How do stereotypes work?

Numerous theories have been proposed about the genesis and effects of stereotypes. For example, both ego justification and group justification, or the notion that people consciously form positive stereotypes about themselves or their groups, have been claimed to explain the formation of stereotypes (Allport Reference Allport1958; Freud Reference Freud1966; Jost and Banaji Reference Jost and Banaji1994; Tajfel Reference Tajfel1981). Levy (Reference Levy1996), in contrast, proposed that positive or negative self-stereotypes are often acquired unconsciously. Banaji, Hardin and Rothman (Reference Banaji, Hardin and Rothman1993) were the first to recognise formally the existence of implicit stereotyping, which they described as the unconscious activation of stereotypes in the laboratory. This is achieved by presenting words associated with stereotypes on a computer-screen quickly enough to prevent their conscious awareness in the mind of the viewer. It has also been shown that many people express these implicit stereotypes only when they are activated unconsciously (Banaji, Hardin, and Rothman Reference Banaji, Hardin and Rothman1993; Devine Reference Devine1989; Eberhardt Reference Eberhardt1993).

What are self-stereotypes of ageing and how are they acquired?

With the rising number and percentage of people aged 65 or more years, stereotypes of ageing and old age and their effects on older adults are currently of great interest and importance. Levy (Reference Levy1996) neatly summarised the findings of many studies about the formation of self-stereotypes. Children adopt stereotypes about older people, which are then reinforced throughout adulthood, often without the person's knowledge. The stereotypes then become self-stereotypes when a person reaches old age. Stereotypes of ageing and old age seem to form in childhood (DePallo et al. Reference DePallo, Thomas, Thompson, Fox, Goyer and Abrams1995; Isaacs and Bearison Reference Isaacs and Bearison1986) and to stem from environmental influences including the family, other care-givers, television and other media (Allport Reference Allport1954). Zhang et al. (Reference Zhang, Harwood, Williams, Ylanne-McEwen, Wadleigh and Thimm2006) examined the portrayal of older adults in advertising in the United States, Great Britain, Germany, India and China and found that: (a) in the US, older people were under-represented in advertising relative to their representation in the population and, more specifically, older women were exceptionally under-represented in magazine advertisements, (b) older people were portrayed less positively than other age groups, (c) commercials geared for people over 45 years of age depicted people over 65-years-of-age as helpless, impaired, weak, lazy and less well informed than younger people. Even positive portrayals of older people often focus on illness (Raman et al. Reference Raman, Harwood, Weis, Anderson and Miller2006).

These stereotypes may result from information that people encounter briefly and appear to dismiss quickly (Langer Reference Langer1989). In the United States, people tend to have more negative stereotypes of old age although there are also some positive stereotypes (Brewer, Dull and Lui Reference Brewer, Dull and Lui1981; Kite and Johnson Reference Kite and Johnson1988; Levy and Langer Reference Levy and Langer1994). Levy (Reference Levy1996) asked subjects to locate positive and negative ageing primes (or prompts) on a screen by using keyboard arrows, and showed that both old and young participants took longer to identify the positive primes, which suggests that both age groups were more familiar with the negative stereotypes. The negative stereotypes of ageing persist even if an individual has positive interactions with older people, for those encountered are viewed as ‘exceptions to the rule’ (Levy and Banaji Reference Levy, Banaji and Nelson2002). Negative stereotypes are often reinforced in North America and Europe by many manifestations in the social environment, including notions that older people are dysfunctional, unreliable and in many ways unable to care for themselves (Dijksterhuis and van Knippenberg Reference Dijksterhuis and van Knippenberg1998; Levy et al. Reference Levy, Hausdorff, Heneke and Wei2000; Murphy, Monahan, and Zajonc Reference Murphy, Monahan and Zajonc1995; Palmore Reference Palmore1999).

It is not surprising, then, that many researchers have found that American children perceive old age in a negative way (Seefeldt et al. Reference Seefeldt, Jantz, Galper and Serock1977), and that many are unaware of their own stereotyping (Perdue and Gurtman Reference Perdue and Gurtman1990). Implicit age stereotypes are easily activated by common cues, such as the voice of an older person, and prompt unthinking reactions, such as younger people's over-accommodating talk with older people (Giles et al. Reference Giles, Coupland, Williams and Nussbaum1992). Making ageing salient contributes to the self-stereotyping process of what the authors call ‘instant ageing’, which leads an older person to look, move, sound and talk older than they would in a context in which age is irrelevant (Giles and Condor Reference Giles and Condor1988).

