Stigma of Aging with PDF reading

The Stigma of Dementia!  (click here for PDF)

Kinds of Stigma

• Self Stigma
• Public Stigma
• Courtesy Stigma

all apply to our understanding of Alzheimers and dementia.

Link & Phelan: Condistions for stigmatization

• labeling
• stereotyping
• seapration
• status loss
• discrimination

Does Diagnosis help or hurt? The Negative consequences of labeling

•  Step 1: Diagnosis
• internalization of negative cultural images (dangerous, incompetant)

• Step 2: Defensive Behaviors
• expect others to reject them so they act in order to prevent this

Double Whammy! Stigma and Old Age

• cognitively impaired (decision making impaired)
• crazy!!!! (mental illness)
• physically frail
• old fashioned
• grumpy
• cheap
• unattractive
• dying/decline
• dependence
• loss of sexuality

Stress Related Stigma

• stress of stigmatization can lead to other stress related illnesses
• stress can increase symptomology of dementia
• focus on scary late stages of dementia
• fear of institutionalization
• courtesy stigma and family problems

Alzheimer's-the problem of stigma

By Niall Hunter-Editor

Stigma and prejudice against people with Alzheimer's disease are a significant obstacle to the well-being and quality of life of those with dementia and their families, and affect the provision of care to those who need it.This is one of the findings of a major new Irish study on stigma and dementia published to coincide with World Alzheimer's Day.

The report shows that the stigma of dementia is very real, very cruel and widespread.

Components of stigma such as discrimination, devaluation and stereotyping were clearly apparent in the daily lives of those living with the condition, according to the study.

The report indicates that there is also a lack of knowledge about dementias, the impact that new medications can have in the treatment of the condition and the support available to those with a diagnosis of dementias.

The report examined nine aspects of stigma in dementia and its impact on all those affected–the person with the condition and their family/carers.

Researchers from the School of Nursing and Midwifery at TCD, who carried out the study with the Alzheimer's Society, interviewed people with dementia and their carers, as well as health professionals, to understand the experience of living with dementia and the realities of dementia-related stigma and its components.

According to Mary Mc Carron, principal investigator, issues which affect those with a dementia include social isolation, fragmented, unsuitable and poorly-resourced services, lack of information about the services available and the difficulty in navigating a complex health and social care system in which services are often unresponsive to the real needs of people with dementia and their carers.

"That is what we have to target and change," she said.

A key finding of the study was that the daily concerns and day-to-day toll of care- giving on those looking after someone with dementia is hugely burdensome in its own right, and was compounded by the additional load of social isolation, prejudice, discrimination and poorly-developed and fragmented services. (courtesy stigma for caregivers)

The report indicates that a key challenge for service providers and policy-makers is to understand to what extent the service difficulties are due to lack of planning in terms of the implications of a growing ageing population or due to either not valuing a particular group (people with dementia and their carers) or valuing the needs of other groups more.

Honest answers to such considerations will help establish the extent to which dementia impairs service provision for this section of the population, according to the report.

According to the Alzheimer Society of Ireland, it is hoped that the report will encourage a re-examination of the value placed on people with dementia and their carers by policy-makers and that it will make them realize that population trends, health and social care costs and disease burden all point to the fact that dementia must become a national health priority.

There are currently 38,000 people with dementia in Ireland. In 2026 there will be 70,115 and in 2036, 103,998, according to the Alzheimer Society.

There are 50,000 carers of people with dementia in Ireland and it is estimated that the lives of 100,000 people are directly affected by dementia. This figure is reckoned to increase three to four-fold when the effect on the wider family is considered.

"We believe that education and awareness programs, aimed at the general public, GPs and other health providers are absolutely vital in helping to tackle the prejudice and discrimination that those with dementia and their carers encounter on a daily basis," said Maurice O'Connell, Chief Executive of the Alzheimer Society.

The findings of the report were listed under nine themes:

*Stigma and discrimination - is there or isn't there ­ the report indicates there is structural and organisational discrimination which highlighted a failure to prioritise dementia in terms of policy and resource allocation.

*A dark secret still - there are negative public images, stereotypes and terms still associated with dementia, all of which potentially leads to stigmatisation.  Fear linked to dementia means there is a reluctance to engage with those who have a dementia and avoidance was highlighted as a common reaction to the presence of dementia. Significantly, this was also an issue for health professionals.

*Behind the closed door – the reality of dementia – the report shows that the emotional impact of stigma on those with dementia is significant.  Anger and hurt were emotions commonly felt by those with a dementia due to diminished social networks and negative social encounters.  Embarrassment and shame was also felt if others became aware of the dementia or witnessed inappropriate behaviour in public. Carer/family guilt where there was an inability to meet a perceived societal expectation to continue caring on an indefinite basis was also experienced.  It was shown that dementia could either unify or divide a family.

*Loss of place – the report proves that there is a huge potential for people with dementia to be treated inhumanely in society.  Enforced social isolation was commonly experienced due to withdrawal of friends etc. and barriers to social participation were outlined. Carers described themselves as being at risk of similar experiences to the person with dementia and having to undergo a significant redefinition of life space and role changes.

*Navigating the system–the complexity of interactions and experiences of the health and social care systems potentially contributes to dementia related stigma. The report indicates that those with a dementia and their family/ carers found services to fragmented, inadequate and inflexible and failed to offer choice or meet their needs. 

*Making safe – constant vigilance – the report highlights the fact that carers/family members maintain a constant vigilance in terms of protecting the person with dementia.  This protective role involves decisions as to when and to whom the diagnosis of dementia is disclosed, ensuring that the person with dementia is not exposed to the gaze of others or environments unsuitable to his/her needs and protecting them against exposure to stigmatizing experiences.

*Double whammy –ageism and dementia – the report points out that where people with a dementia are older, ageist societal attitudes compounded the experience of dementia and such people are at risk of being doubly stigmatised.

