Amy Gorely, who works for a retirement community in North Carolina, once suggested that her neighbor visit a senior center.
"I don't want to hang out with old people," the woman replied.
She was 90. And she wasn't kidding.
Ageist attitudes among the aged are common, say those who work with older people.
Some people in their 80s reject senior housing because they don't want to live with old people. Once there, the more independent older residents often don't want to eat with people in wheelchairs, let alone those whose brains are faltering. They complain that they don't want the place to look like a nursing home.
Nancy Hodgson, chair of gerontology at Penn Nursing, recently worked with a Baltimore retirement community that wanted to create a common space for residents of all abilities. Some of the people in independent living — the level where residents get the least help — resisted strongly.
"People were quite verbal and quite open about insisting that there be very distinct spaces," she said.
Kathleen Douglass, clinical liaison and dementia specialist for Sage Life, which operates senior housing in the Philadelphia region, said it's common to have a clique of "mean girls" who "think everybody is old and feeble and crazy, and those are the words they use." These women are often older than those they criticize.
Some older people hide their aging skin, with its bruises and wrinkles, because it doesn't meet their impossible expectations of themselves. Some would literally rather fall than use canes or walkers that they think will make them look old. They'd rather miss conversations — and raise their risk of dementia — than wear a hearing aid.
"It's really a cruel irony," said Jill Vitale-Aussem, vice president of consulting services for Capella Living Solutions in Denver. "If there's one place that you should be safe from ageism, it's a senior living community."
Ageism — negative attitudes toward older people — and its cousin, "ableism" — negative attitudes toward people with disabilities — have serious consequences for seniors. These prejudices can lead to isolation and loneliness. Older people may limit themselves more than they need to because they believe that seniors can't learn new things or are too weak. People may hide their need for help out of fear that they'll be moved to assisted living or a nursing home.
Becca Levy, a Yale University epidemiology professor, has found that people who held negative age beliefs earlier in life died 7.5 years earlier than those with more positive perceptions. People biased against the aged in early adulthood were more likely to have heart attacks, strokes or brain changes associated with dementia in their 60s.
Those with positive age attitudes were 44 percent more likely to recover from severe disability than people with negative stereotypes.
Levy thinks that people who are more optimistic about old age may take better care of themselves throughout life. Another possibility is that the stress of being the target of prejudice or believing the bias yourself may accelerate physical problems.
Why would older people be ageist? Todd D. Nelson, a psychologist at California State University-Stanislaus, has called ageism "prejudice against our feared future self." Levy said that children as young as 3 or 4 have absorbed cultural stereotypes about aging. There is "deep stigma about being dependent or a burden," said Tracey Gendron, a gerontologist at Virginia Commonwealth University. Seniors have had those negative ideas reinforced for decades with ads for "anti-aging" products, job bias or messages that older people take more than they give.
"It's in the air we breathe," said Kirsten Jacobs, director of dementia and wellness education for LeadingAge, an organization that represents many nonprofit retirement communities.
The result for many older adults, Gendron said, is "internalized ageism," which makes people want to distance themselves from age peers or from the idea that they themselves are old. People who tour senior housing with multiple levels of care often won't go beyond the independent-living areas to even look at assisted-living or skilled-nursing units, experts said.
Complicating matters is the fact that, while many aspects of aging, such as increased wisdom or resilience, are positive, some truly are not. "That's the tricky part of ageism," Gendron said. "There is decline. We are mortal."
Seeing frail elders reminds many older people of what likely lies ahead, and some respond with denial. Life in a diverse senior living complex "is a giant mirror that gets placed in front of them, and it's hard to look at sometimes," Douglass said. In some Sage facilities, staff put those who arrive in wheelchairs into regular seats, and hide the wheelchairs in "corrals" during the meal.
LeadingAge has made combating ageism a priority for about two years, and is seeing results at some facilities. In Denver, Vitale-Aussem tells residents that ageism "is no more acceptable than racism. You are harming other people. We don't do that."
Gorely, who is director of community relations at Carolina Meadows in Chapel Hill, N.C., started her "Be Bold, Claim Old" campaign last fall to help elders focus on positive aspects of aging.
Russell Mast, executive director of Rydal Park, a continuing-care retirement community with 500 residents in Jenkintown, said staff and residents are starting to talk about ageism. Elders sometimes don't realize how much they have in common with people they think have more problems. "I don't think any of us sees ourselves exactly as we are," he said. One independent-living resident, he said, has started by organizing an inclusive Passover seder.
A few Rydal Park residents who gathered to talk about ageism wouldn't admit to avoiding anyone based on their age or infirmity. But they made it clear they don't like the word "old," which they thought connoted limits and helplessness.
Linda Martin, 68, the youngest in the group, said she felt old when she started using a wheelchair because of an autoimmune disease. "I felt like one day I was young and the next I was an old person," the retired kindergarten teacher said. When she arrived at Rydal Park a year ago, fellow residents often asked whether she was from the "medical center." They seemed more interested in her when they discovered she was in the independent living part of the community.
Helen Waite, a former oncology nurse who has lived at Rydal Park for five years, would not disclose her age, a holdover from her youth, she said, when she wasn't allowed to discuss the age of older relatives. She thinks of aging as being linked more to attitude than years. "There are people here that I would say, yes, they're old," she said. "Other people, in my mind, they have as much spirit and life … they're no different to me than when they were 50."
Barbara Evans, 77, remembered a grandmother who refused to be called grandmother. When she introduced her, Evans had to say, "This is my mother's mother." Now her husband doesn't want to be called grandpa. "To him, it means old, and he doesn't feel old."
But Florinda Doelp, 82, a retired architect, said, "I'm a great-grandmother, and I don't care about discussing my age. … I worked very hard for every one of these, my gray hairs."
Martin, too, finds "something precious" in being called grandmom and sees much that is positive about aging. "You just have more wisdom about life, wisdom you can pass on," she said. "Frankly, my family, we looked up to older people."
Helping seniors see themselves and their peers more positively while also acknowledging the drawbacks of aging is a challenge.
At Sage, Douglass, who is a fan of social worker and writer Brené Brown's work on embracing vulnerability, talks with residents about their fears when they balk at using walkers and other devices that could allow them to be more capable. " 'Here's the deal. This is what we can do together still,' " she'll tell people. "We actually are always looking forward."
Vitale-Aussem's continuing-care clients have begun holding events for everyone in their nursing-home wings so it feels normal to go there. People who raised their children to be kind, who fought against racial injustice, need to treat their peers well, too, she urges clients to stress.
"It changed the whole culture," Vitale-Aussem said. "It's easier than people think it is."
Today, the most celebrated seniors tend to be those who can climb mountains and run marathons. Instead of glorifying outliers, Jacobs said, it would be far more helpful to talk about people who optimize aging and use a walker.
Gorely's "Claim Old" campaign has focused on fostering age pride and creating a more positive narrative. For one art project, she paired photos of residents and staff with something they celebrated about their age. Her favorite came from a man in his mid-90s who wrote, "I've outlived all my enemies."