People worldwide are living longer. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% (900 million people) to 22% (2 billion) [1
]. The extent to and speed at which these demographic transitions are happening underscore the pressing need to develop appropriate responses to population ageing. However, commonly held perceptions and assumptions about older people and ageing pose serious challenges to developing an adequate societal response to population ageing. Older age is generally typecast as a period of frailty and inevitable decline in capacity, with the depiction of older people as a homogeneous group that is care dependent, burdensome on health and social care spending, and a hindrance to economic growth. This is inconsistent with the diversity in health and functioning that is seen in older age [2
Ageism is the umbrella term for the stereotyping, prejudice and discrimination towards individuals on the basis of their chronological age or a perception of them as being “too old” or “too young” to be or do something [3
]. Stereotypes affect how we think (cognition), prejudice affects how we feel (emotion), and discrimination affects how we act (behaviour) towards people on the basis of their age. Although ageism can affect any age group, it most often affects older people [4
], and it is strongly institutionalised, generally accepted and unchallenged, largely because of its implicit and subconscious nature [5
]. Ageist depictions are prevalent in everyday language and in the media [6
]. Ageist policies such as health care rationing by age and institutional policies and practices that perpetuate stereotypical beliefs, such as mandatory retirement and the shortage of training programmes on ageing for health professionals, are widespread [7
A growing body of research has examined the effects of ageism on the health and physical and cognitive functioning of older adults. For example, a meta-analysis found that direct exposure to negative ageing stereotypes was significantly associated with poorer performance on a range of physical and cognitive tasks in older people [9
]. Once perceived as an “older adult”, not only do individuals become subjected to external stereotyping and discrimination but the ageist attitudes are internalised into unconscious self-stereotypes [10
]. This internalisation process is significantly associated with poorer physical and mental health in older adults [11
Despite an improved understanding of the negative consequences of ageism on the health and functioning of older people, there is limited understanding of the prevalence of this phenomenon and its relation to individual- and contextual-level factors. The few studies that have been conducted to study ageism prevalence across the world have used a maximum of two items to measure ageism [12
]. This is problematic given the complex and multidimensional nature of this phenomenon. Other cross-national studies that have used a larger set of items to measure ageism had a limited geographical scope, covering one or two regions only [14
To increase our knowledge in this area and to overcome the limitations of previous research, this study aimed to examine the global prevalence of ageism using a large population sample, nine different items and multi-level latent class analysis as the analytical strategy. It further aimed to study the association between ageism and a range of possible explanatory factors.
Ascertaining the global prevalence of ageism and associated factors is a necessary step in understanding the magnitude of this public health issue. This study used the largest sample to date to examine ageism and its relation to various personal, demographic and development factors, including sex, age, education and healthy life expectancy (HLE).
This study shows that ageism is highly prevalent across the world, with the highest prevalence observed in poorer countries. Individuals with high ageist attitudes were more likely to reside in low- and lower-middle-income countries, such that low- and lower-middle-income countries were five times more likely to be ageist than high-income countries. The large heterogeneity observed in the meta-analysed estimates of individual-level ageist attitudes by country reflects the true variation in the prevalence of ageism across countries. In the multi-level analysis, we found that contextual factors did explain the source of variance in prevalence.