*Viewing dementia as a disability – the report concluded that conceptualizing dementia in terms of disability was advocated as a positive step to advance measures to address dementia related stigma, with the focus on addressing prejudice and discrimination.

*The future –dementia ready –the report recommends numerous interventions targeted at personal, organizational and societal levels with the intention of addressing dementia related stigma and its components.

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INTRODUCTION

There is mounting evidence to suggest that older adults constitute a stigmatized group in the United States (and in most Western societies). Indeed, youth is of such value in U.S. culture that efforts to stay young fuel a multibillion dollar industry. The prevailing view is “If I can buy enough pills, cream, and hair, I can avoid becoming old” (Esposito, 1987). Certainly, individuals' efforts to avoid the near-certain, uncontrollable outcomes of old age (if one is lucky enough to survive) reveal the stigma and negative attitudes associated with advanced age. Similar to sexism or racism, “ageism” (Butler, 1969) refers to the negative attitudes, stereotypes, and behaviors directed toward older adults based solely on their perceived age. Evidence of ageism can be observed in any number of domains, including the workplace (e.g., Finkelstein, Burke, and Raju, 1995; McCann and Giles, 2002; Rosen and Jerdee, 1976) and health care facilities (e.g., Caporael and Culbertson, 1986; DePaola, Neimeyer, Lupfer, and Feidler, 1992). For instance, age discrimination in the workplace, such as mandatory retirement ages, led to the inclusion of age as a protected category with the Age Employment Discrimination Act of 1967. More subtle ageist behavior can be found in the expectancies that doctors hold regarding the capabilities of older individuals, attitudes that in turn shape treatment recommendations and decisions (e.g., Adelman, Greene, and Charon, 1991; Greene, Adelman, Charon, and Hoffman, 1986).
There have been numerous reviews of the literature from various fields documenting the differential, and sometimes expressively negative, treatment of older adults in many social domains (see Nelson, 2002). We do not repeat this information, but rather attempt to integrate that work with the emerging literature on the social psychology of stigma. Using a social-psychological approach, we explore the literature on age stigma with respect to both potential perpetrators (society, younger adults) and potential targets (older adults).¹ Specifically, in the first section we review the literature on perceivers of older adults—namely, younger adults—and their stereotypes, attitudes, and behaviors vis-à-vis older individuals. In the second section we focus on the targets—older adults—and their self-concepts, self-stereotyping, and coping in the face of ageism.

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AGE STIGMA FROM THE PERCEIVER'S PERSPECTIVE

Chronological age, similar to sex and race, is a dimension on which individuals categorize others rather automatically (Brewer, 1988; Fiske, 1998). Cues to age are perceived from physical appearance, such as hair and facial morphology, as well as from verbal and nonverbal aspects of individuals' communications (Bieman-Copland and Ryan, 2001; Hummert, Garstka, and Shaner, 1997; Montepare and Zebrowitz-McArthur, 1988). Upon presentation of these cues, age is readily perceived, perhaps even unconsciously, often shaping interactions between younger and older individuals. For instance, younger individuals often use stereotypes associated with advanced age to make inferences regarding older adults' intentions, goals, wishes, and capacities and guide their behavior accordingly. First we examine the perceptions, attitudes, and stereotypes associated with older adults. Next, we consider the ways in which these stereotypes and attitudes shape behavior toward older adults. Last, we investigate potential directions for future research that may eventually change ageist stereotypes and attitudes.

Attitudes and Stereotypes

In general, individuals express predominantly negative attitudes and beliefs toward older adults, especially in comparison to their attitudes toward younger people. The difference between the attitudes of young and old is particularly pronounced when the general category of “older adults” is being considered rather than specific exemplars (Kite and Johnson, 1988; Palmore, 1990; see also Kite and Wagner, 2002, for a review). Numerous studies show, however, that older adults are not always perceived as a homogeneous group (Braithwaite, Gibson, and Holman, 1986; Brewer, Dull, and Lui, 1981; Brewer and Lui, 1984; Hummert, 1990; Hummert, Garstka, Shaner, and Strahm, 1994; Schmidt and Boland, 1986). The broad category of “older adults” consists of as few as three and as many as twelve subtypes (Hummert et al., 1994). Some work suggests that a large subset of older adults is perceived as “senior citizens” who are vulnerable, often lonely, physically and mentally impaired, and old-fashioned (Brewer et al., 1981). But at least two positive subtypes of older adults have also emerged in this work. The “perfect grandmother” subtype consists of women who are kind, serene, trustworthy, nurturing, and helpful. The “elder statesman” subtype consists of men who are competent, intelligent, aggressive, competitive, and intolerant. In addition to these, other well-replicated subtypes include the “golden ager,” the shrew/curmudgeon, the John Wayne conservative, and the severely impaired (Hummert et al., 1994; Schmidt and Boland, 1986). The research on subtypes thus suggests that perceptions of older adults are both complex and differentiated, including both positive and negative exemplars.
The heterogeneity in attitudes and stereotypes toward different older adult subtypes has given rise to spirited debate as to whether ageism really exists. If perceptions about certain subtypes are positive, how can there be negative attitudes toward the group? Research conducted by Neugarten (1974)distinguishing between the “young-old” (i.e., individuals between 55 and 75 years old) and the “old-old” (i.e., individuals 75 years old and older) offers one explanation. Neugarten suggested that many of society's negative stereotypes about older people (e.g., being sick, poor, slow, miserable, disagreeable, and sexless) are based on observations of the old-old, and that these observations get overgeneralized to the young-old. Recent empirical investigations of this hypothesis suggest that various subtypes of older people reflect differences in chronological age (Hummert, 1990, 1994; Hummert, Garstka, Shaner, and Strahm, 1995). For instance, Hummert (1994) presented college students with photographs of older men and women whose facial features suggested three age ranges: young-old (55-64), middle-old (65-74), and old-old (75 years and over). Results revealed that physiognomic cues to advanced age (e.g., eye droop, wrinkled vs. smooth skin, grey hair) led to differing perceptions and stereotypes. Consistent with predictions, participants tended to pair photographs of young-old individuals with positive stereotypes, and to pair photographs of old-old individuals with negative stereotypes. This work suggests that the more positive subtypes of old age may be associated primarily with individuals in the early stages of older adulthood.
A different perspective on the heterogeneity of stereotypes of older adults stems from recent research finding that although certain subtypes of older adults are viewed more positively than others, positive stereotypes can also manifest in attitudes that are not positive (Fiske, Cuddy, Glick, and Xu, 2002). Fiske and colleagues (2002) argue that stereotypes of most social groups cluster on two dimensions—competence and warmth. Out-groups are perceived as high on one dimension but not the other, and in some cases they are perceived as low on both. Attitudes, emotions, and behaviors regarding out-groups are thought to follow these relative warmth and competence judgments (Fiske et al., 2002). Consider, for instance, the “perfect grandmother” subtype. Grandmothers are perceived positively as warm and likable, but they are also perceived as cognitively incompetent (Cuddy and Fiske, 2002). Low cognitive competence coupled with relatively high warmth results in pity, and, accordingly, grandmothers (and those perceived as grandmotherly) tend to be disrespected and denied opportunities in many domains. This type of research reveals the complexity of the relative positivity and negativity of various older adult subtypes, and the issue of ageism more generally.

