Regarding the perception of older workers, various studies affirm that in smaller companies, older workers are viewed more positively than in companies with larger workforces (Bellmann et al. 2003; Boockmann and Zwick 2004). Similar results have been found when asked about self-perceived stereotyping: Older workers employed by small companies report to be more frequently confronted with positive stereotyping than older employees working in larger companies (Hess 2013). Flat hierarchies and close social embeddedness within the respective workforce, the monopoly held by older workers on company-specific knowledge (Hilzenbecher 2006), or the fact that older workers often hold key positions within small companies, which are unlikely to be filled easily by others such as younger workers (Beck 2013), could be explanatory factors for the relatively positive view on older workers within small and medium sized enterprises. Additionally—even though often not sufficiently recognized—the prevalence of less formal, work-integrated measures focused on older workers in small and medium sized companies could also be a preventive factor for ageist behaviour.

#### **5.3 Contextual Factors as Sources of Ageism at the Workplace**

#### *5.3.1 Industrial and Sectorial Affiliation*

Not only the size of a company or the age structure of its labour force influence the perception of older workers in their work environment, the same goes for the sector or industry in which older workers are employed. According to 'age-typed theory' by Oswick and Rosenthal (2001) workers are judged by the fit between the requirement of a particular job and the assumed competences they bring to the table. Negative stereotyping and ageist behaviour towards older workers may result from a perceived 'lack of fit' between a job's requirement and the abilities of a worker. Within certain sectors job requirements 'match up' better with competences

generally attributed to older workers (such as stability, loyalty or experience) and therefore these sectors may supply more 'fitting places' of work for older employees (Richardson et al. 2013; Turek and Perek-Bialas 2013). An easy example can be drawn by looking at the German craft sector—a work environment which highly depends on knowledge as well as experience of workers, both attributes generally ascribed to older workers (Hilzenbecher 2006). Whereas in small craft businesses, older workers are often highly valued and their retirement day considered a dreaded event, research has shown that in other industries, where the question of productivity of workers is high on the agenda, older workers are more often confronted with negative stereotyping (Van Dalen et al. 2010; Malmberg et al. 2008). Hess (2013) estimated differences between sectors and/or industries in Germany by focusing on the prevalence of stereotyping experienced by workers (49+ years). A more positive stereotyping—'older workers being more reliable than their younger colleagues'—was often found in the retail and health care sectors, whereas negative stereotypes—'older workers being less adaptable' and/or 'less productive' occurred more often in the educational sector, public administration as well as manufacturing. Henkens (2005) finds that amongst Dutch mangers in the public sector, negative stereotypes towards older workers are much stronger than in the private sector. He suggests this might be due to the seniority-based salary system and high job-protection.

The sectorial variations in employment rates of older workers are also found to be influential of a negative age-discrimination climate in industries and ultimately companies (Kunze et al. 2013; Stettes 2012). The cultural and political contexts or more generally speaking the 'institutional surroundings' in which employers operate (e.g. when hiring an older worker) are linked not only to the major changes in national level policies but also to experiences with and normative assumptions about older workers within their respective sectors/industries (Shiu et al. 2015). Employers with a high share of older workers (50+ years) in their respective companies are more likely to report that older workers are less often sick than their younger counterparts, whereas management personnel from 'younger' companies do not share this perception (Stettes 2009). Whereas sectors such as agriculture and fishing are known for employing the oldest workforces (Macinol 2010), in sectors with a predominantly younger workforce such as advertising (Carrigan and Szmigin 2003), older job seekers are often more liable to age discrimination (Richardson et al. 2013). Nevertheless, this behaviour is reported to go both ways. Metcalf and Meadows (2010) concluded from a British survey that close to one fifth of employers viewed certain jobs as more suitable for particular age groups, with a tendency to favour the middle age group (30–50 years old) over not only older but also younger workers (Taylor 2011).

#### *5.3.2 Legal Framework for Prohibiting Discrimination Based on Age*

Discriminating behaviour based on age in the field of employment and occupation has been subject to legal controls for several decades (Doron et al. 2013). While acknowledging the wide range of legislations worldwide, due to the level of sophistication, the existing European legal framework presents an especially interesting case in this regard and will be discussed in the following section.3

Since the broadening of the scope of anti-discrimination measures beyond sex and nationality with the Amsterdam Treaty (1997), the European Union limits the circumstances under which member states may permit employers a different treatment of workers on the ground of age. Imposed under the European Council directive 2000/78/EC, member states are to be encouraged to combat early resigning as well as to facilitate the hiring, employment, career development and retirement of older workers (Numhauser-Henning 2013; O'Cinneide 2005). By 2006, almost all of the member states had implemented the directive in their national discrimination, employment and labour laws (Spencer 2013).

While prohibiting age discrimination is an important legal mechanism in order to promote the equal treatment of older workers in employment, training and the workplace, it is questionable how successful these non-discrimination laws are in practice. Taking the example of compulsory retirement practices, some authors have argued that legal retirement ages are one of the leading forms of age discrimination, since they exclude people *en masse* from the workforce, solely due to their age (Walker 1990). Other authors concluded that driven by economic and political interest's mandatory retirement can be interpreted as an institutionalized form of ageism (McDonald 2013; Woolever 2013).

A steady stream of law cases was brought to the Court of Justice of the European Union and while one would expect compulsory retirement age to be contrary to the ban on discriminatory behaviour based on age, so far the Court of Justice of the European Union has accepted age limits if proportionate means of achieving a legitimate aim arise. The court has argued that 'age' is to be set apart from other protected characteristics under the Discrimination Directive because it is shared by everyone and can be seen as a continuum which changes over time: Over the span of a lifetime, almost every worker will benefit from provisions targeting older workers (Vickers and Manfredi 2013). Secondly, according to the Directive a different treatment of workers does not constitute age discrimination if one does not distinguish based on individual factors but based on "legitimate employment policy, labour market and vocational training objectives" (Numhauser-Henning 2013, p. 401).

3For a more detailed overview on this topic please see Doron et al. (2018; Chap. 19); Mikołajczyk (2018; Chap. 20) and Georgantzi (2018; Chap. 21) as well as Abuladze and Perek-Białas (2018; Chap. 28) in this volume.

Even if such discrimination lawsuits make it to court the 'learning effect' on the employer's side seems to be rather questionable as the review of recent literature addressing age-related cases from the United States of America reveals: It seems that a number of legal firms have established themselves in the lucrative market of assisting human resource managers to avoid lawsuits by terminated older workers. Instead of advising management to adapt more ethical practices towards their older workers, these legal firms specialize in preventing companies to become the target of age-related lawsuits in the first place (Woolever 2013). Furthermore, research has shown that even though legal frameworks are in place individuals are reluctant to acknowledge ageist behaviour (and go to court for it), possibly due to the fact that they do not view themselves as being 'old' and therefore attribute perceived harassment at the workplace as not being related to their age (Blackstone 2013). In addition, in contrast to their younger counterparts, older workers tend to not report harassment at the workplace, while at the same time employers, lawyers as well as other actors within the legal system, tend to treat age discrimination cases as less serious than race or gender based offences (Spencer 2013).

Taking a look at the hiring practice, the existing limitation of laws become obvious: Oblivious to existing legal regulations, ageism can occur in hiring practices when human resource personnel "consciously or subconsciously applies age limits to older applicants" (Spencer 2013, p. 147). Existing stereotypes regarding the productivity or performance of older workers on the employer or human resource side furthermore might lead to older workers taking longer to find new employment or when being reemployed tend to receive a lower salary than in their former employment (Woolever 2013). Although their importance is non-negotiable, laws are often insufficient to guide the personnel actions of human resource managers as a wide range of policies and actions fall outside the domain of the law. Therefore, ethics in general as well as a company's attitude towards their ageing workforce become increasingly important in the daily work of human resource managers.

#### **5.4 Conclusion: Fighting Ageism at the Workplace**

Against the background of ageing societies in general and an ageing workforce in particular, the subject of old age discrimination at the workplace has moved into the spotlight. Age discrimination or ageism has among others a negative impact on older workers' productivity, quality of work and organizational commitment and, thus, also harms the companies and organizations they are working in. Therefore, fighting ageism must be a priority of policy makers, employers and trade unions. To mitigate the effects of age discrimination, we must know its origins. In this chapter, we focused on the meso-level and the origin of ageism at the workplace. Seven main determinants of ageism were detected: organizational structure and hierarchy; age structure; age-diverse climate; human resources measures; company size; industrial and sectoral affiliation; and the legal framework.

Regarding a company's *organizational structure*, four components were identified at which age discrimination is possible: the organization of work itself; decision making process; performance evaluations; and information networks. Moreover, the formal and informal structure of the organization determines the need for certain skills over others, and these skills can be the subject of ageism. Hence, there can be an indirect effect of the organizational structure on ageism through skills. Our literature review reveals a striking lack of research on the relation between age and organizational structure, especially when compared to research on gender and organizations. This could be an interesting path to develop in future research.

A company's *age structure* can influence the occurrence of ageism in two ways: on the one hand growing age diversity can lead to more contact between workers of different ages and, thus, reduce ageism. On the other hand, it could make age as a category more salient and increase its importance as an element of categorization and potentially lead to discrimination because of age.

*Company size* is linked with ageism in two ways: Larger companies have institutionalized human resources departments offering age management measures that help to tackle ageism. At the same time, the informal organizational structure of smaller companies might help to create contacts between different generations of workers and, thus, decrease ageism. In addition, less formal work-integrated measures might likewise contribute to a more positive reception of older workers in small and medium sized companies. Further research in this regard could add valuable input to the debate.

A coherent *human resources* strategy—e.g. age inclusive training programs and an age blind recruitment and promotion procedure—will help to reduce ageism. Closely linked to the human resource strategy, the concept of *age friendly climate and corporate identity* can play an important role. Creating an atmosphere of ageistfree language, procedures and products is an important step to fight ageism.

Whereas the first five determinants are closely linked to the company level, the last two determinants of ageism at the workplace—*industrial and sectorial affiliation* and the *legal framework*—are located between the meso and macro level and therefore policy makers and stakeholders have to put the topic of ageism actively on the political agendas in order to prevent ageist behaviour in the workforce.

What implications can be drawn from this analysis of ageism's sources at the workplace? First, it is important to recognize that older and younger workers are both valuable members of the workforce, and policies should refrain from playing out different labour market groups against each other. Second, employers and trade unions should try to create an ageist-free environment at the workplace. One main tool to do so is the implementation of human resource measures as described above. Third, when trying to fight ageism, companies must seek for tailor fit solutions according to their sizes, sector and the age compositions of their employees. A 'one size fits all' approach will not be sufficient in order to prevent discrimination based on age in the labour market. Fourth, the state should set a legal framework that in alliance with companies' anti-discrimination measures grants workers protection from discrimination based on age. Last, all efforts to combat discrimination because of age at the workplace should be synchronized with each other and be embedded into a general strategy of fighting ageism not only at the workplace but also in society in general.

#### **References**

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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# **Chapter 6 Ageism and Age Discrimination in the Labour Market: A Macrostructural Perspective**

**Justyna Stypińska and Pirjo Nikander**

## **6.1 Introduction**

Ageism and age discrimination in the labour market have been topics of scholarly interest since the early twentieth century. Today, in markedly different economic conditions, with increasingly globalised labour markets, the victories and failures of workers' movements, and the changing conditions of the European welfare state, the problem of unequal and negative treatment of older workers still prevails. This chapter looks at the phenomenon of age discrimination and ageism in the labour market from a socio-political perspective and draws attention to deciding factors in its emergence. We add to the individualistic and micro accounts adopted by psychological research (see Lev et al. 2018; Chap. 4, in this volume) and the meso level studies of organisation and work environment conditions (see Naegele et al. 2018; Chap. 5, in this volume) by examining the role of macrostructural processes and transformations to identify their link to the persistence of ageism and age discrimination in contemporary labour markets. First, we provide an overview of the most common conceptual understandings of ageism and age discrimination in employment. Second, we investigate the dynamics between the phenomena of ageism and age discrimination and a range of socio-political contexts, cultural settings, and legal and economic conditions. We then discuss the costs and consequences of age discrimination in employment, and examine various policy responses to these costs and consequences.

