Prof Mélanie Levasseur

Mélanie Levasseur is responsible for a project entitled “Breaking with ageism”, funded by the Fonds de recherche du Québec – Société et culture (FRQSC).

Intersectoral action plan to break with ageism

In context

Despite the existence of several innovative and effective strategies to promote social participation and provide an active and healthy life course for older adults (Levasseur et al., 2018), the effectiveness of these strategies is limited by a concerning reality: ageism. Representing " stereotypes (thoughts), prejudices (feelings) and discrimination (actions) against people based on their age" (World Health Organization [WHO], 2021), ageism affects nearly two in three older Canadians who report being treated unfairly or differently because of their age (International Federation on Ageing, 2014). Eight in 10 Canadians also believe that seniors aged 75 and older are perceived as less important and are more often ignored than younger generations in society. Since ageism reduces seniors' health, their integration into the community and their power to act, aging is then reduced to a decline in health, thus influencing societal choices (WHO, 2002). This stigmatization and depreciating of older adults in the community has been intensified during the pandemic (COVID-19; Lagacé et al., 2022).

Ageism can be experienced in a variety of ways. As reported by Canadians, the three most common forms are 1) being ignored or treated as invisible (41%); 2) being treated as having nothing to offer (38%); and 3) being seen as inadequate (27%) (International Federation on Ageing, 2014). Eight in 10 Canadians also believe that older adults aged 75 and over are perceived. Specifically, older women, older adults with low incomes, and those with dementia are at greater risk of experiencing ageism (Barnett, 2005; Rippon et al., 2014).

Studies have shown that ageism has significant impacts on older adults, including decreased health and wellbeing (Jackson et al., 2019), social exclusion and marginalisation (Billette, 2012), increased depressive symptoms and feelings of dependence on family and friends (Han and Richardson, 2015), and decreased life span and quality of life (Nelson, 2016), and cognitive functions (Marquet et al., 2016). In addition to the impact on older adults' health and wellbeing, ageism also carries significant financial costs. In the United States, ageism incurs an additional US$63 billion in costs each year from several health problems (WHO, 2021).

Objective of the intersectoral action plan to break with ageism

Developed for Quebec and developed for seniors, stakeholders working with seniors, young people and students, community organizations, decision-makers and the Quebec population, this Intersectoral Action Plan (PAI) to break with the ageism aims to propose strategic orientations (O) and actions (A) in different sectors (nature and technology; health; society and culture) in a sustainable and socially acceptable way, in order to break with ageism by promoting place of older people in society.

Process for developing the Intersectoral Action Plan to Overcome Ageism

Research-action stemming from a citizen action

Carried out by and for older adults and supported by an intersectoral team, the project "Breaking with ageism: co-construction of an intersectoral action plan promoting better health, valorization and social participation of older Quebecers" has enabled citizen action through research-action (Dolbec & Prud'homme, 2009), which includes a realistic review of the literature, key informant forums, secondary data analysis of a population-based survey, and a Great Interaction to Overcome Ageism (GIRA). This new perspective on ageism helped to co-construct a shared perspective of the position of older adults in our community and to identify, in partnership with community organizations and older adults, promising actions to overcome ageism (Levasseur et al., 2020).

Realistic Review of the Literature

As recommended by WHO (2021), our work includes a realistic review of the literature, targeting two subgroups(young people under 18 and and health and social services students)which provided a rich and detailed understanding of actions to overcome ageism. Specifically, the realistic review of the literature identified links between the contexts, mechanisms and outcomes of three types of actions to be implemented to overcome ageism: educational, intergenerational and a combination of both (Bétrisey et al., 2021).

Three types of actions can help overcome ageism:

Key Informant Forums

Two key informant forums, involving older adults, stakeholders and leaders of community and health and social service organizations, improved the results of the realistic review of the literature and co-construct a shared perspective of the position of older adults in our community (Levasseur et al., 2021).

Main findings from the key informant forums

1. Because older adults are marginalized and there is a lack of recognition of their knowledge and experience, their position in society is ill-defined and stigmatized.
2. The experience of older aduls is not sufficiently valued (eg in media and political discourse).
3. Older adults are perceived as a homogeneous, vulnerable group with chronic conditions, as well as non-active or non-engaged persons.
4. This homogeneous representation of older adults, their classification according to age or health status, conceptual issues (e.g., using non-representative and negative terms; non-consensual and vague definitions), individualistic society (e.g., lack of solidarity and mutual aid between generations), their limited access to the labour market and their precarious socio-economic position are barriers to their inclusion in society.
5. The resources put in place to meet the needs of older adults and their opportunities for social participation are insufficient and often unsuited to their situations.

