Stigma of Aging: Dementia and Alzheimers

 The Stigma of Dementia!  (click here for PDF)

Kinds of Stigma

• Self Stigma
• Public Stigma
• Courtesy Stigma

all apply to our understanding of Alzheimers and dementia.

Link & Phelan: Condistions for stigmatization

• labeling
• stereotyping
• seapration
• status loss
• discrimination

Does Diagnosis help or hurt? The Negative consequences of labeling

•  Step 1: Diagnosis
• internalization of negative cultural images (dangerous, incompetant)

• Step 2: Defensive Behaviors
• expect others to reject them so they act in order to prevent this

Double Whammy! Stigma and Old Age

• cognitively impaired (decision making impaired)
• crazy!!!! (mental illness)
• physically frail
• old fashioned
• grumpy
• cheap
• unattractive
• dying/decline
• dependence
• loss of sexuality

Stress Related Stigma

• stress of stigmatization can lead to other stress related illnesses
• stress can increase symptomology of dementia
• focus on scary late stages of dementia
• fear of institutionalization
• courtesy stigma and family problems

Alzheimer's-the problem of stigma

By Niall Hunter-Editor

Stigma and prejudice against people with Alzheimer's disease are a significant obstacle to the well-being and quality of life of those with dementia and their families, and affect the provision of care to those who need it.This is one of the findings of a major new Irish study on stigma and dementia published to coincide with World Alzheimer's Day.

The report shows that the stigma of dementia is very real, very cruel and widespread.

Components of stigma such as discrimination, devaluation and stereotyping were clearly apparent in the daily lives of those living with the condition, according to the study.

The report indicates that there is also a lack of knowledge about dementias, the impact that new medications can have in the treatment of the condition and the support available to those with a diagnosis of dementias.

The report examined nine aspects of stigma in dementia and its impact on all those affected–the person with the condition and their family/carers.

Researchers from the School of Nursing and Midwifery at TCD, who carried out the study with the Alzheimer's Society, interviewed people with dementia and their carers, as well as health professionals, to understand the experience of living with dementia and the realities of dementia-related stigma and its components.

According to Mary Mc Carron, principal investigator, issues which affect those with a dementia include social isolation, fragmented, unsuitable and poorly-resourced services, lack of information about the services available and the difficulty in navigating a complex health and social care system in which services are often unresponsive to the real needs of people with dementia and their carers.

"That is what we have to target and change," she said.

A key finding of the study was that the daily concerns and day-to-day toll of care- giving on those looking after someone with dementia is hugely burdensome in its own right, and was compounded by the additional load of social isolation, prejudice, discrimination and poorly-developed and fragmented services. (courtesy stigma for caregivers)

The report indicates that a key challenge for service providers and policy-makers is to understand to what extent the service difficulties are due to lack of planning in terms of the implications of a growing ageing population or due to either not valuing a particular group (people with dementia and their carers) or valuing the needs of other groups more.

Honest answers to such considerations will help establish the extent to which dementia impairs service provision for this section of the population, according to the report.

According to the Alzheimer Society of Ireland, it is hoped that the report will encourage a re-examination of the value placed on people with dementia and their carers by policy-makers and that it will make them realize that population trends, health and social care costs and disease burden all point to the fact that dementia must become a national health priority.

There are currently 38,000 people with dementia in Ireland. In 2026 there will be 70,115 and in 2036, 103,998, according to the Alzheimer Society.

There are 50,000 carers of people with dementia in Ireland and it is estimated that the lives of 100,000 people are directly affected by dementia. This figure is reckoned to increase three to four-fold when the effect on the wider family is considered.

"We believe that education and awareness programs, aimed at the general public, GPs and other health providers are absolutely vital in helping to tackle the prejudice and discrimination that those with dementia and their carers encounter on a daily basis," said Maurice O'Connell, Chief Executive of the Alzheimer Society.

The findings of the report were listed under nine themes:

*Stigma and discrimination - is there or isn't there ­ the report indicates there is structural and organisational discrimination which highlighted a failure to prioritise dementia in terms of policy and resource allocation.

