Fairer AI in ophthalmology via implicit fairness learning for mitigating sexism and ageism.

The transformative role of artificial intelligence (AI) in various fields highlights the need for it to be both accurate and fair. Biased medical AI systems pose significant potential risks to achieving fair and equitable healthcare. Here, we show an implicit fairness learning approach to build a fairer ophthalmology AI (called FairerOPTH) that mitigates sex (biological attribute) and age biases in AI diagnosis of eye diseases. Specifically, FairerOPTH incorporates the causal relationship between fundus features and eye diseases, which is relatively independent of sensitive attributes such as race, sex, and age. We demonstrate on a large and diverse collected dataset that FairerOPTH significantly outperforms several state-of-the-art approaches in terms of diagnostic accuracy and fairness for 38 eye diseases in ultra-widefield imaging and 16 eye diseases in narrow-angle imaging. This work demonstrates the significant potential of implicit fairness learning in promoting equitable treatment for patients regardless of their sex or age.

Americans harbor much less favorable explicit sentiments toward young adults than toward older adults.

Public and academic discourse on ageism focuses primarily on prejudices targeting older adults, implicitly assuming that this age group experiences the most age bias. We test this assumption in a large, preregistered study surveying Americans' explicit sentiments toward young, middle-aged, and older adults. Contrary to certain expectations about the scope and nature of ageism, responses from two crowdsourced online samples matched to the US adult population (N = 1,820) revealed that older adults garner the most favorable sentiments and young adults, the least favorable ones. This pattern held across a wide range of participant demographics and outcome variables, in both samples. Signaling derogation of young adults more than benign liking of older adults, participants high on SDO (i.e., a key antecedent of group prejudice) expressed even less favorable sentiments toward young adults-and more favorable ones toward older adults. In two follow-up, preregistered, forecasting surveys, lay participants (N = 500) were generally quite accurate at predicting these results; in contrast, social scientists (N = 241) underestimated how unfavorably respondents viewed young adults and how favorably they viewed older adults. In fact, the more expertise in ageism scientists had, the more biased their forecasts. In a rapidly aging world with exacerbated concerns over older adults' welfare, young adults also face increasing economic, social, political, and ecological hardship. Our findings highlight the need for policymakers and social scientists to broaden their understanding of age biases and develop theory and policies that ponder discriminations targeting all age groups.

Carving and making space through dance - Older people using dance to experience their ageing body and challenge ageist discourse.

Drawing on qualitative data from a study of older adults' participation in a contemporary dance group, this paper asks what can be gained from new materialist concepts of the older body, and how they can expand cultural gerontological thinking about embodiment. This paper examines the connections between the older body, movement, thoughts, words and spaces, arguing that dance demonstrates that there is a spatial dimension to embodiment. In drawing from models of materiality emerging in gerontology, this paper provides insights about the experience of age, questioning fundamental categorizations promoted in Western culture, and re-thinks agency in relation to the body and space. Emphasising the importance of the material world in the production of the social has important implications in terms of understanding the experience of ageing within an ageist society.

Representation of older adults in Turkish newspaper reports during the COVID-19 pandemic.

This research investigates the representation of older adults in Turkish newspaper reports during the first national lockdown due to the COVID-19 pandemic in Turkey in order to understand the representation and reinforcement of ageism in this context. To this end, fifty newspaper reports from five top-selling Turkish newspapers at the time were selected randomly and analysed using critical discourse analysis for the text producers' linguistic choices in the representations of older adults. The findings show that the older adults were represented predominantly in relation to the lockdown measures and as members of a homogeneous group. They were mainly evaluated negatively as a vulnerable, passive, and at risk group who lacked truthfulness and exhibited unusual behaviour. They were also found to be not among the intended readers of the newspaper reports. This resulted in the infantilisation of older adults and the removal of their agency. Our findings point to the linguistic choices realising these discursive practices in the Turkish context. We argue that these findings follow a trend of representation of older adults in discursive practices and that these practices are instrumental in forming ageist stereotypes and reinforcing age-related bias.

Hattie and Sammler: Saul Bellow's older woman and older man.

Hattie in Saul Bellow's "Leaving the Yellow House" and Sammler in Bellow's Mr. Sammler's Planet are both elderly characters. This article intends to compare the two characters from a gender perspective, to illustrate how these characters appear to experience and respond to old age and how other characters in these two fictions respond to the old age of their respective elderly characters. The comparison of these two characters in the fiction of Saul Bellow gives rise to the observation that old age is not merely a phase of negative changes but also of positive ones; ageism claims victims among both men and women whose suffering is aggravated by other kinds of injustice, such as racism and sexism.

Ageism and the digital divide in Switzerland during COVID-19: Lessons for the post-pandemic world.

