ArticlePDF AvailableLiterature Review

A systematic review of existing ageism scales

Authors:
  • Lietuvos Socialinių Mokslų Centras
  • Jagiellonian University, Kraków, Poland and Warsaw School of Economics, Warsaw, Poland

Abstract and Figures

Ageism has been shown to have a negative impact on older people’s health and wellbeing. Though multiple scales are currently being used to measure this increasingly important issue, syntheses of the psychometric properties of these scales are unavailable. This means that existing estimates of ageism prevalence may not be accurate. We conducted a systematic review aimed at identifying available ageism scales and evaluating their scope and psychometric properties. A comprehensive search strategy was used across fourteen different databases, including PubMed and CINAHL. Independent reviewers extracted data and appraised risk of bias following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Of the 29,664 records identified, 106 studies, assessing 11 explicit scales of ageism, were eligible for inclusion. Only one scale, the ‘Expectations Regarding Aging’ met minimum requirements for psychometric validation (i.e., adequate content validity, structural validity and internal consistency). Still, this scale only assesses the ‘stereotype’ dimension of ageism, thus failing to evaluate the other two ageism dimensions (prejudice and discrimination). This paper highlights the need to develop and validate a scale that accounts for the multidimensional nature of ageism. Having a scale that can accurately measure ageism prevalence is key in a time of increasing and rapid population ageing, where the magnitude of this phenomenon may be increasing.
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Ageing Research Reviews
journal homepage: www.elsevier.com/locate/arr
Review
A systematic review of existing ageism scales
Liat Ayalon
a,1
, Pnina Dolberg
b
, SarmitėMikulionienė
c
, Jolanta Perek-Białas
d
, Gražina Rapolienė
e
,
Justyna Stypinska
f
, Monika Willińska
g
, Vânia de la Fuente-Núñez
h,1,
a
Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, 52900, Israel
b
Ruppin Academic Center, Emek Hefer, 4025000, Israel
c
Institute of Sociology, Lithuanian Social Research Centre, Vilnius, LT-01108, Lithuania
d
Institute of Sociology and Center of Evaluation and Public Policy Analysis, Jagiellonian University in Cracow, Cracow, 31-004, Poland
e
Institute of Sociology, Lithuanian Social Research Centre, Vilnius, LT-01108, Lithuania
f
Free University Berlin, Institute for East European Studies, Department of Sociology, Berlin, 14195, Germany
g
School of Health and Welfare, Jönköping University, 551 11, Jönköping, Sweden
h
Department on Ageing and Life Course, World Health Organization, 20 Avenue Appia, Geneva, 1221, Switzerland
ARTICLE INFO
Keywords:
Ageism
Scale
Discrimination
Stereotype
Prejudice
Systematic review
ABSTRACT
Ageism has been shown to have a negative impact on older peoples health and wellbeing. Though multiple
scales are currently being used to measure this increasingly important issue, syntheses of the psychometric
properties of these scales are unavailable. This means that existing estimates of ageism prevalence may not be
accurate. We conducted a systematic review aimed at identifying available ageism scales and evaluating their
scope and psychometric properties. A comprehensive search strategy was used across fourteen dierent data-
bases, including PubMed and CINAHL. Independent reviewers extracted data and appraised risk of bias following
the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Of
the 29,664 records identied, 106 studies, assessing 11 explicit scales of ageism, were eligible for inclusion. Only
one scale, the Expectations Regarding Agingmet minimum requirements for psychometric validation (i.e.,
adequate content validity, structural validity and internal consistency). Still, this scale only assesses the ste-
reotypedimension of ageism, thus failing to evaluate the other two ageism dimensions (prejudice and dis-
crimination). This paper highlights the need to develop and validate a scale that accounts for the multi-
dimensional nature of ageism. Having a scale that can accurately measure ageism prevalence is key in a time of
increasing and rapid population ageing, where the magnitude of this phenomenon may be increasing.
1. Introduction
Ageism is increasingly recognized as a public health issue and as one
of the most prevalent forms of stereotyping, prejudice and discrimina-
tion (World Health Organization, 2015). Although ageism can aect
any age group, existing evidence suggests that older people are at
higher risk of suering from its negative consequences. Indeed, ageist
beliefs and attitudes have been shown to impair older peoples cognitive
and functional performance (Lamont et al., 2015), result in poorer
mental health (Wurm and Benyamini, 2014), increased morbidity
(Allen, 2015) and poorer recovery from disability (Levy et al., 2012).
Ageism is also associated with a shorter lifespan (Levy et al., 2002) and
feelings of distress and loneliness (McHugh, 2003), and can result in the
marginalization of older adults (Vitman et al., 2013) as well as their
exclusion from meaningful roles in society (Wethington et al., 2016). In
a time of increasing and rapid population ageing, it is possible that the
prevalence of ageism against older adults is increasing. However, ex-
isting knowledge about the measures used to estimate its magnitude
and prevalence is rather limited (Ocer and de la Fuente-Núñez, 2018;
Wilson et al., 2019). Hence, existing estimates existing estimates of
ageism prevalence may not be accurate.
Ageism is considered to include three dimensions: stereotypes
(cognitive component - e.g., I think older adults are a burden to society);
prejudice (emotional component - e.g., I do not enjoy conversations
with older adults); and discrimination (behavioral component - e.g., I
try not to interact with older adults) (Iversen et al., 2009). It can be
directed towards others (e.g., I enjoy telling jokes about older adults)or
towards oneself (e.g., I am concerned about my own aging)(Ayalon and
https://doi.org/10.1016/j.arr.2019.100919
Received 4 April 2019; Received in revised form 17 May 2019; Accepted 18 June 2019
Corresponding author.
E-mail address: delafuentenunezv@who.int (V. de la Fuente-Núñez).
1
Contributed equally to this work.
Ageing Research Reviews 54 (2019) 100919
Available online 19 June 2019
1568-1637/ © 2019 Published by Elsevier B.V.
T
Tesch-Römer, 2017), it can be positive (e.g. the stereotype that older
adults are wise) or negative (e.g. the stereotype that older adults are
slow), and it can be explicit (conscious) or implicit (unconscious) (Levy
and Banaji, 2002). The extent to which these various dimensions and
facets of ageism are reected in existing ageism scales is not known.
Our understanding of what existing ageism scales measure is further
compounded by the lack of standard and operational denitions in the
eld, especially around the concept of older person. For example,
ageism scales often include terms like old people(e.g. I enjoy being
around old people) without providing clear indications as to what this
term refers to. The use of age cut-ostodene dierent age groups
could be an option to resolve this challenge though it comes with its
own issues. Age categories or groups are socially dened, so selecting
one age cut-oover another is inevitably arbitrary and may not be
equally relevant across dierent contexts. We also lack systematic
knowledge about the psychometric properties of available scales. Thus,
it is currently unclear what existing ageism scales measure and what
psychometric quality they have.
To address these gaps, we conducted the rst ever systematic review
aimed at identifying available scales of ageism against older adults and
evaluating their scope and psychometric properties. This knowledge is
essential for the identication of comprehensive and psychometrically
valid scales that can be eciently used to map out dierent aspects of
ageism and its prevalence. It can also serve as an important reference
point when assessing if and how available strategies developed to re-
duce or prevent ageism work.
2. Methods
2.1. Search strategy and selection criteria
We conducted a systematic review in accordance with the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines and following a protocol that was registered in PROSPERO
(ID: CRD42018087371). The results of all searches were entered into
the Covidence software programme for systematic reviews (Covidence,
2017). A comprehensive search string on ageismwas developed for
PubMed and subsequently translatedfor searches in 13 additional
electronic databases up until December 2017 (see Appendix A). Fol-
lowing an initial phase of removing duplicates and completely irrele-
vant records, titles/abstracts were screened to determine inclusion by at
least two independent raters among the authors. Records were divided
randomly across reviewers, and disagreements were resolved through
consensus with a third reviewer.
A snowball search was conducted to identify additional records for
full-text review by using Google Scholarsrelated toand cited by
functions for each of the articles included in the original search
(Atkinson and Cipriani, 2018). To ensure comprehensiveness, a specic
search of articles mentioning the scales identied in the initial round
was also conducted in selected databases (EMBASE, Web of Science,
EBSCO). The bibliographies of the nal set of records were also re-
viewed for the identication of additional articles. Full-text review was
performed independently by at least two raters, who resolved dis-
agreements through consensus with a third reviewer (among LA, VFN,
MW, JPB).
Eligible studies met the following inclusion criteria: a) available in
English, Spanish or French; b) published between 1970 (as the term
ageismwas coined in 1969) and 2017; c) aimed to develop/evaluate
measurement properties of a quantitative scale of ageism against older
adults; d) presented original research; e) assessed an ageism scale that
was evaluated by at least two additional independent research groups.
The rationale for this last criterion is that a minimum number of in-
dependent studies are needed for the psychometric validation of a scale.
This criterion was also applied to cases where signicantly dierent
scales used the same reference name (e.g. the implicit association test,
which covers a wide range of methodologies and content). In addition,
studies that assessed a subscale of ageism, rather than a whole scale,
were excluded.
2.2. Data extraction and quality assessment
The data extraction and risk of bias tool was adapted from the
COnsensus-based Standards for the selection of health Measurement
INstruments (COSMIN) guidelines (Mokkink et al., 2018;Terwee et al.,
2018), piloted and rened before extraction. Four main categories of
data were extracted: study characteristics, scale characteristics, quality
of measurement properties and methodological quality of measurement
properties per study. Nine psychometric properties were assessed for
each scale: content validity, structural validity, internal consistency,
cross-cultural validity, reliability, measurement error, criterion validity,
construct validity, responsiveness (details provided in Supplementary
Appendix A). The COSMIN guidelines were used to evaluate both the
measurement properties of each scale (adequate (+), inadequate (-) or
indeterminate (?)), and the methodological quality of each measure-
ment property per study (Very good, Adequate, Doubtful, Inadequate)
(COSMIN criteria provided in Supplementary Appendix B).
Two independent, randomly assigned raters among the authors
extracted data from each included record and appraised risk of bias for
each psychometric property per study. Disagreements were resolved
through consensus with a third reviewer (LA or VFN).
