What Is Gerontophobia?

Introduction

Gerontophobia is the irrational fear of elderly people and old age. The word comes from the Greek words for old man (‘geron’) and fear (‘phobos’). Gerontophobia is a specific phobia which refers to an intense fear directed towards a specific object or situation. The term ‘gerontophobia’ was coined by psychologist Joseph H. Bunzel. He defined it as the unreasonable fear or irrational hatred of older people by society and by themselves.¹  

According to the Diagnostic and Statistical Manual (DSM-5) published by the American Psychiatric Association, a specific phobia is a type of anxiety disorder involving a marked fear or anxiety about a specific object or situation.² 

The object or situation that a phobia is directed at is known as a phobic object. Based on the phobic object, a specific phobia can be of five types:  

• Animal type (e.g., the fear of fish or insects)
• Natural environment type (e.g., the fear of thunderstorms or closed spaces)
• Blood-injection-injury type (e.g., the fear of needles or wounds)
• Situation type (e.g., the fear of social interactions or carnivals)
• Unspecified type (e.g., the fear of children or old age)    

Understanding gerontophobia

How is gerontophobia diagnosed? 

Gerontophobia, like any specific phobia, is diagnosed when  

• A particular object or situation, known as the phobic stimulus, provokes immediate and marked fear or anxiety.
• The fear experienced is intense or severe, varying with proximity to and occurring in anticipation or presence of the phobic object. 
• Fear response is evoked nearly every time the phobic object is encountered, though the degree of fear might vary across situations.
• The person actively avoids the object or situation or faces it with intense anxiety.
• The fear or anxiety experienced is out of proportion to the actual danger that the phobic stimulus presents.
• The fear, anxiety, or avoidance is persistent, typically lasting over 6 or more months.
• The specific phobia causes significant distress or impairment in important areas of functioning. 
• The disturbance cannot be explained by symptoms of another mental disorder.²

What are the signs and symptoms of gerontophobia?

Gerontophobia is described as an unspecified type of phobia. Along with the traditional conception of a phobia, research about gerontophobia as a concept defines it as the negative attitudes or dislike that individuals feel for the old and elderly. 

Bunzel describes different forms of gerontophobia in terms of the attitudes and behaviours influencing it.¹ These are: 

• Overt gerontophobia: Negative attitude and behaviour towards the elderly. It is expressed through negative prejudice and negative discrimination. For example, a bank employee who refuses to work with and assist elderly customers. 
• Covert gerontophobia:
  • Type 1: Negative attitude and positive behaviour towards the elderly. It is expressed as treating older people positively or respectively despite having negative attitudes towards them. For example, a nurse with conflicted relations with her grandparents treats her patients with care.
  • Type 2: Positive attitude and negative behaviour towards the elderly. This type of covert gerontophobia emerges as a result of an individual rationalising their negative behaviours with positive thoughts. For example, a manager refuses to hire elderly employees, believing them to be bad workers, though he admits to having no problem with old people.

Physiological signs of gerontophobia are similar to those of other phobias, such as: 

• Increased heart rate, difficulty in breathing, tightness or pain in the chest
• Sweating, chills, hot flushes, or pallor (blood rushing out of your face)
• Shaking, muscle tension, trembling, dizziness, fainting
• Nausea, stomachaches, upset stomachs, vomiting 
• Panic attacks, in extreme cases 

Emotional signs of gerontophobia are related to the attitudes a person might have about elderly people or ageing: 

• Intense distress, fear, and anxiety in the presence of old people 
• Fears are associated with physiological signs of ageing, such as wrinkles, pains and aches, decreasing stamina, memory loss, etc. 
• Fear and distress at the thought of mortality, ageing, death, and similar processes
• Negative attitudes, including disgust, dislike, or hatred of the elderly, which can include family members

Behavioural signs of gerontophobia can be either avoidance or discriminatory behaviours: 

• Refusing to interact or engage with elderly people 
• Avoiding places or situations with elderly people, such as care/nursing homes or hospitals
• Overt signs of distress when encountering elderly people
• Excessive preoccupation with ageing and symptoms of ageing and marked distress at the thought of ageing 

How does gerontophobia develop? 

