Dr. Kathy Pichora-Fuller is Professor Emerita in Psychology at University of Toronto and Adjunct Professor in Gerontology at Simon Fraser University, Canada. She was a guest professor in the Linneaus Centre for Hearing and Deafness Research at Linköping University in Sweden (2010-2014). She translates her experimental research on auditory and cognitive aging to address the rehabilitative and communication accessibility needs of older adults with age-related hearing and cognitive impairments, including a new focus on social engagement and healthy aging. She has won numerous awards including the International Research Award from the American Academy of Audiology and Eve Kassirer Lifetime Achievement Award from Speech-Language and Audiology Canada. Currently, she is President of the International Collegium of Rehabilitative Audiology, the audiology expert for the Canadian Longitudinal Study of Aging and the Canadian Consortium on Neurodegeneration in Aging, and is working with the International Federation on Ageing on a new initiative on “Hearing in Later Life”.
Views of aging: Intersections with multiple stigmas influencing help-seeking and interventions for sensory, physical and cognitive health
Dr. Alison Chasteen is a Professor of Psychology at the University of Toronto in Toronto, Ontario, Canada. She is a social psychologist with specialized training in aging who studies prejudice, stereotyping, and stigma from both the perceiver’s and the target’s perspective. She and her team investigate a number of prejudices, including biases based on age, gender, race, sexuality, and religious view, as well as the intersections of many of these identities. With respect to aging, Chasteen and her collaborators have been examining people’s experiences of aging and ageism and investigating ways to counteract stereotype-based views of aging in older adults.
Dr. Manfred Diehl is a University Distinguished Professor in the Department of Human Development and Family Studies at Colorado State University. His research program focuses on how middle-aged and older adults become aware of their own aging, and how self-perceptions of aging are related to developmental outcomes, such as psychological well-being and physical health. This work has resulted in the development of an intervention program that targets adults’ negative views of aging as a mechanism to promote healthy aging.
Dr. Louise Hickson is Professor of Audiology and Associate Dean External Engagement in the Faculty of Health and Behavioural Sciences at The University of Queensland. She is recognized internationally as a leader in audiologic rehabilitation and in person and family-centred hearing care. Professor Hickson is the Chair of the Phonak Expert Circle on Family-Centered Hearing Care, Chair of the Ida Institute Advisory Board, Fellow and past President of Audiology Australia, President Elect of the International Society of Audiology and an Editor of the International Journal of Audiology. She has won numerous awards including the International Research Award from the American Academy of Audiology and The University of Queensland Leadership Award.
Dr. Walter Wittich is an Associate Professor at the School of Optometry at the University of Montreal, in Montreal, Quebec, Canada. His research focuses on the rehabilitation of older adults with combined vision and hearing loss. Walter is the inaugural chair of the Deafblind International Research Network and chair of the Visual Impairment and Rehabilitation axis of the Quebec Vision Health Research Network, is a Fellow of the American Academy of Optometry and is Quebec’s first Certified Low Vision Therapist.
Dr. Nyblade is a Fellow and Senior Technical Advisor on Stigma and Discrimination in the division for global health, International Development Group, RTI International. For the past two decades, she has built and led a portfolio of research and programmatic work on HIV stigma with a focus on data utilization to support evidence-based program implementation and policy at local, national, and global levels, with a recent focus on addressing HIV and intersecting stigmas in health facilities. Working in close collaboration with civil society and governments across Sub-Saharan Africa, South and South-East Asia and the Caribbean, she has led the design, roll out and evaluation of evidence-based HIV stigma reduction programs, the development of programmatic tools to engage multiple audiences, and the development and validation of stigma measures. Her research and programmatic interests have concerned health stigma more broadly and explored where commonalities may exist that can be leveraged for a more efficient and effective response to health stigma, either through translations of lessons learned around one health stigma to another, or through joint intervention research programs that tackle multiple health stigmas together. In this context, Dr. Nyblade is currently leading a sub-working group on hearing loss stigma under the Lancet Commission on Global Hearing Loss.