2.3. Data analysis
Two independent raters (LA, VFN) appraised the overall rating for
each psychometric property and the overall quality of the body of
evidence for each measurement property of a given scale, following the
COSMIN guidelines (Mokkink et al., 2018;Terwee et al., 2018). The
overall rating of each psychometric property per scale could be either
sucient (+), insucient (-), indeterminate (?) or inconsistent ( ± )
and would depend on the scores obtained across individual studies. For
example, if a given measurement property was graded as insucient in
most of the individual studies, then the overall rating would be in-
sucient. Indeterminate (?) ratings given for individual studies were
disregarded when determining the overall quality of a measurement
property of a scale unless the measurement property had no sucient
or insucientratings across individual studies. As COSMIN guidelines
require reviewers to conduct their own assessment of the content va-
lidity of each scale, indeterminate (?) overall ratings for content validity
are never possible. To evaluate the overall rating for content validity,
we independently assessed the face validity of each scale (LA, VFN).
This evaluation was conducted based on the rst published version and
the rst proposed division into factors or subscales. To form our jud-
gement, we examined whether the items included in the scale were
relevant to the concept of ageism, whether the items included under
each subscale fell into a cohesive domain, and whether the phrasing of
the items and the instructions were easy to understand (Terwee et al.,
2018).
The overall quality of the body of evidence per psychometric
property was downgraded on three accounts: risk of bias, inconsistency
of ndings across individual studies and imprecision (see
Supplementary Appendix C). A fourth factor, indirectness, was not
considered relevant in this review because the ageism scales included in
the study did not have a clearly dened target population. For struc-
tural validity and internal consistency, we also downgraded the overall
quality of the evidence if substantial variations in the number of items
and factors used for the same scale were evident across studies, as we
considered this part of inconsistency.
In interpreting the ndings, the presence of adequate content va-
lidity, structural validity and internal validity were considered as
minimal criteria to support the psychometric validation of a scale
(Mokkink et al., 2018).
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
2
3. Results
A total of 29,664 records were retrieved based on the original
search. Of these, 158 were identied for full-text review following re-
moval of duplicates and irrelevant records. An additional 157 records
were identied for full-text review via snowballing, the specic search
strategy and bibliographic searches. Of these 315 records, 209 were
excluded (See Fig. 1). This resulted in 106 records included in this
systematic review, which assessed 11 scales aimed at measuring explicit
ageism. Table 1 reports the number of studies looking into each in-
dividual scale. Details on the characteristics of the dierent studies
included in the review, and the characteristics of the 11 scales are
provided in Supplementary Table 1 and Supplementary Table 2, re-
spectively. It is worth highlighting that most studies were conducted in
English speaking, high-income countries, including Australia, Canada
and the United States of America, and that no studies were conducted in
low and lower-middle income countries. It is also worth noting that
participants in these studies were mainly older adults or university
students. Information on the psychometric properties of each scale per
individual study and on the quality of the evidence for each psycho-
metric property per individual study is available upon request.
Table 2 reports the aggregated rating of the psychometric properties
of each scale, as well as the overall quality of the evidence for each
measurement property across studies. Of the included scales, only one,
the Expectations Regarding Aging Questionnaire, had adequate ratings
on the three psychometric properties that are considered indispensable
for psychometric validation (content validity, structural validity, in-
ternal consistency). This scale was assessed in six studies. Its longer
version consists of 38 items and two subscales (Sarkisian et al., 2002)
whereas the shorter version consists of 12 items along three subscales
(Sarkisian et al., 2005). The scale examines stereotypes towards old age
in general (When people get older, they need to lower their expecta-
tions of how healthy they can be) and towards oneself (I expect that
as I get older, I will get tired more quickly). The response scale oers
four options (1-denitely true, 4-denitely false).
Content validity was judged as adequate as included items were
easy to understand and were adequately distributed into two subscales,
one measuring self-expectations and the other measuring general ex-
pectations regarding ageing. Structural validity, internal consistency,
reliability, and construct validity (known groups, convergent) were also
judged as adequate. The quality of the evidence ranged between
moderate (content validity, structural validity, reliability, convergent
validity), low (internal consistency, known groups), and very low (cross
cultural validity).
Fig. 1. Study selection.
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
3
Two additional scales met two of the three minimum criteria for
psychometric validation (structural validity and internal consistency)
and may benet from further modications to resolve the current in-
consistent rating ( ± ) for content validity. The rst is the Attitudes to
Aging Questionnaire, which was assessed by nine dierent studies (with
some studies conducted by the same group and possibly using over-
lapping data (Laidlaw et al., 2018,2007;Lucas-Carrasco et al., 2013;
Shenkin et al., 2014)). It consists of 24 statements about old age divided
into three subscales, and ranked on a 5-point Likert scale (Laidlaw
et al., 2007). The scale examines stereotypes, prejudice and dis-
crimination towards others and towards oneself. Content validity was
judged as inconsistent ( ± ) because the proposed factor structure in-
cluded, under the same factor, items that assess both stereotypes to-
wards others (old age is a time of loneliness) and towards oneself (I
am losing my physical independence as I get older). Some items
seemed ambiguous with regards to the age group concerned (e.g. I feel
excluded from things because of my age), and others seemed to be only
appropriate for people over a certain age (e.g. I dont feel involved in
society now that Im older). The quality of the evidence for this
property was moderate. Structural validity, internal consistency, and
construct validity (convergent and known-groups validity) were judged
as adequate, with the quality of the evidence being rated as low across
all measurement properties, except for known-groups validity, which
was rated as moderate. Reliability was indeterminate and cross-cultural
validity was inadequate with the quality of the evidence being rated as
moderate for both properties.
The second scale that met two of the three minimum criteria for
psychometric validation was the Kogans Attitudes towards Old People
Scale, which was evaluated by 17 dierent studies (with two of the
studies being based on the same data (Hicks et al., 1976;Wingard,
1980)). This is a 34-item scale, composed of a positive subscale in-
cluding 17 items (e.g., it is evident that most old people are very
dierent from one another) and a negative subscale including 17 items
(e.g., old people have too much power in business and politics). The
scale assesses explicit prejudice and stereotypes towards older people
using a 7-point Likert response scale. The content validity of this scale
was rated as inconsistent ( ± ) because the proposed factor structure
fails to consider the two dimensions of ageism that are being assessed -
prejudice and stereotypes. For example, an item assessing prejudice (If
old people expect to be liked, their rst step is to try to get rid of their
irritating faults) is included under the same factor as an item assessing
stereotypes (Most old people are constantly complaining about the
behavior of the younger generation). Also, though the two proposed
factors are supposed to include identical items phrased either positively
or negatively, this is not always the case. For example, the negative
factor includes the item If old people expect to be liked, their rst step
is to try to get rid of their irritating faultsin opposition to the item
When you think about it, old people have the same faults as anybody
else.Some items are also dicult to understand (e.g. “…its hard to
gure out what makes them tick). The overall quality of the evidence
for this property was moderate. Structural validity, internal con-
sistency, reliability and known groups validity were rated as adequate
and their evidence base was rated as low, except for reliability which
was rated as moderate. Convergent validity was rated as inconsistent
and criterion validity as indeterminate (?) with the quality of evidence
being low and very low, respectively.
Table 1
Number of studies per scale.
Scale name Dimension(s) of ageism assessed No. of
articles
References
Aging perceptions questionnaire Explicit: Stereotypes, prejudice,
discrimination
7(Barker et al., 2007;Ingrand et al., 2012;Sexton et al., 2014;Slotman et al., 2015;Chen
et al., 2016;Moghadam et al., 2016;Slotman et al., 2017)
Aging semantic dierential Explicit: Stereotypes 15 (Rosencranz and McNevin, 1969;Underwood et al., 1985;Gekoski et al., 1991;
OHanlon et al., 1993;Intrieri et al., 1995;Villar Posada, 1997;Polizzi and Millikin,
2002;Polizzi, 2003;Stewart et al., 2007;Iwasaki and Jones, 2008;Boudjemad and
Gana, 2009;Gluth et al., 2010;Gonzales et al., 2010;Carlson, 2015;Gonzales et al.,
2017)
Anxiety about ageing questionnaire Explicit: Stereotypes, prejudice,
discrimination
6(Lasher, 1987;Watkins et al., 1998;Rivera-Ledesma et al., 2007;Gao, 2012;Koukouli
et al., 2013;Sargent-Cox et al., 2014)
Attitudes to aging questionnaire Explicit: Stereotypes, prejudice,
discrimination
9(Laidlaw et al., 2007;Chachamovich et al., 2008;Kalfoss et al., 2010;Lucas-Carrasco
et al., 2013;Shenkin et al., 2014;Brown et al., 2015;Helmes and Pachana, 2016;
Marquet et al., 2016;Rejeh et al., 2017)
Expectations Regarding Aging Explicit: Stereotypes 6 (Sarkisian et al., 2001,2002;Sarkisian et al., 2005;Joshi et al., 2010;Beser et al., 2012;
Sparks et al., 2013)
Facts on aging quiz Explicit: Stereotypes 35 (Palmore, 1977;Klemmack, 1978;Holtzman and Beck, 1979;Miller and Dodder, 1980;
Laner, 1981;Luszcz, 1982;Romeis and Sussman, 1982;Matthews et al., 1984;Miller
and Dodder, 1984;Courtenay and Weidemann, 1985;Dail and Johnson, 1983,1986;
McCutcheon, 1986;Donnelly et al., 1987;Norris et al., 1987;Kline et al., 1990;Kline
and Kline, 1991a,b;OHanlon et al., 1993;Lusk et al., 1995;Harris and Changas, 1994;
Harris et al., 1996;Kramer et al., 2001;Pennington et al., 2001;Obiekwe, 2001;Seufert
and Carrozza, 2002;Cowan et al., 2004;Runkawatt, 2007;Unwin et al., 2008;Wang
et al., 2010;Nakao et al., 2013;Pachana et al., 2013;Van der Elst et al., 2014;Helmes,
2016;Helmes and Pachana, 2016;Shiovitz-Ezra et al., 2016)
Fraboni scale of ageism Explicit: Stereotypes, prejudice,
discrimination
8(Fraboni et al., 1990;Rupp et al., 2005;Bodner and Lazar, 2008;Boudjemad and Gana,
2009;Lin et al., 2010;Kutlu et al., 2012;Helmes and Pachana, 2016;Shiovitz-Ezra
et al., 2016)
Image of aging scale Explicit: Stereotypes 3 (Levy et al., 2004;Bai et al., 2012;Fernández-Ballesteros et al., 2017)
Kogans attitudes towards older
people scale
Explicit: Stereotypes, prejudice 17 (Kogan, 1961;Hicks et al., 1976;Wingard, 1980;Hilt, 1997;Söderhamn et al., 2000;
Lambrinou et al., 2005;Ogiwara et al., 2007;Runkawatt, 2007;Iwasaki and Jones,
2008;Helmes and Campbell, 2009;Yen et al., 2009;Erdemir et al., 2011;Küçükgüçlü
et al., 2011;Kiliç and Adibelli, 2011;Rejeh et al., 2012;Matarese et al., 2013;Vitman-
Schorr et al., 2014)
Reactions to aging questionnaire Explicit: Stereotypes, prejudice 5 (Gething, 1994;Netz et al., 2001;Getting et al., 2002;Gething et al., 2004;Helmes and
Pachana, 2016)
Tuckman and Lorge questionnaire Explicit: Stereotypes 6 (Tuckman and Lorge, 1954;Axelrod and Eisdorfer, 1961;Eisdorfer, 1966;Hicks et al.,
1976;Wingard, 1980;Helmes and Campbell, 2009)
Note: Some articles evaluated more than one scale.
