Negative Age Stereotypes Associated with Older Persons' Rejection of COVID‐19 Hospitalization

Abstract

During the pandemic, excess deaths (the difference between observed and expected deaths, based on mortality rates from previous years) have far exceeded the number of deaths officially attributed to COVID-19.1 This is partially due to older persons with COVID-19 avoiding hospitals and dying at home without an official diagnosis.2, 3 We examined a potential explanation for this avoidance. Specifically, the current study considered for the first time whether resistance to hospitalization can be explained by a psychosocial factor among older persons: stress-inducing negative age stereotypes (disparaging characterizations of older persons as a category) that are assimilated from society. A prevalent-negative-age-stereotype theme is inevitable debilitation.4, 5 Previous research demonstrated that these stereotypes, which engender a sense of futility, lead to risky health behaviors, delayed recovery from disability, and low will to live among older persons.4-6 According to stereotype embodiment theory, and its supporting research, negative age stereotypes have a greater impact on older persons, for whom the stereotypes are self-relevant, compared to younger persons, for whom the stereotypes are self-irrelevant.4 We expected that, compared to older persons with positive age stereotypes, older persons with negative age stereotypes would be more likely to oppose older individuals going to the hospital when extremely sick with COVID-19. We also conducted two specificity analyses. First, we expected that the age stereotypes of older persons would not be associated with their view of whether younger persons should go to the hospital when extremely sick with COVID-19. Second, we expected that among younger persons, age stereotypes would not be associated with their view of whether older or younger individuals should go to the hospital when extremely sick with COVID-19. To examine these hypotheses, we assessed 1,590 participants drawn from two online platforms: Amazon Mechanical Turk and Lucid.7 Both platforms provide data validity and reliability similar to that collected through in-person settings.7 Inclusion criteria were 18 years or older, English fluency, and U.S. residence. Forty-eight percent of the participants were in the older group (age 65 or greater). The cohort, similar to the U.S. population, was 55% female, 70% white, 19% African-American, 14% Hispanic, and 7% Asian. Participants were surveyed between April 23 and May 5, 2020, during which 28% of excess deaths were not officially reported as due to COVID-19.1, 8 Negative age stereotypes were measured with the reliable and valid 18-item Image of Aging scale.9 Views of whether hospitalization was appropriate were measured by asking participants how much they agreed with the following statements: “If older persons are extremely sick with COVID-19, they should stay at home and not go to the hospital;” and “If younger persons are extremely sick with COVID-19, they should stay at home and not go to the hospital.” Covariates included: age, sex, race, self-rated health, education, marital status or financial stress (measured by asking, “How much has the pandemic affected you financially?”). As hypothesized, negative age stereotypes significantly predicted a rejection of hospitalization for older persons who are extremely sick with COVID-19, among older participants β = .20, P = .04, but not among younger participants, β = .14, P = .24. Also as hypothesized, negative age stereotypes did not predict views of whether younger persons who are extremely sick with COVID-19 should be hospitalized, among older and younger participants, β = .17, P = .09 and, β = .19, P = .09, respectively. Despite widely-disseminated media reports about the relatively high risk of older persons for COVID-19 mortality,10 the saliency of negative age stereotypes still led to its association with their view that they should avoid hospitalization when extremely sick with COVID-19. It is notable that this association was greater than the one found among younger persons holding negative age stereotypes. Future research is needed to determine the extent to which the negative age stereotypes of older persons are among the risk factors contributing to pandemic deaths and how to best mitigate these societal-based stereotypes. The Patrick and Catherine Weldon Donaghue Medical Research Foundation supported this research with a grant to the first author. We appreciate our participants taking the time to engage in this research. The Patrick and Catherine Weldon Donaghue Medical Research Foundation. None. Becca R. Levy developed the concept and wrote the manuscript. Natalia Provolo and E-Shien Chang collected the data and provided feedback on the manuscript. Martin Slade conducted the data analysis and provided feedback on the manuscript. None.