Ageism and COVID-19: what does our society's response say about us?

The goal of this commentary is to highlight the ageism that has emerged during the COVID-19 pandemic. Over 20 international researchers in the field of ageing have contributed to this document. This commentary discusses how older people are misrepresented and undervalued in the current public discourse surrounding the pandemic. It points to issues in documenting the deaths of older adults, the lack of preparation for such a crisis in long-term care homes, how some 'protective' policies can be considered patronising and how the initial perception of the public was that the virus was really an older adult problem. This commentary also calls attention to important intergenerational solidarity that has occurred during this crisis to ensure support and social-inclusion of older adults, even at a distance. Our hope is that with this commentary we can contribute to the discourse on older adults during this pandemic and diminish the ageist attitudes that have circulated.

Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults. OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability. DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012. PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study. MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years. KEY RESULTS: In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27). CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

Oldsters and Ngrams: age stereotypes across time.

Google Books Ngram Viewer searches over five million books published between 1800 and 2000 and plots trends in word usage. With this tool, the frequencies of literary references to younger and older adults were assessed across time. Young and old women were shown to be underrepresented in the literature for the past 200 years. In addition, the usage of different terms and adjectives to describe older adults were tracked and found to change across time. The literature of the early 1900s, e.g., revealed a shift from more positive to less positive terms, which may reflect a change in attitude toward older adults.

Aged over 50 years and practising: separation and changes in nursing practice among New Zealand's older Registered Nurses.

AIM: To describe temporary and permanent separation patterns and changes in nursing practice over 5 years, for the 2006 cohort of nurses aged ≥50 years in New Zealand. BACKGROUND: As ageing populations increase demand on nursing services, workforce projections need better information on work and retirement decision-making of large 'baby-boomer' cohorts. DESIGN: Retrospective cohort analysis using the Nursing Council of New Zealand administrative dataset. METHODS: A cohort of all nurses aged ≥50 years on the register and practising in 2006 (n = 12,606) was tracked until 2011. RESULTS: After 5 years, a quarter (n = 3161) of the cohort (equivalent to 8·4% of all 2006 practising nurses) was no longer practising. There were no significant differences in permanent separation rates between the ages of 50-58; between 18-54% of annual separations re-entered the workforce. On re-entry, 56% returned to the same clinical area. Annual separations from the workforce declined sharply during the global financial crisis and more of those leaving re-entered the workforce. In 2006, half the cohort worked in hospitals. After 5 years, the number of cohort nurses working in hospitals fell by 45%, while those in community settings increased by 12%. Over 5 years, weekly nursing practice hours declined significantly for every age-band. CONCLUSIONS: To retain the experience of older nurses for longer, workforce strategies need to take account of patterns of leaving and re-entering the workforce, preferences for work hours and the differences between the sub-groups across employment settings and practice areas.

[Caricatures of aging in German newspapers and magazine cartoons. Historical comparison between the 1960s and the present]. / Altersbilder in Karikaturen deutscher Zeitschriften und Zeitungen. Historischer Vergleich zwischen den 1960er Jahren und der Gegenwart.

BACKGROUND: The focus of this study was the collective images of aging that were unconsciously used despite rationally led social discourse on aging. Hypothesized was that despite changes in aging over the last 50 years these images went unaltered and thereby negative stereotypes of previous generations were maintained. In an effort to verify this hypothesis images of aging in cartoons were empirically examined, a first in the field of German language. METHODS: Using a social scientific operationalization of age stereotypes and culturally historical topoi as a basis, a content analysis was conducted on 2,546 cartoons (with 8,882 characters) from the years 1960-1964 and 2007. RESULTS: In general both young and old age are equally encoded with negative connotations by deficient characteristics and acknowledged stereotypes partially significantly more often in the cartoons from 2007 than from 1960-1964. CONCLUSIONS: The last 50 years have seen no substantial changes in the images of aging as depicted by magazine and newspaper cartoons. Humor requires more frequent analysis as it often unconsciously reveals socially unacceptable images of aging, even those embedded in science.

Culture Linked to Increasing Ageism During COVID-19: Evidence From a 10-Billion-Word Corpus Across 20 Countries.

