Promoting Physical Activity

Challenging Aging Stereotypes

Strategies for Creating a More Active Society
Marcia Ory, PhD, MPH, Melane Kinney Hoffman, Margaret Hawkins, Brigid Sanner,
Robin Mockenhaupt, PhD, CHES
Background: The myths of aging provide a partial explanation for why older people have not been
primary targets for health promotion and disease-prevention programs. Accelerated
population aging signals an urgent need for increased attention to health promotion and
disease-prevention interventions across the entire life course.
Objective:

The purpose of this article is to review what is known about: (1) the prevalence and nature
of ageist stereotypes; (2) the varied ways in which ageist stereotypes are harmful to health,
functioning, and well-being; and (3) strategies for effective communication with older
adults around lifestyle issues, with particular emphasis on physical activity.

Method:

This article reviews literature on current myths and reality of aging in the context of
designing health promotion programs for older adults. Strategies for combating ageist
stereotypes are based on a multilevel view of determinants of health and aging.

Conclusions: Ageist stereotypes are pervasive in U.S. society and harmful to older adults psychological
well-being, physical and cognitive functioning, and survival. Concrete strategies for
communicating with older adults can increase the effectiveness of health promotion
programs. Strategies for combating ageism and creating a healthier society must address all
segments of society, and include educational and media campaigns, an expansion of
current research foci, greater sensitivity from care providers, more opportunities for
intergenerational linkages, the design of productive roles for older adults, a retrofit of the
built environment, and intensified and collaborative action from both the public and
private sectors.
(Am J Prev Med 2003;25(3Sii):164 171) 2003 American Journal of Preventive Medicine

Introduction

he dramatic aging of the U.S. population underscores an urgent need for research to elucidate
steps that can be taken to enhance the health
and quality of life of Americans as they age. The
well-cited demographic facts reveal a generic picture of
our aging nation. One in eight Americans is now aged
65 years and many more people than ever before are
living into their 80s, 90s, or even 100s.1 Over the next
few decades, there will be a doubling of persons aged
65 from a current high of 35 million to an unprecedented 70 million older Americans.2 Since chronic
illness and disabilities and associated healthcare use
increase with aging, escalating healthcare costs and

From the School of Rural Public Health, Texas A&M University

System (Ory), College Station, Texas; AARP (Kinney Hoffman,
Hawkins), Washington DC; Sanner and Company (Sanner), Dallas,
Texas; and The Robert Wood Johnson Foundation (Mockenhaupt),
Princeton, New Jersey
Address correspondence and reprint requests to: Marcia Ory, PhD,
MPH, Department of Social and Behavioral Health, School of Rural
Public Health, 1266 TAMU, 3000 Briarcrest Drive, Suite 310, Bryan
TX 77802. E-mail: mory@srph.tamu.edu.

164

other negative societal effects are often seen as inevitable consequences of the graying of America.3,4
Yet, this demographic revolution is not occurring in
a vacuum. Twenty-five years of gerontologic research
have generated a growing knowledge base about the
characteristics of the older population and the challenges facing older adults, their families, and society as
a whole.5 8 We are also learning that population aging
can signal an opportunity for increased attention to
health promotion and disease prevention interventions
for older adults.9,10 The extent to which such interventions will be promulgated, proven successful, and ultimately disseminated widely is dependent, in part, on
our views of the malleability of the older population
and the potential of health promotion activities for
improving the lives and functioning of older adults.
Set within the context of an ever-changing society,
this article explores the existence of ageist stereotypes,
including the manner in which they still exist at the
beginning of the twenty-first century; the varied ways in
which ageist stereotypes are harmful to health, functioning, and well-being; and strategies for effective
communication with older adults around lifestyle is-

Am J Prev Med 2003;25(3Sii)

2003 American Journal of Preventive Medicine Published by Elsevier Inc.

0749-3797/03/$see front matter

doi:10.1016/S0749-3797(03)00181-8

sues. Physical activity programs are given emphasis

since physical activity is now recognized as a major risk
factor for morbidity and mortality in later life. Additionally, there is a growing research literature about the
effectiveness of physical activity interventions for people aged 50. The article concludes with specific
recommendations for confronting lingering ageist stereotypes and promoting activities for older and functionally disabled people to lead healthier, more active
lives.

