Background
As “one of the most salient social categories” [
51, p. 477], age activates a variety of societally shared beliefs about older people, their attributes, behavior, competencies and desires, also referred to as
old age stereotypes. By exaggerating the extent to which older people resemble each other, stereotypes both homogenize them and separate them from other social groups [
4]. It has been shown that individuals in all age groups hold both positive and negative stereotypes of older people [
20]. Positive stereotypes depict them, for example, as warm-hearted, loyal, or reliable [
3]; however, negative stereotypes have been repeatedly found to predominate [
2,
3,
27,
44,
51]. Common negative stereotypes about older people include their suffering from poor health and loneliness, physical and cognitive incompetency, unproductivity and unattractiveness [
2,
3,
9,
44].
Previous research reported adverse effects of age stereotypes on developmental outcomes including physical and cognitive performance [
24], objective as well as subjective health [
26,
52], and mortality [
25]. Old age stereotypes also influence behavior, expectations, and judgements of people towards older individuals [
2,
3,
27]. Due to ageist attitudes, “older people may be judged as inferior to middle-aged adults in terms of power and social status, wealth, respect, and influence” (age-based social status, [
47, p. 650]). Perceptions of a typical older person being disengaged from “positions associated with prestige and respect” [
38, p. 531] have led to an image of older people having no active or necessary role in society [
15], even posing an economic burden on society [
29]. While this deficit-oriented perspective has been challenged by a number of positive aging models that emphasize the potentials of older people, such as
successful [
39],
active [
17], or
productive aging [
6], critics argue that these concepts include all the more prescriptive stereotypes. By posing demands on older people to contribute, they put those with lacking options or motives to do so at risk of negative judgement (e.g., [
46]).
In line with the distinction between inner valuation and external worth (utility) of an individual’s life as two kinds of life results [
48], we expect external evaluations to constitute a crucial part of older individuals’ quality of life [
31,
48,
50]. Building the framework of our paper, the challenges and potentials (CHAPO) model of quality of life of the very old [
50] considers societal standards a resource for or threat to individual quality of life (QoL). Correspondingly, one’s perceived recognition and position within society is regarded as an individual life result [
50]. Specifically, it targets very old individuals’ perceptions of being needed by society vs. being treated as a burden to society. Feeling needed has been shown to be a crucial part of purpose in life [
8] as well as positive life orientation [
45], both being linked to mortality. Moreover, literature on perceived burdensomeness reports that it is related to suicidal ideation severity as well as suicide attempt history [
7].
In today’s western societies, with their strong orientation towards youth and performance [
2], people in very old age, as distinguished from the so-called
young old [
32], are expected to be particularly confronted with lacking societal acceptance [
11]; however, there are no representative analyses of perceived societal appreciation in very old age, and individual factors contributing to (not) feeling societally appreciated in very old age remain unclear. Against the background described above, the stereotypes about very old people prevailing in their environment are a promising contextual information for a more thorough understanding of perceived societal appreciation in very old age and its predictors. Therefore, the aim of the current paper is threefold:
First, the present article analyzes the subjectively perceived societal appreciation (PSA) of people in very old age (VOA) in the German federal state of North Rhine-Westphalia, as well as individual factors predicting PSA. Due to the prescriptive stereotypes promoted by current concepts of positive aging and the stigma attached to older people’s alleged inability to contribute to the economic power of the country [
47], we expect individuals to feel more appreciated if they lead an
active or engaged life (e.g., volunteering). In addition to aspects of their current lifestyle, we are interested in whether
past achievements (child education; social status as a result of education and professional biography) are similarly significant to PSA in very old age. Lower socioeconomic status has been found to be associated with experiences of age discrimination [
14,
37]. Moreover, we expect
health-related indicators (e.g., number of chronic diseases, cognitive status, care dependency) to be crucial to PSA as they co-determine options of engagement and are known to carry a discernible stigma [
41]. Functional limitations have also been found to be related to experiences of age discrimination [
14]. In light of the double standard of aging (e.g., [
5]) and the fact that women have been shown to be more likely to attribute experiences of discrimination to their age than men [
14], we consider
gender as another possible predictor of PSA. Finally, we consider
age, which should not only intuitively be an important predictor but has been shown to be the primary driver of perceived age discrimination [
13].
Second, we describe stereotypes about people in VOA held by stakeholders from key societal areas in North Rhine-Westphalia. Due to their position, they contribute to the normative age climate, and very old people’s opportunities within their environment.
Third, the present paper discusses the results of both studies and their possible connections. To our knowledge, this is the first study to use information on the societal values towards very old people and very old people’s perceived appreciation by society to complement each other as an example of the relation between external standards and individual life results, according to the CHAPO model.