Not only are many people unaware of age stereotypes in the culture, many are unaware of the stereotypes that they themselves hold (Devine Reference Devine1989; Fazio et al. Reference Fazio, Jackson, Dunton and Williams1995; Nosek, Banaji and Greenwald Reference Nosek, Banaji and Greenwald2002a). A person's implicit stereotypes are often disconnected from what they explicitly believe (Devine Reference Devine1989; Nosek, Banaji and Greenwald Reference Nosek, Banaji and Greenwald2002b; Rudman and Glick Reference Rudman and Glick2001). A person may never explicitly express negative stereotypes but, when subliminally exposed to stereotypical words, reveal their implicit stereotypes (Devine Reference Devine1989). Though there are both positive and negative stereotypes of ageing (Brewer, Dull and Lui Reference Brewer, Dull and Lui1981; Kite and Johnson Reference Kite and Johnson1988; Levy and Langer Reference Levy and Langer1994), the negative stereotypes are more likely to be implicit (Nosek, Banaji and Greenwald Reference Nosek, Banaji and Greenwald2002b). Moreover, according to Zajonc's (Reference Zajonc2001) ‘mere exposure’ effect, repeated exposure to implicit stimuli may have a stronger effect than repeated exposure to explicit stimuli. Implicit negative stereotypes of ageing are also difficult to counteract because people will not try to change something of which they are unaware (Levy Reference Levy1996).

Sherif (Reference Sherif, Sherif and Wilson1953) demonstrated that the classification of a person by a group or in society is ‘artificial’ because the person does not necessarily accept the classification. Perhaps the stereotype does not become a self-stereotype until the person actually classifies him or herself in that way (whether this happens explicitly or implicitly). For people diagnosed with probable AD, it may be difficult to avoid considering themselves as part of the group stereotyped as dysfunctional. It is also challenging for healthy others to avoid making negative attributions regarding older people, especially when most of their encounters are with those who attend clinics and the like.

The importance of context

In a recent and welcome in-depth analysis of a German sample, Kruse and Schmitt (Reference Kruse and Schmitt2006) presented a multidimensional scale by which the salience of age can be measured in social interactions, thereby shedding light on age-related stereotypes or ‘sets of beliefs’. The authors noted that our beliefs about the attributes of people in particular social groups ‘influence [our] perceptions, judgements, and behaviour in ways that depend upon the social context, because the context modifies the relevance of those beliefs’ (2006: 395). Accordingly, in our view, hospital and memory clinics are fertile ground for the activation, among those who assess ‘patients’, of negative stereotypes of older people as being ill and dysfunctional. Kruse and Schmitt noted the extent to which people at different ages subscribed to statements that were age-salient, and found that the oldest in their study, aged 65–75 years, agreed more strongly than did those aged 45–64 years that ‘older people are a burden on society’. This suggests that the oldest people were the most likely to concur with negative stereotypes, possibly because the contexts of hospital and memory clinics or other medical facilities raise the salience of age-related stereotypes and pessimistic beliefs. Those in the German national sample were not identified as having health-related problems such as dementia, and the authors clearly did not employ questions that tapped the attitudes and beliefs of their sample about AD or other dementias. We propose nonetheless that the findings pertain to people who are beginning to manifest some signs of memory difficulties and those diagnosed with mild cognitive impairment (MCI) or AD.

The following case study reported by Corner and Bond (Reference Corner and Bond2006) is illustrative. Rose, a 65-year-old woman who experienced memory lapses, was told by one physician that she was experiencing ‘normal ageing’, and by another a few months later that she had mild cognitive impairment. Though she did not feel any different, she was sent to memory groups and clinics ‘with other folk who you know were just like vegetables. … I mean it's saying “that's going to be you in a few years”’ (Corner and Bond Reference Corner and Bond2006: 8). Though Rose did not initially count herself among the group of people she described as ‘vegetables’, she was clearly threatened by her future. Perhaps such self-classification could have been avoided if: (a) her physician had not told her that she had mild cognitive impairment, and/or (b) she did not then attend memory groups and clinics with people who were far more impaired. Clearly, physicians are heavily involved in deciding these matters, and the ethical issues entailed in diagnosing people with mild cognitive impairment are hardly settled (Whitehouse and Moody Reference Whitehouse and Moody2006). In order to make the best decision, it is important to consider the potential harm of self-stereotyping and stereotype threat on memory performance.

