The Fraboni Scale of Ageism (FSA): An Attempt at a More Precise Measure of Ageism

A Cross-National Study of Dementia Stigma Among the General Public in Israel and Australia

BACKGROUND

Despite the increasing amount of research on dementia stigma, there is a dearth of cross-national studies conducted on this subject. This is surprising since the experience of stigma is closely associated to socio-cultural aspects.

OBJECTIVE

The present study intended to expand knowledge about the impact of culture on dementia stigma by comparing the level and correlates of stigmatic beliefs about dementia among the general public in Israel and Australia.

METHODS

A cross-sectional study using an online survey was conducted with two age-matched samples: 447 adults in Israel and 290 adults in Australia.

RESULTS

Overall, dementia stigma was moderate in both countries. However, the level of dementia stigma was significantly higher in Australia than in Israel. Lower levels of subjective knowledge and higher levels of ageism were associated with increased levels of stigmatic beliefs in both countries. Gender was a significant correlate of dementia stigma, with male participants reporting higher levels of public stigma than women, although this gender difference was mainly driven by the Australian sample.

CONCLUSION

Our findings indicate that providing knowledge and decreasing ageist attitudes should be key considerations in dementia awareness and stigma reduction campaigns despite the cultural context. In addition, developing gender-specific messages should be considered as a way of improving the effects of such campaigns.

Addressing stereotypes of aging and interest in careers working with older adults through education

Negative stereotypes about older adults are increasing and contributing to a shortage of professionals in gerontology. Building on the PEACE model (Positive Education about Aging and Contact Experiences), two experiments used education to address stereotypes associated with older adults. Participants were randomly assigned to read brief articles that: challenged stereotypes about older adults (condition 1), challenged stereotypes about careers working with older adults (condition 2), challenged both stereotypes (condition 3), or described careers in general (control; condition 4). In Study 1, 399 undergraduates in all 3 experimental conditions (vs. control participants) reported lower levels of ageism, more positive age perceptions, and more aging knowledge in an immediate and delayed (1-2 weeks) post-test. In Study 2, 446 national community participants (ages 18- 25) in all experimental conditions (vs. control participants) reported greater positive age perceptions, aging knowledge, and interest in psychology and social work careers with older adults in an immediate post-test. These findings highlight the promise of using brief online methods to challenge stereotypes, provide more positive and accurate views of aging and older adults, and increase interest in careers working with older adults. Implications are discussed.

Further examination of knowledge and interactions in ageism among college students: Value for promoting university activities

Ageism is recognized as a reason that few students pursue careers in aging. While widely studied, the findings regarding factors that contribute to ageism are mixed. The findings from previous studies are also tempered by methodological issues. To better understand the factors that contribute to ageism among students and guide the development of programming and activities to reduce ageism, a survey study was conducted. The study explores associations between frequency of interactions with older adults, quality of the interactions, and ageism. Students' knowledge of aging is also examined. Using refined measures to assess knowledge of aging and interactions with older adults, the study includes data from 1,040 college students, most of whom are traditional age students (i.e., under the age of 25). Findings from multiple regression analyses document the interplay between frequency and quality of interactions and the role of knowledge on multiple dimensions of ageism. Frequency of interactions with older adults is significantly associated with lower levels of ageism only when the interactions are perceived as favorable. Knowledge of aging is significantly associated with lower levels of ageism. The findings provide valuable information for developing activities to reduce ageism. A new ageism reduction program, which was guided by the study findings and age-friendly university framework, is described. Implications for gerontological education are also discussed.

Assessing knowledge and ageist attitudes and behaviors toward older adults among undergraduate nursing students

Caring for older adults is viewed as a low prestigious profession and a less attractive career option for nursing students. Knowledge deficit is a major perceived barrier to reliving ageist attitudes and behaviors among nursing students. In the Middle East, there is limited evidence regarding ageism among nursing students. This study aimed to examine the association of nursing students' demographics and knowledge of aging with ageist attitudes and behaviors. A cross-sectional design was used to recruit a convenience sample of 290 undergraduate nursing students in Jordan. The majority of nursing students reported poor knowledge, held ageist attitudes, and expressed ageist behaviors. A significant difference was found between senior and junior nursing students in the level of knowledge about aging. Also, significant correlations were found among students' knowledge about aging and ageist attitudes and behaviors. Targeting knowledge deficit and ageist attitudes and behaviors among nursing students is crucial for optimal geriatric care.

Assessing Age Inclusivity in Higher Education: Introducing the Age-Friendly Inventory and Campus Climate Survey (ICCS)

BACKGROUND AND OBJECTIVES

This study introduces a theoretical framework for assessing age inclusivity in higher education environments and describes the Age-Friendly Inventory and Campus Climate Survey (ICCS). The ICCS measures age-friendly campus practices as reported by administrators, perceptions of age friendliness by campus constituents, and the fit between objective practices and subjective perceptions as an overall indicator of age inclusivity.

RESEARCH DESIGN AND METHODS

The ICCS was administered at a public university in the northeastern United States. Administrators completed the Inventory of potential age-friendly campus practices associated with their units. Campus constituents (n = 688) completed the online Campus Climate Survey to assess subjective awareness of these practices, perceived age-friendliness, and personal beliefs about age inclusivity.

RESULTS

The Inventory yielded a score of 66% of potential age-friendly practices in place as reported by administrators. The Campus Climate Survey showed low overall perceptions of age-friendliness and varied beliefs about age inclusivity on campus. Fit was measured by comparing the Inventory practices and Campus Climate Survey awareness of the existence of 47 of 73 potential practices. Convergence on this campus showed an awareness of 36% of age-friendly practices.

