The Ageing Experience: Perceived age discrimination and self-perceptions of ageing in the ...

274 Pages·2016·2.42 MB·English

by  Isla Rippon

The Ageing Experience:
Perceived age discrimination and self-perceptions of ageing
in the English Longitudinal Study of Ageing (ELSA)

Isla Rippon

Thesis submitted to University College London for the Degree of
Doctor of Philosophy

Department of Epidemiology and Public Health
University College London
2016
Declaration of authorship

I, Isla Rippon confirm that the work presented in this thesis is my own. Where
information has been derived from other sources, I confirm that this has been indicated
in the thesis.

Signed …………………………..

Isla Rippon

Date ……………………………….

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Abstract

An ageing population has important implications for wider aspects of society including
our own perceptions of and attitudes to ageing. This thesis investigated how perceived
age discrimination and self-perceptions of ageing may affect wellbeing at older ages.
Using data from the English Longitudinal Study of Ageing (ELSA), Study 1
investigated the association between perceived age discrimination and socio-
demographic characteristics in England. The results indicated that around a third of
over 52 year olds in England reported perceptions of age discrimination. Perceived age
discrimination was associated with older age, and it was associated with higher levels
of education, lower levels of household wealth and lack of paid employment. The
second study then went on to compare perceived age discrimination in everyday
situations in England and the USA, using data from ELSA and the Health and
Retirement Study (HRS). The results indicated that perceived age discrimination was
higher in England in comparison with the USA (34.8% vs 29.1%).
Study 3 revealed that self-perceived age predicted all-cause and cardiovascular
mortality but not cancer mortality over a follow-up period of 99 months. The strength of
the association was reduced once existing health problems, functional limitations and
health behaviours were accounted for. There was some evidence to indicate that there
was a bi-directional association between self-perceived age and functional capacity
and emotional health (Study 4). In the fully-adjusted models, self-perceived age was
associated with elevated depressive symptoms and limited ADLs four years later, but
not with impaired mobility. Conversely, only impaired mobility was associated with self-
perceived age four years later, once all covariates were accounted for.
Key implications for future research and policy include addressing our own and
societal attitudes towards ageing. The findings of this thesis indicate that there is scope
to change this and that interventions may be possible.

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Publications

Peer reviewed papers resulting from this thesis

Rippon, I., Zaninotto, P., & Steptoe, A. (2015). Greater perceived age discrimination in
England than the United States: results from HRS and ELSA. The Journals of
Gerontology Series B: Psychological Sciences and Social Sciences, 70(6), 925-933.

Rippon, I., & Steptoe, A. (2015). Feeling old vs being old: associations between self-
perceived age and mortality. JAMA Internal Medicine, 175(2), 307 - 309.

Rippon, I., Kneale, D., De Oliveira, C., Demakakos, P., & Steptoe, A, (2014). Perceived
age discrimination in older adults. Age and Ageing, 43(3), 379 – 386.

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Acknowledgements

I would like to thank my PhD supervisors Professor Andrew Steptoe, Dr Panayotes
Demakakos and Dr Cesar de Oliveira. Thank you to my primary supervisor, Andrew
Steptoe, for his expert guidance and valuable feedback on this PhD project. His advice
and time have been very much appreciated. Thank you also to Cesar de Oliveira and
Panos Demakakos for their constructive advice and support throughout and for their
assistance with the ELSA data. I am also grateful to Dr Paola Zaninotto for her advice
on statistical methods, in particular for study two.

This thesis has been supported through an Impact PhD studentship from the
International Longevity Centre-UK (ILC-UK) and UCL. I would like to thank Sally-Marie
Bamford, David Sinclair and Brian Beach at ILC-UK for their time and support during
my studentship. In addition, I would like to thank Dr Dylan Kneale for his continued
advice and encouragement after leaving ILC-UK.

I am grateful to Professor Anthea Tinker for giving her time and examining my MPhil to
PhD upgrade and for her useful advice on the future of my thesis.

I would also like to thank my friends and PhD colleagues; in particular, Lauren Bird,
Amanda Hughes, Natasha Wood and Baowen Xue amongst others for their support as
we worked on our respective projects.