J. Stypińska (\*)

Free University Berlin, Berlin, Germany e-mail<EMAIL_ADDRESS>
P. Nikander University of Tampere, Tampere, Finland e-mail<EMAIL_ADDRESS>
© The Author(s) 2018 91

L. Ayalon, C. Tesch-Römer (eds.), *Contemporary Perspectives on Ageism*, International Perspectives on Aging 19, https://doi.org/10.1007/978-3-319-73820-8\_6

#### **6.2 Ageism and Age Discrimination in the Labour Market: Key Theoretical Distinctions**

The concepts of age discrimination and ageism in the labour market have been variously defined and conceptualized in the literature. According to Palmore (1999), "Age discrimination may take the form of refusal to hire or promote older workers, or forcing retirement at a fixed age regardless of the worker's ability to keep working" (p. 119). Macnicol (2006) defined age discrimination as "the use of crude 'age proxies' in personnel decisions" (p. 6), and Carmichael et al. (2011) proposed a definition based on actual experiences of older workers who themselves define workplace age discrimination as "not being allowed to do something you are capable of or willing to do just because of your chronological age" (p. 122). The definition based on subjective perception of age discrimination allows for improved understanding of phenomenological aspects of how ageism operates, casting more light on the individual experiences of older workers.

Another significant distinction was introduced with the tripartite definition of ageism that is in frequent use especially among psychologists (Cuddy and Fiske 2000; Levy and Banaji 2004). This model assumes ageist attitudes as constituted of three mechanisms: prejudice (affective), discrimination (behavioural), and stereotyping (cognitive). Here age discrimination is differentiated from the general concept of ageism as it represents only those elements that have a behavioural and externally manifested character. This partition helped enhance the understanding of ageism and age discrimination and was adopted by McMullin and Marshall (2001), who suggested two further distinct dimensions of ageism: "ageist ideology" and "ageist behaviours." Ageist ideology includes negative stereotypes, beliefs, and attitudes; and ageist behaviours refer to behaviours that exclude certain people and place them in a disadvantaged situation relative to others on the basis of their chronological age (McMullin and Marshall 2001). This distinction is especially useful when referring to the legal prohibition of age discrimination in employment (Macnicol 2010). A key distinction based on empirical research that follows is that biased ageist attitudes may, but do not necessarily, lead to discrimination (Furunes and Mykletun 2010). Thus, ageism can exist without age discrimination.

To better comprehend the behavioural component of ageism (age discrimination), its specific *manifestations* in the labour market need to be discussed. Studies point to several different types of age discrimination. The first type could be defined as those behaviours which occur in strict relation to the employment status of the worker, i.e. the hiring and firing decisions of employers. Refusing to hire an older person or firing someone because of his or her age form the bluntest type of age discrimination. A plethora of research shows a preference among employers to hire younger workers while placing older ones in a disadvantaged position already in the recruitment process (Malinen and Johnston 2013). The second area where ageism

manifests is in practices occurring within the workplace. Furunes and Mykletun (2010) identified several such practices: being paid less than younger workers, being left out of promotions, not being accepted to training programmes, and being left out of companies' modernisation processes. Stypińska and Turek (2017) distinguished between two types of age discrimination in the labour market: soft and hard. Hard discrimination refers to the types of discrimination mentioned above, whereas soft discrimination consists of practices that occur in the interpersonal sphere and in the general atmosphere of the workplace; it is also not directly prohibited by law. Examples of these include hearing ageist jokes or remarks; being treated disrespectfully by employers, co-workers or clients; receiving lower evaluation of work outcomes; hearing that "you are too old for something"; or being humiliated or intimidated because of your age (Stypińska and Turek 2017). This is by no means an exhaustive list, but rather examples of possible manifestations of age discrimination on the level of personal experiences.

An important concept in ageism studies is *institutional ageism,* which refers to a bias against or in favour of (see *positive ageism* below) actions inherent in the operation of any of society's institutions, including schools, hospitals, police, and the workplace (Wilkinson and Ferraro 2004). Institutional ageism has been explained by Palmore (1999) as a "policy of institutions or organizations, which is discriminatory in a positive or negative way towards older persons" (p. 44). One standard example of institutional ageism in the area of employment is the statutory retirement age that serves as an obligatory condition for leaving the labour market. Institutionalisation of retirement at fixed chronological age boundaries, such as 60 or 65, has, in many industrialised countries, led to an increase of institutional ageism (Breda and Schoenmaekers 2006). Rigid chronological age boundaries support the social conviction that once past a certain age, the economic and social value of an individual suddenly drops, regardless of actual skills and qualifications. Shifting the responsibility for institutional ageism from the individual onto an institution or organisation may lead to its further institutionalisation which, if not contested, might further decrease control over possible consequences (Bytheway 1995).

To introduce the flipside of the predominantly negative term, *positive ageism* is understood as those stereotypes, attitudes, and practices of individuals and institutions which influence the situation of older adults positively (Palmore 1999). Palmore (1999) recognized eight major positive stereotypes about older adults: kindness, wisdom, dependability, affluence, political power, freedom, eternal youth, and happiness. A number of favourable stereotypes specifically about older employees also exist (Loretto et al. 2007), which can work to their advantage in the labour market, including maturity, experience, responsibility, reliability, stability, loyalty, customer service skills, and patience (Loretto et al. 2000; Malinen and Johnston 2013; Posthuma and Campion 2009). However, studies also show that even when employers display positive attitudes towards older workers, these do not directly translate into positive practices (Loretto and White 2006).

#### *6.2.1 Specific Features of Age Discrimination in the Labour Market*

To better understand the dynamics of labour market age discrimination, we need to separate it from ageism in other areas of social life (health care, law, media, access to services, etc.). This distinction boils down to two primary features. First, ageism and age discrimination in the labour market use different chronological ages as benchmarks to define old age than other spheres of life. There is ample evidence of ageist practices being applied to workers and job seekers already in their 30s or 40s (Ghosheh 2008; Stypińska 2015). The contextual character of age that stems from its clearly socially constructed meanings (Aronsson 1997; Hazan 1994; Maier 2009; Nikander 2000) further contributes to the complexity and specificity of the phenomenon of labour force age discrimination. The definition of who is an older worker varies between branches of economy and types of entrepreneurship, as well as among various cultural and local organizational contexts. Certain types of occupations (e.g., programmers, customer service workers, online marketers) and economic branches (e.g., hospitality, new technologies, entertainment, social media, and tech start-ups) are permeated with ageist attitudes, and the "middle age" in these types of companies can be as early as 27 years old (Gaster et al. 2002; Stypińska 2015). To reflect the phenomenon of extreme ageism in modern high tech and start-up working environments, the term *Silicon Valley ageism* has been coined, which describes the dominant ageist attitudes of most enterprises in this sector (Wickre 2017). It is best manifested in the infamous words of Mark Zuckerberg, CEO and co-founder of Facebook, who stated that "young people are just smarter".

The second important distinction is that age discrimination in the labour market is the only area of social life where legal protection against unequal treatment is deeply institutionalised due to binding regulations, and thus provides a specific context for country-specific analyses. The protection of older workers inscribed in European Union law since the early 2000s, and in the USA since 1967, allows for efficient counteraction to inequalities due to age, be it at the individual or organizational level.

#### *6.2.2 Intersectional (Multiple) Discrimination*

A further framework for enhancing the understanding of age discrimination in employment, and beyond, is the academic and legal perspective of intersectionality. Crenshaw (1991), who launched the concept within academic research, claimed that the experiences of individuals who hold several disadvantaged statuses are utterly unique, and thus any comparison to single-status disparity is not justified in legal or political terms. Intersectional (or multiple) discrimination is seen to operate between various socio-demographic categories, such as sex, race, age, ethnicity, class, and sexual orientation, and to be structurally carved into societal institutions, creating a

tangle of multiple oppressions (Baer et al. 2010). The intersectionality framework has also been widely adopted in gerontological research. So far, the most commonly studied aspect of intersectionality in ageing studies has been the combination of age and gender (Calasanti and King 2005; Krekula 2007; Ojala et al. 2016). The literature on the intersection of these two statuses goes back to the work of Simone de Beauvoir's seminal book, *The Coming of Age* (1970). In this classic work, the common situation of older women was first described as a "double jeopardy" that combines both age and gender, whereas older men were seen to hold only one marginal status (de Beauvoir 1970). The categories of age and gender have also been coupled with minority statuses such as ethnic origin and race when analysing the experiences of older women with different types of discrimination in employment (Moore 2009; van den Heuvel and van Santvoort 2011). In such cases one can talk about "triple jeopardy", where the person suffers from discrimination based on three grounds (Macnicol 2005). These intersecting statuses are also the source of difference in the experiences of various social groups within the labour market. The effects are visible in lower labour force participation rates, lower earnings, and, consequently, lower pension benefits among female populations across Europe. Ample evidence exists of the fact that older women experience barriers to reentering the labour market and that these experiences also vary substantially according to the women's ethnic origin or race. In the area of self-employment, older minority women are similarly precluded from embarking on an entrepreneurial path, as they are constantly confronted with the normative white male ideal type for the entrepreneur (Ainsworth and Hardy 2008).

Intersectional experiences of discrimination often prove challenging for empirical researchers and legal practitioners. Despite the wide theoretical agreement on the fact that intersectional discrimination occurs and that it has detrimental effects on the individual, a lack of agreement prevails as to how to measure this type of discrimination, and moreover, how to address it at the policy level. It is crucial to note, however, that minority statuses as grounds for discrimination and inequality in the labour market are not static functions which operate with the same force throughout the lives of individuals. Work force dynamics and the interplay of sociodemographic characteristics should therefore be analysed from a broader, life-course perspective. The differences between different age groups (cohort effect) as well as the differences between different stages of life (age effect) are certainly valuable and should be incorporated into the intersectional analysis of relatively more static statuses, such as gender, ethnicity, and migration background.

#### *6.2.3 Ageism and Discrimination Across the Life Course*

Loretto et al. (2000) observed a loosening of the tight association of the term *ageism* solely with older employees. Instead, ageism is increasingly being recognised as potentially affecting all age categories. Negative stereotypes and discrimination of older people are matched by similar stereotypes and discrimination of children or young adults, which is called *adultism*. Studies of ageism in Europe revealed that across the European Social Survey (ESS) countries, respondents felt more positively towards people aged over 70 than people in their 20s (Abrams et al. 2011). A study of age-related prejudice in the UK showed that younger age groups (below 25 years of age) were more likely to report age discrimination as more serious than older groups (over 64). Moreover, it showed that younger respondents are at least twice as likely to have experienced age prejudice than all other age groups (Swiery and Willitts 2012). Studies also confirm that these attitudes can have a negative effect on the employment opportunities of young adults (Abrams et al. 2011). Similar to challenges faced by older workers, younger employees often come across discriminatory practices, such as lower wages, disadvantaged working conditions, mistrust for their skills and competencies, as well as for their loyalty to the employer (Loretto et al. 2000; Sargeant 2010). What sets experiences of ageism in these age groups apart, however, is their potential outcome. Research shows that younger workers suffer less because of discriminatory practices and have greater opportunities to find alternative employment and to develop new career paths, simply due to the longer span of time available to work ahead of them. Older workers, on the other hand, resort to voluntary resignation much more frequently than younger workers. For older workers this entails a risk, as their options of finding a new job are more limited due to widespread age discrimination in recruitment practices (Sargeant 2010).