DISCUSSION AND IMPLICATIONS

Based on the proposed theoretical framework for age inclusivity, the ICCS offers a way of assessing the age-friendliness of the objective environment across campus functions, the subjective environment across campus constituents, and the fit between subjective and objective environments on campuses. The ICCS will help higher education institutions identify strengths and challenges for advancing age inclusivity.

Ageist Attitudes Are Associated with Will-to-Live and Moderated by Age, Medical Conditions and Attitudes toward Aging

The extent to which older adults’ ageist attitudes associate with their will-to-live has barely been studied. Moreover, whether this effect is moderated by older adults’ age, medical conditions, and attitudes toward their own aging has not been investigated. These associations were examined by two studies. Study 1 examined the relationship between ageist attitudes and will-to-live among individuals aged 48–97, and the moderating roles of age and medical conditions on this connection. Study 2 reassessed this connection in a new sample of older adults (people aged 60–94 years) and examined the moderating role of their attitudes toward aging in this regard. In line with the hypothesis of the first study, ageist attitudes and will-to-live were negatively associated among older adults with more medical conditions. In accordance with the hypotheses of study 2, the ageist attitudes and will-to-live connection was reconstructed, and when regressed on the ageist attitudes × attitudes toward aging interaction, it remained significant only among those with increased ageist attitudes. These findings demonstrate the negative effect that ageist attitudes may have on will-to-live, especially among the very old, and particularly when their health deteriorates, and support the utility of interventions aimed at increasing their will-to-live.

Ageism, Aging Anxiety, and Death and Dying Anxiety Among Doctors and Nurses

Ageism is an important phenomenon that affects individuals and how society relates to older adults. It is important to evaluate ageism in the medical staff because of its potential effect on treatment for older adults. A cross-sectional study to assess the negative attitudes of doctors and nurses toward older adults was conducted using the Fraboni Scale of Ageism (FSA), a method for evaluating attitudes toward ageism in medical teams. Additional variables associated with ageism such as aging anxiety, and death and dying anxiety were also assessed. The study population included doctors and nurses working in a large university hospital or in community clinics in southern Israel. In all, 431 questionnaires were collected, 203 from the hospital (47.5%) and 224 from the community (52.5%). Of these, 216 (50.1%) were from doctors and 215 (49.9%) from nurses. The mean ageism score in the FSA was 2.8. In a linear regression model, doctors were less ageist than nurses; ageism was directly associated with aging anxiety, and dying anxiety, and was inversely associated with death anxiety. Among doctors, prominent ageist attitudes were directly associated with aging and dying anxiety, inversely associated with graduation from medical school in Israel, and death anxiety. Among nurses, prominent ageism attitudes were directly associated with dying anxiety and inversely associated with work in the hospital. Ageist attitudes were found among doctors and nurses in both the hospital and community clinics. The results emphasize the need to raise awareness of ageism in medical teams and to include this subject in professional training programs designed to reduce its prevalence.

The Relationships Between COVID-19 Anxiety, Ageism, and Ableism

The COVID-19 pandemic is a source of anxiety globally, and lockdowns have increased anxiety symptoms, contributed to economic stress, and influenced an increase in prejudice, particularly prejudice directed at the elderly and people with disabilities. Terror management theory serves as an explanation for the association between COVID-19 anxiety, ageism, and ableism. Recruiting participants from Amazon MTurk, I assessed anxiety about COVID-19, ageism, and ableism. Hierarchical linear regression analyses demonstrate that COVID-19 anxiety is significantly associated with ageism, and with ableism, as well as age and gender. The results of this study have implications for the effect of COVID-19 anxiety on those who are most vulnerable in the current pandemic, particularly with regards to isolation and social connection; those who are most anxious about the pandemic might spend less time trying to connect with their older friends and relatives, and likewise for the people in their lives who might have a disability.

Attitudes of Health Care Professionals Toward Older Adults' Abilities to Use Digital Technology: Questionnaire Study

BACKGROUND

Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption.

OBJECTIVE

The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults' abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association.

METHODS

A new measurement to assess health care professionals' attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals' attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals.

RESULTS

In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, (β=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R²=0.19; F_6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals' attitudes more than did the experience of working with older patients or the professionals' age.

CONCLUSIONS

Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT.

Quality of Gerontological Nursing and Ageism: What Factors Influence on Nurses' Ageism in South Korea?

With the aging of the population, age-related problems are emerging, which has caused age discrimination. Particularly, most nurses care for a large number of old patients in the clinical setting. Nurses' attitude toward the clients has a significant effect on the quality of nursing, so it is time to identify their perspective to the aged. The quality of nursing could greatly depend on who provides and how to provide care. If older patients meet nursing staff with an ageist perspective, whether intentionally or unintentionally, they experience negative attitudes toward them during served health care, and trust cannot be formed, resulting in a deterioration in the quality of medical services. This study aimed to identify factors influencing nurses' ageism attitudes. A total of 162 general hospital nurses completed a questionnaire consisting of the Wong and Law Emotional Intelligence Scale (WLEIS), the Contact with Elderly People (CEP), the Anxiety about Aging Scale (AAS), and the Fraboni Scale of Ageism (FSA). Data were analyzed by descriptive statistics, t-test, one-way ANOVA, Scheffé post hoc, Pearson's correlation coefficients, and stepwise multiple regression using SPSS/WIN 26.0 program. The average score of FSA was 2.63 ± 0.36 (range 1-4); FSA showed a statistical difference according to cohabitation with an old adult in the past (t = 2.42, p = 0.017). Factors influencing FSA were the fear of old people (β = 0.34, p < 0.001) and fear of loss (β = 0.28, p < 0.001) of the AAS; and these variables explained 21.1% of FSA (F = 22.56, p < 0.001). Based on these results, the development and application of nursing education focused on intergenerational contact is needed in order to reduce the anxiety about aging and to acquire a high quality of gerontological nursing with a reduction of ageism.