Discussion
In our quantitative study, we found that PSA was primarily predicted by health-related variables along with aspects of an engaged lifestyle. Other aspects of the person and their biography were not shown to be relevant in the multivariate analysis, indicating that older people’s perceived external appraisal depends on their current condition and performance, irrespective of their previous path of life. Gender not showing a significant effect on PSA could be explained by the fact that the model controls for level of engagement, as traditional role expectations demand more caring behavior from women than from men. This possible interaction effect was not investigated in our model and could be a matter for future research on societal appreciation in very old age; however, not all productive activities had positive effects. Financial and emotional support as well as family caregiving each had a negative effect on one of the PSA dimensions. This might be explained by emotional support being perceived as less
measurable or
profitable than instrumental, and financial support as well as caregiving being in many cases unavoidable or concealed acts within the closest family. The adverse impact of caregiving is in line with abundant evidence of caregiver burden and various negative consequences of family caregiving [
1].
The qualitative analysis showed that societal stakeholders shared similar overarching perceptions of people in VOA, but differed in more detailed perceptions, and in how they contextualized and interpreted certain perceptions. In general, stakeholders working in direct interaction with (very) old people drew a more differentiated picture of VOA-related losses (e.g., adverting to positive implications of losses), and expressed a more positive view on very old people. They showed higher awareness of the impropriety and danger of negative stereotypes about people in VOA, and repeatedly pointed to shortcomings in societal treatment of very old people. In contrast, stakeholders whose work did not primarily include direct contact with (very) old people tended to adopt a societal perspective. They primarily saw disadvantages in very old people’s
otherness, addressed challenges and burdens arising with population aging, and tended to expect that very old people’s remaining resources are, and should be, used for the benefit of others. The observed differences between these groups of stakeholders are consistent with previous research reporting that closer contact to older people leads to more differentiated, and positive beliefs of them [
3].
2 Moreover, it is striking that since the official identification of younger audiences as the advertising-relevant target group by a German private transmitter in the 1990s [
30], little has changed about the industry’s perceptions of older people despite an aging society. This result is in line with various content analyses reporting underrepresentation of older people in the media (e.g., [
28]).
The views of the latter group of stakeholders mirror the relevance of physical and functional health and an engaged lifestyle to PSA found in our quantitative study. There are several pathways through which this correspondence might come about.
First, individuals are expected to be aware of the stereotypes about them held by others, and to rely on these when predicting the opinion of others about them [
10,
34,
49]. Hence, our results about determinants of PSA imply that very old people perceive less differentiated and more negative stereotypes as more representative of societal notions. This is consistent with numerous findings that negative stereotypes prevail in western societies [
2,
3,
27,
51].
Second, stereotypes lead to certain behavior culminating in stigmatization and discrimination [
2,
27]. Observing verbal and nonverbal behavior of others helps to determine how one is viewed by them [
10]. Against this background, our results indicate that those with more health-related losses and those unable or unwilling to engage in certain activities experience worse societal treatment. This highlights that age-related stereotypes and their manifestations are most often not only ageist, but also ableist. They consider older people to be of less value because they are sick, dependent, and therefore unproductive [
18]. Norms of achievement and social utility, which are typical for midlife, are projected on the last phase of life, with discriminatory effects on those who do not or cannot fulfil them [
11,
18,
46].
Finally, there is overwhelming evidence that through processes of internalization, individuals integrate stereotypes held about them into their self-image [
3,
51,
53]. Being another source for estimating how one is seen by others, an adverse self-image due to exposure to negative stereotypes will reinforce the expectation to be judged negatively [
10]. Moreover, internalized beliefs influence older people’s behavior and, in turn, reinforce others’ perceptions of them. This also points to the concept of “doing age”, which describes age as a social construction resulting from a process of social ascriptions and interactive demonstrations, which influences the image of older people held by others, but also held by older people themselves [
42].
Summing up, societal attitudes towards the very old population and perceived societal appreciation in VOA might relate to each other in different ways that are not mutually exclusive, but likely interdependent. This illustrates the relevance of external standards and normative stipulations for individual QoL as presumed by the CHAPO model of QoL of the very old [
50], and highlights the need for a normative perspective in the discussion about QoL and possible measures for its enhancement.
Limitations and future research
In our qualitative study, we sampled representatives of markedly different areas. Although this might seem problematic for the drawing of overarching conclusions, a heterogeneous sample captures a wide range of perspectives on the topic of interest and is therefore an important strategy to approach conceptual (not statistical) representativity (maximum variation sampling, [
43]). We believe that the heterogeneity of our sample was necessary to capture the perspectives of an extensive range of societal stakeholders in order to identify common themes but also uniqueness that differentiate them from each other [
43].
Moreover, we did not calculate intercoder reliability (ICR) in our qualitative study, although it is frequently recommended and can enhance rigor and transparency of the coding frame; however, its use is not uncontroversial among qualitative researchers nor appropriate for every qualitative study (for a synopsis of arguments in favor of and against ICR, see [
33]). In our case, the calculation of ICR did not seem reasonable as intersubjective congruence in the explorative, consensual construction of categories cannot be postulated [
35, p. 102–103]. Rather, the process gains from discussion between coders, which ensures the tapping of the full creative potential of the team [
33,
35].
Note that our study design naturally did not allow for causal conclusions. Nonetheless, we aimed to give some thoughts about the possible connection of the observed stereotypical beliefs and very old people‘s perceived societal appraisal. Following this initial approach to merging societal and individual perspectives on very old people and their value in society, future research could further entangle both levels, e.g. by considering individuals’ different degrees of exposure to relevant societal forces.