Do social and psychological resources mitigate the effects of self-perceived negative and positive ageism on older adults' quality of life?

doi:10.21203/rs.3.rs-5342214/v1

The present study examined the association of self-perceived negative and positive ageism (PNA/PPA) by older adults in Greece on their quality of life (QoL) and the moderating effects of psychological capital (i.e., self-efficacy, optimism, hope, and resilience) and social support. This web-based cross-sectional study recruited 351 participants from the community through a convenience sampling method. Their mean age was 72.5 years (SD = 9.1), with the majority being women (62.7%), and married (45.3%). Participants completed online self-reported questionnaires on quality of life (The Μental Health Quality of Life; MHQoL), perceived ageism (Perceived Ageism Questionnaire; PAQ-8), social support (the Lubben Social Network Scale-6; LSNS-6), psychological resources (the Compound PsyCap Scale-12; CPC-12R), and socio-demographic characteristics. The results showed that PNA was more strongly correlated with QoL than PPA. QoL was predicted by PNA (negatively) and PPA (positively), as well as by social and psychological resources (positively). Psychological resources moderated the effects of both PNA and PPA on QoL, while social support moderated only the effects of PPA on QoL. Higher PNA was associated with lower QoL only for participants with low levels of psychological resources. In contrast, higher PPA was associated with higher QoL for those with low levels of psychological resources and high levels of social support. The study findings contribute to the literature on self-perceived negative and positive ageism and lay the groundwork for social policy guidelines aimed at developing interventions to enhance psychosocial resources, thereby improving the QoL for older adults.

Geriatrics & Gerontology

self-directed ageism

Psychological Capital

social support

older people

quality of life

Ageism and self-perceived ageism

The understanding of the concept "ageism" advanced considerably since 1969 when Dr. Robert Butler introduced the term to refer to the systematic discrimination against older people [1]. Lately, ageism has been conceptualized as a complex and multi-dimensional construct including cognitive (stereotypes), emotional (prejudice), and behavioral (discrimination) aspects, that can be expressed explicitly (consciously) or implicitly (subconsciously) and can be observed in the individual, social, and institutional levels. Furthermore, it is clear today that ageism can be directed to any age group, and not only against older people [2]. Ageism can be internalized and directed towards oneself (self-oriented ageism) or to others pertaining to the same age group (other-directed ageism), Finally, it can include positive attitudes as well (called perceived positive ageism), and not only negative biases and discrimination as originally considered (called perceived negative ageism) [3].

Despite these developments, research attention has mainly focused on perceived negative ageism (PNA), potentially because of its high prevalence and far-reaching deleterious ramifications in all areas of living [4, 5], such as subjective accelerated aging [6, 7], cognitive decline [8], increased social isolation and loneliness [9], increased stress, anxiety, and depressive symptoms [10, 11], poorer physical and mental health, and increased mortality [12–15]. This is rather surprising since perceived positive ageism may also have negative consequences, as is the case with so-called compassionate stereotypes, which can lead to overwhelming empathy or condescension ultimately increasing negative negative ageism [16]. One of the most harmful effects of ageism is the deterioration of older people's quality of life [4, 10, 17, 18].

Quality of life in old age and ageism

Quality of life (QoL) is a central concept in public health and its importance is continuously growing in research and public policy in general and for older people in particular. Although there is no unanimously accepted definition, QoL in old age is widely considered a multidimensional concept that covers many domains (e.g., physical, psychological, and social) [19].

The association between QoL and self-perceived ageism in older adults has been examined in different countries, using various samples and instruments. Despite these differences, all studies have reported a negative association between PNA and QoL [4, 17, 18, 20–25]. Much less is known about the effects of PPA. The few relevant studies reported a positive and weaker association of PPA with QoL (see Velainthal et al.,[25]). Thus, the first aim of this study was to expand knowledge regarding the relationship between negative and positive self-perceived ageism and QoL among older adults. Our specific hypotheses were:

H1: Self-perceived negative ageism (PNA) will be negatively and significantly associated with QoL

H2: Self-perceived positive ageism (PPA) will be positively and significantly associated with QoL

H3: The magnitude of the association will be stronger for negative rather than for positive self-ageism.