OBJECTIVES: Older adults experience higher risks of getting severely ill from coronavirus disease 2019 (COVID-19), resulting in widespread narratives of frailty and vulnerability. We test: (a) whether global aging narratives have become more negative from before to during the pandemic (October 2019 to May 2020) across 20 countries; (b) model pandemic (incidence and mortality), and cultural factors associated with the trajectory of aging narratives. METHODS: We leveraged a 10-billion-word online-media corpus, consisting of 28 million newspaper and magazine articles across 20 countries, to identify nine common synonyms of "older adults" and compiled their most frequently used descriptors (collocates) from October 2019 to May 2020-culminating in 11,504 collocates that were rated to create a Cumulative Aging Narrative Score per month. Widely used cultural dimension scores were taken from Hofstede, and pandemic variables, from the Oxford COVID-19 Government Response Tracker. RESULTS: Aging narratives became more negative as the pandemic worsened across 20 countries. Globally, scores were trending neutral from October 2019 to February 2020, and plummeted in March 2020, reflecting COVID-19's severity. Prepandemic (October 2019), the United Kingdom evidenced the most negative aging narratives; peak pandemic (May 2020), South Africa took on the dubious honor. Across the 8-month period, the Philippines experienced the steepest trend toward negativity in aging narratives. Ageism, during the pandemic, was, ironically, not predicted by COVID-19's incidence and mortality rates, but by cultural variables: Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation. DISCUSSION: The strategy to reverse this trajectory lay in the same phenomenon that promoted it: a sustained global campaign-though, it should be culturally nuanced and customized to a country's context.

Aging Narratives Over 210 Years (1810-2019).

OBJECTIVES: The World Health Organization launched a recent global campaign to combat ageism, citing its ubiquity and insidious threat to health. The historical context that promoted this pernicious threat is understudied, and such studies lay the critical foundation for designing societal-level campaigns to combat it. We analyzed the trend and content of aging narratives over 210 years across multiple genres-newspaper, magazines, fiction, nonfiction books-and modeled the predictors of the observed trend. METHOD: A 600-million-word dataset was created from the Corpus of Historical American English and the Corpus of Contemporary American English to form the largest structured historical corpus with over 150,000 texts from multiple genres. Computational linguistics and statistical techniques were applied to study the trend, content, and predictors of aging narratives. RESULTS: Aging narratives have become more negative, in a linear fashion (p = .003), over 210 years. There are distinct shifts: From uplifting narratives of heroism and kinship in the 1800s to darker tones of illness, death, and burden in the 1900s across newspapers, magazines, and nonfiction books. Fiction defied this trend by portraying older adults positively through romantic courtship and war heroism. Significant predictors of ageism over 210 years are the medicalization of aging, loss of status, warmth, competence, and social ostracism. DISCUSSION: Though it is unrealistic to reverse the course of ageism, its declining trajectory can be ameliorated. Our unprecedented study lay the groundwork for a societal-level campaign to tackle ageism. The need to act is more pressing given the Covid-19 pandemic where older adults are constantly portrayed as vulnerable.

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

OBJECTIVE: Although there is anecdotal evidence of ageism occurring at both the structural level (in which societal institutions reinforce systematic bias against older persons) and individual level (in which older persons take in the negative views of aging of their culture), previous systematic reviews have not examined how both levels simultaneously influence health. Thus, the impact of ageism may be underestimated. We hypothesized that a comprehensive systematic review would reveal that these ageism levels adversely impact the health of older persons across geography, health outcomes, and time. METHOD: A literature search was performed using 14 databases with no restrictions on region, language, and publication type. The systematic search yielded 13,691 papers for screening, 638 for full review, and 422 studies for analyses. Sensitivity analyses that adjusted for sample size and study quality were conducted using standardized tools. The study protocol is registered (PROSPERO CRD42018090857). RESULTS: Ageism led to significantly worse health outcomes in 95.5% of the studies and 74.0% of the 1,159 ageism-health associations examined. The studies reported ageism effects in all 45 countries, 11 health domains, and 25 years studied, with the prevalence of significant findings increasing over time (p < .0001). A greater prevalence of significant ageism-health findings was found in less-developed countries than more-developed countries (p = .0002). Older persons who were less educated were particularly likely to experience adverse health effects of ageism. Evidence of ageism was found across the age, sex, and race/ethnicity of the targeters (i.e., persons perpetrating ageism). CONCLUSION: The current analysis which included over 7 million participants is the most comprehensive review of health consequences of ageism to date. Considering that the analysis revealed that the detrimental impact of ageism on older persons' health has been occurring simultaneously at the structural and individual level in five continents, our systematic review demonstrates the pernicious reach of ageism.

