Special Issue

Journal of Applied Gerontology

2023, Vol. 0(0) 1–10
Loneliness as a Potential Mechanism of the © The Author(s) 2023
Article reuse guidelines:
Association Between Ageism and Mental sagepub.com/journals-permissions
DOI: 10.1177/07334648231158484
journals.sagepub.com/home/jag
Health Outcomes in the Chilean Context

Javiera Rosell1,2,3  and Alvaro Vergés1,4

Abstract
The negative impact of ageism on the mental health of older persons has been well studied, but the mechanisms underlying this
relationship have not been explored in detail. The present study examines the relationship of ageism with depressive and
anxious symptoms in older people, evaluating the indirect effect via loneliness. The analysis was carried out with a sample of 577
older adults living in Chile, using structural equation modeling to assess the direct and indirect effects of the proposed model.
The results showed the direct and indirect association of ageism with mental health outcomes. Ageism is positively related to
loneliness and, in turn, to increased depressive and anxious symptoms. We discuss how loneliness linked with an ageist context
contributes to anxiety and depressive symptomatology in the older population and the need to reduce ageism to favor the
mental health of this age group.

Keywords
ageism, loneliness, older adults, depression, anxiety

What this paper adds

• Ageism is linked with the mental health of older people.
• High levels of ageism are associated with a higher risk of loneliness and mental health problems in older adults.
• We provide evidence from the Chilean population in Latin America and during the COVID-19 pandemic, a little
explored context.
Applications of study findings
• Reducing ageism is necessary to improve the quality of life of older adults, especially regarding mental health.
• Public policies promoting cultural change through reducing ageism could lead to lower feelings of loneliness in the
older population.
• Interventions to reduce ageism are especially relevant in contexts of high stress, segregation, and discrimination, as
was the COVID-19 pandemic for older persons.

