. 2023 Dec 15;18:2093–2116. doi: 10.2147/CIA.S396833

Table 1.

Articles

Reference	Data Source and Study Design	Sampling Method and Sample Characteristics	Aging Stigma Variable	Health Variable	Main Findings Relevant to Aging Stigma and Health
Experimental Studies
Barber & Mather³⁸	2 experiments Both with 2 arms stereotype threat control (anti-stereotype threat) Health task data	Convenience samples recruited in California Exp 1: N=31 Ages 63–78, mean 70.4 Exp 2: N=64 Ages 61–86, mean 70.9	Exposure to stereotype threat related to memory and age Exp 1: fictitious news articles describing research confirming that memory declines with age³⁹ Exp 2: instructions indicated interest in age differences in memory, previous findings on age-based differences in memory, and had participants state their age aloud	Cognition: word recall (Exp 1 and 2), recognition tests (Exp 2)	Stereotype threat associated with Mixed findings for memory-worse recall (Exp 1) but no difference in recognition accuracy (Exp 2) Lower proportion of memory errors (Exp 1 and 2) Better recall of items with penalties initially but difference not sustained. No differences in recall of items with rewards (Exp 2)
Barber et al⁴⁰	4 arms Stereotype threat and rewards Stereotype threat and penalties Control & rewards Control & penalties (control=anti-stereotype threat) Comparisons within and between participants Health task and self-reported survey data	Convenience sample from California N=80 Ages 61–80, mean 69.5	Exposure to stereotype threat related to memory and age Fictitious news articles describing research confirming that memory declines with age³⁹ Told study designed to confirm that memory declines with age Told own age puts participant at the older end of age range being tested	Psychological wellbeing (anxiety, positive and negative affect) Memory & cognition: word recall-4 and recognition tests	Stereotype threat associated with Greater short-term anxiety No differences in affect Cognitive & recall impairments in presence of rewards but not penalties Memory & cognition not mediated by perceived age stereotype threat or anxiety
Brubaker & Naveh-Benjamin⁴¹	2 experiments Exp 1 with 4 arms Stereotype threat-older adults Nonthreat-older adults Stereotype threat-young adults Nonthreat-young adults Exp 2 with 2 arms Control-older adults Control-young adults Comparisons within and between participants	Convenience samples from Missouri Exp 1: Older adult subsample N=60 Ages 65–87, mean 72.5 Young adult subsample N=60 Ages 18–25, mean 19.5 Exp 2: Older adult subsample N=40 Ages 65–86, mean 74.0 Young adult subsample N=40 Ages 18–23, mean 18.8	Exp 1: Exposure to stereotype threat related to memory and age Instructions indicated interest in age differences in memory and previous findings of age-related declines in memory⁴² Exp 2: No exposure to explicit stereotype threat or nonthreat Instructions did not discuss age at all	Cognition: word and image item recall, associative (pairings), and recognition tests	Stereotype threat associated with Worse associative memory and more errors among older adults (Exp 1) No differences in item recall and errors (Exp 1) Pattern documented in stereotype threat conditions both explicit (Exp 1 threat condition) and subtle (Exp 2 control, with no priming but context potentially activating stereotype threat)
Hess et al⁴³	4 arms Negative primes and high accountability Negative primes only Positive primes and high accountability Positive primes only Self-reported survey data collected before aging stigma exposure, physiologic and health task data collected after	Convenience sample from North Carolina N=144 Ages 65–85, mean 72	Priming with positive or negative aging stereotype via forming impressions of pictures and vignettes of happy or sad/grumpy older adults⁴⁴ Expectations Regarding Aging (ERA-12) scale⁴⁵	BP Heart rate Cognition: letter recognition	Negative stereotype primes and high accountability associated with elevated systolic BP initially but not sustained Negative aging attitudes associated with elevated systolic BP among those with high intrinsic motivation Positive stereotypes not associated with systolic BP All aging stigma variables not associated with diastolic BP, heart rate, and memory
