Unmasking bias and perception of lead surgeons in the operating room: A simulation based study.

BACKGROUND: Perception of a surgeon based on physical attributes in the operating room (OR) environment has not been assessed, which was our primary goal. METHODS: A common OR scenario was simulated using 8 different actors as a lead surgeon with combinations of age (<40 vs. >55), race (white vs. black), and gender (male vs. female). One video scenario with a survey was electronically distributed to surgeons, residents, and OR nurses/staff. The overall rating, assessment, and perception of the lead surgeon were assessed. RESULTS: Of 974 respondents, 64.5% were females. There were significant differences in the rating and assessment based upon surgeon's age (p = .01) favoring older surgeons. There were significant differences in the assessments of surgeons by the study group (p = .03). The positive assessments as well as perceptions trended highest towards male, older, and white surgeons, especially in the stressful situation. CONCLUSION: While perception of gender bias may be widespread, age and race biases may also play a role in the OR. Inter-professional education training for OR teams could be developed to help alleviate such biases.

Discrimination and Subsequent Mental Health, Substance Use, and Well-being in Young Adults.

OBJECTIVES: Discrimination has been shown to have profound negative effects on mental and behavioral health and may influence these outcomes early in adulthood. We aimed to examine short-term, long-term, and cumulative associations between different types of interpersonal discrimination (eg, racism, sexism, ageism, and physical appearance discrimination) and mental health, substance use, and well-being for young adults in a longitudinal nationally representative US sample. METHODS: We used data from 6 waves of the Transition to Adulthood Supplement (2007-2017, 1834 participants) of the Panel Study of Income Dynamics. Outcome variables included self-reported health, drug use, binge drinking, mental illness diagnosis, Languishing and Flourishing score, and Kessler Psychological Distress Scale score. We used logistic regression with cluster-robust variance estimation to test cross-sectional and longitudinal associations between discrimination frequency (overall, cumulative, and by different reason) and outcomes, controlling for sociodemographics. RESULTS: Increased discrimination frequency was associated with higher prevalence of languishing (relative risk [RR] 1.34 [95% CI 1.2-1.4]), psychological distress (RR 2.03 [95% CI 1.7-2.4]), mental illness diagnosis (RR 1.26 [95% CI 1.1-1.4]), drug use (RR 1.24 [95% CI 1.2-1.3]), and poor self-reported health (RR 1.26 [95% CI 1.1-1.4]) in the same wave. Associations persisted 2 to 6 years after exposure to discrimination. Similar associations were found with cumulative high-frequency discrimination and with each discrimination subcategory in cross-sectional and longitudinal analyses. CONCLUSIONS: In this nationally representative longitudinal sample, current and past discrimination had pervasive adverse associations with mental health, substance use, and well-being in young adults.

Ageism in the COVID-19 pandemic: age-based discrimination in triage decisions and beyond.

Ageism has unfortunately become a salient phenomenon during the COVID-19 pandemic. In particular, triage decisions based on age have been hotly discussed. In this article, I first defend that, although there are ethical reasons (founded on the principles of benefit and fairness) to consider the age of patients in triage dilemmas, using age as a categorical exclusion is an unjustifiable ageist practice. Then, I argue that ageism during the pandemic has been fueled by media narratives and unfair assumptions which have led to an ethically problematic group homogenization of the older population. Finally, I conclude that an intersectional perspective can shed light on further controversies on ageism and triage in the post-pandemic future.

#BoomerRemover: COVID-19, ageism, and the intergenerational twitter response.

Early reports of COVID-19 often inaccurately presented the virus as a serious concern only among older adults. On the social media platform of Twitter, #BoomerRemover originated as a hashtag intended to express the age-related disparities of COVID-19. This study used a content analysis to examine tweets over a two-week period in March 2020 that used #BoomerRemover to discuss COVID-19 among older adults. A total of 1875 tweets were analyzed. Salient themes include: (1) There's a Real Intergenerational Divide, (2) Young People are Affected Too, (3) It's Being Used for Political Gain, and (4) #BoomerRemover is Simply Disrespectful. Findings suggest that many of the tweets employing #BoomerRemover were grounded in either personal or political ageism. In addition, a significant portion of tweeters used #BoomerRemover to defend older adults and speak out against ageism. This study highlights the importance of recognizing and addressing the growing intergenerational divide on social media, particularly during the COVID-19 pandemic.