Introduction
Ageism is conceptualized as the negative social representa-
tions of age (Butler, 1969). These are detrimental to older Manuscript received: July 1, 2022; final revision received: January 25,
2023; accepted: January 27, 2023.
people because they are considered cognitively impaired,
1
depressive, dependent, and useless, among other things Escuela de Psicologı́a, Pontificia Universidad Católica de Chile, Macul,
Santiago, Chile
(Cuddy & Fiske, 2002). Thus, ageism has a cognitive (ste- 2
Millennium Institute for Care Research (MICARE), Santiago, Chile
reotypes) and affective (prejudice) component that leads to 3
Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
discrimination (behavioral aspect) (Cuddy & Fiske, 2002). 4
Universidad de los Andes, Chile, Escuela de Psicologı́a
Ageism has many consequences on the psychosocial and
physical well-being of older adults, including increased de- Corresponding Author:
Javiera Rosell, Escuela de Psicologı́a, Facultad de Ciencias Sociales, Pontificia
pressive symptomatology, anxiety, isolation, loneliness, Universidad Católica de Chile, Avda. Vicuña Mackenna 4860, Santiago
chronic illness, lower life satisfaction, and reduced capacity 7820436, Chile.
to cope with adverse events and changes (Allen, 2016; Email: jerosell@uc.cl
2 Journal of Applied Gerontology 0(0)
Brothers et al., 2021; Han & Richardson, 2015; Robertson,
2017; Robertson & Kenny, 2016). Regarding generalized
anxiety disorder and major depression, a longitudinal study
showed that people with more negative age stereotypes are
more likely to develop these mental health problems, and they
need to engage in active coping to reduce this risk (Levy et al.,
2019). Thus, mental health and negative images of aging are
associated in a negative direction (Losada-Baltar et al., 2020).
These ideas reinforce social inequities, especially in vul-
nerable groups that are discriminated against for multiple
reasons. For example, women are marginalized because of
their gender and age (Krekula et al., 2018).
The relationship between ageism and loneliness is partic-
ularly relevant. Ageism produces dynamics of social exclusion
that lead to isolation and self-isolation of the older population.
The lack of inclusion is linked to higher risk of loneliness in old
age (Shiovitz-Ezra et al., 2018). In addition, loneliness is
relevant to the mental health of older adults. Those with higher
levels of loneliness are more likely to exhibit mental health
problems (Coyle & Dugan, 2012). Though loneliness could be
considered for studied a constitutive aspect of mental health
problems such as depression, it is now generally considered a
separate construct (Cacioppo et al., 2015).
At this point, it is necessary to be aware that the image that
older people are lonely and isolated from their environment is
an ageist belief (Cuddy & Fiske, 2002). A longitudinal study
showed that people who believe in this ageist idea report
higher levels of loneliness when they reached this stage of life
(Pikhartova et al., 2016). These findings could be understood
considering the stereotype embodiment theory, which in-
cludes the notion of a self-fulfilling prophecy that occurs with
ageism because it is internalized at very young ages, and we
act according to these ideas, making them real in old age
(Levy, 2009, 2022). The main problem is that ageism is not
questioned, neither by society nor by the individual. Thus,
ageism hinders the health of older adults, including psy-
chological aspects, such as loneliness, anxiety, and depres-
sion (Levy, 2022; Levy et al., 2019; Pikhartova et al., 2016).
Conversely, people who have a higher self-perception of
aging tend to have better mental health indicators. This can
happen because of the mentioned self-fulfilling prophecy
according to the ageist ideas and because of the lower-quality
access to services, for example, those related to mental health
(Levy, 2022).
In times of the COVID-19 pandemic, ageism became the
protagonist of public policies and information against older
persons, favoring intergenerational tension (Ayalon, 2020;
Ayalon et al., 2021). Levels of mental health problems such
as depressive and anxious symptomatology increased
among the older population during this period (Herrera
et al., 2021). However, the resilience of older people in
this adverse scenario was also highlighted because they
reported better mental health indices than other age groups
facing this stressful situation (Herrera et al., 2021; Losada-
Baltar et al., 2020).
During the COVID-19 pandemic, Chile confronted the
great challenge of dealing with a pandemic after a social
outbreak in October 2019, consisting in numerous protests
against social inequality (Jiménez-Yáñez, 2020). As in other
countries, public health measures were prioritized over other
social and mental health initiatives (Caqueo-Urizar et al.,
2020; Ramı́rez-Pereira et al., 2020). Older persons were a
group of particular concern in avoiding contagion. Some
ageist health policies were taken, for example, mandatory
quarantine for those over 80 years of age during some months
in 2020 (Olivares, 2020). This measure was defined ac-
cording to age, since people under 80 years old had access to
sanitary permits to carry out procedures such as purchasing
basic supplies.
In this context, it is necessary to perform studies on ageism
considering the cultural context, which provides information
on how widespread this phenomenon is in the world. The
relevance of the cultural context was observed in a systematic
review that showed a higher prevalence of age discrimination
related to different health domains (e.g., reduced longevity
and more mental health problems) in developing countries
compared to more developed countries (Chang et al., 2020).
Additionally, the level of education is closely linked to the
level of ageism, where people with lower education levels
tend to report more ageist ideas (Naegele et al., 2018). Also,