The situation of younger workers has also significantly deteriorated in recent years, with the global economic crisis of 2008 bringing an unprecedented rise in unemployment rates among the youngest age cohorts (under the age of 25) (European Commission 2014). The most recent data show a 19.7% unemployment rate on average in the European Union, with the highest rates found in Greece (48%), Spain (46%), Croatia (44%), and Italy (38%), and the lowest in Germany (7%), Denmark (10%) and the Czech Republic (11%) (Eurostat 2016). Even though no direct link between the levels of unemployment and age discrimination can be established with certainty, there is evidence that in dire economic situations, younger people tend to be confined to more precarious and insecure jobs with lower levels of workers' protection, including protection from discrimination (Blackham 2015). The harsh effects of the crisis have concentrated on one particular generation, namely those born in the 1980s (Hills et al. 2013). According to Hills et al. (2013), "Despite being better qualified than previous generations, people in their twenties were worst hit by the crisis in terms of unemployment, pay and incomes…The legal cases of age discrimination of younger workers suggest that the phenomenon is relatively widespread and goes underreported when compared with cases from older workers" (p. 6). However, despite its significance, more in-depth study into the experiences of age discrimination in the labour market by younger persons is still largely lacking (Furunes and Mykletun 2010).

#### **6.3 Macrostructural Processes and Age Discrimination in the Labour Market**

Three levels of analysis should be used to explain the origins of age discrimination in the workplace: the micro level, where psychological structures of deep-rooted prejudices, stereotypes, and biases are discussed; the meso level, where structures of the enterprise and of the management and interpersonal relations between employees can be studied, and the macro level, where the importance of macrostructural processes and factors on a global scale can be linked to the experiences of older workers with age discrimination. Since the literature on age discrimination pays less attention to the latter, this section digs deeper and discusses the role of macrostructural factors. These will be discussed in three subsections reflecting different macrostructural processes: social and cultural change (in the section on "Modernisation"); mechanisms of capitalist development (in the section on "Globalisation and Economic Crises"); and retirement regulations and antidiscrimination laws (in the section on "The Political Economy of Old Age").

#### *6.3.1 Modernisation*

Modernisation processes of the last two centuries in industrialised countries have impacted the status of older workers and dramatically changed the structure of the labour market (Hofaecker 2010; Kohli 1985; Palmore and Manton 1974). This change is based on the shift within the economy and society to higher levels of productivity, efficiency, and competitiveness—all core values inscribed in capitalism. Such emphasis has often worked to the disadvantage of older workers, who stereotypically have difficulties keeping up with the strength of younger workers, and with the increasing levels of technological advances and new forms of employment (Macnicol 2006; Palmore 1999).

One of the key theories explaining the decreasing status of older people in societies and the labour market is the modernization theory of Cowgill and Holmes described in 1972 in the book *Aging and Modernization*. The modernization theory shows that the reduced status of older people occurred because of the transformation from traditional, agrarian societies to modern, urbanised, and industrialised societies. Four major shifts occurred in the social structure throughout the modernising process: (1) improvement of health care resulting in the extension of the lifespan and hence institutionalisation of retirement schemes, but also more competition for jobs; (2) technological advances making older persons' skills obsolete and leading to the emerging pattern of preference for younger workers; (3) urbanisation and the rapid movement of younger people out of traditional housing and family settings which led to the collapse of close ties in extended families and to the loss of status of "wise elders"; (4) the expansion of the public education system and the disruption of traditional ways of intergenerational knowledge transfers (Cuddy and Fiske 2000). Although appealing, the modernisation theory has also faced criticism for employing imprecise definitions of social status, overgeneralising the processes of modernisation, and disregarding intervening variables such as ideology and value systems (Morgan and Kunkel 2007). In the process of testing the theory of modernization, Palmore and Manton (1974) concluded that indeed "employment status does decline steadily with the shift from agriculture, but that occupation and education status have a J-shaped1 relationship to modernization…It is suggested that as societies move beyond a transitional stage of rapid modernisation, discrepancies between the aged and non-aged decrease, and the relative status of the aged may rise" (p. 205).

#### *6.3.2 Globalisation and Economic Crises*

Globalisation involved similar processes to those that occurred in modernization period. For this reason, the impact of globalisation on older workers needs careful consideration. Research suggests that globalisation processes have greatly deteriorated the situation of older workers. The loss of status of older workers in globalised economies is seen as a consequence of the demands of a global labour market in which cost-efficiency, flexibility, adaptability, and transferable skills are required (Baars et al. 2006; Hofaecker 2010). Hofaecker (2010) approached the worsening of the situation of older workers with an explanation of profound structural changes that the global economy imposed on labour markets. One such change is the deep restructuring of the traditional industrial sectors of the economy, where older workers were overrepresented. The aftermath of these processes meant increasing unemployment rates for older workers and difficulty in re-entering the labour force, which in turn prompted an intensification of age discrimination. Moreover, replacing older workers with younger ones has sometimes been seen by employers as a cost-saving technique (Roscigno et al. 2007). Age started to turn into a stigma also outside traditional industries, as the competitiveness of new working environments worked to the advantage of younger workers.

Since 2008, the global labour market has been affected by financial crises, the age-specific effects of which are only recently becoming evident (Eurostat/European Commission 2012). The evidence from European social surveys carried out in the first year after the economic crisis of 2008 (European Commission 2009) showed a strong conviction that the economic crisis would negatively influence the position of older workers in job markets through the increase in age discrimination. Analysis from the point of view of employers and companies also revealed that in a situation of economic slowdown and deterioration of market opportunities, the burden shifted towards older employees by cutting their salaries (which are sometimes higher due

1 **J-shaped relationship** refers to a variety of J-shaped diagrams where a curve initially falls, then steeply rises above the starting point.

to seniority schemes) or by making them redundant (Cheung et al. 2010). The research evidence from recent years, however, shows that while younger people in many EU countries have faced severe difficulties in finding jobs since the crisis of 2008, employment rates of prime-age and older workers have remained remarkably stable (Eichhorst et al. 2013).

#### *6.3.3 The Political Economy of Old Age*

Despite the key role of modernisation and globalisation processes discussed above, the crucial role of state policies can shed light on the way older workers started to be perceived as unattractive and a burden rather than as capital to the economy and welfare systems. The political economy of old age describes the complex and dynamic relationship between the situation of older people and the social and political organisation of labour, retirement, and social assistance. The role of the state is central to the understanding of how the political economy of old age operates and thus the implications of certain state policies need to be analysed separately. According to Alan Walker (1981), the state regulated boundaries of productive economic activity (in the form of fixed retirement age) lead to high levels of dependency of older people in capitalist societies. The evidence for this process comes from theoretical deliberations on *structured dependency -* a term used to describe how the dependency of older people came to be artificially structured or deepened as an effect of various state policies (Townsend 2006). Among the most significant are policies dating back to the 1960s and 1970s, such as a fixed age for retirement; the minimal subsistence afforded on the state pension; substitution of retirement status for unemployment; near-compulsory admission to residential care of people whose abilities were fairly intact; the dependence of many residents in homes and of patients in hospitals and nursing homes; and the conversion of domiciliary services into commodity services (Townsend 2006). When it concerns age discrimination, however, the early retirement schemes introduced in many industrialised countries impacted the status of older workers the most (Breda and Schoenmaekers 2006; Neumark and Button 2014), and thus will be discussed below in more detail.

Early retirement represents a long-term process, the first attempts of which can be traced back to the 1950s for some industrialised countries. In the economically prosperous period of the 1950s and early 1960s, most societies still practiced a full labour force participation of older workers. It was only in the 1970s that early retirement started to significantly increase in most Western societies (Hofaecker 2010). The reason for early retirement schemes was attributed to the expansion of welfare systems that provided financial security for old age and worked to pull older workers out of active labour participation. Second, higher unemployment rates for older workers in the late twentieth century represented a push factor for early retirement. High unemployment rates were also grounds for the introduction of early retirement

policies in Eastern European countries in the 1990s,2 and also eased the effects of the end of guaranteed employment after the collapse of Communism (Zimmer and McDaniel 2016). The effects of early retirement policies triggered changes in retirement behaviours of older workers, but also influenced the image of older workers in general, as well as employers' attitudes towards them. Employers increasingly started to perceive workers aged 50 and over as redundant and unemployable, and accordingly tended to disadvantage them in recruitment, training, and retirement practices. Moreover, companies became used to early-exit policies as an "easy solution" for personnel management, especially in times of radical change in the global economy (Baars et al. 2006; Bytheway 2007). Workers even in their 40s are often seen as a risky investment and are therefore subjected to age discrimination in the workplace.

The reversal of early retirement options has proven a difficult path for many governments. In recent years, policy makers are increasingly developing strategic goals for raising employment rates among older workers. The most prominent examples of this have been the so-called "Stockholm" and "Barcelona" targets introduced by the European Union, which aim to reach an average employment level of 50% among older workers aged 55 to 64 years, as well as a 5-year postponement in the typical age of retirement (Hofaecker 2010). From 2002 onwards, the employment rate of people aged 55–64 in the EU has grown steadily to reach 55.3% in 2016, compared with 38.4% in 2002 (Eurostat 2017). Any increase in the number of employed older persons does not on its own necessarily indicate that the levels of age discrimination have decreased, but certainly points to a steady direction of greater inclusion of older workers into productive labour.

#### **6.4 The Consequences and Costs of Ageism in Employment**

The negative consequences and costs of ageism and age discrimination in the labour market can be divided into individual, institutional, economic (pecuniary), and societal (Minichiello et al. 2000; Palmore 2005; Taylor et al. 2012). Each category is discussed below.

#### *6.4.1 Individual and Institutional Costs and Consequences*

The negative consequences of age discrimination for older workers themselves include barriers to recruitment and hiring, diminished conditions of work and employment, limited career development and, in the absence of legislation, diminished employment protection and rights. Negative effects can be observed not

2Although some aspects of these policies had been introduced before the 1990s.

only in career paths and occupational opportunities, but also increasingly in family life, wellbeing, health outcomes, with increased stress levels, lower self-esteem, and loss of a sense of control (North and Fiske 2012). These negative consequences can in turn lead to self-inflicted discrimination, as victims of prejudice and discrimination sometimes adopt the dominant group's negative image of the subordinate group, start to behave accordingly, and thus further reduce their chances in the labour market (Palmore 2005). Research also shows that age discrimination reportedly leads older persons to consider changing their occupation or retraining, to give up looking for work altogether, or to consider early retirement (Australian Human Rights Commission 2015).

The institutional cost of age discrimination for employers is also on the rise. Demographic analyses show unequivocally that older workers are the fastest growing labour pool. One in four workers will be over 55 in 2020, versus one in six in 2007 (Hofaecker 2010). Employer- and manager-level prejudice and bias against older workers results in company loss of experienced workers and decreased efficiency in the workplace (Ghosheh 2008; Stypińska 2014). Employers that do not hire on merit, in other words, risk their own survival as they compete among themselves for a shrinking pool of younger workers.

#### *6.4.2 Social and Economic Costs and Consequences*

The social costs of ageism and age discrimination can be understood as the effects of long-term exclusion from the labour market that result in social, economic, and cultural segregation, which are detrimental for individuals and societies at large (Simms 2004). Social isolation which might result from economic inactivity among older workers can impact the integrity of families and local communities, pose a great threat to their wellbeing, and impose an additional burden on the welfare state.

The costs of an ageist environment can be detrimental to the financial situation of any company. Workplaces that embrace age diversity, and that are perceived as doing so, tend to have higher levels of employee engagement, and motivated employees are more productive, profitable, safe, create better customer relationships, and are more loyal to the company (Parry and Tyson 2011). In contrast, less engaged or motivated workers cost businesses in lost productivity, workers' compensation claims, and wasted time. Assessing the costs of age discrimination to a single company's economic performance is not easy. Some estimates are available, however. According to a Gallup study, in a 10,000-person company, disengagement of the workers due to unequal treatment represents 5000 unexcused days of absence, and about \$600,000 in lost salary per annum (Wilson 2006). Calculations concerning the Australian labour market suggest that an increase of 5% in paid employment of Australians over the age of 55 would result in a \$48 billion impact on the national economy every year (Australian Human Rights Commission 2015).

