Talking With Becca Levy: Age Stereotypes and Elder Health

A leading researcher discusses how images of aging affect older people's health, abilities, and life expectancy.

“People act on the basis of their perception of reality,” a pollster for Ronald Reagan once said -- and in modern America, people’s perceptions are largely shaped by the media. The fascinating research that Yale psychologist Becca Levy is doing on images of aging in the media and elsewhere shows how they influence not only older people’s perceptions of their own reality but also how long they live.

In a 2005 study of 60- to 92-year-olds, Levy, an associate professor of epidemiology and psychology at Yale School of Public Health, and her associates found that those who watched more television had more negative views of aging. Some members of Levy’s study who were asked to evaluate the images of seniors portrayed on TV provided insight as to why the occasional bumbling, forgetful television grandma or cranky old next-door neighbor can be more depressing than amusing to seniors.

An 81-year-old participant wrote that old people “shouldn’t be the targets of jokes so much” on TV. A 68-year-old woman, noting that seniors are mostly absent from television shows (less than two percent of prime-time characters are 65 or older), added, “I feel like we’ve been ignored … like we are nonexistent.”

The findings were particularly significant because seniors, who represent about 13 percent of the population in the United States, view more television than any other age group, including children. As hearing and sight become impaired, and elderly people find themselves increasingly lonely or alone, television becomes a “companion” and connection to the greater world.

Levy’s research digs well below older people’s emotional response to negative or positive images to how those images affect their health and functioning. In a 2002 study of attitudes about aging in 660 people over age 50 in Oxford, Ohio, she found that those who viewed aging as a positive experience lived and average of 7.5 years longer. This means that a positive image had a greater impact than not smoking or maintaining a healthy weight. (Levy is quick to point out that factors such as exercise and good nutrition are still significant contributors to longevity.)

Levy’s other research has shown that seniors exposed to negative images of old age performed worse on hearing tests and showed a heightened cardiovascular response to stress. In her latest study, which will be published in Psychology and Aging early next year, she found that seniors exposed to words like “feeble” and “forgetful” also respond worse on memory and balance tests.

Coupled with the findings of a recent study of the negative effects of “elderspeak” on nursing home residents with mild to moderate dementia, Levy’s work goes to the heart of how society treats and thinks about its aging members. She spoke with about her research and how seniors and their caregivers can make use of it.

What have you learned about television exposure and the elderly?

We’ve found that there’s a correspondence between the amount of television that people report watching throughout their lives and their views of aging. Those who’ve watched more television tend to have negative stereotypes of aging.

We’ve also looked at personality as something that may modify how people take in the stereotypes of their culture. People who are more open-minded may be better able to question some of the stereotypes they encounter, and they tend to have more positive views about aging in general, but also about their own aging.

Have you studied aging stereotypes across different cultures?

Yes, and we have found that different cultures report very different views of aging.

We’ve studied the Chinese, and within the United States, we’ve compared mainstream hearing Americans and deaf Americans. The reason for that is that some anthropological studies have suggested that the deaf culture has more positive views of aging within the United States.

We found that China had the most positive stereotypes of aging, deaf Americans had the second most positive, and mainstream Americans were the most negative. In that study, we also looked to see if there was a correspondence with memory performance, and we found a similar relationship. So we found that the older Chinese performed the best on memory tests, deaf Americans were in the middle, and mainstream Americans had the worst memory performance.

What would cause the difference between deaf and hearing Americans? Does that have to do with television watching?

One hypothesis is that deaf people are exposed to less of the everyday negative portrayals of aging on television, on radio, and in conversation. But it’s also thought that deaf culture is an intergenerational culture. For example, there are deaf clubs that really mix people of all ages – they get together to practice sign language and to socialize. Another factor may be that a lot of deaf people are born to hearing parents. One hypothesis is that when these children actually meet deaf older people, they become very positive role models. So there probably are a couple of reasons for their more positive views.

Does television watching have the impact it does because TV presents negative stereotypes or because of our culture’s obsession with youth, which is manifest on TV?

