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Becca Levy and the Fight Against Ageism

Yale Public Health Magazine, Focus: Spring 2023
by Jane E. Dee


It’s Valentine’s Day, and Becca Levy has just made a quick stop at the store only to find the line stretching out the door.

“Apologies. I am running a few minutes late. Parking my car. Ok to start in 5ish minutes?” she emails. A few minutes later, Levy logs onto Zoom for our late-afternoon interview and spends the next hour patiently answering my questions.

The conversation allowed me to catch up with Levy to discuss her scientific discoveries about how positive and negative age beliefs influence how we age. In her recent book, Breaking the Age Code, Levy brought her published academic research to a mainstream audience. A professor of social and behavioral sciences at Yale School of Public Health and of psychology at Yale University, Levy reveals surprising insights about how the mind-body connection influences the aging process through groundbreaking research. Levy’s research also has shown how the stigmatization of older people, which increased during the COVID-19 pandemic, is internalized, and activated across our life spans. Exposure to harmful stereotypes about older people comes from a wide range of societal sources, such as traditional and social media. We absorb these stereotypes without fully realizing it.

“Most of us like to consider ourselves as capable of thinking fairly accurately about other people,” Levy writes in her book. “But the truth is, we are social beings who carry around unconscious social beliefs that are so deeply rooted in our minds that we don’t usually realize they’ve got their hooks in us.”

Positive Age Beliefs

Levy’s research shows how health problems that have been thought to be entirely due to aging, such as memory loss, hearing decline, and cardiovascular events, are instead influenced by negative age beliefs. Positive age beliefs, on the other hand, lead to better health and even longer life – 7.5 years on average, in fact.

While a Harvard graduate student, she received a National Science Foundation Fellowship to study why the Japanese have the longest life span in the world. Soon after she arrived in that country, she noticed that in Japan old age is treated as a time to enjoy rather than to fear and she started to wonder how culture impacts aging. She described in her book how the Japanese don’t make a lot of fuss about menopause, for example, treating it as a valued phase of life, unlike in the U.S. where it is sometimes treated like a midlife affliction. As a result, older Japanese women are less likely to experience hot flashes and other symptoms of menopause than women of the same age in the U.S.

“For better or for worse, those mental images that are the product of our cultural diets, whether it’s the shows we watch, the things we read, or the jokes we laugh at, become scripts we end up acting out,” Levy wrote.

One of her most remarkable discoveries is that positive age beliefs act as a buffer against developing dementia, including in people who carry the Alzheimer’s gene APOE e4. News of this finding traveled from the Yale campus to the University of Chile, where José Aravena Castro was studying how social issues and culture impact aging and the risk of dementia. Aravena, a Fulbright scholar, is now a doctoral student in Social and Behavioral Sciences at Yale School of Public Health, working with Levy. He is currently collecting data for his dissertation among the Mapuche people in southern Chile.

Resource for Recovery

Positive age beliefs not only offer the possibility of greater functional health in older people, but they also help with recovery from illnesses and injuries.

“Just as there is a widespread false belief that functional health inevitably declines with age, it is also assumed that older people do not recover well in the wake of acute injuries or illness,” Levy said. A study by Yale’s Thomas M. Gill, MD, Humana Foundation Professor of Medicine (Geriatrics) and Professor of Epidemiology (Chronic Diseases) and of Investigative Medicine, upended this assumption, showing that most older people who couldn’t bathe or feed themselves after a bad fall or injury were eventually able to do those things again.

To learn what drives these recoveries and whether it could be age beliefs, Levy put an age belief measure in the baseline of Gill’s Precipitating Events Project (PEP Study), which has allowed her to have an analysis of older people over time in the New Haven area. She found that the older adults who participated in the study who have positive age beliefs were 44% more likely to fully recover from severe disability – showing that positive age beliefs can act as a resource for recovery. The paper, Association Between Positive Age Stereotypes and Recovery from Disability in Older Persons, was published in JAMA.

A new paper by Levy is on the role of positive age beliefs in mild cognitive impairment recovery. The study considered for the first time whether a culture-based factor, positive age beliefs, contributes to MCI recovery. Levy hypothesized that older persons with positive age beliefs would be more likely to recover from MCI and that they would do so sooner, compared to those with negative age beliefs. She based this hypothesis on her previous experimental studies with older persons that found positive age beliefs were shown to reduce the stress caused by cognitive challenges, increase self-confidence about cognition, and improve cognitive performance.

$63 billion: The Cost of Ageism

Levy also conducted the first analysis of the health care costs of ageism with collaborators Shi-Yi Wang, associate professor of epidemiology (Chronic Diseases), Martin Slade, lecturer in internal medicine, E-Shien Chang, and Sneha Kannoth.

“The persistent status of ageism as one of the least acknowledged forms of prejudice may be due in part to an absence of quantifying its costs in economic terms. In this study, we calculated the costs of ageism on health conditions for all persons aged 60 years or older in the United States during one year,” the authors wrote. They found that the one-year cost of ageism was $63 billion which is greater than the total amount the U.S. spent on health care costs of morbid obesity for the same year.

Ageism and COVID-19

In 2022, Levy and colleagues published a paper that looked at whether structural ageism in the form of media messaging can harm older persons' mental health, and if age-positive messages can benefit older persons’ mental health.

She and the team of researchers, E-Shien Chang; Sarah Lowe, associate professor of public health (Social and Behavioral Sciences); Research Assistant Natalia Provolo; and Martin Slade found that the prevalent negative messaging about aging during the pandemic led to worse mental health. In contrast, they found that the relatively uncommon positive messaging about aging, such as news reports of older health care workers who came out of retirement to help their colleagues on the front line of COVID, benefited older individuals’ mental health. The paper, “Impact of Media-Based Negative and Positive Age Stereotypes on Older Individuals’ Mental Health,” received the Yale School of Public Health 2022 Award for a paper demonstrating Excellence in Public Health Research.

Levy also looked at how beliefs about aging impacted the decision to go to the hospital or not to get treated for COVID, and found, “unfortunately, that people with negative age beliefs were much more likely to say that they would probably not get treated if they had severe COVID,” Levy said.

“It is imperative to not only take action against the COVID-19 pathogen, but also against the negative messaging it has prompted,” the authors wrote.

An Age Revolution

Levy and her research have been the foundation for the World Health Organization’s campaign Combatting Ageism, which is supported by 194 member countries. There are signs, she said, that society is on the verge of a social movement that could change how we perceive aging in the U.S. and around the world.

“I feel like we're reaching a critical moment, a tipping point,” she said. “There's a growing recognition of the public health crisis that ageism can bring about and a growing recognition, too, that there's a lot of hope from the research, because we know that age beliefs are malleable; we can change them,” she said. “So, I think there's growing awareness of the damage of ageism, as well as a growing awareness of the potential benefits of positive age beliefs. It is just a matter of time before we resist and overcome structural ageism to bring about benefits for people of all ages.”

82% - the number of older Americans who report encountering ageism regularly.

Did you Know?

The fact that so many people are getting to experience old age, and doing so in better health, is one of society’s greatest achievements.

25% of our health is due to genes. That means three-quarters of our health is determined by environmental factors, many of which we can control, including age beliefs.

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