Finally, thank you to my partner, Saqib Ahmad, and my family for their support and
encouragement during this time. I would also like to acknowledge my grandfather,
Henry Richards, who inspired me to return to study and I would like to dedicate this to
his memory.
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Table of Contents

Declaration of authorship .............................................................................................. 2
Abstract ........................................................................................................................ 3
Publications .................................................................................................................. 4
Acknowledgements ....................................................................................................... 5
List of Tables .............................................................................................................. 10
List of Figures ............................................................................................................. 12
Abbreviations .............................................................................................................. 13
1 Introduction .......................................................................................................... 14
1.1 Ageing population ....................................................................................................... 14
1.2 Age discrimination policy ............................................................................................. 18
1.3 Outline of remaining chapters ..................................................................................... 19
2 Perceived age discrimination: a review of the literature ....................................... 21
2.1 Introduction .................................................................................................................. 21
2.1.1 Age discrimination and ageism ........................................................................... 21
2.2 Methods ....................................................................................................................... 23
2.2.1 Search Strategy................................................................................................... 23
2.2.2 Selection criteria .................................................................................................. 23
2.3 Results ........................................................................................................................ 25
2.3.1 Description of studies .......................................................................................... 25
2.3.2 Measurement of perceived age discrimination ................................................... 26
2.4 Discussion ................................................................................................................... 37
2.4.1 Discrimination attributed to age ........................................................................... 37
2.4.2 Predictors of age discrimination .......................................................................... 39
2.4.3 Cross-national studies ......................................................................................... 41
2.4.4 Discriminatory situations ..................................................................................... 44
2.4.5 The impact of perceived discrimination on health ............................................... 46
2.4.6 Stereotypes of ageing ......................................................................................... 50
2.4.7 Stereotype embodiment theory ........................................................................... 51
2.5 Summary of literature review ...................................................................................... 52
3 Perceived age discrimination in older adults in England (Study 1) ....................... 54
3.1 Introduction .................................................................................................................. 54
3.1.1 Aims .................................................................................................................... 54
3.2 Methods ....................................................................................................................... 55
3.2.1 Measures ............................................................................................................. 57
3.2.2 Statistical Analyses ............................................................................................. 61
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3.3 Results ........................................................................................................................ 61
3.3.1 Sample characteristics ........................................................................................ 61
3.3.2 Descriptive analyses ........................................................................................... 64
3.3.3 Multivariate analyses ........................................................................................... 65
3.4 Discussion ................................................................................................................... 73
4 Greater perceived age discrimination in England than the United States: results
from HRS and ELSA (Study 2) .................................................................................... 79
4.1 Introduction .................................................................................................................. 79
4.1.1 Aims and Objectives ........................................................................................... 80
4.2 Methods ....................................................................................................................... 82
4.2.1 Study samples ..................................................................................................... 82
4.2.2 Measures ............................................................................................................. 84
4.2.3 Statistical Analyses ............................................................................................. 86
4.3 Results ........................................................................................................................ 87
4.3.1 Descriptive analyses ........................................................................................... 87
4.3.2 Multivariate analyses ........................................................................................... 91
4.3.3 Individual discriminatory situations...................................................................... 99
4.4 Discussion ................................................................................................................. 105
5 Self-perceptions of ageing: a review of the literature .......................................... 112
5.1 Introduction ................................................................................................................ 112
5.2 Self-perceived age .................................................................................................... 113
5.3 Associations between self-perceptions of ageing and mortality ............................... 114
5.3.1 Method .............................................................................................................. 114
5.3.2 Results .............................................................................................................. 116
5.3.3 Discussion ......................................................................................................... 122
5.4 Self-perceptions of age and health status ................................................................. 127
5.4.1 Self-perceptions of age and functional capacity ............................................... 128
5.4.2 Self-perceptions of age and emotional health ................................................... 133
5.5 Self-perceived age and health: direction of association and potential pathways ..... 138
5.6 Pathways ................................................................................................................... 143
5.7 What frameworks exist to explain these relationships? ............................................ 144
5.7.1 Stereotype embodiment theory ......................................................................... 144
5.7.2 Awareness of Ageing ........................................................................................ 145
5.8 Evidence from empirical studies on interventions ..................................................... 147
5.9 Conclusion ................................................................................................................. 148
6 Feeling old vs being old: associations between self-perceived age and mortality
(Study 3) ................................................................................................................... 150
6.1 Introduction ................................................................................................................ 150
6.1.1 Aims and objectives .......................................................................................... 151
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6.2 Methods ..................................................................................................................... 152
6.2.1 Measures ........................................................................................................... 156
6.2.2 Statistical analyses ............................................................................................ 163
6.3 Results ...................................................................................................................... 164
6.4 Discussion ................................................................................................................. 176
6.4.1 Possible mechanisms and implications ............................................................ 178
6.4.2 Strengths and weaknesses of study ................................................................. 180
6.5 Conclusions ............................................................................................................... 181
7 Is the relationship between self-perceived age, emotional wellbeing and functional
capacity bidirectional? (Study 4) ............................................................................... 182
7.1 Introduction ..................................................................................................................... 182
7.1.1 Functional capacity............................................................................................ 183
7.1.2 Emotional wellbeing .......................................................................................... 184
7.1.3 The direction of the association between self-perceived age and health ......... 185
7.1.4 Confounders and covariates ............................................................................. 185
7.1.5 Aims and objectives .......................................................................................... 187
7.2 Methods ..................................................................................................................... 190
7.2.1 Sample .............................................................................................................. 190
7.2.2 Measures ........................................................................................................... 190
7.2.3 Covariates ......................................................................................................... 192
7.2.4 Statistical analyses ............................................................................................ 193
7.3 Results ...................................................................................................................... 195
7.3.1 Baseline characteristics and missing data ........................................................ 195
7.3.2 Self-perceived age as a predictor of future elevated depressive symptoms, ADL
limitations or impaired mobility .......................................................................................... 200
7.3.3 Elevated depressive symptoms, ADL limitations or impaired mobility as
predictors of future self-perceived age .............................................................................. 211
7.3.4 Sensitivity analyses ........................................................................................... 222
7.4 Discussion ................................................................................................................. 224
7.4.1 Self-perceived age as a predictor of emotional wellbeing and functional capacity
225
7.4.2 Emotional distress and functional capacity as predictors of self-perceived age 227
7.4.3 Explanatory variables ........................................................................................ 228
7.4.4 Strengths and limitations ................................................................................... 229
7.5 Conclusion ................................................................................................................. 231
8 General Discussion ............................................................................................ 233
8.1 Aims .......................................................................................................................... 233
8.2 Summary of findings ................................................................................................. 235
8.2.1 Study one .......................................................................................................... 235
8.2.2 Study two ........................................................................................................... 236
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8.2.3 Study three ........................................................................................................ 237
8.2.4 Study four .......................................................................................................... 238
8.3 Strengths and limitations ........................................................................................... 239
8.3.1 Strengths ........................................................................................................... 239
8.3.2 Limitations ......................................................................................................... 240
8.4 Stereotype Embodiment Theory and wider relevance .............................................. 244
8.5 Relevance for policy and implications for future research ........................................ 245
8.5.1 Policy ................................................................................................................. 245
8.5.2 Future research ................................................................................................. 250
8.6 Conclusion ................................................................................................................. 252
References ............................................................................................................... 253