Competence Stereotypes

Such variety in perceptions and subtypes of older adults suggests that there is not complete consensus regarding who belongs in the category or, by extension, what characteristics the members of the category possess. Nevertheless, research indicates that there are some consistent stereotypes of older individuals that shape perceptions. At the most general category level, older adults are stereotyped as deficient interpersonally, physically, and cognitively (e.g., Pasupathi, Carstensen, and Tsai, 1995). That is, older adults are expected to be slow or poor thinkers, movers, and talkers. Because age-related changes in cognitive function have been documented (Baltes, Lindenberger, and Staudinger, 1998; Salthouse, Hambrick, and McGuthry, 1998; Schaie, 1994), the “kernel of truth” in these stereotypes affords them particular strength. However, research taking more ecologically valid, adaptive approaches to the study of age-related cognitive differences suggests that stereotypes of cognitive functioning in older age are more severe than most actual deficits and, furthermore, that the stereotypes largely mask age-related cognitive performance gains (e.g., Adams, Labouvie-Vief, Hobart, and Dorosz, 1990; Blanchard-Fields and Chen, 1996; Colonia-Willner, 1998).
Forgetfulness. Among stereotypes about cognitive abilities, one of the most pernicious is forgetfulness (Bieman-Copland and Ryan, 1998; Ryan, Bieman-Copland, Kwong See, Ellis, and Anas, 2002). Erber and colleagues have conducted numerous studies regarding the forgetfulness stereotype (e.g., Erber, 1989; Erber, Caiola, and Pupo, 1994; Erber, Szuchman, and Prager, 2001; Erber, Szuchman, and Rothberg, 1990a, 1990b). The stereotype is widely held by both young and old (Parr and Siegert, 1993; Ryan, 1992), and is readily applied to explain “forgetful” behavior by older adults (Erber et al., 1994). Even identical behavior by older and younger individuals is attributed to mental deterioration for the older target but not the younger (Erber et al., 1990a, 1990b). In fact, rude and sometimes even criminal behavior on the part of older adults that can be attributed to forgetfulness tends to be excused as such (Erber et al., 2001). In general, the research suggests that older adults are thought to be forgetful due to biological changes associated with aging and therefore are not held accountable for forgetful behavior (e.g., missing an appointment, forgetting a birthday). Although this research reveals a potential benefit of being stereotyped as forgetful (i.e., lack of accountability for breaking social norms), the costs of the forgetfulness stereotype in other domains (e.g., the workplace) may outweigh the potential benefits.
Mental incompetence. Stereotypes about other mental capabilities of older adults have also been found to influence younger adults' interpretation of ambiguous events (Carver and de la Garza, 1984; Franklyn-Stokes, Harriman, Giles, and Coupland, 1988; Rubin and Brown, 1975; see also Giles, Coupland, Coupland, Williams, and Nussbaum, 1992, for a review). In these studies young adult participants read a brief description of a car accident involving a motorist of either one of two ages (22 or 84; Carver and de la Garza, 1984) or one of five ages (22, 54, 64, 74, or 84; Franklyn-Stokes et al., 1988). Participants were asked to rank order a set of provided questions that they would ask the motorist in order to discern the cause of the accident. In both studies, participants sought out stereotype-consistent information to shape their inquiries. Specifically, participants ranked statements about the motorist's physical, mental, and sensory state as more diagnostic the older the perceived age of the motorist, and they ranked alcohol consumption as more diagnostic the younger the perceived age of the motorist. In Franklyn-Stokes et al. (1988), the trends both for the motorist's capacity and for alcohol were linear, suggesting that ageist information seeking may take place “throughout the life span and [be] well grounded in middle age” (p. 420). This work suggests that stereotypes of older adults, similar to stereotypes of other groups, influence information processing, shaping what is both attended to and remembered about particular older adult targets (e.g., Hense, Penner, and Nelson, 1995).

