Global reach of ageism on older persons' health: A systematic review

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

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

Everyday life experiences of Chinese community-dwelling oldest old who live alone at home

PURPOSE

Older adults aged ≥ 80 years living alone at home are more likely to experience challenges. Daily life experiences regarding living alone are still limited in the Asian context. This study explored the everyday life experiences of older Chinese residents living alone at home. Research questions included: (1) How do Chinese community-dwelling old people describe everyday life experiences related to living alone? (2) What kind of difficulties and needs do Chinese community-dwelling older people living alone face in everyday lives? (3) How do Chinese community-dwelling older people cope with challenges faced in their everyday lives related to living alone?

METHODS

This was qualitative descriptive research. Purposive sampling was adopted to recruit 13 participants aged 80-92 years of age from communities and one hospital. Semi-structured interviews were conducted to collect data which was analysed by conventional content analysis.

RESULTS

Three themes were identified: theme 1-difficulty in finding a sense of belonging, theme 2-striving to maintain independence, theme 3-hard to gain a sense of control.

CONCLUSIONS

This study provided novel insights into understanding the difficulties and needs of Chinese older people living alone at home. Three key challenges and associated strategies they used to cope with in daily lives were presented.

Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review

Purpose of Review

We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality.

Recent Findings

Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults' intersectional identities.

Summary

Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.

Leaving no one behind: successful ageing at the intersection of ageism and ableism

BACKGROUND

The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens.

METHOD

A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health.

RESULTS

We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia.

DISCUSSION

We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities.

CONCLUSION

Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.

Tellegacy: An Intergenerational Wellness and Health Promotion Project to Reduce Social Isolation and Loneliness in Older Adults: A Feasibility Study

Emerging research demonstrates that social isolation and loneliness are linked to significant physical and mental health conditions. To address these concerns, the Tellegacy program was developed as an intergenerational health-promoting intervention to ameliorate older adult social isolation and loneliness in an effort to increase wellness. The purpose of this study was to reflect on testing of the Tellegacy program as a behavioral intervention. University students trained in goal setting, mindfulness, and listening strategies were paired with 11 older adults in the northern Midwest area via weekly in-person and phone conversations. Oral reminiscence therapies were used and books containing their stories were given to the older adults after participation. Older adults were surveyed using the University of California Los Angeles Loneliness Scale, Satisfaction of Life Scale, and patient health questionnaire-9 (PHQ-9) scale to elucidate the effectiveness of the intervention. Improved scores in loneliness, satisfaction of life, and PHQ-9 demonstrated favorable improvements in older adults. Additional benefits for the student Legacy Builder were revealed from self-reported changes. This suggests the potential benefits of structured encounters between trained students and isolated or lonely older adults. The Tellegacy intergenerational feasibility program warrants further studies to fully demonstrate its impact on health outcomes.

Internalization of negative societal views on old age into self-perceptions of aging: exploring factors associated with self-directed ageism

Introduction

A growing number of research has provided evidence for the negative impact of ageism on older people's health and well-being. Among the three different manifestations of ageism, namely institutional, interpersonal and self-directed ageism, significant ageism-health associations have been proved to be strongest for self-directed ageism. This supports stereotype embodiment theory, which maintains that lifetime exposure to negative age stereotypes leads to the internalization of ageism as a form of negative attitudes towards own aging and it adversely affects health and well-being in old age. However, little is known about how people internalize negative age stereotypes held in the society into self-perceptions of aging.

Methods

This study aimed to explore how socially shared beliefs about old age are internalized into self-perceptions of aging focusing on uncovering factors related to self-directed ageism. Data were derived from the survey that had examined citizen's attitudes towards old age and aging in Finland. Multinominal logistic regression models were performed to examine the association of sociodemographic and contextual factors with different combinations of societal age stereotypes and two indicators of self-perceptions of aging: subjective views on old age and personal feelings of own old age.

Results

The analyses showed that being female, attaining tertiary education, evaluating poor quality of life and awareness of institutional old age discrimination were related to holding negative views on aging towards both society and oneself.

Discussion

The findings from univariate and multivariate models suggest that it is not age per se, but structural and cultural circumstances shaped with growing older that turns socially shared negative age stereotypes into negative self-perceptions of aging. Even though the study addressed situations in one country, the findings have an important implication for other rapidly aging societies regarding how social and cultural contexts are closely linked to the formation of self-directed ageism.

Do we all perceive experiences of age discrimination in the same way? Cross-cultural differences in perceived age discrimination and its association with life satisfaction

Age discrimination is pervasive in most societies and bears far-reaching consequences for individuals' psychological well-being. Despite that, studies that examine cross-cultural differences in age discrimination are still lacking. Likewise, whether the detrimental association between age discrimination and psychological well-being varies across contexts remains an open question. In this study, therefore, we examined cross-cultural differences in perceived experiences of age discrimination and their detrimental association with a specific indicator of psychological well-being, which is life satisfaction. The sample was drawn from the Ageing as Future study and comprised 1653 older adults (60-90 years) from the Czech Republic, Germany, Hong Kong, Taiwan, and the USA. Participants self-reported their experiences of age discrimination and their life satisfaction. Findings indicated that participants from Hong Kong and Taiwan reported experiences of perceived age discrimination more often than participants from the Czech Republic, Germany, and the USA. Furthermore, experiences of age discrimination were negatively associated with life satisfaction. Cultural context moderated this relation: We found a smaller detrimental association between perceived experiences of age discrimination and life satisfaction in Eastern cultures, that is, in contexts where such experiences were perceived to be more prevalent. These findings highlight the importance of examining age discrimination across cultures. Experiences of age discrimination are clearly undesirable in that they negatively affect psychological well-being. Our results indicate that a higher self-reported prevalence of perceived age discrimination in the samples studied weakens this negative association. We discuss these findings in terms of adaptation (versus sensitization) in response to discrimination.

The Impact of Caregiving History on Later-Life Self-Perceptions of Aging

OBJECTIVES

Theories suggest that self-perceptions of aging (SPA) reflect structural and cultural ageism together with an individual's personal life experiences. We examine the impact of an individual's history of informal caregiving on their SPA.

METHODS

Using data from the Health and Retirement Study (HRS, N = 8,372, age range 50-102 years), we investigated caregiving history as a determinant of later-life SPA. HRS participants provided reports of up to 5 episodes of caregiving, the life-course timing of each episode (start/end year), and their relationship with the care recipients. SPA was measured by the HRS Attitudes Toward Own Aging Scale. We conducted linear regressions to examine associations between specific caregiving histories and later-life SPA. Models included controls for current sociodemographic and health status.

RESULTS

Individuals who were ever a caregiver reported more negative SPA than noncaregivers. Variations in the impact of histories of caregiving were also revealed. Specifically, compared to people who had cared for adult(s) only, HRS participants who cared for both a child with special needs and an adult reported more negative SPA later in life.

DISCUSSION

The study provides insight into potential life-course precursors of SPA and highlights the importance of conceptualizing caregiving history as a complex life experience that might affect an individual's SPA later in life.