We didn’t break it apart, but I think it’s probably a little bit of both. A lot of shows don’t have any older people on them, and some media analysts have said that when you don’t have examples of your own group portrayed, it can be debilitating. Then there are the shows with sort of comic negative portrayals -- like the older babysitter who is off sleeping in a corner, incompetent in some way or another. But I think the reverence of the youth culture is also part of it.

In a study of positive attitudes and longevity, you looked at whether the will to live was a factor in longer life spans.

We were trying to see what a mechanism might be that would lead those with more positive self-perceptions of aging to have a survival advantage, and we looked at will to live as a potential mechanism. We did find evidence that it was a partial mechanism -- so it explained part of the advantage. There are probably a number of other factors that also contribute.

What did you find in your most recent study of how stereotypes affect memory and balance?

Basically, we looked to see whether positive and negative age stereotypes had an effect on memory performance and balance -- such as a person’s ability to get in and out of a chair. To test that, we subliminally flashed words associated with aging -- words that represent everyday physical and cognitive stereotypes about old people -- onto a computer screen, at a speed that allows perception without awareness.

For example, one negative physical word was “shaky,” and a negative cognitive was “forgetful.” A positive cognitive stereotype was “wisdom,” and a positive physical one would be “spry.” This was a controlled laboratory study, so it has the advantage of being able to really isolate the impact of the stereotypes.

We found that those exposed to the positive age stereotypes performed significantly better at remembering and balance than those exposed to negative stereotypes. We also found that the cognitive stereotypes had more effect on the cognitive function, memory, and the physical stereotypes had more effect on the physical, balance.

Are the stereotypes you select usually related to the task a study participant is asked to perform?

No, in one study, we asked elderly people who were having their hearing tested every 18 months, “When you think of an old person, what are the first five words or phrases that come to mind?” We found that those who had more negative age stereotypes and more appearance-oriented stereotypes showed a steeper decline in their hearing performance.

Do you have a current research project in the works?

One of the things that we’re interested in is looking at minority elderly. Most of our studies have been primarily of white people, but in one study we looked at whether the age stereotype effects existed in African Americans, and we found that they did. In fact, for some measures, such as cardiovascular response to stress, we found the effects were stronger. But there are also some studies to suggest that minorities may have more positive age stereotypes.

What’s your advice to the elderly and their caregivers when they come up against negative stereotypes from eldercare workers and others who use terms like “sweetie,” which some find offensive?

One of the overall messages is that it’s good to be aware of the age stereotypes that exist in society, and it’s good to question them. I’ve heard some people say they want to be able to use terms of endearment for older people -- it’s their way of expressing their affection -- but I’ve heard older people say it can be belittling. I think some older people like it and some don’t. In terms of healthcare settings, it’s probably a good idea to ask people how they want to be addressed -- what is most comfortable for them -- and to set up a communication agreement.

Increasing awareness is also part of it. I think some people who use baby talk with the elderly don’t even realize they’re doing it.

Family caregivers who are advocates for an older family member can also be on the lookout for these things. Some people send me stories about how in healthcare settings, the healthcare provider will often only speak to the younger relative, and that irks both the older person and younger person.

How did you get interested in studying aging?

My first job was working at a psychiatric hospital on a geriatric ward. One of my jobs was taking some of the patients to get electric convulsive therapy for depression. I was supposed to go with the patient in the room and comfort them before they received it.

I knew nothing about the population, and the whole experience was very rewarding for me. The staff discussions about choosing electric convulsive therapy as a treatment were very provocative, and I had a lot of questions and observations that I thought would be really interesting to pursue, including how people’s cultural backgrounds influenced health, how the older patients were treated, and such. So I applied to graduate school with the study of aging as my primary focus.

As I’ve become more interested in how society treats the elderly, I think I’ve become more sensitive to observing the kind of language people use to talk about aging in general, their own aging, and that of other people they encounter.