How stereotypes are harmful: self-stereotyping and memory performance decrements

Many older adults believe that their memory declines in old age (Hertzog, Dixon and Hultsch Reference Hertzog, Dixon and Hultsch1990), and feel helpless in preventing its decline or improving its performance (Lachman Reference Lachman1991). They tend to attribute memory deficits or difficulties to dispositional rather than situational factors like poor effort (Blank Reference Blank1982; Lachman and McArthur Reference Lachman and McArthur1986; Weaver and Lachman Reference Weaver and Lachman1990). The poor perception of one's own memory can lead to many other problems, such as dependency, the avoidance of situations requiring good memory function, unnecessary medical attention, medication, depression, anxiety, and decreased effort and motivation to use memory (Bandura Reference Bandura1989). Low confidence and perceived helplessness to prevent further memory decline contribute to poor performance on recall tasks (Berry, West and Dennehey Reference Berry, West and Dennehey1989; Hertzog, Dixon and Hultsch Reference Hertzog, Dixon and Hultsch1990; Lachman, Steinberg and Trotter Reference Lachman, Steinberg and Trotter1987), and on tests such as the Mini Mental State Examination, which has many items that require recall (Folstein, Folstein and McHugh Reference Folstein, Folstein and McHugh1975).

How do beliefs about poor memory in old age contribute to poor performance on memory tests? Levy and Langer (Reference Levy and Langer1994) found that scores on recall tasks (i.e. recalling the pattern of seven dots on a grid and recalling the sentences previously paired with photographs) were different for three culturally different samples (mainland Chinese, Americans with hearing difficulties, and Americans with unimpaired hearing) of old and young people when unaware that they were taking memory tests. Among the old participants, the mainland Chinese performed best on the memory tests, followed by the Americans with hearing difficulties – interestingly, the Chinese had the most positive views of ageing. Furthermore, there were no significant differences in the performances of the old and the young Chinese participants even though recall is often impaired in old age (Schacter, Kaszniak and Kihlstrom Reference Schacter, Kaszniak, Kihlstrom, Yanagihara and Petersen1991). Therefore, the Americans’ negative stereotypes of ageing were said to have had a detrimental effect. Given that people with probable AD have recall problems too, it may be that negative stereotypes of ageing exacerbate their recall difficulties. If negative self-stereotypes add to the recall problems of people with probable AD, it may be prudent to find ways that would: (1) allow such people to change their negative self-stereotypes, or (2) not create circumstances that would activate such self-stereotypes.

Changing self-stereotypes

Positive alterations in self-stereotypes have been attempted through explicit as well as implicit interventions. Lachman et al. (Reference Lachman, Weaver, Bandura, Elliot and Lewkowicz1992) compared the performance of older adults on memory tasks of four kinds: (1) subjects who were taught through cognitive restructuring that they have some control over the decline of their memories, (2) those taught skills to improve memory, (3) both (1) and (2), and (4) those given practice on memory tasks. There was also a control group with no intervention. Each kind of training explicitly attempted to alter the subjects' negative self-stereotypes about their memory, and each group improved their memory performance to the same extent. Those in Group 3, however, had the greatest increase in perceived control over their ability to improve their memory, suggesting that they developed a more internal locus of such control, which may protect against stereotype threat.

Levy (Reference Levy1996) attempted to alter negative self-stereotypes of old age using two explicit and one implicit intervention with older adults. The explicit interventions were false positive feedback with either internal attribution for memory (i.e. telling subjects that better results on tests occurred because their memories were better than they thought), or external attribution for memory (i.e. telling subjects that they were exposed to memory enhancing light). Neither improved the subjects' memory performance. On the other hand, the implicit intervention, subliminally flashing positive stereotypes of ageing on a computer screen for 10 minutes, improved memory performance 20 minutes later.