Suitability of the Attitudes to Aging Questionnaire Short Form for Use among Adults in Their 50s: A Cross-Sectional e-Survey Study

This cross-sectional e-survey study examines the suitability (reliability and validity) of the 12-item Attitudes to Aging Questionnaire Short Form (AAQ-SF) for use among adults in their 50s. The AAQ-SF instrument was originally designed to capture subjective perceptions of physical change, psychosocial loss, and psychological growth by asking people aged 60 and beyond how they feel about growing older. Our sample comprised 517 people residing in three Canadian provinces. Respondents completed the Attitudes to Aging Questionnaire Short Form, the Rosenberg Self-Esteem Scale, and a short sociodemographic profile. Our findings replicate the original AAQ-SF structure for physical change, psychosocial loss, and psychological growth, with a promising internal consistency range for the third subscale. In our sample, psychological growth is best represented as 'Self' and 'Generativity', with a particularly greater capacity to explain variations in scores for item 18 and item 21. Physical change and psychosocial loss scores strongly differed based on perceived health and chronic illness presence. Psychosocial loss and psychological growth were moderately correlated with two aspects of self-esteem. We relate these patterns of findings within the context of prevailing growth and development theory and their perceived implications within the context of COVID-19 and post-pandemic life.

The Self-Stigma of Hearing Loss in Adults and Older Adults: A Systematic Review

OBJECTIVES

Previous studies have demonstrated that individuals with hearing loss can internalize social stigmas, resulting in several self-perceived negative connotations, such as incompetence, cognitive impairment, and social disability. This systematic review aimed to investigate the impact of the social stigma associated with hearing loss on the self-stigma experienced by adults and older adults.

DESIGN

Combinations of words and appropriate truncations were selected and adjusted specifically for each electronic database. The Population, Exposure, Comparator, Outcomes, and Study Characteristics strategy was used to delimit the scope of the review, bearing in mind the importance of a well-formulated research question.

RESULTS

A total of 953 articles were retrieved from the final search of each database. Thirty-four studies were selected for full-text reading. Thirteen were excluded, and 21 studies were ultimately included in this review. The results of this review were divided into three themes: (1) impact of social stigmas on self-stigma, (2) effect of emotions on self-stigma, and (3) other factors that impact self-stigma. The themes were related to the relationship between the individual and social perceptions reported by the participants with respect to their hearing experiences.

CONCLUSIONS

Our results suggest that the impact of social stigma associated with hearing loss on the self-stigma of adults and older adults is strongly associated with the effects of aging and hearing loss, which may lead to withdrawal, social segregation, and negative self-perception.

Older adults' perceptions of ageism before and during the COVID-19 pandemic

OBJECTIVES

Studies assessing the effects of ageism on older adults during the COVID-19 pandemic suggest that perceiving ageism is associated with lower self-reported mental and physical health. Yet, it remains unknown whether these pandemic associations are distinct from pre-pandemic associations. The present study addressed this issue by controlling for pre-pandemic levels of ageism and mental and physical health in order to assess which pandemic-era experiences of ageism predict well-being in older people.

METHOD

Both prior to and during the pandemic, 117 older adults completed measures of perceived ageism, self-perceptions of aging, subjective age, subjective health, and life satisfaction.

RESULTS

During the pandemic, perceived ageism predicted lower subjective health and life satisfaction. However, when controlling for pre-pandemic measures, perceived ageism during the pandemic predicted only subjective health but not life satisfaction. Perceptions of continued growth positively predicted both measures across most analyses.

CONCLUSION

The present findings suggest caution when interpreting the effects of ageism on well-being during the pandemic, as those associations may already have existed pre-pandemic. The finding that perceptions of continued growth positively predicted subjective health and life satisfaction suggests that promoting more positive self-perceptions of aging, along with combatting ageism in society, may represent important policy objectives.

Positive Aging and Death or Dying: A Scoping Review

BACKGROUND AND OBJECTIVES

This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying.

RESEARCH DESIGN AND METHODS

An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models.

RESULTS

The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models.

DISCUSSION AND IMPLICATIONS

The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.

The Conceptual and Methodological Characteristics of Ageism During COVID-19: A Scoping Review of Empirical Studies

BACKGROUND AND OBJECTIVES

Printed and social media, as well as professional and scholarly platforms, have extensively discussed the proliferation of ageism during the coronavirus disease 2019 (COVID-19) pandemic. However, no study has systematically examined the body of knowledge on the topic. Framed around the characteristics of ageism in general, the aim of this review was to identify and characterize the conceptual and methodological underpinnings of the global, peer-reviewed, and empirical literature on ageism during COVID-19.

RESEARCH DESIGN AND METHODS

We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using PubMed, CINAHL, AgeLine, and PsycINFO. Quantitative and/or qualitative, English-language, and peer-reviewed articles were included. Data were tabulated and synthesized.

RESULTS

Thirty six articles examining ageism during the COVID-19 pandemic met inclusion criteria. Most were quantitative (64%) and cross-sectional (81%). The level, correlates, and consequences of ageism during the pandemic were similar to the ones reported before it. Studies about ageism during COVID-19 had similar conceptualization and measurement problems to those before the pandemic.

DISCUSSION AND IMPLICATIONS

Empirical studies did not find ageism during COVID-19 to be a unique phenomenon, as suggested by the media. More theoretically sound and methodologically rigorous studies, using longitudinal designs and validated unique measures are needed to examine this unique phenomenon.

Nursing students' knowledge and attitudes toward older adults

Nursing students, as the future healthcare workforce, hold immense potential in providing quality care to older adults and becoming advocates for promoting aging and public health, thus contributing significantly to addressing the multifaceted challenges of our aging society. Nurses' knowledge and attitudes about aging affect health care quality. Negative and unattractive representations of the social problems associated with aging contaminate nursing students' attitudes. Nursing schools are challenged to develop new curricula to prepare future nurses for the inherent complexity of an aging society. This study aims to assess the knowledge and attitudes of nursing students toward older adults and identify the variables that can influence these attitudes. Quantitative research was carried out through the application of an online survey using a cross-sectional descriptive research design. A total of 182 nursing students completed the online survey. Progression in the nursing course was statistically significant; the more students advanced, the more positive attitudes and knowledge they revealed about aging; 39% of students have daily contact with their grandparents; however, only 14.8% would like to work with older adults. Multiple linear regression revealed that the most important factor for positive attitudes and knowledge about aging was regular contact with grandparents, followed by progression in the nursing course. The students' age was not a significant factor in improving attitudes or expanding knowledge regarding older adults. In a multidimensional logic, the deepening of knowledge about aging and the socialization of students with older adults are central factors that should reinforce curricula in nursing education.

Ageism directed to older adults in health services: A scoping review

OBJECTIVE

to map the expressions of ageism directed to older adults in health services and the respective coping measures.

METHOD

a scoping review of primary studies in English, Spanish and Portuguese, without time delimitation and collected from 14 databases. Selection of the titles, abstracts and full text was in charge of two independent and blinded reviewers, totaling a corpus comprised by 41 articles. Data extraction was performed by pairs. The data were presented in narrative summaries and charts.