As with most phobias, the development of gerontophobia can be explained through the concept of associations. Association is the establishment of a mental connection or link between an object (or situation) and a feeling of fear or anxiety. This can occur through three main processes: 

• Classical conditioning: Repeated associations between a neutral stimulus and a stimulus that naturally causes distress result in the neutral stimulus producing the same distress. Thus, the neutral stimulus (like an old person) becomes the conditioned stimulus. For example, a child who hears bedtime stories about an old and evil wizard associates old age with fear, thus developing a phobia.
• Operant conditioning: Reinforcement, which can either be a negative or positive consequence, determines whether a person will repeat or engage in a particular behaviour. Negative consequences (e.g., shock or anxiety) resulting from a behaviour result in fear of that object, making a person stop showing them. Positive consequences (reduction of anxiety or fear) achieved by avoiding a stimulus will reinforce an individual to repeat their avoidant behaviours. 
• Modelling: Observing people around you or engaging in social interaction is another way association can occur. For example, if your friend associates old people with ghosts and is visibly afraid of them, you might also learn to do the same thing. 

What causes gerontophobia? 

Though there is no one specific cause of gerontophobia, it may be influenced by factors such as: 

• Past experiences and trauma: Childhood experiences, traumatic incidents (either experienced or witnessed by a person), and negative life events might lead to the development of a phobia. 
• Ageism: Ageism refers to the negative and discriminatory perceptions of people based on stereotypes about their age. The elderly become especially vulnerable targets of ageist practices. An individual may learn ageist beliefs from their immediate surroundings or social context, thus developing gerontophobia. Alternatively, the societal focus on youth and productivity can cause people to fixate excessively on their physical appearance and, thus, develop phobias related to ageing and becoming old. 
• Individual traits: Personality traits like self-consciousness, need for autonomy and independence, internal pressures and stress can increase chances of developing gerontophobia. Genetic predispositions to developing disorders, including specific phobias, may increase the likelihood of gerontophobia and co-morbid disorders like generalised anxiety disorder (GAD), or depression.
• Fear of old age: Fear of ageing or being perceived as old emerges from misconceptions and negative attitudes about it.⁵ People often associate being old with:
  • Excessive dependence on others
  • Deteriorating physical and mental functions 
  • Being perceived as incompetent or dismissed by others 
  • Being perceived as unwanted and undesirable
  • Unproductive and useless
  • Weakness, poor health, diseases, and injury 

Prevalence and demographics 

The prevalence rates for specific phobias in the world isn’t too high but accounts for significant findings.In the USA and European countries, the rates are between 6%-9%, while Asian, African, and Latin American countries report rates between 2% to 4%. Age-wise reports of specific phobias indicate that 5% of children, 16% of teenagers, and 3% to 5% of older adults are diagnosed with the disorder.²  

A study conducted in 2018 that surveyed a sample size of 1,23,902 adult participants reported that the cross-national lifetime and 12-month prevalence rates of specific phobias were 7.4% and 5.5%, respectively.3 People assigned female at birth (AFAB) are more likely to have specific phobias compared to those assigned male at birth (AMAB). Blood-injection-injury-type phobias are more prevalent in AMAB populations, while AFAB populations report more environment, animal, and situation-type phobias.²

The exact prevalence of gerontophobia specifically cannot yet be clearly defined since research in the area is limited. However, studies indicate that gerontophobia is common, especially in societies emphasising youth, beauty, and productivity, and is not necessarily restricted to an age group, gender, or cultural background. Societal ageism, i.e., the negative attitudes and stereotypes about ageing and the elderly, is often internalised by individuals and manifests as gerontophobia.⁴

Impact of gerontophobia 

1. Healthcare challenges and access

Gerontophobia is a major challenge in healthcare settings. It can result in elderly patients facing instances of misdiagnosis, inadequate assessment, or undertreatment of healthcare concerns. Alternately, gerontophobic individuals might internalise fears about ageing and be reluctant to seek medical care due to a fear of ageing. The avoidance can be the cause of unaddressed health concerns, delayed diagnosis and worsened health outcomes.⁴