Ageism Among Physicians and Nurses in Russia

The phenomenon of ageism has been studied extensively in the Western world, but there is only a small number of studies among medical staff in Russia. The aim of this study was to assess the prevalence of ageism and to identify variables that can explain ageism in a sample of physicians and nurses in Russia. This is a prospective cross-sectional study of physicians and nurses who participated in a training course in the years 2016-2018 in Russia. Data collected before the start of training included the Fraboni scale of ageism (FSA) questionnaire, and sociodemographic characteristics including age, gender, profession, professional seniority, place of work, and number of older adults treated by the study participant over the past half year. In total, 903 physicians and nurses participated in the study. The mean FSA score was 2.75 ± 0.49, which indicates a moderate degree of ageism. There was a trend to higher scores among nurses compared with physicians (2.78 ± 0.50 vs. 2.76 ± 0.48, p < 0.465). There was a weak, but statistically significant, correlation between ageism and age (r = 0.157, p < 0.0001), professional seniority (r = 0.098, p < 0.003), and the number of older adult patients treated by the participant over the prior half year (r = 0.075, p < 0.025). There were no differences in other characteristics including gender, profession, work setting, or serving as main caregiver for a family member and the magnitude of ageism. The phenomenon of ageism exists among physicians and nurses in Russia. Older participants with greater professional seniority and a larger number of older patients had stronger ageism attitudes.

Working with Older Adults Scale: Application of the Theory of Planned Behavior

BACKGROUND AND OBJECTIVES

The expanding population of older adults in the United States, coupled with provider hesitance to work with this population, is expected to result in a large service gap, particularly in the health care field. Research on provider hesitancy has largely focused on the impact of attitudes toward older adults and professional competency, with some recent explorations of social influences. There is currently no comprehensive measure that includes all of these areas.

RESEARCH DESIGN AND METHODS

The present study outlines the development of the Working with Older Adults Scale (WOAS), which is grounded in the theory of planned behavior as applied to working with older adults. The WOAS is composed of 20 items, rated on a 7-point Likert scale, that make up four subscales: (i) Attitude, (ii) Subjective Norm, (iii) Perceived Behavioral Control, and (iv) Intention.

RESULTS

Results indicated that, for the young adult college student sample it was developed with, the measure has an excellent factor structure and good internal reliability and construct validity. Consistent with the theory of planned behavior model, intention to work with older adults was significantly predicted by attitudes, subjective norm, and perceived behavioral control. Subjective norm accounted for the greatest amount of variance. Further analyses revealed differential effects of age, gender, and experience on the WOAS subscales.

DISCUSSION AND IMPLICATIONS

The WOAS, and underlying theory, offers new insights and ideas for future exploration of the service gap between older adults' needs and professional availability across health service fields.

Measuring attitudes of those caring for people living with dementia: A quantitative survey

Background: The prevalence of dementia is increasing with more healthcare workers being required to care for people living with this progressive neurological disorder. The knowledge level and attitude of healthcare workers caring for those living with dementia need to be assessed and resources targeted effectively to ensure best quality care is provided. Healthcare workers for the purpose of this paper include anyone employed to care for those living with dementia.Aim: To investigate the attitudes of healthcare workers towards people living with dementia.Methods: A survey of 110 healthcare workers was undertaken between October 2016 and December 2017, using the Dementia Attitude Scale to measure attitudes towards people living with dementia. Demographic data were collected by a survey to explore whether a person's age; cultural background; qualification level; or experience level had an impact on their attitude towards people living with dementia.Results: The full survey was completed by n = 85 healthcare workers with the majority having strongly positive views about people living with dementia, with an average score of 88.31/100. However, a large number reported being afraid of people living with dementia (n = 76, 89.4%) and would avoid people with dementia who were agitated (n = 51, 61.4%). While 100% (n = 85) agreed or strongly agreed that it was possible to enjoy interacting with people living with dementia, they were more ambivalent with n = 26 (31.6%) strongly agreeing with the statement that working with people living with dementia is rewarding. A significant difference in attitude was found using one-way analysis of variance within groups due to age (p < .000) and cultural background (p < .035).Conclusions: Healthcare workers within this study had mainly positive attitudes towards people with dementia as demonstrated by the high attitude scores. However, this paper has shown that healthcare workers may require further education to improve attitude and care towards those living with dementia.

Development and Initial Validation of the Adolescents' Ageism Toward Older Adults Scale

BACKGROUND AND OBJECTIVES

Ageism toward older adults, prevalent in contemporary societies, seems to be internalized during childhood and consolidated during adolescence. Although several instruments have been developed to measure adolescents' ageism, they present a number of limitations. The study aimed at developing a new instrument, the Adolescents' Ageism Toward Older Adults Scale, and testing its psychometric properties.

