land

Article
Anti-Ageism Social Actions: Lights and Shadows
Macarena Sánchez-Izquierdo 1, * , Rodrigo García-Sánchez 2 and Rocío Fernández-Ballesteros 3

1 UNINPSI Clinical Psychology Center, and Department of Psychology, Comillas Pontifical University,
C. Universidad Comillas, 3-5, 28049 Madrid, Spain
2 Department of Psychology, Comillas Pontifical University, C. Universidad Comillas, 3-5, 28049 Madrid, Spain;
[email protected]
3 Department of Psychobiology and Health, Autonomous University of Madrid,
Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain; [email protected]
* Correspondence: [email protected]; Tel.: +34-(91)-7343950

Abstract: Ageism refers to the stereotypes, prejudices and discrimination towards others or oneself
due to age, and it is the most prevalent type of social disadvantage, even more so than those due
to gender and race, with negative effects worldwide. Ageism is an evidently real social problem
that needs to be addressed and fought. Our study has two main objectives: firstly, to study to
what extent programmes, projects or actions have been developed to combat ageism around the
world; and secondly, to what extent they have been evaluated via the positive outcomes registered



by the participants. Two different information sources were used: (a) a literature review of ageism

 programmes or interventions; and (b) an online questionnaire sent to international and national
Citation: Sánchez-Izquierdo, M.; institutions surveying their policies or programmes against ageism. Our results show a relatively
García-Sánchez, R.; high number of actions combating ageism but a lack of a systematic evaluation of the outcomes of
Fernández-Ballesteros, R. those actions. In conclusion, first, it is necessary to develop programmes and actions combating
Anti-Ageism Social Actions: Lights
ageism, and the evaluation of these programmes is urgently needed in order to identify strategies
and Shadows. Land 2022, 11, 195.
that truly and effectively tackle ageism. There is a need to urge institutions to perform external
https://doi.org/10.3390/
evaluations of their anti-ageism social policies and to encourage scientists to conduct randomized
land11020195
and controlled studies.
Academic Editors:
Vanessa Zorrilla-Muñoz, Keywords: images; ageism; aging stereotypes; social policies; programmes; differences by countries
Maria Silveria Agulló-Tomás,
Eduardo Fernandez,
Blanca Criado Quesada,
Sonia De Lucas Santos
1. Introduction
and Jesus Cuadrado Rojo
Ageism is a concept defined by Butler [1] through three psychosocial dimensions,
Received: 15 December 2021 attributed and/or associated with others or oneself, based on age: stereotypes, prejudice
Accepted: 25 January 2022 and discrimination. These three psychological constructs referring to older adults imply
Published: 26 January 2022 how they, because of their chronological age, are perceived, what emotions they provoke,
Publisher’s Note: MDPI stays neutral and what type of behaviours they usually experience from others.
with regard to jurisdictional claims in A recent study based on the European Social Survey has found that ageism is the most
published maps and institutional affil- prevalent type of discrimination, as it reported by almost 35% of all participants over the
iations. age of 18 [2]. Sexism and racism represent relatively stable categories that do not vary
across the life course of an individual. Age, on the other hand, changes with time, and
people are likely to change age group affiliation with the passage of time. Hence, in contrast
to the other two “isms” (sexism and racism), everyone is susceptible to experiencing ageism
Copyright: © 2022 by the authors. if they live long enough [3,4]. Moreover, ageism might exacerbate the negative impact of
Licensee MDPI, Basel, Switzerland.
other forms of discrimination, including sexism and racism, influencing the quality of older
This article is an open access article
adults’ life [5], with devastating effects on older women [6].
distributed under the terms and
As confirmed by recent history [7], a pandemic is an extremely dangerous situation,
conditions of the Creative Commons
not only because human life is at risk, but because other negative socio-economic events
Attribution (CC BY) license (https://
concerning the future are involved, and also because a pandemic is a historical event in
creativecommons.org/licenses/by/
4.0/).
which extreme shared emotions come to light, ageism among them. This was warned

Land 2022, 11, 195. https://doi.org/10.3390/land11020195 https://www.mdpi.com/journal/land

Land 2022, 11, 195 2 of 18

against, predicted, and denounced very early on, at the start of 2020, by an international
group of social scientists [8] asking us to engage in Avoiding Ageism and Fostering Inter-
generational Solidarity. They denounced that “with the pandemic there has been a parallel
outbreak of ageism” (p. 1). This statement is based on the analysis of the public discourse in
social media and public announcements made by government representatives, emphasising
the extreme frailty of older adults and their cost to society and overgeneralising some of
their traits of the entire older population, which is, precisely, highly diverse. Older adults
are a high-risk group; thus, the health and safety behaviour modifications implemented
during the pandemic have been more restrictive for them than for people of other ages,
influencing, at the same time, how society views older adults (i.e., ageist stereotypes) and
agitating intergenerational tensions [8–10], although chronological age is not an objective
formulation for a policy implementation since we can find a diversity of health statuses
within older age groups [11], even there are older people that are relatively less vulnerable
than many younger people and vice versa [12].
Nevertheless, the repercussion from this overgeneralisation could have a boomerang
effect in society, thus following Levy’s embodiment theory [13], which posits that “the
extension of older adults’ negative stereotypes can be internalised by people of all ages and
when these views become self-relevant, influencing older persons’ beliefs about their own
aging, they can detrimentally impact health” (p. 1), as a diversity of studies have supported
(among others: [14–16]. Along the same line, a recent study assessing negative cultural
views about older adults in 29 European countries has highlighted that they are negatively
associated with active ageing both at the individual and population level. This is also
supported by the negative cultural view of older adults being considered a health threat in
themselves, at the population and individual level [17]. Finally, it must be emphasised that
the paper by Ayalon et al. [8] does not end with negative predictions based on psychosocial
theories, but with recommendations for combating ageism and increasing intergenerational
solidarity. The key question here is whether predictions and recommendations coming
from social science have had a positive influence on what is happening across the world.
After reviewing several studies from different sources, ageism seems to be growing
as the COVID-19 pandemic continues [18–21]. At the same time, a strong call from inter-
national organisations (such as WHO [22]) demanding public and private social agents
for anti-ageism movements, policies and actions has been spread around the world. Nev-
ertheless, there is no information regarding the effect of these calls and to what extent
new anti-ageism policies emerge, so much more research must be conducted because, as
expressed by several institutions and scientists, “policies and laws are among the most
important strategies to include in any effort to combat ageism” ([22] p. 104).
This paper aims to obtain sufficient information to evaluate the programmes and
their effectiveness, including (1) to what extent policies, programmes or actions have been
developed to combat ageism around the world; and (2) to what extent positive effects in
the participants have been registered.