The twin faces of ageism, glorification and abjection: A content analysis of age advocacy in the midst of the COVID-19 pandemic.

While the government responses to the COVID-19 pandemic have varied across the globe, there has been a unifying cry from academia and public health professionals warning of the detrimental effects of attaching our understanding of this new threat to our already ageist attitudes. What is inescapable is that COVID-19 has an age-related risk component and the latest data shows that risks start to rise for people from midlife onwards. As governance agencies, professional practice, and academia work towards assessing, communicating, and addressing this risk, we ask: are existing gerontological conceptualisations of ageism appropriate for this exceptional situation and what is being (re)produced in terms of an aged subjectivity? Following van Dyk's (2016) critique of gerontology's 'othering' through both 'glorification' (third age) and 'abjection' (fourth age), a content analysis of statements and policy documents issued in response to COVID-19 provides evidence of well-meaning and inadvertent ageism through homogenizing language, the abjection/glorification binary within 'old age', and the power binary constructed between age and an age-neutral midlife. The paper concludes with reflections on future directions for ageism research beyond COVID-19.

Calculated Ageism: Generational Sacrifice as a Response to the COVID-19 Pandemic.

OBJECTIVES: Popular responses to the pandemic illustrate ageism's pervasiveness and the extent of collective acquiescence to its newest expressions. We explore these themes by analyzing Twitter reactions to "calculated ageism"-a term we use to refer to a political figure's edict that older adults should sacrifice their lives if it will mitigate the pandemic's economic damage to younger people. METHOD: Using thematic analysis, we examine tweets (n = 188) responding to Texas Lt. Governor Dan Patrick's March 23, 2020, statement that encouraged generational self-sacrifice. Themes that emerged included positions of support or opposition and tweeters' critiques. RESULTS: The large majority of tweets-90%-opposed calculated ageism, while only 5% supported it and 5% conveyed no position. Opposition centered on moral critiques, political-economic critiques, assertions of older adults' worth, and public health arguments. Support centered on individual responsibility and patriotism. DISCUSSION: While prior research reveals ageism's entrenchment in popular culture, our study finds that it has limits and identifies the reasons underlying them. The most common reasons for opposing calculated ageism center on its immorality and on its privileging of the economic interests of the powerful few over the many, patterns suggesting that the boundaries of ageism are influenced by core beliefs about fairness. They also are shaped by a bedrock conviction that older lives have value. This intergenerational solidarity could be leveraged to reduce ageism during the pandemic and beyond.

Societal Views of Older Adults as Vulnerable and a Burden to Society During the COVID-19 Outbreak: Results From an Israeli Nationally Representative Sample.

OBJECTIVES: To examine the factors associated with older adults' perceptions of ageism in society during the COVID-19 outbreak, in particular the portrayal of older people as a burden and as vulnerable. METHOD: Data are based on a nationally representative survey of adults aged 50+ in Israel, conducted during the COVID-19 outbreak (N = 888). Regression models predicted perceptions of societal ageism. The independent variables were dying anxiety, experiences of age-based discriminations, and social resources. RESULTS: Participants who believed older adults were perceived as a burden during the COVID-19 outbreak had higher dying anxiety and reported more age-based discrimination. Living with children and contact with family were protective against perceptions of adults as a burden. Participants who believed older adults were perceived as vulnerable had higher dying anxiety and were less likely to live with children. DISCUSSION: The daily lives of older adults can impact their perceptions of societal ageism during the COVID-19 outbreak.

Modern Senicide in the Face of a Pandemic: An Examination of Public Discourse and Sentiment About Older Adults and COVID-19 Using Machine Learning.