RESEARCH DESIGN AND METHODS

A 3-phase process was followed: the instrument's items were developed empirically from focus groups of adolescents; its content validity was evaluated; and finally, its psychometric properties were tested through a multicenter cross-sectional study involving 575 adolescents.

RESULTS

Exploratory factor analysis of the new scale retained 33 items grouped into six factors: Moodiness, Traditionalism, Physical deterioration, Anti-technologism, Sageness and Sociability. Confirmatory factor analysis evidenced a second-order factor structure. Omega coefficients measuring internal consistency were above the cut-off of 0.60 for the six factors except for Anti-technologism. Intraclass correlation coefficients for the entire scale and for the six factors were greater than 0.70, again excepting Anti-technologism.

DISCUSSION AND IMPLICATIONS

The Adolescents' Ageism Toward Older Adults Scale is a promising measure of adolescents' negative and positive attitudes toward older adults. Its validation highlighted some criticalities that can be resolved by a few modifications. Further testing of the scale should be conducted after these modifications.

Ageism and the Factors Affecting Ageism among Korean Nursing Students: A Cross-Sectional Study

With the increasing population of older adults, ageism is an obstacle to health equity and can negatively affect older adults’ quality of life and nursing care. This study aims to examine the level of ageism and the factors associated with ageism among nursing college students, who will become the main workforce for gerontological nursing. A cross-sectional survey was conducted among 238 nursing students in two nursing colleges in South Korea. The total score for ageism was 37.06 (SD 5.94) out of a maximum of 72. In the multiple regression model, the predictors of ageism were aging anxiety (β = 0.420, p < 0.001), frequency of contact (β = −0.204, p < 0.001), preference for gerontological nursing (β = 0.150, p = 0.003), age (β = 0.145, p = 0.003), and quality of contact (β = −0.143, p = 0.030), revealing that these were factors influencing ageism in the evaluated nursing students. The results suggest that tailored gerontological education programs or community link programs in the nursing curriculum are necessary to share feelings of contact, increase positive experiences with older adults, and reduce anxiety about aging.

The psychometric properties, confirmatory factor analysis, and cut-off value for the Fraboni scale of ageism (FSA) in a sampling of healthcare workers

PURPOSE

The Fraboni scale of ageism (FSA) is one of the scales used to determine ageism, which is the expression of prejudice toward the elderly because of their age through attitudes and behaviors. The purpose of this study is to determine the psychometric properties, factor analysis, and cut-off value for the FSA in a sampling of healthcare workers.

DESIGN AND METHODS

The sampling of this study was conducted methodologically in a descriptive and relationship-seeking type of research and comprised 814 healthcare workers employed at a university and state hospital.

FINDINGS

As a result of the exploratory and confirmatory factor analyses, it was found that the FSA comprised 29 items and three subdimensions, that these three factors explain approximately 30.23% of the total variance, and that the cut-off value is 78.

PRACTICE IMPLICATIONS

This study determined that the Turkish adaptation of the FSA is a suitable tool to measure the ageism of healthcare workers.

The assessment of views on ageing: a review of self-report measures and innovative extensions

This is a review of existing self-report measures for assessing views on ageing. It provides an overview of instruments, for which basic psychometric properties are available and describes them according to the purposes for which they are suitable. Literature search resulted in the inclusion of 89 instruments which were categorised along eight dimensions. The majority of measures focus on explicit cognitions about people's own age and ageing or other (older) people. A substantial amount of tools account for the multidimensionality and multidirectionality of views on ageing, i.e. the idea that ageing is accompanied by both gains and losses in several different domains. To some extent, measures reflect that ageing is a long-term process and that views on ageing are malleable, rather than just stable traits. Cluster analysis revealed heterogeneity in instruments regarding the dimensions of Ecosystem, Balance, Stability, Dynamics, and Complexity. It becomes apparent, however, that approaches to measure views on ageing should be extended to more specifically target the implicit level as well as affective, physiological, and behavioural manifestations. Additionally, means for capturing views on ageing on the societal level and tools with a distinct time reference are needed. This is particularly important when one wants to account for the lifelong dynamics of views on ageing.

Pre-pandemic Ageism Toward Older Adults Predicts Behavioral Intentions During the COVID-19 Pandemic

OBJECTIVES

During the coronavirus disease 2019 (COVID-19) pandemic, older adults have been disproportionately affected by high rates of health complications and mortality. Reactions toward older adults included a mix of prosocial behaviors and ageist responses, consistent with the history of positive and negative views and treatment of older adults in the United States.

METHODS

In a two-part study (n = 113, Mage = 18.49, SD = 0.50; range 18-19), we examined whether pre-pandemic ageism among undergraduates predicts prosocial behavioral intentions toward older adults both specific to COVID-19 and in general.

RESULTS

Pre-pandemic ageism toward older adults predicted less intentions to help older adults generally and specific to COVID-19. Whereas viewing older adults as incompetent predicted greater intentions to help specific to COVID-19.

DISCUSSION

These results reflect the complexity of predicting helping behaviors and suggest that even supportive behaviors toward older adults during the COVID-19 pandemic may be rooted in negative ageist stereotypes. Implications and directions for future research are discussed.

Reducing Ageism With Brief Videos About Aging Education, Ageism, and Intergenerational Contact

BACKGROUND AND OBJECTIVES

With an increasing older population, ageism continues to be a significant social issue. Interventions to reduce ageism and improve intergenerational contact are needed.

