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The Pernicious Reach of Ageism

How ageism's age-based discrimination hurts our physical and mental health

By Dr. Christine Nguyen

As the U.S. grapples with all forms of prejudice, ageism remains under most people's radar. Some researchers say ageism is the last socially acceptable form of discrimination. This year, the World Health Organization and the United Nations called for urgent action to combat ageism. The stakes for all of us couldn't be higher. Ageism leads to poorer health and premature death.

A middleaged woman grabbing her chest in pain. Ageism, heart disease, ageist, Next Avenue
Credit: Getty

Ageism is stereotyping or discrimination against a person based on their age. It's a global problem that costs society billions of dollars a year – $63 billion in the U.S. alone, mainly in excess health care costs, according to a Yale University study.

The coronavirus pandemic exposed some troubling aspects of ageism. In some places, blanket rules about a person's age decided access to medical care.

If a person internalizes age stereotypes earlier in life, they can create a self-fulfilling prophecy.

"Ageism thrived during the pandemic," says Becca Levy, professor of epidemiology and psychology at Yale School of Public Health and author of a systemic review of the global impact of ageism. "Politicians made statements that devalued older persons. There was a lot of messaging about older persons as if they were homogenous and had equal risk factors and behaviors, putting them all in one category."

Levy found during the pandemic that people who internalized negative stereotypes about their age were less likely to go to the hospital for care, even when they were very sick.

While it may be easy to imagine how age discrimination could cause psychological and financial harm, Levy's findings add to a deep body of research that also show age discrimination can cause measurable short- and long-term physical harm.

Ageism can cause cardiovascular problems, chronic stress, inflammation and brain changes associated with Alzheimer's disease.

Ageism Harms Your Heart

If a person internalizes age stereotypes earlier in life, they can create a self-fulfilling prophecy.

In one Yale study, researchers followed people 18-49 years old for 40 years and measured their attitudes toward aging. Examples of negative attitudes toward aging were "old people are helpless" and "old people are absent-minded."

Those who had negative views about normal aging were more likely to have cardiovascular events later in life. These cardiovascular events included chest pain from blocked heart vessels, poor heart function, heart attacks and strokes.

The same adults who were pessimistic about aging also had these cardiovascular events earlier. The findings were true regardless of other factors such as obesity, depression, education, family history of heart problems, blood pressure, cholesterol, smoking or marital status.

If people's opinions on aging become gloomier over time, the study found, the risk of cardiovascular problems increased even more. However, if study subjects became more optimistic, for example describing older persons as "wise" or "creative," their risk of cardiovascular disease decreased.

Ageism Magnifies Stress

People who have positive thoughts about aging tend to live longer than people the same age who are more cynical about getting older. Negative beliefs magnify stress and positive beliefs protect from stress.

People develop prejudice against older adults in childhood. Encouraging children to have meaningful relationships with older people sets the tone for their outlook on aging throughout their life.

Doctors can measure stress using markers such as C-reactive protein and cortisol, both of which are correlated with negative outlooks on aging. These stress responses can start in young adulthood and continue over a person's lifespan.

Having a sunnier outlook about aging reduces the stress markers. And reducing stress can help mitigate weight gain, diabetes and high blood pressure.

Ageism May Predict Alzheimer’s

Apolipoprotein E is a fat-binding protein in the brain that can affect the development of Alzheimer's disease.

People with higher levels of one particular subtype of this protein, called APOE2, may have less risk of Alzheimer's. But a person's attitudes can influence the amount of protection the protein conveys.

Research shows that having a positive outlook on aging magnified the protein's protective effect against Alzheimer's. Even more surprisingly, having a negative outlook decreased the protein's protection from Alzheimer's.  

Aside from gene expression, there's even more research into how negative age stereotypes can modify the actual structure of the brain.

Levy used MRIs to study the brains of study participants every year for up to 10 years. She found that the hippocampus, a part of the brain involved in learning and memory, shrank more in people who had negative age stereotypes.

Furthermore, after they died, the people who had negative age stereotypes measured years earlier had more amyloid plaques and neurofibrillary tangles­ in their brains – both findings are associated with Alzheimer's disease.

3 Interventions to Combat Ageism

1. Promote quality contacts between younger and older generations. "The ideal is to think about messaging starting at a young age," says Levy. People develop prejudice against older adults in childhood.

Encouraging children to have meaningful relationships with older people sets the tone for their outlook on aging throughout their life. By about 4-7 years old, children will develop stereotypes about aging.

Children tend to see older adults as slow and less mobile, but also tend to describe them as kind. Researchers found children 10-12 years old had the most positive views about aging. But as children approached teenage years, they generally became more ageist. In all stages of childhood, boys typically have more negative impressions about aging and older people than girls.

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A predictor of whether children would have ageist stereotypes was the quality of interactions they had with an older person. In a study of children and their grandparents, it was less important to see a grandchild frequently than to have fewer, more meaningful interactions.

Young adults who had quality or prolonged contact with older adults, either through school, work or in their neighborhoods and social circles had fewer negative expectations about them and less anxiety about what would happen when they themselves became old. Even knowing that other young people had good relationships with older people was helpful in reducing ageism.

"Among young adults in their twenties, the age beliefs that they take in from their culture and that they expressed at that age impacted their risk of having a cardiovascular event when they reach their sixtieth birthday," says Levy.

2. Encourage challenging physical activities among older people. This is a message that many older adults don't hear often enough.

The fitness and health industries can perpetuate ageist stereotypes. Physicians and physical and occupational therapists sometimes make exercise recommendations based on age alone, rather than assessing each person as an individual. Therapists may fall back on recommending "senior type" low intensity physical activities such as walking or gardening.

Older adults receive inadequate encouragement to exercise vigorously, and they rarely challenge pervasive stereotypes about their physical abilities. It could be helpful to encourage older people to envision themselves, if safe, in gyms participating in more high intensity activities, which can prevent cardiovascular problems.

3. Educate health professionals to recognize and combat ageism. Unfortunately, the health care system isn't immune to ageist attitudes.

Whether it's actively seeking out a geriatrician, a primary care doctor with additional training in treating older adults, or challenging your existing clinician's ageist beliefs, older adults can improve their medical care and reject the status quo of harmful ageist beliefs.

Health professionals can model nondiscriminatory behavior, contribute to ageism-focused policy statements and research within their specialties, and become advocacy collaborators.

Dr. Christine Nguyen is a clinical assistant professor at Stanford University Medical School and an online and audio journalist. She was a Gerontological Society of America Journalists in Aging Fellow. Find her on Twitter and on her website. Read More
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