Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina, USA.
International Development Group, RTI International, Research Triangle Park, North Carolina, USA.
Ear Hear. 2024;45(Suppl 1):62S-69S. doi: 10.1097/AUD.0000000000001475. Epub 2024 Sep 19.
Ageism appears widely across the globe and poses an important threat to older people's well-being and health. With respect to hearing health, experiences, perceptions, and fear of ageism can delay the diagnosis of hearing loss, reduce pursuit of hearing care, and fuel reluctance to wear a hearing device. Ageism intertwines with hearing loss stigma, which potentially deepens the negative effects of both; however, little evidence exists to quantify the effects of the intersection of ageism and hearing loss stigma. This lack of data on both hearing loss stigma and ageism, and their intersection, may stem from the lack of validated measures for both. Therefore, as part of a parent study to develop and preliminarily validate d/Deaf and hard of hearing stigma measures, we also adapted and preliminarily validated measures of both experienced and observed ageism.
We adapted four ageism measures through a literature review, expert discussions, and cognitive interviews and validated them in the United States through self-administered online surveys with convenience samples of (1) people aged 60 and older who became d/Deaf or hard of hearing (d/DHH) after developing language or in adulthood ("acquired" d/DHH), (2) care partners of people aged 60 or older who are d/DHH (acquired), (3) health care providers, and (4) the general population. For each of the scales, we applied exploratory factor analysis and estimated scale reliability with ordinal α.
For the population of persons over age 60 who are d/DHH (acquired) (N = 146), nine social stigma items and four employment discrimination items loaded well onto two separate factors, one which measures social stigma and one which measures employment discrimination. All loadings were >0.7. The two factors were moderately correlated at 0.428. For care partners of people aged 60 or older who are d/DHH (N = 72), nine items loaded well onto a single factor, with loadings between 0.650 and 0.936 and an ordinal α of 0.95. Among the general population (N = 312), 10 items loaded cleanly onto a single factor, with loadings between 0.702 and 0.919 and an ordinal α of 0.96. For the health care providers (N = 203), 11 items loaded well onto a single factor, with loadings between 0.541 and 0.874. For these three populations, each of the single factors measure social stigma.
Ageism threatens the health and wellbeing of older people in both high- and low-income countries. Validated measures of ageism are necessary to understand the relationship between ageism, d/DHH stigma and the well-being of older adults and to design effective ageism-reduction and mitigation interventions. This preliminary validated set of experienced ageism measures offers a starting point for more studies that not only further validate these measures but are larger in scale, occur in more diverse settings, and provide insights into the experience of ageism and its effects on the health and well-being of older adults.
年龄歧视在全球范围内广泛存在，对老年人的福祉和健康构成了重要威胁。就听力健康而言，年龄歧视的经历、看法和恐惧可能会延迟听力损失的诊断，减少对听力保健的追求，并阻碍对听力设备的使用。年龄歧视与听力损失污名相互交织，这可能会加深两者的负面影响；然而，几乎没有证据表明年龄歧视和听力损失污名交叉的影响。这种缺乏关于听力损失污名和年龄歧视及其交叉的证据，可能源于缺乏经过验证的测量工具。因此，作为开发和初步验证聋人和重听人污名措施的一项主要研究的一部分，我们还通过文献回顾、专家讨论和认知访谈改编和初步验证了针对经历和观察到的年龄歧视的测量工具。
我们通过文献回顾、专家讨论和认知访谈改编了四项年龄歧视测量工具，并通过自我管理的在线调查在便利样本中对美国的人群进行了验证，该样本包括（1）在成年后（“后天”）因语言或其他原因而变成聋人或重听的 60 岁及以上人群；（2）年龄在 60 岁及以上的聋人或重听人的照顾者（后天）；（3）医疗保健提供者；以及（4）一般人群。对于每个量表，我们应用了探索性因子分析，并使用有序 α 估计了量表的可靠性。
对于年龄在 60 岁及以上的后天聋人或重听人群（N=146），九个社会污名项目和四个就业歧视项目很好地加载到两个单独的因子上，一个因子衡量社会污名，另一个因子衡量就业歧视。所有负荷都大于 0.7。两个因子之间的相关性为 0.428。对于年龄在 60 岁及以上的聋人或重听人的照顾者（N=72），九个项目很好地加载到一个单一因子上，负荷在 0.650 到 0.936 之间，有序α为 0.95。在一般人群（N=312）中，10 个项目干净地加载到一个单一因子上，负荷在 0.702 到 0.919 之间，有序α为 0.96。对于医疗保健提供者（N=203），11 个项目很好地加载到一个单一因子上，负荷在 0.541 到 0.874 之间。对于这三个群体，每个单一因子都衡量社会污名。
年龄歧视威胁到高收入和低收入国家老年人的健康和福祉。需要经过验证的年龄歧视测量工具来了解年龄歧视、聋人和重听人污名与老年人福祉之间的关系，并设计有效的减少和缓解年龄歧视的干预措施。这套初步验证的经历年龄歧视测量工具为进一步验证这些工具提供了一个起点，这些工具不仅要进一步验证，而且要规模更大、在更多样化的环境中进行，提供对年龄歧视的体验及其对老年人健康和福祉的影响的见解。