the segregation of older adults could be reinforced due to
educational factors because younger generations tend to have
higher education levels (Ayalon & Tesch-Römer, 2018).
However, according to the report on global ageism, the
Americas is one of the regions with lower levels of ageism
(World Health Organization, 2021). Data in Latin America
showed that Chile has a lower level of ageism (Aranco et al.,
2022). Still, during the pandemic, the perception of a negative
representation of old age reported by older people reached
69% in 2021, in contrast to 35% in 2019 (Observatorio del
Envejecimiento para un Chile con Futuro, 2021a).
Ageism is higher in older people than in their younger
counterparts. It has been hypothesized that this is related to
higher education levels and gerontological knowledge in
younger groups with more access to education (Rosell et al.,
2020). Thus, the knowledge about technology and higher
educational levels in younger populations contribute to a
hierarchy where the older ones remain at the bottom (Ayalon
& Tesch-Römer, 2018).
In addition, ageism should intersect with other types of
discrimination such as sexism. The representations of older
men and women are different. Women are required to be
physically beautiful, and may be portrayed as loving grand-
mothers, while men are portrayed as grumpy (Levy, 2022).
The Current Study
This study explores the relationship between ageism and two
dimensions of mental health in older people: depressive and
anxious symptomatology. Loneliness was considered a
Rosell and Vergés
potential mediator of this relationship, given that ageism
contributes to perpetuating exclusion, isolation, and loneliness
(Shiovitz-Ezra et al., 2018). Besides, it harms the mental health
of older adults, for example, increasing depressive and anxious
symptoms (Levy, 2022; Levy et al., 2019). Additionally,
loneliness has been shown to hinder the mental health of this
age group by decreasing psychological well-being (Coyle &
Dugan, 2012). Thus, the hypotheses of this study are:
H1. Ageism will be positively associated with feelings of
loneliness among older adults.
H2. Ageism will be positively associated with depressive
and anxiety symptoms in older people.
H3. Loneliness will be positively associated with lower
mental health in older persons, as assessed by depressive
and anxious symptomatology.
H4. Loneliness will mediate the relationship between ageism
and mental health outcomes (i.e., depressive and anxious
symptomatology). This is explained by the role of ageism in
favoring feelings of loneliness and, in turn, the role of
loneliness in worsening mental health in this age group.
The novelty of this research lies in the proposed model. As
far as we know, no studies have focused on exploring
loneliness as a mechanism underlying the relationship be-
tween ageism and mental health outcomes.
Although efforts were made to study ageism and its
consequences in Latin America, evidence is still limited
compared to European and North American countries. To our
knowledge, this is the first study in the region to account for
the direct association of ageism with mental health problems
in older adults and its underlying mechanisms.
This information will help reaffirm the relevance of
eradicating ageist ideas from the culture. This knowledge is
particularly relevant in Latin American countries such as
Chile, which has one of the most accelerated demographic
changes in the region. By 2085, Latin America will be one of
the regions with the largest number of older adults, with 1 in 3
people over 65 years old (Aranco et al., 2022).
Method
Sample and Procedures
The sample consisted of people aged 60 years or older living
in Chile. The exclusion criteria considered time disorienta-
tion, a good indicator of cognitive impairment (O’Keeffe
et al., 2011). All participants were asked what date it was
when they answered the survey, and those who made a
mistake or omitted the question were excluded. Twenty-one
participants were removed for this reason. The final sample
was comprised of 577 older persons living in Chile.
Participants were invited through social media to answer an
online questionnaire. They responded voluntarily and agreed to
an informed consent approved by the Institutional Scientific
Ethical Committee in Social Sciences, Arts, and Humanities.
3
The sampling was carried out during the first semester of 2020,
which coincided with the arrival of the COVID-19 in Chile in
March of the same year, and the beginning of the first wave of
the pandemic (Aguilera et al., 2022).
Sample Characteristics. The mean age of the sample was 66.57
(SD = 4.83), ranging between 60 and 82 years. Eighty-seven-
point thirty-five percent of the participants were women, and
most had a high education level, such as a bachelor’s degree
or postgraduate degree (59.1%). Table 1 presents the char-
acteristics of the sample in detail.
Measures
Ageism. Stereotypes about old age were assessed through the
revised version of the Questionnaire of negative stereotypes
about old age, CENVE-R (Rosell et al., 2020). This instru-
ment was developed by Blanca Mena et al. (2005) and
Fernández-Ballesteros (1992) and then adapted and validated
in Chile with good psychometric properties (Omega = .92),
(Rosell et al., 2020). Fifteen items with a unidimensional
structure comprised this version. The questions asked about
the perception of older people in cognitive, social, and
personality domains (i.e., “the vast majority of people
60 years or older start to have a considerable deterioration of
their memory”). It uses a 4-point Likert scale from “com-
pletely disagree” (1) to “completely agree” (4). Higher scores
indicate a higher level of ageist beliefs. In our sample, the
Cronbach Alpha was .92.
Loneliness. This aspect was measured using the Three-Item
UCLA Loneliness Scale (Hughes et al., 2004). It asked for
different dimensions of loneliness, such as (a) How often do
you feel you lack companionship? (b) How often do you feel
