Transcript: How Our Beliefs About Aging Impact Health and Well-Being with Becca Levy, PhD (podcast episode)
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Dr. Regina Koepp
Welcome back to the psychology of aging podcast. So this is season two. And I wanted to launch these into at the beginning of May. So as I record this, it’s May 3 2022. Because May is Mental Health Awareness Month and may is also Older Americans Month, and I couldn’t think of a better time to launch this continuing education podcast, then may 2022. So welcome. Let me tell you how this season is different. This season, we are offering continuing education for psychologists, social workers, therapists, aging life care experts, or certified care managers for listening to the podcast. How it works is you listen to the full episode, then you complete a post test and program evaluation and presto, you get your certificate. To learn more about the continuing education program, go to www dot mental health and ageing.com. You’ll learn more there. My goal with this podcast is to democratize education related to mental health and aging. So what does that mean? We are making this program available to anybody who needs this information, regardless of their ability to pay. So anybody can listen, you, your family, older adults, caregivers, professionals, anyone. We only ask for payment if you are looking for continuing education. And actually the continuing education program allows us to put on this program for free for other folks who might need the information but might not be able to pay for this information. So thank you for being here and doing your part. All right. Now I cannot wait to tell you about today’s guest it’s really a dream come true. I am the president of her fan club. That’s a metaphor. I’m not really a president in her fan club. But I would be if she had one, maybe, maybe you and I could start one. So let me introduce you to today’s esteemed guest. Dr. Becca Levy is the leading authority on how beliefs about aging influence aging health. She is a professor of epidemiology at the Yale School of Public Health and professor of psychology at Yale University. Her pathfinding studies have changed the way we think about aging and have received awards from the American Psychological Association, the Gerontological Society of America, and the International Association of gerontology and geriatrics. Dr. Levy has given invited testimony before the US Senate on the adverse effects of ageism, and she has contributed to US Supreme Court briefs to fight age discrimination. She serves as a scientific adviser to the World Health Organization’s campaign to combat ageism. Dr. Levy received her PhD in Psychology from Harvard University and completed a postdoctoral fellowship at the Division of Aging and the Department of Social medicine at Harvard Medical School. Her expertise on aging is frequently sought out by outlets such as the New York Times, NPR and BBC. Dr. Levy is also author of an incredible new book hot off the press called breaking the age code, how your beliefs about aging, determine how long and well, you live, I invite you to check out Dr. Levy’s bio and more about her in the show notes. All right, let’s jump into this interview with Dr. Levy.
Dr. Regina Koepp
Dr. Becca Levy, thank you so much for joining us today on the psychology of aging Podcast. I’m delighted that you’re here.
Dr. Becca Levy
Thank you. It’s great to join you. Thank you so much for having me on your show.
Dr. Regina Koepp
How did you get interested? You’re such a prolific researcher, you’ve done so much work in this space. How did you get interested in aging and ageism?
Dr. Becca Levy
Yeah, so that’s a good question. So I actually first became really interested in the topic of ageism when I was in graduate school, and I had the opportunity to go to Japan. And I went with the goal of trying to understand why it is that Japan has the longest lifespan in the world. And what I immediately noticed when I arrived there is how differently the older people were treated it from what I was used to seeing. So I lived in Boston at the time, and I was used to seeing a lot of examples of ageism and everyday life and and so what I immediately noticed in Japan when I arrived was that older people were treated with a lot more respect, and there was sort of the celebration of aging. So for example, they have a national holiday that celebrates older people and they have if when I turn on the television, there were the centenarians and Supercentenarians people who are 110 and older who were celebrated on television, as these rock stars or celebrities. And so I became really interested in the idea of is it possible that these age beliefs that exists This in a culture could have an impact on older individuals health, and survival or lifespan. And what I’ve found following that experience is through, through my research, many pieces of evidence that show that that is the case.
Dr. Regina Koepp
And and that’s what we’re going to talk about today is, is sort of how our beliefs about aging influence our older adulthood and our and our overall quality of life and wellness. Exactly, yes. You often talk about the stereotype embodiment theory to help us understand ageism, you know, there’s structural ageism, and then there’s internalized ageism. And then, and then othering. Can you talk a bit about the stereotype embodiment theory? What is that? And how does that help us understand ageism?