2. Materials and Methods

Two different sources were used: (a) a literature review of ageism programmes or
interventions; and (b) an online questionnaire sent to international and national institutions
surveying their policies or programmes against ageism.

2.1. Source of Data 1: Literature Review of Ageism Programmes

2.1.1. Procedure
The literature search strategy and selection criteria were the following. We conducted
a literature review of ageism programmes with the following databases: PscyInfo and
EBSCO. The search strategy was guided by a specific question: which programmes or
actions have been developed to combat ageism around the world and have had positive
effects? The search strategy combined key terms related to “ageism”, “age discrimination”,
“age prejudice”, “age stereotype”, or “social exclusion” and “interventions” or “programme”
Land 2022, 11, 195 3 of 18

with terms related to “elder” or “older adults” that have been used from January 2018
onwards. Eligible studies met the following inclusion criteria: (1) they evaluated an
intervention designed to reduce ageism, (2) they examined at least one ageism outcome
in relation to older adults and (3) they were published after 2018, when the meta-analysis
Interventions to Reduce Ageism Against Older Adults was carried out [23].

2.1.2. Method
Database searches were conducted in July 2021. Following an initial phase of removing
duplicates and completely irrelevant records not meeting the inclusion criteria, one reviewer
screened records for potentially eligible titles and abstracts and subsequently reviewed full
texts to determine their inclusion in the literature review.

2.2. Source of Data 2: An Online Questionnaire for International and National Institutions
2.2.1. Procedure
Civil society organisations of/for older adults who might have developed programmes
or policies against ageism were searched via Google, and the following principal interna-
tional associations were contacted: International Federation on Aging, Helpage Interna-
tional European Federation of Older Persons, AGE Platform Europe, Association Age Well
Foundation and American Federation for Aging Research, and their members were also
contacted. To collect the sample, in August 2020 and July 2021 we contacted the 369 identi-
fied institutions, including 69 in the European Union, 3 in the UK (United Kingdom), 21 in
the USA (United States of America), 3 in Canada, 196 in Latin America, 35 in Africa, 11 in
Australia and 31 in Asia (n = 369). A letter of invitation was sent to all these institutions,
describing the purpose of our research project, along with a letter of introduction to inform
and request their collaboration in the study:
“We are addressing you, and your Association, on behalf of the Research project XXXXXXX.
This project has been developed under the auspices of the Government of the Madrid Re-
gion by the Spanish National Research Council, with the collaboration of the Autonomous
University of Madrid. As you know, the COVID-19 pandemic has increased negative
views about older adults related to discrimination and ageism. One of the objectives of
this project, therefore, is to find strategies, policies and/or programmes, at national and
international levels, with which to fight against ageism and age discrimination.
As member of the Association, could you please answer the 6-ITEM GOOGLE FORMS
SURVEY regarding this subject? It will only take you a few minutes to complete:
https://forms.office.com/r/icNeecNtxz (last accessed date 28 June 2021)
If you have any questions, and to receive information about XXXXX (http://encage-
cm.es/, accessed on 1 December 2021), please contact us; and if you have any further
information you could offer, please write to us at the address below”.

2.2.2. Method
The online questionnaire contained the following eight questions: 1. Name of the
reporting entity. 2. Do you have any strategy, policy or programme with the purpose of
fighting against ageism or age discrimination? 3. If “yes”: could you provide its name?
4. What is/are its general objective/s? 5. Could you please briefly describe it (actions,
materials, people involved, etc.)? 6. Do you have any public information about it (URL,
flyer, etc.)? 7. Could you give us the name and contact details of the contact person?
8. In case of multiple strategies, policies or programmes, could you please repeat these six
questions/answers as many times as needed?
An intensive examination of their webpages was performed, seeking evidence regard-
ing outcome evaluation (effectiveness, efficacy and efficiency) of the programmes facilitated
(different types of activities carried out, number of people involved in each project and
results obtained or objective reach).
Land 2022, 11, 195 4 of 18

The information collected was stored following ethical requirements. The study
followed the Declaration of Helsinki’s principles [24] at all times. The research was carried
out abiding by the ethical principles related to personal data, consent, confidentiality
and their use. All participants gave their consent in writing after being informed of the
voluntary nature of their participation and their total freedom to withdraw from the study.
All participants received and signed the same informed consent form to participate in
this study.

3. Results
In this section we firstly present the results from the literature review of ageism
programmes. Secondly, we review the results from the online questionnaire for international
and national institutions.