The COVID-19 pandemic erupted in early 2020. The Swiss Federal Council implemented a semi-lockdown in March 2020, asking people, particularly older adults, to stay at home to limit the transmission of the disease and to use digital tools to maintain their social relations and activities. This study inquired how older adults confronting precarity experienced these restrictions, how digital tools functioned in this context, and what learning could therefore be imbibed for the post-pandemic era. We conducted semi-structured telephone interviews with adults aged between 66 and 90 years living in a rural and mountainous Swiss region. The obtained data were subsequently thematically analyzed. The results revealed that the respondents experienced ageism during the semi-lockdown and reported limited or non-existent opportunities to use digital tools to maintain online social contact. This predicament increased their sense of loneliness and amplified their feelings of rejection by the outside world. These observations elucidate the need for the enhancement of non-ageist social support for older people, including individuals with limited social and material resources. We advocate the adoption of innovative initiatives in the post-pandemic era to better include precarious older people in our localities and neighborhoods.

Ageism and lookism as stereotypes of health disparity in intensive care units in Iran: a critical ethnography.

BACKGROUND: The intensive care unit presents structural complexities, and the prevailing power imbalance between patients and staff can lead to health disparities. Hence, unveiling the underlying factors that give rise to and reinforce these disparities can contribute to their prevention. This study aims to shed light on the stereotypes linked to ageism and lookism, which perpetuate health disparities within the intensive care unit setting in Iran. METHODS: This critical ethnographic study employed Carsepkan's approach and was carried out in intensive care units in the west of Iran from 2022 to 2023. The data collection and analysis were conducted through three interconnected stages. In the initial stage, more than 300 h of observations were made at the research site. In the subsequent stage, a horizon analysis was performed. Conversations with 14 informants were conducted in the final stage to enrich the dataset further. Then the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. To verify the validity and reliability of the study, credibility, conformability, dependability, and transferability were all taken into account. FINDINGS: The ageism and lookism stereotypes emerged from seven main themes; youth-centric; negative ageism; age-friendliness; age-related priority; centered care for pediatric patients and families; appearance-centeredness; and a contradiction between belief and behavior. CONCLUSION: This critical study showed that ageism and lookism stereotypes permeated the intensive care unit's culture. These stereotypes have the potential to influence equality dynamics, as well as to foster and support health disparity in the intensive care unit.

Ageism and Dementia-ism in Health Care: A Proposed Framework to Guide Treatment Decisions in Frail Older Persons.

Global population ageing underscores the imperative of ageism and dementia-ism in the heath care setting as there is both anecdotal and published evidence that older persons are liable to receive less than optimum evidence-based treatments on account of their age and apparent frailty. This article explores the reasons for this phenomenon and limitations of current approaches of clinical decision making. We propose a framework to guide decision making to optimize care, with a paradigm shift in redefining a default toward clinical practice guideline-recommended treatments, guided by evidence-based medicine within an ethical means-end proportionality framework, and regularly reviewed advance care plans and goals of care conversations to secure the best interests of older persons.

The shifts in intergenerational relations in Cameroon and their potential impact on the health of older adults.

INTRODUCTION: Africa is experiencing a gradual demographic shift due to rising life expectancy and increasing urbanisation. In sub-Saharan Africa, elderly individuals typically reside with their children. The rise in life expectancy by almost a decade and the prevalence of precarious living conditions raise concerns about the sustainability of the healthcare system, which has traditionally relied on intergenerational solidarity. METHODS: The research aims to analyse the evolving role of older adults in Cameroonian society and to examine the potential impact of this change on intergenerational relationships and the health of older adults. A qualitative methodology was employed, using intergenerational focus groups in Cameroon. RESULTS: Traditionally, older adults held a central role in knowledge transmission through discourse. However, the modernisation of society is challenging this position.The emergence of new technologies, particularly communication tools, is leading to a questioning of older adults' experiential knowledge. Societal changes are contributing to a decline in respect for older adults in discourse. Older adults deplore these societal changes and fear for their place in society while young people are questioning the central role of older people in society. DISCUSSION: These changes could reduce the sense of usefulness of older people, with negative consequences for their health. Several studies have highlighted the impacts of ageism on the health of older adults in industrialised countries. However, there are little data on the impact of the marginalisation of older adults on their health in industrialising societies. Further research is needed to study the impact on the health of older adults.

Professional attractiveness among long-term care workers in nursing homes in China: a cross-sectional study.