Dr. Becca Levy
Sure, yes, thank you for asking about that. So I develop the stereotype embodiment theory as a framework to try to understand just the process that we were just talking about, of how it’s possible that these age beliefs that exists in a culture can actually get under our skin and have a direct impact on aging health. And so the framework is both a way to make sense of our growing number of results that have come out of out of my laboratory, but also make predictions about things that we can explore and examine in the future. And what the theory actually includes four components. And they all get this idea that the stereotypes that exist in a culture can impact health as they become self relevant. So that also could go through the four areas. So the first is that they become stereotypes become internalized across the lifespan. And so we know that children as young as age three have already taken in the age beliefs of their culture. And then they’re reinforced over time. And there’s a lot of ways that these stereotypes can be taken in it’s starting at a young age. And so for example, one of the images that I think that I was exposed to as a child was the Hansel and Gretel story. And so as you’re probably familiar, it actually presents this older woman who fattens up the children so that she can eat them. So it’s this terrible image of, of an older woman that and I remember hearing that story and you know, being quite scared at a young age. So there are these all these ways that we can communicate messages to children, and then those are reinforced over time across the lifespan. The second component of the stereotype embodiment theory is that they can operate unconsciously or without our awareness. And the reason that that’s important is, if we don’t actually know that the age beliefs are impacting us, it’s hard to fight them off if they’re negative. So, you know, in my research, I’ve been able to design studies in which we implicitly present the age stereotypes. And we can find, even without awareness, when we present the age stereotypes that they can have these dramatic impacts on people’s health, other people’s health and functioning. The third way that the theory operates is that they gain salience from self relevance. So yes, so that’s the third component of the theory. And this is the idea that the age beliefs, as we said, we take them in at a young age. But it’s not until they become self relevant, or they’re part of our own way that we think about ourselves as as an older person that they actually become impactful on health and functioning. And so in my research, I found that we actually don’t see the results of these age beliefs impacting health and functioning on younger adults, because they’re not yet self relevant. But when people start to identify as being older, that’s when we see the impact. And it can happen both directions can happen with both positive age beliefs having, you know, a beneficial impact and then the negative ones having having a detrimental impact. And then the last, the fourth component of the stereotype embodiment theory is that the way that these stereotypes get under our skin or actually impact our health and functioning is through multiple pathways. And so that’s actually the part of the theory that gets at the mechanism. And we have found in the research that there are three mechanisms that seem to be really important that operate, so one is on the behavioral level. So I’ve found that when people take in more positive age beliefs, they have better health behaviors are more likely to take prescribed medications and more likely to exercise on the psychological level. We found that people who take in more positive edge beliefs are more likely to have a sense of mastery and self efficacy and better well being. And then on the physiological level, I’ve found that those who taken more positive, he believes have better physiological markers. So for example, those who’ve taken in more positive beliefs tend to have lower cortisol levels. And we know from a lot of research, as you know that these kinds of stress biomarkers over time can have an impact on our health. So, yes, so those are the four components.
Dr. Regina Koepp
And what inspired you to create this model? I know you do a ton of research, is it was this a way to help people begin to operationalize what ageism, how it takes form, what the outcomes are when we have positive or negative beliefs. And I guess my question more specifically, is, what are you hoping us to learn? get from using this model or using this model as a conceptualization
Dr. Becca Levy
tool? Yes, so thanks for asking that. So I developed the model, in part because when I started this research, almost all the research was being done on younger adults. So how younger people think about older people how younger people’s behaviors is, are impacted by their, their, their thoughts about older people. So I was really interested in giving a voice to the older people themselves, and really think about how it can impact older people. And after I went to Japan, and I observed this cultural association that I thought might be operating, I wasn’t really sure how to go forward. So I thought, Okay, well, it seems like there’s some relationship between these cultural beliefs that I’m observing and something in their lifespan, but how do I actually connect them? And so I thought a lot about what are the components? Or how can we actually identify those age beliefs? What’s the best way to get at that? And what’s the best way to connect that to, to health outcomes? And the framework was a, an attempt to try to bring together those pieces and really think, how can how can it be that these cultural beliefs have an impact on health?
Dr. Regina Koepp
I know today we’re going to talk about some of that research. Because you’re pointing to cultural differences. You’ve also done some research on in cross cultural or cultural differences as it relates to beliefs about aging. I’m thinking about a study you did some time ago, looking at Deaf Americans. Is it white Americans, and then mainland Chinese?
Dr. Becca Levy
It was. So it was, yeah, mainland Chinese and deaf Americans, and then hearing Americans. So those were Yeah, those were the three groups and right. So that was an attempt, as we talked about to try to pull apart. How is it? How can we actually observe that there is an association between these age beliefs and health. And that was, in that study, I did a lot of investigation to try to identify cultures that might have more positive age beliefs. And after going through a lot of anthropological texts, the cultures that I identified for that study were mainland Chinese culture, which has all these, you know, Confucian ideas of respect, and a lot of intergenerational contact between different generations. And then the Deaf culture was one that I hadn’t didn’t know about before. But there was this wonderful text by Galen Becker on Deaf, older people. And she described the culture and she actually focused on San Francisco deaf clubs. And she wrote about these, this wonderful intergenerational culture within that community. And actually, I know that you have I heard one of your podcasts talking about death as being an important component of thinking about aging and a really important population. And so I loved that text. And I love those sort of anthropological findings. So in that study, what we did is I interviewed people, older people and younger people in mainland China than the United States within the deaf culture older and younger, Deaf culture members, and then the mainland and then a hearing American comparison group. And what we found was that the most positive age beliefs were expressed in mainland China, followed by the deaf community and then followed by the hearing Americans and then what we found was among the older groups in those three communities, those who had more positive age beliefs also had better memory performance. So there was a significant association between more positive age beliefs of the culture and actually how they performed and memory tasks.
Dr. Regina Koepp
What am I remembering this right in that study? Did you also in summarizing or in thinking or discussing that study? Did you also talk about the influence of American media on on how a person thinks about aging, am I remembering that right?
Dr. Becca Levy
Yes. So you’re right. So the media and social media definitely has is a big source of some of those messages of age beliefs. And so in one study, actually, after my daughter has pointed out to me, some of the negative messaging on social media that they were observing related to aging, I did a study and tried to look at all publicly accessible sites that had a focus on older people. And we did a content analysis of it. And what I found was, unfortunately, that most of the sites had negative stereotypes about older people. And 37% of them actually advocated banning older people from different public activities, like swimming and going to shopping malls. So it was this really terrible presentation of older people. And these are publicly accessible, so anybody could get on to the group and look for it. And I at the time, I actually I reported some of the most offensive groups to Facebook, they have a community standards board. And unfortunately, you know, many months later they were they were all still up. So you know, that that’s a one source of which I mean, I think social media could be a great place to really bring generations together. But there are these signs, unfortunately, that it can also be a place to spread ageism.