Kathleen Pichora-Fuller, University of Toronto and Simon Fraser University, Canada
Alison Chasteen, University of Toronto, Canada
Manfred Diehl, Colorado State University, USA
Louise Hickson, Queensland University, Australia
Walter Wittich, University of Montreal, Canada
Laura Nyblade, International Development Group, RTI, International, United States
In this symposium, we will consider how the views of aging held by older adults may combine with disability-related stigmas regarding sensory, physical and cognitive health. How positively or negatively an individual views aging is known to affect many health domains and even longevity. It is also well known that with increasing age there is an increased likelihood that a person will experience multiple health conditions. Hearing impairment and vision impairment are among the most prevalent age-related disabilities. These age-related sensory impairments are associated with each other and with psychological (e.g., cognitive decline and dementia, depression) and physical (e.g., falls) health issues. Health promotion interventions to reduce risk and/or rehabilitative interventions, including the use of assistive technologies, may benefit older adults. Nevertheless, ageism and other stigmas may delay help-seeking and complicate decision-making for older adults. There is increased awareness of the importance of ageism and disability-specific stigmas as threats to healthy aging and aging well, but little is known about the intersection of ageism with stigmas to age-related sensory and cognitive declines. The presentations in the symposium will begin with a report on research showing that views of aging are associated with self-perceptions and performance on measures of hearing and memory in older adults and that there are also significant associations between hearing and memory measures. The second paper will describe ongoing research to evaluate an intervention designed to counter-act negative ageist views in order to promote increased physical activity as a way to reduce risk of cognitive decline. The third paper will describe a multi-method research program to investigate how ageism and stigma to hearing loss and hearing aids affects older adults and their family members and influences their decisions regarding help-seeking and uptake of interventions to address age-related hearing loss. The fourth paper considers the intersections between ageism and other health-related and technology-related stigmas for older adults with dual sensory (hearing and vision) loss. The final paper will describe a framework for hearing loss stigma and how a new approach for measuring stigma recognizes the intersection of ageism with stigma to hearing loss in the context of a consideration of intersectional theory and intersectional stigma. In the final discussion we will explore how these important intersections could be incorporated in future directions for research, practice and policy.
Presenter #1, Alison L. Chasteen
Older adults’ views of aging predict hearing and memory performance through self-perceived hearing and memory abilities: A replication and extension
Co-authors: Maria Iankilevitch, April Pereira, Manfred Diehl and M. Kathleen Pichora-Fuller
The interplay between older adults’ views of aging and their cognitive and sensory function has received little attention. One of the few studies (Chasteen et al., 2015) on this topic found that older people’s views of aging were negatively associated with their self-perceived hearing and memory abilities, which in turn were positively associated with their hearing and memory performance. In the present study, we replicated and extended these findings by using additional measures in a new sample (N=261) and also tested for the lagged effects of performance on later perceptions. Our earlier model was replicated, with all associations in the same direction. Moreover, this pattern of associations held when including additional measures. Lagged analyses revealed that better memory performance at Time1 predicted more positive views of aging and marginally predicted more positive self-perceived memory at Time2. A similar pattern occurred for hearing, whereby worse hearing performance at Time1 predicted more negative self-perceived hearing and marginally predicted more negative views of aging at Time2. The results emphasize the importance of older people’s views of aging when assessing their function in both sensory and cognitive domains, and stress the need to consider the long-term influence of performance on those views.
Presenter #2, Manfred Diehl
Designing interventions addressing ageism and negative age stereotypes to improve physical and cognitive health
Recent years have seen systematic attempts to design interventions that address ageism and negative age stereotypes as mechanisms that undermine adults’ motivation to engage in behavior that can optimize healthy aging. Specifically, these interventions use strategies rooted in cognitive-behavioral theory to create an understanding in individuals about everyday ageism and the effects of negative views of aging, including the effects of negative age stereotypes, on individuals’ attitudes and behavior as they grow older. This presentation will describe an intervention program, the AgingPLUS program, that implements this approach. In particular, I will describe the program content related to addressing ageism and negative age stereotypes, including exercises the participants complete to (a) understand these concepts, and (b) find ways in which they can address incidents of negative age stereotyping in their own lives. Data from two pilot studies and an ongoing clinical trial will be presented to provide evidence in support of the efficacy of the AgingPLUS program. Although these efficacy studies have focused on increasing adults’ engagement in physical activity as a major way to promote healthy aging, I will also discuss why extensions to other areas, such as sensory and cognitive aging, should be explored.