RESEARCH DESIGN AND METHODS

Building on the Positive Education about Aging and Contact Experiences (PEACE) model, undergraduates in an online experiment were randomly assigned to watch videos that provided education about aging, ageism, and positive intergenerational contact (experimental condition) or education about wallpaper (control condition).

RESULTS

In Part 1, 845 undergraduates in the experimental condition (vs. control condition) reported lower levels of ageism, less negative age stereotypes, more positive age stereotypes, and more aging knowledge in an immediate post-test. In Part 2 (1-6 weeks later), undergraduates in the experimental condition (vs. control condition) reported more positive age stereotypes in a delayed post-test.

DISCUSSION AND IMPLICATIONS

These findings highlight the promise of providing information about aging and positive intergenerational contact to reduce ageism. Brief online educational videos based on the PEACE model hold promise as an effective tool to reach a wide audience and reduce ageism.

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses' Ageism Toward Older Adults: A Randomized Controlled Trial

Background

Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses.

Methods

A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students’ responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393).

Results

Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group.

Conclusions

CBT is an effective evidence-based psychological intervention for relieving nurses’ ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses’ accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

Electronic supplementary material

The online version of this article (10.1007/s10608-020-10167-4) contains supplementary material, which is available to authorized users.

Personality traits and fears of death and dying predict ageism

Ageism, or the discriminative attitudes toward specific age groups, often older adults, is a common prejudice with many negative consequences. This study explored the relationships between personality, fears of death and dying, and subscales of ageism (i.e., Avoidance, Discrimination, and Antilocution). Participants (N = 436) completed measures of personality, death and dying fears, and ageism. Multiple linear regressions showed that agreeableness, openness, and fearing others' death were negatively associated with ageism, whereas fearing the dying process of others was positively associated with ageism. This study demonstrates the distinct effects of personality and fears of death and dying on ageism.

Insecurity about getting old: age-contingent self-worth, attentional bias, and well-being

Objectives: Older adulthood has often been recognized as a time of increased well-being and positive cognitive biases. However, older adults can also experience many social and identity challenges. We sought to investigate which older adults might be most vulnerable to these difficulties. We propose that to the extent an older adult has age-related contingent self-esteem they will be at risk for lower well-being and negative attentional biases.Methods: Across three studies, we measured older adults' self-reported aging self-worth contingencies, as well as various measures of well-being including subjective stress. We then had participants complete a cued-dot probe task, where each trial either began with an aging threat or not.Results: In an initial pilot study, we found that older adults reporting specific cognitive decline contingencies held an attentional bias toward rejection, primarily when cued with the word senile. In Study 1, we found general aging contingencies to be associated with lower well-being and a rejection bias when cued with old. In Study 2, we found that a stronger rejection bias, particularly when cued with old, was associated with greater stress.Conclusions: These findings demonstrate that older adults who are insecure about aging may have lower well-being and negatively biased social cognitive patterns. Negatively biased attentional patterns may play a key role in maintaining feelings of insecurity. Importantly, our research sheds light on those older adults who may not experience a positivity effect.

Chinese Medical Students' Attitudes toward Older Adults and Willingness To Consider a Career in Geriatric Medicine: A Cross-Sectional Survey

Phenomenon: Ageism is a significant social issue, especially in China. Ageism adversely affects willingness to consider a career in geriatric medicine. However, few studies have examined this topic among Chinese medical students. This study aimed to investigate attitudes toward older people among medical students in China, examine the factors related to these attitudes, and determine the relationships between attitudes and willingness to consider geriatric medicine as a career after graduation. Approach: Responses from 1,022 Chinese medical students were included in the analyses. Students provided demographic information and completed the Fraboni Scale of Ageism (FSA). The data were analyzed using the Statistical Package for Social Sciences, version 24.0 (IBM SPSS Corp). Findings: The mean score of the FSA was 64.42 ± 6.58. Multiple regression analysis showed that the significant predictors of ageism were being male, longer years of training in medical school, and no caregiving experiences with older adults during clinical practice (R ² = .038, F = 13.520, p < .001). Students who had higher FSA scores were more unwilling to consider a career in geriatric medicine after graduation (t = 4.281, p < .001, Cohen's d = .268). Insights: Chinese medical students have fewer positive attitudes toward older adults than what has been reported in other countries. Future studies should examine the determinants of ageism among medical students in various cultures to guide the development, implementation, and assessment of interventions designed to nurture a more positive attitude toward older adults and increase willingness to consider a career in geriatric medicine.

Adaptation and psychometric characteristics of a scale to evaluate ageist stereotypes

OBJECTIVES

Negative ageism impacts on the well-being of older persons; therefore, its identification is important to generate interventions that allow its decrease. CENVE is a widely used instrument to evaluate stereotypes towards old age in Spanish. However, its factor structure in older population and its invariance between those over and under 60 years old have not been confirmed. The objectives of the study are to evaluate the psychometric properties of the instrument and its invariance by age and gender.

METHODS

The total sample was 439 people with 54 % of people over 60. This was divided into two random subsamples. With the first subsample, a confirmatory factor analysis of the different models proposed was carried out until an adequate fit was achieved, which was confirmed with the second subsample. Then, the invariance of the instrument was evaluated with the total sample by age and gender.

RESULTS

The revised CENVE consists of 15 items with a unifactorial structure that showed good psychometric properties. It presented good reliability, including a .92 Omega. In addition, it proved to be an invariant instrument according to age and gender, which allows comparison between groups.