The Conservation of Resources (COR) theory and the association between ageism, QoL and psychosocial resources

The COR theory provides an adequate framework for reducing the effects of ageism on QoL. According to this theory, humans will struggle to gain and retain resources they value as well as to prevent and reduce the loss of these resources (Hobfol, 1989). In accordance with positive psychology assumptions, social and psychological resources are among the most valued assets a person can have. Studies have examined the effect of perceived social support – i.e., the belief of having friends and family who will provide all types of support if needed [26] – as the most common social resource, and reported positive correlations with QoL [27–29]. Thus, we also hypothesized that:

H4: A positive and statistically significant relationship will be found between social resources and QoL.

Psychological resources are intrapersonal attributes or personality factors that help individuals manage stress [30]. The most common psychological resources studied are self-efficacy, optimism, hope, and resilience [31]. Most studies have examined the association of QoL with different psychological resources separately (e.g., Kang & Kim, [10]; Wurm & Benyamini,[32]). However, recently it has been suggested that all these constructs share a common basis reflecting a person's reserve capacity and therefore, it is recommended to use an aggregated measure [33]. Thus, the psychological capital (PsyCap) measure has been introduced to embrace the positive psychological abilities of self-efficacy, optimism, hope, and resilience [31]. Since its introduction, the relationship between PsyCap and QoL has been well-established [34–36], though scant attempts have examined this relationship among older adults (e.g., Pramanik & Biswal,[37]). Thus, we hypothesized that:

H5: A positive and statistically significant relationship will be found between psychological capital (PsyCap) and QoL.

The moderating role of social and psychological resources

As knowledge about the adverse effects of ageism on QoL accumulates, researchers and clinicians try to identify factors that might mitigate these effects. Within the frame of stress theories in general and of the COR theory in particular, social and psychological resources have been widely considered as mediating the impact of life stressors on older persons' QoL [38], motivating, therefore, the efforts to retain them rather than to lose them. The few studies that have examined the role of social support in the relationship between ageism and QoL, have confirmed a moderating effect, particularly regarding perceptions of instrumental support [39–41].

Research about the role of psychological resources in understanding the association between ageism and QoLis much richer. The most common psychological resources examined in the area of ageism and QoL include optimism, positive emotions, confidence in the future, age proudness, and body self-confidence [10, 27, 32, 42], resilience and coping strategies [17]. Similar to social support, these studies have confirmed that psychological resources modify the effect of ageism on QoL.

Despite their importance, all studies till today have two important limitations. First, they are restricted to the examination of PNA, ignoring the associations with PPA. Second, as mentioned above, they examined different psychological resources separately and not as an aggregated measure. This study intends to address these gaps by examining the role of social and psychological resources as moderating factors of the associations of negative and positive ageism with QoL. Our hypotheses are:

H6: Social resources will moderate the effects of PNA on QoL so that the negative relationship will be weaker when levels of social support are high.

H7: Psychological resources will moderate the effects of PNA on QoL so that the negative relationship will be weaker when levels of psychological resources are high.

H8: Social resources will moderate the effects of PPA on QoL so that the negative relationship will be weaker when levels of social support are high.

H9: Psychological resources will moderate the effects of PPA on QoL so that the negative relationship will be weaker when levels of psychological resources are high.

Sample

Three hundred and fifty-nine participants were recruited from the community through a convenience sampling method. Inclusion criteria were being 60 years or older, living in Greece, and with a satisfactory level of Greek language comprehension. Potential participants having a self-reported diagnosis of dementia or cognitive impairment were excluded from the study. After applying these criteria, a total of 351 participants remained in the study. The majority of the participants was female (62.7%), had a mean age of 72.5 (SD 9.1, 60–96), were married (45.3%), and had primary school education (34.5%). Additionally, two-thirds (66.4%) were retired and 50.4% lived in a village. Participants’ sociodemographic characteristics are presented in Table 1.