Implicit or Unconscious Attitudes and Stereotypes

A growing body of research in social cognition suggests that individuals' attitudes and beliefs concerning various social groups (e.g., race, gender) can be activated without conscious awareness of the activation (e.g., Bargh and Chartrand, 1999; Fazio and Olson, 2003). Fazio, Jackson, Dunton, and Williams (1995) demonstrated, for instance, the automatic activation of racial attitudes. Specifically, white participants responded faster to negative target adjectives when they were preceded by primes that were photographs of blacks than when they were preceded by photographs of whites. Presumably, because participants held relatively negative attitudes toward blacks, it was easier for them to process, and therefore respond to, adjectives that were also negative (i.e., congruent with the valence of the racial prime).
Perdue and Gurtman (1990) found a similar reaction time bias when evaluating words that were primed with the words “young” or “old”: individuals took longer to identify positive words when presented after the word “old” than when presented after the word “young.” Differential automatic evaluations of racial, gender, and age groups have also been detected using a method developed by Greenwald and his colleagues (the Implicit Association Test, or IAT) (Dasgupta and Greenwald, 2001; Dasgupta, McGhee, Greenwald, and Banaji, 2000; Greenwald, McGhee, and Schwartz, 1998; Hummert, Garstka, O'Brien, Greenwald, and Mellott, 2002; Nosek, Banaji, and Greenwald, 2002). Specifically, both young and older participants have been found to associate “pleasant” words more readily with pictures of younger adults than with pictures of older adults (Hummert et al., 2002; Nosek et al., 2002.) The differential ease with which pleasantness is associated with young rather than old reflects an automatic age bias against older adults (see Levy and Banaji, 2002, for a review).
Like stereotypes, attitudes about older adults also differ depending on the subtype brought to mind (Hummert, 1990; Schmidt and Boland, 1986). For instance, a recent study found that the “perfect grandparent” subtype yielded less automatic age bias than either the general category “the elderly” or the negative “old curmudgeon” subtype (Jelenec and Steffens, 2002). Interestingly, the general category of “the elderly” yielded attitudes as negative as the curmudgeon subtype, suggesting that many younger individuals may automatically think of negative subtypes when generating attitudes about older adults. Consistent with this hypothesis, recent work finds that young perceivers view negative exemplars of the older adult category to be more typical (more like older adults in general) than positive exemplars (Chasteen, 2000; Chasteen and Lambert, 1997; but see also Hummert, 1990).
Gender Differences. Although only a few studies have considered the effect of target sex or gender in perceptions of older individuals, beliefs about older women and men appear to differ at least on some dimensions (Canetto, Kaminski, and Felicio, 1995; Kite, Deaux, and Miele, 1991; Kogan and Mills, 1992; but see also O'Connell and Rotter, 1979). Sontag (1979) suggested that there is a double standard of aging in that women are judged more harshly than men, and some support for this view has been found in the ages selected for the onset of older adult status for men and women (e.g., Dravenstedt, 1976; Zepelin, Sills, and Heath, 1986-1987) as well as in attractiveness ratings (Deutch, Zalenski, and Clarke, 1986). In a study of stereotyping, Hummert and colleagues (1997) also found gender differences. Perceivers associated positive stereotypes with photographs of “young-old” and “middle-old” women less than with similarly aged men, but they associated “old-old” men with positive stereotypes less often than for similarly aged women.
In contrast to this work, O'Connell and Rotter (1979) found little evidence that gender interacts with age in shaping evaluations of older adults. Specifically, they found that 25- and 55-year-old men were rated as more competent than women of those ages, but there were no differences in the competence judgments of 75-year-old men and women. Taken together, these studies suggest that future research is necessary to elucidate how age and gender may interact to shape perceptions. Similarly, there is a dearth of research examining the combined effects of age and other basic categories (e.g., race, sexual orientation) on stereotypes of and attitudes about older adults. It is likely that the combination of these factors, rather than age alone, shapes attitudes and behavior toward individuals (e.g., Conway-Turner, 1995).

Behavior Toward Older Adults

Stereotypes such as forgetfulness and mental deficiency generate negative expectancies for older adults that often translate into behavior with respect to housing availability, in the workplace, during medical encounters, and perhaps even with family and friends. As are racial minorities, older adults are susceptible to housing discrimination. One study found, for example, that rooms previously advertised as available for rent were more likely to be described as unavailable when an older person inquired about availability than when a younger person made the inquiry (Page, 1997). Even children have been found to discriminate against older adults (Isaacs and Bearison, 1986). Children (ages 4, 6, or 8) were asked to work on a jigsaw puzzle with either an old (age 75) or a young (age 35) confederate. Results revealed that the children sat farther away from, made less eye contact with, spoke fewer words to, initiated less conversation with, and asked for less help from the older confederate compared to the younger confederate.
There is also evidence that older adults face discriminatory treatment in medical encounters with both nurses and physicians. Perhaps because these professionals consistently see some of the most impaired older adults, negative attitudes toward older adults in general are common among health care workers (e.g., DePaola et al., 1992; Kahana and Kiyak, 1984; Penner, Ludenia, and Mead, 1984; Sherman, Roberto, and Robinson, 1996). The impact of these negative attitudes can be found in the treatment of nursing home residents (Baltes, 1988; Baltes, Burgess, and Stewart, 1980) and in physicians' diagnoses of older adults' medical problems (Adelman et al., 1991; Adelman, Greene, Charon, and Friedman, 1992; Greene et al., 1986; Greene, Adelman, Charon, and Friedman, 1989; Lasser, Siegel, Dukoff, and Sunderland, 1988). For instance, depression often goes unnoticed in older adults or gets misdiagnosed as dementia (Lamberty and Bieliauskas, 1993), and older adults with acute and chronic pain are sometimes mistreated (Gagliese and Melzack, 1997) or overlooked for preventive measures such as routine screenings because of physicians' beliefs about the course of normal aging (Derby, 1991). Negative beliefs among medical care workers are particularly worrisome in that expectations can become self-fulfilling prophecies (Learman, Avorn, Everitt, and Rosenthal, 1990).
These studies present just a few domains in which older adults may face discrimination (see Pasupathi and Lockenhoff, 2002, for a review). However, not all behavior that differs between young and older adults is discriminatory, making the issue of distinguishing between discriminatory and appropriately differentiated behavior rather complex. In order to develop interventions that reduce harm to, but maximize benefits for, older adults, disambiguating negative discriminatory and beneficial age-differentiated behavior is of paramount importance. In the section that follows, we present the case of disentangling patronizing from accommodating intergenerational communications in order to reveal the nuances associated with many forms of age-differentiated behavior.