Dr. Regina Koepp
Yeah. And, and we know, it doesn’t only existing social media, and research also often excludes older adults, you know, I’ve often see, we’re recruiting people for our study 18 to 64.
Dr. Becca Levy
Actually, yeah, so you’re right. So there are that is a big problem with a lot of clinical trials that they tend to have a upper age limit and exclude older people from from trials. And actually, some of the trials are looking at trying to improve health outcomes that are particularly common in older people. And so yeah, it’s your right, that’s another way that other people are excluded from a really important area of our society.
Dr. Regina Koepp
Do you find you know, there are so many stereotypes and myths about aging and older adults? What are some of the most common stereotypes that we have?
Dr. Becca Levy
Yeah, so that’s a good question. So in in the book, breaking the age code I present about, I think it’s 14, common negative stereotypes about aging, and then present the, what I call ammunition to fight those negative stereotypes, because they’re all have counter evidence, or we can find the science that goes against some of those common stereotypes. And a lot of them actually, some of the evidence shows that there’s, in fact, strengths in those areas. So for example, perhaps the most common negative stereotype about aging is that all cognition declines for all older people. And the science shows that that’s just not the case, there’s just many different types of memories. So there’s some that stay pretty stable, such as procedural memory, or the ability to like, remember to ride a bike, for example, there are other types of cognition and memory that actually improve in later life. So exam, for example, the ability to learn new vocabulary also, life review seems to improve and later life and also ability to solve conflict seems to improve in later life. So these great qualities that actually improve. And then we also know that there are examples of older people who take on these memory tasks and accomplish fantastic things. So one of the things I really enjoyed in writing the book was I got to interview different people. And, for example, there was one man who showed to me how these age leads can operate with memory. So this was an 84 year old man named John, who took on the task of trying to memorize a 60,000 word poem. And he did this over over time. And he and he actually performed it, and did this great job of performing this this poem. And one of the things that he told me, which I thought was really interesting is that when he was taking on this memory task, he had his own positive age belief that he drew on which in his case was this chalice that he thought of who performed this beautiful music on his cello in his 80s and 90s. So he had this positive image of somebody who was performing that both inspired him and motivated him, and allowed him to accomplish this, this wonderful memory task. So So that’s yes. And then also in my research, I’ve also found that these positive age beliefs can have a real impact on memory, performance and later life. So there’s lots of pieces of evidence that that stereotype in particular has a lot of counter information that shows the snow but not accurate.
Dr. Regina Koepp
Yeah, and I think Trinity College in London in the last couple of years published something about that too, around. Older, the older participants had better problem solving skills had more flexible, cognitive flexibility, and could self regulate their emotions better than the younger participants.
Dr. Becca Levy
Right? Right. That’s an important area to You’re right about emotion regulation. So exactly. So there’s just a lot of these skills that we don’t always recognize. But if we find out about the science and try to bring those ideas into everyday life, I think we can really help maybe reverse some of that negative messaging.
Dr. Regina Koepp
Yeah, you know, I’m thinking about myself and my own this, my own my own stereotypes that I held about older adults. Before I started working with older adults, so I did not grow up with grandparents or have many older people in my life. And, and I started grab a replace, I would go, I would gravitate to older people. And because I needed that, I think, and when I started working as a psychologist, I, I think I had the belief well, Old Dogs can’t learn new tricks, like older adults are rigid and can’t change is, is therapy really going to be effective for them? You know, are these ways of living and belief systems so entrenched that they can’t be changed? I think I held that until I got to learn the truth about older adults. Can you speak a little bit to that? I know that’s a really common myth that a lot of mental health and well meaning helpers have it what’s the what’s the ammunition to fight that belief?
Dr. Becca Levy
Yes, that’s a really common negative belief. You’re right. And actually, in the tap in the, in the book, I have a chapter on mental health and growth. And in part, because that stereotype that later life, that people don’t benefit from therapy, that depression and anxiety are very common, and there’s nothing that can be done about it, or those beliefs are really entrenched. And unfortunately, not just in the general culture, but also, you know, in some health care providers, I think, unfortunately, there’s not enough training for mental health, around the topic of mental health and aging. So I think some of those negative stereotypes are allowed to continue even after people have gone through their, their training. And so, yes, but I also went into the field of psychology with those same kinds of stereotypes. So actually, my first job after college was working in a mental health hospital in a psychiatric hospital. And the only position that was open at the time was on a geriatric unit. And I remember at the time, I thought, I don’t think I want this position, this is going to be so depressing, working with people who aren’t going to be able to get better. And it’s, but then since it was the only position open, I thought, well, maybe I’ll give it a try for a few weeks, you know, we’re worse comes to worse, I’ll move on, if it’s really as bad as I think it is. And what I found working, there was the complete opposite. So I observed all these cases of older people really benefiting from therapy, and I got to observe these really dedicated mental health professionals who thought about their issues from a very complex way and thought about different ways to really help help the patients and I saw them, you know, get most of them got better, and were able to go back into the community. And that was so inspiring to me to see how, in actuality, there’s just all these ways that older people can improve their mental health and grow in later life.