Table 1

Sociodemographic characteristics of the sample (N = 351)
	N/M	%/SD
Gender
Female	220	62.7
Male	131	37.3
Age	72.45	9.12
Marital status
Married/living together	159	45.3
Single	45	12.8
Cohabiting	6	1.7
Divorced	123	35.0
Other (e.g., Widow)	18	5.1
Educational level
Primary	121	34.5
Secondary	70	19.9
High school	50	14.2
University	43	12,3
Postgraduate	17	4.8
None accomplished	50	14.2
Employment status
State employee	32	9.1
Private employee	21	6.0
Freelancer	49	14.0
Retired	233	66.4
Unemployed	16	4.64.
Place of residence
Village	134	50.4
Town	6	2.3
City	70	26.3
Big city	56	21.1
Note. Age is presented in mean and standard deviation.

Instruments

Quality of Life. The Μental Health Quality of Life (MHQoL; [43]) was used to assess respondents’ self-reported current mental health quality of life across seven dimensions (MHQoL-7D: self-image, independence, mood, relationships, daily activities, physical health, and the future). The MHQoL was initially developed for assessing QoL in people with mental health problems. However, it has been used in other samples such as people with chronic musculoskeletal pain [44], students [45], and older adults [46]. Each dimension includes four response options ranging from 0 to 3 (e.g. for self-image ‘I think very negatively about myself’ to ‘I think very positively about myself’). Thus, the total score ranges from 0 to 21, with higher scores denoting better mental health-related quality of life. In this study, Cronbach alpha reliability coefficient was .86.

Perceived Ageism. The self-administered 8-item Perceived Ageism Questionnaire (PAQ-8; [20]) was used to assess both positive (3 items; e.g., being considered as a wise or sensible person because of one’s age) and negative (5 items; e.g., being addressed as a child because of one’s age) self-perceived stereotypes, prejudices, and discrimination Respondents were asked to report on a 5-point Likert-type scale, ranging from 1 = never to 5 = very often, the frequency to which they experienced each situation during the past year. The corresponding item scores were summed to a total self-perceived positive ageism (PPA) and a total self-perceived negative ageism (PNA), with higher scores denoting higher levels of each. In this study, Cronbach alpha reliability coefficients were .84 for both PNA and PPA.

Social support. The short version of the Lubben Social Network Scale-6 (LSNS-6; [47]) was used to assess perceived social support received by family and friends among older adults. This scale has been widely used in research and clinical settings to assess social networks and screen for social isolation risk. It includes three items on family and three identical items on friends (by replacing the word relatives with the word friends), asking the number of social network members with whom the respondent has contact (e.g., sees or hears from at least once a month), emotional easiness (e.g., feels at ease talking about private matters) and closeness (e.g., feels close enough to call for help). The items are rated on a 6-point scale, ranging from 0 = none to 5 = nine or more. The corresponding item scores were summed to a total score ranging from 0 to 30; higher scores denote stronger ties with family and friends. In this study, Cronbach alpha reliability coefficient was .84.

Psychological resources. The revised version of the Compound PsyCap Scale-12 (CPC-12R; [48]) was used to assess the four concepts of psychological capital: ‘hope’ (e.g., If I should find myself in a jam, I could think of many ways to get out of it), ‘self-efficacy’ (e.g., I am confident that I could deal efficiently with unexpected events), ‘resilience’ (e.g., I consider myself to be able to stand a lot, I am not easily discouraged by failure), and ‘optimism’ (e.g., I am looking forward to the life ahead of me). Each concept includes three items rated on a 6-point Likert-type scale ranging from 1 = strongly disagree to 6 = strongly agree. The corresponding item scores were summed to a total score, ranging from 12 to 72, with higher scores denoting higher levels of psychological capital/resources. In this study, Cronbach alpha reliability coefficient was .97.

Socio-demographic characteristics

These included gender, age, marital status, educational level, employment status, and place of residence.

Translation of the instruments

All instruments were translated into Greek by a bilingual psychologist and back-translated by an independent translator. The translations were compared, minor amendments were made and a final Greek translation was agreed upon for each instrument.

Procedure

Data were collected using convenience sampling and a cross-sectional online survey from September to December 2023. Informed consent was presented on the front page of the questionnaire and obtained online. The study was approved by the Ethics Committee of the [omitted for review] and carried out following the Declaration of Helsinki.

