Abstract
BackgroundFrailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Ageism is “a process of systematic stereotyping and discrimination against people because they are old.” Explicit biases involve deliberate or conscious controls, while implicit bias involve unconscious processes. Multiple studies show that self-directed ageism is a risk factor for increased morbidity and mortality. The purpose of this study was to determine whether explicit ageist attitudes are associated with frailty in Veterans.MethodsThis is a cross-sectional study of Veterans 50 years and older who completed the Kogan’s Attitudes towards Older People Scale (KAOP) scale to assess explicit ageist attitudes and the Implicit Association Test (IAT) to evaluate implicit ageist attitudes from July 2014 through April 2015. We constructed a frailty index (FI) of 44 variables (demographics, comorbidities, number of medications, laboratory tests, and activities of daily living) that was retrospectively applied to the time of completion of the KAOP and IAT. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by multinomial logistic regression models with frailty status (robust, prefrail and frail) as the outcome variable, and with KAOP and IAT scores as the independent variables. Age, race, ethnicity, median household income and comorbidities were considered as covariates.ResultsPatients were 89.76% male, 48.03% White, 87.93% non-Hispanic and the mean age was 60.51 (SD = 7.16) years. The proportion of robust, pre-frail and frail patients was 11.02% (n = 42), 59.58% (n = 227) and 29.40% (n = 112) respectively. The KAOP was completed by 381 and the IAT by 339 participants. In multinomial logistic regression, neither explicit ageist attitudes (KAOP scale score) nor implicit ageist attitudes (IAT) were associated with frailty in community dwelling Veterans after adjusting for covariates: OR = .98 (95% CI = .95–1.01), p = .221, and OR:=.97 (95% CI = .37–2.53), p = .950 respectively.ConclusionsThis study shows that neither explicit nor implicit ageist attitudes were associated with frailty in community dwelling Veterans. Further longitudinal and larger studies with more diverse samples and measured with other ageism scales should evaluate the independent contribution of ageist attitudes to frailty in older adults.
Highlights
Frailty is a state of vulnerability to stressors which is associated with higher morbidity, mortality and healthcare utilization in older adults [1]
Longitudinal studies demonstrate that having negative stereotypes and attitudes toward older adults at younger ages were associated years later with cardiovascular disease [7], memory impairment [8], decreased capacity to recover from disability [9], hearing loss [10], diminished will to live [11], lower participation in preventive activities [12], lower perception of functional health [13], poor recovery after myocardial infarction [14], increased risk for hospitalization [15], and increased mortality [16] compared with people who viewed old age more favorably
There was no correlation between the Kogan’s Attitudes towards Older People Scale (KAOP) and the Implicit Association Test (IAT) scores (r = .043, p = .431)
Summary
Frailty is defined as a state of vulnerability to stressors that is associated with higher morbidity, mortality and healthcare utilization in older adults. Longitudinal studies demonstrate that having negative stereotypes and attitudes toward older adults at younger ages were associated years later with cardiovascular disease [7], memory impairment [8], decreased capacity to recover from disability [9], hearing loss [10], diminished will to live [11], lower participation in preventive activities [12], lower perception of functional health [13], poor recovery after myocardial infarction [14], increased risk for hospitalization [15], and increased mortality [16] compared with people who viewed old age more favorably. The stereotype threat theory posits that under specific conditions involving these stereotypes, older persons would act subconsciously to fulfill those stereotypes, even if detrimental to themselves [18]
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