Dr. Regina Koepp
Yeah, and that, and to your point, that is exactly why I started the Center for Mental Health and Aging is to help shift some of the education to be more inclusive of, of mental health for older adults. And, you know, studies show older adults benefit from therapy, especially for depression and anxiety at the same rates as younger adults, and in substance use treatment programs. Actually, some studies show even better outcomes. There’s better matriculation and adherence to some of the treatment recommendations, and then overall better outcomes even a year later.
Dr. Becca Levy
Yeah, so it’s great that you see a set up your center, because it’s so important. And you’re right. I mean, the science dis really supports the benefits of mental health interventions. And in later life.
Dr. Regina Koepp
Let’s back up for a minute. Tell us about your lab. Because you were saying at my lab, we do this research, tell us, fill us in on your lab a little bit. And then let’s dive into some research around you know, physical health and how our beliefs influence our physical health and you would do so much good work there in our mental health too. So tell us about your lab and then we can dive into some of that other research.
Dr. Becca Levy
Sure. Yes. So one of the things I love about conducting this research is that there There are multiple methods that we can take to really understand the process of how these psychosocial factors, how age beliefs can impact eating health. And so in my research group, we actually take on three different types of methodologies. So one is experimental. So that’s the most controlled kinds of studies where we bring people into a laboratory, or we actually go out to their homes often. And we randomly assign people to different conditions. And that allows us to look at the impact of age beliefs above and beyond other factors. So that’s kind of the gold standard of clinical trials, which were because of methods that I’ve developed to look at these age beliefs, were able to do it in that same kind of way. But in addition, we do cross cultural work. So that to me is really important, because as we talked about, there are these really dramatic differences in how cultures think about aging, and the meaning they give to aging. And one of the ways that is really effective to understand that is to actually study these different cultures. And then the third way is that we look at people over time in longitudinal studies. So So I started off as an experimental psychologist. And over time, I’ve also added in what’s called psychosocial epidemiology methods, which allows us to look at people over a much longer time span. And so those are often studies that I’ve been able to do with these wonderful longitudinal data sets that are out there that have asked people about their age beliefs early on in the study, and then have followed them over decades. And we can track how their initial age beliefs can impact different kinds of health outcomes and with taking advantage of one of the ideas we talked about earlier with stereotype embodiment theory that these age beliefs are often operate over our lifespan. So there’s, it’s really interesting to be able to understand some of those processes over decades with people as well.
Dr. Regina Koepp
I’m thinking about some of that research. And I don’t know what which the studies I’m thinking about, I don’t know if they’re, if they’re cross sectional or longitudinal. Or you can tell me, but I’m thinking about the studies around how our beliefs about aging influence cardiovascular events, how our beliefs about aging influence Alzheimer’s disease? Can you fill us in on some of that research?
Dr. Becca Levy
Sure, yes. So you’re right. So those are findings that we have in different studies. And the cardiovascular study is interesting, because in our study that looked so in one study, we looked at whether age beliefs influence cardiovascular outcomes over time. And in that study, we were able to include that was done with the Baltimore Longitudinal Study of Aging. And they actually measured people’s age beliefs as young as 18. And then they followed them over decades. And so what I was able to do with with our team was to look at whether these initial age beliefs expressed in young adulthood impacted their cardiovascular events after they turned 60. And what we found was, indeed, those who had taken in more negative age beliefs at a young age, were twice as likely to have a cardiovascular event when they turn 60. And what’s important about that finding is, it shows that these early age beliefs can be really important into in future aging health. So it really, I think, points the way to the importance of prevention or intervention starting starting at a young age.
Dr. Regina Koepp
Yeah, that’s so powerful. Did it measure or do you know, what sorts of age beliefs that people held?
Dr. Becca Levy
Yes, so in that, so in different studies, we have different measures of age beliefs, and we get it, it’s different ways. But in that particular study, they did have a survey that they filled out at the beginning, and it asked people, when you think of an older person, you know, how much do these adjectives describe the older person that you have in mind, and it would be some of the more positive words would be something like capable and some more negative would be something like senility. So so in that study was actually matching keywords to their imagery,
Dr. Regina Koepp
similar to the Harvard implicit associations test and thinking that you associate the word and the image that you see quickly. And then what about with Alzheimer’s disease? I’m thinking I think you have at least two studies I’m thinking of one is around the progression of illness. And and I know these are very specific, so I might be throwing you off but and then ones around people with genetic risk factors like with the APOE e4. Yeah. Yeah. Tell us about that.
Dr. Becca Levy
‘m impressed that you know these findings.
Dr. Regina Koepp
oh, my gosh, I will I have to tell you, I think I’m I’m the president of your fan club.