In order to promote their inclusion in the community, valuing the aging process, intergenerational ties in the community, as well as improving the care and support services offered to older adults must be prioritized.

Secondary data analyses of a population-based survey of associations between ageism and biological aging

In addition to a realistic review of the literature and key informant forums, secondary data analyses based on the Health and Retirement Study have examined the associations between ageism and biological aging in older adults.

Great Interaction to Overcome Ageism (GIRA)

Through roundtables, Facebook discussions and press coverage, the Great Interaction to Overcome Ageism (GIRA) was an opportunity to hear the concerns of Quebec citizens regarding aging and ageism.

GIRA is an initiative led by the Research Centre on Aging of the CIUSSS de l'Estrie-CHUS and co-constructed by researchers, communication students, older adults and stakeholders. Led by Professor Dany Baillargeron and his team, and funded by the FRQ - Dialogue Program, this interactive and intergenerational meeting proposes various ways to transform perceptions of aging and to generate inclusive behaviours based on scientific research on the causes, effects and challenges of ageism.

The three objectives of GIRA

1. Promote awareness of the challenges, effects and forms of ageism;
2. Demonstrate that solutions exist to overcome ageism;
3. Engage in a dialogue around ageism research.

To foster an intergenerational exchange, GIRA uses a range of approaches (dynamic and interactive website; Facebook outreach and dialogue strategy; traveling exhibition of photos by artist Ariane Clément; press relations [GIRA, 2021])

Orientations and strategic actions to promote the place of older adults in society

To overcome ageism by reassessing the place of older adults in society, this research-action has identified eight strategic actions (A) according to three orientations (O): O1) to promote the value of aging, O2) to foster intergenerational connections in the community, as well as O3) to improve the care and social services offered to older adults. In a cross-sectional way, the strategic actions serve to preserve and reinforce the ability of older adults to act by increasing their self-esteem, by promoting a genuine understanding of their perspectives and a respect for their choices and interests. The Strategic actions are in line with the WHO's recommendations regarding the need to change perceptions about aging and to recognize the value of older adults (WHO, 2021). They are also consistent with all eleven strategic choices put forward by the 2018-2023 Action Plan Un Québec pour tous les âges (Government of Québec, 2018).

Orientations	Strategic actions
O1 Valuing aging	In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)1 Present a nuanced and diverse view of aging In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)2 Educate the population about the realities of advancing in age
O2 To foster intergenerational connections in the community	In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)3 Develop mutual aid between generations In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)4 Promote multi-generational housing In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)5 Foster intergenerational activities
O3 To improve the care and social services offered to older adults	In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)6 Support home care for seniors and their loved ones In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)7 Facilitate access to programs and services offered to seniors In Sherbrooke: contact the Sherbrooke Accorderie at 819-821-7162 (extension 7)8 Promote the integration and retention of older workers in the labor market

Considering the importance of the ageism phenomenon, its severe consequences among older adults (e.g., decreased health and wellbeing), and its relevance to health equity, it is critical to act quickly and make ageism a priority since it is a social determinant of health that has been neglected for too long (Levasseur et al., 2022).

The team members are

Melanie Levasseur, University of Sherbrooke (Head)
Dany Baillargeon, University of Sherbrooke (Co-investigator)
Mary Beaulieu, University of Sherbrooke (Co-investigator)
Annie Carrier, University of Sherbrooke (Co-investigator)
Alan Arthur Cohen, University of Sherbrooke (Co-investigator)
Sylvain Giroux, University of Sherbrooke (Co-investigator)
Martine Lagace, Laval University (Co-investigator)
Laurie Kirouac, University of Sherbrooke (Co-investigator)
Sebastien Lord, University of Montreal (Co-investigator)
Christine Morin, Laval University (Co-investigator)
André Tourigny, CHU de Québec – Laval University (Co-investigator)
Marika Lussier-Therrien, University of Sherbrooke (research professional)
Carine Betrisey, University of Sherbrooke (Postdoctoral fellow)
Mingxin Liu, University of Sherbrooke (Master's student in biochemistry)

Stakeholders are

Quebec Association for the Defense of the Rights of Retired and Pre-Retired Persons (AQDR)
Luc Maurice Foundation
Laboratory of innovations by and for seniors (LIPPA)
The Network of Friends of Sherbrooke
Sherbrooke Grandparents' House
FADOQ network
Regional consultation table for seniors in Estrie

Taken from the FRQSC website.

References

Barnett RC. Ageism and sexism in the workplace. Generations. 2005;29(3):25‑30.

Bétrisey C, Carrier A, Beaulieu M, Tourigny A, Lagacé M, Baillargeon D, et al. Interventions auprès d’enfants et d’adolescents pour rompre avec l’âgisme envers les personnes aînées: Résultats d’une recension réaliste. Présentation par affiche présenté à: Journée PIVOT : Mieux vieillir; 2021 mai 11; Orford (QC), Canada.