3.1. Results from the Literature Review of Ageism Programmes

The database identified 1232 total articles, and we identified 21 records for a full-text
review following removal of duplicates and irrelevant records, and only 13 fulfilled our
inclusion criteria.
Ageism intergenerational interventions demonstrated a significant effect on negative
stereotypes about ageing [25–29], attitudes [25,30–35], positive behaviour towards older
adults [30], knowledge [33], comfort [35], aging anxiety [27,28], death anxiety [34] and
well-being in older adults [26], but no significant effects on working with older adults [30]
or in affective attitudes toward older adults [28] were found. Although the Intergenera-
tional Artistic Installation of Madrigal et al. [36] found an improvement in younger adults’
attitudes toward older adults, but not in younger adults’ attitudes toward aging. An
empathy-building intervention by Bailey et al. [37] did not find self-reported ageism and
aging anxiety after the intervention.
Following the World Health Organisation’s outstanding strategies [22], programmes
were classified into three groups: policy and law; intergenerational programmes; and
educational programmes. We have not found any policy or law interventions. Ageism
interventions were mostly intergenerational interventions [25,27,35,36], educational pro-
grammes [30–32,37] and interventions that included both educational and intergenerational
contact components [28,29,33]. We also found cognitive behavioural therapy [34].
The majority of studies (n = 9) used a quasi-experimental design, and only four studies
were randomised controlled trials (see Table 1).

Table 1. Studies included.

No. of Participants
Study Intervention Design Control Group Intervention Group Ageism Outcome
25 older Negative stereotypes
21 older institutionalised
Randomised institutionalised about ageing and
[26] Intergenerational adults and
controlled trials adults and emotional well-being in
24 young students
24 young students older adults
61 undergraduate
Post-test only Stereotypes about ageing
[27] Intergenerational Students and at least
research design and ageing anxiety
19 older adults
Quasi-experimental
Intergenerational design. pre- and n = 151: 73 older and n = 161: 77 older and Attitude and sense
[35]
programme post-test control 78 young participants 84 young participants of comfort
group (CG) design
Intergenerational Quasi-experimental 302 participants Stereotypes about ageing
[25]
contact study design aged 18–29 and ageist attitudes
Land 2022, 11, 195 5 of 18

Table 1. Cont.

No. of Participants
Study Intervention Design Control Group Intervention Group Ageism Outcome
Attitudes toward aging
Quasi-experimental 34 undergraduate
[36] Intergenerational and attitudes toward
study design students
older adults
Pre-test–post-test
38 care staff members in
Educational trial model and
[31] one nursing home Attitudes toward aging
intervention quasi-experimental
study design
Ageism and knowledge
of aging and behaviour
Educational Randomised 104 undergraduate 83 undergraduate
[30] toward older adults and
intervention control trial Students Students
willingness to work with
older adults
Pre-test–post-test
Educational trial model and
[32] 134 medical students Attitudes Toward Aging
programme quasi-experimental
study design
Educational:
Quasi-experimental 197 students
[37] transformative Stereotypes about ageing
study (18–48 years)
learning intervention
Study 1: 266
undergraduates:
Education about Attitude and stereotypes
86 education, 86, Ext.
aging, extended Study 1: 88 and aging anxiety and
Randomised contact 94 combined
[33] intergenerational undergraduates anxiety about interacting
control trial Study 2: 505 community
contact, combined Study 2: 132 with older Adults and
participants ages 18–59:
condition aging knowledge
122 education, 125 ext.
contact, 128 combined
Stereotypes about ageing
Interventions that
and aging anxiety and
included both
Quasi-experimental 14 undergraduate psychological concerns
[28] educational and
study design students about aging and affective
intergenerational
attitudes toward
contact components
older adults
Cognitive Randomised
[34] 55 nurses 55 nurses Death anxiety and ageism
behavioural therapy controlled trial
Interventions that
included both
Quasi-experimental 23 undergraduate
[29] educational and Stereotypes about ageing
study design students
intergenerational
contact components

3.2. Results from the Online Questionnaire for International and National Institutions
Of the 369 institutions, 21 agreed to participate in our research (Table 2), signing
an informed consent form and providing contact information and filling out the online
questionnaire (see link to the online questionnaire in the procedure section), but three were
not carrying out programmes focused on older adults. Finally, 18 institutions carrying out
some programmes focused on older adults were included (Figure 1). The data provided by
participants were carefully managed, preserving anonymity and confidentiality.
Again, following the World Health Organisation’s outstanding strategies [22], pro-
grammes were classified into three groups: (1) policy and law; (2) intergenerational pro-
grammes; and (3) educational programmes. Additionally, we added two more blocks:
a fourth block regarding social participation, and a fifth regarding anti-discrimination
programmes during the COVID-19 pandemic.
Land 2022, 11, 195 6 of 18

Table 2. Institutions that completed the online questionnaire and their programmes.

Country Institution Programmes

USA (New York) Long Term Care Community Coalition Policy and law

• Policy and law: defence of

human rights.
• Policy and law: health and
European Union HelpAge International active ageing programmes.
• Intergenerational programmes.
Social participation
• Educational interventions

• Policy and law: defence of

human rights.
• Policy and law: health and
Greece 50plus Hellas active ageing programmes.
• Intergenerational programmes
• Anti-discrimination
programmes during the
COVID-19 pandemic

Euskofederpen: Territorial Federation of

• Policy and law: health and
active ageing programmes.
Spain Provincial Associations of Pensioners and
Retirees of Álava, Guipúzcoa and Vizcaya
• Intergenerational programmes.
Social participation

National Association of Social Centres,

• Intergenerational programmes
Italy Committees of the Elderly, and Gardens
• Anti-discrimination
European Union

programmes during the

(ANCeSCAO—APS)
COVID-19 pandemic

APRe! Associação de Aposentados, • Policy and law: defence of

Portugal
Pensionistas e Reformado human rights

• Policy and law: defence of

human rights
• Intergenerational programmes
Serbia and Austria Serbian Red Cross • Educational interventions
• Anti-discrimination
programmes during the
COVID-19 pandemic

• Policy and law: defence of

human rights
• Policy and law: health and
“Turbota pro-Litnih v Ukraine” (Age active ageing programmes.
Ukraine • Intergenerational programmes.
Concern Ukraine)
Social participation
• Anti-discrimination
programmes during the
COVID-19 pandemic

• Policy and law: defence of

human rights
Russia Eduard Kariukhin
• Policy and law: health and
active ageing programmes.