Krendl et al⁴⁶	6 arms Threat before encoding-older adults Threat before retrieval-older adults Control-older adults Threat before encoding-young adults Threat before retrieval-young adults Control-young adults Health task data collected after aging stigma exposure	Convenience sample recruited from Boston Older adult subsample N=92 Mean ages 75.1 Young adult subsample N=77 Mean age 19.1	Subliminal priming with negative aging stereotypes in the form of brief exposure to negative age-related stereotype words masked by a string of consonants	Cognition: word encoding and retrieval (recognition)	Negative stereotypes associated with Impaired memory accuracy among older adults when threat occurred prior to retrieval activity (vs prior to encoding or not at all) Increased memory errors among older adults when threat occurred prior to retrieval activity (vs not at all)
Molden & Maxfield⁴⁷	5 arms Mostly positive stereotypes Half positive/half negative stereotypes Mostly negative stereotypes All negative stereotypes No stereotypes control Comparisons within and between participants Self-reported survey data collected at baseline and following aging stigma exposure	Convenience sample from western US N=80 Ages 61–90, mean 71.7	Priming with different proportions of positive and negative age-related stereotype words⁴⁸ prior to memory assessments	Psychological wellbeing (dementia anxiety, positive and negative affect)	Negative stereotypes associated with Higher levels of dementia worry (higher proportions of negative stereotypes associated with more dementia worry than mixed, more positive, and control) Especially when stereotypes were self-relevant (own age ≥ self-identified lower threshold of old age) Not associated with change in affect
Popham & Hess⁴⁹	4 arms Positive stereotypes-older adults Negative stereotypes-older adults Positive stereotypes-young adults Negative stereotypes-young adults Health task data collected following aging stigma exposure	Convenience sample from North Carolina Older adult subsample N=62 Ages 65–83, mean 71 Young adult subsample N=64 Ages 18–23, mean 19	Exposure to stereotype threat related to cognitive tasks and age (older adults only) Instructions indicated interest in age differences in cognitive tasks, previous research findings that young people perform better than older adults, and asked to indicate age Exposure to stereotype threat related to academic discipline (young adults)	Cognition & memory: regulatory focus (speed/ accuracy in letter-canceling task), working memory tasks	Negative aging stereotypes associated with Poorer regulatory focus due to slower task speed Fewer errors No difference in working memory
Smith et al⁵⁰	4 arms Stereotyped & warned Stereotyped, not warned Not stereotyped, warned Control (not stereotyped or warned) Health task data collected following aging stigma exposure	Convenience sample from Massachusetts N=166 Ages 56–90, mean 70.6	Exposure to stereotype threat in the form of written passage on age-related declines in memory⁵¹	Cognition: (recognition test) with and without warning about deceptive nature of recognition test	Aging stereotypes associated with More likely to make some types of errors but not others Employment status and education moderated associations Warnings did not reduce errors, perhaps due to other moderators
Tan & Barber⁵²	3 arms Stereotype threat Stereotype alleviation Intervention: prior to stereotype threat, read passage on Confucian filial piety values instilled in Chinese American young people Health task data collected following aging stigma exposure Data collected: 2016–2017 **also Intervention Study	Convenience sample of culturally Chinese adults from California N=114 Ages 55–84, mean 68.5	Exposure to stereotype threat in the form of instructions indicating interest in age-related memory decline, comparison to younger adults, and asked to indicate age prior to memory test (stereotype alleviation indicated test “age-fair”).	Cognition: word recall	Stereotype threat alone associated with Poorer memory performance compared to stereotype alleviation and intervention prior to threat arms (latter two did not differ)
Thomas et al⁵³	2 experiments Both with 4 arms Stereotype threat-older adults No threat-older adults Stereotype threat-young adults No threat-young adults Health task data collected following aging stigma exposure	Convenience samples from Massachusetts Exp 1 Older adult subsample N=62 Mean age 73.5 Young adult subsample N=61 Mean age 19.4 Exp 2 Older adult subsample N=66 Mean age 72.6 Young adult subsample N=66 Mean age 20.7	Exposure to stereotype threat in the form of written passages reporting fictitious research that memory declines with age⁵¹	Cognition: recall (Exp 1 and 2), working memory-letter recall and math (Exp 1)	Stereotype threat associated with Less accurate recall when able to skip questions among older adults (exp 1) but opposite or null effect among older adults under more challenging circumstances (exp 2) No differences in working memory among older adults (exp 1)