Levy (Reference Levy1996) also claimed that memory performance was affected after implicitly altering stereotypes of ageing only if the person could relate to the stereotype, that is, if it was a self-stereotype. In support of her claim, she showed that the performance of the older participants improved in four out of five memory tasks following positive ageing-related primes, and that it decreased in four out of five memory tasks following negative ageing-related primes. The performance of young participants, however, actually improved on two of five memory tests (learned recall and photo recall tasks) following negative primes because, according to the author, the young participants saw themselves in a more positive light than older people when presented with a negative old-age prime. The young participants predicted that they would perform better on memory tests following negative old-age primes and worse on memory tests following positive old-age primes (i.e. wisdom), because in the latter case they felt inferior. Contrary to the claim that priming affects memory performance only if the person can relate to the stereotype activated, in Levy's study the primes that activated old-age stereotypes did alter the performance of young participants. This suggests that activation of a stereotype about a group other than one's own can affect performance. Of course, ‘relating to’ a stereotype can also mean feeling better, because one is not part of the negatively stereotyped group. Rose, discussed previously, could thus be negatively affected by implicit stereotypes of people with mild cognitive impairment (MCI), dementia, and/or memory dysfunction even if she managed to escape the forced self-classification as a member of those groups.

The effects described by Levy (Reference Levy1996) have not found unequivocal support. Although Stein, Blanchard-Fields and Hertzog (Reference Stein, Blanchard-Fields and Hertzog2002) also found that using a negative age stereotype as a prime undermined performance on a photo-recall task, the same effect was not found on a task that required recall of the location of dots on a grid. Furthermore, contrary to Levy's findings, Stein and colleagues showed that using a positive age stereotype prime did not increase older adults' memory performance. They suggested, however, that the positive age stereotypes that they and Levy used as primes were not specific to good memory (the primes were ‘accomplished’, ‘wise’, ‘creative’, ‘guidance’ and ‘insightful’), and that there may have been practise effects.

For the present purpose, it is worth noting that Levy (Reference Levy1996) employed the following words as negative stereotype primes: ‘Alzheimer's’, ‘senile’, ‘forgetful’ and ‘dying’, while Stein, Blanchard-Fields and Hertzog (Reference Stein, Blanchard-Fields and Hertzog2002) employed ‘Alzheimer's’, ‘decline’, ‘dependent’, ‘senile’, ‘misplaces’, ‘dementia’, ‘confused’, ‘decrepit’, ‘incompetent’, ‘dying’ and ‘diseased’. The researchers thereby give unequivocal credence to the idea that negative stereotypes are indeed associated with the very attributes under discussion. If these words are laden with ‘negativity’, the question arises as to whether or not adults who have been exposed to decades of negative connotations associated with AD, dementia and old age, and who now are probably diagnosed with AD, are susceptible to the effects of negative self-stereotyping and to stereotype threat. Sterin (Reference Sterin2002), in a discussion of her own lived experience of AD, indicated compellingly the derogatory, depersonalising, dehumanising effects of terms such as ‘demented’. Likewise, Dr M, a 75-year-old woman in the moderate to severe stage of ‘probable AD’, described the depersonalising way she was treated by a support group leader when she or he first discovered that Dr M was ‘a group person’ rather than ‘a person’ (viz. a healthy spouse carer) (Sabat Reference Sabat2001). The second author interviewed Dr M weekly over two years, during which time she described in detail her experience of having AD, wondering if it was ‘more embarrassing than having a sexual disease’. There are many other examples in the literature of people in the mild as well as moderate to severe stages of AD who are adversely affected by negative stereotypes (Kitwood Reference Kitwood1997; Snyder Reference Snyder1999; Husband Reference Husband2000; Sabat Reference Sabat2001, Sabat et al. Reference Sabat, Napolitano and Fath2004). Words such as ‘forgetful’, ‘dependent’, ‘confused’ ‘senile’ and ‘Alzheimer's’ all call attention to attributes that are anathema to such people, even though these same people, have many positive, valued attributes in which they take pride.