left out? (c) How often do you feel isolated from others? The
response format is from “hardly ever” (0) to “often” (2),
ranging from 0 to 6. Higher scores indicate a higher level of
loneliness. The scale showed modest reliability in the original
study and is widely used nowadays (Cronbach’s Alpha = .72).
In this study, the Cronbach Alpha was .8.
Depressive Symptomatology. The Geriatric Depression Scale
(GDS) was used to measure depressive symptomatology
(Brink et al., 2008). The Chilean version was shortened and
validated with modest psychometric properties (Cronbach’s
Alpha = .72) (Hoyl et al., 2000). The 5-item version includes:
(a) Do you feel basically satisfied with your life? (b) Do you
frequently feel bored? (c) Do you often feel useless? (d) Do
you prefer to stay at home instead of going out and doing new
things? (e) Do you often feel helpless or worthless? The
response format is “yes” or “no.”
Higher scores indicate more depressive symptomatology,
considering the inverse coding of the first item. In this sample,
the Cronbach Alpha was .62.
4 Journal of Applied Gerontology 0(0)
Table 1. Sociodemographic Characteristics.
n (%)
Age M = 66.57 (SD = 4.83)
Gender
Women 504 (87.35)
Men 73 (12.65)
Education level
Low (primary or secondary school) 108 (18.72)
Medium (technical education) 128 (22.18)
High (bachelor’s degree, postgraduate) 341 (59.1)
Anxiety Symptoms. The Geriatric Anxiety Inventory (GAI)
was used to measure anxiety symptomatology (Pachana et al.,
2007). It comprised 20 items (e.g., “I often feel nervous”)
with a “yes” or “no” response format. Higher scores mean
higher levels of anxiety. In Chile, the scale was validated,
showing good psychometric properties (Cronbach’s Alpha =
.93) (Miranda-Castillo et al., 2019). In our sample, the
Cronbach Alpha was .92.
Data Analysis
To achieve the aim of the study, we used structural equation
modeling (SEM). This technique has become increasingly
popular in the social sciences because it allows testing the-
oretical models (Anderson & Gerbing, 1988), which can be
very complex due to the number of variables and their as-
sociations. This technique allowed us to evaluate the rela-
tionship between ageism, loneliness, and depressive and
anxiety symptomatology. The full SEM included the indirect
effects of ageism on depressive and anxious symptomatology
via loneliness. We incorporated sociodemographic charac-
teristics such as age (continuous variable), gender (women =
1, men = 2), and education level (low = 1, medium = 2, and
high = 3) as covariates, that is, adjusting for their relationships
with loneliness (as mediator) and mental health outcomes
(depressive and anxious symptomatology).
The analysis was performed in two steps (Anderson &
Gerbing, 1988). The first one included the measurement
analysis to evaluate the factor loadings of the items in each
latent factor, so each item loaded separately on the latent
factor corresponding to its scale. The second step was the full
SEM, which incorporated relationships among latent vari-
ables and the indirect effect assessment, including the cor-
relation between mental health outcomes (i.e., depressive and
anxious symptomatology). We evaluated the asymmetric
confidence intervals using the bootstrap technique with 2000
replications and a p-value of .05 for statistical significance.
Additionally, we considered the influence of sample size for
χ 2 significance in evaluating model fit. Thus, we assessed the
conventional cut-off: >.95 for CFI and TLI, <.06 for RMSEA,
and close to .8 for SRMR (Hu & Bentler, 1999).
The analyses were performed using Mplus 8 (Muthén &
Muthén, 2017).
Results
Ageism
Table 2 presents the frequency and percentage of different
aspects of ageism. One idea with a high percentage of
agreement is that older persons are less interested in sex,
where 56.9% pointed out that they strongly agreed or agreed.
Likewise, the idea that older persons begin to have a con-
siderable deterioration of their memory had 47.7% of par-
ticipants who strongly agreed or agreed.
Measurement Model
According to the data analysis plan, the first step was
evaluating the measurement model. This fit well to the data:
χ 2 (854) = 1492.971, p < .001, CFI = .96, TLI = .96,
RMSEA = .036 (95% CI [.033, .039]), SRMR = .07.
All factor loadings were above .05 in their corresponding
latent factor and were statistically significant (see
supplementary material). The only exception was one item in
the ageism dimension regarding the sexual desire of older
people (λ = .33, p < .001). Considering its content relevance
and statistical significance, the item was retained. Addi-
tionally, correlations between the latent variables and co-
variates are shown in Table 3.
With these results, the model was retained and used to
evaluate the full SEM.
Full Structural Model and Indirect Effects
The full model considered the relationship between ageism
and mental health outcomes, namely, depressive and anxious
symptomatology. We included loneliness as a mediator to
evaluate the indirect effect. Additionally, age, gender, and
education level were entered as covariates. The model is
shown in Figure 1, including the standardized paths and
correlations between variables. The covariates were omitted
from the figure, but the standardized coefficients between
these variables and dependent variables are presented in
Table 4. The model fit to the data properly: χ 2 (974) =
1707.767, p < .001, CFI = .96, TLI = .96, RMSEA = .036
(95% CI [.033, .039]), SRMR = .095.
The results showed a positive and significant effect be-
tween ageism and loneliness (b = .34, β = .25, p < .001), as
well as ageism and both outcomes of mental health: de-
pressive symptomatology (b = .29, β = .22, p < .001) and
anxious symptomatology (b = .37, β = .24, p < .001). Also,
loneliness was positively associated with depressive symp-
tomatology (b = .69, β = .70, p < .001) and anxious
symptomatology (b = .60, β = .53, p < .001).
Rosell and Vergés 5