Intervention Studies
Geraci et al⁵⁴	2 experiments Exp 1 with 3 arms Intervention: verbal task success Intervention: picture task success Control (no success task) Exp 2 with 2 arms Intervention: motor task success Control (no success task) Health task and self-reported survey data	Convenience samples from Texas Exp 1: n=90 Ages 64–89, mean 73.5 Exp 2: n=56 Ages 65–90, mean 74.1	Implicit stereotype threat activation, as reflected in lexical decision task assessing speed forming words representing positive aging stereotypes, negative ones, and neutral words Stereotype threat questionnaire⁵⁵	Cognition: word recall	Successful verbal and picture task completion, but not motor, were associated with higher subsequent recall, but this relationship was not mediated by stereotype threat activation or self-reported stereotype threat
Levy et al⁵⁶	7 arms Intervention: pairing negative and positive age stereotyped content with personified and enumerative information Control: neutral content Self-reported survey data collected following intervention Data collected: 2020	Convenience sample of us residents from Lucid and Mturk online platforms Older adult subsample n~763 Ages 65–106, mean 70.2 Younger adult subsample n~827 Ages 18–64, mean 39.7	Intervention: messaging about real-life news stories published during COVID-19 pandemic. First vignette reflected content with negative age stereotypes, positive age stereotypes, or neutral (not about older adults) and personified information (stories about older adults). Second vignette reflected negative/positive/neutral content and enumerative information (statistics about older adults)	Psychological wellbeing (anxiety, peacefulness)	Negative age stereotypes intervention associated with: More anxiety among older adults Less peacefulness among older adults Positive age stereotypes intervention associated with: Less anxiety among older adults More peacefulness among older adults Personified & enumerative interventions with comparable associations with health variables
McDougall et al⁵⁷	2 arms Intervention: senior wise memory training Control: health promotion curriculum Health task and self-reported survey data collected at baseline, 2- (post-intervention), 6-, 14-, and 26-month follow-up	Convenience sample from Texas N=265 Ages ≥65, mean 75 at baseline	Intervention: senior wise memory training designed to build self-efficacy and reduce aging memory stereotype threat Measure: stereotype threat related to memory/cognition and age measured using proxy of anxiety subscale of metamemory in adulthood questionnaire (MIA⁵⁸)	Cognition: tests of verbal, visual, and everyday memory Functional health (instrumental activities of daily living)	Stereotype threat at baseline associated with Poorer baseline verbal memory, lower memory self-efficacy Not related to changes in memory or functional health over time Intervention associated with Decline in stereotype threat Stereotype threat change over time associated with Verbal memory improvement in intervention group in stratified analyses but not moderation analyses (memory–arm interaction)
Menkin et al⁵⁹	4 arms Intervention: reduce negative age stereotypes message Intervention: promote positive growth or maintenance with age message Intervention: emphasize diversity of aging across domains message Control: anti-aging stigma messages received post data collection Self-reported survey data collected immediately following intervention	Convenience sample from California & Illinois N=349 Ages 50–92, mean 72	Intervention: brief anti-aging stigma messages Measures: Views of aging (AgeCog physical losses and ongoing development subscales⁶⁰)	Motivation to attend physically active programs Motivation to attend other senior center activities (social, creative, cognitively engaging)	Anti-aging stigma intervention associated with Greater motivation for physical activities among ages >71 only Greater motivation for other activities among ages ≥84 Lower motivation among ages ≤64 Findings strongest among promote positive message arm No difference in views of aging