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
4
Table 2
Overall rating of each measurement property per scale and grading of the quality of evidence per measurement property per scale across all studies.
Aging
perceptions
questionnaire
Aging semantic
dierential
Anxiety about
ageing
questionnaire
Attitudes to
aging
questionnaire
Expectations
Regarding
Aging
Facts on aging
quiz
Fraboni scale
of ageism
Image of aging
scale
Kogans attitudes
towards older
people scale
Reactions to aging
questionnaire
Tuckman & Lorge
Questionnaire
Content validity Overall
rating
+/- + +/- +/- + +/- +/- + +/- +/- +/-
Quality
of
evidence
Moderate Moderate Low Moderate Moderate Moderate Moderate Moderate Moderate Moderate Very low
Structural validity Overall
rating
++ + + + + +/- + ? ?
Quality
of
evidence
Low Low Moderate Low Moderate Moderate Moderate Low Low Moderate Very low
Internal
consistency
Overall
rating
+++? +/- + ?
Quality
of
evidence
Low Low Low Low Low Low Low Low Low Moderate Low
Cross cultural
validity/
measurement
invariance
Overall
rating
+––?? +––
Quality
of
evidence
Low Moderate Low Moderate Very low Moderate Low Moderate Very low
Reliability Overall
rating
+ + +/- + ++ +
Quality
of
evidence
Moderate Moderate Moderate Moderate Moderate Very low Moderate Moderate Moderate
Measurement error Overall
rating
?
Quality
of
evidence
Very low
Criterion validity Overall
rating
+??
Quality
of
evidence
High Moderate Very low
Construct validity Overall
rating
+ (convergent
& known
groups)
+(convergent)
+/- (known
groups)
+(convergent) -
(known groups)
+ (convergent
& known
groups)
+ (convergent
& known
groups)
-(convergent),
+ (known
groups)
+
(convergent
& known
groups)
+ (convergent
& known
groups)
+/-(convergent),
+ (known groups)
+/-(convergent),?
(known groups)
?(convergent)+
(known groups)
Quality
of
evidence
High
(convergent),
Moderate
(known
groups)
Low
(convergent &
known groups)
Moderate
(convergent &
known groups)
Low
(convergent),
Moderate
(known
groups)
Moderate
(convergent),
Low (known
groups)
Low
(convergent &
known groups)
Moderate
(convergent
& known
groups)
High
(convergent),
Low (known
groups)
Low (convergent &
known groups)
Low (convergent),
Moderate (known
groups)
Very low
(convergent),
Moderate (known
groups)
Responsiveness Overall
rating
? + ?
Quality
of
evidence
Very low Very low Very low
Overall rating of psychometric property: + (sucient), - (insucient), +/- (inconsistent),? (indeterminate). Overall quality of the evidence: High (very condent that the true measurement lies close to the estimate),
Moderate (moderately condent in the measurement property estimate), Low (limited condence in the measurement property), Very low (very little condence in the measurement property estimate).
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
5
4. Discussion
Identifying a comprehensive scale with adequate psychometric
properties is a necessary step in tackling ageism. As past research in the
eld of ageism has largely relied on scales that have not been com-
prehensively evaluated for psychometrics properties (Ayalon and Gum,
2011;Palmore, 2001), interpretations about prevalence of ageism are
questionable. This is the rst study to systematically evaluate existing
ageism scales. The 106 records included in this study assessed the
psychometric properties of 11 scales. All scales evaluated in this review
explicitly assess ageism. An explicit assessment of ageism enquires
about peoples thoughts, feelings or behaviors towards older adults
because of their age (Palmore, 2001), whereas an implicit assessment
does not reveal that the focus of the assessment concerns age. Hence,
there is no possible control over the responses given to implicit tests,
which are thought to be free of social demand characteristics (Cherry
et al., 2015;Greenwald et al., 2002).
Despite the number of scales available to explicitly measure ageism,
only the Expectations Regarding Aging has adequate content validity,
structural validity and internal consistency. Further studies are how-
ever required to get a clearer understanding of the cross-cultural va-
lidity, measurement error, criterion validity, and responsiveness of this
scale. Moreover, the fact that this is an explicit scale that only assesses
stereotypes precludes its use as a comprehensive ageism scale. The re-
maining ten scales included in this review need further psychometric
evaluation and renement. It is worth noting that two of the scales
reviewed, the Attitudes to Aging Questionnaire and the Kogans
Attitudes towards Older People Scale, which had adequate structural
validity and internal consistency, may benet from revisions to improve
their content validity. Indeed, one important nding from this study is
that the dimension(s) of ageism assessed by existing scales is not always
clear. The concept attitudesis often used to refer to several dimensions
of ageism (e.g. stereotypes and prejudice) without clear indications of
the intended meaning. Given the multi-dimensional nature of ageism, it
is desired to have scales, which clearly address all three dimensions.
The reference populations used across scales also varied with some
scales including multiple references. Research has shown that older
adults seem to distinguish between their own ageing and the ageing of
others (Gething, 1994;Helmes and Pachana, 2016), so including mul-
tiple reference populations in a single scale may be benecial.
In reviewing the ndings, it is important to note the studys lim-
itations. Despite ongoing consultations with information specialists, the
use of snowballing, and the conduct of specic bibliographic searches,
it is possible that relevant articles were missed. In addition, the
COSMIN guidelines do not yet oer an easy-to-use-format for data ex-
traction and quality assessment. As a result, it is possible that errors
were inadvertently made when extracting data, assessing properties and
quality of the evidence. To overcome this limitation, two independent
raters conducted the initial extraction and assessment, with at least a
third rater checking and conrming the results.
5. Conclusions
This systematic review reveals a gap in the ageism eld. Of all
available ageism scales, only one met minimum requirements for psy-
chometric validation but still failed to cover all dimensions of ageism.
This review also revealed that there is a general lack of psychometric
assessments of existing ageism scales with many having less than three
independent studies as their evidence base. For those scales that do
have assessments by three or more independent studies, evidence is
often of low quality and /or provided on only a handful of psychometric
properties. Moreover, studies often yield indeterminate or inconsistent
results on the measurement properties assessed.
Without comprehensive and psychometrically valid ageism scales
we may not be able to accurately assess the prevalence of ageism and
evaluate if available strategies to reduce or prevent it work, which can
result in poor investments and hinder global and national eorts to
tackle ageism. This study signals a need to further study scales that
evaluate explicit aspects, with a specic focus on those scales that
measure the three dimensions of ageism. It also highlights the need to
identify scales that evaluate implicit aspects of ageism. Even though it is
possible that such scales exist, they have not been examined by in-
dependent research groups and are therefore still lacking psychometric
support. Our ndings also highlight the need for research in a more
diverse group of countries, and the inclusion of a more diverse pool of
participants. The development and validation of a new ageism scale
that covers all dimensions of ageism, includes dierent reference tar-
gets (i.e. self and others), and accounts for both positive and negative
ageism, and explicit and implicit manifestations of this phenomenon is
desirable.
Contributors
LA and VFN contributed equally to this work, and were involved in
study conceptualization and design, data collection and screening, data
extraction and synthesis, results interpretation and manuscript writing.
PD, SM, JPB, GR, JS, MW contributed to data screening, data extraction
and nal drafting of the paper.
The Corresponding Author (VFN) had full access to all the data in
the study and had nal responsibility for the decision to submit for
publication.
Transparency declaration
The lead authors (LA, VFN) arm that this manuscript is an honest,
accurate, and transparent account of the study being reported; that no
important aspects of the study have been omitted; and that any dis-
crepancies from the study as planned (and, if relevant, registered) have
been explained.
Ethics approval
Not required for this study.
Declaration of Competing Interest
The authors have no conict of interest to report.
Funding
This research did not receive any specic grant from funding
agencies in the public, commercial, or not-for-prot sectors.
Acknowledgements
This article was developed thanks to partnerships created through
COST Action IS1402 Ageism - a multi-national, interdisciplinary per-
spective, supported by COST (European Cooperation in Science and
Technology). We thank Kavita Kothari and Tomas Allen for their sup-
port in developing the search strategy. We also thank Chantal Barber,
Joana Mendonça and João Mariano for their assistance in the removal
of completely irrelevant records, as well as Karl Pillemer for supporting
access to Covidence software. Special thanks are also extended to Eva
Evertsson and Elisabeth Nylander from Jönköping University Library
for their help in sourcing out the relevant literature. The authors alone
are responsible for the views expressed in this article and they do not
necessarily represent the views, decisions or policies of the institutions
in which they are aliated.