#### **6.5 Policy Responses to Ageism**

The remaining space of this chapter is dedicated to specific policies targeting ageism in employment. Anti-discrimination legislation and active ageing policies are discussed in particular.

#### *6.5.1 Legal Solutions and Responses*

One policy tool that is receiving growing attention concerns age discrimination legislation. Its main function is to safeguard access of older workers to employment and hiring opportunities under conditions of equality with other age groups. Second, it protects the employment status and training/career development opportunities of those already employed (Ghosheh 2008). In the European context, until only recently, age discrimination did not receive recognition and attention to the same extent as other forms of discrimination based on gender or nationality (Mikołajczyk 2013). This lack of acknowledgement is due to two facts: first, age discrimination has different characteristics from other types of inequality, because it applies to a social group with less clearly identifiable features than women or ethnic minorities, for instance. Age distinctions are more fluid as there is no fixed upper or lower boundary at which the worker can be defined as old. Second, not all age distinctions in employment necessarily constitute age discrimination, which makes recognising them particularly challenging.

Whereas recognition of age discrimination by the European Union is quite a recent fact, the United States started acknowledging, identifying, and tackling the problem much earlier. American anti-discrimination legislation came into force in 1967 with the adoption of the Age Discrimination in Employment Act (ADEA). It was part of an unprecedented turn in the 1960s, when public policy started advancing toward economic and social justice by defending the rights of vulnerable social groups (Rothenberg and Gardner 2011). In the first instance, the law covered workers between 40 and 65 years old. With the abolition of the mandatory retirement age in 1986, the regulatory means gained a new momentum and older workers were also covered (Friedman 2003; Macnicol 2006). The actions prohibited by the law pertained only to the employment field and covered discriminatory job advertisements, discrimination in pay, and discrimination in the use of company facilities (Friedman 2003).

Several authors have suggested that the European legislation was modelled on the American law, but with additional distinctive features (Friedman 2003; Lahey 2010). The approach adopted to combat age discrimination in the European Union labour market is important due to two factors. First, the legal provisions existing in the European law are binding for all member states and must be implemented in national legal systems. This means that employers in all member states can be held accountable for them. The proof that the legislation is not a dead letter law can be seen in the systematically growing number of age discrimination cases in national

courts, as well as in the European Court of Justice (Rothermund and Temming 2010; Umhauser-Enning 2013). Second, these regulations are crucial, because although ageism and age discrimination may occur in a range of fields, including health care, financial services, housing, and education, it is the labour market which has been given priority in the legal system of the EU (Mikołajczyk 2015).

Discrimination in the labour market can take many forms. EU legislation makes a distinction between *direct* and *indirect discrimination*, *harassment*, and *instruction to discriminate* (Ghosheh 2008). Direct age discrimination occurs when a person is treated less favourably than another person in an analogous situation due to his or her age. Indirect age discrimination happens when an "apparently neutral provision, criterion or practice would disadvantage people on the grounds of age unless the practice can be objectively justified by a legitimate aim" (Furunes and Mykletun 2010, p. 125). Harassment is defined as "unwanted conduct related to … age with the purpose or effect of violating the dignity of a person and of creating an intimidating, hostile, degrading, humiliating or offensive environment" (European Commission 2009, p. 29). Instruction to discriminate occurs when, using existing power dependencies, such as employer–employee, a person is told to discriminate against another person (Ghosheh 2008).

The effects of anti-discrimination legislation are difficult to measure (Loretto et al. 2000; Mikołajczyk 2015; Neumark 2009). Existing studies show that legislation could increase employment levels of older workers, but that there is no positive impact on the hiring practices of protected workers as their contracts are more difficult to terminate (Neumark 2009). Other studies have found that a minor number of reported cases of age discrimination go to trial and an even smaller number terminate in compensation. This is due to the difficulties of proving age discrimination in court (Rothenberg and Gardner 2011). Moreover, severe labour market distractions, such as the economic crisis, make it difficult to recognise discrimination and can weaken the effects of stronger state age discrimination legislation (Neumark and Button 2014). It has also been found that anti-discrimination legislation can raise awareness of the problem among older workers and employers (Amiraux and Guiraudon 2010). However, as noted by Amiraux and Guiraudon (2010), the social fluidity of discrimination contrasts with the boundaries of its legal existence, which calls for more interaction between the two spheres to enhance the efficiency of the legislation and to increase its social impact.

#### *6.5.2 Active and Productive Ageing Policies of the European Union*

The second leg of European policies aiming at reducing age discrimination in the labour market consists of policies in the realm of active ageing, or, as it used to be called, "productive ageing." The history of active ageing policies can be traced back to the 1960s in the United States, where it was argued that the key to successful ageing was the maintenance of the activity patterns and values typical of the middle age. This approach came to be known later as activity theory (Walker 2002). In 104

relation to the area of employment, active ageing measures might include age management; lifelong education and continuous training; reconsideration of policies that stimulate early exit; abolishing mandatory retirement age; and introducing flexible options for pre-retirement employment (e.g., half-time contracts). A more recent approach consists of policies targeted at combating age discrimination, age boundaries in the labour market, and motivating employers to recruit and retain older workers. Walker (2002) noted that "age discrimination is the antithesis of active ageing," and thus concerted efforts should be made at work in order to combat it. He claimed that raising pension ages without fighting ageism in the workplace would only result in more social isolation and poverty in old age. On the other hand, policies targeting activity in older age have been systematically criticised since their implementation. Moulaert and Biggs (2012) called such policies "a new orthodoxy of ageing subjectivity" (p. 3), which restricts the social contribution of older adults to work and work-like activities and propagates a one-size-fits-all model for a very heterogeneous population of older adults.

In the EU, the most recent focus of Active Ageing as part of the Europe 2020 strategy is to enable older people to contribute fully both within and outside the labour market. These policies envision older people as empowered to remain active as workers, consumers, carers, volunteers, and citizens (European Commission 2012a). A special policy programme titled "A European Year for Active Ageing and Solidarity Between Generations" was introduced in 2012. It presented tools for improving the situation of older persons and preventing their exclusion, including a new index, the Active Ageing Index, that monitors the situation of older people in society. The index measures the extent to which older individuals can realise their full potential with regard to employment, participation in social and cultural life, and independent living. It also measures the degree to which the environment they live in enables seniors to lead an active life. Attempting to evaluate the impact of the reforms within the Active Ageing programmes is limited because they were introduced relatively recently. As a result, only a few evaluations of their actual impact have been carried out to date. Nevertheless, some countries have observed increased participation of older workers in the period since the reform was introduced (European Commission 2012b).

#### **6.6 Conclusions**

The aim of this chapter was to give an overview of conceptual distinctions between ageism and age discrimination in the labour market, and to examine the impact of macro-structural processes on the status of older workers in modern economies. Age discrimination in employment is not only an effect of the individual prejudices and stereotypes of the employers, but rather, has a longer history in industrial relations, and is firmly embedded in the structural components of global labour markets. The strong relation between the status of older workers and economic situations and state policies propagated in the past explain the structured nature of ageism and age discrimination in the labour market. The critical question remains, however: can

ageism and age discrimination decrease let alone disappear from the workplace over time? The overview of policies introduced in the EU during the last decade suggests that a certain improvement in the situation of older workers can be observed, especially with regard to their increasing employment rates. A further chance for improvement comes from the fact that an ever-growing older population will inevitably change the social structure of age. This means that as older people become increasingly difficult to ignore, perceptions of older employees will need to adjust to the same measure and the relationship between work and retirement will need to be reconsidered.

#### **References**

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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# **Chapter 7 Introduction to the Section: On the Manifestations and Consequences of Ageism**

**Liat Ayalon and Clemens Tesch-Römer**

The chapters in this section describe in detail the manifestations and consequences of ageism. The diversity of settings and situations described in this section clearly indicates the pervasiveness of the phenomenon. Ageism occurs at the individual level as well as at the societal/structural level, and the interaction between these two levels further perpetuates its occurrence. The negative impact of ageism on the lives of older adults is clearly discussed and demonstrated in the ten chapters presented in this section.

The first chapter in this section, by Kydd, Fleming, Gardner, and Hafford-Letchfield (2018; Chap. 8) critically examines ageism in the third age that is directed towards individuals in their fourth age. This chapter follows the definition of ageism as the "enemy within" (Levy 2001) by discussing ways in which older adults attempt to disassociate themselves from old age and decline. This division between the third and the fourth age is clearly articulated by the author John Burroughs (1837–1921): "To me, old age is always ten years older than I am". In the successful or active ageing models, the third age is associated with good health and a high degree of societal participation, whereas the fourth age represents the failure to maintain the functioning of middle age and the surrender into decline and decay. Hence, the fourth age is classified as "old," whereas the third age makes attempts to stay "forever young."

The second chapter in this section, by Shiovitz-Ezra, Shemesh, and McDonnell-Naughton (2018; Chap. 9) corresponds to the chapter by Kydd et al. (2018; Chap. 8) by articulating the negative consequences of ageism on older adults' satis-

L. Ayalon (\*)

Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan 52900, Israel e-mail<EMAIL_ADDRESS>
C. Tesch-Römer (\*) German Centre of Gerontology, Berlin, Germany e-mail<EMAIL_ADDRESS>
© The Author(s) 2018 109

L. Ayalon, C. Tesch-Römer (eds.), *Contemporary Perspectives on Ageism*, International Perspectives on Aging 19, https://doi.org/10.1007/978-3-319-73820-8\_7

faction with social life, manifested in high levels of loneliness. In the case of older adults, ageism likely plays a role as an intra-psychic experience that inhibits older adults from developing relationships with other older adults (similar to the case described by Kydd et al. 2018) as well as with people of different age groups. Ageism also serves as a structural barrier in societies that divide young and old, allowing for very little contact between people of different generations. Finally, although loneliness is in part a subjective experience associated with dissatisfaction with one's relationships, it is important to acknowledge that many objective losses in old age also make older adults particularly vulnerable to loneliness. These vulnerabilities are further intensified by the experience of ageism.

Another area where ageism plays a role is sexuality. At the micro-level, the perceptions and beliefs of older adults impact their expectations as well as behaviours regarding sexuality. However, older adults do not operate in isolation. Instead, their experiences, expectations, and behaviours are largely influenced by messages portrayed in the media, and by health care professionals, long-term care providers, and family members, among others. The chapter by Gewirtz-Meydan, Hafford-Letchfield, Benyamini, Phelan, Jackson, and Ayalon (2018; Chap. 10) points to the role of ageism in shaping the discourse about sexuality in old age. The view of sexuality as non-existent and invisible in old age, or as a purely bio-medical "problem," serves to deprive older adults of their sexuality and does not allow for the actual diversity of experiences, desires, and beliefs about sexuality among older adults.

The media as a way to portray and also influence reality is discussed in the chapter by Loos and Ivan in this section (2018; Chap. 11). The chapter demonstrates how the visual presentation of older adults has changed over the years. Whereas early representations of older adults were minimal and tended to focus on the negative, current representations of older adults follow the spirit of successful and active ageing. Although the latter perspectives represent an attempt to move away from the pathology of old age and ageing, they clearly place on older adults the responsibility for their own decline and eventual mortality and, thus, they can be seen as promoting another form of ageism (Liang and Luo 2012). The unreasonable expectations disseminated by the media likely reinforce ageism and may increase social isolation and loneliness among older adults who "fail" to age successfully (e.g., the fourth age in Kydd's chapter (2018; Chap. 8)).