Table 2. Frequency and Percentage of Ageism Measured by the Questionnaire of Negative Stereotypes about Old Age (CENVE-R).

Strongly Strongly
CENVE-R Item Disagree Disagree Agree Agree

1. Start to have a considerable deterioration of their memory 61 (10.6) 240 (41.7) 247 (43) 27 (4.7)
2. Are less interested in sex 38 (6.6) 210 (36.5) 292 (50.8) 35 (6.1)
3. Get angry easily and are “grumpy” 60 (10.4) 286 (49.7) 213 (37) 17 (3)
4. Have a mental illness severe enough to impair their normal abilities 195 (33.9) 327 (56.9) 46 (8) 7 (1.2)
5. Have fewer friends than young people 97 (16.9) 224 (39) 229 (39.8) 25 (4.3)
6. Experience a strong deterioration of their health compared to their level of health 47 (8.2) 274 (47.7) 232 (40.3) 22 (3.8)
before the age of 60
7. Lose interest in things 109 (19) 365 (63.5) 94 (16.3) 7 (1.2)
8. Are like children 181 (31.6) 301 (52.2) 76 (13.3) 15 (2.6)
9. Have a number of disabilities that make them depend on others 139 (24.2) 328 (57) 101 (17.6) 7 (1.2)
10. Start to lose the ability to solve the problems they face 124 (21.6) 345 (60) 103 (17.9) 3 (0.5)
11. Their defects get worse with age 70 (12.2) 251 (43.7) 234 (40.7) 20 (3.5)
12. Have cognitive impairment (memory loss, disorientation, confusion) 67 (11.7) 279 (48.5) 220 (38.3) 9 (1.6)
13. Don’t work as well as a young person would 120 (20.9) 297 (51.7) 147 (25.6) 11 (1.9)
14. Have weakened mental faculties 139 (24.2) 364 (63.4) 69 (12) 2 (0.3)
15. Isolate themselves from their surroundings and those around them 135 (23.6) 333 (58.1) 96 (16.8) 9 (1.6)

Table 3. Correlations among Latent Variables in the Measurement Model and Covariates.

1 2 3 4 5 6

1. Ageism —
2. Loneliness .29*** —
3. Depressive symptoms .44*** .78*** —
4. Anxious symptoms .39*** .60*** .75*** —
5. Age .01 .01 .04 .11* —
6. Gender .05 .14 .04 .07 .15* —
7. Education level .24*** .18*** .30*** .16*** .06 .04