*A dark secret still - there are negative public images, stereotypes and terms still associated with dementia, all of which potentially leads to stigmatisation.  Fear linked to dementia means there is a reluctance to engage with those who have a dementia and avoidance was highlighted as a common reaction to the presence of dementia. Significantly, this was also an issue for health professionals.

*Behind the closed door – the reality of dementia – the report shows that the emotional impact of stigma on those with dementia is significant.  Anger and hurt were emotions commonly felt by those with a dementia due to diminished social networks and negative social encounters.  Embarrassment and shame was also felt if others became aware of the dementia or witnessed inappropriate behaviour in public. Carer/family guilt where there was an inability to meet a perceived societal expectation to continue caring on an indefinite basis was also experienced.  It was shown that dementia could either unify or divide a family.

*Loss of place – the report proves that there is a huge potential for people with dementia to be treated inhumanely in society.  Enforced social isolation was commonly experienced due to withdrawal of friends etc. and barriers to social participation were outlined. Carers described themselves as being at risk of similar experiences to the person with dementia and having to undergo a significant redefinition of life space and role changes.

*Navigating the system–the complexity of interactions and experiences of the health and social care systems potentially contributes to dementia related stigma. The report indicates that those with a dementia and their family/ carers found services to fragmented, inadequate and inflexible and failed to offer choice or meet their needs. 

*Making safe – constant vigilance – the report highlights the fact that carers/family members maintain a constant vigilance in terms of protecting the person with dementia.  This protective role involves decisions as to when and to whom the diagnosis of dementia is disclosed, ensuring that the person with dementia is not exposed to the gaze of others or environments unsuitable to his/her needs and protecting them against exposure to stigmatizing experiences.

*Double whammy –ageism and dementia – the report points out that where people with a dementia are older, ageist societal attitudes compounded the experience of dementia and such people are at risk of being doubly stigmatised.

*Viewing dementia as a disability – the report concluded that conceptualizing dementia in terms of disability was advocated as a positive step to advance measures to address dementia related stigma, with the focus on addressing prejudice and discrimination.

*The future –dementia ready –the report recommends numerous interventions targeted at personal, organizational and societal levels with the intention of addressing dementia related stigma and its components.

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INTRODUCTION

There is mounting evidence to suggest that older adults constitute a stigmatized group in the United States (and in most Western societies). Indeed, youth is of such value in U.S. culture that efforts to stay young fuel a multibillion dollar industry. The prevailing view is “If I can buy enough pills, cream, and hair, I can avoid becoming old” (Esposito, 1987). Certainly, individuals' efforts to avoid the near-certain, uncontrollable outcomes of old age (if one is lucky enough to survive) reveal the stigma and negative attitudes associated with advanced age. Similar to sexism or racism, “ageism” (Butler, 1969) refers to the negative attitudes, stereotypes, and behaviors directed toward older adults based solely on their perceived age. Evidence of ageism can be observed in any number of domains, including the workplace (e.g., Finkelstein, Burke, and Raju, 1995; McCann and Giles, 2002; Rosen and Jerdee, 1976) and health care facilities (e.g., Caporael and Culbertson, 1986; DePaola, Neimeyer, Lupfer, and Feidler, 1992). For instance, age discrimination in the workplace, such as mandatory retirement ages, led to the inclusion of age as a protected category with the Age Employment Discrimination Act of 1967. More subtle ageist behavior can be found in the expectancies that doctors hold regarding the capabilities of older individuals, attitudes that in turn shape treatment recommendations and decisions (e.g., Adelman, Greene, and Charon, 1991; Greene, Adelman, Charon, and Hoffman, 1986).
There have been numerous reviews of the literature from various fields documenting the differential, and sometimes expressively negative, treatment of older adults in many social domains (see Nelson, 2002). We do not repeat this information, but rather attempt to integrate that work with the emerging literature on the social psychology of stigma. Using a social-psychological approach, we explore the literature on age stigma with respect to both potential perpetrators (society, younger adults) and potential targets (older adults).¹ Specifically, in the first section we review the literature on perceivers of older adults—namely, younger adults—and their stereotypes, attitudes, and behaviors vis-à-vis older individuals. In the second section we focus on the targets—older adults—and their self-concepts, self-stereotyping, and coping in the face of ageism.