Dr. Becca Levy
Oh, thank you. Yes, I’m very flattered that you that you know these results. So yes. So in the dementia research, we have found that I found that those who have more negative age beliefs are significantly more likely to develop dementia over time, or conversely, those who’ve taken a more positive age beliefs are protected from developing dementia. That’s a trend that we see in in general. And then in another study, as you said, I was really interested in trying to understand the interaction of the genes that were born with, and then these cultural age beliefs. So I’m really interested in the field of epigenetics or trying to understand how cultural beliefs or psychosocial factors can impact the likelihood that different kinds of genes are going to be expressed. And so in, in that study, I identified people who had this risky gene for developing dementia, and look to see whether in that group who’ve been born with this risky gene, how likely are they to develop dementia? And is there some advantage to acquire these positive aged beliefs. And what we found was that in this risky group, the ones who were born with this risky gene, if they develop more positive age beliefs, they were 40% less likely to develop dementia, and in fact that their risk of developing dementia was as low as people who are not born with the the risky gene. So that was a really kind of exciting study to find the way that these positive age beliefs can have an impact even in this high risk group.
Dr. Regina Koepp
I’ve been such powerful research. Now, why do you suppose it is that the way we think about things directly impacts our health?
Dr. Becca Levy
Yeah, so that’s a good question. So we do know, as Yeah, as we talked about, with stereotype, embodiment theory that there are these different levels. And in, in my research, I have focused on the different levels and different studies. And so it’s probably the case that all of these levels are operating together. So far, in my research, I’ve tried to really isolate each mechanism. And so what I’ve looked at are in the different studies are the different levels on which they operate. So we, I know that the age beliefs are very present in society. And one of the ways that they that we sort of take them in is without awareness. And because they can operate implicitly, we don’t necessarily, and often it starts at a very young age, when the age police are just not relevant to us. So if somebody tells a child the story, there’s no reason for them to question it. And so we get a lot of messages that either we take in implicitly, or they’re taken at a younger age before before we have the skills to to question them. And then when people become older, those beliefs are somewhere in our in our mind, and we know that they can be the activated and start to act as a lens in how we take in information around aging, and you know, our own our own aging process. And then, as we talked about, there is evidence that they can operate on these three levels. So people who’ve taken in more positive age beliefs from their culture, are more likely to have better health behaviors, they’re more likely to exercise to eat healthy food, to take prescribed medications. on a psychological level, they’re more likely to have a higher will to live, they’re more likely to feel efficacious about taking on different kinds of behaviors, and then on a physiological level as well. And as we talked about with dementia, for example, I have a study that found that those who’ve taken in more negative age beliefs are actually more likely to develop the plaques and tangles in their brain that are one of the key biomarkers of dementia. So it really seems like that they can operate on on in these different levels and really have an impact on health
Dr. Regina Koepp
and have an impact on longevity. So one of I think you’ve also identified in your work that people with a positive system or positive belief system around aging live seven and a half years longer. Is that right? Yeah.
Dr. Becca Levy
Right. Yes. So um, so after I got back from Japan, and I was really interested in this idea that age bliss might impact longevity or lifespan. I searched for a way attached to study that some more and it took me a little while but then I found this great study in Ohio that had been started by the sociologist Robert Ashley. And what he did in in 1975, I think is is when he started this study was Um, the his team interviewed everybody in the town of Oxford, Ohio, who was 50 or older at the time. And and one of the questions they asked them is, they asked them about their age beliefs. And so when I heard about this study, I was really excited because it was asked, you know, so many so many decades earlier, that I thought if only I could match those people to some lifespan information, maybe we could actually connect those early expressed age beliefs. And so after searching around, I discovered that there actually is a way to do that, that there is this something called the National death index, which you can apply to us. And so I worked with a sociologist, Suzanne Panko, and we match these early age beliefs to longevity information. And as you said, what we found was that those who had expressed more positive age police are taking in more positive age police at the start of the study, actually had a median survival advantage of seven and a half years, beyond those who had taken in more negative age beliefs.
Dr. Regina Koepp
Do you have any sense of their quality of life?
Dr. Becca Levy
We did in that study also look at different kinds of other kinds of health outcomes. And it seems like I think in part because these age beliefs operate as a lens that can impact a number of different outcomes. We also found that they did have other positive health outcomes, including better functional health. So So yeah, so it seems like it’s not just lifespan, but it extends to other aspects of health?
Dr. Regina Koepp
And can you define for us what functional health is just for people who are a little less familiar with that term?
Dr. Becca Levy
Yes. So functional health would be the ability to physically navigate in our space. So there are different measures to get at that, which would include balance and walking speed. In one of the most popular measures, it involves, also timing of how fast somebody can get sit and stand. And so it could be. So there’s a number of different skills that allow us to take walks go up and down stairs. So those are the kinds of things which are measured with functional health.
Dr. Regina Koepp
Yeah, and help with maintaining independence are necessary for independence.
Dr. Becca Levy
Exactly. Yes. That’s an important piece of it. Right.
Dr. Regina Koepp
So okay, so do you think we’ve sufficiently covered physical health? Are there other important physical health studies?
Dr. Becca Levy
So right, so I think, yes, we talked about cardiovascular health, and that we have different studies on walking speed and physical health, in functional health, and we have studies on biomarkers. So that’s another outcome that we found with with outcomes such as cortisol. There is also we have a study with inflammation as an outcome. So yes, so there are these different outcomes that are there’s sort of a synergy of finding. So we’re finding similar patterns with different kinds of outcomes and different methodologies. But they all support this idea that his age beliefs can be, you know, important to aging health.
Dr. Regina Koepp
That is so cool. Because you know, what that says to me that we have a lot of influence as individuals in our own aging and our own health. And that’s really cool. I feel very inspired and empowered about my own health. And, and people I love and people like, you know, serve clinically.