In this section, Dolberg, Sigurðardóttir, and Trummer (2018; Chap. 12) discuss an unexplored yet highly topical issue that has made the headlines recently, namely, immigrants and immigration policies. Although ageism is not the first topic that comes to mind when considering immigration, there is no doubt, after reading this chapter, that ageism plays a substantial role in the life of older immigrants. As illustrated in the chapter, older immigrants are exposed to double or even triple jeopardy by policies that privilege younger immigrants and by cumulative stresses and disadvantages associated with the deleterious effects of immigration status and old age combined.

The chapter by Wyman, Shiovitz-Ezra, and Bengel (2018; Chap. 13) on ageism in the health care system and the chapter by Fialová, Leppee, Kummer, and Držaić (2018; Chap. 14) on ageism and medication in older adults are highly important given the fact that older adults have to rely on adequate health care services and are at a high risk for taking a large number of medications. This reliance on medical services in later life has even led some philosophers to ask whether older adults have a duty to die (Hardwig 1997). The chapter by Wyman, Shiovitz-Ezra, and Bengel (2018) provides a comprehensive overview of the role of ageism in the health care system by demonstrating how ageism operates at the individual level, at the mesolevel, and at the macro-level to impact the quality of health care provided to older adults. This chapter is complemented by the chapter on ageism and medication use, which outlines the negative consequences of ageism on the prescription of medication for older adults. This chapter also contains recommendations for strategies to reduce inappropriate prescribing, risky polypharmacy, and medication non-adherence in older patients.

Bodner, Palgi, and Wyman (2018; Chap. 15) offer a fresh perspective on ageism in mental health care. They vividly illustrate how both the assessment and the treatment of mental illness are impacted by ageism. The role of countertransference has received substantial attention in the mental health literature, but, in this chapter, it is viewed in the context of ageism, as the psychologist's feelings and attitudes about age. Given the stigma of old age, many symptoms of mental illness are seen as signs of ageing and vice versa. This often hampers the quality of treatment provided to older adults with mental illness.

Like mental illness, dementia is a highly stigmatized condition. Hence, the chapter by Evans in this section (2018; Chap. 16) explores the role of double stigma in the life of older adults who suffer from dementia, and describes how this double stigma impacts the care provided to them. Evans illustrates how older adults and having dementia become synonymous at times. In addition to other chapters in this section (Wyman, Shiovitz-Ezra, and Bengel 2018; Fialová et al. 2018; Bodner et al. 2018; and Ben-David, Malkin, and Erel 2018), this chapter stresses the pervasive and debilitating presence of ageism in the health care system. Clearly, ageism impacts older adults' access to health care services, as well as the quality and availability of services.

The concluding chapter in this section is by Ben-David et al. (2018; Chap. 17) This chapter provides a brave attempt to dispute a priori assumptions about the relationship between old age and cognitive decline and deterioration. The authors argue for a sensory decline, rather than "the usual suspect" of cognitive decline, as a barrier to adequate performance on neuropsychological tests. Moreover, another major obstacle faced by older adults who encounter neuropsychological assessments is the threatening and unfamiliar testing situation, which often puts them at a disadvantage compared with younger adults. Self-fulfilling prophecies and the internalization of negative stigma regarding the relationship between old age and cognitive impairments are also substantial obstacles to adequate performance of older adults on neuropsychological tests.

These highly diverse chapters have several aspects in common. First, they address *multiple levels of manifestations of ageism*. All of the chapters in this section show that ageism is manifested in social interactions involving older adults (see, for example, Kydd et al. 2018). Moreover, ageism is well-internalized and impacts older adults through their belief systems and expectations, influencing social integration and their relations to other people (Shiovitz-Ezra et al. 2018; Gewirtz-Meydan et al. 2018). Ageism is also present at the meso-level, and manifests in interactions with professionals (Wyman, Shiovitz-Ezra, and Bengel 2018; Bodner et al. 2018; Ben-David et al. 2018). These may include a variety of health or mental health care professionals (Wyman, Shiovitz-Ezra, and Bengel 2018; Fialová et al. 2018; Bodner et al. 2018; Evans, Ben-David et al. 2018) or long-term care workers (Gewirtz-Meydan et al. 2018). Finally, ageism also occurs at the macro-level, as clearly illustrated in policies which discriminate against older immigrants (Dolberg, Sigurðardóttir, and Trummer 2018), older adults with dementia (Evans), or older adults with other health conditions (Wyman, Shiovitz-Ezra, and Bengel 2018).

Another common feature of these chapters is the emphasis on *multiple jeopardies* that older adults experience. The chapters demonstrate that ageism increases vulnerability in old age, which is often further amplified by impaired health status (Gewirtz-Meydan et al. 2018; Wyman, Shiovitz-Ezra, and Bengel 2018; Fialová et al. 2018), immigration status (Dolberg, Sigurðardóttir, and Trummer 2018), mental illness (Bodner et al. 2018), dementia status (Evans), or a sensory decline (Ben-David et al. 2018). These multiple vulnerabilities correspond with the chapter by Krekula et al. (2018; Chap. 3) in the previous section, and support the need to view ageism in context, as part of other potential sources of discrimination. Healthism, disablism, lookism, and sexism represent discrimination based on qualities other than age. The ten chapters presented in this section clearly demonstrate the interaction of ageism with these other bases for discrimination. Hence, it is often not age per se, but age in combination with other qualities that promotes discrimination.

One question raised by this section is "What would be considered a *non-ageist approach*?" The chapter on ageism in the visual media by Loos and Ivan (2018; Chap. 11) attempts to answer this question by arguing for the importance of diversity in older adults' representations and experiences. They support a transition from the portrayal of older adults in the visual media as invisible, weak, or frail to other, more nuanced portrayals of ageing and old age. However, they argue that the current successful ageing and active ageing models do not fit the ageing process of all older adults, and, thus, they must be diversified. This is similar to the arguments made by Gewirtz-Meydan et al. (2018) in this section regarding sexuality in the age of Viagra. Providing older adults with diverse models of ageing is a necessary next step in creating a non-ageist society. This claim is also supported in the previous section by Lev et al., who see a long continuum that includes impairment, failure, and disability as well as successful or active ageing, which should be acknowledged and respected. The chapters by Wyman, Shiovitz-Ezra, and Bengel (2018) and Fialová et al. (2018) in this section, on the other hand, argue that a non-ageist approach must be individually tailored. Although age can be one characteristic to take into account in medical diagnosis or treatment, it is by no means the only criterion. An individualized approach to care takes into account a variety of factors, not just chronological age. Such an approach is non-ageist and highly appropriate for both young and old.

Other chapters, such as the chapter by Bodner et al. (2018; Chap. 15) on ageism in the mental health system, the chapter by Evans (2018; Chap. 16) on ageism and dementia, and the chapter by Ben-David et al. (2018; Chap. 17) on ageism and neuropsychological assessment, argue for increased knowledge and awareness as a means to address ageism. These authors, as well as others in this section, demonstrate the role of the beliefs and attitudes of health and mental health professionals in shaping reality. Greater awareness of ageist attitudes can help overcome some of the ageist practices currently in use.

This section on the manifestations and consequences of ageism is important because it demonstrates the pervasiveness of ageism and its negative contribution to the life and care of older adults. Ageism can be subtle and hardly noticed or explicit and well-acknowledged. Regardless of its form, it shapes the views of older adults about their abilities and needs as well as the views of the people surrounding them. Although the chapters do not aim to provide solutions to combat ageism, they do point to future directions which could improve the wellbeing and quality of life of older adults. These can be at the policy level (detailed in the next section), as well as at the individual level, for example in the form of educational interventions to promote individualized approaches and increase awareness of ageist attitudes.

#### **References**

**Open Access** This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

## **Chapter 8 Ageism in the Third Age**

**Angela Kydd, Anne Fleming, Sue Gardner, and Trish Hafford-Letchfield**

#### **8.1 Introduction**

Older people are the largest group accessing and using care services within Europe (Eurostat 2015) and are often referred to as a "burden" (Beard and Bloom 2015). Improvements in public health, medical screening, timely treatments, and improved health and social care services in industrialized countries have all contributed to people living longer and healthier lives (Carr and Komp 2011). Average life expectancy is now estimated to be 78 years in developed countries and 68 years in less developed countries, with the gap continually narrowing every year. By 2045–2050, life expectancy is projected to reach 83 years in more developed countries and 75 years in less developed countries (Department of Economic and Social Affairs Population Division 2013).

Whilst a defining characteristic of the ageing process may involve increased vulnerability to a decline in health and wellbeing (Kirkwood 2014), novel approaches to wellbeing alongside complex biological, medical, psychosocial, political, and economic factors can influence both individual and group trajectories in later life. Ageing remains an extremely complex field in terms of understanding the relationships between these contributory factors and the transitions that connect them.

A. Kydd (\*)

A. Fleming Independent Researcher, Edinburgh, Scotland, UK

S. Gardner Independent Researcher, Thame, UK

T. Hafford-Letchfield Social Care, Middlesex University, London, UK

Edinburgh Napier University, Edinburgh, Scotland, UK e-mail<EMAIL_ADDRESS>
© The Author(s) 2018 115 L. Ayalon, C. Tesch-Römer (eds.), *Contemporary Perspectives on Ageism*, International Perspectives on Aging 19, https://doi.org/10.1007/978-3-319-73820-8\_8

Simultaneously, there has been a reorganization of health and social care services, caused in part by the universal adoption of economic rationalism, managerialism, and fiscal restraint (Hafford-Letchfield 2014). Not least, there has been a notable change in the retreat of government from its traditional role as a provider of institutional care, which has led to greater promotion of individualization while at the same time reducing eligibility for services (Scourfield 2010). These expectations and developments pose enormous challenges, tensions, and ambiguities for how the ageing trajectory and the multiple factors affecting it over the life course are understood.

The increasingly older population is accompanied by a new discourse about "active and successful ageing" (Foster and Walker 2014). However, the "good" and "successful" versus "bad" and "burdensome" dichotomy that is set up by this discourse may especially impact active older people who are averse to viewing their future older selves as a burden (Nelson 2005). Both "good" and "bad" ageing discourses differentiate between those who are "successfully" ageing and those people for whom successful ageing is not possible. This may contribute to tensions between third and fourth agers.

Discourses associated with ageing, and interactions between these two cohorts, may indeed contribute to intergenerational ageism. Although there are few empirical studies of these tensions, this chapter capitalizes on the timeliness of exploring such discourses by synthesizing some of the relevant literature and the possible themes to increase our understanding. We address previous classifications of ageing; demography; key concepts of the third and fourth ages; evidence of distancing between these two cohorts; and implications for health and wellbeing. We conclude with recommendations for further research.

#### **8.2 Classifications of Ageing**

Gerontology has always engaged with critical theory to question normative theories about ageing, wellbeing and the significance of deconstructing these theories to promote self-determination and human rights (Cocker and Hafford-Letchfield 2014). Age-related prejudice and discrimination is commonly seen as a social construction based on classification systems. Yet the classification of old age is ill defined. Morrow-Howell (2012, p. 379), writing her paper at the age of 60, asked, "Will we continue to use 60 or 65 years old to define the older population, even when the majority of people in that category will be there for 20 or 30 more years?"

To classify people from the age of 55 to over 100 as "old" implies that there have to be overwhelming commonalities in this period of life. Serra et al. (2011) believed that age classifications would serve to dispel the image of the "burdensome old" and suggested chronological age categories, such as octogenarians (80–89); nonagenarians (90–99); centenarians (100–104); semi-supercentenarians (105–109), and supercentenarians (110+). However, from the studies reviewed in this chapter, there are no references to sexagenarians (age 60–69) or septuagenarians (age 70–79), and there is no apparent consistency in defining age groups. Using such categories would remove the words "young" and "old" from common parlance and would serve to describe cohorts over the life course. Further life-course categorizations would include denarian (age 10–19); vicenarian (20–29); tricenarian (30–39); quadragenarian (40–49); and quinquagenarian (50–59). These conventions, however, consider each category as homogeneous and based solely on chronology, and such theorizing denies the complex intersectionality of ageing and the importance of recognizing and responding to extremely divergent life experiences (Hafford-Letchfield 2013).