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AGE STIGMA FROM THE PERCEIVER'S PERSPECTIVE

Chronological age, similar to sex and race, is a dimension on which individuals categorize others rather automatically (Brewer, 1988; Fiske, 1998). Cues to age are perceived from physical appearance, such as hair and facial morphology, as well as from verbal and nonverbal aspects of individuals' communications (Bieman-Copland and Ryan, 2001; Hummert, Garstka, and Shaner, 1997; Montepare and Zebrowitz-McArthur, 1988). Upon presentation of these cues, age is readily perceived, perhaps even unconsciously, often shaping interactions between younger and older individuals. For instance, younger individuals often use stereotypes associated with advanced age to make inferences regarding older adults' intentions, goals, wishes, and capacities and guide their behavior accordingly. First we examine the perceptions, attitudes, and stereotypes associated with older adults. Next, we consider the ways in which these stereotypes and attitudes shape behavior toward older adults. Last, we investigate potential directions for future research that may eventually change ageist stereotypes and attitudes.

Attitudes and Stereotypes

In general, individuals express predominantly negative attitudes and beliefs toward older adults, especially in comparison to their attitudes toward younger people. The difference between the attitudes of young and old is particularly pronounced when the general category of “older adults” is being considered rather than specific exemplars (Kite and Johnson, 1988; Palmore, 1990; see also Kite and Wagner, 2002, for a review). Numerous studies show, however, that older adults are not always perceived as a homogeneous group (Braithwaite, Gibson, and Holman, 1986; Brewer, Dull, and Lui, 1981; Brewer and Lui, 1984; Hummert, 1990; Hummert, Garstka, Shaner, and Strahm, 1994; Schmidt and Boland, 1986). The broad category of “older adults” consists of as few as three and as many as twelve subtypes (Hummert et al., 1994). Some work suggests that a large subset of older adults is perceived as “senior citizens” who are vulnerable, often lonely, physically and mentally impaired, and old-fashioned (Brewer et al., 1981). But at least two positive subtypes of older adults have also emerged in this work. The “perfect grandmother” subtype consists of women who are kind, serene, trustworthy, nurturing, and helpful. The “elder statesman” subtype consists of men who are competent, intelligent, aggressive, competitive, and intolerant. In addition to these, other well-replicated subtypes include the “golden ager,” the shrew/curmudgeon, the John Wayne conservative, and the severely impaired (Hummert et al., 1994; Schmidt and Boland, 1986). The research on subtypes thus suggests that perceptions of older adults are both complex and differentiated, including both positive and negative exemplars.
The heterogeneity in attitudes and stereotypes toward different older adult subtypes has given rise to spirited debate as to whether ageism really exists. If perceptions about certain subtypes are positive, how can there be negative attitudes toward the group? Research conducted by Neugarten (1974)distinguishing between the “young-old” (i.e., individuals between 55 and 75 years old) and the “old-old” (i.e., individuals 75 years old and older) offers one explanation. Neugarten suggested that many of society's negative stereotypes about older people (e.g., being sick, poor, slow, miserable, disagreeable, and sexless) are based on observations of the old-old, and that these observations get overgeneralized to the young-old. Recent empirical investigations of this hypothesis suggest that various subtypes of older people reflect differences in chronological age (Hummert, 1990, 1994; Hummert, Garstka, Shaner, and Strahm, 1995). For instance, Hummert (1994) presented college students with photographs of older men and women whose facial features suggested three age ranges: young-old (55-64), middle-old (65-74), and old-old (75 years and over). Results revealed that physiognomic cues to advanced age (e.g., eye droop, wrinkled vs. smooth skin, grey hair) led to differing perceptions and stereotypes. Consistent with predictions, participants tended to pair photographs of young-old individuals with positive stereotypes, and to pair photographs of old-old individuals with negative stereotypes. This work suggests that the more positive subtypes of old age may be associated primarily with individuals in the early stages of older adulthood.
A different perspective on the heterogeneity of stereotypes of older adults stems from recent research finding that although certain subtypes of older adults are viewed more positively than others, positive stereotypes can also manifest in attitudes that are not positive (Fiske, Cuddy, Glick, and Xu, 2002). Fiske and colleagues (2002) argue that stereotypes of most social groups cluster on two dimensions—competence and warmth. Out-groups are perceived as high on one dimension but not the other, and in some cases they are perceived as low on both. Attitudes, emotions, and behaviors regarding out-groups are thought to follow these relative warmth and competence judgments (Fiske et al., 2002). Consider, for instance, the “perfect grandmother” subtype. Grandmothers are perceived positively as warm and likable, but they are also perceived as cognitively incompetent (Cuddy and Fiske, 2002). Low cognitive competence coupled with relatively high warmth results in pity, and, accordingly, grandmothers (and those perceived as grandmotherly) tend to be disrespected and denied opportunities in many domains. This type of research reveals the complexity of the relative positivity and negativity of various older adult subtypes, and the issue of ageism more generally.