Dr. Becca Levy
Oh, good. Yeah, I think you’re right. I mean, I think I’m really inspired by the finding that that I just described in the book that it’s these beliefs are really malleable. So even though we do take them in from the culture, they’re not set in stone. So we have evidence that we really can be empowered and can shift them from these more negative messages to more positive messages. So I you know, at any age, I think, too, we can, we can work on making those shifts.
Dr. Regina Koepp
Okay, let’s talk about mental health for a minute. So, there’s a phenomena that happens that as we age, we become more psychological ly resilient. Can you can you speak a little bit to that you kind of touched on it a little bit earlier, but what about how we think about aging influencing our mental health?
Dr. Becca Levy
Yes, so. So I have a couple of studies in which we’ve looked at mental health outcomes. And we have found that those who’ve taken in more positive beliefs have different kinds of benefits in their mental health. So for example, people who’ve taken more positive beliefs tend to have lower levels of depression, lower levels of anger. at lower levels of suicidal ideation, even so there, there are a number of positive impacts of of taking into positive a place. And then we also have found in a study that those who have a more active coping style, who try to actively question and resist some of the negative messaging that that can lead to an improvement in these different kinds of mental health outcomes. So you know, regardless of the age beliefs that people start off the study in, so, so even if somebody has been exposed to a lot of the negative messages, if they take on this active coping style, they can show the same kinds of benefits of positive age beliefs, reducing the likelihood of different kind of worse mental health outcomes or reduce the risk of like developing depression and anxiety.
Dr. Regina Koepp
So you’re, you’re very focused on how we think about aging really matters and influences our health and well being. And you’ve taken a pretty strong focus on this, how we think about aging, and what sorts of associations we assigned to aging. Can you say a little bit about? I know, in the book, you really focus on how we think about aging versus our health behaviors. And I know health behaviors are really popular right now, especially for reducing risk for dementia. How did you make that decision to? Okay, I’m going to write a book. And I’m going to focus on how we think and believe about aging. Why focus there? Because we also know that health behaviors also have some benefit.
Dr. Becca Levy
Right, exactly. So I think the reason that I have taken a focus on each release is I think they operate as a, what I call as an upstream factor. And I think they can influence other downstream factors. And what I mean by that is that if we could shift our age beliefs to more positive age beliefs, we know that that can impact health behaviors. And that in turn can impact different kinds of health outcomes. And we also know that if we can improve it positively, so that can have an impact on mental health or psychological factors. So I think that what’s really key about these in place is that they operate as a lens that can impact a number of other types of health outcomes, including health behaviors. And so we know I need some some of the research on health behaviors alone, that it’s sometimes difficult to show sustainable, lasting change in health behaviors, if you don’t change the context, that’s leading to those health behaviors. And so what I’ve found in my research is that, you know, one of those factors that’s really important, is our age beliefs that then go on to impact our health behavior. So if we can shift the age beliefs that can have this sustainable change on different kinds of outcomes.
Dr. Regina Koepp
Okay, so now we’re gonna have to, we’re gonna have to go to class with you, because I think now is the time that we need you to tell us or teach us? How do we go about shifting our age beliefs? And I know you have this ABC model that you talk about? Could you help us do this? Like, what what do you recommend for shifting age beliefs?
Dr. Becca Levy
Sure. So yeah, so that’s a great question. And in breaking the age code, one of the things that I was really excited about is to present some evidence based tools that people can start to use right away. And so in, in the book, I present something called as you said, the ABC method, which is, stands for raising awareness, A is for raising awareness, the B is for shifting blame for problems to where the blame is due. And the C is for challenge or challenging than the negative age beliefs and ageism, and promoting the the positive eight age beliefs. And so, in the book, I present 15 evidence based tools. But to give you an example of one that seems to be particularly powerful that is in the first part of it in raising awareness is so I’ve found that it’s really key to because these ageism, often operates without our awareness and can operate implicitly as we talked about. The first step is really to raise our own awareness of our own age beliefs, but also the age beliefs that are operating in society. And so one method that I have found is particularly powerful is some I call age belief journaling. And what I suggest to people is for one week to write down every portrayal of aging that that you encounter in everyday life. So it could be when you go on social media, it could be when you’re streaming your favorite show on Netflix, it could be when you are overhearing a conversation of somebody in front of you in the supermarket lines. So whenever you hear somebody talk about aging in any kind of way, write down what it is that how the portrayal of older person came up. And also, it’s important to also acknowledge or to notice when older people are not presented, so when they’re omitted from conversations when they’re emitted from your favorite television show. So if you watch your favorite television show, and it, it only shows high school students, you know, that can be really fun to watch. But just notice that there’s nobody over the age of whatever it is over 20, who is who appears on that show. So and so if you write down over a week, all of these examples of how older people are presented or not presented in these different formats, then what’s important is to go back and look at the portrayals and the negative examples. Try to think about, is there any other way that that older person could have been presented? So when I watched that show, and there was this cranky mean principal who seemed like she was older who was presented with could there been another way to represent present that principle in that show for, for example. So and what I found is that process of recording and really acknowledging these messages, and then giving oneself a little bit of time to evaluate what they are, can have a real impact on him starting to improve our age beliefs and monitoring some of them that were exposed to.
Dr. Regina Koepp
And what about shifting blame? Tell us about that?