Ageism and Ageist Stereotypes

First coined by Robert Butler,11 ageism is likened to
other forms of bigotry such as racism or sexism. Initially
referring to discrimination against people because they
are old, the definition has been broadened to include
prejudice or discrimination against or in favor of an age
group. Ageist views can come from several sources,
including a lack of knowledge about the real status of
older people, lack of close interactions with older
people, or a fear of becoming old translating into a
desire to distance ones self from being old.12,13
Ageism is sometimes played out as intergenerational
warfare, where the needs and issues of one generation
are pitted against another in federal budget fights
about which age group is more deserving of federal
allocations.14
Stereotypes and stereotyping are closely related
terms and often used synonymously.15 Exaggerated
views or conceptions about a person or a group based
on simplistic generalizations, stereotypes do not consider individual characteristics. Common stereotypes
depict old age as a time of poor health and functioning,
or a regression back to childhood.16 Aging stereotypes
can be either positive or negative, with some people
holding multiple views of a person or group.17
Stereotypes are not fixed but may change over time.
For example, there is some evidence that aging stereotypes have changed in the past 30 years as social and
healthcare policies have improved the economic status
of older people and their access to medical care and
public health interventions.18 Some now see older
people especially those in the younger age ranges of
the older populationin an advantaged position.16,19,20 However, neither extremethe historical
view of older people as sick and poor or the newer
view as healthy and wealthyis an adequate reflection of the lives of large numbers of individual older
people. There is great diversity among older people
and such stereotypes do not adequately reflect the
subgroups within the aging population, as well as
variations by age, functional level, geographic residence, or ethnic/minority status.2,10 For example,
while poverty rates have indeed declined for older
adults since the 1960s, certain segments of the older
population are more vulnerable, such as very old non-

white women.1 Similarly, while the young old may be

healthier than previous cohorts, the population aged
85 is growing most rapidly, and this is the age group
with the most severe functional limitations and
disabilities.7,21

Popular Myths of Aging

Stereotypic views of older people and the aging process
lead to several myths about aging. In their classic book
summarizing findings of the MacArthur Foundation
Study on Successful Aging, Rowe and Kahn22 describe
six common myths of aging. Each of these myths has
been debunked by empirical evidence synthesized in
their book.
Myth 1: To be old is to be sick. Reality: Although
chronic illnesses and disabilities do increase with age,
the majority of older people are able to perform
functions necessary for daily living and to manage
independently until very advanced ages. The effects of
population aging are mediated, in part, by declining
disability rates.23,24
Myth 2: You cant teach an old dog new tricks. Reality:
Older people are capable of learning new things, and
continue to do so over the life course. This relates to
cognitive vitality as well as the adoption of new
behaviors.
Myth 3: The horse is out of the barn. Reality: The
benefits of adopting recommended lifestyle behaviors
continue into the later years. It is never too late to gain
benefits from highly recommended behaviors, such as
increasing physical activity.
Myth 4: The secret to successful aging is to choose
your parents wisely. Reality: Genetic factors play a
relatively small role in determining longevity and quality of life. Social and behavioral factors play a larger role
in ones overall health status and functioning.
Myth 5: The lights may be on, but the voltage is low.
Reality: While interest and engagement in sexual activities do decline with age, the majority of older people
with partners and without major health problems are
sexually active, although the nature and frequency of
their activities may change over time.
Myth 6: The elderly dont pull their own weight.
Reality: The majority of older adults who do not work
for pay are engaged in productive roles within their
families or the community at large.