Figure 1. Full structural model. Note. The path coefficients for the covariates are presented in Table 4.
6 Journal of Applied Gerontology 0(0)
Table 4. Path Coefficients of Covariates and Loneliness and Mental
Health Outcomes.
Age Gender Education Level
Loneliness .03 .09 .18***
Depressive symptoms .04 .05 .15**
Anxiety symptoms .11** .02 .05
Regarding the indirect effect via loneliness, both indirect
paths were significant. The path from ageism to depressive
symptomatology via loneliness exhibited an indirect effect of
β = .18, p < .001, 95% CI [.13, .38]. The path from ageism to
anxious symptomatology via loneliness showed an indirect
effect of β = .13, p < .001, 95% CI [.12, .31]. These results
account for partial mediation through loneliness, as ageism
continues to have a significant association with mental health
outcomes, despite the inclusion of the mediator in the model.
Discussion
The present study provides evidence of the association between
ageism and different outcomes of mental health, specifically
depressive and anxiety symptoms, considering the indirect
effect via loneliness. The results revealed a direct effect of
ageism on depressive and anxiety symptoms. These findings
are consistent with previous evidence that showed the harm of
ageism on the mental health of older people (Chang et al.,
2020; Levy, 2009, 2022; Robertson, 2017; Robertson &
Kenny, 2016). Similarly, a direct path was observed be-
tween ageism and loneliness, which was also raised from a
theoretical perspective (Shiovitz-Ezra et al., 2018).
The novelty of this study lies in the structural model,
which sheds light on the underlying mechanisms of this
association. As far as we know, this is the first study to
propose that loneliness is related to ageism in association with
mental health outcomes such as depressive and anxiety
symptoms. The results showed that those who reported more
levels of ageism referred to more loneliness and, in turn, more
depressive and anxiety symptoms. Notably, the results ac-
count for partial mediation, as ageism continues to have a
significant association with depressive and anxious symp-
tomatology, despite the inclusion of loneliness as a mediator.
This shows the strong association of ageism with different
indicators of well-being in old age, which might be due to
additional mediators, such as lifestyle, social support, quality
of life, among others.
Even though we were not focused on the pandemic effects,
the sampling was gathered during this period, and we need to
discuss this context to understand the findings in detail. Thus,
the COVID-19 pandemic brought measures based on age,
predominantly affecting older people, creating a particularly
adverse context for this age group (Ayalon et al., 2021;
Previtali et al., 2020). However, evidence showed the re-
silience capacity of older adults compared with other age
groups (Losada-Baltar et al., 2020). For example, in Chile,
smartphone use among the older population increased from
47% in 2019 to 58% during the COVID-19 pandemic in
2021. This means that the pandemic played an essential role
in the digital inclusion of people aged 60 years and older, as
they used it to cope with the necessity of being connected
with the outside world during the quarantines (Observatorio
del Envejecimiento para un Chile con Futuro, 2022).
The effect of the pandemic on the mental health of people
could not be ignored because their indicators worsened in
contrast to the pre-pandemic period (Herrera et al., 2021) and
this was associated with ageism (Bergman et al., 2020). These
results are probably replicable in a non-pandemic context due
to all the previous evidence showing the detrimental effect of
ageism on the quality of life of the older population (Bodner
et al., 2018; Levy, 2009, 2022; Robertson, 2017; Robertson &
Kenny, 2016).
On the other hand, our findings confirm that ageism is an
obstacle to exercising active and healthy aging, as previously
stated (Nelson, 2016; Swift et al., 2017). It is impossible to
age with quality of life if there is a decline in mental health,
which brings physical and social consequences (Segal et al.,
2018). In this context, it is worth asking about the most
effective mechanisms to reduce ageism. A meta-analysis
showed that of all interventions, psychoeducation and in-
tergenerational contact were the most effective tools (Burnes
et al., 2019). These interventions do not require enormous
financial resources; therefore, they could be massively im-
plemented to generate a cultural change and favor older
people’s mental health. Moreover, both interventions, par-
ticularly intergenerational contact, can potentially reduce
loneliness among older adults, impacting one crucial di-
mension related to ageism and mental health.
Stereotypes and prejudices based on age could lead to
discrimination against older people, then, their elimination is
a matter of human rights. Ageism hinders the enjoyment and
exercise of the human rights of older persons, for example,
the right to health, through lack of information and timely
access to diagnosis and treatment. People with high levels of
ageism tend to normalize mental health pathologies and,
therefore, do not access timely and adequate treatment
(Peisah et al., 2022). In addition, ageism among health
professionals can obstruct access to treatment according to
the needs of older adults because higher levels of ageism
influence clinical decisions, and there is a tendency to provide
lower-quality services to this age group (Wyman et al., 2018).
Specifically in mental health, there could be a matter of life or