RESULTS

the ageism expressions are understood at the interpersonal level through images and attitudes that depreciate, devalue life and delegitimize older adults' needs, as well as at the institutional level, which confers barriers to accessing health services, generating non-assistance and neglect. The coping measures consist of educational interventions and expansion of communication channels between aged people, health professionals and managers.

CONCLUSION

the results may make health professionals vigilant for care/neglect guided by age bias and sensitive for coping with ageism by obtaining diverse scientific knowledge. The analysis of the phenomenon in the Unified Health System context constitutes a knowledge gap, as well as the implicit ageism expressions. (1) Ageism expressions involve interpersonal and institutional relationships. (2) Ageism directed to older adults permeates from diagnosis to treatment. (3) The coping measures comprise educational actions and also scientific research studies. (4) It is necessary to recognize the presence of ageism in health services. (5) It is necessary to recognize care/neglect practices guided by age bias.

Ageism directed to older adults in health services: A scoping review

OBJECTIVE

to map the expressions of ageism directed to older adults in health services and the respective coping measures.

METHOD

a scoping review of primary studies in English, Spanish and Portuguese, without time delimitation and collected from 14 databases. Selection of the titles, abstracts and full text was in charge of two independent and blinded reviewers, totaling a corpus comprised by 41 articles. Data extraction was performed by pairs. The data were presented in narrative summaries and charts.

RESULTS

the ageism expressions are understood at the interpersonal level through images and attitudes that depreciate, devalue life and delegitimize older adults' needs, as well as at the institutional level, which confers barriers to accessing health services, generating non-assistance and neglect. The coping measures consist of educational interventions and expansion of communication channels between aged people, health professionals and managers.

CONCLUSION

the results may make health professionals vigilant for care/neglect guided by age bias and sensitive for coping with ageism by obtaining diverse scientific knowledge. The analysis of the phenomenon in the Unified Health System context constitutes a knowledge gap, as well as the implicit ageism expressions. (1) Ageism expressions involve interpersonal and institutional relationships. (2) Ageism directed to older adults permeates from diagnosis to treatment. (3) The coping measures comprise educational actions and also scientific research studies. (4) It is necessary to recognize the presence of ageism in health services. (5) It is necessary to recognize care/neglect practices guided by age bias.

The Association of Technology-Based Ageism with Using Digital Technology in Physical Therapy for Older Persons

Integrating digital technologies in healthcare for older adults can enhance their independence and quality of life. Nevertheless, ageism among healthcare professionals impacts treatment decisions and may deprive older patients of technology-based treatment. This study explores whether technology-specific ageism influenced physiotherapists' use of technology-based healthcare with older patients. Seventy-eight physiotherapists in Luxembourg filled out an online survey. Participants filled out the Attitudes Towards Older Adults Using Technology (ATOAUT-11) scale, Expectations Regarding Aging, attitudes towards technology use in the work environment, and whether they had not offered technology-based treatment in the past because of a patient's age. Using logistic regression, negative ATOAUT was found to predict not offering technology-based treatment, such that participants with more negative attitudes (1 standard deviation) were two times more likely not to offer treatment. Positive attitudes towards using technology in the work environment were also found to be a significant predictor. All other characteristics (gender, age, experience and percentage of patients over 50) were not predictive of not offering treatment. This study demonstrates that technology-specific ageism may lead to discrimination and deprive older persons of optimal treatment. More research is needed to identify the magnitude of ageism in using technology-based treatment and develop interventions to overcome it.

[Factors associated with the perception of discrimination: ageism and quality of life of the geriatric population from a bioethical approach]

Introduction

There are a set of conditions that directly affect the quality of life of older adults, causing marginalization and discrimination of this age group.

Objective

Determining the factors that affect the perception of discrimination and quality of life of older adults in the province of El Oro, Ecuador.

Methods

Observational, descriptive, qualitative-phenomenological, cross-sectional, cross-sectional study in older adults aged 65 years, between September 2019 and November 2020. The sample consisted of 399 older adults. The questionnaire "Biopsychosocial assessment of older adults from a bioethical approach" was used. The following variables were measured: discrimination and self-perception of quality of life. Multiple correspondence analysis was used to examine the association between discrimination, quality of life and the variables under study.

Results

61.7% of the respondents considered that discrimination exists, with ageism predominating. The variable most related to the perception of discrimination of the MAs was the treatment in health care, and the family environment. The quality of life in a significant percentage was unsatisfactory due to: their family environment, poor social integration and dissatisfaction with their health.

Conclusions

The quality of life of older adults was unsatisfactory in almost half of the respondents, influenced by the relationship with the family, social integration, and health status. The older adults reported that there is discrimination and ageism in the treatment perceived in the health services and the family environment, in violation of the principles of bioethics.

Examining Public Awareness of Ageist Terms on Twitter: Content Analysis

Background

The World Health Organization, the Centers for Disease Control and Prevention, and the Gerontological Society of America have made efforts to raise awareness on ageist language and propose appropriate terms to denote the older adult population. The COVID-19 pandemic and older adults' vulnerability to the disease have perpetuated hostile ageist discourse on social media. This is an opportune time to understand the prevalence and use of ageist language and discuss the ways forward.

Objective

This study aimed to understand the prevalence and situated use of ageist terms on Twitter.

Methods

We collected 60.32 million tweets between March and July 2020 containing terms related to COVID-19. We then conducted a mixed methods study comprising a content analysis and a descriptive quantitative analysis.

Results

A total of 58,930 tweets contained the ageist terms "old people" or "elderly." The more appropriate term "older adult" was found in 11,328 tweets. Twitter users used ageist terms (eg, "old people" and "elderly") to criticize ageist messages (17/60, 28%), showing a lack of understanding of appropriate terms to describe older adults. Highly hostile ageist content against older adults came from tweets that contained the derogatory terms "old people" (22/30, 73%) or "elderly" (13/30, 43%).

Conclusions

The public discourse observed on Twitter shows a continued lack of understanding of appropriate terms to use when referring to older adults. Effort is needed to eliminate the perpetuation of ageist messages that challenge healthy aging. Our study highlights the need to inform the public about appropriate language use and ageism.

Older Adults Documenting Purpose and Meaning Through Photovoice and Narratives

BACKGROUND AND OBJECTIVES

The purpose of this study was to explore how older adults perceived meaning and purpose in their lives.

RESEARCH DESIGN AND METHODS

Participants (N = 15) ranged in age from 66 to 89 years, and were asked to document purpose and meaning in their lives for 15 consecutive days by using photovoice and narrative methodologies. Latent thematic analysis was used to interpret the data.

RESULTS

Findings indicated 3 themes including: (1) mindful practices, (2) active participation in society with a subtheme on technology, and (3) goal-oriented mindset. Mindful practices involved spending time in nature and working to improve it and reflecting and engaging in creative endeavors to help understand the changing world. Active participation in society created feelings of usefulness and belonging among participants and ranged from taking care of and helping others to leaving a legacy. The subtheme on technology demonstrated it used to maintain social relationships, particularly during the pandemic. Examples of the goal-oriented mindset incorporated informal lifelong learning opportunities that encouraged physical and cognitive stimulation. In addition, possessions appeared to bring increased meaning and purpose to individuals who were more homebound.