Pervasiveness of Stereotypes in the Cultural

Landscape
Stereotypes of older people are universal in the United
States and displayed in many different sectors of American life.
Am J Prev Med 2003;25(3Sii)

165

Media

Older Peoples Experience with Ageism

Ageism and negative stereotypes are pervasive in American society. The U.S. Senate Special Committee on
Aging recently held a hearing titled Image of Aging in
Media and Marketing.25 Expert witnesses testified
about the continued negative images of older persons
as feeble, ineffective, helpless, and irrelevant both in
print and on television.13 Despite an emphasis on
demographically based marketing principles, youth
dominate the advertising world. In their rush to target
younger audiences, advertisers totally neglect or fail to
recognize the variability in the 50 age group, a market
that is increasing in purchasing power and influence.26
There is a growing recognition that negative views of
older people might backfire on advertisers, with older
people refusing to buy products with age-biased ads.27
Snyder26 argues that values-based segmentation versus
current lifestyle or age-based segmentation will be more
effective in reaching older adults. An exception to the
under-representation of older people in ads can be
seen in the recent plethora of pharmaceutical ads that
have mushroomed since bans on direct advertising to
patients were lifted. Interestingly, these ads typically
portray older people as active and attractive.

A recent survey of adults aged 50 has documented the

various forms of ageism and their prevalence in the
United States and Canada.31,32 The majority of respondents (84% of Americans and 91% of Canadians)
reported one or more incidents of ageism, with more
than 50% reporting multiple experiences. From a list of
20 possible types of ageism, 20% of the Americans
denied ever experiencing any form of ageism. The most
common types involved a mild form of ageism that
respondents did not always recognize as negative stereotyping being told a joke or sent a birthday card
that made fun of older people. While this may seem
harmless, these actions perpetuate negative stereotypes
of older people. There were frequent reports of negative social interactions based on age being ignored or
treated with less dignity because of their age or being
referred to by an insulting name related to their age.
Almost half of the respondents reported experiencing
situations in which their healthcare providers attributed ailments to their age or that they were told they
were too old for that. Severe age discrimination such
as being denied housing, loans, or medical treatment
was very rare. While exploratory and based on nonrepresentative samples, these studies help to further our
understanding of aging stereotypes by conceptualizing
different types of ageist experiences and getting a
preliminary assessment of which types are most
prevalent.

Health Care and Social Services

Medical ageism and stereotyping take a variety of forms.
Ageism in medical care is manifested in doctors tendency to give less aggressive treatments based on age
characteristics alone, regardless of how the older person would actually fare with the withheld treatments or
regimens.28,29 While healthcare providers withholding
a full range of treatment options may truly believe they
are acting in the best interests of their patients, stereotyping of older patients can also be overtly judgmental
and involve very negative labeling of older patients,
such as crocks or vegetables.13 Such ageist attitudes
have a negative impact on communication with patients
and can result in suboptimal treatments and follow-up
care.30 Doctors who are uncomfortable with their own
aging or who lack knowledge about aging processes and
special geriatric issues miss opportunities to diagnose
and offer appropriate treatments for sensitive geriatric
conditions (e.g., depression, urinary incontinence, sexual dysfunction, elder abuse). In the realm of physical
activity, doctors may believe that older people deserve
a rest and thus do not actively encourage them to
become physically active, despite the known benefits of
increased activity levels for patients of all ages. Similarly, human services professionals may exhibit ageist or
stereotypic behaviors toward older clients by being
unaware of their needs and covertly or overtly restricting services.
166

Harmful Consequences of Ageist Stereotypes

Early work by Palmore17 enumerates the potentially
damaging effects of ageism. According to Palmore,17
people subjected to negative stereotyping may adopt
the negative views and act accordingly with detrimental
effects to their own self-image, confidence, and abilities. Regardless of responseacceptance, denial, or
avoidancestereotypes devalue a persons basic worth
and dignity and can have potentially negative consequences. Levy33 adds to this literature by directly examining the consequences of negative stereotypes and
self-perceptions of aging on older peoples physiologic
responses, functioning, and even longevity. Using rigorous experimental methods for exposing older people
to subliminal stereotypes, Levy33 finds that those exposed to negative stereotypes had reduced memory
performance, self-efficacy, and the will to live. Negative
stereotypes also heightened cardiovascular response to
stress, whereas positive stereotypes exerted a protective
effect, bringing their physiologic changes back to baseline levels.16 Examining the long-term effects of selfperceptions of aging, these investigators also find that
individuals with more positive attitudes reported better
functional health with this relationship being partially
mediated by improvements in perceived control.34

American Journal of Preventive Medicine, Volume 25, Number 3Sii

Building on these earlier studies, Levy et al.35 have

recently uncovered a survival benefit associated with
positive images of aging. In a follow-up to the Ohio
Longitudinal Study on Aging, Levy et al.35 found a
7.5-year mean survival advantage for those who expressed a more positive self-perception of aging relative
to those holding more negative perceptions. This finding is the strongest evidence to date that the internalization of negative stereotypes can be viewed as an
important health hazard.