DISCUSSION AND IMPLICATIONS

The use of CENVE will allow the identification of ageist stereotypes, with which interventions can be carried out to reduce them, both in groups older and younger than 60. In addition, it can be useful to generate a discussion about ageism in different fields, such as professional training.

Instapals: Reducing ageism by facilitating intergenerational contact and providing aging education

Utilizing the PEACE (Positive Education about Aging and Contact Experiences) model as a theoretical foundation, Instapals was a novel ageism reduction intervention with undergraduate students in a non-gerontology course that 1) provided aging education and 2) facilitated positive 1-to-1 intergenerational relationships with older adults (individuals 65+) through daily exchanges on Instagram for 30 days and two in-person meetings. Paired t-tests demonstrate a significant decrease in aging anxiety, psychological concerns about aging, and negative stereotyping of older adults. Results from coded open-ended responses suggest an overall positive experience with Instapals and more positive attitudes toward aging and older adults across a semester. Findings from the first test of Instapals, a theoretically-driven intervention, shows promise for reducing ageism among larger samples and in other settings.

Young Group Identification and Motives as Predictors of Ageism, Aging Anxiety, and Life Satisfaction

The present study examined young group identification and young group motives (i.e., self-esteem, distinctiveness, belonging, meaning, efficacy, and continuity) as predictors of ambivalent ageism, stereotyping of older people, aging anxiety, and life satisfaction among Turkish university students. Participants (N = 226) completed scales measuring age group identification, social identity motives, ambivalent ageism, stereotyping of older people, aging anxiety, and life satisfaction. Multiple hierarchical regression analyses showed that belonging to a young group was a significant predictor for ambivalent ageism. Young group identification and meaning were significant predictors for negative stereotyping of older people. Young group self-esteem was a significant predictor for aging anxiety. Young group identification, self-esteem, and meaning were significant predictors for life satisfaction. None of the independent variables was a significant predictor for positive stereotyping of older people.

Psychometric properties of a Chinese version of the Fraboni scale of ageism: evidence from medical students sample

BACKGROUND

The increasing of older adults has led to enormous demand for medical care. However, as a group with unique needs and characteristics, older adults are often discriminated against in the medical field. In this paper, we aimed to translate the Fraboni Scale of Ageism (FSA) into Chinese and examine its construct validity, content validity, and reliability in Chinese mainland medical students. In order to evaluate the prevalence of ageism in Chinese medical students and prompt medical college to adopt necessary teaching methods to mitigate ageism in medical students.

METHODS

By Brislin's translation guidelines, FSA was translated to Chinese. The convenient sampling method was used to select samples for this survey, including 1,974 students from two medical schools in central and north China. Construct validity was verified by the exploratory and confirmatory factor analysis. The content validity index (CVI) was used to assess content validity. The Cronbach's alpha coefficients and intraclass correlation coefficient (ICC) were used to estimate reliability.

RESULTS

The alpha coefficients for FSA (Chinese version) was 0.81 and ICC was 0.87. The CVI was 0.93. Three factors were identified by exploratory factor analysis explaining 34.84% of the total variance and a three-factor model was confirmed to fit by confirmatory factor analysis.

CONCLUSIONS

FSA (Chinese version) is a reliable and valid scale for measuring discrimination degree against older adults in Chinese medical students.

The Comparative Macro-Level Ageism Index: An International Comparison

Ageism, socially constructed discrimination against seniors, influences the quality of life of older adults. This study aimed to compare ageism in 15 Organization for Economic Cooperation and Development (OECD) countries using the scientifically developed Comparative Macro-Level Ageism Index (CMAI). We developed the CMAI by reviewing previous index research on the life of older people and conducting expert interviews using a Delphi method. We identified five domains, economic status, health, employment, environment, and social participation, and 17 indicators of ageism. Standardized ageism scores were compared across 15 OECD countries. The results indicated that the overall ageism score was highest in Turkey and lowest in Japan. Turkey was the most likely while South Korea was the least likely to practice age discrimination in the workplace. Yet, South Korea had the highest score for discriminating against seniors based on economic status while Spain had the lowest score in this domain. Japan had favorable conditions for economic status, health status, and social participation for older adults. Implications of this study and suggestions for further studies on developing an objective indicator of structural age discrimination are discussed.

Ageism between Medical and Preliminary Medical Persons in Korea

Background

We aimed to analyse the trends in ageism among health care providers and medical students in the Republic of Korea.

Methods

We used the Fraboni Scale of Ageism (FSA), Relating to Older People Evaluation (ROPE) questionnaire, Anxiety about Aging Scale (AAS), and the Facts on Aging Quiz II to assess ageism in medical students (n=90), nurses (n=114), and physicians (n=83). We grouped health care providers based on the percentage of aged patients (over 65 years) that they treated.

Results

Compared to the other groups, physicians had more knowledge about aging and the highest and lowest total scores in the FSA and ROPE, respectively. The total FSA scores were negatively correlated with the percentage of aged patients treated. Regarding the ROPE score, negative and positive ageist behaviors were positively correlated with the percentage of aged patients. Conclusions: Ageism and ageist behavior among physicians differed from previous reports and those of the other groups mentioned in the present study. Although physicians had more knowledge of aging, they had expressed a high levels of ageism. However, they did not act ageistically. Health care providers who treat a large number of older patients had minimal ageism but more ageist behavior. These findings indicate that continued education of geriatrics and ageism for medical staff and prospective medical personnel could help improve this situation.