Russia Irina Khalay Association

• Intergenerational programmes
• Educational interventions

Bangladesh Nobo Jatra Foundation

• Policy and law: defence of
human rights
Asia

National Senior Citizen Federation

Nepal • Intergenerational programmes
(NASCIF)
Land 2022, 11, 195 7 of 18

Table 2. Cont.

Country Institution Programmes

USA (New York) Long Term Care Community Coalition Policy and law

• Policy and law: defence of

Association Nos Années de Vie (ANAVIE) human rights
Togolese Republic • Intergenerational programmes.
Social participation
Africa

Coalition of Caregivers and Defenders of the • Policy and law

Liberia
Elderly in Liberia (COCAEL).
Uganda Reach the Aged Association • Policy and law
Uganda
(URAA)
Kenyan Ministry of Labour, Social Security • Intergenerational programmes.
Kenia
and Services

Figure 1. PRISMA from the online questionnaire by international and national institutions.

Here, we describe the main features (active principles) of each programme category,
providing examples of them, as well as, in the case that evaluation data are presented
(directly through the questionnaire or in their annual reports), providing information about
the programme’s effects.
1. Policy and law
Here, we found two programme blocks: (1) programmes focused on the defence of
human rights and the defence of rights programmes; and (2) programmes focused on health
and active ageing programmes.
Land 2022, 11, 195 8 of 18

Programmes focused on the defence of human rights and the defence of rights pro-
grammes, logically, contain an essential principle: the protection of the rights of older people.
In the European Union, the Associação de Aposentado, Pensionistas e Reformados
of Portugal (Association of Retired Persons and Pensioners—APRe!) defence of rights
programme stands out, with its programme “An APRe! on the move” and efforts to
support all demands for better living conditions for retirees and pensioners, to pressure the
political power regarding pensions and warning actions (to pressure the political power,
dialogue with central and local authorities to define policies) to improve continuous and
long-term palliative care. The Serbian Red Cross, with its programme “Empowerment of
older women: prevention of violence by challenging social norms in Serbia and Austria
(EmPreV)”, carried out 35 workshops to sensitise health and social staff and volunteers
about this problem, including 35 information sessions with older women.
The 50plus Hellas institution in Greece, with its programme “The Europe we want is
for all ages (2019)” and the Ukrainian Charity’s program “Turbota pro-Litnih v Ukraine”
(Age Concern Ukraine), focused on revealing and preventing abuse towards older people
with the Elder Abuse Prevention programme in the Ukraine, a programme of 300 volunteers
who brought these mistreatments to light. In addition, the Strengthening the Voices of
Older People in Ukraine programme helped older people better understand their rights
and learn how to defend them. To this end, they questioned 1500 people who suffered from
age discrimination and low self-esteem.
Two programmes carried out by HelpAge International stand out: (1) the programme
“Making older women count”, where they monitored the achievement of gender equality
in the Sustainable Development Goals (SDG) segregated by sex and age, and other reasons
of discrimination; and (2) the programme on ageing and SDGs: six steps for the inclusion of
older people to promote the rights and inclusion of older people;programme 1500 members
were directly participating in the campaign, but there were 350,000 more participants
engaging with the programme via social networks, and 7.5 million readers were registered
for ageism articles.
In addition, the Russian institution Eduard Kariukhin was tasked with informing
society and the state about ageism and its negative consequences on the quality of life of
older people, seeking a legislative, executive and civil response.
Likewise, in Asia, Bangladesh wanted to focus on document and resource management
and strengthening nursing home establishments, obviously not forgetting to safeguard of
the rights of this very vulnerable group in this continent. The Nobo Jatra Foundation of
Bangladesh also collaborated with these types of programmes, implementing the rights
of older people via advocacy, education and training, research, consulting and direct
support services. In addition, the foundation organised a meeting to share and observe the
International Day of the Elderly (about 50 older adults, men and women attended).
In Africa, the Association Nos Années de Vie (ANAVIE) of the Togolese Republic
stands out with its programme that developed policies to improve the quality of life of
the elderly in Liberia. However, the most striking of these were two top-down proposals.
One of them advocated for the inclusion of older people in the Affirmative Action Law
Project to improve services and rights and to finance national programmes. They provided
services to the elderly during the Ebola crisis (2014) by creating the Coalition of Caregivers
and Defenders of the Elderly in Liberia (COCAEL). Uganda Reach the Aged Association
(URAA), with the National Endowment for Democracy (NED) and VOICE programmes,
understood and challenged age discrimination. Likewise, along with the work of the
paralegal advisers and support for access of the rights of older refugees in Adjumani,
they supported more senior people and their homes with access to justice and vindication
of rights; thanks to this, they sensitised at least 400 older people to cases involving the
violation of rights. Likewise, the advisers resolved 51 issues of gender violence.
In short, nine international institutions have fought to defend the rights of older
people. For this, programmes have been carried out to empower this social group and
make their rights, which are not currently being respected, visible. In addition, the HelpAge
Land 2022, 11, 195 9 of 18