death, as some symptomatology could be normalized by the
professionals, even legitimizing suicide in older adults
(Bodner et al., 2018).
Social exclusion and discrimination based on age could
worsen mental health in the population. In addition, long-term
discrimination against older people could promote behavioral
avoidance (e.g., keeping away from social engagement ac-
tivities) and foster isolation and loneliness (Shiovitz-Ezra et al.,
Rosell and Vergés
2018), which can reinforce the negative consequences on
mental health, as shown by the results of this study.
Latin America, particularly Chile, is a territory with lower
levels of ageism compared with other locations in the world
(Aranco et al., 2022; World Health Organization, 2021), but
there is still a need for more training programs in gerontology
and the inclusion of this topic in the undergraduate and
postgraduate careers of different disciplines (Observatorio del
Envejecimiento para un Chile con Futuro, 2021b). In Chile,
the perception of older adults about the negative represen-
tation of this age group in social media rose from 35% in 2019
to 69% in 2021 (Observatorio del Envejecimiento para un
Chile con Futuro, 2021a), showing a negative representation
of aging during the COVID-19 pandemic. This scenario was
also observed in other countries, which shows the role of the
pandemic in reinforcing these ageist ideas (Amundsen, 2022;
Bravo-Segal & Villar, 2020; Morgan et al., 2021).
It is essential to note that self-reporting of ageism implies
recognizing it. Although the instrument we used to assess
ageism asks about the perceptions of older adults in general,
this is not necessarily representative of the person’s individual
experience of ageism (Voss et al., 2018). If we also take into
consideration that responding to stereotypes about a group is
a sensitive topic, ageism in our survey and others assessing
this dimension may be underreported.
Some limitations must be considered in interpreting these
results. The convenience sampling led to a greater number of
women and people with a high level of education. Therefore,
the extrapolation of the results should be done with caution.
For example, given the high correlation of education level
with the variables in the model, including more variability in
this dimension could be interesting to explore. This is as-
sociated with online sampling, where it is more complex to
capture the experience of those older persons who are less
digitized (typically those with low education level). Addi-
tionally, the measure for depression symptomatology does
not have the best reliability coefficient in our sample, despite
its wide and effective use in the Chilean population.
The cross-sectional design does not allow causality to be
established, and these associations are likely bidirectional.
Given the negative impact of COVID-19 on the mental health
of older persons and its link with health measures that pro-
moted isolation, one could consider the reverse indirect effect
to the one presented in this study (i.e., examine the impact of
loneliness via ageism on mental health in the context of
COVID-19). For example, older persons could attribute their
experience of loneliness to increased vulnerability, thus in-
creased ageism. However, the role of ageism in perpetuating
loneliness and social exclusion is clear from previous liter-
ature, as well as its part in self-fulfilling prophecy, that is, the
expectation of feeling lonely in old age that becomes real
because of the stereotyped embodiment (Pikhartova et al.,
2016; Shiovitz-Ezra et al., 2018; Wang et al., 2018).
Future research should assess the mediation model with
longitudinal data. Likewise, studies evaluating interventions
7
to reduce ageism should also consider indicators of loneliness
and depressive and anxious symptoms to reach a better
understanding of this phenomenon. Moreover, future studies
should attempt to identify other mechanisms beyond lone-
liness that might explain the association between ageism and
mental health outcomes. Also, other variables should be
included to explore possible moderator variables, for ex-
ample, access to the health system, use of digital devices, and
other sociodemographic variables.
Conclusion
Ageism is undoubtedly detrimental to the quality of life of the
older population. This study shows the link of ageism with the
mental health of older adults, particularly depressive and anx-
ious symptoms. Thus, ageism is strongly associated with
feelings of loneliness and, in turn, with higher anxiety levels and
depressive symptoms. Public policies should consider this in-
formation to improve the mental health of older people, focusing
on reducing ageism within society. This approach will be es-
pecially relevant in adverse contexts where older persons may be
discriminated against, as during the COVID-19 pandemic.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This work
was supported by the National Agency for Research and Devel-
opment ANID-PFCHA/Doctorado Nacional/2017-21170060; and
the ANID Millennium Science Initiative/Millennium Institute for
Research on Depression and Personality-MIDAP ICS13_005 the
ANID Millennium Science Initiative Program ICS2019_024.
Ethical Approval
Institutional Scientific Ethical Committee in Social Sciences, Arts
and Humanities, Pontificia Universidad Católica de Chile. ID
Protocolo: 190409009.
ORCID iD
Javiera Rosell  https://orcid.org/0000-0003-1283-5710
Supplemental Material
Supplemental material for this article is available online
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