2. Impact on individual well-being

Gerontophobia can cause extreme stress, despair, helplessness, and hopelessness.⁶ Research shows that people who take in negative beliefs about ageing show worse physical, cognitive, and mental health.⁵ Gerontophobic people can develop a negative self-perception of themselves as inadequate, unproductive, or burdensome. This might hold them back from pursuing their interests and hobbies or having meaningful social interactions.⁴

3. Impact on social relationships

Elderly gerontophobic people may withdraw from the public sphere and avoid social interactions. Younger people may avoid the elderly in their social circles, including family members, community members, colleagues, educators, etc. Overall, this leads to strained intergenerational links, decreased communication, and reduced social support. As a result, ageism may persist or be strengthened, increasing the risk of gerontophobia in society. Ageism is also closely linked to elder abuse, which can take different forms. 

Managing and preventing gerontophobia

How is gerontophobia treated? 

Joseph H. Bunzel recommended three basic therapeutic means for the management of gerontophobia, which are mass education, insight therapy, and intra-group management.¹ 

1. Mass education: 

Increasing awareness about old age as a stage of life and a transition of roles can help to correct negative views of ageing. A 2019 study revealed that increasing intergenerational contact combined with education about the ageing process was the most effective intervention to challenge age-related stereotypes and biases.⁵

2. Insight therapy: 

Insight therapy is a short-term, client-centred talk therapy that helps the client gain self-knowledge about how their thoughts, emotions, and feelings impact and influence their lives. Psychologists can thus help patients address their internalised beliefs about getting older and begin to see ageing as a role transition rather than something to fear. 

3. Intragroup management: 

Gerontophobia can interfere with successful ageing in how it can be the basis of discrimination against the elderly, as well as contribute to negative self-perception and old age. Internalised negative messages about ageing can result in worse physical, cognitive, and mental health.⁵ Studies show that improving outlooks on the ageing process in middle-aged adults and strengthening positive age beliefs can improve physical and psychological functioning and reduce the severity of gerontophobia. 

4. Exposure therapy:

In vivo exposure therapy is commonly used as an intervention for specific phobias. The principle behind it is to slowly and gradually expose the patient to the phobic stimulus that causes fear and anxiety until the symptoms reduce. Relaxation techniques are also taught to the patient to effectively manage their symptoms.

Systematic desensitisation is a technique in which the patient is exposed to phobic stimuli after being taught relaxation techniques. The patient and therapist construct a fear hierarchy based on the intensity of fear, and the stimuli on the hierarchy are gradually exposed to the patient.  

5. Medication:

For extreme and severe cases of specific phobias, including gerontophobia, medication may be prescribed by a licensed medical practitioner. These can be anxiolytics (anti-anxiety) or antidepressant medications alongside therapy. 

How can gerotophobia be prevented? 

Gerontophobia can be prevented using different strategies, such as: 

1. Education and Awareness 
   • Creating awareness about gerontophobia 
   • Helping people recognise their fears and seek professional help 
   • Increasing knowledge about the ageing process
2. Intergenerational interaction and contact
   • Creating spaces for the young and old to meet, interact, and spend time 
   • Improving access of elderly people to activities in public spheres 
3. Challenging ageist beliefs in society 
   • Helping people address their fears of getting older
   • Reframing negative perceptions and expectations about ageing
   • Establishing ageing as a process of role transition rather than deterioration and degeneration  
   • Questioning social attitudes about productivity, social importance, and independence based on age 

Summary

Gerontophobia is the irrational fear of old people and old age. It comes from the Greek words ‘geron’ meaning ‘old man’ and ‘phobos’ meaning ‘fear’. It is a specific phobia, which is an anxiety disorder characterised by fear and anxiety about a specific object or situation. Gerontophobia can be the basis of negative attitudes towards the elderly and can result in discrimination based on age. Gerontophobia can be managed by increasing education and awareness, insight therapy and challenging ageist beliefs, and promoting the well-being of the elderly by encouraging intergenerational interactions. It can be reduced by addressing ageist attitudes and fear of old age.