International association focused on the rights of older people, in general, and older women,
in particular. This social group is discriminated against by both age and gender.
The second programme block is focused on health and active ageing programmes.
In USA, the New York Long Term Care Community Coalition is dedicated to improving
nursing home care to prevent neglect and abuse of the elderly in residential care settings.
In the European Union, the HelpAge International stands out, which, via the Health
Outcomes Tool and Better Health programmes, has managed to serve 2 million older
people; provided community help to 170,000 older people; and improved facilities to serve
30,000 people with disabilities and 20,000 refugees. Older people benefited from all the
improvements in health, rehabilitation and psychological counselling service.
In addition, its Stay Active festivals programme, in which 1140 older people (75%
women) participated, has created festivals and workshops in several cities in Greece to
empower older people to engage in a more active and healthier lifestyle. In addition, 50plus
Hellas in Greece created Android applications to obtain valid information on issues related
to seniors with the Stay Active programme.
In Russia, the active ageing programmes stand out. These aim to raise awareness
concerning the need to improve the quality of life of older people by increasing their
knowledge of civil law. In addition, they celebrate events such as the International Day of
the Elderly. The Active Generation (62 events and 200 participants) and the Golden Age
School (30 events and 150 participants) programmes received donations from individuals.
Additionally, in the European Union, the Ukrainian Charity’s progamme “Turbota pro-
Litnih v Ukraine” (Age Concern Ukraine) wanted to promote an active and healthy lifestyle
among older people thanks to the programme “Support for the Madrid International Plan
of Action on Aging Relating to Ukraine” (UNFPA). Finally, in Spain, Euskofederpen: Terri-
torial Federation of Provincial Associations of Pensioners and Retirees of Álava, Guipúzcoa
and Vizcaya increased the voluntary activity of older people in their social centres, thus
creating a network of social intervention programmes at a regional level aimed at active
and healthy ageing, and cognitive stimulation programmes for adults with or without
cognitive impairment through the Burulogy programme.
Various programmes have been developed within the African continent. For exam-
ple, the Association Nos Années de Vie (ANAVIE) (Togolese Republic), with its “Aging
in good health” programme, was able to bring together 35 sick, older people to carry
out regular monitoring at their homes, as well as emergency tasks such as screening for
contagious diseases.
Some institutions carried out more specific programmes aimed at universal access to
health. Along these lines, we have the Community Initiative for Peace and Development:
food from South Sudan with the provision of non-food items (NFI) materials to the elderly,
or the Uganda Reach the Aged Association (URAA) with the social protection of older
people and Saidia Wazee Karagwe (SAWAKA) (Tanzania) facilitating access to equitable
and affordable health services.
Within this group, we found associations that have sought to promote policies erad-
icating any form of discrimination against older people. For example, Kenya’s Ministry
of Labour, Social Security and Services incorporates laws and policies, including geriatric
research and studies in education and training curricula, to expand the health care support
system for older people, and seeks to guarantee access to a healthy diet for the elderly.
In summary, programmes have been collected from eleven international institutions
whose objectives were to promote active and healthy ageing of the elderly and avoid
discrimination in access to health programmes due to age. The most notable association has
been HelpAge International, which has served more than two million older adults thanks
to their international programmes. In addition, they managed to provide community help,
improve health facilities and promote a more active and healthy life in older people.
2. Intergenerational programmes
In continuation, we highlight the most outstanding initiatives regarding intergenera-
tional programmes.
Land 2022, 11, 195 10 of 18

Within the European Union, Greece and Italy stand out, including 50plus Hellas from
Greece, who, via the DIGITOL and “the value of time” programmes, work with the elderly
to develop digital skills and encourage recognising what older people bring to the young.
In Italy, the only entity that offers some data is the National Association of Social Centres,
Committees of the Elderly, and Gardens (ANCeSCAO—APS). This is an association with
activities that, through the Time to Care programme (still running), promotes generational
exchange using telephone contact, assistance activities and telecare service. The number of
participants involved has varied according to the area of Italy. Still, the most critical data
were available for Matera, where 1500 young people under 35 years of age participated
in this intergenerational programme. The municipality of Castenaso carried out a task
clocking up 250 h.
In Russia, the Irina Khalay Association develops the Active Generation and School of
the Golden Age programmes, which are dedicated to sharing the life experience of older
people with younger people. On the other hand, we have the blog published by the Serbian
Red Cross on the importance of intergenerational solidarity.
In Asia, the National Senior Citizen Federation (NASCIF) brings together various asso-
ciations throughout Nepal, developing multiple programmes. Within the intergenerational
area, it seeks to promote dialogue and discourse to reduce the generation gap.
In summary, programmes have focused on fostering mutual respect between genera-
tions and promoting the participation of older people in society, valuing their knowledge
and skills. In addition, the Italian institution ANCeSCAO—APS attracted many partic-
ipants in the Italian municipalities of Matera and Castenaso. It advocated promoting
generational exchange using electronic devices, among other ideas.
3. Educational interventions
The educational interventions we refer to (all in the European Union) focus on self-
development. Personal development programmes aim to develop the skills and self-
development of older people as an essential principle.
The HelpAge International institution has carried out three programmes: (1) the
Older Citizen Monitoring (OCM) programme, for which they developed a training manual
to strengthen the knowledge and skills of the elderly and in which 200 older refugees
participated. (2) With the Rohingya Response Project, they were able to help 2000 older
refugees with skills training, as well as providing them with loans to help them start
fishing net businesses, setting up small shops, etc. (3) With the Community Safe Spaces
programme, they created a meeting space in which older people could learn new skills and
carry out social activities, serving 700 older people altogether.
In Russia, the Irina Khalay institution held forums and round tables and master classes
under the sewing programme for older women to increase this group’s legal literacy and
quality of life.
Finally, the Serbian Red Cross has contributed to digital inclusion via older peoples’
access to information and communication technologies. There were ten older adult partici-
pants in each of the 29 Serbian municipalities.
In summary, three institutions for self-development stand out, whose objectives were
to develop the skills and regular progress of the elderly. The programmes are from a
Russian institution, a Serbian institution and HelpAge International, which carried out
three high-participation programmes to train older people in new skills.
4. Social participation programmes
Some institutions have focused on social participation. Logically, social participation
programmes focus on an essential principle: promoting participation in society by older
people, and, therefore, intergenerational contact.
In the European Union, the entity HelpAge has carried out two programmes: (1) The
first, called Maintaining Our Dignity, with the participation of 300 older people, was tasked
with presenting HelpAge and its network members in the 11th session of the OEWG
(open-ended working group) on ageing and your rights to justice and work; (2) the second
Land 2022, 11, 195 11 of 18

