Experiencing Old Age: Pilot Study Examining the Effects of Age Simulation on Ageism in Adolescents

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Introduction

Lines 62-63: What were the ages of participants in previous studies on aging simulation suits?

Materials and Methods

Line 75: Data *were* collected (not was) 

Line 87-89: was this same alphanumeric code used for pre- and post? What if someone forgot?

Line 102-105: is this the same questionnaire described above in Lines 82-92? 

Consider having "participants", "measures", and "procedure" as sub-headings within this section to clarify how the study moved forward

Line 107: did wearing of the simulation suit happen on the same day as the questionnaire? How long was the entire session (questionnaire took x amount of time, simulation suit took 2 hours)? Did the 43 participants who did not use the simulation suit stay for the whole time or did they go home? Was the questionnaire completed on individual computers that the researcher provided?

Line 133-134: How were participants who did not wear the simulation suit debriefed? 

Results

What happened to data from the other 43 participants? Were they the control group? If so, were there data also analyzed to assess potential change after observing the simulation experience, but not wearing the suit themselves?

Where you are able to have discretion over wording (e.g., not in context of the questionnaire responses), I would recommend using the term "older adults" throughout, rather than "elderly"

Line 182-183: for these 4 participants, what were their initial responses (e.g., were they already at ceiling and that's why their attitude remained unchanged?)

 

Author Response

  TO REVIEWER No1:   1. Lines 62-63: What were the ages of participants in previous studies on aging simulation suits? In ref. No 8 (Leedahl et al, 2020) participants were „the student population“, no precise age shown. In ref. No 9 (Allen 2018) participants were aged 18-59. In ref. No 10 (Gerhardy 2022) the authors analyzed numerous studies, of which the majority (16 papers) enrolled participants aged 18-30 years, while 5 studies enrolled participants aged 18-64 years. For the rest of them we could not find these data. Thank you for your review and we appreciate your remarks immensely. 2. Line 75: Data *were* collected (not was). We corrected this in our paper. 3. Line 87-89: was this same alphanumeric code used for pre- and post? What if someone forgot? The code was the same, as we explained in corrected version of text. The participants were able to leave the investigation in case they could not complete the investigation (for example if they forget their code), but they all completed investigation. Thank you for your review and we appreciate your remarks immensely. 4. Line 102-105: is this the same questionnaire described above in Lines 82-92? The questionnaire was the same described in given lines. But the 20 participants who were randomly selected also completed the FSA (Fraboni Scale of Ageism) which was the main tool for investigation the attitudes toward ageing. To clarify this, we changed this passage in text.  5. Line 107: did wearing of the simulation suit happen on the same day as the questionnaire? How long was the entire session? Did 43 participants who did not use the simulation suit stay for the whole time of did they go home? Was the questionnaire completed on individual computers that the researcher provided? The baseline testing (demographic, family structure, frequency and type of contact with grandparents... as well as FSA questionnaire) was performed at the same day for all 63 participants. Selected participants were wearing the suit as described in next 10 days, 2 participants per day, in the morning (between 8 am and 1 pm). To clarify this, we corrected this passage in text. 43 participants who were not selected did not continue the investigation, and the results of their baseline testing were not included in this paper. The questionnaire was presented and completed on individual tablets provided by research. Thank you for your review and we appreciate your remarks immensely. 6. Were you able to have discretion over wording? In Serbian literature the term „elderly“ is officially reffered to population older than 65 years. We acknowledged the problem in limitations section.  7. Line 182-183: for these 4 participants, what were their initial responses (e.g., were they already at ceiling and that’s why their attitude remained unchanged? The given participants had average initial results regarding attitude towards aging, which remained unchanged. Thank you for your review and we appreciate your remarks immensely.     Thank you for your remarks on the manuscript. We corrected the manuscript in accordance with your suggestions.   

Reviewer 2 Report

Comments and Suggestions for Authors

This is a well-written article describing a well-designed study.  I have a few concerns, questions, and observations that can improve the contributions of the article.

1. Was the Fabroni used in English, or translated and back-translated? Is the cultural context of your study important regarding values about aging and older adults?
2. While the Fabroni Scale of Ageism is indeed widely used, there are many other scales to measure ageism that do not extensively use “the elderly” or “elderly”. These terms are now acknowledged as ageist themselves. Many journals have guidelines prohibiting the use of these terms for that very reason.  Obviously, the authors cannot do anything about the inherent ageism in the scale they used, except perhaps to acknowledge the problem in their limitations section.
3. I have similar concerns about the inherent ageism in use of the “Senior Suit” to simulate aging. Again, this has been a standard way of sensitizing students to aging, there is extensive criticism about the fact that this “simulation” conveys nothing but negative messages about aging as loss (vision, hearing, range of motion, strength, coordination, etc.). The authors appropriately point out that this “experiential learning” might increase empathy.  However, empathy, which can easily turn into sympathy, does little to reduce ageism.  It may increase kindness, but it does not reduce ageism. Given the major advancements in anti-ageism awareness, it would be helpful for the authors to acknowledge this limitation of a simulation that provides only negative messages about aging.
4. The authors designed the study as quasi-experimental, but seem to report only the findings for the treatment group. That is puzzling.  Intergroup comparisons would greatly strengthen the findings. Since all 63 students participated in a “designated classroom session”, it is possible that the session itself might have sensitized students in some way.  Tell us more about that session, and why the comparison data for treatment and controls was not included.
5. The second part of Table 2 (which I believe is referred to in the text as Table 3) reports the percent of the treatment group who gave various response at time 1 and time 2. It is hard to make conceptual or empirical sense of this table. The authors state on page 5, lines 165 to 168, that a notable finding was the shift in the percent of participants who perceived older adults as “bad” went from a majority down to 5%. However, the data show that 65% completely disagreed with this statement at baseline.  Did the authors consider collapsing some of the response categories?  This table and its interpretation need work.