BACKGROUND: The population aging trend and the shortage of elderly care workers require the long-term care profession to become more attractive. However, the professional attractiveness among long-term care workers has yet to be extensively studied. This study aims to identify the factors that influence the attractiveness of the long-term care profession for nursing home (NH) care workers.. METHODS: A cross-sectional study was conducted in more than 50 NHs. Perception of professional attractiveness among long-term care workers and potential associated factors were measured using the Attractive Work Questionnaire (AWQ) and structural instruments including the Fraboni Scale of Ageism (FSA) and the Maslach Burnout Inventory (MBI). A multiple linear regression method was employed to explore the influence of potential independent variables on professional attractiveness. RESULTS: The overall response rate was 99%. The results showed the score of professional attractiveness (185.37 ± 20.034), as well as the scores of each component (99.26 ± 11.258 for work condition, 30.13 ± 3.583 for work content, and 55.99 ± 7.074 for job satisfaction). Findings of multiple linear regression analysis indicated that age(ß = 0.129, p<.05), years of work(ß = 0.156, p<.05), 12-hour shifts(ß = 0.185, p<.05), and training times per year(ß = 0.148, p<.05) positively associated with long-term care workers perceived professional attractiveness. Whereas only ageism(ß=-0.267, p<.05) significantly and negatively influenced professional attractiveness. CONCLUSIONS: The perceived professional attractiveness of long-term care workers in NHs was acceptable. Age, years of work, shifts, training opportunities, and ageism contributed to the professional attractiveness of nursing home care workers in China. Target intervention measures should be taken to enhance the attractiveness of long-term care careers so as to avoid the shortage of long-term care workers.

Ageism directed at older nurses in their workplace: A systematic review.

AIMS: To identify and synthesise evidence related to ageism in older regulated nurses' practice settings. DESIGN: A systematic review following Joanna Briggs Institute methodology. METHODS: The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta-analysis reporting (SWiM) guideline was employed in the review. DATA SOURCES: Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered. RESULTS: Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well-being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age-inclusive. CONCLUSION: To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational-led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age-inclusive work environment that supports an age-diverse nursing workforce. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti-ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role-playing and simulation during in-service training may also be effective interventions. Additionally, incorporating anti-ageism initiatives into staff meetings and mandating anti-ageism training could support the continuation of practice for older nurses while fostering a more age-diverse nursing workforce. IMPACT: We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well-being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age-inclusive policies that support older nurses' continuation of practice. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis checklists were used to report the screening process. TRIAL AND PROTOCOL REGISTRATION: The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214). No Patient or Public Contribution.

Translation and validation of ageism scale for dental students into Malay language.

AIMS: Identifying ageism among dental students is essential in gerodontology courses. This study aimed to perform a preliminary validation of a Malay version of the ageism scale for dental students (ASDS-My). METHODS AND RESULTS: The 27-item ASDS were translated into Malay language and completed by 168 dental students. Exploratory factor analysis (EFA) with Promax rotation, Polychoric Correlation Matrix and Principal Axis Factoring was conducted. Internal consistency reliability and discriminative validity were analysed. Criterion validity was measured by comparing ASDS-My with Fraboni Scale of Ageism (FSA). A Kaiser-Meyer-Olkin of 0.612 and a Bartlett's Test of Sphericity yielding p < .001 confirmed the adequate factorability. EFA revealed a 15-items scale distributed into five-factors explaining 54.5% of overall variance, with acceptable reliability. The two factors involved cost-benefit of dental treatment on older patients and challenges during medical history taking. The third, fourth and fifth factors explained attitude towards older patients, negative views of older patients and exposure of dental students to Gerodontology training and experiences respectively. Most factors were significantly positively related to FSA. Discriminative validity revealed significant differences for gender, place of stay and year of study. CONCLUSION: Preliminary validation of the ASDS-My produced a five-factors 15-items scale with acceptable validity and reliability.

"We are the future": Advant-aged women speak-out through spoken word poetry.

This study aims to investigate women between the ages of 50 and 70 who write and perform spoken word poetry, through which they wish to lead positive social change, by turning the culture of silence into open discourse. This period represents a new phase of life. These women are at an "in-between" phase of being no longer young but not yet old and are between life roles. This is a new age group that has not yet been studied. We argue that this stage of life requires a new term. The term chosen for this study is advant-age because it implies the advantages and opportunities that this period of life affords. Although this group of women is growing in relation to the general population, the ageism and sexism they experience are increasing, creating a gradual process of social exclusion and reduction in their agency. Spoken Word Poetry (SWP) is written on a page but performed live in front of an audience. It is a poetic piece that includes rhythm, rhyme, and sometimes humor, which help convey complex messages with finesse. The importance of the current research lies in revealing a new and unresearched social phenomenon that has been developing in Israel in recent years: Advant-aged women are discussing issues that society usually silences, using methods that traditionally have been associated with younger groups. Through SWP, advant-aged women are enabling the possibility of raising these issues for public discussion and creating an opportunity for social change.