programme, called Improving urban environments for older people, was an investigation
of urban problems, in which 1300 people participated.
Additionally, in Europe, the Ukrainian Charity association “Turbota pro-Litnih v
Ukraine” (Age Concern Ukraine), on the other hand, developed a collaboration with local
authorities for older people to help them decide on local priorities. This was achieved
thanks to the programme “Improving Government Accountability Through Older Citizens’
Monitoring in Ukraine”.
Additionally, in Spain, Euskofederpenha has actively worked on transmission be-
tween institutions and social centres, claiming the right of older people to be active and
improving conditions in social centres, as well as a digital transformation so that they
remain connected.
In Africa, the Association Nos Années de Vie (ANAVIE) of the Togolese Republic
stands out. This Association has created clubs for older people (Tabligbo & Clubs d’Agomé-
Kpodzi et de Kpalimé-Tsivé). It has encouraged the participation of older people in social
and cultural events within the community. It has also carried out psychotherapeutic
programmes, psychological consultations and capacity-building workshops. For example,
older adults can learn to use digital banking channels such as mobile money accounts. It
has also been concerned about the fight for their rights and the fight against abuse, ensuring
a minimum income for older people. It should be noted that this entity has published
various documents and reports such as Why is it time for a convention on the rights of the elderly
and the Report of the conference on strengthening the rights of the world’s elderly. In addition, in
Kenya, the Kenyan Ministry of Labour, Social Security and Services has developed the adult
education programme In Liberia, the Centre for Community Advancement and Family
Empowerment (CECAFE), which provides social services to older adults in order to develop
partnerships with communities and government and non-governmental organisations to
ameliorate older peoples’ social problems and challenges.
In summary, five institutions at the international level have opted for the participation
of older people in society through different programmes. The most prominent is HelpAge
International, where 300 more senior people and 1300 people of all ages participated. All
the institutions involved have fought, through their different programmes, to make older
people visible and encourage their participation in society.
5. Anti-discrimination programmes during the COVID-19 pandemic
There have also been more specific programmes, such as those against discrimination
during the COVID-19 pandemic, such as one carried out by HelpAge International, where
they developed a series of guidelines for the elderly, families, caregivers and nursing
homes to support them, as well as making the age discrimination faced by many older
people throughout the pandemic visible. During the pandemic, these programmes against
discrimination were joined by the National Association of Social Centres, Aged and Garden
Committees (ANCeSCAO—APS) in Italy, the Uganda Reach the Aged Association (URAA),
Serbian Red Cross and 50plus Hellas in Greece.
In addition, programmes were carried out for the provision of material and food that
supplied sanitary and health products and hygiene kits and supported the elderly confined
at home in daily tasks, highlighting the work of Europe, specifically the Ukrainian Charity
“Turbota pro-Litnih v Ukraine” (Age Concern Ukraine), which was tasked with deliver-
ing food and hygiene items to more than 1000 older people in various non-government-
controlled areas in Donbass. The donors were Germany, with the EVZ Grant from the
German Federal Fund with 50,000 euros and France, with the French Embassy contributing
5000 euros.
In summary, during the COVID-19 pandemic, anti-ageism programmes have been
carried out to make the existing discrimination visible, in addition to providing health and
nutritional aid. Eight institutions worldwide participated.
Land 2022, 11, 195 12 of 18

4. Discussion
Research on ageism is important given that ageism may have a negative effect on
both individuals and society, and it has increased since the COVID-19 pandemic [9,10,38]
Moreover, the WHO has identified reducing ageism as a key target for improving human
health [39]. Although we can find numerous interventions and programmes to combat
ageism, the overall effectiveness of these programmes is still unknown [40], especially
considering the variation across different cultures and among older adults themselves [23].
This paper has examined policies and programmes developed to combat ageism through
two sources of information: a literature review, searching for updated academic studies
and an online questionnaire, addressed to worldwide institutions to obtain information
about programmes carried out in different countries (and cultures) and their results.
The literature review has shown, as Burnes et al. [23] have already highlighted, that
ageism interventions are mostly intergenerational interventions, educational programmes
and interventions that include both educational and intergenerational contact components.
Burnes et al. [23] reviewed 63 studies and showed that these three interventions had an
effect on attitudes towards ageing (including stereotypes towards ageing and prejudice
towards older people), and increasing knowledge about ageing. Additionally, they showed
that the greatest change in attitudes towards aging, knowledge of aging and well-being
in dealing with older adults occurred when education and intergenerational contact were
combined, but these changes did not occur in terms of anxiety about their own aging, or in
terms of interest in working in the field of the elderly.
Our findings suggest that these interventions reduced negative stereotypes about
ageing and improved attitudes toward ageing, combating ageism and, in turn, improving
the health and well-being of older people, although only four of the studies developed
were randomised, with the rest using a quasi-experimental design. As Burnes et al. [23]
concluded in their review, “more rigorous designs to examine the effects of interventions are
strongly recommended” (p. 10). In contrast, we did find that an educational intervention
might provoke more positive behaviour toward older adults, and more willingness among
social work students to consider a career in geriatrics [30]. Furthermore, intergenerational
service learning has emerged as an intervention that can significantly decrease ageism
scores in undergraduate students [37], and in addition of the opportunity to engage in
“real-life” contact experiences with older adults, the students also engaged in personal
exploration of older adults’ service settings. Having the opportunity to increase knowledge
of ageing and familiarity with the reality of the older adults’ world may encourage empathy
and a more positive vision of older adults in students and younger people [41]. The
promotion of empathy emerges as a construct that might provoke the willingness to work
with older adults.
On the other hand, most of the studies reviewed by Burnes et al. [23] were from the
United States; therefore, the authors recommended that research be undertaken in different
places around the world, taking into account the possible variations across different cultures.
In our study, we performed an updated literature review of ageism programmes from
different databases, searching for studies around the world. We found a study comparing
ageism during the COVID-19 pandemic in three English-speaking countries (Australia, the
United Kingdom and the United States) finding no variation [42], but there were no more
studies from different cultures. This is one of the reasons for our second data source: an
online questionnaire sent to international and national institutions surveying their policies
or programmes against ageism worldwide.
The online questionnaire sent to the international and national institutions that we
surveyed regarding their policies or programmes against ageism was answered by a small
percentage of the entities, although it was sent to five continents.
The institutions that completed the questionnaire were from all around the world,
developing different programmes and actions in five blocks during the COVID-19 pan-
demic: (1) policy and law; (2) intergenerational programmes; (3) educational programmes;
(4) social participation programmes, and (5) anti-discrimination programmes. Addition-
Land 2022, 11, 195 13 of 18