DISCUSSION AND IMPLICATIONS

Older adults identified purpose and meaning in their lives and demonstrated adaptability. For example, due to the pandemic or other personal dynamics such as declining mobility, some participants modified their activities to compensate. These findings have implications for policy and practice. Although older adults in this study demonstrated adaptability, others will need guidance and resources to successfully adapt and maintain levels of well-being.

Nursing Education as a Key Strategy to Combat Ageism: Preparing Nurses to Proactively Dismantle Their Own Ageist Views as Well as Ageist Practices Within Health Care Settings

ABSTRACT

The prevalence of ageism in health care prevents nurses from providing the best care to older adults. Nursing education can prepare nurses to proactively dismantle their own ageist views as well as ageist practices within health care settings. Active learning strategies, such as role-play and case studies, can be used to teach nurses how to become anti-ageism advocates and improve the quality of health care for older adults.

Outcomes of Cochlear Implantation in Age Subgroups of Veterans Over 50 Years Old

Objective

This study aimed to determine whether there was a difference in postoperative Arizona Biomedical (AzBio) speech recognition scores in 2 differently aged subgroups of veterans 50 years and older after cochlear implantation (CI).

Study Design

Retrospective chart review.

Setting

Tertiary referral center.

Patients

Seventy-one patients aged 50 to 74 years (younger cohort) were compared with 56 patients aged 75 years and older (older cohort) at the time of CI.

Interventions

Patients underwent therapeutic CI.

Main Outcome Measures

Comparison of AzBio speech recognition test scores in a quiet environment between the 2 differently aged cohorts of veterans 50 years and older.

Results

Despite no significant differences in preoperative AzBio score between the younger (mean 22.2%) and older cohorts (mean, 17.3%; P > 0.05), when examining the 6- and 12-month postoperative time points, the older cohort had significantly lower mean AzBio scores (50%, 55.8%; P < 0.05) than the younger cohort (69.8%, 71.9%; P < 0.05).

Conclusions

All patients aged >50 years experienced significant improvement in speech recognition scores following CI, although the cohort of ages 50 to 74 years scored significantly higher in later follow-up visits. These findings suggest that CI should be offered to appropriate candidates, regardless of age, although earlier intervention may be more advantageous.

Associations Between Everyday ICT Usage and (Self-)Ageism: A Systematic Literature Review

BACKGROUND AND OBJECTIVES

Both rapid technological changes and (self-)ageism are pervasive challenges of the 21st century, potentially affecting older adults' everyday functioning, health, and well-being. This systematic literature review aimed to synthesize scholarly evidence to determine the associations between everyday information and communication technology (EICT) usage and (self-)ageism as well as potential moderators.

RESEARCH DESIGN AND METHODS

A systematic search was performed in 8 academic databases, covering the time frame from January 1995 to January 2021. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a total of 15 articles met the inclusion criteria and were involved in the analysis. The standardized National Heart, Lung, and Blood Institute's quality assessment tools were used for risk bias.

RESULTS

Several studies demonstrated significant associations between EICT usage and stereotype embodiment (n = 8), stereotype threat (n = 2), and age discrimination (n = 3). Age (group), gender, and motivation were examined as potential moderators.

DISCUSSION AND IMPLICATIONS

This review provides initial evidence on the associations between (self-)ageism and EICT usage. It highlights the importance of positive subjective aging perceptions for active EICT usage in older adults, but also emphasizes the detrimental consequences of ageism in EICT learning settings and technology design on older persons' willingness and ability to use EICT. Further ecologically valid and methodologically sound research is needed to better understand both the nature and direction of the association between EICT usage and (self-)ageism.

Use and Acceptance of Digital Communication Technology by Older Adults for Social Connectedness During the COVID-19 Pandemic: Mixed Methods Study

BACKGROUND

Older adults are at higher risk for health issues, including mental health problems. This was especially apparent during the COVID-19 pandemic, where older adults were simultaneously more vulnerable to the disease and the mental health concerns created by social distancing. Subsequently, the use of digital communication technology (DCT) became a critical option for maintaining social connectedness in older adults. Prior to the pandemic, the low uptake and use of technology by older adults was an established problem, known as the digital divide. However, not much is known about how this may have changed as a result of the pandemic.

OBJECTIVE

This study aims to explore how older adults maintained social connectedness through DCT during the pandemic and to understand factors influencing the use and acceptance of DCT.

METHODS

A mixed methods explorative field study was set up, involving surveys and interviews of 25 community-dwelling older adults (65-88 years old) living in the United Kingdom. The surveys included the internet acceptance questionnaire (based on the Technology Acceptance Model [TAM]); COVID-19 dysfunctional anxiety was captured using the COVID-19 Anxiety Scale (CAS). Background information (demographics, use of technology) was gathered before conducting semistructured interviews. We hypothesized that CAS would affect constructs of TAM and that predictive constructs of TAM would have remained valid during the pandemic. We also posited that there would be unidentified themes outside TAM that impacted the acceptance and use of DCT. We used the quantitative data to guide the semistructured interviews, which were then analyzed through thematic analysis to identify additional themes.

RESULTS

Correlational analysis showed that CAS influences all constructs of TAM. We also saw that the predictive constructs of TAM, especially the perceived ease of use (PEU) and perceived usefulness (PU), remained valid during the pandemic. Common acceptance-influencing themes were encountered in both quantitative and qualitative analyses, with 3 matching the known constructs of TAM (PU, PEU, and behavioral intention). We identified 2 additional themes affecting acceptance, namely influence of the pandemic (situational context) and privacy and security concerns. DCT use (especially email and videoconferencing use) increased during the pandemic, but the results related to social networking sites were mixed.

CONCLUSIONS

The COVID-19 pandemic impacted technology acceptance and use by older adults, encouraging their use of certain DCT apps (email and videoconferencing apps, such as WhatsApp). These apps helped insulate them from adverse effects (social isolation and loneliness). Other social networking apps, however, exerted a negative influence, increasing anxiety and a general feeling of negativity. Future studies should maximize older adult agency related to design, privacy, security, and user requirements for development. We also recommend that when studying DCT acceptance for older adults, our additional identified themes should be considered alongside the existing TAM constructs.

Outcomes of dose-escalated IMRT and ADT in Octogenarians with prostate cancer

INTRODUCTION

We evaluated long-term outcomes for octogenarians with localised prostate cancer treated using dose-escalated image-guided intensity-modulated radiation therapy (IMRT) at our institution.

METHODS

The charts of octogenarians treated for localised prostate cancer were retrospectively reviewed. Overall survival (OS), prostate cancer-specific survival (PCaSS), toxicity rates and changes from baseline were collected.