Coping with negative stereotypes: the contribution of control theory

Coping with the adverse effects of negative stereotypes is not a simple matter for people with AD. Examining the problem in light of the notions of primary and secondary control (Heckhausen and Schulz Reference Heckhausen and Schulz1995) is instructive. Primary control refers to a person's attempt to ‘change the world’, so as to conform to his or her own needs, whereas secondary control refers to internal processes the goal of which is to ‘minimize losses in, maintain, and expand existing levels of primary control’ (1995: 284). People with AD clearly experience losses in primary control through the effects of brain injury and social constraints fuelled by negative stereotypes and malignant positioning that are imposed by healthy others (Sabat Reference Sabat2001). So to what degree can such people employ secondary control? It is through secondary control that a person buffers the effects of losses in primary control by: (a) adjusting one's goals to take into account the losses they experience in primary control, or (b) using downward social comparison whereby they feel better about their circumstances by comparing themselves to imagined others who are worse off (Wills Reference Wills1981). Within the framework of the theory of control, it might be argued that: (a) the effects of negative stereotypes offer possibilities for secondary control, and (b) a perspective of enhanced competence regarding old age might serve to impair self-esteem among those who suffer from AD or other severe deficits.

The use of downward social comparison by people who have a degenerative illness such as AD can be complicated because, although others are worse off than an individual, that person is keenly aware that his or her condition will inexorably deteriorate with time. Thus, the effect of downward comparison, even if positive, will be transitory. In addition, there is the problem that people with AD can compare their present and reduced abilities to their former abilities when healthier (Sabat Reference Sabat2000, Reference Sabat2001). This comparison may offer little solace because the person with Alzheimer's disease is aware of and frustrated about his or her own personal predicament, irrespective of others’ predicaments. On the other hand, the use of another form of secondary control, adjusting one's goals to account for losses in primary control, is a distinct possibility, but often requires facilitation from carers.

Steele and Aronson (Reference Steele and Aronson1995) suggested that reducing the frustration experienced (a type of secondary control) while performing stereotyped tasks may reduce stereotype threat. Several strategies can be employed by people with dementia to reduce their frustration with memory retrieval. Because there is often more than one way to perform a task or communicate an idea, Sabat (Reference Sabat2001) suggested that people with dementia who have word-finding problems be encouraged to use extra-linguistic forms of communication. An example can be seen in the following exchanges with Dr M, who throughout her life had been exceptionally literate. She found her present word-finding problems anathema, and they led her to be less and less willing to speak. She was, therefore, encouraged to use mime and gestures, as when trying to describe an aspect of her son's life. She said, ‘he's very, uh’, and then made large ‘busy’ movements with her arms. The interviewer suggested, ‘active’, to which Dr M replied, ‘Exactly … who need words?’ and laughed heartily (Sabat Reference Sabat2001: 86). Dr M was encouraged to adjust her methods of interpersonal communication and thereby was able to exercise secondary control.

One can also encourage circumlocution, describing a word without using the word itself. The second author said to Dr M, ‘You may have trouble finding the word, “physician”, and so you'll say, “the person who takes care of me when I'm having any problem physically”’ (Sabat Reference Sabat2001: 74). Although some view circumlocution as pathological, it can be of great value in maintaining communication. Another form of secondary control entails the use of diaphragmatic breathing – inhalation from the diaphragm rather than the thoracic area of the chest – to decrease arousal when one is unable to perform a desired task (Rosenbaum Reference Rosenbaum1989). Teaching people with AD forms of secondary control to reduce their frustration may also reduce the effect of negative self-stereotyping and thereby enhance performance.

Another method of avoiding the negative effects of stereotype threat may be to reduce factors such as anxiety and an external locus of control, both of which increase one's vulnerability to stereotype threat. Anxiety and frustration operate together, so the strategies used to reduce frustration may also reduce anxiety. Many means of increasing the internality of one's locus of control have been examined. Though the cognitive restructuring and memory improvement skills that Lachman et al. (Reference Lachman, Weaver, Bandura, Elliot and Lewkowicz1992) taught to older people did not reduce self-stereotyping, it is likely that such skills would reduce stereotype threat through their ability to increase a person's perceived control over his or her life. Amrhein, Bond and Hamilton (Reference Amrhein, Bond and Hamilton1999) and Rodin (Reference Rodin1980) found that they were able to increase internal locus of control by giving people more responsibility and control over personal decisions.