ally, although for some of them we could ascertain how many people participated or the
number of programmes developed, we found no analysis of how the situation changed (an
experimental design with a pre- and a post-evaluation), or an analysis of the outcomes.
The discrimination that older adults experience increases in the case of women, who
are subject to greater discrimination [43,44]. Therefore, gendered ageism is an increasing
issue that must be attended to. In this study we found that there are international insti-
tutions that are working towards the human rights of older women, which indicates that
society is going in the right direction, although these programmes have not been evaluated.
In sum, there is no global analysis of strategies that can work towards addressing
ageism, and, therefore, it is necessary to analyse what strategies and policies exist. Al-
though Dixon and Sibthorpe [45] emphasised the importance and role of policy makers
and scientists in promoting health and well-being, there is still a need to evaluate the
programmes and policies that have been carried out in order to identify the strategies that
truly and effectively tackle ageism.
Social policy is concerned with the ways societies across the world meet human needs
for security, education, work, health and well-being. Social policy has the goal of addressing
how societies respond to important challenges, such as the growth of the elderly population,
demographic and economic change, poverty, pensions, health and social care. Social policy
considers the different roles of national governments, the family, civil society, the market
and international organisations in providing services and support across the course of life
of individuals.
In the present moment, living in the midst of the COVID-19 pandemic, it is even more
important, since we have seen evidence of openly ageist discourses, and we have even seen
hashtags such as #BoomerRemover on social media platforms [46], or other ageist phrases,
such as coffin dodger and boomer doomer, expressing younger adults’ hostility toward
older adults, blaming older adults as the culprits of all the health and safety behaviour
modifications implemented during the pandemic [42]; thus, this reflects younger peoples’
views that the pandemic is an issue for older people (“old people problem”) [42]. These
ageist discourses and social media messages are contributing to feelings of worthlessness
in older people and a sense of having no value [10], and at the same time, it has reinforced
paternalistic perceptions that infer older adults are fragile and vulnerable [41,47].
In this sense, some society support (mainly long-term care and adult children) has been
directed towards protect older adults with overaccommodative polices and/or behaviours
(such as avoiding contact with or sequestering older adults) that may undermine older
adults’ autonomy, their right to make their own health-based decisions and even their social
and emotional wellbeing [21,47]. Vale et al. [48] showed that both hostile and benevolent
ageism predict divergent responses to the pandemic; while hostile ageism is associated
with less pandemic-related health and safety precautions, benevolent ageism is related
to increased behaviour changes, but only as a result of increased pandemic-related fear.
These findings are fundamental for developing programmes or policies representing older
people in the context of the pandemic, as well as in deciding which messages to use,
because they may have indirect consequences on how older people are viewed and thus
treated [42,47,48].
Furthermore, taking into account the determinants that seem to contribute to other
and self-directed forms of ageism, interpersonal contact with older adults emerges as
fundamental, specifically the quality of the contact over frequency and in regards to the
importance of how older individuals are presented [49]. Therefore, several aspects need
to be addressed: firstly, stimulating intergenerational contact in a positive context and
secondly, promoting the presentation of more positive images of older adults. These are
themes that must be taken into consideration by social policies.
In our study, we determined that it is necessary to carry out more rigorous studies on
the effect of anti-ageism programmes. While it is true that studies carried out by scientists
are more “objective”, only a small number of them are randomised controlled trials, which
are necessary to obtain proven data on the benefits of these programmes. On the other hand,
Land 2022, 11, 195 14 of 18

although we can only discuss the institutions that answered our questionnaire (constituting
a small percentage of the existing entities), they did not offer the results of the programmes
carried out, and in the few cases that they did, if at all, it was only via the annual reports of
the entities. Nonetheless, we can affirm that there are entities on four continents that carry
out policy and laws, intergenerational and social participation and educational and specific
programmes during the COVID pandemic: Asia, Africa, America and Europe, although we
only obtained a small number of answers to our online questionnaire.
As Scriven stated ([50], p. 1) “Evaluation is the process of determining the merit, worth
and value of things, and evaluations are the products of that process” and is considered a
basic methodology of social sciences. Furthermore, social policies refer to those sets of ideas,
plans, projects or programmes developed for responding to social needs, aimed at reducing
inequalities in access to services between citizens, independently of their socio-economic
status, race, ethnicity, migration status, gender, sexual orientation, disability or age.
Weiss [51] is one of the pioneers in linking social policies and programme evaluation
through the concept of policy analysis, having created the journal Educational Evaluation
and Policy Analysis in 1979, which addresses many of the crucial and complex issues that
concern evaluators and public managers. Weiss explains how the political context in
which social programmes work and evaluations are implemented could help programme
managers and evaluators improve. More specifically, she examines how evaluation research
can help improve public policy making and how programme evaluation studies can be
utilised. She also describes theory-based evaluation and why it matters, as well as the
implications of the political nature of public programmes. In Spain, Agulló-Tomás et al. [52]
have analysed 439 programmes for older people caregivers, which were mostly carried
out by non-profit institutions and public Spanish entities; the authors highlighted several
identified weaknesses: the lack of adaptation to different contexts (social and cultural and
political and institutional), a lack of specific targets as outcome indicators and the need for
more outcome evaluations and better quality of the evaluation itself.
The methodology resources do not appear to have been extensively or systematically
utilised in the study of social policies. As pointed out previously by Officer & de la
Fuente-Núñez [40], programmes and policies need to be evidence-based to understand the
nature of the problem, who is affected and how, and which actions have been successful.
Furthermore, they should be supported via long-term funding to ensure sustained actions
to combat ageism. Therefore, programmes would benefit from the optimal use of evidence,
which could reliably inform practice and policy.
The COVID-19 pandemic has had an overwhelming impact on older persons. One
lesson to learn is that addressing ageism is critical for creating a more equal world in
which the dignity and rights of every human being are respected and protected. As several
authors have highlighted, the pandemic provides an optimal opportunity to work on
ageism in natural situations, not in artificial research scenarios [8,21,42,48].
In sum, the state of the art of anti-ageism social policies could be summarised as some
lights and plenty of shadows. We are going to discuss the light and shadows at an academic,
social and political level.
In academic studies, we found the following lights: (1) Interpersonal contact with older
adults is crucially important, specifically the quality of the contact over frequency and also
the importance of how older individuals are presented. (2) The greatest changes occurred
when education and intergenerational contact are combined, which may reduce negative
stereotypes about ageing and improve attitudes toward ageing, combating ageism and, in
turn, improve the health and well-being of older people. Moreover, educational interven-
tion might provoke more positive behaviour toward older adults and more willingness in
students to consider a career in geriatrics.
On the other hand, we found the following shadows: (1) There is a lack of studies
across different cultures. There is a need for more worldwide research, so scientists can
analyse the possible variation across different cultures, and therefore, design programmes
and policies personalized to each culture, if necessary. Older adults’ images may vary
Land 2022, 11, 195 15 of 18

