Age Discrimination, Eppur Si Muove (Yet It Moves)

Cultural stereotypes in care contexts

INTRODUCTION

The main goal of the present study was to examine the stereotype content model (SCM) assumption for universality and to test whether the mediating role of cultural views about older adult caregivers is maintained in other health care contexts.

METHODS

One hundred and sixty professionals and volunteers who worked with older adults in day care centers (DCCs) and senior citizen centers (SCCs) and 1,151 participants from a representative sample of the Spanish population were examined using the SCM questionnaire; older adult and personnel functioning were assessed through an observation procedure with two subscales of the Evaluation Scale from the Sistema de Evaluación de Residencias de Ancianos.

RESULTS

The results showed that the context does not seem to influence the cultural views about older adults held by caregivers. All results support the cultural stereotype pattern in which members of the older adult group are viewed with high warmth (HW) and low competence (LC) as posited by the SCM model. With respect to the mediation of cultural stereotypes on caregivers/older adult functioning, this has not been supported in this study. Neither cultural views of warmth (predicted by the SCM) nor views of competence (from our previous studies) influence either caregiver functional behaviors or older adult functioning.

CONCLUSION

Two post hoc hypotheses can be inferred: 1) there is more variability in competence and warmth in DCCs and SCCs and 2) although we did not find significant differences in the pattern of competence and warmth in perceived cultural stereotypes about older adults, more healthy environments could reduce the influence of cognitive views on behavior.

Identifying inequitable healthcare in older people: systematic review of current research practice

BACKGROUND

There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair.

METHOD

A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability.

RESULTS

Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles.

CONCLUSIONS

Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.

The role of perceived discrimination on active aging

Among older adults, perceived age discrimination is highly associated with unhealthy outcomes and dissatisfaction. Active aging is a multidimensional concept described by a set of characteristics, particularly health, positive mood and control; most importantly, active aging is currently at the core of public policies. The aim of the present study was to test to what extent perceived discrimination influences active aging. Methods A total of 2005 older adults in three representative samples from regions of Germany, Mexico and Spain participated; they were tested on active aging and perceived discrimination. First, active aging was defined as high reported health, life satisfaction and self-perception of aging. Second, authors introduced the assumption that, in the total sample, structural equation modelling would confirm the hypothesis of a direct negative link between perceived age discrimination and active aging. Finally, multiple group comparison performed through structural equation modelling also provided support for the negative association between perceived discrimination and active aging proposed. In spite of the differences found among the three countries in both active aging variables and age discrimination perception, multiple group comparison indicates that regardless of the culture, perceived discrimination is a negative predictor of active aging.

Is older adult care mediated by caregivers' cultural stereotypes? The role of competence and warmth attribution

PURPOSE

The purpose of this study is to examine, from the stereotype content model (SCM) perspective, the role of the competence and warmth stereotypes of older adults held by professional caregivers.

METHODS

A quasi-experimental design, ex post facto with observational analyses, was used in this study. The cultural view on competence and warmth was assessed in 100 caregivers working in a set of six residential geriatric care units (three of them organized following a person-centered care approach and the other three providing standard geriatric care). In order to assess caregivers' cultural stereotypical views, the SCM questionnaire was administered. To evaluate the role of caregivers' cultural stereotypes in their professional performance as well as in older adult functioning, two observational scales from the Sistema de Evaluación de Residencias de Ancianos (assessment system for older adults residences)-RS (staff functioning and residents' functioning) were applied.

RESULTS

Caregivers' cultural views of older adults (compared to young people) are characterized by low competence and high warmth, replicating the data obtained elsewhere from the SCM. Most importantly, the person-centered units predict better staff performance and better resident functioning than standard units. Moreover, cultural stereotyping of older adult competence moderates the effects of staff performance on resident functioning, in line with the findings of previous research.

CONCLUSION

Our results underline the influence of caregivers' cultural stereotypes on the type of care, as well as on their professional behaviors and on older adult functioning. Caregivers' cultural stereotypes could be considered as a central issue in older adult care since they mediate the triangle of care: caregivers/older adults/type of care; therefore, much more attention should be paid to this psychosocial care component.