Patronizing Versus Accommodating Speech

Research on intergenerational interactions suggests that negative stereotypes and attitudes toward older adults can manifest in patronizing behavior (Hummert, Shaner, Garstka, and Henry, 1998; Ruscher, 2001; Williams and Nussbaum, 2001). One form of patronizing behavior is known as secondary baby talk or elderspeak (Caporael, 1981; Culbertson and Caporael, 1983; Kemper, Finter-Urczyk, Ferrell, Harden, and Billington, 1998). Elderspeak is a simplified speech register that is characterized by slowed speech with exaggerated intonation, higher pitch, simplified grammar, limited vocabulary, and the use of short sentences (Caporael and Culbertson, 1986; Kemper, 1994). Elderspeak has been observed in a number of naturalistic settings, such as residential care facilities for older adults (Ashburn and Gordon, 1981; Caporael and Culbertson, 1986; see Ryan, Hummert, and Boich, 1995, for a review), as well as in laboratory interactions between young and older adults (e.g., Kemper, Vandeputte, Rice, Cheung, and Gubarchuk, 1995; Thimm, Rademacher, and Kruse, 1998).
Patronizing behaviors can reveal ageism insofar as they communicate to older adults that they are no longer the equals of middle-aged adults and therefore their opinions, capabilities, and choices are unworthy of serious consideration (Caporael and Culbertson, 1986; Kemper, 1994; Ryan, Hamilton, and Kwong See, 1994). Indeed, research has linked elderspeak and similar speech accommodations with the speakers' beliefs about the functional ability of older adults (Caporael, Lukaszewski, and Culbertson, 1983) and with their holding negative stereotypical perceptions of older adult listeners (Hummert et al., 1998; Thimm et al., 1998). Furthermore, the use of baby talk with high-functioning older adults has been found to have negative consequences, such as lower self-esteem (O'Connor and Rigby, 1996), feelings of humiliation and dependency (Caporael et al., 1983; Ryan et al., 1994), and increased feelings of communicative incompetence (Kemper et al., 1995). For instance, older adults who participated in a communication task with young adults who used elderspeak reported that they experienced more communication problems during the interaction and were more likely to perceive themselves as cognitively impaired (Kemper et al., 1995; Kemper, Othick, Gerhing, Gubarchuk, and Billington, 1998; Kemper, Othick, Warren, Gubarchuk, and Gerhing, 1996). This work suggests that the misapplication of stereotypes about old age to high-functioning older adults can have deleterious consequences for those individuals' actual level of functioning and mental health.
Similar to the issues underlying the “kernel of truth” of competence stereotypes, elderspeak is ambiguous in that there seem to be both costs and benefits (Caporael et al., 1983; Cohen and Faulkner, 1986; Kemper et al., 1995, 1996). Kemper and colleagues (1995) found that when younger adults spontaneously used elderspeak during a task that involved providing older adults with verbal instructions for finding a destination on a map, their older adult participants benefited in the form of improved task performance. And using a form of elderspeak with older adults suffering from Alzheimer's disease has been found to improve communication between caregivers and patients (Ripich, 1994). Given the negative psychosocial but positive performance consequences of elderspeak, Ryan and colleagues (1995) argued that there exists a “communicative predicament of aging” (p. 1). Specifically, elderspeak directed to high-functioning older adults is perceived as patronizing and seems to decrease their perceived communicative self-efficacy, but failure to use some form of elderspeak may undermine the actual communicative efficacy of lower-functioning older adults.
In a series of elegant experiments, Kemper and her colleagues (1995, 1996, 1998a, 1998b, 1999)sought to examine the components of elderspeak that underlie the positive benefits of communication but are not accompanied by negative psychosocial consequences. This work finds that providing semantic elaborations and simplifying speech by reducing the use of subordinate embedded clauses, but not by shortening speech segments, results in better performance by older adults (Kemper and Harden, 1999). Using short sentences, speaking in a slow rate, and using a high pitch do not benefit older adults, and instead result in negative self-perceptions as well as negative perceptions of the speaker by the older adult (Kemper and Harden, 1999). This work suggests that there is a form of elderspeak that is not perceived as condescending or patronizing and that is an appropriate and beneficial accommodation for healthy older adults. Similarly, older adults with Alzheimer's disease may also reveal improved performance on communication tasks with some but not all aspects of elderspeak. Small, Kemper, and Lyons (1997) found, for instance, that repeating and paraphrasing sentences improved patients' sentence comprehension, but saying the sentences more slowly did not.
Clearly this research has important practical implications for caregivers, family members, and researchers. Treatment and diagnosis disparities (e.g., misdiagnosed pain, depression) could stem from ineffective physician-patient communication (Grant, 1996; Greene et al., 1986; Lagana and Shanks, 2002; Radecki, Kane, Solomon, and Mendenhall, 1988; Revenson, 1989; but see also Hooper, Comstock, Goodwin, and Goodwin, 1982). This work also highlights the need for research to disambiguate stereotypes from actual group differences, in order to develop interventions that address actual needs without reinforcing group stereotypes and that therefore are not rejected as patronizing. Other age-differentiated behaviors must also be examined with similar scrutiny in order to disambiguate discrimination from beneficial differentiation.

Posters for final projects

Poster Session 101 (required along with written mini-ethnography)

General format

1. Determine the one essential concept you would like to get across to the audience.
2. Re-read your abstract once again - are those statements still accurate?
3. Determine the size of the poster (if you had read the instructions, you would already know this!).
4. Determine if you have all the elements you'll need for the poster: Bits & pieces?Poster board, glue, razor blades, Band aids . . . Data? Do you have the data you will need? How much time will you need to prepare the data for presentation (tables, photographs, etc.)? Outside agencies? Does material need to be sent out & returned (photographic services, collaborators)?