Reducing Ageism: Education About Aging and Extended Contact With Older Adults

BACKGROUND AND OBJECTIVES

Ageism is of increasing concern due to the growing older population worldwide and youth-centered focus of many societies.

RESEARCH DESIGN AND METHODS

The current investigation tested the PEACE (Positive Education about Aging and Contact Experiences) model for the first time. Two online experimental studies examined 2 key factors for reducing ageism: education about aging (providing accurate information about aging) and extended contact (knowledge of positive intergenerational contact) as well as their potential combined effect (education plus extended contact).

RESULTS AND DISCUSSION

In Study 1, 354 undergraduates in all 3 experimental conditions (vs. control participants) reported less negative attitudes toward older adults (delayed post-test) and greater aging knowledge (immediate and delayed post-tests), when controlling for pre-study attitudes. In Study 2, 505 national community participants (ages 18-59) in all experimental conditions (vs. control participants) reported less negative attitudes toward older adults (immediate post-test) and greater aging knowledge (immediate and delayed post-tests). In summary, across 2 online studies, education about aging and knowledge of intergenerational extended contact improved attitudes toward older adults and aging knowledge.

IMPLICATIONS

Thus, brief, online ageism-reduction strategies can be an effective way to combat ageism. These strategies hold promise to be tested in other settings, with other samples, and to be elaborated into more in-depth interventions that aim to reduce ageism in everyday culture.

Generation Z Undergraduate Social Work Students' Knowledge of and Attitudes Toward Older Persons: Implications for Professional Training

Appropriate gerontological social work services are, amongst others, dependent on social workers' knowledge of and attitudes toward older persons. The current cohort of students, known as Generation Z, are global citizens. This study determined and described South African undergraduate social work students' knowledge of and attitudes toward older persons. A cross-sectional survey was undertaken with B Social Work students (N = 395) at two universities. Data collection included the three scales of Palmore's First Facts of Aging Quiz in multiple-choice format (1996) and four scales of Fraboni's Scale of Agism (1990). Age and five categorical factors were considered to determine their simultaneous impact on each of the seven scales/subscales of the two instruments by performing multi-way ANOVA models. An unexpected finding was that the factor 'completed a course in gerontology' did not have any impact on any scale. Year level of study, area of childhood residence and consideration to work exclusively with older persons after graduation simultaneously impacted respondents' 'overall attitude' toward older persons. Two factors (i.e., year level of study and area of childhood residence) mutually impacted respondents' 'overall knowledge' of aging. Recommendations for the training of Generation Z students are offered concerning course content and pedagogical interventions.

The Effect of Educational Interventions on Willingness to Work with Older Adults: A Comparison of Students of Social Work and Health Professions

The study examined the effect of an educational intervention on the willingness of Israeli social work students to work with older adults, comparing them to students of nursing, speech therapy, and physiotherapy. A sample of 187 first-year students were divided into two groups: a research group (n=83) exposed to an educational intervention on ageing, and a control group (n=104) that received no intervention of any kind. Following the intervention, ageism among social work students in the research group decreased and positive behavior toward older adults increased. No significant differences were found among students of the health professions following the intervention. In addition, ageism mediated between knowledge of ageing and willingness to work with older adults.Furthermore, the higher the students assessed the contribution of the intervention, the lower their level of ageism, the more positive their behavior toward older adults, and the more willing they were to consider a career in geriatrics. The results suggest that introducing into the curriculum a variety of learning methods aimed at increasing knowledge of ageing and familiarity with the world of older adults is likely to encourage more students of social work and other therapeutic professions to work with the older population.

Becoming a Home Care Worker: Job-Seekers' Push and Pull Factors

This study examined "push and pull" factors associated with the decision to become home care workers among job-seekers in Israel. Participants completed measures of ageism, anxiety about aging, attitudes toward the home care profession, and personal relationship with older adults. Of 1,492 participants, 32.0% accepted the offer to become home care workers and were no longer in the job market, 36.7% accepted the offer but worked in the past, and 31.2% refused the offer. Compared to participants currently employed, the odds of being employed in the past were higher for participants who were younger, with poorer health and higher ageism; the odds of refusal were higher for males, Arabs, younger participants, with more education, lower ageism, and fewer personal relationship with older adults. The findings have implications for practice with job-seekers and for retaining current home care workers in the field. This may assist in expanding the home care workforce.

A systematic review of existing ageism scales

Ageism has been shown to have a negative impact on older people's health and wellbeing. Though multiple scales are currently being used to measure this increasingly important issue, syntheses of the psychometric properties of these scales are unavailable. This means that existing estimates of ageism prevalence may not be accurate. We conducted a systematic review aimed at identifying available ageism scales and evaluating their scope and psychometric properties. A comprehensive search strategy was used across fourteen different databases, including PubMed and CINAHL. Independent reviewers extracted data and appraised risk of bias following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Of the 29,664 records identified, 106 studies, assessing 11 explicit scales of ageism, were eligible for inclusion. Only one scale, the 'Expectations Regarding Aging' met minimum requirements for psychometric validation (i.e., adequate content validity, structural validity and internal consistency). Still, this scale only assesses the 'stereotype' dimension of ageism, thus failing to evaluate the other two ageism dimensions (prejudice and discrimination). This paper highlights the need to develop and validate a scale that accounts for the multidimensional nature of ageism. Having a scale that can accurately measure ageism prevalence is key in a time of increasing and rapid population ageing, where the magnitude of this phenomenon may be increasing.