RESULTS

The median follow-up was 97 months. Of 107 eligible patients, 27.1% had intermediate-risk and 72.9% had high-risk localised prostate cancer. Median dose was 78Gy, and 97.2% received ADT. OS was 91.4% and 67.2% at 5 and 10 years. PCaSS was 98.0% and 88.7% at 5 and 10 years. In all, 39 (36.4%) of patients died, with the cause of death known in 30: in 26.7% of these patients, prostate cancer was the cause of death. Grade ≥ 2 late GI and GU toxicity was 0.9% and 24.3% respectively. In all, 11.2% and 22.4% of patients reported worsening of GI or GU function from baseline, and 13.1% and 21.5% reported improvement in GI and GU function compared to baseline.

CONCLUSION

Selected octogenarian patients with localised prostate cancer appear to benefit from radiation therapy and ADT. Despite excellent long-term PCaSS, 26.7% of patients died of prostate cancer. Rates of GI and GU toxicity were acceptable, and deterioration of urinary and bowel function compared to baseline was just as common as improvement in function from baseline.

Essentials to Improve the Effectiveness of Healthy Aging Programming: Consideration of Social Determinants and Utilization of a Theoretical Model

Older adult health, while partially determined by genetics, is mostly determined by behavioral and lifestyle choices. Researchers and interventionists develop and administer behavioral health interventions with older adults, and interventions are advertised in any number of settings, for example, by providers in healthcare settings and by activity directors in senior centers or assisted living facilities. However, previous studies and metanalyses indicate that many interventions targeting older adults are unsuccessful in recruitment or in retention. While providers and activity directors may assume older adults are unwilling to participate in behavioral change, in reality, low participation may be caused by erroneous design and administration. The objective of this manuscript is to recommend to creators and implementers of behavioral interventions for older adults that they focus on two critical considerations: the contextual perspective pertaining to healthy aging as well as an appropriately employed theoretical model that most effectively informs program design and implementation. In this commentary, we discuss how Prochaska and DiClemente's Transtheoretical Model of Health Behavior Change may lead to more desirable outcomes as it considers that a person may be at any one of six stages of change, from pre-contemplation to maintenance. Currently, many behavioral interventions are targeted at individuals who are poised for action or in maintenance phases, ignoring those in earlier phases, resulting in limited overall success. Regarding viewing healthy aging in a contextual manner, determinants external to the individual may remain unnoted and unconsidered when designing or recruiting for a behavioral intervention. In conclusion, the integration of an intrapersonal health behavior model such as the Transtheoretical Model of Health Behavior Change, coupled with clearer considerations of the interplay of contextual factors operating in the lives of older adults, may allow for more effective design and implementation, as well as resulting in higher participation in behavioral interventions targeted toward older adults.

Negative and positive ageism in an Italian sample: how ageist beliefs relate to epistemic trust, psychological distress, and well-being

Ageism is a social issue of growing concern; ageist beliefs can shape the individual and collective experience of aging. The present study aimed to explore positive and negative ageism in young adults (YA) (18-30 years) and adults (AD) (31-60 years) and their relationship with epistemic trust, psychological distress, and psychological well-being. 301 Italian adult participants completed an online survey that included the following self-report questionnaires: attitudes towards older people scale, epistemic trust, mistrust and credulity questionnaire, depression anxiety stress scale-21, and Warwick-Edinburgh mental wellbeing scale. Negative ageism was significantly higher in YA compared to AD; on the contrary, AD presented more positive ageism than YA. When considering the entire sample, negative ageism was correlated with various dimensions of psychological distress and epistemic trust. A mediation model revealed that epistemic mistrust fully mediated the relationship between age and negative ageism, suggesting that changes in ageist beliefs that seem to occur with age are mediated by a mistrustful epistemic stance. Future research should focus on further exploring the link between epistemic trust, mental health, and holding ageist beliefs. The results are also discussed in terms of their implications for the treatment of older patients.

A Systematic Review of Qualitative Research Literature and a Thematic Synthesis of Older LGBTQ People's Experiences of Quality of Life, Minority Joy, Resilience, Minority Stress, Discrimination, and Stigmatization in Japan and Sweden

There is a lack of research on older lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adults. This systematic review aimed to synthesize Japanese and Swedish qualitative research on LGBTQ adults aged 60 years or older following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Japanese and Swedish articles, published in English, were searched across ASSIA, CINAHL, Medline, PsychINFO, PubMed, Scopus, and Sociological Abstracts databases. Additional searches were conducted to include studies in Japanese or Swedish. There were no papers from Japan, whereas five from Sweden were reviewed. One article was excluded due to the wrong phenomenon. Four articles were included, involving 48 participants aged 60-94 years. We summarized the findings using a deductive thematic synthesis. Two major themes emerged: (a) quality of life, minority joy, and resilience (positive aspects), and (b) discrimination, stigmatization, and minority stress (negative aspects). The participants wished to be acknowledged for their own assets and unique life histories, and to be treated as everyone else. They emphasized the importance of knowledge of LGBTQ issues among nursing staff, so that older LGBTQ people are treated in a competent and affirmative way. The study revealed several important topics for understanding older LGBTQ adults' life circumstances and the severe lack of qualitative studies in Japan and Sweden.

The Context of Elder Maltreatment: an Opportunity for Prevention Science

Elder maltreatment (EM) has been understood as a worldwide major public health threat for decades, yet it remains a form of victimization receiving limited attention, resources, and research. EM, which includes caregiver neglect and self-neglect, has far-reaching and long-lasting impacts on older adults, their families, and communities. Rigorous prevention and intervention research has significantly lagged in proportion to the magnitude of this problem. With rapidly growing population aging, the coming decade will be transformative: by 2030, one in six people worldwide will be aged 60 or older, and approximately 16% will experience at least one form of maltreatment (World Health Organization, 2021). The goal of this paper is to raise awareness of the context and complexities of EM, provide an overview of current intervention strategies based on a scoping review, and discuss opportunities for further prevention research, practice, and policy within an ecological model applicable to EM.

Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations

Purpose

To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden.

Patients and Methods

We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis.

Results

The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness.

Conclusion

Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.

Agency and Mental Health Among Peruvian Older Adults During the COVID-19 Lockdown

OBJECTIVES

To explore the experiences of older Peruvian adults living in urban areas of Lima under lockdown due to the National COVID-19 Emergency, this study analyzes how older adults (aged 60 and older) exercise agency while also living with the negative impacts of coronavirus disease 2019 (COVID-19) and related control measures.

METHODS

Between August and December 2020, our research team conducted a telephone-based, qualitative study, in which we undertook semistructured interviews with a purposive sample of low-income older adults living with chronic multimorbidities and limited resources. Forty older adults, 24 women and 16 men, with a mean age of 72 years, participated in the study. For data analysis, we employed thematic analysis with a predominantly inductive approach.

RESULTS

Older adults demonstrated several forms of agency to regulate emotions, maintain crucial bonds, foster social relationships, and seek economic and food security. Older adults experienced entertainment and support by caring for pets, undertaking farm work, and practicing their religious beliefs. For several participants and their families, quarantine was an opportunity to strengthen family relationships and learn new technologies. Older adults and their families reorganized themselves to assume new roles and perform activities that improved self-worth and confidence, thereby improving their well-being and mental health.