A word of advice (the first of many; pick and choose what works for you). Preparing a poster will take as much time as you let it. Allocate your time wisely.

• There are always things that go wrong, so do not wait until the last minute to do even a simple task.
• This is a public presentation; by planning carefully, striving to be clear in what you say and how you say it, and assuming a professional attitude you will avoid making it a public spectacle.
• If you have little experience making posters, it will take longer (estimate 1 week at the very minimum).
• Too much lead time, however, encourages endless fussing about. Do the poster to the best of your ability, then go do something else. 

Sketch it out!

Make a sketch of the poster, using 4 inch x 6 inch cards: Arrange the contents in a series of 3, 4, or 5 columns. This will facilitate the flow of traffic past the poster: 

Place the elements of the poster in position:

• The title will appear across the top.
• A brief introduction (3 - 5 sentences) will appear at the upper left.
• The conclusions will appear at the lower right.
• Methods and Results will fill the remaining space. 

The Title banner

This part of the poster includes the title of the work, the authors names, the institutional affiliations, and the poster number.

Think BIG!

1. The title banner should be readable from 15 - 20 feet away.
2. If space permits, use first names for authors to facilitate interactions.
3. Middle initials and titles are seldom necessary, however.
4. Use abbreviations where possible.
5. City names, or even states, often may be dropped from the institutional affiliations.
6. There are seldom rules regarding line justification of the title. Determine if you will left or center justify the text of the title banner once it has been formatted, based upon personal preferences and space constraints.
7. Refer to your meeting guidelines for more details specific to the meeting you plan to attend. 

Title Fonts:

Make it easy on your information-saturated audience.

1. Use a simple, easy to read font. A san serif style, such as Helvetica (Mac) or Arial (IBM), is ideal.
2. Use boldface and all-caps for the title itself.
3. Use boldface and mixed upper/lower case for the authors names.
4. Use plain text, no boldface, and mixed upper/lower case for affiliations.
5. Use boldface for the poster session number (the number you are assigned by the organizing committee). 

Title sizes

The most important parts of the title banner, the title itself and the poster session number, should be readable from about 25 feet away. Your title will lure viewers closer to see your imaginative and exciting study. The rest of the title, and the body of the poster, should be readable from about 10 feet away.

1. The final size of letters in the title itself should be about 1.5 - 2 inches tall. That is about a 96 point size (or 48 points enlarged by 200% when printed.
2. The authors names may be printed smaller, at 72 points (1 - 1.5 inches)
3. Titles (Ph.D., M.D.) are usually omitted, although the meeting organizers may require that the presenting author, student authors, or society members be indicated.
4. Affiliations can be even smaller, at about 36 - 48 points (0.5 - 0.75 inch)
5. The poster session number should be printed separately, at about 96 point size. It typically is placed in the top of the title banner, to the left, right, or at the center. 

Banner assembly:

A one-piece banner is easiest to carry, and some places have an in-house banner-making service. Commercial firms may also offer this service - try a Kinko's or similar company. I've noticed that branches of these companies that are located close to a university are more flexible in meeting academic & scientific needs than those branches located in shopping malls or the business community.

If you choose this route:

• Call the banner service and ask for specific instructions regarding formatting and submission. Here are some Details for those at the KU Medical Center.
• Proofread the banner. Several times.
• Save it to disk. Then back it up onto another disk.

An alternative is to use a laser printer and double-stick tape: 

1. Set the printer output to landscape (wide) format, using 11 x 14 inch paper (you'll have fewer seams than if you use 8.5 x 11 inch paper).
2. Print the title & lay it out on a table. Proofread it now, rather than after you have assembled it!
3. Successive pages should overlap with only a small margin.
4. Trim the overlap off one side of each page, and place a piece of double-stick tape in that position on the other page, then align the successive pages.
5. This process is easier if you have included 2 thin, parallel lines across all pages of the banner, one above the text & one below. These lines will make it easier to align multiple pages. Once the banner is printed and put together, you can trim away the parallel lines with a straightedge & razor blade.

Either method produces a title banner which should be about 4 - 8 inches tall, and which can be rolled into a compact cylinder for travel.

Use of Color

Mount poster materials on colored art, mat, or bristol board:

1. Mat board is available in a large range of colors.
2. Mat board is heavier, making it more difficult to crease the poster while traveling.
3. Mat board has a more durable surface than other art papers.
4. Mat boards is, however, heavier and more difficult to attach to display boards in the poster session.

Use a colored background to unify your poster:

1. Muted colors, or shades of gray, are best for the background. Use more intense colors as borders or for emphasis, but be conservative - overuse of color is distracting.
2. Two to three related background colors (Methods, Data, Interpretation) will unify the poster.
3. If necessary for emphasis, add a single additional color by mounting the figure on thinner poster board, or outlining the figure in colored tape.

Color can enhance the hues or contrast of photographs:

1. Use a light background with darker photos; a dark background with lighter photos.
2. Use a neutral background (gray) to emphasize color in photos; a white background to reduce the impact of colored photos.
3. Most poster sessions are held in halls lit with harsh fluorescent light. If exact colors are important to the data, balance those colors for use with fluorescent lighting. Also, all colors will be intensified; bright (saturated) colors may become unpleasent to view. 

Sequencing contents

The poster should use photos, figures, and tables to tell the story of the study. For clarity, it is important to present the information in a sequence which is easy to follow:

1. Determine a logical sequence for the material you will be presenting.
2. Organize that material into sections (Methods, Data/Results, Implications, Conclusions, etc.).
3. Use numbers (Helvetica boldface, 36 - 48 points) to help sequence sections of the poster.
4. Arrange the material into columns.
5. The poster should not rely upon your verbal explanation to link together the various portions. 