Ageism in Health Care: A Systematic Review of Operational Definitions and Inductive Conceptualizations

PURPOSE

International and national bodies have identified tackling ageism in health care as an urgent goal. However, health professionals, researchers, and policy makers recognize that it is not easy to identity and fight ageism in practice, as the identification of multiple manifestations of ageism is dependent on the way it is defined and operationalized. This article reports on a systematic review of the operational definitions and inductive conceptualizations of ageism in the context of health care.

DESIGN AND METHODS

We reviewed scientific articles published from January 1995 to June 2015 and indexed in the electronic databases Web of Science, PubMed, and Cochrane. Electronic searches were complemented with visual scanning of reference lists and hand searching of leading journals in the field of ageing and social gerontology.

RESULTS

The review reveals that the predominant forms of operationalization and inductive conceptualization of ageism in the context of health care have neglected some components of ageism, namely the self-directed and implicit components. Furthermore, the instruments used to measure ageism in health care have as targets older people in general, not older patients in particular.

IMPLICATIONS

The results have important implications for the advancement of research on this topic, as well as for the development of interventions to fight ageism in practice. There is a need to take into account underexplored forms of operationalization and inductive conceptualizations of ageism, such as self-directed ageism and implicit ageism. In addition, ageism in health care should be measured by using context-specific instruments.

Age differences in attitudes about older adults with dementia

Dementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.

Using the Relating to Older People Evaluation tool to measure ageism in higher education

BACKGROUND

The global population is ageing and this trend is expected to continue. Attitudes towards older people differ worldwide. Ageism is a complex, multifaceted concept that includes attitudes and behaviours. In the UK, ageism and discriminatory practices exist in nursing, and educationalists and clinicians need to address ageist attitudes and promote the care of older people. In nursing there is a lack of synthesised evidence measuring ageism among nursing students.

AIM

To explore the use of the Relating to Older People Evaluation (ROPE) questionnaire in different student populations in higher education, including nursing students.

METHOD

A systematic search was conducted for articles written in English describing the use of ROPE, published between 2007 and 2017. Six quantitative studies were identified that met the inclusion criteria. Statistical analysis was not possible and a thematic analysis of these studies was completed.

FINDINGS

Two themes emerged: attitudes predict behaviour and socialisation to ageism in higher education. Ageist attitudes were correlated with negative ageist behaviours and the socialisation of nursing students in clinical practice increased ageist attitudes.

CONCLUSION

Ageism and the ageist attitudes of nursing students must continue to be explored. ROPE is a suitable tool to measure nursing students' ageist attitudes and behaviours.

Where are we now in relation to determining the prevalence of ageism in this era of escalating population ageing?

Population ageing is escalating rapidly now worldwide. This is an important time to determine if ageism or discrimination against older people is of concern, such as it being prevalent and/or increasing in prevalence. Over the years, many ageism measurement tools have been developed, with research findings from their use of prime consideration then for determining the prevalence of ageism and any prevalence trends. All print and open access English-language research articles published in 1953+ that used one or more ageism measurement tools in a study were sought using the Directory of Open Access Journals and EBSCO Discovery Service. A total of 25 ageism measurement tools were identified. However, only six had been used one or more times to measure the prevalence of ageism. The identified prevalence levels varied considerably, but most investigations using small convenience samples, with limited generalizability of findings. This paper highlights the need to continue developing ageism measurement tools to estimate ageism or use other measures, such as census and population-representative polling, to assess the extent and impact of ageism. This foundational measurement is needed, as ageism could be prevalent and growing in effect.

Neural and behavioral markers of observed pain of older adults

To contribute to better understanding of empathy of younger adults for the pain of older adults, this study examined whether brain responses and behavioral ratings of young adult participants to the observed physical pain of older people differed from that to younger people. fMRI was used to measure participants' brain responses to seeing younger and older people receiving a painful compared with non-painful touch, while they rated both the level of perceived pain observed and their own level of personal discomfort from observing the painful touch. The young participants showed greater brain activation when observing younger versus older people receiving painful stimuli, and they rated the needle-touch to the younger people to appear more painful and more personally distressing. Furthermore, those participants reporting a greater level of contact with older adults at work showed less brain activation in the left insula cortex, a typical neural marker for observed pain, when observing painful touch to the older people. These have implications for understanding both the emotional responses and perception of pain of young adults when observing pain in the elderly.

Ageism in an Aging Society: The Role of Knowledge, Anxiety about Aging, and Stereotypes in Young People and Adults

The progressive aging of society, caused by profound demographic changes, brings with it the necessity of confronting the subject of biases against the elderly. Ageism, in fact, can influence society’s attitudes regarding this population, in addition to impacting the self-perception of elderly people. This, in turn, has consequences for positive outcomes during the aging process. The current research aims to investigate the simultaneous relationships between knowledge, age, anxiety about aging, and stereotypes toward the elderly, as well as their predictive roles with respect to ageism. A self-report questionnaire was administered to 886 participants, with an average age of 35.8 years (Standard Deviation—SD = 14.2), predominantly female (64.8%). Descriptive and correlational analyses were performed, along with structural equation modeling. Based on the analyses conducted, anxiety about aging and knowledge are antecedents for stereotypes, which in turn, together with the other variables, influence ageism. Increased education about the aging process could help reduce anxiety and stereotypes against the aging among those who are most responsible for prejudice against the elderly. Knowledge of the antecedents of prejudice toward the elderly is fundamental to promoting positive attitudes toward them.