DISCUSSION

Peruvian older adults exerted agency in different ways to respond to and sustain their mental health during the COVID-19 lockdown. Policymakers should value and recognize the agency of older adults when planning future health responses.

Double Stigma in Portuguese Lesbian, Gay, and Bisexual Older Adults: A Study of Health Status

The double stigma-sexual stigma and ageism-can affect the health status of lesbian, gay, and bisexual (LGB) older adults, but little is known about this topic in Portugal and internationally. The aim of this study was to assess the health status and the prevalence of chronic diseases of Portuguese LGB older adults, as well as to assess the relationship between double stigma and health status. A sample of 280 Portuguese LGB older adults completed a chronic disease questionnaire, the Homosexuality-Related Stigma Scale, the Ambivalent Ageism Scale, and the SF-12 Short Form Health Survey. A structural equation model was performed using the double stigma variables as independent variables and health status as outcome. The mental health status of Portuguese LGB older adults was lower when compared to people from studies from more than 10 countries. Higher sexual self-stigma, sexual enacted stigma related to health care, and benevolent ageism significantly explained the worse general health status. The double stigma significantly affects the health status of these older adults in a profile of internalization of sexual stigma and benevolent age discrimination, and not necessarily by a hostile/aggressive profile. More research is needed on the double stigma.

Longitudinal effects of subjective aging on health and longevity: An updated meta-analysis

This article updates and extends an earlier meta-analysis (Westerhof et al., 2014) on the longitudinal effects of subjective aging (SA) on health outcomes. A systematic search in different databases (APA PsycInfo, PubMed, Web of Science, and Scopus) resulted in 99 articles, reporting on 107 studies. Participants: Studies had a median sample size of 1,863 adults with a median age of 66 years. A randomized effect meta-analysis showed a significant, small effect (likelihood ratio = 1.347; 95% confidence interval [1.300, 1.396]; p < .001), similar in magnitude to the previous meta-analysis of 19 studies. Although the results showed high heterogeneity in the longitudinal link between SA and health outcomes, there were no differences in effects according to chronological age of participants, welfare state status (more or less developed social security system), length of follow-up, type of health-related outcome, or quality of the study. Effects were stronger for multiitem measures of self-perceptions of aging than for the frequently used single-item measures assessing subjective age, especially for indicators of physical health. Based on this meta-analysis, building on five times more studies than the 2014 review, we consider the associations of measures of SA with health and longevity across time as robust, albeit small in size. Future research should concentrate on the clarification of pathways mediating the relation between SA and health outcomes, as well as potential bidirectional effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Age-based exclusion is common and multifactorial in spinal RCTs: a systematic review and quantitative analysis

Most diseases of the spine disproportionately impact older persons, with the modal (i.e., commonest) patient a female in their 8th decade of life. We examined the corpus of spinal RCTs to determine how many included "average" spine patients. We searched PubMed for randomized clinical trials published in the top 7 spine journals over a period of 5 years from 2016 to 2020 and extracted nominal upper age cut-offs and the distribution of ages actually recruited. We identified 186 trials of 26,238 patients. We found that only 4.8% of trials could be applied to an "average" 75-year-old patient. This age-based exclusion was not dependent on funding source. Age-based exclusion was exacerbated by explicit upper age cut-offs, however, the age-based exclusion went beyond explicit age cut-offs. Only few trials were applicable to older patients even amongst trials with no age cut-off specified. Age-based exclusion from clinical trials starts at late middle age. The mismatch between spinal patient's age seen in clinical practice and spinal patient's age in trials was so severe that over the 5 years (2016-2020) almost no RCT evidence was produced applicable to the "average" aged-patient across the body of literature available. In conclusion, age-based exclusion is ubiquitous, multifactorial, and happens on a supratrial level. Eliminating age-based exclusion involves more than an arbitrary lifting of explicitly stated upper age cut-offs. Instead, recommendations include increasing input from geriatricians and ethics committees, establishing updated or new models of cares, and creating new protocols to facilitate further research.

Specific form of ageism in dental care: Convergent validity of the Ageism Scale for Dental Students and its implications for education

INTRODUCTION

The World Health Organisation considers ageism as an important barrier to age-appropriate care for older adults. An Ageism Scale for Dental Students (ASDS) has been validated in the United States, Brazil, Greece, Romania and in France. At present, the convergent validity of ASDS has never been evaluated. Moreover, a specialised and disciplinary tool as the ASDS may not overlap with more general ageism assessment which may highlight the need for specific courses during the education of the future health professionals.

MATERIALS AND METHODS

The survey was administered from December 2020 to January 2021. All the undergraduate students of the last 3 years of study at the dental school of Clermont-Ferrand were invited to complete both scales. Two hundred sixteen students were randomly divided into two equal groups. The first group answered first Aging Semantic Differential- ASD then ASDS, the second in reverse order. The convergent validity between ASDS and ASD was assessed by computing a Pearson correlation coefficient and discriminant analysis between each component of the two scales.

RESULTS

The response rate was of 53.7%. The correlation analysis conducted on the total scores of the ASDS and of the ASD shows a significant, yet weak relationship. The discriminant analysis indicates that only the first component of the ASDS is significantly associated with each dimension of the ASD, whereas the second component is totally independent from the ASD and the third component almost independent from the ASD, except for the integrity dimension.

CONCLUSIONS

This specialised questionnaire may assess a form of ageism that is not captured at all in more general scales. Such a scale may help to identify the different dimensions of ageism among dental students which is required to reduce ageism in medical care. This reduction should pass by adapted courses in gerodontology.

Neighborhood Social Environment and Self-Perceptions of Aging

Background and Objectives

Self-perceptions of aging (SPA) are associated with health and well-being later in life. Although prior studies have identified individual-level predictors of SPA, the role of neighborhood social context in SPA remains largely unexplored. A neighborhood social environment may act as a critical avenue for older adults to remain healthy and socially active, contributing to their evaluations of how they grow old. The present study aims to fill the previous research gap by examining the relationship between neighborhood social environment and SPA, and how age may moderate this relationship. This study is guided by Bronfenbrenner's Ecology of Human Development theory and Lawton's Ecological Model of Aging, positing that an individual's aging experience is deeply rooted in their residential environment.

Research Design and Methods

Our sample includes 11,145 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study. We included 4 social and economic aspects of neighborhoods: (1) neighborhood poverty; (2) percentage of older adults; (3) perceived social cohesion; and (4) perceived disorder.

Results

Multilevel linear regression models showed that respondents in neighborhoods with higher percentages of the older population and with perceptions of high neighborhood disorder reported more negative SPA. Those who perceived their neighborhoods as more socially cohesive reported more positive SPA. Controlling for individual socioeconomic and health status, only neighborhood social cohesion remained significant. We also found significant interaction effects between neighborhood social cohesion and age: The effects of neighborhood cohesion on SPA were stronger in middle age than in old age.