Competence Stereotypes

Such variety in perceptions and subtypes of older adults suggests that there is not complete consensus regarding who belongs in the category or, by extension, what characteristics the members of the category possess. Nevertheless, research indicates that there are some consistent stereotypes of older individuals that shape perceptions. At the most general category level, older adults are stereotyped as deficient interpersonally, physically, and cognitively (e.g., Pasupathi, Carstensen, and Tsai, 1995). That is, older adults are expected to be slow or poor thinkers, movers, and talkers. Because age-related changes in cognitive function have been documented (Baltes, Lindenberger, and Staudinger, 1998; Salthouse, Hambrick, and McGuthry, 1998; Schaie, 1994), the “kernel of truth” in these stereotypes affords them particular strength. However, research taking more ecologically valid, adaptive approaches to the study of age-related cognitive differences suggests that stereotypes of cognitive functioning in older age are more severe than most actual deficits and, furthermore, that the stereotypes largely mask age-related cognitive performance gains (e.g., Adams, Labouvie-Vief, Hobart, and Dorosz, 1990; Blanchard-Fields and Chen, 1996; Colonia-Willner, 1998).
Forgetfulness. Among stereotypes about cognitive abilities, one of the most pernicious is forgetfulness (Bieman-Copland and Ryan, 1998; Ryan, Bieman-Copland, Kwong See, Ellis, and Anas, 2002). Erber and colleagues have conducted numerous studies regarding the forgetfulness stereotype (e.g., Erber, 1989; Erber, Caiola, and Pupo, 1994; Erber, Szuchman, and Prager, 2001; Erber, Szuchman, and Rothberg, 1990a, 1990b). The stereotype is widely held by both young and old (Parr and Siegert, 1993; Ryan, 1992), and is readily applied to explain “forgetful” behavior by older adults (Erber et al., 1994). Even identical behavior by older and younger individuals is attributed to mental deterioration for the older target but not the younger (Erber et al., 1990a, 1990b). In fact, rude and sometimes even criminal behavior on the part of older adults that can be attributed to forgetfulness tends to be excused as such (Erber et al., 2001). In general, the research suggests that older adults are thought to be forgetful due to biological changes associated with aging and therefore are not held accountable for forgetful behavior (e.g., missing an appointment, forgetting a birthday). Although this research reveals a potential benefit of being stereotyped as forgetful (i.e., lack of accountability for breaking social norms), the costs of the forgetfulness stereotype in other domains (e.g., the workplace) may outweigh the potential benefits.
Mental incompetence. Stereotypes about other mental capabilities of older adults have also been found to influence younger adults' interpretation of ambiguous events (Carver and de la Garza, 1984; Franklyn-Stokes, Harriman, Giles, and Coupland, 1988; Rubin and Brown, 1975; see also Giles, Coupland, Coupland, Williams, and Nussbaum, 1992, for a review). In these studies young adult participants read a brief description of a car accident involving a motorist of either one of two ages (22 or 84; Carver and de la Garza, 1984) or one of five ages (22, 54, 64, 74, or 84; Franklyn-Stokes et al., 1988). Participants were asked to rank order a set of provided questions that they would ask the motorist in order to discern the cause of the accident. In both studies, participants sought out stereotype-consistent information to shape their inquiries. Specifically, participants ranked statements about the motorist's physical, mental, and sensory state as more diagnostic the older the perceived age of the motorist, and they ranked alcohol consumption as more diagnostic the younger the perceived age of the motorist. In Franklyn-Stokes et al. (1988), the trends both for the motorist's capacity and for alcohol were linear, suggesting that ageist information seeking may take place “throughout the life span and [be] well grounded in middle age” (p. 420). This work suggests that stereotypes of older adults, similar to stereotypes of other groups, influence information processing, shaping what is both attended to and remembered about particular older adult targets (e.g., Hense, Penner, and Nelson, 1995).