Targeting Older People in Health Promotion

Programs
The myths of aging22 provide partial explanation for
why older people have not been primary targets for
health promotion and disease prevention programs.
Elaborating on the myths of aging presented earlier in
this paper, Ory et al.8,36 38 provide additional explanations for why older people have been traditionally
neglected from active interventions, despite more than
a decade of epidemiologic evidence documenting the
life-long benefits associated with the adoption of
healthy lifestyles or relinquishing of unhealthy habits.39,40 In contrast to health promotion programs directed at younger people, interventions to promote
health in the aged have traditionally been considered
as occurring too late to be effective. There has been a
supposition that behavioral or lifestyle changes in late
life have only a minimal impact on health and functioning. Stereotypes cast older people as inflexible,
unwilling, or unable to change health attitudes, behaviors, or lifestyles. In addition, health promotion interventions have historically been thought to be too
strenuous for older people to tolerate. The fallaciousness of these ageist assumptions can be graphically
illustrated in images of octogenarian and nonagenarian
nursing home residents engaging in very successful
strength-training programs41 or frail older adults participating in home-based resistance training.42
A better understanding of the potential benefits for
older adults was also hampered by the research designs
traditionally utilized to learn about the efficaciousness
of various intervention strategies. In an attempt to
minimize potentially confounding factors such as the
presence of comorbid conditions, researchers historically excluded older people from their studies.43 Recruitment of older participants was also seen as more
problematic, even though there was little scientific
evidence about factors affecting recruitment in older
subjects. Recent studies from multicenter trials of
health promotion efforts indicate that neither frailty
nor intervention intensity was a predictor of recruitment outcomes. Older people can be successfully recruited into beneficial health promotion programs, but

investigators need to be aware of and address challenges that do occur.44

Age Considerations in Communicating to Older

Adults about Healthy Lifestyles
AARP (formerly known as the American Association of
Retired Persons), a membership organization for people aged 50 that strives to improve the quality of life
for all people as they age, has established a top priority
of increasing physical activity levels among this population (www.aarp.org/activeforlife). In planning and
preparation for this initiative, AARP, with help from the
Centers for Disease Control and Prevention and funding support from The Robert Wood Johnson Foundation, developed a consumer market research plan to
identify audience segmentation strategies, barriers, and
opportunities for individual and community behavior
change, potential methods and messages, and various
options for intervention design. The research included
numerous sets of focus groups, in-depth one-on-one
interviews, and three national surveys. When taken
together, the findings of this consumer market research provide a picture of which approaches are the
most motivating to this audience, as well as those that
are not motivating.
To be effective, promotional messages for physical
activity must assume that the target audience already
knows the health benefits of exercise, but for various
reasons has not taken any action. For example, AARP
survey research reveals that 98% of people aged 50
say that getting exercise is important to staying healthy,
63% say it is the best thing to do to stay healthy, and
47% believe they should exercise more than they do.
Consequently, messages must move beyond conveying
basic health benefits to focus on encouraging and
inspiring audience members to get moving, all the
while being careful not to alienate or turn them off.
Focus groups in which participants reviewed and
commented on a number of print advertisements,
group interviews, and one-on-one in-depth interviews
in which participants reviewed a self-directed physical
activity handbook, have helped AARP to identify concepts, messages, and tonalities that are likely to be
successful in motivating adults aged 50 to 79 to adopt
and stick with a physical activity regimen.
In most cases, the visual imagery was very important,
and could either inspire participants or cause them to
shut out the message. In general, focus groups reacted
positively to ads and handbook covers showing men
and women together and older and younger generations together, images that featured people enjoying
themselves, and ones that showed people exercising in
groups. Beautiful settings also elicited a positive
response.
Am J Prev Med 2003;25(3Sii)