OBJECTIVES: This study examined public discourse and sentiment regarding older adults and COVID-19 on social media and assessed the extent of ageism in public discourse. METHODS: Twitter data (N = 82,893) related to both older adults and COVID-19 and dated from January 23 to May 20, 2020, were analyzed. We used a combination of data science methods (including supervised machine learning, topic modeling, and sentiment analysis), qualitative thematic analysis, and conventional statistics. RESULTS: The most common category in the coded tweets was "personal opinions" (66.2%), followed by "informative" (24.7%), "jokes/ridicule" (4.8%), and "personal experiences" (4.3%). The daily average of ageist content was 18%, with the highest of 52.8% on March 11, 2020. Specifically, more than 1 in 10 (11.5%) tweets implied that the life of older adults is less valuable or downplayed the pandemic because it mostly harms older adults. A small proportion (4.6%) explicitly supported the idea of just isolating older adults. Almost three-quarters (72.9%) within "jokes/ridicule" targeted older adults, half of which were "death jokes." Also, 14 themes were extracted, such as perceptions of lockdown and risk. A bivariate Granger causality test suggested that informative tweets regarding at-risk populations increased the prevalence of tweets that downplayed the pandemic. DISCUSSION: Ageist content in the context of COVID-19 was prevalent on Twitter. Information about COVID-19 on Twitter influenced public perceptions of risk and acceptable ways of controlling the pandemic. Public education on the risk of severe illness is needed to correct misperceptions.

From "Coffin Dodger" to "Boomer Remover": Outbreaks of Ageism in Three Countries With Divergent Approaches to Coronavirus Control.

OBJECTIVES: This article compares responses to coronavirus control in Australia, the United Kingdom, and the United States, 3 countries in which public ageism erupted over the social and economic costs of protecting older adults from Covid-19. METHODS: Thirty-five (35) newspapers, media websites, and current affairs magazines were sourced for the study: 8 for Australia, 12 for the United Kingdom, and 15 for the United States. Searches were conducted daily from April to June 2020, using key words to identify age-related themes on pandemic control. RESULTS: Despite divergent policies in the 3 countries, ageism took similar forms. Public responses to lockdowns and other measures cast older adults as a problem to be ignored or solved through segregation. Name-calling, blame, and "so-be-it" reactions toward age vulnerability were commonplace. Policies banning visits to aged care homes angered many relatives and older adults. Indefinite isolation for older adults was widely accepted, especially as a vehicle to end public lockdowns and economic crises. DISCUSSION: Older adults have and will continue to bear the brunt of Covid-19 in terms of social burdens and body counts as the pandemic continues to affect people around the globe. The rhetoric of disposability underscores age discrimination on a broader scale, with blame toward an age cohort considered to have lived past its usefulness for society and to have enriched itself at the expense of future generations.

Perception of Old Age by the Inhabitants of Poland.

Introduction: People's self-esteem and public perception of senior citizens both play important roles in perceiving old age. The public perception manifests itself in adopting specific attitudes toward the elderly. Aim of the work: The work aimed at attempting to specify how adults and the elderly perceive old age. Material and method: The diagnostic poll method was employed as the main research tool, whereas the Rosenberg Self-Esteem Questionnaire by Morris Rosenberg and the Kogan's Attitudes toward Old People Scale, as well as authors' own sociodemographic variables metrics, were used as research tools. The investigation was administered in a cohort of 206 people living in Poland. Results: The average number of points on the Rosenberg Self-Esteem Questionnaire by Morris Rosenberg (SES) was 29.01 (SD = 4.24). People over the age of 60 (M = 30.07 points), males (M = 32.05 points), those in a relationship (M = 30.22 points), declaring higher education (M = 30.33 points), and a good material situation (M = 30.12 points) enjoyed higher self-esteem. The average number of points on the Kogan's Attitudes toward Old People Scale (KAOP) in the research cohort was 126.48. The assessment of the elderly was higher among those below 60 (M = 127.06), females (M = 127.29), those in a relationship (M = 129.78), those declaring higher education (M = 128.56), and those in a good material situation (M = 126.99). Conclusions: Respondents perceived old age positively, albeit at a low level. It is necessary to review activities undertaken in the sphere of social policy in Poland because activities undertaken to date are failing to improve old age perception. Actions need to be undertaken aiming at raising self-esteem level in Polish senior citizens, and available financial, social, and psychological resources from the government and community associations should all be used to this end.