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
6
Appendix A. AgeismSearch terms for PubMed & Electronic databases
PubMed search strategy
Filter applied: published after 1970
# Search string
1(Ageism[MeSH] OR ageism[TiAb] OR agism[TiAb] OR ageist[TiAb] OR agist[TiAb] OR age discrimination[TiAb] OR age prejudice[TiAb] OR age stereotype[TiAb]
OR self perceptions of ageing[TiAB] OR self perceptions of aging[TiAB] OR age identity[Tiab])
2((Aged[Mesh] OR Aged, 80 and over[MeSH] OR Frail Elderly[MeSH] OR elder*[TiAb] OR seniors[TiAb] OR older adult[TiAb] OR older person[TiAb] OR older
adults[TiAb] OR older persons[TiAb] OR older peoples[tiab] OR older people[TiAb] OR aging[MeSH] OR ageing[TiAb] OR aging[TiAb] OR Old age[Ti]) AND
(Social Exclusion[Tiab] OR social rejection[TIab] OR Social Acceptance[TIab] OR stereotyped behavior[Mesh] OR social perception[Ti] OR age identication[ti]
OR self-perceptions[tiAb] OR Prejudice[MeSH] OR prejudice[TiAb] OR stereotyp*[TiAb] OR Stereotyping[MeSH] OR Social Discrimination[Mesh] OR
Intergenerational Relations[Mesh]))
3(AnimalsNOT (Animals[Mesh] AND Humans[Mesh]))
4Plants[Mesh]
5Step 1 OR Step 2 NOT Step 3 NOT Step 4
Electronic databases searched
PubMed, PsychInfo, Ageline, CINAHL, EBSCO, EMBASE, Cochrane Database of Systematic Reviews, Global Index Medius, Campbell
Collaboration, Prospero, Epistemonikos, DARE, Open Grey and Greynet.
Appendix B. Supplementary data
Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.arr.2019.100919.
References
Allen, J.O., 2015. Ageism as a risk factor for chronic disease. Gerontologist 56, 610614.
Atkinson, L., Cipriani, A., 2018. How to carry out a literature search for a systematic
review: a practical guide. Bjpsych Adv. 24.
Axelrod, S., Eisdorfer, C., 1961. Attitudes toward old people: an empirical analysis of the
stimulus-group validity of the Tuckman-Lorge questionnaire. J. Gerontol.
Ayalon, L., Gum, A.M., 2011. The relationships between major lifetime discrimination,
everyday discrimination, and mental health in three racial and ethnic groups of older
adults. Aging Ment. Health 15, 587594.
Ayalon, L., Tesch-Römer, C., 2017. Taking a Closer Look at Ageism: Self-and Other-di-
rected Ageist Attitudes and Discrimination. Springer.
Bai, X., Chan, K., Chow, N., 2012. Validation of self-image of aging scale for Chinese
elders. Int. J. Aging Hum. Dev. 74, 6786.
Barker, M., OHanlon, A., McGee, H.M., Hickey, A., Conroy, R.M., 2007. Cross-sectional
validation of the Aging Perceptions Questionnaire: a multidimensional instrument for
assessing self-perceptions of aging. BMC Geriatr. 7, 9.
Beser, A., Kucukguclu, O., Bahar, Z., Akpinar, B., 2012. Study of validity and reliability of
the scale regarding the expectations about aging. Health Med. J. 6, 31073112.
Bodner, E., Lazar, A., 2008. Ageism among Israeli students: structure and demographic
inuences. Int. Psychogeriatr. 20, 10461058.
Boudjemad, V., Gana, K., 2009. Ageism: adaptation of the Fraboni of Ageism Scale-
Revised to the French language and testing the eects of empathy, social dominance
orientation and dogmatism on ageism. Can. J. Aging. La revue canadienne du vieil-
lissement 28, 371389.
Brown, L., Bowden, S., Bryant, C., Brown, V., Bei, B., Gilson, K.-M., Komiti, A., Judd, F.,
2015. Validation and utility of the Attitudes to Ageing Questionnaire: links to me-
nopause and well-being trajectories. Maturitas 82, 190196.
Carlson, K.J., 2015. Individual perceptions of older adults. The University of Nebraska-
Lincoln.
Chachamovich, E., Fleck, M.P., Trentini, C.M., Laidlaw, K., Power, M.J., 2008.
Development and validation of the Brazilian version of the Attitudes to Aging
Questionnaire (AAQ): an example of merging classical psychometric theory and the
Rasch measurement model. Health Qual. Life Outcomes 6, 5.
Chen, X., Hu, Y., Zhu, D., Li, J., Zhou, L., 2016. Chinese version of the Aging Perceptions
Questionnaire (C-APQ): assessment of reliability and validity. Aging Ment. Health 20,
567574.
Cherry, K.E., Allen, P.D., Denver, J.Y., Holland, K.R., 2015. Contributions of social de-
sirability to self-reported ageism. J. Appl. Gerontol. 34, 712733.
Courtenay, B.C., Weidemann, C., 1985. The eects of a dont knowresponse on
Palmores facts on aging quizzes. Gerontologist 25, 177181.
Covidence systematic review software, 2017. Veritas Health Innovation. Available at.
Veritas Health Innovation, Melbourne, Australia. www.covidence.org.
Cowan, D.T., Fitzpatrick, J.M., Roberts, J.D., While, A.E., 2004. Measuring the knowledge
and attitudes of health care statoward older people: sensitivity of measurement
instruments. Educ. Gerontol. 30, 237254.
Dail, P.W., Johnson, J.E., 1983. Measuring Change in Undergraduate Students
Perceptions About Aging Using the Palmore Facts on Aging Quiz.
Dail, P.W., Johnson, J.E., 1986. Measuring change in undergraduate studentsperceptions
about aging using the Palmore Facts on Aging Quiz. Gerontol. Geriatr. Educ. 5,
6167.
Donnelly, M.B., Duthie Jr., E.H., Kirsling, R.A., Gambert, S.R., 1987. The use of the
combined Palmore and Dye and Sassenrath aging quizzes to assess gerontological
knowledge in medical education. Gerontol. Geriatr. Educ. 6, 1124.
Eisdorfer, C., 1966. Attitudes toward old people: a re-analysis of the item-validity of the
stereotype scale. Young 115, 112.
Erdemir, F., Kav, S., Citak, E.A., Hanoglu, Z., Karahan, A., 2011. A Turkish version of
Kogans attitude toward older people (KAOP) scale: reliability and validity assess-
ment. Arch. Gerontol. Geriatr. 52, e162e165.
Fernández-Ballesteros, R., Olmos, R., Santacreu, M., Bustillos, A., Schettin, R., Huici, C.,
Rivera, J.M., 2017. Assessing aging stereotypes: personal stereotypes, self-stereotypes
and self-perception of aging. Psicothema 29.
Fraboni, M., Saltstone, R., Hughes, S., 1990. The Fraboni Scale of Ageism (FSA): an at-
tempt at a more precise measure of ageism. Can. J. Aging /La revue canadienne du
vieillissement 9, 5666.
Gao, Y.-J., 2012. Measurement of aging anxiety in Taiwan: an application of a multi-
dimensional item response model. Soc. Behav. Personal. Int. J. 40, 557566.
Gekoski, W.L., Knox, V.J., Kelly, L.E., 1991. The factor structure of the aging semantic
dierential: a failure to replicate Rosencranz and McNevin. J. Soc. Psychol. 131,
593595.
Gething, L., 1994. Health professional attitudes towards ageing and older people: pre-
liminary report of the Reactions to Ageing Questionnaire. Aust. J. Ageing 13, 7781.
Gething, L., Fethney, J., McKee, K., Persson, L.O., Go, M., Churchward, M., Matthews,
S., Halvarsson, M., Johannsson, I., 2004. Validation of the reactions to ageing
questionnaire: assessing similarities across several countries. J. Gerontol. Nurs. 30,
4754.
Getting, L., Fethney, J., McKee, K., Churchward, M., Go, M., Matthews, S., 2002.
Knowledge, stereotyping and attitudes towards self ageing. Australas. J. Ageing 21,
7479.
Gluth, S., Ebner, N.C., Schmiedek, F., 2010. Attitudes toward younger and older adults:
the German aging semantic dierential. Int. J. Behav. Dev. 34, 147158.
Gonzales, E., Marchiondo, L.A., Tan, J., Wang, Y., Chen, H., 2017. The aging semantic
dierential in mandarin chinese: measuring attitudes toward older adults in China. J.
Gerontol. Soc. Work 60, 245254.
Gonzales, E., Tan, J., Morrow-Howell, N., 2010. Assessment of the rened aging semantic
dierential: recommendations for enhancing validity. J. Gerontol. Soc. Work 53,
304318.
Greenwald, A.G., Banaji, M.R., Rudman, L.A., Farnham, S.D., Nosek, B.A., Mellott, D.S.,
2002. A unied theory of implicit attitudes, stereotypes, self-esteem, and self-con-
cept. Psychol. Rev. 109, 3.
Harris, D.K., Changas, P.S., 1994. Revision of Palmores Second Facts on Aging Quiz From
a Truefalse to a Multiplechoice Format.
Harris, D.K., Changas, P.S., Palmore, E.B., 1996. Palmoresrst Facts on Aging Quiz in a
multiplechoice format. Educational Gerontology: An International Quarterly 22,
575589.
Helmes, E., 2016. Development of a canadian adaptation of the facts on aging quiz. Adv.
Aging Res. 5, 71.
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
7
Helmes, E., Campbell, A., 2009. Dierential sensitivity to administration format of
measures of attitudes toward older adults. Gerontologist 50, 6065.
Helmes, E., Pachana, N.A., 2016. Dimensions of stereotypical attitudes among older
adults: analysis of two countries. Geriatr. Gerontol. Int. 16, 12261230.
Hicks, D.A., Rogers, C.J., Shemberg, K., 1976. Attitudestoward the elderly: a com-
parison of measures. Exp. Aging Res. 2, 119124.
Hilt, M.L., 1997. The Kogan attitudes toward old people scale: is it time for a revision?
Psychol. Rep. 80, 13721374.
Holtzman, J.M., Beck, J.D., 1979. Palmores facts on aging quiz: a reappraisal.
Gerontologist 19, 116120.
Ingrand, I., Houeto, J.L., Gil, R., Mc Gee, H., Ingrand, P., Paccalin, M., 2012. The vali-
dation of a French-language version of the Aging Perceptions Questionnaire (APQ)
and its extension to a population aged 55 and over. BMC Geriatr. 12, 17.
Intrieri, R.C., von Eye, A., Kelly, J.A., 1995. The aging semantic dierential: a con-
rmatory factor analysis. Gerontologist 35, 616621.
Iversen, T.N., Larsen, L., Solem, P.E., 2009. A conceptual analysis of ageism. Nord.
Psychol. 61, 4.
Iwasaki, M., Jones, J.A., 2008. Attitudes toward older adults: a reexamination of two
major scales. Gerontol. Geriatr. Educ. 29, 139157.