Presenter #3, Louise Hickson
To tell or not to tell: Stigma experiences of adults with hearing impairment
Co-authors: Katie Ekberg, Barbra Timmer, Anna Francis, Monique Waite, Carly Meyer, and Nerina Scarinci
Stigma has long been implicated as a reason why adults with hearing impairment take an average of 7 to 10 years to seek help and why outcomes of hearing device fitting are less than optimal for some clients. In our research, the stigma experiences of 20 adults with hearing impairment (aged 50+ years; 10 who wear hearing aids and 10 who do not) and their families have been captured by 1) administering questionnaires about stigma and affiliate stigma, 2) surveying people with hearing impairment in real time in their everyday environments using Ecological Momentary Assessment delivered via smartphone; 3) video recording social interactions of participants in the real world; and 4) interviewing adults with hearing impairment and their families about their stigma experiences and perspectives. People with hearing impairment and their families agree that hearing impairment and hearing aids are associated with stereotypes of ageing, reduced intelligence and having a problem or deficit, and that these stereotypes negatively impact help-seeking for hearing and the uptake and use of devices. Participants experienced the ‘tell or not to tell’ dilemma and the risks to losing their social identities as a ‘normal’ if they disclose the hearing impairment and/or wear hearing aids.
Presenter #4, Walter Wittich
Intersectional stigma and self-stigma: The case of combined vision and hearing impairment
Traditionally, stereotypes, ageism and negative views of stigmatizing traits have been studied in isolation. In recent years, however, the concept of intersectional stigma has received more attention, especially given that the number of older adults living with more than one chronic health condition has drastically increased. Intersectional stigma refers to the potential overlap of several stigmatizing traits within the same individual or social group. For example, while older adults may have adjusted to their hearing impairment by integrating hearing aids into their life and identity, this process may be challenged by the later onset of a visual impairment that requires the use of a white cane. Adjusting to a new identity (in this case combined sensory loss or deafblindness) may challenge the resilience of the individual more so than one impairment would alone. Self-stigma, or the internalized stigma held by the person before the onset of the impairment, can play a key role in this adjustment process and be a barrier with multiple layers, especially when multiple stigmatizing conditions converge. This presentation will take a closer look at the evidence on intersectional and self-stigma, specifically in the context of older adults living with combined vision and hearing impairment.
Presenter #5, Laura Nyblade
Foundational steps to address the intersection of hearing loss stigma and ageism to promote healthy aging
While hearing loss (HL) stigma is recognized as an integral part of living with hearing loss, few studies have used a “stigma” lens to systematically explore and measure HL stigma, its intersection with ageism, and the role and impact of HL stigma on individuals with acquired HL through aging. In response, under the Lancet Commission for Global Hearing Loss, a team of stigma and HL experts developed a stigma framework for HL that incorporates intersecting stigmas, including ageism. We also developed HL measures for stigma (experienced, internalized, anticipated and perceived) through a systematic process of: 1) a literature review to inform draft measures; 2) a modified Delphi process of expert consultation meetings with service providers and groups with lived experienced of HL; 3) cognitive interviews and pre-test surveys; 4) validation surveys with a range of target groups, including older adults with acquired HL (n=400). The latter two steps being conducted in Ghana and the US. Preliminary survey results on the prevalence of different forms of HL stigma and ageism will be shared, alongside the stigma framework for HL to stimulate a discussion on the importance of measuring and addressing the intersection of HL stigma and ageism to support healthy aging.