Older people's experiences are not shaped by only one aspect of their identity, but by a combination of factors, such as gender, age, religion, disability, health, location, sexual identity, migration history, socioeconomic status, and ethnicity. Key processes that shape outcomes for older people may include the texture of dayto-day life, the decisions and assumptions that people make as individuals, and the interactions between people (Hafford-Letchfield 2013). One example is the impact of economic vulnerability on insecurity and sensitivity in the wellbeing of older individual households and communities (Victor 2013). External factors may also be mediated by internal factors such as an older person's responsiveness and resilience to risks they face in later life. These critiques draw attention to the inadequate nature of normative life-course theories.

#### **8.3 Perceptions of One's Own Old Age**

Heikkinnen (2000) searched for a narrative of ageing in a study of Finns (n = 20) aged 80 in 1990, with a follow-up 5 years later (n = 17). The participants were all born in the same year and all lived in the same city in Finland. In her group, she found that experiences of ageing were expressed according to the positive and negative meanings that individuals attached to these experiences. In other words, she found that their experiences of ageing were heterogeneous, together with the social, physical, and cultural environments in which they occurred. At the baseline, her participants did not consider themselves to be old, as they were not experiencing problems with everyday life, thus placing her 80-year-old participants firmly in the third age. At follow-up, when they were 85 years old, most of her participants felt that they were now old, due to deterioration in health, loss of human relationships, and an increase in frailty and/or pain. The participants had to change the way they perceived themselves and the way they organized their days to match with their abilities.

Nicholson et al. (2012) interviewed 17 older people, aged 86–102 years and living at home, to gain an understanding of the experience of living and dying with frailty in old age. Their data analysis revealed three main themes: the dynamics of physical and psychosocial frailty, sustaining connections within the home, and connecting with death and dying. The first theme was concerned with increasing uncertainty and loss as a result of physical and psychosocial deterioration, which changed how the individual perceived themselves and how they were perceived by others. The second theme was concerned with the work and adaptations participants made to compensate for increasing frailty in order to maintain satisfactory routines and sustain a feeling of being at home. The third theme focused on the participants' recognition that they were approaching the end of life, which the authors describe as "inhabiting the space between living and dying".

In exploring self-perceptions of ageing with those who had outlived the average age of their birth cohorts, both Nicholson et al. (2012) and Heikkinnen (2000) highlighted resilience and capacity for change in contrast to traditional negative stereotyping. They showed the ability of much older people to change their perceptions of self and the rate at which they felt becoming old happened to them and the strategies they used to achieve this. According to Johnson and Barer (1997), older adults' re-conceptualization of their self-perception is thought to occur in the following four domains. In the first, one accepts the temporality of life and places oneself towards the end of it. In the second, the self-concept belies the reality of the situation; for example, although physically and/or mentally less competent than they used to be, they describe themselves as being in good health. In the third, they detached voluntarily from some aspects of the world surrounding them, such as unwanted roles and responsibilities. And the fourth involved living in the present a "one day at a time" approach.

Comparing oneself to others is a widely reported positive strategy in developing or refining self-perception in old age: positive comparisons such as "I am much fitter than others are" or "I can still get around without a wheelchair, unlike my friend" are used to construct a more positive identity (Johnson and Barer 1997). However, these positive messages can also be said to emphasize loss of function: "I can *still* get around without a wheelchair" or "I can get around without a wheelchair … but only around the house". Another strategy that is commonly used is to separate the mind from the body: for example, "It's just my knees that are old; my mind is still sharp".

The most common strategy in older age is to maintain a sense of control over both health and lifestyle, perhaps because ageing is a process over which people feel they have no control (Johnson and Barer 1997). Betts Adams et al. (2010) explored changes in activity and interest in the third and fourth ages (in their study this referred to ages 64–79 and 80+, respectively). They referred to the concept of selectivity introduced by Baltes and Baltes (1993), in which older people decided themselves where to focus their energies to best advantage. They found that both the younger cohort (n = 50) and older cohort (n = 128) demonstrated a pattern of disengagement from active pursuits in favour of more passive social and spiritual pursuits in the fourth age. Heikkinnen (2000) suggested that individuals organize their daily life in a way that is consistent with their abilities. The participants in her study who described themselves as feeling old reported that they structured their days around their physical needs and had replaced earlier activities with more simple tasks. Nicholson et al. (2012) suggested that these daily routines not only provide a sense of control, or pass the time, but that they also serve to connect individuals to the past as well as the present through the provision of a pattern of work and rest. Routine, they suggest, can also be helpful in distracting the mind from unwanted thoughts of dependency or decline.

How older people view themselves and their peers has an impact on how they make choices and whether or how they engage with services. Sarkisian et al. (2002) found that having low expectations of ageing not only had a negative impact on preventative health behaviours, but also indicated a low engagement with healthcare services for conditions such as depression and urinary incontinence. Half of the participants in their study expected ageing to lead to depression, dependency, decreased ability to have sex, more aches and pains, trouble sleeping, less energy, and becoming less attractive. Those with low expectations were less likely to seek healthcare for age-associated conditions. Levy and Myers (2004) measured the attitudes of older people aged 50–80 years (n = 241) towards their own ageing to explore how age beliefs predicted a variety of preventative health behaviours and the impact of these over a 20-year period. Older people with a positive selfperception of ageing reported engagement in more preventative health behaviours over the course of the study, with significantly higher self-rated health than those with a negative self-perception of ageing. This predictive value of ageing selfperceptions may therefore be valuable to those researching or practising preventative health behaviours. In contrast, Jopp et al. (2008) found that both young-old and old-old people showed high levels of valuation of life (VOL), which reduced from the third to the fourth age. Nonetheless, this study supported earlier work in demonstrating that, despite high levels of health impairment, the oldest-old can still hold high levels of VOL through a complex process of balancing the positive and negative aspects of life. The young-old group in this study placed a higher value on health factors, while the old-old placed more value on social factors.

Litwin and Stoeckel (2013) examined the associations between social networks, life satisfaction and feelings of wellbeing in a young-old cohort (60– 79 years) and an old-old cohort (80 years and over) from the second wave of the Survey of Health, Ageing and Retirement in Europe study (n = 14,728). They found that social networks were greatly valued in very old age, but not in the same way as in younger-old adults: for example the older cohort living with one or more adult children reported this as having a positive impact on wellbeing, while the younger cohort demonstrated a negative association between living with adult children and quality of life. Other opposite findings between the cohorts studied by Litwin and Stoeckel (2013) included living with a spouse; this related to better quality of life in the younger group, and was negatively associated with quality of life by the older participants. Similarly, being in receipt of personal or practical assistance from someone outside the household had a negative impact on wellbeing for the younger cohort, but a positive impact on wellbeing for the older cohort. Associations between social networks and life satisfaction were also found to be opposing between the two cohorts; for example, having a greater number of grandchildren was associated positively by the younger cohort and negatively by the older cohort.

Exploring the potential for isolation and loneliness in old-old age was a key part of a study by Fischer et al. (2008).  These included important life events, the experience of growing old, experiences of loneliness, difficult life events, positive life events, and experiences of comfort and consolation. Four themes emerged: embracing weakness and strength; embracing slowness and swiftness of time; embracing reconciliation and regret; and embracing connectedness and loneliness (Fischer et al. 2008). Their findings suggest the importance of embracing the contradictions and challenges that come with longevity, and echo Erikson's stages of psychosocial development. This comprehensive psychoanalytic theory identifies eight stages of life, which occur in healthy developing individuals from infancy through to late adulthood. The stages unfold as an individual advances through the life course and each stage is characterized by a psychosocial crisis of two conflicting forces, those in later adulthood being integrity versus despair (Erikson 1968). The theory was updated in the late nineties to include a ninth stage, allowing for the increased ageing of the population (those over 80); the conflicting forces being dystonic versus syntonic, illustrating a negative or positive approach to facing the challenges of ageing (Erikson 1997).

#### **8.4 The Creation of the Third and Fourth Age**

Distinctions between the third and the fourth age have generally been determined by the average life expectancy in a population/demography-based or a person-based equation (Baltes and Smith 2003). In developed countries, a population-based equation would put the transition from third to fourth age at 80–85, whereas a personbased equation depends on the estimated maximum lifespan of the individual. The transition from third to fourth age could be at 60 years for some and at 90 years for others.

The original concept of the third age is associated with Neugarten (1968) and the fourth age with Laslett (1994), who both sought to dispel the marginalization of the old. Neugarten (1968) stated that in social organizations, the relations between individuals and between groups are organized by age differences, but little attention had been placed on age grading to show relationships between generations. Similarly, with reference to age grading, Laslett (1994) argued that after retirement the "old" were a consumer group of growing importance, with the potential for achieving personal fulfilment and active participation in the economy, politics, and policy making, making the newly retired a different group of older people from the oldest old. This development in ideas about later life served to emphasize autonomy, agency and self-actualization. It also served to distinguish the concept of the fourth age, with dependency as a key marker in the transition.

Narratives that describe the third age as an opportunity and the fourth age as a threat point to a discursive "othering" wherein the fourth age functions as social imagery of a fear of incapacity, poverty, and decrepitude, rather than age per se (Higgs and Gilleard 2014). "Within this social imagery, old age is represented less as a status and more as a state of being, one that is typically envisioned through discourses about the costliness, the frailties and the indignities of old age" (Higgs and Gilleard 2014, p. 10).

George (2011) suggested that creating distinctions between a third and fourth age only serves to postpone the onset of what seems to be old age and creates a more severe form of ageism for those in the fourth age. She wrote, "Just as the image of the third age is socially desirable because it is not old age, the image of a fourth age is socially undesirable because it reinforces negative stereotypes of later life. Fourth agers will be viewed as frail, dependent, lonely, sick and as coping with impending death" (George 2011, p. 253).

So how does this creation of a distinction between the active and the dependent old impact those making the transition from the third to the fourth age?

#### **8.5 The Third Age Distancing Itself from the Fourth Age**

Leaving paid employment to pursue hobbies and engage in activities that the time constraints of work would normally not allow makes retirement, once seen as the end of one's life, now attractive (Kuh 2007). Retired active people can partake of successful active ageing strategies which generally exclude the old-old, the frail old, and the disabled, who are less likely to be able to pursue these activities (Betts Adams et al. 2010). Gilleard and Higgs (2011a) suggested that members of the third age can reject old age as a collective voice through lifestyle choices, but this can only come with economic stability and health. Where people in the third age are not conceptualized as being really old, it is argued that this group wish to distance themselves from the ageist stereotypes seemingly afforded to those in the fourth age. This is demonstrated by George (2011, p. 253) who wrote, "The eagerness of many to proclaim the third age strikes me first and foremost as a desire to avoid or postpone being labelled as old and suffering the negative social stereotypes that accompany that label. The image of the third age appears to reflect the same desire to view oneself and have others view one as not being old." However, Higgs and Gilleard (2014) suggested that such distancing, in order to avoid being classed as one of the oldest old, is potentially damaging to individuals in both age groups.

#### **8.6 Evidence of Distancing**

There is very little robust evidence to help understand the concept of distancing between the third age and the fourth age, especially due to methodological inconsistencies in determining what is meant by "old" and "oldest old". Characteristics, personal appearance, identifying traits, and practices that might link a person to the

fourth age are actively forestalled by some. This might be related to how people seek to maintain their appearance through cosmetic means in the quest to avoid being seen as one of the "real" old. As Hazan (2009, p. 98) put it, "The liminal geography of the third age stretches between the face-lifted edges of a dream of middle age and the murky terrains of lived in and feared old age."