Implicit or Unconscious Attitudes and Stereotypes

A growing body of research in social cognition suggests that individuals' attitudes and beliefs concerning various social groups (e.g., race, gender) can be activated without conscious awareness of the activation (e.g., Bargh and Chartrand, 1999; Fazio and Olson, 2003). Fazio, Jackson, Dunton, and Williams (1995) demonstrated, for instance, the automatic activation of racial attitudes. Specifically, white participants responded faster to negative target adjectives when they were preceded by primes that were photographs of blacks than when they were preceded by photographs of whites. Presumably, because participants held relatively negative attitudes toward blacks, it was easier for them to process, and therefore respond to, adjectives that were also negative (i.e., congruent with the valence of the racial prime).
Perdue and Gurtman (1990) found a similar reaction time bias when evaluating words that were primed with the words “young” or “old”: individuals took longer to identify positive words when presented after the word “old” than when presented after the word “young.” Differential automatic evaluations of racial, gender, and age groups have also been detected using a method developed by Greenwald and his colleagues (the Implicit Association Test, or IAT) (Dasgupta and Greenwald, 2001; Dasgupta, McGhee, Greenwald, and Banaji, 2000; Greenwald, McGhee, and Schwartz, 1998; Hummert, Garstka, O'Brien, Greenwald, and Mellott, 2002; Nosek, Banaji, and Greenwald, 2002). Specifically, both young and older participants have been found to associate “pleasant” words more readily with pictures of younger adults than with pictures of older adults (Hummert et al., 2002; Nosek et al., 2002.) The differential ease with which pleasantness is associated with young rather than old reflects an automatic age bias against older adults (see Levy and Banaji, 2002, for a review).
Like stereotypes, attitudes about older adults also differ depending on the subtype brought to mind (Hummert, 1990; Schmidt and Boland, 1986). For instance, a recent study found that the “perfect grandparent” subtype yielded less automatic age bias than either the general category “the elderly” or the negative “old curmudgeon” subtype (Jelenec and Steffens, 2002). Interestingly, the general category of “the elderly” yielded attitudes as negative as the curmudgeon subtype, suggesting that many younger individuals may automatically think of negative subtypes when generating attitudes about older adults. Consistent with this hypothesis, recent work finds that young perceivers view negative exemplars of the older adult category to be more typical (more like older adults in general) than positive exemplars (Chasteen, 2000; Chasteen and Lambert, 1997; but see also Hummert, 1990).
Gender Differences. Although only a few studies have considered the effect of target sex or gender in perceptions of older individuals, beliefs about older women and men appear to differ at least on some dimensions (Canetto, Kaminski, and Felicio, 1995; Kite, Deaux, and Miele, 1991; Kogan and Mills, 1992; but see also O'Connell and Rotter, 1979). Sontag (1979) suggested that there is a double standard of aging in that women are judged more harshly than men, and some support for this view has been found in the ages selected for the onset of older adult status for men and women (e.g., Dravenstedt, 1976; Zepelin, Sills, and Heath, 1986-1987) as well as in attractiveness ratings (Deutch, Zalenski, and Clarke, 1986). In a study of stereotyping, Hummert and colleagues (1997) also found gender differences. Perceivers associated positive stereotypes with photographs of “young-old” and “middle-old” women less than with similarly aged men, but they associated “old-old” men with positive stereotypes less often than for similarly aged women.
In contrast to this work, O'Connell and Rotter (1979) found little evidence that gender interacts with age in shaping evaluations of older adults. Specifically, they found that 25- and 55-year-old men were rated as more competent than women of those ages, but there were no differences in the competence judgments of 75-year-old men and women. Taken together, these studies suggest that future research is necessary to elucidate how age and gender may interact to shape perceptions. Similarly, there is a dearth of research examining the combined effects of age and other basic categories (e.g., race, sexual orientation) on stereotypes of and attitudes about older adults. It is likely that the combination of these factors, rather than age alone, shapes attitudes and behavior toward individuals (e.g., Conway-Turner, 1995).