Edit Ruthlessly!

There ALWAYS is too much text in a poster.

1. Posters primarily are visual presentations; the text materials serve to support the graphic materials.
2. Look critically at the layout. If there is about 20% text, 40% graphics and 40% empty space, you are doing well.
3. When in doubt, rephrase that text or delete it. (Keep chanting this mantra: Therealways is too much text. Always too much text.)
4. Use active voice when writing the text; It can be demonstrated becomes The data demonstrate.
5. Delete all redundant references and filler phrases, such as see Figure ...
6. Remove all material extraneous to the focal point of the poster.
7. Since the abstract is usually published, there is no need to repeat it in the poster. The brief introduction should be sufficient to identify the purpose of the study.
8. Since graphs & figures will have explanatory captions, there is no need to label the graphic with Figure 1, Table 2, etc.

The poster is not a publication of record, so excessive detail about methods, or vast tables of data are not necessary. This material can be discussed with interested persons individually during or after the session, or presented in a handout.

Illustrations

The success of a poster directly relates to the clarity of the illustrations and tables.

• Self-explanatory graphics should dominate the poster.
• A minimal amount of text materials should supplement the graphic materials.
• Use regions of empty space between poster elements to differentiate and accentuate these elements.
• Graphic materials should be visible easily from a minimum distance of 6 feet.
• Restrained use of 2 - 3 colors for emphasis is valuable; overuse is not. 

Show no mercy when editing visual materials!

Once again, ruthless editing is very important.

Visual distractions increase fatigue and reduce the probability of viewers giving the poster a thorough read. 

• Restrained use of large type and/or colored text are the most effective means of emphasizing particular points.
• Use short sentences, simple words, and bullets to illustrate discrete points.
• Have the left edges of materials in a column aligned; center alignment produces ragged left & right edges. This makes reading the poster more difficult.
• Avoid using jargon, acronyms, or unusual abbreviations.
• Remove all non-essential information from graphs and tables (data curves not discussed by the poster; excess grid lines in tables)
• Label data lines in graphs directly, using large type & color. Eliminate legends and keys.
• Artful illustrations, luminous colors, or exquisite computer-rendered drawings do not substitute for CONTENT.
• Lines in illustrations should be larger than normal. Use contrast and colors for emphasis.
• Use colors to distinguish different data groups in graphs. Avoid using patterns or open bars in histograms.
• Use borders about 0.5 inches all around each figures. Border colors can be used to link related presentations of data.
• Colored transparency overlays are useful in comparing/contrasting graphic results

Poster text

Double-space all text, using left-justification; text with even left sides and jagged right sides is easiest to read.
The text should be large enough to be read easily from at least 6 feet away. 

• Section headings (Introduction, Methods, etc.); use Helvetica, Boldface, 36 point
• Supporting text (Intro text, figure captions, etc.); use Helvetica, 24 point (boldface, if appropriate)
• If you must include narrative details, keep them brief. They should be no smaller than 18 point in size, and printed in plain text. Remember that posters are not publications of record, and you can always come to the session armed with handouts.

One option is to consider using a larger size (36 pt) for the Conclusion text, and a smaller size (18 pt) for Methods text.

Attempt to fit blocks of text onto a single page:

• This simplifies cutting and pasting when you assemle the poster.
• For the same reason, consider using 11 x 14 inch paper in the landscape mode when printing text blocks on laser printers.

Other options for fonts include Helvetica, Arial, Geneva, Times Roman, Palatino, Century Schoolbook, Courier, and Prestige. Note that these fonts represent a range of letter spacing and letter heights. Keep in mind that san serif fonts (having characters without curliques or other embellishments) are easiest to read.

Finally, be consistent. Choose one font and then use it throughout the poster. Add emphasis by using boldface, underlining, or color; italics are difficult to read.

The Poster's Background

Two basic rules to keep in mind are that

1) Artistry does not substitute for content

2) The fancier the poster, the greater the time investment.

There are several common approaches.

• Some folks use pieces of mat board (or Bristol board) to make a solid background for the entire poster. They may then choose to use a complementary color as a border for important elements of the poster.
• Others use smaller pieces of board to frame only the elements of the poster, leaving spaces between the elements empty.
  Either approach works; the former gives a unified appearance and is easier to hang straight, while the latter is easier to carry to and from the meeting. It is also possible, but often expensive, to have a commercial house reproduce your completed poster as a single large sheet of paper, which can then be rolled into a cylinder for transport.
  The choice of a background (and complement) color is up to you. The general consensus, however, is that softer colors (pastels, greys) work best as a background - they are easiest to view for hours at a time, and offer the best contrast for text, graphic, and photographic elements.

With an increasing reliance placed upon poster presentations for information transfer at meetings, there comes an increased impatience with poorly presented materials.

Although the poster preparation will expand to fill whatever time you allow it, don't be caught with an unfinished poster!

Plan ahead!

You have probably heard this again and again. That is because it is IMPORTANT!

Planning ahead is particularly important if photographs are to be used.

• Allow time for at least two rounds of photographic processing to take place, just in case.
• Custom photo processing may be more expensive, but offers rapid turn-around and precise color balancing.
• Use sufficient enlargement to allow details to be seen at a distance of 6 feet or more. 

Down to the Wire and Beyond

Those who choose to live on the edge should note that:

• Many larger meetings will have computers available for modifying posters. These facilities are, however, usually crowded.
• There are always photo supply stores near the meeting which will sell you poster materials.
• If you are unfamiliar with the city, ask the hotel concierge for local businesses which might be able to help. Remember to tip!
• Many hotels will have photocopy and Fax machines for guest use, and telecommunication ports in the hotel rooms.
• The world of portable computers and the Internet offers interesting possibilities for a graceful recovery. Leave your poster on a server and you can access it from a remote site.
• Before you leave for the trip, make a final backup copy & leave the disk in an obvious place. That way, you can have someone who has stayed behind print portions of the poster and fax then to you.