Racial/ethnic disparities in colorectal cancer treatment utilization and phase-specific costs, 2000-2014.

BACKGROUND: Our study analyzed disparities in utilization and phase-specific costs of care among older colorectal cancer patients in the United States. We also estimated the phase-specific costs by cancer type, stage at diagnosis, and treatment modality. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify patients aged 66 or older diagnosed with colon or rectal cancer between 2000-2013, with follow-up to death or December 31, 2014. We divided the patient's experience into separate phases of care: staging or surgery, initial, continuing, and terminal. We calculated total, cancer-attributable, and patient-liability costs. We fit logistic regression models to determine predictors of treatment receipt and fit linear regression models to determine relative costs. All costs are reported in 2019 US dollars. RESULTS: Our cohort included 90,023 colon cancer patients and 25,581 rectal cancer patients. After controlling for patient and clinical characteristics, Non-Hispanic Blacks were less likely to receive treatment but were more likely to have higher cancer-attributable costs within different phases of care. Overall, in both the colon and rectal cancer cohorts, mean monthly cost estimates were highest in the terminal phase, next highest in the staging phase, decreased in the initial phase, and were lowest in the continuing phase. CONCLUSIONS: Racial/ethnic disparities in treatment utilization and costs persist among colorectal cancer patients. Additionally, colorectal cancer costs are substantial and vary widely among stages and treatment modalities. This study provides information regarding cost and treatment disparities that can be used to guide clinical interventions and future resource allocation to reduce colorectal cancer burden.

Psychological wellbeing of middle-aged and older queer men in India: A mixed-methods approach.

Borrowing concepts from public health, we examined the association of several social determinants with the mental health of middle-aged and older queer men in India by combining quantitative and qualitative methodologies. A cross-sectional survey guided by Meyer's Minority Stress Model was carried out to assess the links between minority stressors (internalized homophobia and degree of closetedness), age-related stressors (ageism and fear of ageing) and psychological wellbeing (loneliness, depressive symptoms and sexual compulsivity) among 207 Indian men (aged 40 years and above) who identified themselves as non-heterosexuals. Results from simple and multivariable linear regression models showed significant positive associations of ageism, internalized homophobia, and fear of ageing with loneliness, even after accounting for sociodemographic and stress mitigating factors. Ageism was not significantly related to depressive symptoms. However, fear of ageing and internalized homophobia was positively associated with depressive symptoms after accounting for covariates. Further, regression models demonstrated a consistent and statistically significant inverse association between income and adverse psychological outcomes suggesting the centrality of social class in the lived experience of Indian gay and bisexual men. The qualitative inquiry addressed the same research questions as the quantitative survey through in-depth interviews of thirty middle-aged and older gay and bisexual men in Mumbai. We found that older and midlife gay and bisexual men with higher income (a proxy for social class) found ways to manage their masculinities with no discernible adverse psychological outcomes. Depressive symptoms and loneliness in this population made them further vulnerable to excessive sexual impulses, especially in the older queer men who were passing off as heterosexuals. Overall, the theory-driven empirical findings suggest that even in India, where family and friends are social insurance for later life, the issues of ageism and internalized homophobia have the potential to lead to worse mental health outcomes among older queer men.

Effect of Discrimination on Presenteeism among Aging Workers in the United States: Moderated Mediation Effect of Positive and Negative Affect.