Data analyses

Descriptive statistics including means (M), standard deviations (SD), numbers (N), and percentages (%) were used to describe the sample and the main variables. The internal consistency of the scales was examined with Cronbach’s alpha. Pearson correlations (r) were used to examine relationships among the study variables. Analyses were performed using IBM SPSS v23 and the two-tailed significance level was set at p < .05. Moderation effects were examined with Hayes’ Process model no. 2 for two moderating variables and a continuous dependent variable [49], using 5000 bootstrap samples, and 95% confidence interval. Variables were standardized and gender (1-male, 0-female) and age were controlled for. Collinearity was not a threat to the analyses, since correlations were below .65, all tolerances ≥ .32, and all VIF ≤ 3.2. Finally, hierarchical multiple regressions were conducted. Age and gender were entered as controlled variables in Step 1. Then, ageism variables (PNA/PPA) were entered in Step 2 to examine the main effects of these variables. Social and psychological resources were entered in Step 3, and the interaction terms in Step 4. To further explore interaction effects graphically, the two-way interaction graph was plotted.

Descriptive statistics and correlations for the measured variables

Participants reported relatively low levels of negative and positive ageism. Over half of the participants (53.3%) reported a score of 9 or below for PNA, and 58.1% reported a score of 8 or below for PPA. Finally, participants reported relatively high levels of QoL and moderate levels of social and psychological resources (Table 2).

Table 2

Means, standard deviations, and correlations for the study variables (N = 351)
	M (SD)	Range	1.	2.	3.	4.
1. PNA	9.82 (4.23)	5–25	1
2. PPA	8.02 (3.32)	3–15	− .02	1
3. Social support	13.58 (5.67)	0–30	− .27^***	− .19^***	1
4. Psychological resources	50.27 (14.18)	12–72	− .34^***	− .02	.45^***	1
5. QoL	14.41 (4.01)	0–21	− .44^***	.18^**	.39^***	.56^***
Note. PNA: self-perceived negative ageism; PPA: self-perceived positive ageism; QoL: quality of life; ^p < .01, ^* p < .001

All study variables were significantly correlated, except PNA with PPA and PPA with Psycap. As expected (H1), PNA was negatively associated with QoL. However, contrary to our hypothesis (H2), PPA was positively associated with QoL. The correlation between the variables was considerably stronger with PNA than with PPA, confirming our third hypothesis (H3). Finally, as can be seen in Table 2, H4 and H5 were confirmed, since social and psychological resources were significantly and positively correlated with QoL.

Main effects of PNA and PPA on QoL

As can be observed in step 2 of Tables 3 and 4, while both PNA and PPA were significant predictors of QoL, the first accounted for 11% while the second accounted for only 1% of the variance of QoL.

Table 3

Linear regression model for the moderating effects of social support and psychological resources in the association between PNA and QoL (N = 351)
	β (SE)	p	95%CI
Step 1
Gender (male)	.05 (.04)	.232	− .03, .13
Age	− .18 (.04)	< .001	− .27, − .09
Step 2
PNA	− .19 (.05)	< .001	− .28, − .10
Step 3
Social support	.16 (.05)	< .001	.07, .25
Psychological resources	.37 (.05)	< .001	.28, .47
Step 4
PNA x Social support	.01 (.04)	.970	− .08, .09
PNA x Psychological resources	.13 (.04)	.004	.04, .21
R²	.44, p < .001
F(7, 343)	39.18, p < .001
Note. R² for step 1: .14, ΔR² for step 2: .11, ΔR² for step 3: .17, ΔR² for step 4: .02.
PNA: self-perceived negative ageism

Table 4

Linear regression model for the moderating effects of social support and psychological resources in the association between PPA and QoL (N = 351)
	β (SE)	p	95% CI
Step 1
Gender (male)	.02 (.04)	.610	− .06, .10
Age	− .13 (.05)	.006	− .23, − .04
Step 2
PPA	.20 (.05)	< .001	.11, .29
Step 3
Social support	.22 (.05)	< .001	.13, .31
Psychological resources	.50 (.05)	< .001	.40, .61
Step 4
PPA x social support	.17 (.05)	< .001	.07, .27
PPA x psychological resources	− .21 (.04)	< .001	− .29, − .12
R²	.45, p < .001
F(7, 343)	39.87, p < .001
Note. R² for step 1: .14, ΔR² for step 2: .01, ΔR² for step 3: .26, ΔR² for step 4: .04.
PPA: self-perceived positive ageism

Main effects of social and psychological resources on QoL

The social and psychological resources accounted for 17% of the variance in Qol when examining its association with PNA, and 26% when examining the association of QoL with PPA (step 3 in Tables 3 and 4, respectively).

