Interventions to Reduce Self-Directed Ageism Among Older Adults: A Systematic Literature Review and Meta-Analysis

Background and Purpose. Research has found a strong link between older adults’ self-directed ageism in the form of negative stereotypes, self-perceptions of aging, or views of aging, and risks to their physical and psychological wellbeing. A recent meta-analysis has shown that intergenerational and educational interventions are effective at reducing ageism among younger people. However, little is known about the design and effectiveness of interventions that target older adults’ own negative beliefs and prejudice against themselves. This systematic review and meta-analysis will assess the relative effects of interventions designed to change older adults’ self-directed ageism.

Methods. We searched 10 electronic databases. Eligible studies were those that (1) evaluated an intervention designed to reduce self-directed ageism among middle and older adults (age 50 and older), (2) examined at least one self-directed ageism (perceptions/views/attitudes of aging, age stereotypes, discriminations), (3) used a design with a comparison (randomized, nonrandomized, or baseline), (4) published after 1970, when the ageism concept was developed. Two reviewers completed the screening process and extracted study-level data independently.

Results. We found 6 eligible studies with a total of 732 participants. The average age was 70.1 years and 79.5% female, 90% White, 46.5% married or partnered, and 71.6% received above high school education. The primary outcomes categories were positive self-directed ageism (i.e. ongoing growth and development, satisfaction), negative self-directed ageism (i.e. physical, mental and cognitive declines), and age stereotypes about older adults in general.

Half of the interventions are long-term (4-12 weeks). Two programs used cognitive-behavior-therapy (CBT)-informed training to identify and neutralize negative thoughts of aging, and one targeted at self-efficacy building. The three short-term interventions targeted at eliciting positive aspects of aging. There are a wide variety of measurements ranging from the AgeCog scale (2), Expectations Regarding Aging scale (ERA, 2), Attitudes to Ageing Questionnaires (AAQ, 1), Image of Aging scale (1), Awareness of Age-Related Change (AARC, 1). Also, the operationalization of positive and negative aspects of self-directed ageism varies among studies. The same ERA scale was used to measure positive perceptions of aging in one study and negative views on aging in another study. 4) The sample lacks gender and racial diversities. The interventions did not have a significant effect on positive self-perceptions of aging (d = 0.01 SE = 0.05 p = 0.84), on negative self-perceptions of aging (d = -0.01 SE = 0.06 p = 0.86), or on age stereotypes (d = 0.03 SE = 0.07 p = 0.97).

Conclusions and Implications. The synthesized effects of interventions on self-directed ageism are not statistically significant. Potential reasons for the synthesis results are not enough long-term interventions and inconsistent operationalizations of self-directed ageism. However, self-directed ageism among older adults has well-established effects on physical and mental health of older people. The relatively small number of interventions solely focusing on older adults, comparing to the intergenerational and educational ones, reveals the importance of further developing rigorous interventions that specifically focus on reducing older adults’ self-directed ageism.