Coronavirus, Ageism, and Twitter: An Evaluation of Tweets about Older Adults and COVID-19.

OBJECTIVES: In March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic. High morbidity and mortality rates of COVID-19 have been observed among older adults and widely reported in both mainstream and social media. The objective of this study was to analyze tweets related to COVID-19 and older adults, and to identify ageist content. DESIGN: We obtained a representative sample of original tweets containing the keywords "elderly," "older," and/or "boomer" plus the hashtags "#COVID19" and/or "#coronavirus." SETTING: Tweets posted between March 12 and March 21, 2020. MEASUREMENTS: We identified the type of user and number of followers for each account. Tweets were classified by three raters as (1) informative, (2) personal accounts, (3) personal opinions, (4) advice seeking, (5) jokes, and (6) miscellaneous. Potentially offensive content, as well as that downplaying the severity of COVID-19 because it mostly affects older adults, was identified. RESULTS: A total of 18,128 tweets were obtained, of which a random sample of 351 was analyzed. Most accounts (91.7%) belonged to individuals. The most common types of tweets were personal opinions (31.9%), followed by informative tweets (29.6%), jokes/ridicule (14.3%), and personal accounts (13.4%). Overall, 72 tweets (21.9%) likely intended to ridicule or offend someone and 21.1% had content implying that the life of older adults was less valuable or downplayed the relevance of COVID-19. CONCLUSION: Most tweets related to COVID-19 and older adults contained personal opinions, personal accounts, and jokes. Almost one-quarter of analyzed tweets had ageist or potentially offensive content toward older adults. J Am Geriatr Soc 68:1661-1665, 2020.

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

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

Discrimination and drinking: A systematic review of the evidence.

Although it is widely accepted that discrimination is associated with heavy and hazardous drinking, particularly within stress and coping frameworks, there has been no comprehensive review of the evidence. In response, we conducted a systematic review of the English language peer-reviewed literature to summarize studies of discrimination and alcohol-related outcomes, broadly defined. Searching six online data bases, we identified 938 non-duplicative titles published between 1980 and 2015, of which 97 met all inclusion criteria for our review and reported quantitative tests of associations between discrimination and alcohol use. We extracted key study characteristics and assessed quality based on reported methodological details. Papers generally supported a positive association; however, the quantity and quality of evidence varied considerably. The largest number of studies was of racial/ethnic discrimination among African Americans in the United States, followed by sexual orientation and gender discrimination. Studies of racial/ethnic discrimination were notable for their frequent use of complex modeling (i.e., mediation, moderation) but focused nearly exclusively on interpersonal discrimination. In contrast, studies of sexual orientation discrimination (i.e., heterosexism, homophobia) examined both internalized and interpersonal aspects; however, the literature largely relied on global tests of association using cross-sectional data. Some populations (e.g., Native Americans, Asian and Pacific Islanders) and types of discrimination (e.g., systemic/structural racism; ageism) received scant attention. This review extends our knowledge of a key social determinant of health through alcohol use. We identified gaps in the evidence base and suggest directions for future research related to discrimination and alcohol misuse.

Trends and Patterns in Age Discrimination in Employment Act (ADEA) Charges.

The Age Discrimination in Employment Act (ADEA) protects individuals aged 40 years and over from discrimination throughout the employment process. Using data on ADEA charges from the Equal Employment Opportunity Commission from 1993 to 2010, we present labor force-adjusted charge rates demonstrating that the highest charge rates are among those in the preretirement age range, and only the rate of charges among those aged 65 years and older has not decreased. We examine characteristics of ADEA charges including the prevalence of different alleged discriminatory actions (or issues) and highlight the increasing proportion of age discrimination charges that are jointly filed with other antidiscrimination statutes. Through a regression analysis, we find that the likelihood of citing various issues differs by charging party characteristics, such as age, gender, and minority status, and on charges that cite only age discrimination as compared to those that are jointly filed. Implications of these findings for employers are discussed.

«No es país para viejos» con infarto agudo de miocardio y elevación del segmento ST / «No country for old men» with ST-segment elevation myocardial infarction

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