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Messages That Motivate

To be successful, promotional messages should also
have the characteristics listed below.
Feature ordinary people doing ordinary things.
Adults aged 50 responded best to promotional messages when they could identify with the people and the
activities featured in ads. Focus group participants
preferred ads that showed real people like us taking
part in realistic activities. For example, both men and
women identified strongly with a smiling female jogger
who was physically attractive without looking like a
model, who was doing something that most of them
could do, and did not look old, even though she had
gray hair. Many participants commented that the jogger looked like someone they would like to have as a
friend. They were outspoken in their views that it is not
encouraging to see images of people who are super-fit
elite athletes, even if those people were their age. Male
participants in one focus group said that a man featured in one print ad concept looked more athletic
than they would ever be, and they found that
discouraging.
Provide concrete information. While audiences need
motivation and encouragement to get moving, they are
also hungry for specific directions and guidance. Focus
group participants always appreciated being directed to
other resources, such as Web sites or telephone numbers, where they could find more information. They
also thought it would be helpful to know about specific
events, activities, and classes that would help them get
and stay motivated.
Be specific. Two options for an exercise prescription were tested. One suggested that people aged 50
take at least a brisk walk every other day, and the
other recommendation was to get your heart rate up
for at least 30 minutes, most days. Focus group participants preferred the second recommendation, but
found most days to be too vague. In response, the
message was changed to a more specific get your heart
rate up, at least 30 minutes a day, at least 5 days a week.
This guideline reflects the recommendations for moderate exercise distributed through the Healthy People
2010 initiative.
Recognize the obstacles that people face. A significant number of focus group participants identified
strongly with messages that acknowledged the busy lives
that audience members lead. For example, one ad
introduced Terry Watkins, a 53-year-old Ohio resident
who was pictured taking a brisk walk in a park, even
though he had many other responsibilities that demanded his time and attention. The ad copy read,
Terry Watkins takes the kids to practice. He takes his
dad to therapy. He takes on a full-time job. In addition,
he takes time to stay fit at least every other day. Because
Terry knows taking care of himself gives him the power
to do it all better. Focus groups found Terry Watkins
168

story inspiring. They liked the fact that, despite the

demands on Terry, he was trying to be more active, and
doing it for himself. Because Terry looked like a nice
guy, focus groups found it easy to believe that taking
time out of a busy schedule for physical activity is
neither selfish nor uncaring. In focus group discussions
about the self-directed Active for Life handbook, participants greatly appreciated the tone of tolerance for
lapses from a personal activity plan and that the handbook directly acknowledged that it is often difficult to
find the time, energy, and inspiration to be active.
Family is a key motivator. Images of older people
being physically active with their children or grandchildren were motivating, as was the concept of being
physically active to maintain health and vitality to
prolong time with younger generations. In one ad,
72-year-old George Bowman tells readers, I stay active
because she deserves a dance with grandpa. The ad
features two photographs of George: in one, he is
waving at friends as he walks down a suburban street; in
the other, he is dancing with his granddaughter at her
wedding. Ads like this, which play on family-centered
emotions and values, appealed to both male and female
focus group participants.

Messages That Do Not Motivate

In addition to identifying positive messages, focus
groups were also very clear about the messages that will
not work with people aged 50. To be successful,
physical activity promotional messages for this age
group should stay away from the approaches listed
below.
Do not make exercise look like work. Researchers
discovered quickly that fun and social interaction are
much more inspiring than hard work. Images of grimacing, sweaty, straining exercisers that may inspire
younger people will not entice many older people to
change their behavior. Study participants were not
comfortable with ads that showed a male biker exercising at a level they felt was far too strenuous and
potentially dangerous. Instead, they liked seeing people
who were smiling and chatting with their companions.
Do not call it exercise or refer to fitness. Focus
groups associated the word exercise with hard work
and disciplined routines. Exercising meant going to
aerobics class, working on a treadmill, or playing softball on the weekend. On the other hand, participants
equated being active and physically active with
walking to the subway or to a restaurant for lunch,
taking the stairs on the way to a meeting, or picking up
after the children. Physical activity was viewed as a
non-threatening term that let audience members
choose how they would get moving and integrate it into
their everyday life.
Do not play the age card. Reminding readers about
their age does not necessarily motivate them to exercise