Avoiding the use of aids and equipment or living in environments that might put them (in their own and other people's eyes) in the oldest old category is another way some older people distance themselves from the fourth age. Distancing is not purely physical, but can also be demonstrated in attitudes and behaviours. An Israeli study (n = 955) by Bodner et al. (2012), using the Fraboni Scale of Ageism (Fraboni et al. 1990), found that in cohorts of young (18–39), middle-aged (40–67), and old (68– 98) participants, middle-aged participants were significantly more ageist than younger and older participants. In all age groups, men showed more avoidance and stereotypical attitudes toward older adults than women. The authors then subdivided the old age group and found participants aged 81–98 held more ageist attitudes than those aged 68–73. The authors concluded that ageism changes across the lifespan and it is necessary to explore the reasons why ageist attitudes change in different stages of life. One reason has been suggested by Iecovich and Lev-Ran (2006) in their examination of the attitudes held by well older people towards disabled older people living in the same facility (n = 140: age >64). Well older people tended to hold more negative attitudes towards frail older people when they lived in an integrated facility, with the more able voicing a preference for segregated facilities. Iecovitch and Lev-Ran suggested that holding these negative attitudes may ameliorate the frightening thoughts of one's own mortality, and recommended that further gerontological studies examine intergenerational prejudices.

Similarly, Gilleard and Higgs (2011a) reported that some older people avoid exposure to forms of assessment that may put them in a category for health and social care services, thereby avoiding "objectification" as a "needy" older person. Such assessments may result in recommending aids or equipment to the individual because of physical problems. This may not be acceptable to some who feel this would then make them look old. However, the consequences of refusing aids and adaptations can be damaging to the individual, their families, and other people they are close to. For example, if individuals seek to compensate for and actively hide disabilities, such as memory loss or hearing loss, they may isolate themselves for fear of being "found out". Such avoidance of help was found by Costley (2008) to be the result of an effort by the old (defined by Costley as ages 69–91) to resist the social stigma of old age. However, an earlier US study by Hackstaff et al. (2004) found that some older people refused services for a myriad of personal reasons, including cost or fear of new people.

Despite the dearth of evidence, there is a clear message that some older people do not want to be seen as the "burdensome" oldest-old, and that this ageist distancing of the third age from the fourth age can be detrimental to an individual's health and wellbeing.

#### **8.7 The Fourth Age**

The lifespan is finite and with added years come the losses and illnesses of old age (Cohen-Mansfield et al. 2013). Whilst these may come at earlier or later stages in one's older years, if people live long enough they will experience them, and they will have to adapt to the changes forced upon them. Lloyd et al. (2014, p. 2) wrote of the "event horizon" that puts one into the fourth age, which is seen as a point of no return: "It is within the power of others—professionals and carers—to determine when an individual has lost the capacity for self-care and management of everyday life and thus makes the transition over the event horizon into the fourth age." In making such a transition, Holstein (2011) suggests that individuals have to reinterpret their lives, as some identities they have will disappear and new identities will appear. However, Chang et al. (2013), in agreeing that frailty, comorbidity, and disability are common major health problems affecting the oldest old, suggested that health promotion strategies, careful management of comorbidities, and targeted strategies to prevent further disability can and should be provided by integrated knowledgeable teams.

In his seminal text, *Why Survive?*, Butler (1975) saw the potential in people considered the oldest old (Achenbaum 2013): "We must ask ourselves if we are willing to settle for mere survival when so much more is possible" (Butler 1975, p. xiii). Butler advocated for interdisciplinary care together with enhancement of older people's resources and resilience whilst attending to the health issues that frequently come with advancing years. He stated that the gains of ageing need to be celebrated because old people are survivors.

Coleman and O'Hanlon (2004) called for more positive meanings to be associated with later life, particularly to overcome cultural failures in supporting people's end of life needs. Jopp et al. (2008) concurred with Butler (1975) in the findings from their study of valuation of life in very old age. The participants in this study were 65–94 years of age (n = 356) and this sample was stratified by gender and age (5-year age groups). They found that despite increasingly negative conditions such as physical and social loss, community dwelling older adults maintain a high attachment to, and value of, life. Jopp et al. (2008) suggested the need for professionals to develop interventions that enhance the positive features of old age and temper the negative, in order that older people may live a satisfying and valuable life, even if not always a healthy one.

Developing the work of Butler (1975), Jopp et al. (2008) and Nicholson et al. (2012) sought to capture the dimensions of social, psychological, and physical frailty among people aged 86–102 (n = 17), but found that participants did not describe themselves as frail and gave examples of resilience and capacity in the face of old declining or failing health status. Nicholson et al. (2012) conceptualized the social identities of the third and fourth age as liminal—passing from one culturally defined state or status to another. They considered the transition between ages to involve three distinct stages: the preliminal, liminal, and postliminal. Liminality is described as a threshold space, a space between social structures that is fluid and allows for the potential redefinition of self-identity. Nicholson et al. (2012) suggested that as their participants simultaneously seemed to be living across the third and fourth ages, then the attributes of people in this space are necessarily ambiguous both in terms of their inner conflicts and also in relation to the provision of services by the welfare state. They concluded that frailty is a persistent liminal state, as there is no movement from one stage to another. Therefore frail older people are continually modifying their identities through the construction of personal habits, routines and stories. In order to allow these individuals to lead long and valuable lives, Nicholson et al. (2012) identified a need for older people and health and social care professionals to find shared meanings and understandings of the continual and shifting state of frailty.

A study by Koch et al. (2007) found that ageism was rife in acute hospital settings and that people in the fourth age were most at risk of losing their dignity, identity, and independence when in contact with health and welfare services. Lloyd et al. (2014) explored the perseverance, adaptation, and maintenance of dignity and identity more generally in the fourth age. They found that the way people dealt with ageing and changed health status was dependent upon their views of themselves, how they could or should present themselves in public places, how others behaved towards them, and how accessible the built environment was. The majority of participants (n = 34) felt negative about ageing, that it was something that happened to them and for which they could not prepare. In contrast to these participants, other studies (Kornadt and Rothermund 2014; Koss and Ekerdt 2016) found that planning and preparatory activities for age-related changes helped and were organized by life domains. These domains differed between preparing for the third age (activities peaking around age 65, focusing on leisure, work, and fitness activities, and appearance) and in preparing for the fourth age (activities continued linearly up to age 80, focusing on independence, housing, and financial issues). These preparatory activities also involved accepting, rather than preventing age-related changes. Koss and Ekerdt (2016) focused specifically on how anticipation of the fourth age influences third age decisions about housing in later life. These authors suggest that given the strong association between the fourth age and residential or nursing home care, that where one lives becomes not only a question of accommodation but also a visible marker of one's location in relation to the third and fourth ages. A study by Ayalon (2014) examining older people's attitudes on admission to living in Community Care Retirement Communities (CCRC) in Israel revealed that these communities were viewed either positively as luxurious hotels, or negatively as the "last stop".

#### **8.8 Age and Disability**

The stress of coping with disability can have a detrimental effect on physiological wellbeing and quality of life, such as increased falls and their association with increased morbidities. In relation to the arbitrary differentiation between the third and fourth age, promoting health becomes even more important when chronic conditions begin to appear and interventions need to be in place to prevent further loss of function (Levy and Myers 2004; Wells 1992). Yet age does not mean disability. In an analysis of the health of centenarians, Hitt et al. (1999) observed that health span equals lifespan. In a later study of American centenarians, Rau and Vaupel (2014) noted a marked delay in disability towards the end of the centenarians' long lives and identified centenarians as models of ageing well. The study concluded that as one approaches the limits of lifespan; diseases (morbidity) must have been delayed (or escaped) towards the end of these longest lived lives. This study illustrated that instead of the aging myth that "the older you get, the sicker you get", it is much more the case that "the older you get, the healthier you've been". These concepts are important when examining ageing discourses and research findings for third and fourth age interventions, and how transition points throughout the life course might be recognized as appropriate mediators in promoting positivity and wellbeing.

#### **8.9 Discussion**

But what does the evidence reveal? A census of the characteristics of fourth agers in England and Wales in 2011 (Office for National Statistics 2013) showed an increase of almost 25% in people aged 85 or over since 2001. The number of centenarians living in the UK has risen by 65% over the last decade, to 14,570 in 2015. In this group, 850 people were 105 years old or older—double that of 2005 (Office for National Statistics 2013). Given that frailty is a defining attribute of the fourth age (Gilleard and Higgs 2011b), it is important to note that in 2010, only 25% of the 85–89 year olds in the UK are classed as frail (Clegg and Young 2011). Later statistics show that in England, for example, 37% of people over 80 are providing 20 h or more of care a week, while 34% per cent are providing 35 h or more (Age UK 2017). This overlap of third and fourth age characteristics blurs traditionally prescribed transitional boundaries. Kydd and Fleming (2015) suggested that it is an individual's periodic vulnerability at any given time that needs to be managed rather than their age. The fourth age can be seen as a celebration. For example, Tornstam (2005, 1989) introduced the concept of "gerotranscendence", which sees ageing as part of a person's life-long development and recognizes how individuals embrace the age they are in at whatever age they are. Koch et al. (2007), recording centenarians' stories, found an alternative to negative stereotyping in these people's strong and resilient sense of self, a finding outlined in earlier work by Kaufman (1986). The respondents were matter of fact about their difficulties and losses, which they considered to be a part of life. The overarching finding was that these centenarians had a sense of self that was strong and resilient (Koch et al. 2007). Similarly, Jopp et al. (2008) highlighted the resilience of the oldest old, and the gratitude and celebration of having lived a long life. Experience of losses and deficits were not a focus for these survivors, but were events in their long lives and in no way extraordinary. This reinforces work by Serra et al. (2011), who referred to this group as the most celebrated and least understood cohort.

An additional consideration of age and disability is the ageing of the younger generation. After the 2008 recession, retirement ages have become more flexible, final salary payments have become rare, and a long paid retirement is not guaranteed. The western world is experiencing changes due to digital technology, reduced unskilled labour, greater consumption of high-calorie, low-nutrient fast foods, higher unemployment, and sedentary lifestyles. Many of these factors have been shown to be contributing to a global rise in obesity and accompanying long-term conditions such as type 2 diabetes, coronary heart disease, and cancer (OECD 2017). As a result, the ageing of this generation is not predicted to be as healthy, long, and well-funded as the ageing of the "baby boomers" (Age UK 2017).

#### **8.10 Conclusions**

Since its definition in the 1960s, ageism has been seen as an uncontested phenomenon. It is both universal and individual, and deleterious, but it is also unpredictable and unique. Age-related changes may be inevitable, but they depend on a range of physical, social, economic, political, and global factors. At any stage in life, health promotion and illness prevention strategies will serve to ameliorate certain conditions, and self-care at any age is necessary for physical, psychological, and spiritual wellbeing.

Although ageing is a natural process, how societies view their older citizens and how old age is viewed by individuals will colour both the way older people are treated and the way they view themselves. Chronological ageing is no longer viewed as an illness, with many older people living well into their fourth age and beyond. However, the ageing trajectory is unpredictable and the insecurities that come from not knowing how one will age can manifest itself in a form of ageism—that of not wanting to belong, or to be seen to belong—to the fourth age. This chapter has explored the concept of old age and discussed the age stratifications of those classed as old. The positive aspects of ageing have been seen in the third agers, who are active, engaged, and pursuing their own interests. This in turn has created the fourth agers—those (erroneously) classed as the dependent old. At some point in a third ager's life, they will reach a point where they need help with their everyday living. This point may be associated with increased loss of physical function, and may be labelled as the point, or the event horizon, at which they enter the fourth age. For this reason, some third agers may strive to avoid entering into this fourth age. For many this is seen as the point of "no return" and signals the end of life. However, when reviewing the literature on centenarians, it would appear that this much feared transition to the fourth age can become a celebration as individuals reach their 100th year. In fact in many societies, the 100th year is seen as a triumph, as it celebrates survival and resilience.

