Ageism, Silent Influencer Of Longevity

Can We Achieve Longer Lives By Treating People Better As They Age?

What images come to mind when you hear “80-year-old” or “octogenarian”? A hunched-over man or woman walking with a cane, possibly suffering from memory loss or other forms of cognitive decline? Or someone like Anthony Fauci, who in his early eighties helped lead the US government’s response to an unprecedented public health crisis?

Your answer may be more important than you know, for studies suggest that our attitudes about aging can influence the quality of our golden years and our longevity.

In exploring the intersection of ageism and longevity, a paradox becomes apparent. Researchers Cassie Curryer and Peta S. Cook perfectly encapsulated it in a 2021 paper on the costs of ageism: “[W]hile longevity is celebrated, older age is not.”

In other words: ageism. Defined as stereotyping, prejudice, or discrimination against a particular age group—especially older people—it is often said to be the last acceptable prejudice.

But how significant of a problem is ageism, really?

It’s so prevalent that the World Health Organization in 2021 described it as “an insidious scourge on society” and called for urgent global action to combat it. “Ageism leads to poorer health, social isolation, earlier deaths and costs economies billions,” the WHO said. (Regarding the financial cost: In the United States, health problems that can be linked to and worsened by ageism, such as cardiovascular disease or diabetes, are estimated to cost $63 billion annually.)

The WHO report came out amid heightened debate and discussion around ageism, following some controversial discourse during the pandemic. It was common, for example, to hear people use deprioritizing language along the lines of, “only old people die.” On Fox News, the Texas lieutenant governor went so far as to suggest older Americans would be happy to sacrifice their lives to keep the US economy afloat.

Some of the online debate and conversation during this time descended into hatred. For example, the social media hashtag “#BoomerRemover” trended among people apparently gleeful at the prospect of parents and grandparents dying. Sadly, it doesn’t appear such posts were rare outliers. According to one study, over the course of nine days in March 2020, approximately 22 percent of COVID-related tweets were “intended to ridicule or offend someone” and approximately 20% “had content implying that the life of older adults was less valuable....”

Such discourse is emblematic of society that sees older people as a burden rather than a valuable or contributing group. These attitudes are hurtful to older folks—but ageism has impacts beyond the interpersonal. Numerous studies have found links between a low regard for older people and poor health outcomes.

How does ageism shorten lives? Through a variety of factors, including disparities in healthcare, social isolation and loneliness, and psychological effects, particularly the internalization of ageist ideas and stereotypes.

(One thing to remember, even though it is not the topic of this Substack article: Younger people are also subject to ageist attitudes; for example, during COVID restrictions, people stereotyped young adults as reckless and endangering others.)

Health effects

“Ageism is associated with earlier death.” The 2021 WHO report was unequivocal, citing 10 studies from different countries including Australia, China, Germany, and the U.S. In one study released in 2020, scientists tested their hypothesis that ageism would be harmful to health across geography and health statuses. Their analyses of 422 studies showed that ageism was associated with worse health 95.5% of the time. Less educated people were especially likely to have negative health outcomes linked to ageism.

One issue is disparities in the health care older patients receive. According to research, doctors and other healthcare professionals sometimes dismiss the concerns of older patients as “just old age.” This mindset, combined with potentially prejudicial convictions about the frailty of older patients (especially women), can result in less aggressive treatment options being offered. In one study involving 9,105 hospitalized patients, scientists found that “older age was associated with higher rates of decisions to withhold ventilator support, surgery, and dialysis,” even after accounting for differences in prognoses and patients’ wishes.

Representation in research

Exclusion of older people from health research is a well-recognized and long-standing problem, too. One survey found that older people were omitted from trials in cardiology, internal medicine, nephrology, neurology, preventive medicine, psychiatry, rheumatology, oncology, and urology. In other research, researchers found older people were excluded even from Parkinson’s clinical trials, despite the older  age of most Parkinson’s patients.

Psychological well-being

Being subjected to ageist attitudes can hinder psychological well-being, which in turn can impact physical health and longevity. A constant barrage of negative aging messages on television, in ads—really everywhere in popular culture—erodes self-esteem and sense of purpose. The WHO examined 44 studies that looked at the relationship between ageism and mental health and found that ageism influenced psychiatric conditions in 96% of them. Ageism was linked to the onset of depression, increases in depressive symptoms over time, and lifetime depression in 16 studies. "Based on figures for 2015, globally, about 6.33 million cases of depression are estimated to be attributable to ageism, with 831,041 cases occurring in more developed countries and 5.6 million cases in less developed countries," the report said.

Loneliness and isolation

Another issue is social isolation. Simply put, older people are more likely to withdraw from society or be placed in situations that foster feelings of loneliness, such as care homes. Loneliness and isolation, according to research, can increase the risk of developing coronary heart disease and other problems such as stroke. Loneliness has also been linked to cognitive decline.

While the emphasis in research has been on individual behavior and social network characteristics, some researchers argue, it’s important to look at macro level or societal issues, including stereotyping and discrimination. They believe there are three ways ageism leads to loneliness:

      1) chronic social rejection may lead people to withdraw

      2) individuals internalize ageist ideas such as older age being a lonely time, which can become self-fulfilling

      3) discrimination exacerbates social exclusion

Examples of built-in discrimination include life-altering policies like mandatory retirement, which can reduce social networks as well as income. Some ageism manifests in easily overlooked factors, such as urban planning that fails to account for the needs of older individuals—cracks in sidewalks and inadequate lighting in public spaces, for example.

Internalizing ageism

It's astonishing how much stereotypes can influence us. Research, for example, has shown that negative stereotypes about the elderly can degrade older people's performance on a variety of tasks. Participants in a lab study who were exposed to ageist stereotypes showed obvious changes. "[They] demonstrated worse memory, handwriting, and self-confidence and have appeared to age instantly­­—moving in a stereotypically older manner," said Julie Ober Allen in a 2016 paper that discussed the research.

And over one six-year study in China, researchers found that older people who internalized ageist attitudes had an almost 20% higher likelihood of dying than those with more positive self- perceptions.

Brighter side

What about the flip side—the effect of positivity? One longevity study found that individuals with positive ideas about aging live on average 7.5 years longer than those harboring negative ideas. And a 2022 review of several papers showed that older people “with a high level of psychological well-being” weren’t as hurt by ageism. This was especially true for those who were “proud of their age group, experienced fewer negative emotions, were more optimistic about aging and their future, were more self-confident about their bodies, and were flexible in setting goals.” Likewise, it seems that positivity may help people slow or avoid age-related cognitive problems. The WHO report, for example, cites a German study that found positive self-perceptions related to aging slowed cognitive decline, while negative ones accelerated it.

Thinking about and fighting ageism, then, is of interest to anyone concerned about maintaining health and vitality. Equally so, anyone who wants to ensure overall quality of life for parents, grandparents, and themselves. (Perhaps the most relevant takeaway for many readers will be about research that has shown ageist attitudes can impact cardiovascular health even 40 years later.)

The really good news in this context is that ageist attitudes appear to be changeable—and there are people and groups working to shift those perspectives. (See more resources below.)

For the time being, even if some of the findings revealing the prevalence of ageism seem bleak, there is hope in the sentiment attributed to French writer Jules Renard: 

“It’s not how old you are, but how you are old.”

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Some resources to fight ageism

Old School: The Anti-Ageism Clearinghouse

Changing the Narrative

WHO: Combatting Ageism

Ashton Applewhite TED talk