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List of Tables

Table 2.1 Studies on perceived age discrimination by study design ............................ 28
Table 3.1 Sample characteristics by sex (n=7,653) ..................................................... 63
Table 3.2 Associations between age discrimination and sociodemographic factors .... 67
Table 3.3 Percentage of sample reporting age discrimination in different discriminatory
situations (N=7,653).................................................................................................... 69
Table 3.4 Adjusted odds ratios (95% CIs) from logistic regression of reporting
discrimination in different discriminatory situations and attributing it to age, with
sociodemographic factors ........................................................................................... 71
Table 4.1 Sample characteristics by country ............................................................... 88
Table 4.2 Bivariate associations between perceived age discrimination and socio-
demographic factors ................................................................................................... 90
Table 4.3 Adjusted odds ratios of reporting age discrimination by in the USA and
England ...................................................................................................................... 93
Table 4.4 Adjusted odds ratios of reporting age discrimination by Country ................. 96
Table 4.5 Characteristics of Black and Hispanic respondents ..................................... 98
Table 4.6 Unadjusted and adjusted odds ratios from logistic regression of reporting
discrimination in different situations and attributing it to age ..................................... 100
Table 4.7 Proportion of respondents attributing discrimination to their age in different
discriminatory situations in the USA and England ..................................................... 103
Table 5.1 Studies on self-perceived age and mortality .............................................. 118
Table 5.2 Longitudinal studies on self-perceived age and functional capacity ........... 129
Table 5.3 Longitudinal studies on self-perceived age and emotional health .............. 135
Table 5.4 Longitudinal studies investigating the causal pathway between self-perceived
age and health .......................................................................................................... 139
Table 6.1 Characteristics of respondents who did not complete self-perceived age
measure ................................................................................................................... 154
Table 6.2 Characteristics of the three perceived age groups: percent mortality adjusted
for age and sex (95% confidence intervals) or N (percent) ........................................ 166
Table 6.3 Self-perceived age and all-cause mortality risk ......................................... 169
Table 6.4 Cox regression on mortality in fully adjusted model ................................... 171
Table 6.5 Cox regression on mortality, excluding deaths within 12 months of baseline
(945 deaths) ............................................................................................................. 173
Table 6.6 Self-perceived age and mortality - subgroup analyses .............................. 175
Table 7.1 Prevalence of missing values of each variable of interest ......................... 198
Table 7.2 Baseline characteristics of participants according to self-perceived age group
................................................................................................................................. 199
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