At the heart of this discourse is the fear of the unknown. Many people fear dependency, loss of agency, loss of dignity and death. The experience of very old age is unpredictable and many services are not geared to the needs of the frail old. Perhaps if people felt more supported within their societies, with health and social care services geared to the oldest old, then the fourth age would not be so feared. This is clearly an area for future research.

#### **References**

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## **Chapter 9 Pathways from Ageism to Loneliness**

**Sharon Shiovitz-Ezra, Jonathan Shemesh, and Mary McDonnell/Naughton**

#### **9.1 Introduction**

Europe is seeing unprecedented growth in the ageing population. The World Health Organization projects that from 2000 to 2050, the ageing population over 60 years will triple in size from 600 million to two billion (World Health Organization 2015). As this trend progresses, governments are faced with the ethical and moral imperative to ensure that older persons maintain a high quality of life as they age.

One of the major hazards to older people's well-being is loneliness (de Jong Gierveld et al. 2016). Loneliness is the subjective, unwelcome feeling of lack or loss of companionship (De Jong Gierveld 1998). It is distinguished from social isolation; While the latter reflects an objective social situation characterized by lack of relationships with others (Dykstra 2009), loneliness is a marker of the *quality* of a person's social interactions. As such, loneliness develops when one's social relationships are not accompanied by the desired degree of intimacy (De Jong Gierveld 1998).

In recent years, interest in ageing and loneliness has grown for two primary reasons. First, loneliness is a socially prevalent phenomenon among old people. In a representative sample of British community-dwelling older adults, almost 40%

S. Shiovitz-Ezra (\*)

e-mail<EMAIL_ADDRESS>
J. Shemesh

M. McDonnell/Naughton Department of Nursing and Health Care, Athlone Institute of Technology, Athlone, Ireland

The Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Jerusalem, Israel

The Israeli Gerontological Data Center (IGDC), the Hebrew University of Jerusalem, Jerusalem, Israel

The Israeli Gerontological Data Center (IGDC), the Hebrew University of Jerusalem, Jerusalem, Israel

L. Ayalon, C. Tesch-Römer (eds.), *Contemporary Perspectives on Ageism*, International Perspectives on Aging 19, https://doi.org/10.1007/978-3-319-73820-8\_9

reported experiencing some degree of loneliness (Victor et al. 2005). Similar prevalence rates were found in Finland among a random sample of people aged 75 and over (Savikko et al. 2005). In the United States, Theeke (2007) reports that approximately 17% of the people aged 50 and above reported feeling lonely. Chronic loneliness, afflicting individuals over prolonged periods of time, affects approximately 10% of older people (Harvey and Walsh 2016).

A second reason for the rising interest in late-life loneliness has to do with its detrimental effects to physical and mental health which have been recorded in numerous studies. In a population-based study (CHASRS), loneliness was found to be associated with elevated systolic blood pressure (Hawkley et al. 2006). Moreover, the researchers found loneliness to be a unique predictor of age-related increases in systolic blood pressure (Hawkley et al. 2006). Loneliness was also found to compromise cardiovascular health (Hawkley et al. 2003), and was identified as a significant risk factor for coronary heart conditions (Sorkin et al. 2002; Thurston and Kubzansky 2009). Furthermore, in a study carried out in the Netherlands among 2788 community-dwelling individuals aged between 55 and 85 years, peripheral vascular disease, lung disease, and arthritis were found to be associated with greater loneliness after adjusting for demographic variables and other diseases, such as stroke and cancer (Penninx et al. 1999). A prospective association between loneliness and mortality years later has been repeatedly reported in the literature (Holt-Lunstad et al. 2015; Luo et al. 2012; Shiovitz-Ezra and Ayalon 2010).

Along with its adverse effects on physical health, loneliness is also associated with poor mental health. In both cross-sectional and longitudinal studies, greater loneliness has been associated with higher levels of depression even after taking into account central demographic and psychosocial factors (Cacioppo et al. 2006). Feelings of loneliness are positively associated with psychological distress (Constanca et al. 2006), hopelessness (Barg et al. 2006), serious thoughts of suicide and parasuicide (Stravynski and Boyer 2001), passive death wishes (Ayalon and Shiovitz-Ezra 2011), and negatively associated with emotional well-being (Lee and Ishii-Kuntz 1987).

Several studies, too, have noted the negative association between loneliness and cognition in later life. In a cross-sectional community based study, loneliness was found to be associated with impaired global cognition after adjusting for depression, social network and demographic characteristics (O'Luanaigh et al. 2012). In a longitudinal study conducted in Finland, loneliness at baseline predicted cognitive decline 10 years later (Tilvis et al. 2004). In accordance with these findings, in a prospective study conducted in the U.S., loneliness was found to be a robust risk factor for developing clinical Alzheimer's disease, net of the effect of potential confounders including social isolation (Wilson et al. 2007). More recently, in the English Longitudinal Study of Ageing, loneliness at baseline was found to be associated with poorer cognitive functioning, measured by immediate and delayed recall over a 4-year follow-up (Shankar et al. 2013).

The bio-physiological mechanisms whereby loneliness affects health are not yet well-understood, but growing evidence links loneliness to inflammation and metabolic deregulation. Loneliness was found to be associated with pro-inflammatory cytokine responses. In one study, lonelier participants showed elevated stimulated pro-inflammatory cytokine production in the presence of acute laboratory stress (Jaremka et al. 2013). In another study, loneliness was positively associated with IL-6 responses to acute laboratory psychological stress in an adjusted model that controlled for socioeconomic background and health behaviors among older women (Hackett et al. 2012). Loneliness was also independently associated with elevated HbA1c levels, a bio-marker of metabolic dysregulation (O'Luanaigh et al. 2012).

Considering the high prevalence of late-life loneliness and its deleterious effect on physical, mental and cognitive health, it is critical that we identify the risk factors associated with loneliness earlier in the trajectory of ageing so that appropriate public policy may be put in place to address the issue. One significant, albeit understudied, risk factor for late-life loneliness is *ageism* – stereotypes, prejudice, and discrimination against older persons. Below, we review loneliness and ageism separately. Following, we outline the pathways whereby ageism may contribute to late life loneliness, and bring initial evidence supporting the claims.

#### **9.2 Loneliness**

Loneliness is a subjective marker for deficits in one's social relationships and interactions. These social deficits manifest in terms of both quantity (i.e., limited social interactions or absence of social interactions), and more importantly, quality (i.e., lack of intimacy, reliable alliance, and attachment; De Jong Gierveld 1998; Perlman 2004). Loneliness is characterized as a painful, distressing, and unpleasant experience (Peplau and Perlman 1982) deriving from a perceived discrepancy between desired and actual social connections. According to the cognitive discrepancy model, feelings of loneliness arise when there is a mismatch between what individuals want, need, or desire on the one hand, and their actual social relations on the other hand. Predisposing factors include cultural norms as well as precipitating events such as chronic conditions and widowhood, which become more prevalent in old age and potentially contribute to a gap between one's desired and existing social environment. However, a perceived mismatch does not necessarily entail loneliness. Several cognitive processes of evaluation mediate between the perceived mismatch and feelings of loneliness. These processes include causal attributions, social comparisons, and perceived control. Past experience and the experience of other people in the social environment shape this evaluation process. Therefore, people vary in the way they interpret and react to their social circumstances.

Contrary to other theoretical views of loneliness, such as the social needs approach (represented by Weiss 1973, 1987), the cognitive discrepancy model of loneliness suggests an indirect relationship between objective deficits in one's social network and feelings of loneliness, which is mediated by cognitive processes of perception and evaluation (De Jong Gierveld 1998; Perlman and Peplau 1998; Peplau and Perlman 1982). Therefore, loneliness is only *associated* with deficits in one's objective social situation, but is not synonymous with the circumstances of that situation. For example, people can feel lonely in the company of many others ("lonely in the crowd"), or they can be alone for long periods of time without feeling lonely. Objective isolation does not lead to loneliness when the desired level of social relations is low; being alone is voluntary, or when the social situation is attributed to external factors beyond one's control (Perlman 2004).

Similarly, the evolutionary theory of loneliness (Cacioppo et al. 2015a) views loneliness as an aversive signal deriving from a discrepancy between desired and actual social relationships, which motivates people to socially engage and reconnect. According to this perspective, loneliness plays a key role in the evolution of humanity, because reconnection with others is crucial for survival and reproduction (Goossens et al. 2015). The evolutionary theory argues that loneliness is similar to other biological needs such as hunger, in that it creates significant feelings of discomfort that motivate individuals to take action and extricate themselves from the painful and distressing experience.

Recently, a review of the ontogeny of loneliness has differentiated between environmental triggers of loneliness across the life span (Qualter et al. 2015). It was suggested that as of adolescence, romantic relationships become increasingly important, and that compromised quality of that type of relationship is mostly related to loneliness. This relationship is also evident throughout adulthood, including early adulthood and mid-life, when poor quality of marriage has been found to explain loneliness. Similarly, marital quality and life partnership fulfill needs for belonging in old age. However, at this stage of life these needs are challenged as widowhood, illness, and reduced social activities become sources of loneliness (Qualter et al. 2015).

Previous studies have mostly attempted to attribute late life loneliness to individual (micro) and social network (meso)-level characteristics (Ayalon et al. 2016; Kahn et al. 2003; Shiovitz-Ezra 2013). However, restricted opportunities for meaningful social participation in old age may bring about feelings of loneliness. The following section explores how ageism, including stereotypes, prejudice and discrimination against older persons may lead to late-life loneliness.

#### **9.3 Ageism**

We live in a society that glorifies youth and dreads old age. We are deeply disturbed by the appearance of a new wrinkle adorning our face; we balk at the sight of our ever-expanding forehead gnawing higher and higher at our hairline. Both are reminders of the incontrovertible truth that we are getting older. A 140.3 billiondollar anti-ageing industry capitalizes on these anxieties, selling the public the products – and promise – to hold off wrinkling, blur pigmentation, eliminate excess fat, and restore the growth of youthful hair (Zion Market Research 2016).

But people's concerns about ageing go beyond the cosmetic. The imminent threats of sickness, disability, cognitive deterioration, loss of independence, and death, hang over the prospect of old age. Tremendous efforts on the side of scientists and pharmaceutical companies are made to discover new means to influence the physiological pathways leading to biological ageing, hoping to set back the clock, or at least slow it down. Our relentless efforts to hold off ageing and the sentiments they feed on speak volumes about how we, as a society, regard ageing (one famous gerontologist characterized these sentiments as "dread, discomfort, and denial", Butler 1980, p. 10).

Not only are we disgruntled with our own ageing process, we also harbor ambivalent attitudes towards older people at large. Changes in societal structure over the past few centuries have rendered older adults "marginalized, institutionalized, and stripped of responsibility [and] power" (Nelson 2005, p. 208). The industrial revolution, which brought about increased mobility for workers, also in so doing contributed to the disintegration of the extended family structure. As a result, grandparents no longer lived with their families. In the light of technological advances, older people's work experience became outdated, and their work obviated. Simultaneous advances in medicine extended people's lives, and as the older population grew in size, they came to be regarded as non-contributing burdens on society (Nelson 2005).

A recent large-scale linguistic analysis encompassing two centuries of written American English has found that stereotypes of older adults have grown increasingly negative over the years (having started out slightly positive in the 1800s; Ng et al. 2015). The study found that negativity towards older adults has grown in step with their relative share within society, presumably due to concerns of the younger generation that older adults act as a drain on economic resources (Ng et al. 2015). Complicating matters still, these concerns are not completely unfounded; with fertility rates falling and lifespans extending in recent years, the retired population is growing larger and larger in proportion to the employed sector, and it is expected that care for older adults – formal and informal – will impose a heavy cost on society (Suzman and Beard 2011).