Tan & Barber⁵²	3 arms Stereotype threat Stereotype alleviation (control) Intervention: prior to stereotype threat, read passage on Confucian filial piety values instilled in Chinese American young people Health task data collected following exposure to aging stigma Data collected: 2016–2017 **also experimental study	Convenience sample of culturally Chinese adults from California N=114 Ages 55–84, mean 68.5	Exposure to stereotype threat in the form of instructions indicating interest in age-related memory decline, comparison to younger adults, and asked to indicate age prior to memory test (stereotype alleviation indicated test “age-fair”).	Cognition: word recall	Stereotype threat alone associated with Poorer memory performance compared to control and those receiving intervention prior to threat (latter two did not differ)
Quantitative Studies
Andrews et al⁶¹	Longitudinal study with data from Baltimore Experience Corps randomized controlled trial of volunteering at elementary schools vs elsewhere Self-reported survey collected at baseline, 1- and 2-year follow-up	Convenience sample from Maryland N = 446 Ages ≥60, mean 66.2 at baseline	Expectations Regarding Aging (ERA-12) scale⁴⁵ with 3 subscales: physical health, mental health, cognitive functioning	Physical activity: minutes/week of moderate and vigorous physical activity	ERA & physical activity over 2 years not associated in mixed sex analyses controlling for covariates and arm. More positive ERA associated with more physical activity among women but not men in stratified analyses but not moderation analyses (ERA–sex interaction) More positive ERA physical health subscale scores associated with more physical activity ERA mental health and cognitive functioning subscales not associated with physical activity ERA-physical activity relationship not moderated by time
Han⁶²	HRS Self-reported survey Longitudinal data collected: 2008, 2010, 2012	Subsample from nationally representative sample N=3382 Ages 65–96, mean 73.8 at baseline	Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³	Psychological wellbeing (depressive symptoms) Chronic health conditions Functional health (limitations)	Negative aging attitudes at baseline (T1) associated with Greater functional limitations (T2 only) and more depressive symptoms (T2 & 3) over time Stronger association between chronic illnesses (T1) and later depressive symptoms (T2 only) (moderation) Not associated with differences in association between chronic illnesses (T1) and later functional limitations (T2 & 3) (moderation)
Levy et al⁶⁴	Precipitating Events Project Longitudinal self-reported interview data (baseline) and home assessments (every 18 months) for 129 months Data collected: 1998–2008	Convenience sample from Connecticut with no limits to activities of daily living at baseline and some disability at follow-up N=598 (79.3% of cohort) Ages ≥70 at baseline	Nature of age stereotypes based on free response descriptors of old people (scores dichotomized as positive/negative relative to mean)⁶⁵	Functional health (activities of daily living)	Negative age stereotypes at baseline associated with Faster rate of decline in activities of daily living Lower likelihood of recovery from disability
Levy et al⁶⁶	National Health and Resilience in Veterans Study Longitudinal self-reported survey data Data collected: 2011, 2013, 2015, 2018	Nationally representative sample of US armed forces, reserves, and National Guard veterans N=1373 Ages 55–96, mean 68 at baseline	Expectations Regarding Aging (ERA-3) scale⁴⁵^,⁶⁷ Palmore’s Ageism Survey⁶⁸ Age attribution-attribute bad health events to age⁶⁹	Chronic pain	Negative age stereotypes at baseline associated with Chronic pain (higher incidence, likelihood of having, and earlier development) Age stereotype-chronic pain association fully mediated by age attribution More reported age discrimination associated with chronic pain
Levy et al⁷⁰	Precipitating Events Project Longitudinal self-reported survey data (baseline and 10 years later) and hospitalization and stressful bereavement data (monthly interviews)	Convenience sample from Connecticut N=231 Ages ≥70, mean 76 at baseline	Nature of age stereotypes based on free response descriptors of old people⁶⁵	Hospitalization Psychological wellbeing (stressful bereavements) **health as independent variable	Hospitalization associated with No change in negativity of age stereotypes Stressful bereavements associated with No change in negativity of age stereotypes Negative age stereotypes associated with Greater likelihood of hospitalization over 10 years