Our study also shows that two country-level factors are significantly associated with the presence of individuals with ageist attitudes and ageist countries: lower HLE and fewer people over the age of 60 as a proportion of the total population. In view of the available literature, it is possible that the relationship between HLE and ageism is bi-directional with lower levels of HLE resulting in increased ageism, and increased ageism resulting in lower levels of HLE. Countries with a lower HLE are more likely to have older adults in poor health, and increasing the populations’ exposure to poor health in older age is likely to reinforce negative attitudes towards getting older. Indeed, negative attitudes towards older age have been traced back to people’s assumption that there is an age-related decline in people’s functioning [22
In turn, holding ageist attitudes at an individual level can decrease health and functioning. Self-directed ageism is associated with an increased cardiovascular response to stress [23
], a higher presence of markers of Alzheimer’s disease [24
], lower physical and cognitive function [11
], and worse health behaviours [25
]. Even the threat of stereotypes, raised by explicitly comparing an older person with younger people, is sufficient to reduce older people’s mathematical and cognitive performance by as much as 50% [27
]. Longitudinal research from the United States also found that older people who hold negative attitudes towards ageing live on average 7.5 years less (after controlling for key determinants) than people with positive attitudes to ageing [28
]. This supports previous work that found that being dissatisfied with ageing was a good predictor of mortality [29
The second country-level factor significantly associated with ageism is the percentage of people aged 60 and over. In keeping with other research, these findings show that levels of ageism are lower when there is a greater proportion of older adults in a country [12
]. Currently, higher-income countries have a larger percentage of older adults than low- and middle-income countries, but this is changing rapidly. For example, while France had almost 150 years to adapt to a change from 10% to 20% in the proportion of the total population aged 60 years and over, countries like Brazil and China will have slightly more than 20 years to make the same adaptation [2
]. The association found between population ageing and ageism appears to indicate that as the proportion of older adults increases, members of society become more favourable towards older age. A plausible explanation is that this demographic shift offers increased opportunities for intergenerational contact, which exposes younger people to counter-stereotypical examples that can help challenge the negative associations they hold about older adults [30
]. Indeed, when intergenerational contact meets certain conditions, such as frequency and reciprocity, it is associated with a decrease in negative attitudes [31
]. Future research will be needed to understand if the increase in the proportion of adults over 60 years of age in low- and middle-income countries will result in lower levels of ageism, given that the rapid pace of population ageing in these countries may not offer sufficient time to adapt to the demographic shift and foster positive intergenerational contact, as suggested by North and Fiske [14
]. The influence of these two country-level factors on ageism may help explain the increased levels of ageism found in low- and lower-middle-income countries as these countries tend to have both lower HLE and a lower proportion of older adults.
At the level of the individual, this study found a significant association between higher levels of education and lower levels of ageism. This finding is supported by research on attitudes across cultures showing that more educated populations are less likely to have negative perceptions of older people [15
]. Other cross-cultural studies found that more educated people consider “old age” to start later, do not self-identify as an older person and hence immunise themselves against self-directed ageism [22
]. Attaining a higher level of education has also been correlated with the acknowledgement of age bias and a greater sensitivity to ageism as a social problem [15
Being older was also significantly associated with a decreased risk of exhibiting high ageist attitudes but was not significantly associated with a decreased risk of exhibiting moderate ageist attitudes. Results from past research have been mixed. One previous study found that older adults had lower explicit preferences for younger people [30
], while another showed that older adults tend to be more ageist towards those older than themselves and that middle-aged people are more ageist than both younger and older groups [32
]. In view of our findings and the mixed results obtained in past studies looking into this association, this is an area that would benefit from additional research.
Lastly, this study found that being male is significantly associated with the presence of high ageist attitudes at an individual level. These findings are consistent with other studies that have found that men, across all age groups, are more ageist towards older adults than women [32
] and that women generally identify more with their age and view older adults as contributing more to the economy [15
In reviewing the findings, it is important to consider the limitations of the study. While this study covered two dimensions of ageism (i.e., stereotypes and prejudice), we were unable to capture the third dimension of ageism (i.e., discrimination), as this dimension is not included in the WVS. Additionally, our findings are only as valid as the availability of individual-level indicators and the reliability of the original data sources. As data for many of the World Bank and exposure variables are available only for certain years, covariate and outcome data are not optimally time-matched for all countries. However, we do not regard this as a major threat to the validity of our findings because national-level indicators change slowly. Finally, it is important to note that we do not claim causality for any of the correlations presented here; many potential variables might affect both ageism and our exposures of interest.