American Journal of Preventive Medicine, Volume 25, Number 3Sii

and can even offend people if not done carefully. One

sample ad concept that tried to convince readers that
you can make time move backward brought objections from those who did not like the attempt to use
getting older as a negative condition to be avoided.
Do not be confrontational. Exhorting ad viewers to
get off the couch is not likely to get results, according
to the research. This approach turned off the audience
and, as a result, the audience turned off the message.

Combating Aging Stereotypes: Creating a Healthier

Society
Although ageist stereotypes are rampant in American
society, there are a variety of ways to combat negative
attitudes and beliefs about aging. Stereotypes must be
challenged to reap the full potential of health promotion efforts in the home, community, health arena, or
workplace. This article concludes with a potpourri of
suggestions for challenging ageism in general as well as
encouraging more-active lifestyles in older adults.
Use existing knowledge. Age stereotyping is so endemic that people are often unaware of their negative
stereotypes. One solution is public education about the
myths and realities of aging, starting in primary schools
but also addressing educational opportunities throughout the life course. Based on Palmores17 seminal work
on ageism, various aging quizzes test ones aging IQ
and provide correct information about characteristics
and abilities of the older population and the aging
process. A key learning objective is recognizing the
diversity in the older population and the multilevel
influences on the health and functioning of older
people.
Mobilize public awareness campaigns. Stressing positive images of aging and the capacities of people aged
50 will be beneficial for changing social norms about
aging and older people. This will help counter current
negative images seen in different forms of media and
marketing. Aging stereotypes can be challenged by
highlighting the accomplishments of older people in a
variety of circumstances and settings. The Alliance for
Aging Research (www.agingresearch.org) has created a
Living Legends data bank showing older people
doing unusual things throughout their entire lives and
embarking on new careers and activities late in life.
Another example is the physical activity work being
conducted by AARP in its Active for Life project in two
demonstration-site communities as well as other AARP
programs that involve older people in physical activity
and community service.
Sensitize those providing care to older people. Traditionally, there has been relatively little specific information in medical school or other professional schools
about the special needs of the older population. To
meet the demands of an aging population who will

swell client ranks in the coming years, healthcare

professionals and social service providers need realistic
expectations about what older people can and cannot
do and better skills in communicating with a diverse
population of older adults. The Geriatrics Initiative,
sponsored by the International Longevity Center,45
discusses the current crises in health care and recommends the development of academic departments of
geriatrics and other means for providing quality care to
an aging population. Professionals need to examine
and confront their own stereotypes about aging so that
they may be less biased in their interactions with others.
Create opportunities for intergenerational networks
and linkages. Americans are becoming increasingly age
segregated. Lack of interactions between the old and
young has been cited as one factor contributing to the
perpetuation of negative age stereotypes, which gives
rise to intergenerational clashes over the allocation of
scarce resources. Thus, there needs to be a concerted
effort to bring generations together in friendship and
caring networks, in recreational and fitness activities,
and in living environments, so that common values can
be explored and shared agendas formulated.
Design productive roles for older people. The myth
about older people being unproductive and useless has
some basis in reality if there are no productive roles for
older people in the post-retirement years. Society needs
to encourage more opportunities for productive aging,
and older people themselves need to stay active and
engaged in meaningful activities, whether paid or not.
Volunteerism is an excellent way of helping those less
fortunate, while simultaneously benefiting from engaging in worthwhile activities. Experience Corps is an
example of a model program that links older people to
community service, often linking generations in caring
projects.46
Retrofit the built environment. There needs to be a
greater appreciation of how the physical environment
can facilitate or present roadblocks to independent
functioning over the entire life course, especially in the
later years when changes in physical abilities may make
it more difficult to navigate the environment. With the
aging of the baby boomer generation, it is especially
imperative that environments are designed in an activity-friendly manner that also considers the needs of an
aging population. As one example, the Partnership for
Prevention has recently released a guide titled Creating Communities for Active Aging.47 This guide helps
communities understand the steps in creating a strategic plan for assessment and action that includes consideration of both personal and environmental barriers
to more active aging.
Intensify governmental action. Current health promotion and aging efforts need to be inventoried and an
infrastructure to help coordinate federal promotion
efforts and set priorities for action needs to be created.
Several examples of recent activities can be mentioned.
Am J Prev Med 2003;25(3Sii)