Billette V. D’une société exclusive à une société inclusive et plurielle. Perspectives de solidarités en gérontologie sociale. Réflexions pour le cadre théorique de l’équipe Vieillissements, exclusions sociales et solidarités (VIES). Cah CREGÉS. 2012;3(2012):1‑62.

Dolbec A, Prud’homme L. La recherche-action. Dans: Recherche sociale : de la problématique à la collecte de données. 6^e éd. Québec, Canada: Presses de l’Université du Québec; 2009. p. 505‑40.

GIRA. Grande interaction pour rompre avec l’âgisme [Internet]. 2021. Available at: https://rompreaveclagisme.ca/

Gouvernement du Québec. Un Québec pour tous les âges : Plan d’action 2018-2023 [Internet]. Québec (QC), Canada; 2018. Available at: https://publications.msss.gouv.qc.ca/msss/document-002204/

Han J, Richardson VE. The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: a longitudinal examination of age discrimination. Aging Ment Health. 2015;19(8):747-55.

International Federation on Aging. Revera Report on Ageism [Internet]. Mississauga (ON), Canada: International Federation on Aging; 2014 p. 1‑11. Available at: https://www.reveraliving.com/about-revera/news/publications/report-on-ageism-1/report_ageism

Jackson SE, Hackett RA, Steptoe A. Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing. Lancet Public Health. 2019;4:e200‑8.

Lagacé M, O’Sullivan T, Dangoisse P, Mac A, Oostlander S, Doucet A. Une étude de cas sur l’âgisme pendant la pandémie de COVID-19 [Internet]. Forum fédéral, provincial et territorial des ministres responsables des aînés; 2022. Available at: https://www.canada.ca/fr/emploi-developpement-social/ministere/aines/forum/rapports/agisme-covid19.html

Levasseur M, Dubois MF, Filliatrault J, Vasiliadis HM, Lacasse-Bédard J, Tourigny A, et al. Effect of Personalized citizen assistance for social participation (APIC) on older adults' health and social participation: study protocol for a pragmatic multicentre randomized controlled trial (RCT). Br Med J Open. 2018;8(3):1‑11.

Levasseur M, Bétrisey C, Lussier-Therrien M, Baillargeon D, Giroux S, Cohen AA, et al. Rompre avec l’âgisme:  Vers  l’inclusion  et  la  participation  sociale  des  aînés. Présentation par affiche présenté à: 6e Colloque international du REIACTIS; 2020 mars 2; Metz, France.

Levasseur M, Bétrisey C, Poulin D, Lussier-Therrien M, Carrier A, Beaulieu M, et al. Co-construire une vision commune de la place des aînés dans la société : Résultats de forums d’informateur clés pour rompre avec l’âgisme. Présentation par affiche présenté à: Journée PIVOT : Mieux vieillir; 2021 nov 5; Orford (QC), Canada.

Levasseur M, Cohen AA, Lagacé M, Bétrisey C, Liu M. What is missing in the guideline for equitable COVID-19 pandemic recovery in Canada? Toward greater consideration of the importance of older adults in health and social services, research and society. Can Med Assoc J [Internet]. 2022 [cited 2022 Nov 16]; Available at: https://www.cmaj.ca/content/what-missing-guideline-equitable-covid-19-pandemic-recovery-canada-toward-greater, /content/what-missing-guideline-equitable-covid- 19-pandemic-recovery-canada-toward-greater

Marquet M, Missotten P, Adam S. Âgisme et surestimation des difficultés cognitives des personnes âgées: une revue de la question. Gériatrie Psychol Neuropsychiatr Vieil. 2016;14(2):177‑86.

Nelson TD. The age of ageism. J Soc Issues. 2016;72(1):191-8.

Organisation mondiale de la santé. Vieillir en restant actif: Cadre d’orientation [Internet]. Genève, Suisse: Organisation mondiale de la Santé; 2002 [cité 12 nov 2020]. Available at: https://apps.who.int/iris/bitstream/handle/10665/67758/WHO_NMH_NPH_02.8_fre.pdf;jsessionid=DD1FB1B1460EA18DC067CCCAE170B813?sequence=1

Organisation mondiale de la Santé. Décennie pour le vieillissement en bonne santé : rapport de base : résumé. 2021.

World Health Organization. Global report on ageism [Internet]. Geneva, Switzerland; 2021 [cited 2022 Nov 3]. Available at: https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism/global-report-on-ageism

Rippon I, Kneale D, de Oliveira C, Demakakos P, Steptoe A. Perceived age discrimination in older adults. Age Aging. 2014;43(3):379-86.