Joshi, V.D., Malhotra, R., Lim, J.F., Ostbye, T., Wong, M., 2010. Validity and reliability of
the expectations regarding aging (ERA-12) instrument among middle-aged
Singaporeans. Ann. Acad. Med. Singapore 39, 394398.
Kalfoss, M.H., Low, G., Molzahn, A.E., 2010. Reliability and validity of the attitudes to
ageing questionnaire for Canadian and Norwegian older adults. Scand. J. Caring Sci.
24, 7585.
Kiliç, D., Adibelli, D., 2011. The validity and reliability of Kogans attitude towards old
people scale in the Turkish society. Health 3, 602.
Klemmack, D.L., 1978. An examination of Palmores facts on aging quiz. Gerontologist 18,
403406.
Kline, D.W., Scialfa, C.T., Stier, D., Babbitt, T.J., 1990. Eects of bias and educational
experience on two knowledge of aging questionnaires. Educ. Gerontol. Int. Quart. 16,
297310.
Kline, T.J., Kline, D.W., 1991a. The association between education, experience, and
performance on two knowledge of aging and elderly questionnaires. Educ. Gerontol.
Int. Quart. 17, 355361.
Kline, T.J., Kline, D.W., 1991b. Identication of response Bias on two knowledge of aging
questionnaires by use of radomization tests. Gerontol. Geriatr. Educ. 11, 6776.
Kogan, N., 1961. Attitudes toward old people: the development of a scale and an ex-
amination of correlates. J. Abnorm. Soc. Psychol. 62, 44.
Koukouli, S., Pattakou-Parasyri, V., Kalaitzaki, A.E., 2013. Self-reported aging anxiety in
Greek students, health care professionals, and community residents: a comparative
study. Gerontologist 54, 201210.
Kramer, B.J., Damron-Rodriguez, J., Lee, M., Wong, M.M., 2001. Medical house sta
performance on the facts of aging quiz: a comparison of test formats. Gerontol.
Geriatr. Educ. 21, 4151.
Küçükgüçlü, Ö., Mert, H., Akpınar, B., 2011. Reliability and validity of Turkish version of
attitudes toward old people scale. J. Clin. Nurs. 20, 31963203.
Kutlu, Y., Kucuk, L., Yildiz Findik, U., 2012. Psychometric properties of the turkish ver-
sion of the fraboni scale of ageism. Nurs. Health Sci. 14, 464471.
Laidlaw, K., Kishita, N., Shenkin, S.D., Power, M.J., 2018. Development of a short form of
the Attitudes to Ageing Questionnaire (AAQ). Int. J. Geriatr. Psychiatry 33, 113121.
Laidlaw, K., Power, M., Schmidt, S., 2007. The Attitudes to Ageing Questionnaire (AAQ):
development and psychometric properties. Int. J. Geriatr. Psychiatry 22, 367379.
Lambrinou, E., Sourtzi, P., Kalokerinou, A., Lemonidou, C., 2005. Reliability and validity
of the greek version of Kogans old people scale. J. Clin. Nurs. 14, 12411247.
Lamont, R.A., Swift, H.J., Abrams, D., 2015. A review and meta-analysis of age-based
stereotype threat: negative stereotypes, not facts, do the damage. Psychol. Aging 30,
180.
Laner, M.R., 1981. Palmores facts on aging quiz: does it measure learning? Gerontol.
Geriatr. Educ. 2, 38.
Lasher, K.P., 1987. Development and Initial Validation of the Anxiety About Aging Scale.
Levy, B.R., Banaji, M.R., 2002. Implicit ageism. Ageism: Stereotyping and Prejudice
Against Older Persons. pp. 4975.
Levy, B.R., Kasl, S.V., Gill, T.M., 2004. Image of aging scale. Percept. Mot. Skills 99,
208210.
Levy, B.R., Slade, M.D., Kunkel, S.R., Kasl, S.V., 2002. Longevity increased by positive
self-perceptions of aging. J. Pers. Soc. Psychol. 83, 261.
Levy, B.R., Slade, M.D., Murphy, T.E., Gill, T.M., 2012. Association between positive age
stereotypes and recovery from disability in older persons. JAMA 308, 19721973.
Lin, X., Bryant, C., Boldero, J., 2010. Measures for assessing student attitudes toward
older people. Educ. Gerontol. 37, 1226.
Lucas-Carrasco, R., Laidlaw, K., Gómez-Benito, J., Power, M.J., 2013. Reliability and
validity of the Attitudes to Ageing Questionnaire (AAQ) in older people in Spain. Int.
Psychogeriatr. 25, 490499.
Lusk, S.L., Williams, R.A., Hsuing, S., 1995. Evaluation of the facts on aging quizzes I & II.
J. Nurs. Educ. 34, 317324.
Luszcz, M.A., 1982. Facts on aging: an Australian validation. Gerontologist 22, 369372.
Marquet, M., Missotten, P., Schroyen, S., van Sambeek, I., van den Akker, M., Van Den
Broeke, C., Buntinx, F., Adam, S., 2016. A validation of the French version of the
Attitudes to Aging Questionnaire (AAQ): factor structure, reliability and validity.
Psychol. Belg. 56, 80100.
Matarese, M., Lommi, M., Pedone, C., Alvaro, R., De Marinis, M.G., 2013. Nursing student
attitudes towards older people: validity and reliability of the Italian version of the
Kogan Attitudes towards older People scale. J. Adv. Nurs. 69, 175184.
Matthews, A.M., Tindale, J.A., Norris, J.E., 1984. The facts on aging quiz: a Canadian
validation and cross-cultural comparison. Can. J. Aging/La Revue Canadienne du
Vieillissement 3, 165174.
McCutcheon, L.E., 1986. Development of the psychological facts on aging quiz.
Community/Junior Coll. Quart. 10, 123129.
McHugh, K.E., 2003. Three faces of ageism: society, image and place. Ageing Soc. 23,
165185.
Miller, R.B., Dodder, R.A., 1980. A revision of Palmores facts on aging quiz. Gerontologist
20, 673679.
Miller, R.B., Dodder, R.A., 1984. An empirical analysis of Palmores facts on aging quiz
and the millerdodder revision. Sociol. Spectr. 4, 5369.
Moghadam, L.S., Foroughan, M., Shahboulaghi, F.M., Ahmadi, F., Sajjadi, M., Farhadi, A.,
2016. Validity and reliability of the Persian version of the Brief Aging Perceptions
Questionnaire in Iranian older adults. Clin. Interv. Aging 11, 507.
Mokkink, L.B., Prinsen, C., Patrick, D.L., Alonso, J., Bouter, L.M., de Vet, H.C., Terwee,
C.B., Mokkink, L., 2018. COSMIN Methodology for Systematic Reviews of Patient-
reported Outcome Measures (PROMs). User Manual 78. pp. 1.
Nakao, K.C., Damron-Rodriguez, J., Lawrance, F.P., Volland, P.J., 2013. Examination of
the psychometric properties of the knowledge of aging for social work quiz. Educ.
Gerontol. 39, 761771.
Netz, Y., Guthrie, J., Garamszegi, C., Dennerstein, L., 2001. Attitudes of middle-aged
women to aging: contribution of the Reactions to Aging Questionnaire. Climacteric 4,
306313.
Norris, J.E., Tindale, J.A., Matthews, A.M., 1987. The factor structure of the Facts on
Aging Quiz. Gerontologist 27, 673676.
OHanlon, A.M., Camp, C.J., Osofsky, H.J., 1993. Knowledge of and attitudes toward
aging in young, middleaged, and older college students: a comparison of two mea-
sures of knowledge of aging. Educ. Gerontol. Int. Quart. 19, 753766.
Obiekwe, J.C., 2001. An Item Response Theory Analysis of Palmores Facts on Aging Quiz
(FAQ) Using the Three Parameter Model.
Ocer, A., de la Fuente-Núñez, V., 2018. A global campaign to combat ageism. Bull.
World Health Organ. 96, 295.
Ogiwara, S., Inoue, K., Koshimizu, S., 2007. Reliability and validity of a japanese version
ofAttitudes towards the ElderlyScale. J. Phys. Ther. Sci. 19, 2732.
Pachana, N.A., Helmes, E., Gudgeon, S., 2013. An A ustralian facts on ageing quiz.
Australas. J. Ageing 32, 117121.
Palmore, E., 1977. Facts on aging: a short quiz. Gerontologist 17, 315320.
Palmore, E., 2001. The ageism survey: rst ndings. Gerontologist 41, 572575.
Pennington, N.A.P., Coyle, Sarah L., Helen, 2001. Use of the facts on aging quiz in New
Zealand: validation of questions, performance of a student sample, and eects of a
dont know option. Educ. Gerontol. 27, 409416.
Polizzi, K.G., 2003. Assessing attitudes toward the elderly: polizzisrened version of the
aging semantic dierential. Educ. Gerontol. 29, 197216.
Polizzi, K.G., Millikin, R.J., 2002. Attitudes toward the elderly: identifying problematic
usage of ageist and overextended terminology in research instructions. Educ.
Gerontol. 28, 367377.
Rejeh, N., Heravi-Karimooi, M., Vaismoradi, M., Griths, P., Nikkhah, M., Bahrami, T.,
2017. Psychometric properties of the Farsi version of Attitudes to Aging
Questionnaire in Iranian older adults. Clin. Interv. Aging 12, 1531.
Rejeh, N., HERAVIKARIMOOI, M., Montazeri, A., Foroughan, M., Vaismoradi, M., 2012.
Psychometric properties of the Iranian version of the Kogans attitudes toward older
people scale. Jpn. J. Nurs. Sci. 9, 216222.
Rivera-Ledesma, A., Montero-Lopez Lena, M., Gonzalez-Celis Rangel, A.L., Sanchez-Sosa,
J.J., 2007. Lasher and Faulkender. Anxiety about ageing scale: Psychometric prop-
erties on Mexican elderly. Salud Mental 30, 5561.
Romeis, J.C., Sussman, M.B., 1982. Cross cultural dierences on the Facts on Ageing Quiz:
additional comments on age bias. Ageing Soc. 2, 357370.
Rosencranz, H.A., McNevin, T.E., 1969. A factor analysis of attitudes toward the aged.
Gerontologist.
Runkawatt, V., 2007. Evaluation of the Psychometric Properties of the Thai Versions of
Palmores Facts on Aging Quiz and Kogans Attitude Toward Old People in Thai
Adolescents. State University of New York at Bualo.