Levy et al¹¹	Integration of: Systematic review and meta-analysis to predict impact of ageism on 8 health conditions Health condition prevalence and healthcare spending in 2013	Predictions applied to US adult population ages ≥60	Ageism, captured with 3 measures: Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³ Expectations Regarding Aging (ERA-3) scale⁴⁵ Everyday Discrimination scale attributed to age⁷¹	Healthcare costs Chronic health conditions	Ageism associated with $63 billion in excess US healthcare costs during 2013 17 million cases annually in excess US health conditions
Levy et al⁷²	HRS Longitudinal self-reported survey data (2008/2010), cognitive assessments (every 2 years for 4 years), and salivary APOE ε4 biomarker (2006/2008)	Subsample from nationally representative sample without dementia at baseline N=4765 Ages ≥60, mean 72 at baseline	Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³	Cognition: assessment and APOE ε4 gene (associated with increased dementia risk)	Negative age beliefs at baseline associated with Greater likelihood of developing dementia over 4 years Greater likelihood of developing dementia among those with APOE ε4 gene
Levy et al⁷³	HRS Longitudinal self-reported survey data (2008/2010), cognitive assessments (every 2 years for 8 years), and salivary APOE ε2 biomarker (2006/2008)	Subsample from nationally representative sample N=3895 Ages 60–97, mean 71.1 at baseline	Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³	Cognition: cognitive assessment and APOE ε2 gene (associated with better cognition)	Negative age beliefs at baseline associated with Worse cognition Suppressed benefit of APOE ε2 gene biomarker for cognition (moderation analysis) Greater effect size on cognition than biomarker
Levy & Slade⁷⁴	HRS Longitudinal self-reported survey data and cognitive assessments every 2 years from 2008–2020	Subsample from nationally representative sample N=1716 Ages ≥65, mean 77.8 at baseline	Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³ (scores dichotomized as positive/negative relative to median)	Cognition (mild cognitive impairment)	Negative attitudes toward aging at baseline associated with Lower likelihood of recovery from baseline cognitive impairment, regardless of severity Slower cognitive recovery Higher prevalence and risk of developing mild cognitive impairment during 12-year study period
McDarby et al⁷⁵	Cross-sectional mixed methods study embedded within larger longitudinal study Brief semi-structured qualitative interviews and quantitative self-reported survey data Data collected: 2021 **Also Qualitative Study	Convenience sample from Midwestern US N=73 Ages 65–89, mean 73.3	Ratings of offensiveness, caring for older adults, pity for older adults, and attribution to age for 1) media coverage related to older adults and pandemic (including exposure to 5 stories exemplifying potential aging stigma); and 2) examples of age-focused behaviors Interview questions probing perceptions of media portrayals of older adults during COVID-19 pandemic, influence of media and pandemic on health concerns and own/others’ focus on participants’ age	Psychological wellbeing (quality of life) Adherence to COVID public health recommendations	Differential treatment related to age and media messaging related to COVID-19 pandemic and older adults, sometimes interpreted as benevolent ageism Appreciated by some and offensive to minority (qual and quant) Increase awareness of age (own/others’) made feel Older, “othered”, salience of mortality, appreciate/enjoy life more (qual) Media attention on older adults and pandemic made feel Vulnerable to illness, invisible and stereotyped, persevere with life despite public health/other recommendations, which disregarded (qual)
Steward & Hasche⁷⁶	HRS Self-reported survey data Cross-sectional data collected: 2016	Nationally representative community residing sample N=4561 Ages≥50, mean 67.7	Self-perceptions of aging, as indicated by adapted Attitudes Towards Own Aging scale from the Philadelphia Geriatric Center Morale Scale⁶³ & Berlin Aging Study⁴⁴	Physical activity, frequency **health as independent variable	Exercise associated with Less negative perceptions of aging Relationship partially mediated by personal agency