169

At the highest level, President George W. Bush

launched Healthier U.S.: The Presidents Health and
Fitness Initiative48 to direct agency-wide activities to
promote personal fitness. In contrast to earlier governmental initiatives, this executive order recognizes that
people of all ages can benefit from more-active lifestyles. The U.S. Department of Health and Human
Services has released a state-of-the-art paper on the
benefits of physical activity for older adults49 and
recently instituted a coordinated governmental effort
to document interagency activities designed to promote healthy aging.50 Moreover, the Administration on
Aging is currently testing an innovative health promotion program to get older Americans more active called
USA on the Move: Steps to Healthy Aging.51
Build partnerships with interested public and private
parties. Despite a growing awareness of the importance
of promoting healthy lifestyles for older adults, especially the benefit of increased physical activity for those
aged 50, until very recently there has been a lack of
coordination of research, practice, and policy efforts
both within and outside of government. In response to
this fragmentation of effort, The Robert Wood Johnson
Foundation provided a framework for action by creating a National Blueprint. This is a coalition of over 50
private and public organizations that engage in information exchange, strategic planning, and collaborative
projects.52 This coalition has identified short- and longterm goals in the areas of home and community,
medical practice, and workplace, as well as cross-cutting
issues, such as research, marketing, advocacy, and public policy.
Extend the current knowledge base. Research in the
past decade has documented the benefits of physical
exercise in older adults, identified barriers to initiating
and maintaining more-active lifestyles, and validated
some efficacious models for increasing physical activity
in this population. We need to build on this research
foundation by testing the effectiveness of evidencedbased models in real-world community settings. The
Robert Wood Johnson Foundation has also provided
leadership in sponsoring the Active for Life program
initiative.53 The overarching goal of Active for Life is to
learn how to deliver research-based physical activity
programs to large numbers of mid-life and older adults
and to sustain such programs through existing community institutions.
In addition to a spawning of a new generation of
research questions, it is critical that researchers build
on previous lessons in study recruitment, program
implementation, and evaluation. Arbitrary chronologic
age cut-offs should be eliminated in research studies, as
they are not justified.54 Rather, investigators should
base exclusions on the functional abilities of subjects,
and any such exclusion should relate to the research
question and not any preconceived assumptions about
what an older person can or cannot do or the benefits
170

they will derive. Similarly, investigators will need to be

aware of special needs that some older research participants may have (e.g., hearing, vision, transportation
needs) and plan accordingly. Finally, proposed outcome measures should be appropriate to measure
changes in functioning and other healthcare outcomes
(see related articles in this supplement by Jette55 and
Guralnik et al.56).

Summary
The realities of aging are that older people are interested in their health and ways of enhancing the quality
of their lives through lifestyle changes. With bettertailored messages about the life-long benefits of health
promotion programs that resonate with life histories
and preferences, older adults can be successfully recruited into health promotion programs. Yet, ageist
stereotypes are pervasive in American society and harmful to older peoples health, functioning, and wellbeing.
The creation of a healthier society is dependent, in
part, on combating ageism, an insidious condition that
dilutes the potential for successful aging. This is not a
simple task, as it calls for strategies directed at all
segments of society, including older adults and their
caregivers, policymakers, and the population at large.
We recommend the adoption of educational and media
campaigns, an expansion of current research foci,
greater sensitivity from care providers, more opportunities for intergenerational linkages, the design of
productive roles for older adults, a retrofit of the built
environment, and intensified and collaborative action
from both the public and private sectors.
This article draws support and ideas from Active for Life, a
national program office supported by The Robert Wood
Johnson Foundation. Active for Life is part of the Active
Living Network supported by The Robert Wood Johnson
Foundation.

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