Rupp, D.E., Vodanovich, S.J., Credé, M., 2005. The multidimensional nature of ageism:
construct validity and group dierences. J. Soc. Psychol. 145, 335362.
Sargent-Cox, K.A., Rippon, M., Burns, R.A., 2014. Measuring anxiety about aging across
the adult lifespan. Int. Psychogeriatr. 26, 135145.
Sarkisian, C.A., Hays, R.D., Berry, S., Mangione, C.M., 2002. Development, reliability, and
validity of the expectations regarding aging (ERA-38) survey. Gerontologist 42,
534542.
Sarkisian, C.A., Hays, R.D., Berry, S.H., Mangione, C.M., 2001. Expectations regarding
aging among older adults and physicians who care for older adults. Med. Care
10251036.
Sarkisian, C.A., Steers, W.N., Hays, R.D., Mangione, C.M., 2005. Development of the 12-
item expectations regarding aging survey. Gerontologist 45, 240248.
Seufert, R.L., Carrozza, M.A., 2002. A test of Palmores Facts on Aging Quizzes as alter-
nate measures. J. Aging Stud. 16, 279294.
Sexton, E., King-Kallimanis, B.L., Morgan, K., McGee, H., 2014. Development of the Brief
Ageing Perceptions Questionnaire (B-APQ): a conrmatory factor analysis approach
to item reduction. BMC Geriatr. 14, 44.
Shenkin, S.D., Watson, R., Laidlaw, K., Starr, J.M., Deary, I.J., 2014. The attitudes to
ageing questionnaire: mokken scaling analysis. PLoS One 9, e99100.
Shiovitz-Ezra, S., Ayalon, L., Brodsky, J., Doron, I.I., 2016. Measuring ageism based on
knowledge, attitudes and behavior: ndings from an Israeli pilot study. Ageing Int.
41, 298310.
Slotman, A., Cramm, J.M., Nieboer, A.P., 2015. Validation of the Dutch Aging Perceptions
Questionnaire and development of a short version. Health Qual. Life Outcomes
13, 54.
Slotman, A., Cramm, J.M., Nieboer, A.P., 2017. Validation of the Aging Perceptions
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
8
Questionnaire Short on a sample of community-dwelling Turkish elderly migrants.
Health Qual. Life Outcomes 15, 42.
Söderhamn, O., Gustavsson, S.M., Lindencrona, C., 2000. Reliability and validity of a
swedish version of Kogans old people scale. Scand. J. Caring Sci. 14, 211215.
Sparks, C.R., Meisner, B.A., Young, B.W., 2013. Investigating general and self-expecta-
tions regarding aging in a physical activity context. Int. J. Sport Psychol. 44, 1736.
Stewart, T.J., Eleazer, G.P., Boland, R., Wieland, G.D., 2007. The middle of the road:
results from the aging semantic dierential with four cohorts of medical students. J.
Am. Geriatr. Soc. 55, 12751280.
Terwee, C.B., Prinsen, C., Chiarotto, A., de Vet, H., Bouter, L.M., Alonso, J., Westerman,
M.J., Patrick, D.L., Mokkink, L.B., 2018. COSMIN Methodology for Assessing the
Content Validity of PROMsuser Manual.
Tuckman, J., Lorge, I., 1954. The inuence of changed directions on stereotypes about
ageing; before and after instruction. Educ. Psychol. Meas. 14, 128132.
Underwood, D.G., Eklund, S.J., Whisler, S., 1985. A Reexamination of the Factor
Structure of the Aging Semantic Dierential Using a Generalized Social Object.
Unwin, B.K., Unwin, C.G., Olsen, C., Wilson, C., 2008. A new look at an old quiz: pal-
mores facts on aging quiz turns 30. J. Am. Geriatr. Soc. 56, 21622164.
Van der Elst, E., Deschodt, M., Welsch, M., Milisen, K., de Casterlé, B.D., 2014. Internal
consistency and construct validity assessment of a revised Facts on Aging Quiz for
Flemish nursing students: an exploratory study. BMC Geriatr. 14, 128.
Villar Posada, F., 1997. Construcción y evaluación en diferentes cohortes del DSE
(Diferencial Semántico del envejecimiento). Anales de psicología 13.
Vitman-Schorr, A., Iecovich, E., Alfasi, N., 2014. Reliability and validity of a Hebrew
version of the Kogans attitudes toward old people scale. Educ. Gerontol. 40,
315326.
Vitman, A., Iecovich, E., Alfasi, N., 2013. Ageism and social integration of older adults in
their neighborhoods in Israel. Gerontologist 54, 177189.
Wang, C.-C., Liao, W.-C., Kuo, P.-C., Yuan, S.-C., Chuang, H.-L., Lo, H.-C., Liao, H.-Y.,
Elaine, M., Lee, M.-C., Yen, C.-H., 2010. The Chinese version of the facts on aging
quiz scale: reliability and validity assessment. Int. J. Nurs. Stud. 47, 742752.
Watkins, R.E., Coates, R., Ferroni, P., 1998. Measurement of aging anxiety in an elderly
Australian population. Int. J. Aging Hum. Dev. 46, 319332.
Wethington, E., Pillemer, K., Principi, A., 2016. Research in Social Gerontology: Social
Exclusion of Aging Adults, Social Exclusion. Springer, pp. 177195.
Wilson, D.M., Errasti-Ibarrondo, B., Low, G., 2019. Where are we now in relation to
determining the prevalence of ageism in this era of escalating population ageing?
Ageing Res. Rev. 51, 7884.
Wingard, J.A., 1980. Measures of attitudes toward the elderly: a statistical re-evaluation
of comparability. Exp. Aging Res. 6, 299313.
World Health Organization, 2015. World Report on Ageing and Health. World Health
Organization.
Wurm, S., Benyamini, Y., 2014. Optimism buers the detrimental eect of negative self-
perceptions of ageing on physical and mental health. Psychol. Health 29, 832848.
Yen, C.-H., Liao, W.-C., Chen, Y.-R., Kao, M.-C., Lee, M.-C., Wang, C.-C., 2009. A Chinese
version of Kogans attitude toward older people scale: reliability and validity as-
sessment. Int. J. Nurs. Stud. 46, 3844.
L. Ayalon, et al. Ageing Research Reviews 54 (2019) 100919
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... At present, multiple scales are available to examine the manifestations (or prevalence) of ageism. These scales often reflect stereotypes, prejudices, or expectations towards old age in general (e.g., 'When people get older, they need to lower their expectations of how healthy they can be') or towards oneself (e.g., 'I expect that as I get older, I will get tired more quickly'), and are constructed to evaluate both younger and older adults' perceptions of aging, aging individuals, and (projected) life as an older individual (see [32] for review). Yet, a validated and comprehensive scale to assess ageism as perceived and experienced by older individuals, reflecting all dimensions of ageism, is still lacking. ...
... Moreover, the subscales of the PAQ were found to hold good validity, as the relationships found for the NEG and POS subscales were in line with theoretical hypotheses and existing knowledge of the concept of ageism. The levels of perceived negative and positive ageism were both positively associated with age, albeit less strongly for the positive subscale, which is in line with the idea that ageism increases with age [32]. Our scale is also consistent with the hypothesis of a negative effect of negative ageism on mental health (e.g., [15,18]) by showing a negative relationship between the level of perceived negative ageism and both quality of life and mental well-being, and positive relationships with depression, anxiety, loneliness, and perceived stress (e.g., [42,43]) (i.e., unmediated effects). ...
... Despite the relatively low levels of perceived ageism, considerable individual differences among individuals were present. Indeed, individual differences in both perceived negative and positive ageism were partially explained by age [32], with higher levels of perceived ageism being observed among those high in age. However, even younger individuals (≤67 years old) sometimes reported relatively high levels of perceived negative and positive ageism. ...
Article
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Ageism as perceived by older individuals has been recognized as a potential risk factor for physical and mental health. We aimed to develop a comprehensive scale that can quantify perceived ageism among aging individuals (55+), including both positive and negative stereotypes, prejudices, and discriminations. This effort resulted in an 8-item Perceived Ageism Questionnaire (PAQ-8), with good psychometric properties and a two-factor structure distinguishing a positive (3 items) and negative (5 items) subscale (Analysis 1; n = 500). This dimensionality was confirmed in a separate cross-validation sample (Analysis 2; n = 500). The subscales’ correlation patterns with individuals’ self-perceptions of aging and mental health variables (i.e., quality of life, mental well-being, depression, anxiety, loneliness and perceived stress) accorded with theoretical hypotheses and existing knowledge of the concept of ageism. The PAQ-8 can help to gather more standardized data of the level, role and impact of perceived ageism.
... En la COVID19 el riesgo de gravedad es superior entre quienes tienen determinadas comorbilidades y que suponen el 20% de mayores de 65 años y ha tenido consecuencias devastadoras en las residencias 3 donde apenas viven el 3,5% 16 . Es notorio que se ha promovido una clara división por edad, separando a jóvenes de mayores como si el problema fuera el contacto intergeneracional 14,15 , como si no existiera la diversidad, equiparando edad avanzada con vulnerabilidad, dependencia y contribución social limitada 11,17 . La categorización cronológica como marcador de riesgo durante la pandemia ha tenido otras consecuencias sociales adversas, e incluso ha sido el criterio para tomar decisiones relativas a la elección del tratamiento 6 . ...
... En una época de amenaza para la salud y el bienestar, de creciente y rápido envejecimiento de la población, es posible que la prevalencia de edadismo esté aumentando. Sin embargo, las estimaciones existentes de la prevalencia de la discriminación por edad no son precisas 11 . El problema tiene varias dimensiones, un componente cognitivo (estereotipos), uno emocional (prejuicios) y uno conductual (discriminación). ...
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Resumen El edadismo es una forma de maltrato que tiene influencia negativa en las personas mayores. Aunque la COVID-19 afecta a personas de todos los grupos de edad, ha incrementado el efecto del mismo, limita el acceso de los mayores a diversos recursos, entre ellos, los sanitarios. El edadismo se asocia con sobrecostes, con peor salud y mortalidad precoz. Desde el «Grupo de Trabajo (GdT) de Atención al Mayor de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC)» realizamos una serie de propuestas para combatirlo basándonos en actividades comunitarias que favorezcan las relaciones intergeneracionales y la educación en envejecimiento que permitan una correcta integración de los mayores en la sociedad.