Strategies to Mitigate Age-Related Bias in Machine Learning: Scoping Review.

BACKGROUND: Research suggests that digital ageism, that is, age-related bias, is present in the development and deployment of machine learning (ML) models. Despite the recognition of the importance of this problem, there is a lack of research that specifically examines the strategies used to mitigate age-related bias in ML models and the effectiveness of these strategies. OBJECTIVE: To address this gap, we conducted a scoping review of mitigation strategies to reduce age-related bias in ML. METHODS: We followed a scoping review methodology framework developed by Arksey and O'Malley. The search was developed in conjunction with an information specialist and conducted in 6 electronic databases (IEEE Xplore, Scopus, Web of Science, CINAHL, EMBASE, and the ACM digital library), as well as 2 additional gray literature databases (OpenGrey and Grey Literature Report). RESULTS: We identified 8 publications that attempted to mitigate age-related bias in ML approaches. Age-related bias was introduced primarily due to a lack of representation of older adults in the data. Efforts to mitigate bias were categorized into one of three approaches: (1) creating a more balanced data set, (2) augmenting and supplementing their data, and (3) modifying the algorithm directly to achieve a more balanced result. CONCLUSIONS: Identifying and mitigating related biases in ML models is critical to fostering fairness, equity, inclusion, and social benefits. Our analysis underscores the ongoing need for rigorous research and the development of effective mitigation approaches to address digital ageism, ensuring that ML systems are used in a way that upholds the interests of all individuals. TRIAL REGISTRATION: Open Science Framework AMG5P; https://osf.io/amg5p.

Age differences in emotional reactions to ageist memes and changes in age of one's Best Self.

Memes on social media can carry ageist messages and can elicit reactions that are both emotional and self-evaluative. The present study investigates age-related differences in nine discrete emotions and in the evaluation of when individuals have been or will be their best selves. Participants (n = 360) representing young (m = 26 years), middle-aged (m = 39 years) and older adults (m = 63 years) were randomly assigned to view either non-ageist (animals) or ageist (e.g., incompetent older people) memes. After viewing memes, we assessed nine emotional reactions (i.e., fear, anger, sadness, happiness, anxiety, discomfort, disgust, surprise, enjoyment) and Best Self evaluations. Younger and middle-aged people reported more intense emotional reactions to memes than older people, with the exception that older people reported more discomfort and disgust in response to ageist versus non-ageist memes. Younger adults were less surprised by ageist memes (vs. non-ageist) and for all age groups ageist memes (vs. non-ageist) elicited less happiness and enjoyment and were less likely to be shared. With respect to evaluations of one's Best Self, older individuals were more likely to report being their best selves in the past, while after viewing ageist memes, younger individuals were more likely to report being their best selves in the future. Emotions of disgust and discomfort were related to identifying one's Best Self as further in the past. The current study adds to the literature on the impact of ageism by examining age-related differences in the emotions and self-evaluations experienced when confronted with memes on social media.

Effects of workplace ageism on negative perception of aging and subjective well-being of older adults according to gender and employment status.

AIM: According to stereotype embodiment theory, workplace ageism can worsen older adults' self-perceptions of aging and subjective well-being. However, there has been little research on gender differences in this regard. This study examined the effects of workplace ageism on attitudes toward aging and subjective well-being according to gender and employment status. METHODS: We carried out an online survey of 600 participants aged 60-74 years in October 2021. Participants were equally divided into women who had worked full-time, women who had worked part-time and men who had worked full-time, and further divided by current employment status, forming a total of six groups for comparison. RESULTS: A total of 75% of the participants perceived some form of workplace ageism. Structural equation modeling showed that, for men and women in full-time employment, workplace ageism was associated with a negative self-perception of aging and poor subjective well-being, the effect of which was strong among those currently employed and weak among those who had retired. For women working part-time, the impact of workplace ageism on subjective well-being was stronger among those who were currently unemployed. CONCLUSION: Workplace ageism exacerbates older adults' self-perception of aging and decreases their subjective well-being. Women working part-time might quit their jobs when their subjective well-being worsens due to workplace ageism. Therefore, it is necessary to create a workplace environment that is comfortable for older workers and free of ageism. Geriatr Gerontol Int 2024; 24: 259-265.

How do ageism, death anxiety and ageing anxiety among medical students and residents affect their attitude towards medical care for older patients: a systematic review.

BACKGROUND: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients. METHODS: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: "medical trainees" AND "ageism" OR "death anxiety" OR "ageing anxiety" AND "(attitude AND older patient)". RESULTS: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results. CONCLUSION: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees.