the most comprehensive review of the health consequences of ageing. Summarily, they found that ageism led to significantly worse health outcomes in 95.5% of the studies, with ageism effects in all forty five countries. Disturbingly, the prevalence of significant findings has been significantly increasing over time, over the twenty five years studied (p<0.0001). The study authors noted that ageism had been occurring simultaneously at the structural and individual level in five continents.
The multifactorial nature of suicide in older persons– in particular, the common relation to ageist perspectives – was considered in a paper that additionally noted the failure to respond to suicidality beyond pharmaceutical interventions (de Leo, 2018). Ageistic views were seen as responsible for the perspective that depression was regarded as a normal part of the ageing process – and, with it, the accumulation of physical comorbidities and life events as an appropriate sign that death is a reasonable and expected event. Thus, ageism contributes to suicide as a perceived rational decision. The paper further noted that, given the awareness that suicide is often a crisis decision, older persons who presented as being overwhelmed by their emotions would therefore see suicide as an appropriate response to an unbearable situation.
It is worth postulating where ageist attitudes come from. A postal review of 421 participants (Bryant C, 2016) looking at personality and well-being (measured via the Five-Factor model and the Satisfaction with Life Scale) found that higher levels of neuroticism were associated with less positive attitudes towards age, with more positive attitudes associated with better extraversion and agreeableness scores. Notably, the study additionally found that maintaining better levels of physical and mental health were associated with improved attitudes to ageing in later life, suggesting a positively reinforcing mechanism at a population level.
At a conceptual level, two theories for understanding ageism are repeatedly described in the literature – that is, of social identity theory and terror management theory (Van Wicklin, 2020). Social identity theory posits that in order to promote one’s own self-esteem and sense of identity, younger people identify more strongly with other younger people – pushing away those who are different, and are seen as an “other” social group. That is, the older person is an ‘other’ group. Terror management theory is a more visceral response, with the idea that we avoid stimuli that remind ourselves of our own mortality – such as, the older person. This hypothesis has been proven in observational studies, where ageism was found to be positively correlated with clinician anxiety about death and dying. (Kolushev, 2021)
On a very basic level, ageism in science itself has been noted (Rozell, 2020), in noting that the idea that young people are more productive in scientific fields has been dispelled by the evidence.
There are also legal issues regarding ageism. Surprisingly, ageism (or discrimination on grounds of age) is not regarded as in offence in UK law (Finch, 2019), and can only be peripherally referred to by means of industrial tribunals. Legal gaps are not a uniquely British anomaly, with the United Nations recognising the need for addressing global legal disparities in protecting the rights of older people (Mestheneos, 2020).
Ageism as being stereotype and prejudice is not a new concept (Chen Y, 2019). “Stereotype threat” (Barber, 2017), whilst apparently a group based behaviour, was argued to be a self-concept threat, and related to one’s own perception of one’s ageing, rather than a perception of the behaviours of a group. This was echoed in a discussion of autonomy in health care (Pritchard-Jones, 2017), which argued that ageism was related to the concept of self-relations such as self-trust, self-worth, and self-esteem. It was commented by multiple authorities that studies of ageism have focused on stereotypes and attitudes, but not care practices or more implicit measures.
Similarly, the notion that ageism was related to one’s view on ageing was criticised (Voss, 2017), as whilst one would ordinarily conflate the two, data obtained from the German Ageing Survey noted that negative views on ageing could predispose people to categorise other people’s behaviour as age discrimination – or, in themselves, to act in a way to elicit ageist behaviour in others. Simply put, there is a difference in how we view ourselves and how we view the behaviour of others.
This complexity also raises the issue of ableism (Berridge, 2018), which noted that successful ageing integrates ableism, and therefore was potentially discriminatory in its own right. A discussion of ageism and euthanasia (Prado, 2015) suggests that generalisations regarding perspectives of euthanasia are affected by ageist attitudes, which complicate their viability as independently rational arguments.
Ageism is a complex and nuanced phenomenon, related to negative health outcomes, originating from social discrimination and fear of mortality, and related to explicit as well as implicit ageing. It impacts everything from how we respond to the older person and our perspectives of euthanasia. It is also one of those phenomena that impacts all of us – eventually.
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