Author Response

 

 

 

TO REVIEWER No2:

 

1. Was the Fabroni used in English, or translated and back-translated? Is the cultural context of your study important regarding values about aging and older adults? We used the Serbian version of FSA, which was previously translated and preliminary validated (Popovac et al, 2022) and transculturally adapted (Sesto et al, 2024). We clarify this in text, and we also added these in References.
2. While the FSA is indeed widely used, there are many other scales to mesure ageism that do not extensively use „the elderly“ or „elderly“. We acknowledged the problem in limitations section. Thank you for your review and we appreciate your remarks immensely.
3. I have similar concerns about the inherent ageism in use of the „Senior Suit“ to simulate aging. We acknowledged the problem in liminations section. Thank you for your review and we appreciate your remarks immensely.
4. The authors designed study as quasi-experimental, but seem to report only the finding for the treatment group. After the selection, the 43 nonselected participants did not continue the investigation and their results were not included in this report. We clarified that in corrected text. Thank you for your review and we appreciate your remarks immensely.
5. The second part of Table 2 reports the percent of the treatment froup who gave various response at time 1 and time 2. The comments related to Table 2 and Table 3 are corrected.

 

 

Thank you for your remarks on the manuscript. We corrected the manuscript in accordance with your suggestions.

 

 

Reviewer 3 Report

Comments and Suggestions for Authors

This experimental study with triangulation methods investigates high school students' attitudes toward the elderly. By using an aging simulation suit, it examines if such experience can reshape these attitudes. The research offers insights into promoting inter - generational understanding and combating ageism, which is valuable for educational and social initiatives aiming to foster more inclusive views on aging.

 

However, there are still several issues in the article that need to be clarified.

1. Table 2, titled "Respondents' attitudes regarding aging and the elderly before and after the intervention," may require further clarification. Some items in this table seem unrelated to the experimental intervention. Additionally, the content of these items varies in direction. It is essential for the authors to explicitly state which attitudinal changes are positive. This will help readers better understand the impact of the intervention and the significance of the findings. A more detailed explanation would enhance the clarity and interpretability of the table, allowing for a more accurate assessment of how the simulated aging experience influenced students' perspectives on aging and the elderly.

 

2. Table 3 appears to be based on the Fraboni Scale of Ageism. Currently, the authors present the data in a descriptive manner. However, it is recommended that they further consolidate the information into relevant dimensions and extract key elements from the scale's content. This approach would provide a more structured and comprehensive analysis, enabling readers to grasp the underlying aspects of ageism being measured. By categorizing and synthesizing the data, the authors can highlight patterns and trends more effectively, contributing to a more profound understanding of students' attitudes towards older adults and the implications of the intervention.

Author Response

 

TO REVIEWER No3:

1.    Table 2, titled „Respondens’ attitudes regarding ageing and the elderly before and after the intervention“ may require furter clarification. We added more detailed comments to Table 2. We changed the variability in direction of certain contents of Table 2 and have clarified which attitudinal changes are positive, as mentioned in your review. Thank you for your review and we appreciate your remarks immensely.
2.    Table 3 appears to be based on the Fraboni Scale of Ageism. Currently, the authors present the data in a descriptive manner. We added more detailed comments to Table 3. We extracted the core key elements of the Fraboni scale and analyzed the data in an analytical manner. Thank you for your review.

Thank you for your remarks on the manuscript. We corrected the manuscript in accordance with your suggestions. 

 

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors did a good job of addressing my major concerns.  Two final suggestions: 1)please replace the word "experiment" with a more appropriate term that does not imply experimental or quasi-experimental design; 2) On table 2, please provide a footnote about what "/" in the significance column means. 

Author Response

Thank you very much for all the helpful comments that have significantly improved the quality of the paper.

1) Experimental design has been replaced by the term "prospective interventional study". This is an excellent comment. Thank you very much again.

2) /- null or not applicable. Inserted in the explanation of the tables.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have provided a fairly reasonable explanation for the relevant issues and it is recommended to accept the publication.

Author Response

Thank you very much for all the useful comments that have significantly improved the quality of the work.