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Every fall, Becca Levy asks students in her Health and Aging class at the Yale School of Public Health to imagine an elderly person and share the first five words that come to mind. Don’t think too much, she tells them.
She writes their answers on the board. These include admired words such as “wisdom” and “creative” and roles such as “grandmother”. But “‘senility’ occurs frequently,” Dr. Levy said recently, “and much physical infirmity and decay: ‘hunched,’ ‘sick,’ ‘fallen.'”
Dr. Robert N. Butler, psychiatrist, gerontologist, and founder of the National Institute on Aging, coined the term “ageism” half a century ago. It reflects “sexism” and “racism”, describing the stereotypes and discrimination of older people.
Among the memorabilia in Dr. Levy’s small office at Yale is a treasured photo of her and Dr. Butler, who died in 2010. She is arguably his successor.
A psychologist and epidemiologist, Dr. Levy has demonstrated — in more than 140 published articles over 30 years and in a new book, Cracking the Age Code — that ageism leads to more than hurt feelings or even discriminatory behavior. It affects physical and cognitive health and well-being in measurable ways and can take years off a person’s life.
“Just as we’ve learned in recent decades that structures are biased against women and people of color, leading to poorer health outcomes, she showed that negative feelings about old age lead to poorer outcomes in older adults,” said Dr. Louise Aronson, geriatrician at the University of California, San Francisco and author of the bestselling book, Old Age.
Another memento in Dr. Levy’s office is a card on her bulletin board that reads, “Ask me about 7.5.” The souvenir comes from an anti-aging campaign in Wisconsin and refers to its 2002 Longevity Study, which for two decades followed hundreds of residents over the age of 50 in a small Ohio town. The study found that average survival was seven and a half years longer for those with the most positive beliefs about aging, compared to those with the most negative attitudes.
“I use this in practically every speech I give because it’s shocking,” said Tracy Gendren, who chairs the department of gerontology at the University of Virginia and credits Dr. Levy’s work in “Ageism Unmasked,” her own recently published book. “She was truly a pioneer.”
Dr. Levy and her team measure attitudes about aging in a variety of ways. They use questionnaires or the same five-word exercise she gives her students. They tested for subconscious biases using computer programs that flashed negative or positive words about aging so quickly that participants involuntarily internalized them. They used small experimental samples of a few dozen people and followed the health records of thousands through large national surveys. Thanks to their efforts, we know that in addition to reduced longevity, ageism is also associated with:
Cardiovascular events, including heart failure, strokes and heart attacks. Using the health records of almost 400 participants under 50 in the Baltimore Longitudinal Study of Aging, “we were able to follow people for 40 years,” Dr. Levy said in an interview. “They had twice the risk if they adopted negative stereotypes about aging at a young age.” Their cardiovascular events also occurred at an earlier age.
Physical function. Among 100 older adults (whose average age was 81), those who were exposed to implicit positive age stereotypes every week for a month performed better on tests of gait, strength, and balance than controls groups. In fact, those who received positive exposure improved more than an experimental group of similar age who exercised for six months. In a study of New Haven residents over 70, those with positive beliefs about age were also more likely to fully recover from a severe disability than those with negative beliefs.
Alzheimer’s disease. Some participants in the Baltimore study underwent regular brain scans, and some donated their brains for autopsy. Those who had more negative beliefs about age at a younger age showed a steeper decline in the volume of the hippocampus, the brain region associated with memory. They also show, after their death, more of the brain plaques and nodules that are Alzheimer’s biomarkers.
Another study used data from the National Health and Retirement Study, which included whether participants carried the APOE4 gene, which increases the risk of Alzheimer’s. Those with the gene who had positive beliefs about age “had as low a risk as people without the gene,” Dr. Levy said.
The list goes on. Older adults with positive views about aging perform better on hearing tests and memory tasks. They are less likely to develop psychiatric illnesses such as anxiety, depression, post-traumatic stress disorder and suicidal thoughts.
In fact, Dr. Levy and her colleagues estimate that age discrimination, negative age stereotypes, and negative self-perceptions of aging lead to $63 billion in excess annual costs for common health conditions such as cardiovascular and respiratory disease, diabetes, and injuries.
Dr. Levy, who is 55, credits her focus on aging to a post-college job at a suburban Boston psychiatric hospital, a graduate scholarship in Japan and a crappy crate at a grocery store in Florida.
At the hospital, she worked in a ward for elderly patients, and to her surprise, she liked it. “It inspired me to want to understand the psychology of aging,” she said.
Later, she plans to spend a semester in Japan to study why its residents have the longest life expectancy in the world. “I noticed how differently they treated the elderly,” she said. “They were celebrated. Centenarians were rock stars!”
Before she left for Japan, however, she visited her grandmother, a vivacious seventy-year-old. They were shopping together when Grandma Horthy fell over a crate with jagged metal corners that had been left in the aisle.
The resulting wound on her leg, although bloody, turned out to be superficial. But when her grandmother suggested to the grocer’s owner that she not leave crates around, he replied that old people fall all the time and maybe they shouldn’t be walking around.
“The message stayed with her and seemed to influence her behavior,” observed Dr. Levy. Her grandmother seems to have questioned her competence, asking Dr. Levy to take over the duties she usually handled alone. The incident led Dr. Levy to consider how cultural values and people’s own perceptions of age can affect them.
We internalize these stereotypes from an early age, through disparaging media images and tales of wicked old hags. But institutions — employers, health organizations, housing policies — express similar prejudices, enforcing what’s called “structural ageism,” Dr. Levy said. The turnaround, which will require radical changes – “a movement to liberate the age,” she added.
But she found reason for optimism: Harmful ideas about age can change. Using the same subconscious techniques that measure stereotypic attitudes, her team was able to boost feelings of competence and worth among older adults. Researchers in many other countries have replicated their results.
“You can’t create beliefs, but you can activate them,” Dr. Levy said, exposing people to words like “active” and “full of life” instead of “disturbed” or “helpless” to describe more the adults.
Could a society undertake such a mission? How long can the benefits of such interventions last? Will people need regular boosters to help associate aging with experience and opportunity instead of nervous jokes?
The research, conducted by Dr. Levy and other scientists, is ongoing.
“Although young children already have negative age stereotypes, they are not set in stone,” said Dr. Levy. “They are plastic. We can move them.
Audio produced by Kate Winslet.