Behavior Toward Older Adults

Stereotypes such as forgetfulness and mental deficiency generate negative expectancies for older adults that often translate into behavior with respect to housing availability, in the workplace, during medical encounters, and perhaps even with family and friends. As are racial minorities, older adults are susceptible to housing discrimination. One study found, for example, that rooms previously advertised as available for rent were more likely to be described as unavailable when an older person inquired about availability than when a younger person made the inquiry (Page, 1997). Even children have been found to discriminate against older adults (Isaacs and Bearison, 1986). Children (ages 4, 6, or 8) were asked to work on a jigsaw puzzle with either an old (age 75) or a young (age 35) confederate. Results revealed that the children sat farther away from, made less eye contact with, spoke fewer words to, initiated less conversation with, and asked for less help from the older confederate compared to the younger confederate.
There is also evidence that older adults face discriminatory treatment in medical encounters with both nurses and physicians. Perhaps because these professionals consistently see some of the most impaired older adults, negative attitudes toward older adults in general are common among health care workers (e.g., DePaola et al., 1992; Kahana and Kiyak, 1984; Penner, Ludenia, and Mead, 1984; Sherman, Roberto, and Robinson, 1996). The impact of these negative attitudes can be found in the treatment of nursing home residents (Baltes, 1988; Baltes, Burgess, and Stewart, 1980) and in physicians' diagnoses of older adults' medical problems (Adelman et al., 1991; Adelman, Greene, Charon, and Friedman, 1992; Greene et al., 1986; Greene, Adelman, Charon, and Friedman, 1989; Lasser, Siegel, Dukoff, and Sunderland, 1988). For instance, depression often goes unnoticed in older adults or gets misdiagnosed as dementia (Lamberty and Bieliauskas, 1993), and older adults with acute and chronic pain are sometimes mistreated (Gagliese and Melzack, 1997) or overlooked for preventive measures such as routine screenings because of physicians' beliefs about the course of normal aging (Derby, 1991). Negative beliefs among medical care workers are particularly worrisome in that expectations can become self-fulfilling prophecies (Learman, Avorn, Everitt, and Rosenthal, 1990).
These studies present just a few domains in which older adults may face discrimination (see Pasupathi and Lockenhoff, 2002, for a review). However, not all behavior that differs between young and older adults is discriminatory, making the issue of distinguishing between discriminatory and appropriately differentiated behavior rather complex. In order to develop interventions that reduce harm to, but maximize benefits for, older adults, disambiguating negative discriminatory and beneficial age-differentiated behavior is of paramount importance. In the section that follows, we present the case of disentangling patronizing from accommodating intergenerational communications in order to reveal the nuances associated with many forms of age-differentiated behavior.