between cultures; therefore, it is necessary to take this into consideration in the design of
these programmes, in terms of their effectiveness. For example, a programme designed for
Asian people, in an occidental country, may not be as effective as in an oriental country.
(2) Although there are numerous studies focused on combating ageism, very few of them
use randomised and controlled studies.
Focusing on social and political programmes, there are a number of programmes
combating ageism around the world, although there is a need to know what is really
working and what is not. Between the lights we found: There are numerous programmes
and actions carried out in different countries in five blocks: (1) policy and law; (2) intergen-
erational programmes; (3) educational programmes; (4) social participation programmes,
and (5) anti-discrimination programmes during the COVID-19 pandemic
Between the shadows we found: There is a lack of more rigorous studies on the effect
of anti-ageism programmes. There is no global analysis of the strategies that can work
towards addressing ageism and, therefore, it is necessary to analyse the strategies and
policies that are being carried out. We found numerous programmes worldwide, but there
is no evidence of the overall efficacy, effectiveness and efficiency of such programmes.

4.1. Limitations
The data obtained are not fully representative, since only a small percentage of the
institutions which work for older adults answered our questionnaire. We must take into
account that this study was carried out during the COVID-19 pandemic, and the informa-
tion obtained is important for reflecting on two important points. First, institutions should
be urged to perform external evaluations of their anti-ageism social policies. Furthermore,
institutions should also self-evaluate their programmes regarding policy and comments
that might underlay ageist attitudes and promote age discrimination: for example, is an age
limit proposed to restrict access to intensive care? Should older people isolate themselves
instead of requiring widely implemented social distancing measures? [12,47]. Secondly, it
is necessary to urge scientists to use randomised and controlled studies.

4.2. Future Research

Future academic studies should focus on several important points. Firstly, ageism
programmes around the world should be evaluated, taking into account the possible
variation across different cultures. Moreover, it is important to urge socio-political scientists
to standardize outcome evaluation of all types of socio-political actions and programmes
trying to implement empirical methods and controlled studies.
Secondly, future studies need to evaluate the programmes and policies that have been
carried out in order to identify the strategies that truly and effectively tackle ageism; there
are many programmes carried by different institutions and international government, but
they have not been evaluated.
Regarding social policies, there are two themes that need to be taken into consideration:
firstly, stimulating intergenerational contact in a positive context and secondly, promoting
the presentation of more positive images of older adults. Programmes and policies need to
be evidence-based to understand the nature of the problem: who is affected and how, and
which actions have been successful.

5. Conclusions
Research about the evaluation of programmes combating ageism emerges as a fun-
damental task worldwide. Although we can find numerous actions, interventions and
programmes combating ageism worldwide, the overall results of these programmes are still
unknown. It is important to standardize outcome evaluations of all types of socio-political
actions and programmes, as well as to evaluate programmes and policies that have been
carried out in order to identify those strategies that truly and effectively impact ageism.
Land 2022, 11, 195 16 of 18

Author Contributions: R.F.-B. and M.S.-I. designed the systematic review and online questionnaire.
M.S.-I. extracted the information from the studies from the systematic review. R.G.-S. and M.S.-I.
extracted the information from the online questionnaire. R.F.-B., M.S.-I. and R.G.-S. contributed to the
interpretation of the results. R.F.-B., M.S.-I. and R.G.-S. wrote the manuscript. All authors have read
and agreed to the published version of the manuscript.
Funding: This work is part of the R&D Activities Program ENCAGEn-CM: “Active Ageing, Quality
of Life and Gender. Promoting a positive image of old age and ageing, and combating ageism”.
Funded by the Community of Madrid, Programs of R&D on Social Sciences and Humanities, and co-
financed with the European Social Fund (Ref. H2019/HUM-5698) (https://encage-cm.es/, accessed
on 1 December 2021).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Conflicts of Interest: The authors declare no conflict of interest.
Statement of Ethical Approval: This type of study does not require approval by an ethics committee.
It is not a direct intervention, but a self-report. All participants were informed of the research
and the voluntary nature of participation and were informed about the possibility of dropping out
of the survey at any time. They provided informed consent prior to accessing the questionnaire.
Additionally, all information is encoded or anonymised.

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