Discussion and Implications

Our findings provide insights into how neighborhood social context is associated with SPA, suggesting that a socially cohesive neighborhood may be important to promote more favorable perceptions of aging, particularly for middle-aged residents.

Chronic Effects of Different Intensities of Interval Training on Hemodynamic, Autonomic and Cardiorespiratory Variables of Physically Active Elderly People

Interval training (IT) is a very efficient method. We aimed to verify the chronic effects of IT with different intensities on hemodynamic, autonomic and cardiorespiratory variables in the elderly. Twenty-four physically active elderly men participated in the study and were randomized into three groups: Training Group A (TG_A, n = 8), Training Group B (TG_B, n = 8) and control group (CG, n = 8). The TG_A and TG_B groups performed 32 sessions (48 h interval). TG_A presented 4 min (55 to 60% of HRmax) and 1 min (70 to 75% of HRmax). The TGB training groups performed the same protocol, but performed 4 min at 45 to 50% HRmax and 1 min at 60 to 65% HRmax. Both training groups performed each set six times, totaling 30 min per session. Assessments were performed pre (baseline) after the 16th and 32nd intervention session. The CG performed only assessments. Hemodynamic, autonomic and cardiorespiratory (estimated VO_2max) variables were evaluated. There were no significant differences between protocols and times (p > 0.05). However, the effect size and percentage delta indicated positive clinical outcomes, indicating favorable responses of IT. IT may be a strategy to improve hemodynamic, autonomic and cardiorespiratory behavior in healthy elderly people.

Trends in elder abuse and age discrimination during the COVID-19 pandemic in Hong Kong: Findings from a two-wave representative telephone survey study

OBJECTIVES

Empirical evidence about the heightened risks of elder abuse and age discrimination during the COVID-19 pandemic is scarce. This study aimed to track the changes in rates of both, and investigated their associated factors in the community-dwelling older population in Hong Kong.

METHODS

In this two-wave, cross-sectional telephone survey, we interviewed a population-based sample of individuals (≥55 years), and captured the situation of elder abuse and age discrimination before the COVID-19 outbreak (n = 1209, Wave 1: October-December 2019) and during the pandemic (n = 891, Wave 2: December 2020-January 2021). Participants reported their experiences of different types of abuse and discrimination, financial health, subjective well-being, satisfaction with environment, health and social services, and resilience.

RESULTS

Abuse was reported by 20.2% of the sample before the outbreak and 17.8% during the pandemic; while discrimination was reported by 24.6% and 29.8% at the two time points, respectively. A drop in physical abuse was observed, but it was accompanied by a rise in discrimination in the form of harassment or refusal of services. Findings of logistic regression analysis show that abuse during the pandemic was associated with younger age, poorer subjective well-being, and lower resilience; while discrimination was associated with female gender, being married, and poorer subjective well-being.

CONCLUSIONS

Elder abuse and discrimination were prevalent across time points. The pandemic has highlighted the marginalization of older persons in our communities. There is an urgent need for development of effective interventions to end abuse and discrimination.

COVID-19 pandemic in long-term care: An international perspective for policy considerations

This paper identifies key factors rooted in the systemic failings of the long-term care sector amongst four high income countries during the COVID-19 pandemic. The goal is to offer practice and policy solutions to prevent future tragedies. Based on data from Australia, Canada, Spain and the United States, the findings support evidence-based recommendations at macro, meso and micro levels of practice and policy intervention. Key macro recommendations include improving funding, transparency, accountability and health system integration; and promoting not-for-profit and government-run long-term care facilities. The meso recommendation involves moving from warehouses to “green houses.” The micro recommendations emphasize mandating recommended staffing levels and skill mix; providing infection prevention and control training; establishing well-being and mental health supports for residents and staff; building evidence-based practice cultures; ensuring ongoing education for staff and nursing students; and fully integrating care partners, such as families or friends, into the healthcare team. Enacting these recommendations will improve residents' safety and quality of life; families’ peace of mind; and staff retention and work satisfaction.

Relationship between income and concerns about physical changes and help-seeking by older adult cancer survivors: a secondary analysis

OBJECTIVE

Globally, the number of older adults surviving cancer is anticipated to grow rapidly over the next decades. Cancer and its treatment can leave survivors with a myriad of challenges including physical changes which impact independence and quality of life. This project explored the relationship of income level with concerns and help-seeking for physical changes following treatment in older Canadian survivors of cancer.

METHODS

A Canada-wide survey of community-dwelling survivors of cancer explored their experiences with survivorship care one to three years following completion of treatment. A secondary trend analysis examined the relationship of income with older adults' level of concern and help-seeking experiences regarding physical consequences they attributed to their cancer treatment.

RESULTS

In total, 7,975 people aged 65 years and older who survived cancer responded to the survey, of whom 5,891 (73.9%) indicated annual household income. Prostate (31.3%), colorectal (22.7%) and breast (21.8%) cancer accounted for the majority of respondents. Of those who reported household income data, over 90% wrote about the impact of physical changes following treatment, their concerns about the changes, and whether they sought help for their concerns. The most frequently identified physical challenge was fatigue (63.7%). Older survivors with low annual household incomes of less than $CA25,000 reported the highest levels of concern about multiple physical symptoms. 25% or more of the survey respondents across all income levels reported difficulty finding assistance for their concerns about the physical challenges, especially in their local communities.

CONCLUSION

Older survivors of cancer can experience a range of physical changes, amenable to intervention by physical therapy, yet experience challenges obtaining relevant help. Those with low income are more severely affected, even within a universal healthcare system. Financial assessment and tailored follow-up are recommended.

Self-reported hearing and awareness of age-related change : A domain-specific perspective

BACKGROUND

Impaired hearing is associated with disadvantages in developmental outcomes, such as compromised everyday social communication or reduced well-being. Hearing impairment might also have an impact on how individuals evaluate their own aging as deterioration in hearing can be interpreted as being age-related and as a phenomenon individuals attribute to getting older.

OBJECTIVE

This study investigated how self-reported hearing is related to awareness of age-related change (AARC).

MATERIAL AND METHODS

AARC is a multidimensional construct comprising perceived age-related gains and losses in general as well as across five functional domains (health and physical functioning, cognitive functioning, interpersonal relations, social cognitive and social emotional functioning, lifestyle and engagement). A sample of 423 individuals (age range 40-98 years; mean age, M = 62.9 years; standard deviation (SD) = 11.8 years) was assessed up to 3 times over approximately 5 years.

RESULTS

Based on longitudinal multilevel regression models, controlling for age, gender, subjective health and education, it was found that poorer self-reported hearing was associated with more perceived general AARC losses as well as with more AARC losses in health and physical functioning and in cognitive functioning at baseline. With an older age at baseline, poorer self-reported hearing was associated with a steeper decline in AARC gains regarding interpersonal relations over time, whereas in those who were younger at baseline poorer hearing was related to fewer gains in social cognitive and social emotional functioning at baseline.