... Wyman et al. (2018) discuss the general ageism within healthcare settings that reduces the quantity and quality of the healthcare older adults receive. While ageism becomes increasingly salient in times of almost universal dramatic population aging, the importance of ageism has not yet been reflected in empirical research (Ayalon et al., 2019;Wilson et al., 2019). ...
... This lack of more recent European ageism data is a limitation of our study. Indeed, we second the call for more systematic, harmonized, comparative assessments of ageism (Ayalon et al., 2019;Wilson et al., 2019). ...
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Objectives: The effects of the COVID-19 outbreak on non-COVID-19-related healthcare need further investigation. Methods: Using the Survey of Health, Ageing and Retirement in Europe's COVID-19 module (2020) (N = 57,025), country-level data from the European Social Survey (2008) and OECD (2020), and logistic regressions, this study examines predictors of older Europeans' forgone, postponed, and denied healthcare during the pandemic. Results: Country-level availability of physicians, healthcare systems' generosity, and beliefs that older persons burden healthcare systems all increased forgone healthcare. Healthcare system generosity increased postponed and denied healthcare. Greater medical resources decreased denied healthcare. Furthermore, missed healthcare varied by individual-level gender (higher rates among women), age, education , and health. Discussion: This study reveals predictors of missed healthcare during the pandemic. To decrease un-intended health consequences of a pandemic, both individual-level determinants, such as gender and health, and contextual-level determinants, such as healthcare systems' characteristics, should be considered in research and practice.
... We thus developed this scale in collaboration with a survey methodologist at the Survey Research Center at the University of Michigan Institute for Social Research, using a commonly implemented 5-point Likert-style response scale, and pilot-tested the item along with the full baseline survey prior to data collection (Kobayashi et al., 2021). We elected not to use existing ageism scales, as they typically assess interpersonal experiences of age-based discrimination (Ayalon et al., 2019), while we aimed to examine perceptions of how older adults were treated by society as a whole during the pandemic. Since, the pandemic onset and since our scale was developed, there has been published work that used single-item measures of perceived ageism during the pandemic (e.g., Cohn-Schwartz & Ayalon, 2021). ...
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The cognitive health of older adults since the COVID‐19 pandemic onset is unclear, as is the potential impact of pandemic‐associated societal ageism on perceived cognition. We investigated associations between perceptions of societal ageism and changes in subjective memory over a 10‐month period during the COVID‐19 pandemic. We collected longitudinal data from monthly online questionnaires in the nationwide COVID‐19 Coping Study of US adults aged ≥55 from April 2020 to January 2021 (N = 4444). We analyzed the data using multivariable longitudinal multilevel models. We identified an overall decline in subjective memory, especially in the initial months of the pandemic. Adults who perceived that societal respect for older adults decreased during the pandemic experienced more rapid declines in their subjective memory. These findings suggest that aging adults perceived a decline in their memory, especially during the initial months of the COVID‐19 pandemic. Societal interventions to combat ageism may help improve subjective memory and could decrease risk for cognitive decline among middle‐aged and older adults.
... Although many researchers have commended the strengths and advantages that Palmore's FAQ's multiplechoice version brings to the measurement of ageism (Ayalon, 2019), diverse countries have unique features that disallows its adoption and use in a 'lock, stock and barrel' manner. The issue of timing may also be a potential problem since "responses that were correct at one time may become incorrect as policies and practices evolved with time in company with demographic shifts" (Helmes, 2016, p. 72). ...
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One universal measurement scale of ageism constitutes the Facts on Aging Quiz (FAQ) which consists of 25 true-false statements for dissemination in the United States context. This short communication included two objectives-namely, to develop and update the FAQ for the Maltese context, and to explore the perceptions and knowledge of Maltese older persons on ageing in general and ageism in particular. Following a fact-checking exercise that resulted in seven amendments in the most recent FAQ version, the modified FAQ was completed by 372 community-dwelling older adults in Malta. The mean percentage of correct responses was 56.4%. The three quiz items that received most accurate responses related to 'law abiding', 'injuries at home', and 'fear of crime'. This implied that respondents held an unrealistically high perception of later life as a period of excessive frailty and vulnerability since such positive responses are much higher than actual incidences of medical care attention due to falls at home and being a victim of crime in later life. Conversely, the items on 'volunteers', 'living contexts', and 'poverty' garnered the least correct responses to reaffirm how Maltese older persons perceive later life as a period of increased frailty and vulnerability, and hence, manifest strong degrees of 'internal ageism'.
... Ageist attitudes have been recognized as a factor influencing older adults (World Health Organization [WHO], 2021). Ageism comprises discrimination, prejudice, and stereotypes toward a person based on their age (Ayalon et al., 2019). Ageist attitudes and biases can lead to age-based disparities in healthcare including diagnostic procedures, decision making, and types of treatment offered. ...
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Effective communication between nurses and patients is an important factor to quality nursing care but ineffective nonverbal communication could take a toll on health care. Therefore, understanding the factors that influence nonverbal communication between nurses and hospitalized older adults could help solve communication problems, thus improve nursing care. A sample of 13 nurses and 4 student nurses from two hospitals in Cameroon participated in the study. Data were collected using participant observations and semi-structured interviews, and analyzed using open coding and constant comparative analysis. Three categories were identified as influencing factors: nurse views of hospitalized older adults, hospitalized older adult-related factors, and nurse intrinsic factors. Effective nurses’ nonverbal communication with hospitalized older adults relies mostly on nurses’ intrinsic factors. Identification and nurturing of the positive nurse intrinsic factors are important to develop effective nonverbal communication skills among nurses.
... Further research is then required to explore whether these dimensions may be associated with dimensions assessed in other ageism scales. Yet, since most of them focus on representations 19 the ASDS is more likely unique in its ability to capture ageist attitudes related to dental health. ...
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Background and aims: The World Health Organization considers ageism as an important barrier to age-appropriate care for older adults. An Ageism Scale for Dental Students (ASDS) has been validated in the United States, Brazil, Greece, Romania and in France. At present, the convergent validity of ASDS has never been evaluated. Moreover, a specialized and disciplinary tool as the ASDS may not overlap with more general ageism assessment which may highlight the need for specific courses during the education of the future health professionals. Method: The survey was administered from December 2020 to January 2021. All the undergraduate students of the last three years of study at the dental school of Clermont-Ferrand were invited to complete both scales. 216 students were randomly divided into two equal groups. The first group answered first Ageing Semantic Differential- ASD then ASDS, the second in reverse order. The convergent validity between ASDS and ASD was assessed by computing a Pearson correlation coefficient and discriminant analysis between each component of the two scales. Results: The response rate was of 53.7%. The correlation analysis conducted on the total scores of the ASDS and of the ASD shows a significant, yet weak relationship. The discriminant analysis indicates that only the first component of the ASDS is significantly associated with each dimension of the ASD, whereas the second component is totally independent from the ASD and the third component almost independent from the ASD, except for the integrity dimension. Conclusions: This specialized questionnaire may assess a form of ageism that is not captured at all in more general scales. Such a scale may help to identify the different dimensions of ageism among dental students which is required to reduce ageism in medical care. This reduction should pass by adapted courses in gerodontology.
Article
This multidisciplinary work mainly uses a discourse analytical approach (Fairclough 1995; Sarangi 2010a, 2010b) and fine tools (i.e., corpora and text analysis software, Baker 2010) in order to identify the possible presence of ageism (Butler 1969) from responses provided by psychologists who completed the Fraboni Scale of Ageism (Fraboni et al. 1990) used in the Italian validation (Donizzetti 2010) and further adapted to achieve the objective of this study. In fact, for each item (Tot=19) distributed along this 3-dimensional model (separation and avoidance; stereotypes and antilocution; affective attitudes and discrimination), 177 respondents were asked to express their (dis)agreement, not with numbers, as in the traditional scale, but with a text (D’Amico et al. 2020). With reference to the above-mentioned dimensions, some results unveiled the psychologists’ recurring belief system as follows: 38% of respondents believed that old people complain much more than other people, thus confirming their idea of a separate group from theirs; 35.7% thought that the elderly should be entrusted with the care of infants only when supervised, thus fitting the stereotype of the fixed age-identity category; and 80.6 % declared that they were unwilling to reciprocate if an old person initiated a conversation for external and/or context/personality-dependent reasons, thus justifying their discriminatory attitudes. Limited but not negligible results demonstrate a need for mental health education and training to be monitored in order to better understand the professionals’ belief system that emerges from their discourse on old age, because the reiteration of the same belief system, if cemented in social memory, has the strong effect of conferring an aura of objectivity to prevailing attitudes towards old(er) adults, and of inevitably affecting standard professional inter/actions with them.
Article
This study aims to shed further light on the emergence of ageist attitudes by introducing a theoretically grounded mechanism that helps explain why older persons appear as burdensome by segments of society. We introduce the concept of “marketized mentality” (MM), which depicts a strong personal commitment to the principal values associated with the market economy, to the research on ageism. The results of multilevel regression analyses with World Values Survey data (N = 70,456 individuals in 59 nations) reveal that MM yields the hypothesized, positive relationship with our burden-focused indicator of ageism. Moreover, we observe that countries with high levels of MM—which might be conceptualized as “marketized anomic cultures”—exhibit particularly high levels of this form of ageism.
Article
Background Interventions to support a more “age friendly” world is a key objective set out by the World Health Organisation with health and wellbeing benefits being increasingly identified for both young and old. Whilst multiple studies have explored intergenerational engagement between kindergarten aged children and older adults, there is limited collective knowledge of program design and the potential impact that these programs have on adolescents engaging with older adults in the nursing home setting. Objectives The aims of this systematic review were to: a) examine intergenerational program development and delivery in the nursing home setting b) report on the impact of intergenerational engagement on adolescents and older adults. Design A systematic mixed studies review of intergenerational programs targeting adolescents and older adults. Data source MEDLINE, CINAHL, Embase, PsycINFO, Scopus and ERIC (1995 and 2021) and reference lists were hand-searched. Review Methods The first author conducted a review of the titles and abstracts based on inclusion and exclusion criteria. All authors then reviewed and discussed each paper to determine inclusion. Qualitative appraisal using the Mixed-Methods Appraisal Tool was conducted and all evidence from the quantitative, qualitative, and mixed-methods studies were identified and thematically analysed using a convergent qualitative synthesis design. Results Ten papers were identified for review (six qualitative studies, two quantitative studies and two mixed methods studies). Inconsistencies in the inclusion criteria for older adults limited opportunities to explore the benefits for people with or without dementia. Few studies described the process of program design and there were wide variations in program delivery. Programs ranged from six weeks to eight months with a variety of activities and interactions implemented. Engaging in intergenerational programs resulted in improved wellbeing and perceptions of social inclusion, and reduced ageism. No correlations between program design and impact were identified. Conclusions Intergenerational programs have important socio-emotional benefits for both adolescents and older adults. There is limited understanding of what meaningful intergenerational engagement entails as there is a lack of transparency surrounding the mechanics behind the programs that are associated positive change in the literature. In addition, there is currently no evidence of the longitudinal impacts or the broader social implications of these types of interventions. Future research is needed to explore program design, the longitudinal effects and the wider impacts of intergenerational programs at a community and societal level. Tweetable Abstract Design and impact of intergenerational engagement between adolescents and older adults in the nursing home setting: a systematic review.