Voelkner & Caskie⁷⁷	Health task data and both self-reported survey data Cross-sectional data collected: 2019	Convenience sample of US residents from MTurk online platform N=215 Ages 66–90, mean 69.1	Awareness of Age-Related Change scale (AARC-50⁷⁸) across 5 domains including cognition Palmore’s Ageism Survey⁶⁸	Cognition: perceived functioning, immediate and delayed recall tasks, inductive reasoning (3 tasks) **health as independent variable	Better memory associated with Lower perceived age-related losses (overall and cognitive) Experiences of aging stigma did not mediate Better reasoning associated with Lower perceived age-related losses (overall and cognitive) Lower perceived age-related gains (overall and cognitive) Experiences of aging stigma mediated association with losses but not gains
Qualitative Studies
Makris et al⁷⁹	Precipitating Events Project Semi-structured interviews (n=23) and focus groups (n=16)	Convenience sample of adults with restricting back pain from Connecticut & New York N=93 Ages ≥ 65, median 83	Belief that restrictive back pain is inevitable with age held by participant (internalized aging stigma) and/or healthcare providers (ageist prejudice and discrimination)	Motivation to seek healthcare Use of treatments Chronic pain and restrictions	Prejudices about the age-related inevitability of back pain (self and provider) associated with Limited motivation to seek healthcare and/or use treatments, resulting in ongoing chronic pain and restrictions
Mayo et al⁸⁰	Semi-structured focus groups (n=2) Data collected: 2019	Convenience sample from New England N=27 Ages 60–86 Stratified by generation-baby boomer (N=17) and silent (N=10)	Perceptions of aging stigma and its harms	Use of medical care Psychosocial wellbeing (quality of life, social isolation, self-esteem)	Aging stigma associated with Negative public and personal health outcomes such as poor quality and avoidance of medical care, social isolation, poor self-esteem, anxiety about dependence and loss, disrespect
McDarby et al, 2022⁷⁵	Cross sectional mixed methods study embedded within larger longitudinal study Brief semi-structured qualitative interviews and quantitative self-reported survey Data collected: 2021 **Also Quantitative Study-Cross Sectional	Convenience sample from Midwestern US N=73 Ages 65–89, mean 73.3	Interview questions probing perceptions of media portrayals of older adults during COVID-19 pandemic, influence of media and pandemic on health concerns and own/others’ focus on participants’ age Ratings of offensiveness, caring for older adults, pity for older adults, and attribution to age for 1) media coverage related to older adults and pandemic (including exposure to 5 stories exemplifying potential aging stigma) and 2) examples of age-focused behaviors	Psychosocial wellbeing (quality of life) Adherence to COVID public health recommendations	Differential treatment related to age and media messaging related to COVID-19 pandemic and older adults, sometimes interpreted as benevolent ageism Appreciated by some and offensive to minority (qual and quant) Increase awareness of age (own/others’) made feel Older, “othered”, salience of mortality, appreciate/enjoy life more (qual) Media attention on older adults and pandemic made feel Vulnerable to illness, invisible and stereotyped, persevere with life despite public health/other recommendations (qual)
Wallhagen, 2010⁸¹	Longitudinal dyadic study In-depth interview data collected at baseline, 3- and 12-month follow-up	Convenience sample of older adults from California with hearing loss and communication partners N=91 dyads at baseline Older adult subsample ages 60–93, mean 73 Partner subsample ages 19–92, mean 64.2	Perceived stigma of hearing loss associated with old age Internalized aging stigma Hearing loss/aging stigma reinforced by healthcare providers, partners, and hearing aid marketing	Seeking of healthcare and assistive devices (hearing test, hearing aids) Use of hearing aids Psychosocial wellbeing (quality of life related to disability, self-esteem)	Stigma of age-related hearing loss associated with Resistance & delays in getting hearing tested Less likely to obtain hearing aids Underuse of hearing aids Reduction in quality of life (discomfort with identification as disabled, deterioration, self-esteem)

Note: Studies representing more than one study type listed in all relevant sections.

Abbreviations: BP, blood pressure; HRS, Health and Retirement Survey.