Moderating effects of social and psychological resources on PNA and PPA on QoL

As observed in step 4 of the regression in Table 3, the two-way interaction between PNA and psychological resources was significantly associated with QoL, contributing 2% to the variance. The interaction term with social resources was not statistically significant. Thus, while the moderating effect of psychological resources was confirmed (H7), the hypothesized effect of social resources was not, and H6 was rejected. The two-way interactions between PPA and social and psychological resources significantly predicted QoL, accounting for an additional 4% of the variance (Table 4). Thus, the moderating effects of both types of resources were confirmed as hypothesized (H8 and H9, respectively).

A graphical representation of the interaction effects between PNA and psychological resources (Fig. 1) showed a significant negative effect for low-level values (effect = − .32, SE = .06, p < .001, 95%CI = − .44, − .20), but a non-significant effect for high values (effect = − .07, SE = .07), p = .310, 95%CI = − .20, .06). That is, greater PNA was associated with lower QoL for low levels of psychological resources, whereas no statistically significant association was found for high levels of psychological resources.

The interaction between PPA and social support has shown significant positive effects for high-level social support values (effect = .37, SE = .07, p < .001, 95%CI = .24, .50), and a non-significant effect for low social support values (effect = .02, SE = .07, p = .694, 95%CI = − .11, .16), as shown in Fig. 2. That is, higher PPA was associated with higher QoL, for high levels of social support, but no association was found for low levels of social support. Finally, the interaction between PPA and psychological resources has shown a significant positive effect for low values (effect = .41, SE = .07, p < .001, 95%CI = .27, .55), and a non-significant effect for high values of psychological resources (effect = − .01, SE = .06, p = .850, 95%CI = − .12, .10), as shown in Fig. 3. That is, greater PPA was associated with higher QoL, for participants reporting low levels of psychological resources, but no association was found for high levels of this type of resources.

Ageism has been recognized as a worldwide crisis (Levy et al., 2022), mainly because of its detrimental consequences on older persons' QoL [10]. The general secretary of the WHO has stated that ‘Addressing ageism is critical for creating a more equal world in which the dignity and rights of every human being are respected and protected.’ ([9], p. viiI). The present study contributes to this call by examining social and psychological moderators of self-perceived ageism and QoL in a sample of community-dwelling older adults in Greece. Although previous research has examined psychosocial resources as protective factors of QoL, they were limited to perceived negative ageism (PNA) without examining the associations with perceived positive ageism (PPA) nor using a multi-dimensional measure of psychological resources such as psychological capital (PsyCap).

Consistent with previous research [22, 24, 25] hypotheses 1, 2, and 3 were supported by the data. These findings have important theoretical and practical implications. Theoretically, the findings add to the few studies assessing PPA and stress the importance of conceptualizing ageism as a multi-dimensional construct including both negative and positive stereotypes. On a practical level, the findings suggest that intervention programs aiming at reducing the negative effects of ageism on older persons' QoL should pay attention to both types of ageism to attain optimal results.

Our hypotheses on the relationships between psychosocial resources and QoL (H4 and H5) were also confirmed. In accordance with the assumptions of positive psychology and COR theory, both perceived social support and psychological resources were positively and significantly associated with QoL in our sample. Similar to previous studies conducted among younger and older adults [50–52], the magnitude of the correlations was stronger for the association of QoL with psychological rather than social resources. These results strengthen the importance of internal resources - such as the personality factors included in the PsyCap measure - as motivating and promoting the adoption of effective coping behaviors, including seeking social support [53].

The hypotheses on the moderating effects of psychosocial resources on the association between ageism and older adults' QoL were partially supported for both types of ageism. Although social support did not have a moderating effect on the relationship between PNA and QoL (H6), it did on the relationship between PPA and QoL (H8), with the moderating effect being more prominent for participants who perceived higher levels of social support (H8). This finding is consistent with abundant studies [54–56] demonstrating the importance of perceptions of support from family and friends as buffering the effects of stressful or negative events on older people's QoL or life satisfaction.