Miscellaneous comments

• Since a poster is essentially a visual presentation, try to find ways to show what was done - use schematic diagrams, arrows, and other strategies to direct the visual attention of the viewer, rather than explaining it all using text alone.
• Design the poster to address one central question. State the question clearly in the poster, then use your discussion time with individuals to expand or expound upon issues surrounding that central theme.
• Provide an explicit take-home message.
• Summarize implications and conclusions briefly, and in user-friendly language.
• Give credit where it is due. Have an acknowledgements section, in smaller size type (14 - 18 point), where you acknowledge contributors and funding organizations.
• Vary the size and spacing of the poster sections to add visual interest, but do so in moderation.

 ----------------SUMMARY-------------------------------

Below are particular points to consider when putting your poster together:

Ø      Divide the contents of your poster into appropriate sections.  For instance -- title of paper, author, institutional affiliation; abstract; methodology; data; results; conclusions.  Be sure to include each section on a separate sheet(s) of paper.

Ø      Use larger (than 16 font) lettering for the poster's title, author and institutional affiliation.  Make the lettering at least one inch high.

Ø      Avoid fonts that are script or difficult to read.

Ø      If hand lettering is required, use a black felt-tip pen (Sharpie).

Ø      Be concise with your written material.  Save elaborative points for discussion/interaction with viewers.  For conclusions, focus on a central finding that lends itself to informal discussion.

Ø      Use graphs, charts and/or tables (color if possible) to show results. Graphics help make your poster interesting.

Ø      A neutral poster or matte board is more amenable to the eye than a bright colored background.  A splash of color here and there, perhaps highlighting central finding(s) or provocative results, will make your poster "stand out" from the crowd.

Ø      A mailing tube or portfolio case is recommended for transporting your poster.

Ø      Have a notepad handy when presenting at your poster session.  It may be helpful in elaborating on your findings, or for taking names & addresses of people interested in your research.

Empathy Exercise: Try This in Breakout!

Empathy Test! Try This

Try doing these exercises:

1. Coat a pair of glasses with a thin layer of Vaseline. Put the glasses on and then color a picture in a child’s coloring book. Stay inside the lines.
2. Put an oven mitt on your dominant hand. Open a box of crayons or wooden matchsticks, dump them out on a table, then pick them up one by one and put them back in the box, using the gloved hand.
3. Take a piece of rope and tie your knees together. Walk across the room. Try running. Now hop and jump.
4. Quickly read the following paragraph:                                                                            Eht qaimtimg also proved that, sa wwell sa being a great humter, Cro-Wagom Nam saw a comsiberadle artist. He dah flourisheb ta a tine whem eno fo eht terridle Ice Age saw dlotting out nuch of Euroqe. He dah estadlisheb himself, fought wilb aminals rof livimg sqace, surviveb eht ditter colb, amb left beeq bown umbergroumb nenorials fo his yew fo life!
5. Sit in front of a mirror with a maze or design from a coloring book. Look in the mirror and complete the maze or trace the outline of the design as quickly as possible. Stay in the lines and trace only when looking in the mirror.
6. Put a spoon in your mouth and read the last exercise aloud. 

Now, imagine feeling similar frustrations every waking hour as you try to accomplish even simple tasks that society expects of you. That is the lifelong struggle against intellectual limitations and compromised living skills facing people with mental retardation. 

The exercises only hint at the range of learning and physical impairments that may characterize mental retardation, a term that many people in the field claim is itself stigmatizing and outdated. But the stigma of “intellectual disability,” as many prefer to call it, runs deeper than any label or medical term; it is rooted in a long history of societal perceptions and misconceptions that have categorized people as mentally deficient and, therefore, somehow less than fully human. 

Even as the stigma long stamped on mental illnesses such as depression or schizophrenia has begun to fade, perhaps as a result of wider recognition that these disorders are brain-based biological conditions, a similar public enlightenment has largely bypassed mental retardation. 

DISABILITY: IN THE BRAIN, IN THE PUBLIC MIND-reducing the "stigma"

Some people in the field, however, suggest that thinking about mental retardation as a brain disorder only reinforces the stigma. 

• David Coulter, M.D., current president of the American Association on Mental Retardation (AAMR) says: “With mental illness, emphasizing the biological basis takes it out of the realm of ‘craziness’ or personal fault and into the realm of brain chemistry, something for which a person cannot be held personally responsible. 
• The root of stigma in people with intellectual disabilities is based more on exclusion, perception of differences, lack of respect, and lack of a sense of value and dignity—even sub-humanity. If society emphasizes the biological basis of intellectual disability, it would be making people even more different. It would only reemphasize the things that I think drive the stigma.” 

 “Mental retardation is not a disease,” says Coulter. “It is a statement about how a person is functioning cognitively within a social context.” 

• In 1992, the AAMR published a definition of mental retardation that reflected a new view of the condition, not as a mental illness or even a medical disorder but as a state of functioning that begins in childhood and is characterized by limitation in both intelligence and adaptive skills.
• Coulter believes that “The paradigm shift we introduced in 1992 was truly revolutionary in changing the way people think. What we’re saying is that, while mental retardation depends to some extent on what is going on in a person’s brain, it also depends on the demands and expectations of the environment. Maybe we, as a society, can work on all that to improve functioning.”

“... you can talk about curing mental retardation if you could set up a person’s environment and support him or her in such a way that the person is able to function just as you and I do.

•  His remark hints at a fundamental question to which diverse answers come from researchers, clinicians, and policymakers in the field. What does it mean to talk about the possibility—even the hope—of not only treating but also curing mental retardation? In Coulter’s view, 
• Instead of thinking that it’s something you are born with and is never going to change, we can say, yes, it can change. In the right context, mental retardation could even go away.”