In a similar manner, Sabat (Reference Sabat2001: 153) explained to Dr M how she could share her thoughts with a support group despite her word-finding difficulties: ‘It's taking a certain amount of control. Taking the control for yourself. If someone else has not given you the opportunity or doesn't seem to understand that you need time to develop, to find, the words that you want to use, then you have to say, “Wait a minute, bear with me, please don't interrupt, I'll get to it, you have to be patient”’. Dr M readily took this advice and was able, with some supportive encouragement, to take primary control (Heckhausen and Schulz Reference Heckhausen and Schulz1995) over the situation in the support group and thereby express her thoughts. Many people with AD may not be as capable as Dr M. in taking control over (or exercising primary control in) their lives, and so care-givers, family, friends and health-care professionals should wherever possible consider giving people with AD more responsibility over their own lives. This increased responsibility may, as Amrhein, Bond and Hamilton (Reference Amrhein, Bond and Hamilton1999) and Rodin (Reference Rodin1980) have suggested, help develop a more internal locus of control that may reduce the negative effects of stereotype threat.

Stereotype-threat theory

Steele and Aronson (Reference Steele and Aronson1995) proposed a theory of stereotype threat, which suggests that mere awareness of the existence of a stereotype pertaining to a group with which one identifies can have a negative effect on subsequent performance. Specifically, one's performance may become worse than that of non-stereotyped groups on a task in the stereotyped domain through a fear of either being stereotyped or of perpetuating an existing stereotype. The authors have demonstrated that African-Americans performed worse on tests of intellectual performance than White-Americans when the test was said to measure intellectual performance as opposed to psychological factors in test performance. The authors claimed that because the stereotype threat tested performance explicitly in the stereotyped domain (intellectual performance), regardless of whether or not the African-Americans believed the stereotype, they were subject to stereotype threat because they were aware of the negative stereotypes of the performance of African-Americans on tests of intellectual performance. If performance decrements associated with stereotype threat result from a person's reaction to a particular social context, changing either that person's reaction or the context may reduce stereotype threat.

Similarly, case studies of people with AD have shown that performance appears to be linked to the social context in which it occurs (Kitwood Reference Kitwood1990; Sabat Reference Sabat1991a, Reference Sabat1991b; Sabat and Harré Reference Sabat and Harré1992). Brody et al. (Reference Brody, Kleban, Lawton and Silverman1971) coined the term ‘excess disability’ to describe the additional functional incapacity, not directly resulting from physical impairment, that people experience. Because the effects of AD do not stem solely from neuro-pathology (Tomlinson, Blessed and Roth Reference Tomlinson, Blessed and Roth1970; Homer et al. Reference Homer, Honavar, Lantos, Hastie, Kellett and Millarde1988; Kitwood Reference Kitwood1987, Reference Kitwood1990, Reference Kitwood1997), Sabat (Reference Sabat1994) suggested that disability is exacerbated by dysfunctional social interactions, which Kitwood (Reference Kitwood1990) termed malignant social psychology. By activating negative stereotypes of their memory capacities, stereotype threat may contribute to the disability experienced by people with AD in this way. The awareness of and a reaction to stereotype threat may be seen in the following extract from a conversation between the second author and Dr M, who described her initial experience of a support group for people with AD:

That is, the co-leader of the group initially thought that Dr M was ‘a person’ and not someone who was a ‘group person’. The moment it became clear that Dr M had ‘that’ (AD), the co-leader abruptly ceased speaking with Dr M and announced that she would speak with Mr M (who was ‘a person’). The conjunction of the two events produced great distress in Dr M, for the response to her was quite different once the fact of her diagnosis became clear to the co-leader of the group.

Steele and Aronson (Reference Steele and Aronson1995) examined the role of frustration in stereotype threat. They claimed that it arose when it was thought that the stereotype was true and therefore a threat to the individual, and the outcome was that performance was compromised in several ways. In support, they cited evidence that attention shifts from the task (e.g. Sarason Reference Sarason and Spielberger1972; Wine Reference Wine1971), that lowered expectations lead to reduced effort on tasks (e.g. Bandura Reference Bandura1977, Reference Bandura1986), that stereotyping reduces the cues available to participants (e.g. Easterbrook Reference Easterbrook1959), of being overcautious (Geen Reference Geen1985), and of interference with self-consciousness (e.g. Baumeister Reference Baumeister1984). These processes may occur together or in succession (Steele and Aronson Reference Steele and Aronson1995).