DISCUSSION

Self-reported hearing reveals differential associations with AARC domains; however, changes in most AARC domains of gains and losses seem to be only weakly related to subjective hearing.

"With your age, what do you expect?": Ageism and healthcare of older adults in Spain

INTRODUCTION

Ageism could influence the relationship between older patients' meeting needs and healthcare professionals' answers.

AIMS

To highlight the experience of older adults with healthcare systems, how they perceive ageism from their healthcare providers, and to explore the relationship between perceived ageism and self-perception of aging (SPA).

METHODS

We conducted an exploratory qualitative study. The participants were 14 women over 65 who lived alone in their homes.

RESULTS

Professional responses ignored the expression of preferences of the older patients and excluded them from decision-making processes. These answers influenced older patients' use of health services. Moreover, the negative aspects predominated in a SPA influenced by the internalization of stereotypes and a relationship weighed down by ageist behaviors on the part of health professionals.

CONCLUSION

Explicit situations of ageism influence an imbalance in power relations between older patients and healthcare professionals, a misuse of health services, and a negative SPA.

Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study

BACKGROUND

In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained.

OBJECTIVE

The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied.

METHODS

A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes.

RESULTS

The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors.

CONCLUSIONS

The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism.

Loneliness as a Potential Mechanism of the Association Between Ageism and Mental Health Outcomes in the Chilean Context

The negative impact of ageism on the mental health of older persons has been well studied, but the mechanisms underlying this relationship have not been explored in detail. The present study examines the relationship of ageism with depressive and anxious symptoms in older people, evaluating the indirect effect via loneliness. The analysis was carried out with a sample of 577 older adults living in Chile, using structural equation modeling to assess the direct and indirect effects of the proposed model.The results showed the direct and indirect association of ageism with mental health outcomes. Ageism is positively related to loneliness and, in turn, to increased depressive and anxious symptoms. We discuss how loneliness linked with an ageist context contributes to anxiety and depressive symptomatology in the older population and the need to reduce ageism to favor the mental health of this age group.

Training in Aging as a Diversity Factor: Education, Knowledge, and Attitudes Amongst Psychology Doctoral Students

The population of older adults is growing rapidly and there will be an increased need for psychological services for this population. Current estimates indicate a significant workforce gap such that all psychologists, regardless of specialty area, will likely be called upon to work with older adults. Education and experience in the care of older adults has been consistently connected with improved competence and interest in working with this population. Further, the APA requires that training programmes adequately cover aspects of individual diversity, though age-related education and training may be largely lacking and/or minimally addressed. The present study explores age-related training within a sample of psychology doctoral students. Participants (n = 85) consisted of doctoral trainees recruited via email (listserv) to complete an anonymous online survey as part of a larger study. Results indicate that (1) training in aging varies and is inadequate in some programmes; (2) knowledge in aging varies and is associated with training opportunities; (3) training in aging is less than training in race/ ethnic diversity; and (4) attitudes toward older clients are most strongly predicted by extent of training in aging. The authors offer suggestions for expanding age-related aspects into generalist training.

A qualitative study of older adult trauma survivors' experiences in acute care and early recovery

BACKGROUND

Older adults (aged ≥ 65 yr) account for a substantial proportion of hospital admissions for severe injury, yet little is known about their care experiences and views regarding outcomes. We sought to characterize the acute care and early recovery experiences of older adults who had been discharged after traumatic injury, with a long-term goal to inform the selection of patient-centred process and outcome measures in geriatric trauma.

METHODS

From June 2018 to September 2019, we conducted telephone interviews with adults aged 65 years or older who had been discharged after traumatic injury within 6 months from Sunnybrook or London Health Sciences Centres in Ontario, Canada. Using interpretive description and thematic analysis, we drew on social science theories of illness and aging for data interpretation. We analyzed data to the point of theoretical saturation.

RESULTS

We interviewed 25 trauma survivors aged 65-88 years. Most were injured in a fall. Four themes characterized participants' experiences, as follows: "I don't feel like a senior" (i.e., participants disliked being viewed as a senior or as needing senior-specific care); "don't bother telling him anything" (i.e., participants perceived ageist assumptions and treatment in acute care processes); getting back to normal (i.e., participants emphasized their active lifestyles and functional recovery as goals of care); "I have lost control of my life" (i.e., substantial social and personal losses linked to participants' experiences and adaptations to aging generally).

INTERPRETATION

Findings suggest that older adults experience social and personal loss after injury, and underscore how implicit age bias may influence care experiences and outcomes. This can inform improvements in injury care and guide providers in the selection of patient-centred outcome measures.

Greek dental students' perceptions of treating older patients

BACKGROUND AND AIM

The oral problems of the older population are largely undertreated because of various barriers, including negative perceptions and ageist stereotypes, among care providers. The aim of this study was to record the perceptions of Greek dental students of treating older patients.

MATERIALS AND METHODS

An anonymous written questionnaire including two open-ended questions about the positive and negative issues when treating older patients was administered to clinical dental students. A content analysis was conducted to identify the main themes.

RESULTS

A total of 135 students responded to the questionnaire (response rate 88.23%). Five key themes were identified for the facilitating factors and six for the barriers/challenging factors. The facilitating factors of treating older people were the promotion of the patients' health and quality of life, the good interaction and communication with older patients, the dentist's intrinsic reward treating older people, the positive feedback from the patients and the improvement of professional dental competences when treating complex cases. The barriers included communication and cooperation problems, treatment challenges related to disease and disability, patients' negative beliefs about oral health, barriers to accessing dental care, complex and time-consuming treatment plans, and communication and cooperation problems with the patients' carers.

CONCLUSION

A range of facilitating and challenging factors influence dental students' perceptions of treating older patients. More research is necessary on the methods that will enhance their geriatric knowledge and skills, help them overcome the challenges they detected and improve their attitudes and behaviours towards treating older patients.

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.

Ageism and late-life mortality: How community matters

AGEISM: the deeply entrenched biases that people hold about old age-is a persistent social problem that intensified during the COVID-19 pandemic. The harmful physical, emotional, and cognitive health consequences of individual-level age bias are well-documented, with most studies operationalizing ageism as an older adult's personal encounters with age discrimination, self-perceptions of their own aging, and internalized negative beliefs about old age. However, the impacts of community-level age bias on older adults' well-being have received less attention. This commentary reviews recent evidence (Kellogg et al.,) showing that county-level explicit age bias is associated with lower mortality rates among older adults, with effects limited to older adults residing in counties with relatively younger populations. Effects were not detected in counties with relatively older populations, or for implicit age bias. These counterintuitive findings require further exploration, including the use of more fine-grained measures of community-level ageism, attention to the role of gentrification in communities, and the development of new measures of structural ageism, drawing on approaches used to study the impacts of structural racism. Data science approaches, including the use of social media data in tandem with mortality data, may reveal how age bias affects older adults. Communities are especially important to older adults, who spend much of their time in areas immediately proximate to their homes. As more individuals age in place, and as federal funding for home-based and community services (HCBS) increases, researchers should identify which community-level characteristics, including age bias, undermine or enhance late-life well-being.