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Purpose: Systematic reviews of patient-reported outcome measures (PROMs) differ from reviews of interventions and diagnostic test accuracy studies and are complex. In fact, conducting a review of one or more PROMs comprises of multiple reviews (i.e., one review for each measurement property of each PROM). In the absence of guidance specifically designed for reviews on measurement properties, our aim was to develop a guideline for conducting systematic reviews of PROMs. Methods: Based on literature reviews and expert opinions, and in concordance with existing guidelines, the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) steering committee developed a guideline for systematic reviews of PROMs. Results: A consecutive ten-step procedure for conducting a systematic review of PROMs is proposed. Steps 1-4 concern preparing and performing the literature search, and selecting relevant studies. Steps 5-8 concern the evaluation of the quality of the eligible studies, the measurement properties, and the interpretability and feasibility aspects. Steps 9 and 10 concern formulating recommendations and reporting the systematic review. Conclusions: The COSMIN guideline for systematic reviews of PROMs includes methodology to combine the methodological quality of studies on measurement properties with the quality of the PROM itself (i.e., its measurement properties). This enables reviewers to draw transparent conclusions and making evidence-based recommendations on the quality of PROMs, and supports the evidence-based selection of PROMs for use in research and in clinical practice.
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PurposeThe original COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was developed to assess the methodological quality of single studies on measurement properties of Patient-Reported Outcome Measures (PROMs). Now it is our aim to adapt the COSMIN checklist and its four-point rating system into a version exclusively for use in systematic reviews of PROMs, aiming to assess risk of bias of studies on measurement properties. Methods For each standard (i.e., a design requirement or preferred statistical method), it was discussed within the COSMIN steering committee if and how it should be adapted. The adapted checklist was pilot-tested to strengthen content validity in a systematic review on the quality of PROMs for patients with hand osteoarthritis. ResultsMost important changes were the reordering of the measurement properties to be assessed in a systematic review of PROMs; the deletion of standards that concerned reporting issues and standards that not necessarily lead to biased results; the integration of standards on general requirements for studies on item response theory with standards for specific measurement properties; the recommendation to the review team to specify hypotheses for construct validity and responsiveness in advance, and subsequently the removal of the standards about formulating hypotheses; and the change in the labels of the four-point rating system. Conclusions The COSMIN Risk of Bias checklist was developed exclusively for use in systematic reviews of PROMs to distinguish this application from other purposes of assessing the methodological quality of studies on measurement properties, such as guidance for designing or reporting a study on the measurement properties.
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Background: There is a broad semantic network of aging stereotypes; where different concepts and their measurement are confused: personal stereotypes, self-stereotypes and self-perception of aging. Method: First, we analyze the translated version of the Image of Aging Scale (IAS) measurement model through exploratory and confirmatory factor analysis, with two representative sub-samples of the Spanish population aged over eighteen (N = 1,105) and in a sample of gerontologists and geriatricians (N = 325). Second, in an effort to disentangle the theoretical relationships between personal stereotypes, self-stereotypes and self-perception of aging, both the IAS (with different instructions) and Lawton’s 5-item scale were administered to a representative sample of Spanish people over 50. Results: Our results indicate that the Spanish version of the IAS has a similar psychometric structure to that proposed by the authors. Furthermore, the factorial structure (equal form and metric invariance) is replicated in both samples, but latent means and factor correlations were higher in the professional group. Conclusions: We discuss Levy’s theoretical assumptions about personal-stereotypes and the self-stereotype measured with IAS and their relationship to self-perception of ageing.
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Background: Attitudes to the aging process are affected by the individual’s sociocultural background. The measurement of this important concept among older people in various societies requires the use of tools that are able to demonstrate both reliability and validity. Objective: The objectives of this study were to translate and validate the Attitudes to Aging Questionnaire (AAQ) and investigate its psychometric features among Iranian older people. Methods: In this methodological study, the Farsi version of the AAQ was validated among 400 Iranian older adults who were members of citizen clubs in an urban area of Iran. Content, face and construct (exploratory factor analysis) validities of the AAQ were assessed. In addition, its reliability was assessed in terms of internal consistency and stability. For discriminant validity, the discriminant power of the AAQ in terms of gender and education levels was evaluated. Criterion validity showed a significant correlation between the most subscales of the AAQ and the Short Form 36 (SF-36) and World Health Organization Quality of Life (WHOQOL) questionnaires. Descriptive and inferential statistics were used for data analysis. Results: The exploratory factor analysis confirmed the construct validity of the AAQ. The result of the test–retest reliability with a 2-week interval was satisfactory and reported as r=0.90 (p<0.001). The Cronbach’s alpha coefficient was reported as 0.75 for the whole instrument and 0.85–0.93 for its dimensions. There were associations between the AAQ subscales, SF-36 quality of life (r=0.56, p<0.001) and WHOQOL-BREF (r=0.78, p<0.001), indicating an appropriate convergent validity. The ability to discriminate between male and female participants and those with lower and higher education levels was demonstrated, thus lending support to claims for adequate known-group validity. Conclusion: The Farsi version of the AAQ showed favorable validity and reliability. Therefore, it can be used for assessing attitudes toward aging among older adults. Keywords: aging, Attitudes to Aging Questionnaire, older adults, psychometrics properties, reliability, validity, elderly
Article
Standardized and well-tested instruments are needed in order to study attitudes toward old people. One scale that has been widely used is Kogan's Old People scale. A Swedish version of the scale has been available since 1987. The aim of this study was to test this Swedish version of the scale for reliability and validity, in a sample consisting of students and different health-care professionals. A convenience sample of 319 individuals in western Sweden took part in the study, and data were collected by means of a questionnaire that included the scale. Reliability was assessed as homogeneity and validity as construct validity. All but 4 of the 34 items were found to have significant item-total correlations. The Cronbach's alpha coefficient for the total scale was 0.79. Some evidence of construct validity was found in a three-factor solution, which explained 30% of the variances. Strong evidence of construct validity was shown in the scale's capability to differentiate between individuals who rather preferred to work with old people (p < 0.005) than with young clients. Convergent validity, as a form of construct validity, was also supported for the scale.
Article
Population ageing is escalating rapidly now worldwide. This is an important time to determine if ageism or discrimination against older people is of concern, such as it being prevalent and/or increasing in prevalence. Over the years, many ageism measurement tools have been developed, with research findings from their use of prime consideration then for determining the prevalence of ageism and any prevalence trends. All print and open access English-language research articles published in 1953+ that used one or more ageism measurement tools in a study were sought using the Directory of Open Access Journals and EBSCO Discovery Service. A total of 25 ageism measurement tools were identified. However, only six had been used one or more times to measure the prevalence of ageism. The identified prevalence levels varied considerably, but most investigations using small convenience samples, with limited generalizability of findings. This paper highlights the need to continue developing ageism measurement tools to estimate ageism or use other measures, such as census and population-representative polling, to assess the extent and impact of ageism. This foundational measurement is needed, as ageism could be prevalent and growing in effect.
Article
Performing an effective literature search to obtain the best available evidence is the basis of any evidence-based discipline, in particular evidence-based medicine. However, with a vast and growing volume of published research available, searching the literature can be challenging. Even when journals are indexed in electronic databases, it can be difficult to identify all relevant studies without an effective search strategy. It is also important to search unpublished literature to reduce publication bias, which occurs from a tendency for authors and journals to preferentially publish statistically significant studies. This article is intended for clinicians and researchers who are approaching the field of evidence synthesis and would like to perform a literature search. It aims to provide advice on how to develop the search protocol and the strategy to identify the most relevant evidence for a given research or clinical question. It will also focus on how to search not only the published but also the unpublished literature using a number of online resources. LEARNING OBJECTIVES • Understand the purpose of conducting a literature search and its integral part of the literature review process • Become aware of the range of sources that are available, including electronic databases of published data and trial registries to identify unpublished data • Understand how to develop a search strategy and apply appropriate search terms to interrogate electronic databases or trial registries DECLARATION OF INTEREST None.
Article
Objectives: The original 24-item Attitudes to Aging Questionnaire (AAQ) is well established as a measure of attitudes to aging, comprising domains of psychosocial loss (PL), physical change (PC), and psychological growth (PG). This paper presents a new 12-item short form Attitudes to Aging Questionnaire (AAQ-SF). Methods: The original field trial data used to develop the 24-item AAQ (AAQ-24) were used to compare 6-item, 9-item, and 12-item versions of AAQ-SF (sample 1, n = 2487) and to test the discriminative validity of the selected 12-item AAQ-SF (sample 2, n = 2488). Data from a separate study reporting on the AAQ-24 (sample 3, n = 792) verified the analyses. Results: The 12-item AAQ-SF reported adequate internal consistency in both sample 1 (PL α = .72, PC α = .72, and PG α = .62) and sample 3 (PL α = .68, PC α = .73, and PG α = .61). The AAQ-SF functioned consistently with the profile of the AAQ-24 in that subscales in both formats of this measure discriminate between respondents on key parameters such as depression, subjective health status, and overall quality of life in sample 2. Sample 3 also demonstrated the AAQ-SF can detect the differences in attitudes toward aging between individuals experiencing anxiety and depression and those without psychological symptoms. Confirmatory factor analysis confirmed that the structure of the AAQ-SF mirrors that of the original 24-item AAQ. Conclusions: The AAQ-SF is a robust measure of attitudes toward aging, which can reduce respondent burden when used within longer questionnaire batteries or longitudinal research. Copyright © 2017 John Wiley & Sons, Ltd.