Regarding the role of psychological resources, psychological capital (PsyCap) emerged as a significant moderator for both types of ageism (H7 and H9). However, contrary to expectations, PsyCap’s effect on the relationship between PNA and QoL (H7) was more prominent for participants reporting lower levels of PsyCap. In other words, as PNA increased, participants who perceived having low levels of psychological resources reported lower levels of QoL. This is a noteworthy finding particularly because, contrary to previous studies [17, 32], it suggests that diminished levels of psychological resources increase the negative effect of ageism on QoL while increased levels of these resources do not affect the relationship. The implication of this finding points to the need to focus on older people with low levels of psychological resources, as they can be at a greater risk of being affected by negative self-perceptions of ageism.

Lastly, the effect of PsyCap as moderating the association between PPA and QoL (H9) was more prominent for participants who perceived having low levels of PsyCap. That is, reporting higher levels of PPA was associated with greater QoL for participants reporting low levels of PsyCap. While this finding did not align with our assumptions, it should be noted that research examining the association between one of the core psychological resources – i.e., resilience – with QoL has shown mixed results, with several studies reporting a positive relationship[57, 58] and others no relationship at all [59, 60]. It could be assumed that similar conflicting results might be present when using a multi-dimensional measure of psychological resources as in our study. Alternatively, the findings might be associated with the characteristics of our sample, which was composed of older adults. While studies based on the COR theory's assumptions found that young adults (mainly college students) are motivated by the willingness to gain resources, older people (who are characterized by multiple losses at their age) strive to retain rather than gain additional resources. Thus, the mitigating effect is more noticeable for those participants retaining low levels of resources.

Limitations and strengths of the study

A few limitations should be acknowledged. First, we used a cross-sectional design which disqualifies the possibility of examining causal relationships. Second, we relied on a convenience sample, preventing the possibility to generalize our results to the general population of older adults. Third, relying on self-report measures might have increased the risk of social desirability. The online mode of questionnaire administration may have resulted in response bias (e.g., technologically illiterate older adults may have been unintentionally excluded from the sample). Finally, the PsyCap questionnaire used in this study included four components (hope, self-efficacy, resilience, and optimism). While this is the most commonly used version of the instrument, other versions have been lately developed and validated to be used with specific populations. For example, for assessing psychological resources among older people, Xin and Li[61] suggest using a 7-components version of the questionnaire, including meaning in life, contentment and happiness, optimism, resilience, wisdom, gratitude and dedication, and self-efficacy as a more appropriate measure for this age group. Future, studies should examine our hypotheses using this new version.

Despite these limitations, this study advances knowledge in regard to ageism and its effects on older people's QoL in several ways. Theoretically, it adds to the very scarce literature examining positive ageism and its effects on older people's QoL. Moreover, it allows us to examine the validity of the COR theory on older people, an age group that has been hardly studied within the framework of this theory. Finally, it expands one of the main assumptions of the COR theory - the Resource Investment principle [62], which suggests that people will tend to invest resources to counterbalance lost resources, to recuperate any losses, and to achieve resources. On a methodological level, this study used the PsyCap questionnaire as a multi-dimensional, high-order concept to assess psychological resources into one composite construct. Studies using this measure demonstrated that it has excellent validity, predicts a greater amount of variance than separate psychological resources, and allows the development of effective interventions [63]. Practically, our study findings contribute to developing further the scant interventions to mitigate self-perceived ageism among older adults and safeguard them from its deleterious effects. More specifically, findings underscore the importance of encouraging older people to increase the social support available to them. Since PsyCap is “open to development” ([64], p. 209), interventions may particularly address older people perceiving to have low levels of psychological resources. After all, interventions aiming at promoting better QoL among older adults should be a long-term goal and a concerted attempt by all stakeholders at all levels.

Data availability

The data of this study are available from the senior author upon request.

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The authors declare no competing interests.

Do social and psychological resources mitigate the effects of self-perceived negative and positive ageism on older adults' quality of life?

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Introduction