Further elucidation of the impact of stereotype threat on memory performance is provided by Hess et al. (Reference Hess, Aumann, Colcombe and Rahhal2003), who found that the presence of negative stereotypes was a necessary but not sufficient condition for reduced memory performance among older adults. More specifically, they found that performance was also affected by the value that the subjects placed on their memory ability; the strongest negative effect was among those who had significant personal investment in their memory abilities. Furthermore, it was found that stereotype threat affected performance even when there were no explicit connections to stereotypes about old age. The effects observed may be linked to the declining use of clustering, an important strategy by which successful recall of category items is accomplished, and this was especially true in the cases of subjects for whom memory ability was highly valued. The authors proposed that stereotype threat might disrupt memory performance by increasing the subjects' anxiety or disruptive thoughts that, in turn, adversely affected the selection and use of appropriate strategies. They further noted that:

Congruent with these observations, Kruse and Schmitt (Reference Kruse and Schmitt2006) identified the contexts that stimulate age salience. People with AD who have highly-valued particular cognitive abilities, as for example memory, may be affected adversely by stereotype threat in the clinical testing situation even if negative stereotypes are not explicitly presented. Further research is warranted in this domain, for the results of neuro-psychological assessments (of people with AD, for example) may be affected negatively by: (a) situational factors including the testing environment and how it generates stereotype-threat effects, and (b) stereotyping by physicians and neuro-psychologists, rather than solely by the effects of brain injury.

As hippocampus damage has adverse effects on explicit memory (recall and recognition), people with AD may be susceptible to stereotype threat because they experience frustration with recalling information beyond that of otherwise healthy people of the same age. Dr B, a 68-year-old man with moderate to severe probable AD, was interviewed by the second author weekly over nine months. While describing the frustration of living with AD, he said;

The negative stereotyping of Dr B was apparent in an internist's comment, ‘treating an Alzheimer's patient is like doing veterinary medicine’. How that belief affected the internist's interactions with Dr B, how Dr B may have reacted, nor the prevalence of such stereotypes among physicians and other practitioners was not explored.

Factors that increase vulnerability to stereotype threat

Combining the theories of self-stereotyping and stereotype threat

Stereotype-threat theory differs from the theory of self-stereotyping in many ways (Levy Reference Levy1996). In contrast to theories of self-stereotyping, stereotype-threat theory ignores the process by which stereotypes are internalised, thereby externalising the problem and suggesting that alterations in settings can remove the negative effects of stereotypes (Steele Reference Steele1997). The two theories also differ in that stereotype-threat theory focuses on negative stereotypes that operate within conscious awareness (Steele and Aronson Reference Steele and Aronson1995), and fails to consider implicit and positive stereotypes (Levy Reference Levy1996). Though stereotype-threat theory is allegedly applicable to all stereotypes, including those of old age (Aronson et al. Reference Aronson, Lustina, Good, Keough, Steele and Brown1999), the strategy of removing oneself from the domain in which the stereotype threat occurs (secondary control in Heckhausen's and Schulz's terms) is difficult for older people when the domain is physical or cognitive health (Levy Reference Levy1996). Still, in the confines of an adult day centre, Dr B differentiated himself from the group of participants and preferred to work with the second author rather than engage in any of the group activities (Sabat Reference Sabat2001: 134).

As Dr B stated, ‘I can work in here for 30 times and all that but in this group [the day-centre participants], I'm nothing’. Asked if he was saying that he felt he had no status with the rest of the participants, he replied, ‘Absolutely, oh, absolutely. There, there should be some hier, hierarty [hierarchy]’. When asked, ‘So you feel that you're not treated with as much deference as you think you deserve?’, he replied, ‘Honestly, yes’. Rather than allowing himself to be assimilated into a group in which he felt he would lose status, he preferred to avoid taking part in any group activities. Although his behaviour might have been interpreted as ‘unco-operative’ or ‘reclusive’, Dr B was actively avoiding social situations that, in his view, would lead to his being treated as a stereotypic day-centre participant with AD. Despite these differences between the two theories, both may be useful in understanding the many factors that condition the negative effects of stereotype threat on people with AD. The effects of self-stereotyping may help explain the internal mechanisms that operate alongside the externalised process of stereotype threat described by Steele and Aronson (Reference Steele and Aronson1995).