Dr. Becca Levy
Yes, so shifting blame is maybe the IS is a challenging one. But we have found that people can also do that quite quickly, as they start to work on it, you know it. In the book, I present the story of the 85 year old man who goes to see his doctor, and he says, my knees really hurting me, Can you can you help me doctor? And the doctor says, Well, what do you expect, you’re 85, of course, your your knees gonna be bothering you. And then the 85 year old patient responds well, but my other knee is also 85. And it’s not bothering me at all. And so that, that I think that immediate tendency to think about aging, as the cause is something that is important to question sometimes. So let’s think about mean some take a moment. And when there’s something that either somebody around you is blaming on Aging, or ourselves we’re thinking about is due to aging, take a moment and think about could it be another, another cause that’s leading to it. And so for example, one of the exercises that is relevant to this is to actually generate some challenges that you’ve that yourself you’ve experienced, or an older person, one of your loved ones has experienced that might have been blamed on aging, and then try to think about what other factors might be contributing. So is it possible that the reason that somebody didn’t remember something who’s older is not because it’s a senior moment is, you know, one of those terms that’s used a lot in our culture, maybe it’s that it’s actually that when they were presented, the information that they were distracted, they were listening to music, looking at their cell phone didn’t actually hear somebody, something that was said about some some person, and then when they tried to recall it, they haven’t actually encoded that information. Or maybe they were really, there was something stressful, they had some emotional experience that kept them from encoding the information at the time. So that process of thinking about challenges and then thinking about the different sources of it. And also, you know, ageism can sometimes as we talked about, be a source of leading to different types of types of challenges. So trying to become more aware of those attributions or blame can be can be really important, as well.
Dr. Regina Koepp
Yeah, I fell into that trap, the ageism trap with I had a few years ago, I had a doctor who made a minor medical error. And, and I presented the error to him. He was an older physician, when I presented the error to him, and he and got other opinions and it was per other opinions. Confirmed error, presented it to him. He refused to acknowledge my concern. My initial thoughts when I felt invalidated by him or slighted by him was you need to retire. Right? That was my initial thought and I do this work, right. So we’re all vulnerable to this the ageism trap. And then and then my shifting blame thought, well, then I had to do that awareness. Oh, wow. That’s my initial thought. And then my shifting blame that was no, this is not about age. This is about arrogance. He was arrogant at 30 He’s arrogant at 70 something. This is an arrogance problem. This is not an age problem. But I had to do this a in the awareness and then shifting blame myself just a couple of years ago, and I do this, you know, work I do. I really remember form ageist, right. I’m trying to reform all these ages, beliefs, but but I think we all have the capacity to fall in these ageist traps.
Dr. Becca Levy
Exactly. Yes. And uh, yeah, that’s a great example. I think you’re right, I think it’s really easy to have these go to explanations that quickly come to mind. So. So that’s yeah, that’s a great example of having to take a moment and thinking all right, it’s another way I could think about this. And could that actually be a more helpful way to, to think about the situation that doesn’t reinforce this negative messaging that we’re that we all are exposed to?
Dr. Regina Koepp
Yeah. And then I think related to that we conflate so often age with ability, or ageism and ableism intersect so much. So. You know, I questioned his ability to continue working, right, which would be potentially a disability. And then so I’m conflating age and ability, when it had nothing to do with this interaction, it was arrogance and invalidating my concern. So. And I think it was a way my knee jerk reaction internally that I didn’t say anything to him, but was a way to reclaim some power when I felt very disempowered. But I went about it in a very inaccurate, ageist way, right? And I had to check myself on that and put blame on arrogance and not on age.
Dr. Becca Levy
Right. Right. That’s a great example. And yeah, and I think you’re right. I mean, I think the process can be very empowering. Because I think the another reason that blaming age when it’s not appropriate is that it can feel very disempowering. It could be like, this is inevitable process, there’s nothing I can do about it. And often by switching the way that we think about a challenge, it can point out solutions or ways to actually make a difference that can help us.
Dr. Regina Koepp
Okay, so what is challenging negative beliefs? I think that’s pretty self explanatory. But will you just fill us in on that? See, of the ABCs?
Dr. Becca Levy
Sure, yes. And so there’s, there’s different ways that I talked about in the book to go about challenging, but one of the ways that it seems really important is to challenge the negative messages when they come up in everyday life. And as you talked about, sometimes they they come up, you don’t immediately come up with the solution. And sometimes it takes a little while. And, you know, I found in my my own interactions with with these examples is that I don’t always immediately come up with a retort a way to challenge it, but I often think about it afterwards. And then it’s okay to go back, you know, days later to a situation or you know, a challenge. And so somebody says something that’s really ageist, it’s okay to come back a few days later and say, like, hey, you know, what you said, doesn’t match the science doesn’t match what actually happens with older people. And so in the book, I present 14, negative stereotypes and the ammunition to overcome them. And having that knowledge at our fingertips that we can pull up and then bring to a situation and counter it, you know, I think can be, can be a really powerful way to go forward and challenging the negative messages.
Dr. Regina Koepp
I’m also thinking about all people who are in older adulthood experiencing these experiencing ages and directly. I’m conscious that I’m a 46 year old woman who it you know, hat is, is thinking about older, you know, this older physician in an ageist way, but what about, what are the recommendations when older adults directly experienced the ageist insults or a front? Are they just kind of oppression or negativity?
