Want older people to be healthy? End ageism.

There’s a lot of disagreement around how to frame the last century’s unprecedented increase in human lifespan. Is it a crisis or an opportunity? Will a “grey tsunami” of incapacitated freeloaders sweep us off our feet, or will we tap into the social capital of millions more healthy, well-educated adults?  Are longer lives a blessing or a curse? Experience and ideology shape the responses, of course, but there’s one thing both liberals and libertarians can agree on. What single characteristic of these older Americans will make the most difference? Their health. Living longer looks a lot more attractive when it’s uncoupled from cognitive and physical decline. It’s a lot cheaper too: illness is expensive.

Ask most people if they want to grow old, and they say yes. A qualified yes, that is—“As long as I’ve got my health.” That’s shaped by more than genes and behavior. The beliefs we’ve assimilated about the nature and value of old age—how ageist we are, in other words—also play an important role. A growing body of evidence shows that attitudes towards aging have an actual, measurable, physical effect on how we age. There’s no inherent reason for the effect to be negative; positive attitudes improve mental and physical function. But an ageist culture like this one equates aging and decline. Prejudices are drummed into us by the media and popular culture and go unexamined. Wrinkles are ugly. Old people are incompetent. It’s sad to be old. When we internalize those falsehoods, it actually harms our health.

This isn’t New Age woo woo. Over the last few decades, mainstream medicine has come to accept the existence of a powerful mind-body connection. Clinical trials have shown that psychological factors can play a major role in illnesses and chronic conditions, and that mind-body therapies can help people function better and enjoy life more. This has critical implications for how well we age. Obviously aging isn’t “just a mindset,” but it’s increasingly apparent that attitudes are an important part of the equation. The way we internalize cues in the environment—as abstract as the way older people are depicted in the media or as concrete as that emerging bald spot—significantly affects our physical and psychological trajectories.

I’ve written about Harvard psychology professor Ellen Langer’s fascinating research in this domain. Her famous 1981 counterclockwise study “teleported” a group of 75 to 80-year-old men back in time for a five-day retreat. The subjects were told to imagine they were 55, to talk about that period in the present tense, and to reflect on their lives when they were that age. Afterwards they looked an average of three years younger, their hearing and memory improved, and some had less arthritis—evidence of the physical effects of a mental activity. Psychologist Chris Kurby described these findings by saying, “If we put our minds in a younger place, we may put our bodies in a younger place.”

I heard Kurby speak last week at the 10th Annual Art & Science of Aging Conference at Grand Valley State University, where he and his colleague Jing Chen teach psychology and collaborated on a presentation called “Aging is a Mindset: How We Think About Aging May Influence How We Age.” Chen’s presentation focused on Yale University professor Becca Levy’s theory of stereotype embodiment: we assimilate stereotypes from the culture, they become part of our identity, and this influences how our brains and bodies function. 

Levy’s theory has four components:

• Age stereotypes become internalized across the life span. Kids are exposed to negative stereotypes in all kinds of ways, from ads for wrinkle cream to children’s books. They’re effective because the messages aren’t directed at kids, who feel no need to defend against them. This lays the groundwork for thinking of “oldness” as less privileged and older people as “other.”
• Age stereotypes can operate unconsciously. We know this from the many tests that use subconscious priming (flashing a word on a screen too briefly for subjects to become aware of it). For example, after being exposed to negative terms (e.g. Alzheimer’s, decline, dependent, senile, misplaces, dementia, dying, forgets. confused, decrepit, incompetent, diseased), older subjects did less well on memory tests—evidence that stereotypes affect cognition. Another study assessed handwriting. Judges could tell whether the writers had been exposed to negative or positive stereotypes, and assessed those who’d been negatively primed as eight years older.
• Age stereotypes become more relevant as we get older—and thus more likely to become self-fulfilling prophecies.
• Age stereotypes operate in multiple ways:
  • psychological – those self-fulfilling prophecies
  • physical – via responses to stress, measured by changes in blood pressure and skin conductance. Changes were negative in people exposed to negative age stereotypes, even very subtle subliminal cues, and positive when the cues were positive.
  • behavioral – people with negative self-perceptions around aging were less likely to engage in healthy practices like having regular checkups, controlling weight and diet, and exercising, and vice versa.  Controlled for age gender, socioeconomic status and functional health, these results have been seen repeatedly in longitudinal studies like the blue-chip Baltimore Longitudinal study of Aging. People with higher baseline positive self-perceptions of aging also showed lower risk and later onset of both respiratory and heart disease.

These effects work in both positive and negative directions. People with more positive feelings about aging behave differently from those convinced that growing old means becoming useless or helpless. Those with more positive views not only do better on memory tests and have better handwriting, they can walk faster and are more likely to recover fully from severe disability. And they actually live longer—an average of seven and a half years.

Until we change the culture, perhaps the best news is that the effects of negative age stereotypes are reversible. “Implicit interventions”—as little as four brief exposures to subliminal positive messages about aging—improve physical function. In one 2014 study, participants with a mean age of 81 felt better psychologically and improved their strength, gait, and balance. Remarkably, this short, safe, low-cost intervention was more effective than a six-month exercise program.

Attacking one disease at a time, the “War on Cancer” medical model, may buy us additional years without health—the worst of all outcomes. Consensus is growing for a more holistic approach: intervening in the aging process itself, in order to increase our active years and postpone disability and mortality. Postpone, not prevent. But while death is inevitable, poor health is not, and there’s much we can do to stay well and keep frailty at bay. You know the drill: don’t smoke; eat right; exercise regularly; get enough sleep. Confronting America’s rampant ageism belongs on that list, and not as just a matter of personal wellbeing. Population aging makes it a public health imperative.

In another experiment, social scientists primed a group of college students with negative age stereotypes by having them unscramble sentences that included words like “forgetful,” “Florida,” and “bingo.” The students then walked to the elevator measurably more slowly than a control group! Steps slowed simply because a subliminal script said it was time to totter. Let’s rewrite that script before it shortens steps and cripples self-image. How can we make the goal of increasing not just lifespan but “healthspan” more attainable for Americans of all ages? How about a national anti-ageism campaign to raise awareness of age-based stereotypes and the damage they do. The benefits to health and human potential would be immense.