Patronizing Versus Accommodating Speech

Research on intergenerational interactions suggests that negative stereotypes and attitudes toward older adults can manifest in patronizing behavior (Hummert, Shaner, Garstka, and Henry, 1998; Ruscher, 2001; Williams and Nussbaum, 2001). One form of patronizing behavior is known as secondary baby talk or elderspeak (Caporael, 1981; Culbertson and Caporael, 1983; Kemper, Finter-Urczyk, Ferrell, Harden, and Billington, 1998). Elderspeak is a simplified speech register that is characterized by slowed speech with exaggerated intonation, higher pitch, simplified grammar, limited vocabulary, and the use of short sentences (Caporael and Culbertson, 1986; Kemper, 1994). Elderspeak has been observed in a number of naturalistic settings, such as residential care facilities for older adults (Ashburn and Gordon, 1981; Caporael and Culbertson, 1986; see Ryan, Hummert, and Boich, 1995, for a review), as well as in laboratory interactions between young and older adults (e.g., Kemper, Vandeputte, Rice, Cheung, and Gubarchuk, 1995; Thimm, Rademacher, and Kruse, 1998).
Patronizing behaviors can reveal ageism insofar as they communicate to older adults that they are no longer the equals of middle-aged adults and therefore their opinions, capabilities, and choices are unworthy of serious consideration (Caporael and Culbertson, 1986; Kemper, 1994; Ryan, Hamilton, and Kwong See, 1994). Indeed, research has linked elderspeak and similar speech accommodations with the speakers' beliefs about the functional ability of older adults (Caporael, Lukaszewski, and Culbertson, 1983) and with their holding negative stereotypical perceptions of older adult listeners (Hummert et al., 1998; Thimm et al., 1998). Furthermore, the use of baby talk with high-functioning older adults has been found to have negative consequences, such as lower self-esteem (O'Connor and Rigby, 1996), feelings of humiliation and dependency (Caporael et al., 1983; Ryan et al., 1994), and increased feelings of communicative incompetence (Kemper et al., 1995). For instance, older adults who participated in a communication task with young adults who used elderspeak reported that they experienced more communication problems during the interaction and were more likely to perceive themselves as cognitively impaired (Kemper et al., 1995; Kemper, Othick, Gerhing, Gubarchuk, and Billington, 1998; Kemper, Othick, Warren, Gubarchuk, and Gerhing, 1996). This work suggests that the misapplication of stereotypes about old age to high-functioning older adults can have deleterious consequences for those individuals' actual level of functioning and mental health.
Similar to the issues underlying the “kernel of truth” of competence stereotypes, elderspeak is ambiguous in that there seem to be both costs and benefits (Caporael et al., 1983; Cohen and Faulkner, 1986; Kemper et al., 1995, 1996). Kemper and colleagues (1995) found that when younger adults spontaneously used elderspeak during a task that involved providing older adults with verbal instructions for finding a destination on a map, their older adult participants benefited in the form of improved task performance. And using a form of elderspeak with older adults suffering from Alzheimer's disease has been found to improve communication between caregivers and patients (Ripich, 1994). Given the negative psychosocial but positive performance consequences of elderspeak, Ryan and colleagues (1995) argued that there exists a “communicative predicament of aging” (p. 1). Specifically, elderspeak directed to high-functioning older adults is perceived as patronizing and seems to decrease their perceived communicative self-efficacy, but failure to use some form of elderspeak may undermine the actual communicative efficacy of lower-functioning older adults.
In a series of elegant experiments, Kemper and her colleagues (1995, 1996, 1998a, 1998b, 1999)sought to examine the components of elderspeak that underlie the positive benefits of communication but are not accompanied by negative psychosocial consequences. This work finds that providing semantic elaborations and simplifying speech by reducing the use of subordinate embedded clauses, but not by shortening speech segments, results in better performance by older adults (Kemper and Harden, 1999). Using short sentences, speaking in a slow rate, and using a high pitch do not benefit older adults, and instead result in negative self-perceptions as well as negative perceptions of the speaker by the older adult (Kemper and Harden, 1999). This work suggests that there is a form of elderspeak that is not perceived as condescending or patronizing and that is an appropriate and beneficial accommodation for healthy older adults. Similarly, older adults with Alzheimer's disease may also reveal improved performance on communication tasks with some but not all aspects of elderspeak. Small, Kemper, and Lyons (1997) found, for instance, that repeating and paraphrasing sentences improved patients' sentence comprehension, but saying the sentences more slowly did not.
Clearly this research has important practical implications for caregivers, family members, and researchers. Treatment and diagnosis disparities (e.g., misdiagnosed pain, depression) could stem from ineffective physician-patient communication (Grant, 1996; Greene et al., 1986; Lagana and Shanks, 2002; Radecki, Kane, Solomon, and Mendenhall, 1988; Revenson, 1989; but see also Hooper, Comstock, Goodwin, and Goodwin, 1982). This work also highlights the need for research to disambiguate stereotypes from actual group differences, in order to develop interventions that address actual needs without reinforcing group stereotypes and that therefore are not rejected as patronizing. Other age-differentiated behaviors must also be examined with similar scrutiny in order to disambiguate discrimination from beneficial differentiation.