If I had known the things I’ve learned from my research when I was working at the psychiatric hospital, I might have thought about ways to try to empower some of the elder patients more -- maybe in the team meetings, maybe just in conversations with some of the older patients. That’s one of the messages of this research: Finding ways for our culture and society to empower elders is something we should work toward more actively.


over 8 years, said...

Please help me understand. I have been dealing with depression since 1985. It took years of my life but I finally was diagnosed with PTSD and finally got the proper help through talk therapy, group therapy and of course medications. I remember being so embarrased that I shut myself off from anyone & anything. I realized the stigma depression had back then but now!! My husband & I moved 3 years ago and I was taken out of my comfort zone after doing so well for 10 years. I have been through enough in my life time to know when I am being judged without Dr's and Nurses know who I am. Recently, I was sent to the ER after my husband consulted with a nurse because I was having horrible sharp pain in my left upper thigh. She explained it could be life threatening, maybe a blood clot forming. That was the only way I would go and I was right. She did a dopler and it was normal so she said I was free to go. It shocked me because the pain was excruciating and she did not care. She did not ask any questions or bother checking for anything else. The tech ask if I was given anything for pain and I said no one has offered. He asked the Dr. and she said no. I could tell from the beginning she had already judged me by my records. When I finally got into see my internist, I was told I had the shingles. Not long after that my brother-in-law passed away suddenly an we went to N.C. Also, while I had the shingles the pain in the right leg caused me to loose my balance and I fell down a flight of stairs and hurt my back. Luckily, my regular Dr. had given pain medicine for the shingles. After my brother-in-laws death, we had to wait a month and return to N.C. Before we left I asked my regular Dr if she would give some extra pain medication because we had to go back to N.C.and it was a 12 - 14 hour trip. She agreed as long as I laid down in the back sit or reclined in the chair. When I went to leave, I realized I forgot to tell her about the pressure in my chest. She did an EKG and it was abnormal and told me I needed to go to the ER. She said with my high cholesterol, pressure and shingles she was really concerned about my heart. She talked to my husband and they convinced me to go. She did not even want me to drive home. She sent me to the same ER and I was seen by a different Dr but with the same attitude. He talked to me like I was 12 and his final question was "Has anyone ever told you you are Bi-Polar? What did this have to do with my heart? What they did they could have done as an out patient. The day nurse was nice and very respectful. The evening nurse was rude and quit frankly a bitch. She brought it upon herself to tell me I should not be taking the amount of medicine I am on. This person had never met me had no idea what all I have been through and she was cruel. She said maybe if your seeing a licensed Pyschiatrist the meds are right and I said if it matters to you I am and have been for a long time. I asked them please do not adjust my phych med's without speaking to my Dr. in Birmingham. They did anyway and made everything about my depression instead of the reason I was sent there. I saw 4 different cardiologist and 2 different interns. If they were so concerned that it was all mental, looking for drugs, why did they not have a phychiatrist see me? I will never ever go back there and am furious and trying to let it go but I can't. Not one of those Dr's spoke to me ;the most one said was "it's not your heart Ms. O'Connor". What can I do, as a person who knows that depression is an illness just like diabetes? I am new in this town and quite frankly I am really upset. It would be different if they did it once but they treated me the same way. I am not a mouthy person, infact I am quiet and usually do not speak my mind. I really want to report these Dr's or write a letter to the newspaper. I feel for the people here that deal with this illness. Am I making too much out of this? Why is it still such a stigma and want can be done so Dr's and Nurses treat you with respect no matter what you are there for. One more thing - I was a room with a lady who could not get up by herself. When her family came they spoke horrible to her. Yelling at her, fusing about the way she ate, needs to be in a nursing home, etc. I could not stay in the room when her family came. I did ask a nurse if anyone has gone in the room while her family is there? They told me they try to stay out while family is visiting. I told her someone needs to; what they are doing could be considered elder abuse. Her response - she is leaving tomorrow to go to a nursing home. In otherwards, mind my own business. It did not matter to the nurse because she said the lady did not have her good hearing aids with her so they figured she couldn't hear them. I'm I really that stupid or ignorant? I told that nurse that she had no way of knowing what that lady heard.