This study aimed to examine how perceived everyday discrimination influences presenteeism and how conscientiousness moderates the relationship between discrimination and positive affect among older workers. Structural equation modeling (SEM) was used to examine the mediating effect. The moderated mediation model was examined by PROCESS. The results of the final SEM model showed that discrimination was directly positively associated with presenteeism. Furthermore, positive affect was significantly inversely correlated with discrimination and presenteeism. In addition, negative affect was significantly positively correlated with discrimination and presenteeism. The significant indirect effect between perceived everyday discrimination and positive affect was significantly mediated by positive and negative affect. In addition, the results of the moderated mediation model indicate that positive affect was more likely to be influenced by perceived everyday discrimination among older workers with less conscientiousness, as compared with those with greater conscientiousness. To enhance work outcomes of aging workers in the United States, managers should foster highly conscientious aging workers, award those who are hardworking and goal-oriented, and combine personal goals and organizational goals through bonuses, holidays, and benefits. Policymakers should be mindful of the negative impact of discrimination on presenteeism and should target lowly conscientious older workers.

Principal component analysis and internal reliability of the Polish version of MESA and UDI-6 questionnaires.

OBJECTIVES: Urinary incontinence (UI) can affect up to 50% of the population of women over the age of 50. In order to objectively assess discomfort in women with UI prior to initiating treatment and monitoring the outcomes of the treatment, validated questionnaires need to be used to examine the impact of UI on health-related quality of life (HR-QoL). The Urogenital Distress Inventory - Short Form (UDI-6) and the Medical Epidemiologic and Social Aspects of Ageing (MESA) questionnaires are used typically. Assessment of the Polish translation of the MESA and UDI-6 questionnaires. MATERIAL AND METHODS: 155 patients with symptoms of UI were enrolled. Each of the patients completed the MESA and UDI questionnaires prior to being examined. The final diagnosis was made after diagnostic tests were carried out in the patients. RESULTS: Principle component analysis showed division of the Polish versions of the questionnaires into domains identical to the original version. Analyses of internal consistency reliability revealed high internal consistency for the MESA questionnaire (0.90) and a low reliability of the UDI-6 questionnaire (0.44). CONCLUSIONS: The Polish version of the MESA questionnaire was demonstrated to be a clinically useful diagnostic tool in the studied population, UDI-6 did not reached a sufficiently high reliability in the study group to be recommended as a diagnostic tool.

Age Discrimination and Suicidal Ideation Among Korean Older Adults.

OBJECTIVE: We examined the role of age discrimination in suicidal ideation among community-dwelling older adults in South Korea. METHODS: We analyzed adults aged 65 or older residing in Korea drawn from the 2014 Survey of Living Conditions and Welfare Needs of Korean Older Persons (total unweighted n = 10,279; total weighted N = 6,280,588). Data were analyzed using chi-square, t tests, and logistic regression analyses. RESULTS: Results from logistic regression analysis showed that after adjusting for covariates, Korean elders who experienced age discrimination had 2.26 times higher odds of having suicidal ideation than those who did not. CONCLUSIONS: The experience of age discrimination increased the risk of suicidal ideation among Korean elders. Identifying ways to reduce age discrimination may be an effective means of reducing suicidal ideation, which would, in turn, potentially decrease suicide rates among older adults. There may be cross-cultural clinical implications and variations due to belief systems surrounding respect for older adults.

Stereotypes of Older Adults: Development and Evaluation of an Updated Stereotype Content and Strength Survey.

BACKGROUND AND OBJECTIVES: Stereotypes are beliefs about a particular group often adopted to bypass complex information processing. Like racism and other forms of discrimination, ageism affects individuals and society as a whole. The purpose of the study was to analyze the Stereotype Content and Strength Survey (SCSS) designed to update assessment tools commonly used to measure stereotypes of older adults. RESEARCH DESIGN AND METHODS: An updated survey was developed including aging-related descriptive items from previously published studies. Students enrolled at two Midwestern universities (n = 491) were directed to think about their perceptions of "older adults" and select the proportion they believed could be described by the items used in the tool. Response categories for each descriptive item were dichotomized and operationalized to be a strong stereotype if the collapsed response percentage was significantly ≥80%. RESULTS: A Principal Axis Factor analysis and Direct Oblim rotation was computed on 117 descriptive items representing positive, negative, and physical characteristics, resulting in a 3-factor model with acceptable psychometric properties. Cronbach alpha analyses revealed reliable scales for negative (α = .92), positive (α = .88), and physical (α = .81) stereotypes. Of 117 descriptive items, 33 emerged as strong stereotypes including 30 positive, 2 physical, and 1 negative item. DISCUSSION AND IMPLICATIONS: This updated assessment has the potential to contribute to an understanding of the existence of age-related stereotypes as well as the strength, or the proportion of older adults who could be described by each of the items used in the SCSS.

