Want Older People to Be Healthy? End Ageism

There’s a lot of disagreement around how to frame the last century’s unprecedented increase in human lifespan. Is it a crisis or an opportunity? Will a “grey tsunami” of incapacitated freeloaders sweep us off our feet, or will we tap into the social capital of millions more healthy, well-educated adults?  Are longer lives a blessing or a curse? Experience and ideology shape the responses, of course, but there’s one thing both liberals and libertarians can agree on. What single characteristic of these older Americans will make the most difference? Their health. Living longer looks a lot more attractive when it’s uncoupled from cognitive and physical decline. It’s a lot cheaper too: illness is expensive.

Ask most people if they want to grow old, and they say yes. A qualified yes, that is—“as long as I’ve got my health.” But health is shaped by more than genes and behavior. The beliefs we’ve assimilated about the nature and value of old age—how ageist we are, in other words—also play an important role. A growing body of evidence shows that attitudes towards aging have an actual, measurable, physical effect on how we age. There’s no inherent reason for the effect to be negative; positive attitudes improve mental and physical function. But an ageist culture like this one equates aging with decline. Prejudices are drummed into us by the media and popular culture and go unexamined. Wrinkles are ugly. Old people are incompetent. It’s sad to be old. When we internalize those falsehoods, it actually harms our health. 

This isn’t New Age woo-woo. Over the last few decades, mainstream medicine has come to accept the existence of a powerful mind-body connection. Clinical trials have shown that psychological factors can play a major role in illnesses and chronic conditions, and that mind-body therapies can help people function better and enjoy life more. This has critical implications for how well we age. Obviously, aging is more than a mind-set, but it’s increasingly apparent that attitudes are an important part of the equation. The way we internalize cues in the environment—as abstract as the way older people are depicted in the media or as concrete as that emerging bald spot—significantly affects our physical and psychological trajectories. 

Harvard psychology professor Ellen Langer has done fascinating research in this domain. Her famous 1981 counterclockwise study “teleported” a group of 75- to 80-year-old men back in time during a five-day retreat. The subjects were told to imagine they were 55, to talk about that period in the present tense and to reflect on their lives when they were that age. Afterwards they looked an average of three years younger, their hearing and memory improved and some had less arthritis—evidence of the physical effects of a mental activity. Psychologist Chris Kurby of Grand Valley State University described these findings by saying, “If we put our minds in a younger place, we may put our bodies in a younger place.”

Yale University psychologist Becca Levy has developed a theory about how we come to embody stereotypes of aging: we assimilate them from the culture, they become part of our identity and this influences how our brains and bodies function.

Levy’s theory has four components:

  1. Age stereotypes become internalized across the lifespan, beginning when kids are exposed to negative stereotypes in all kinds of ways, from ads for wrinkle cream to children’s books.
  2. Age stereotypes can operate unconsciously. We know this from the many tests that have used subliminal priming (flashing a word on a screen too briefly for subjects to become aware of it but long enough for them to assimilate the meaning subconsciously). For example, after being exposed subliminally to negative terms (e.g., decline, dependent, senile), older subjects did less well on memory tests—evidence that stereotypes affect cognition. 
  3. Age stereotypes become more relevant to us as we get older—and thus are more likely to become self-fulfilling prophecies.
  4. Age stereotypes operate in multiple ways: 
  • Psychological – via those self-fulfilling prophecies
  • Physical – via heightened physiological responses to stress when older individuals are exposed to negative stereotypes  
  • Behavioral – via health practices: people who expect the worst as they age are less likely to engage in practices like controlling weight and diet, and exercising

These effects work in both directions: positive stereotypes have positive effects. People who are optimistic about aging behave differently from those convinced that growing old means becoming useless or helpless. Those with more positive views not only do better on memory tests, they are more likely to recover fully from severe disability. And they actually live longer—an average of seven and a half years.

Until we change the culture, perhaps the best news is that the effects of negative age stereotypes are reversible. “Implicit interventions”—as few as four brief exposures to subliminal, positive messages about aging—improve physical function. In one 2014 study, participants with a mean age of 81 felt better psychologically and improved their strength, gait and balance. Remarkably, this short, safe, low-cost intervention was more effective than a six-month exercise program. 

Attacking one disease at a time, the “War on Cancer” medical model, may buy us additional years without health—the worst of all outcomes. Consensus is growing for a more holistic approach: intervening in the aging process itself in order to increase our active years and postpone disability and mortality. Postponenot prevent. But while death is inevitable, poor health is not, and there’s much we can do to stay well and keep frailty at bay. You know the drill: don’t smoke, eat right, exercise regularly, get enough sleep. Confronting America’s rampant ageism belongs on that list, and not as just a matter of personal well-being. Population aging makes it a public-health imperative.

How can we make the goal of increasing not just lifespan but “healthspan” more attainable for Americans of all ages? How about a national anti-ageism campaign to raise awareness of age-based stereotypes and the damage they do? The benefits to health and human potential would be immense.