Dr. Becca Levy
Yes, so I think people can take those same messages and when it’s directed at themselves, and bring about the directly talking about the science or the evidence that what was just said is, you know, is hurtful and doesn’t support the science. But I think also one of the things that I was excited about in writing the book is the idea that you don’t have to be alone in the process. So I think that one of the one of the things that we observed from other social movements is that there’s a real power in uniting with other people who are going through a similar experience. And so there is this age liberation movement. which has started and I think one of the things that’s really wonderful about that is it is an opportunity for people of all ages to challenge ageism and work together in documenting some of the current examples of structural ageism, and then actually trying to think about structural changes. So the idea would be that we could reduce ageism on a structural level, you know, but until that happens, it’s great to have these tools that we can counter the negative age beliefs as we encounter them. But ideally, we’ll work towards a society where we won’t need them anymore, we’ll get rid of all the negative messaging about aging.
Dr. Regina Koepp
And with books like yours, and disseminating the message, I think that’s more and more possible. Okay, fill us in in the last few minutes about structural ageism, you in 2020. This is where I’m going to show my fan girl status right now. In 2020. I think you published an article on the financial impact of ageism. And and I think that also points to some of the structure structural ageism. Can you share a little bit about that?
Dr. Becca Levy
Yes. Well, thank you for knowing that finding. I’m really impressed. So yes, so in doing this research, I realized we were getting these findings, and they weren’t necessarily getting out to the public. So I had been mainly publishing the scientific journals. And that was one of the motivations for writing this book was to share the findings with with a bigger group of people who could benefit from from from our findings. But another way that I thought would might be really important in getting the message out about the impact, the negative impact of of ageism in our society, and the need to overcome it, I thought would be to document the financial impact. Because what I’ve been told by different people in the policy sector is that it’s really important to show the financial benefit of taking on a policy and showing that there’s some outcome that is beyond I mean, health is really important. But I think there’s something for policymakers that they want to see that something’s not going to cost more than money that they’re putting into it. So So I was advised if we could show the financial benefit of reducing ageism, that that might have an impact in the policy sector. And so I worked with a health economist and we came up with a model to actually document what the financial cost of structural ageism is on older people. So we did a study that looked at all older people over the age of 60, in the United States. And we were able to come up with a model where we documented the contribution of ageism to the most common most expensive health outcomes in older people. And we found that it led to a cost of about $63 billion in one year, which is about the cost of, of morbidity of for obesity, and which which we know is a very expensive outcome. And so or I guess, morbid obesity. And so those findings, what’s important is it shows that well, the cost of ageism, but also the benefit, if we could reduce the structural ages, then there could be a significant financial benefit for the countries that make that not a factor that’s contributing to these health outcomes.
Dr. Regina Koepp
I think in that you also are maybe it was a separate article are connected to that discussed how ageism contributed to eight of the most expensive medical conditions like cardiovascular disease and chronic obstructive pulmonary disease or and cancers and even older adults not being invited into smoking cessation programs and things like that. And then I think at the end of that article, you say something very hopeful, which is just by shifting our age beliefs, we could reduce, like 1.7 million or something of the I don’t have the research in front of me of the most expensive health conditions in the United States.
Dr. Becca Levy
Yes, exactly. Right. So So you’re right. So in that analysis, we focused on the primary outcome that we’ve reported on because of this policy. Goal was was the finances but you, as you point out, we also talked about the cost to human health and these different illnesses. And so you’re exactly right. So not only is there this large financial savings that could come about by reducing structural ageism, but it could have a huge impact on the risk of a number of major health outcomes as well,
Dr. Regina Koepp
which also impact family economy, because, because when people have more illness and more significant illnesses, is it’s more expensive? And then it creates a greater financial burden on on the whole family? And I think that’s relevant here, too.
Dr. Becca Levy
Yes, exactly. So in that analysis that I talked about, with the $63 billion cost, it actually didn’t include any of what you’re talking about this huge impact on families and loss of wages and people having to leave the workforce and family caregivers that are taking care of the people who have these different kinds of ageism induced outcomes. So yes, you’re exactly right, that that’s a really important piece of it as well.
Dr. Regina Koepp
Well, Dr. Becca Levy, I hope that you feel like sufficiently honored and valued right now, because I just so appreciate the work you do in helping us really understand the impact of how we think about ourselves and about others, has direct implications for our own health and other’s health as well. And I think most of the people who listen to this podcast are helpers, and either professional helpers like me, or family caregivers, or community helpers. And, and we all have the sort of intention, I believe in life, the people who listen to this, to do good and to be helpful and to reduce suffering. And your work really helps us to do that.
Dr. Becca Levy
Thank you so much. I love your comments. And I think your work that you’re doing is fantastic, as well. So I love the work that you’re doing. And with your podcasts second season, congratulations. Really getting the message out in this really important area of mental health and aging, which is gets doesn’t get enough attention. So it’s great that you’re you’re doing this work.
Dr. Regina Koepp
Thank you. I will link to your book in the show notes. I’ll also link to some of the references that we talked about today so folks can learn more if they’re interested. And and just best best wishes to you continue to do this wonderful work and your book you talk about a family in Vermont and we’re going to go to the ER a community in Vermont that’s pretty age liberated and so we’re gonna go visit that my family and I are gonna go visit that community. Hopefully summer.
Dr. Becca Levy
Yeah, so that’s fantastic. Thank you so much. Yeah, really appreciate this conversation with you.
Dr. Regina Koepp
Yeah, thank you.