Sticks and Stones: Perceived Age Discrimination, Well-Being, and Health Over a 20-Year Period.

This study examines associations between perceived day-to-day age discrimination, positive well-being, and physical health over a 20-year span. Data came from all three waves of the National Survey of Midlife Development in the United States (1995-2014). Generalized structural equation modeling was used to analyze 6,016 observations of 3,102 participants and test associations between age discrimination and (a) psychological well-being and positive affect, and (b) self-rated health, instrumental activities of daily living, and chronic conditions. Associations were also examined between the well-being measures and all three health outcomes. Between-persons and within-persons effects were modeled separately but simultaneously. Both between-persons and within-persons results revealed numerous significant associations between age discrimination and physical health, although results were stronger between-persons. Moreover, hypothesized associations of age discrimination with well-being, and of well-being with physical health, were supported both between- and within-persons. Findings suggest diminished well-being may be one mechanism whereby age discrimination harms health.

Ageism Amplifies Cost and Prevalence of Health Conditions.

BACKGROUND AND OBJECTIVES: The persistent status of ageism as one of the least acknowledged forms of prejudice may be due in part to an absence of quantifying its costs in economic terms. In this study, we calculated the costs of ageism on health conditions for all persons aged 60 years or older in the United States during 1 year. RESEARCH DESIGN AND MATERIALS: The ageism predictors were discrimination aimed at older persons, negative age stereotypes, and negative self-perceptions of aging. Health care costs of ageism were computed by combining analyses of the impact of the predictors with comprehensive health care spending data in 1 year for the eight most-expensive health conditions, among all Americans aged 60 years or older. As a secondary analysis, we computed the number of these health conditions experienced due to ageism. RESULTS: It was found that the 1-year cost of ageism was $63 billion, or one of every seven dollars spent on the 8 health conditions (15.4%), after adjusting for age and sex as well as removing overlapping costs from the three predictors. Also according to our model, ageism resulted in 17.04 million cases of these health conditions. DISCUSSION AND IMPLICATIONS: This is the first study to identify the economic cost that ageism imposes on health. The findings suggest that a reduction of ageism would not only have a monetary benefit for society, but also have a health benefit for older persons.

Institutional and Individual Factors Affecting Health and Employment for Low-Income Women With Chronic Health Conditions.

OBJECTIVES: This qualitative study explored risk and protective factors affecting employment and health among low-income older women with chronic health conditions or physical disabilities. METHODS: The authors conducted a secondary data analysis of 14 intensive interviews with low-income older women with chronic health conditions who had participated in a federally funded training and employment program for workers aged 55 and older. Qualitative data were analyzed using thematic analysis. RESULTS: The physical nature of the work and discrimination were risk factors, with unaccommodating work environments, ageism, and/or ableism, and internalized ageism identified as subthemes of discrimination. Protective factors, namely institutional supports (e.g., access to retraining, time management flexibility) enhanced health and self-confidence. Occupational demands matched with the capacity of the individual resulted in continued employment and improved health. DISCUSSION: Working conditions can degrade health through exposure to mental and physical health risks, or support health through access to financial and interpersonal resources. Institutional supports such as workplace flexibility and retraining are crucial to obtaining a good fit between occupational demands and the capacity of individuals, enabling a positive relationship between employment and health. Legislation designed to prevent discrimination, enhance opportunities for lifelong learning, and encourage flexible work arrangements among low-income women with chronic health conditions may facilitate healthier working lives.