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Contexts, Mechanisms and Outcomes of Interventions to Counter Ageism toward Older Adults in Undergraduate Health and Social Services Students: Results of a Realist Review

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Title: Contexts, Mechanisms and Outcomes of Interventions to Counter Ageism toward Older Adults in Undergraduate Health and Social Services Students: Results of a Realist Review
Language: English
Authors: Carine Bétrisey (ORCID 0000-0002-6768-0667), Juliane Scott, Mathilde Groleau, Carolane Caron, Kara Yip, Camille Bourgault, Camille Brisson, Mélanie Levasseur (ORCID 0000-0002-5914-0708)
Source: Educational Gerontology. 2024 50(7):565-593.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 29
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Aging (Individuals), Social Bias, Older Adults, Health Services, Social Services, Allied Health Occupations Education, Undergraduate Students, Student Attitudes, Intervention, Attitude Change
DOI: 10.1080/03601277.2024.2325722
ISSN: 0360-1277
1521-0472
Abstract: Ageism might reduce the effectiveness and quality of care in older adults essential with the aging population. Although interventions to counter ageism were carried out among students, no clear integration of their results described the mechanisms underlying their impact. This study aimed to provide a comprehensive understanding of which interventions amongst undergraduate health and social services students are effective, under which circumstances, how, and with what outcomes. A realist review was carried out using 44 keywords in 6 databases. The configurations for contexts, mechanisms, and outcomes were identified for three types of interventions, considering their impact on stereotypes, prejudices, and discrimination toward older adults. In the 63 studies selected, intergenerational contact interventions exhibited the greatest proportion (14/15; 93.3%) of evidence supporting improvement in outcomes of ageism, followed by combined (67/84; 79.8%) and educational (51/67; 76.1%) interventions. Stereotypes and prejudices were challenged by the transmission of realistic and balanced information, as well as through meaningful and high-quality intergenerational contact. Meeting or hearing about a broad variety of older adults in specific conditions also helped to decrease ageism. Results highlighted the importance of seeing diversity and uniqueness in older adults, and their competencies rather than their limitations. Mechanisms were occasionally hampered by obstacles, such as induced anxiety and confirmation of negative aspects of aging. Countering ageism in health and social services students is essential to ensuring high-quality care. In knowing that educators, professionals, and institutions have a direct influence on students, their awareness of ageism should be enhanced by interventions targeting them.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1428607
Database: ERIC
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  Value: <anid>AN0178024897;egr01jul.24;2024Jun25.06:09;v2.2.500</anid> <title id="AN0178024897-1">Contexts, mechanisms and outcomes of interventions to counter ageism toward older adults in undergraduate health and social services students: Results of a realist review </title> <sbt id="AN0178024897-2">Background</sbt> <p>Ageism might reduce the effectiveness and quality of care in older adults essential with the aging population. Although interventions to counter ageism were carried out among students, no clear integration of their results described the mechanisms underlying their impact. This study aimed to provide a comprehensive understanding of which interventions amongst undergraduate health and social services students are effective, under which circumstances, how, and with what outcomes. A realist review was carried out using 44 keywords in 6 databases. The configurations for contexts, mechanisms, and outcomes were identified for three types of interventions, considering their impact on stereotypes, prejudices, and discrimination toward older adults. In the 63 studies selected, intergenerational contact interventions exhibited the greatest proportion (14/15; 93.3%) of evidence supporting improvement in outcomes of ageism, followed by combined (67/84; 79.8%) and educational (51/67; 76.1%) interventions. Stereotypes and prejudices were challenged by the transmission of realistic and balanced information, as well as through meaningful and high-quality intergenerational contact. Meeting or hearing about a broad variety of older adults in specific conditions also helped to decrease ageism. Results highlighted the importance of seeing diversity and uniqueness in older adults, and their competencies rather than their limitations. Mechanisms were occasionally hampered by obstacles, such as induced anxiety and confirmation of negative aspects of aging. Countering ageism in health and social services students is essential to ensuring high-quality care. In knowing that educators, professionals, and institutions have a direct influence on students, their awareness of ageism should be enhanced by interventions targeting them.</p> <p>Population aging is a worldwide preoccupation, including for health and social services (HSS). In 2022, 10% of the world population was aged 65 and over, a proportion projected to reach 16% in 2050 (United Nations, [<reflink idref="bib69" id="ref1">69</reflink>]). HSS professionals such as doctors, nurses, social workers, psychologists, and other allied health professionals (e.g., physical or occupational therapy), therefore frequently intervene among older adults (Chonody, [<reflink idref="bib17" id="ref2">17</reflink>]; Gallo, [<reflink idref="bib25" id="ref3">25</reflink>]; Samra et al., [<reflink idref="bib63" id="ref4">63</reflink>]). Because of increasing HSS demand, efficient services and more professionals with geriatric expertise are required.</p> <p>The interest of HSS professionals in older adult care, and effectiveness and quality of their interventions, are influenced by ageism (Gallo, [<reflink idref="bib25" id="ref5">25</reflink>]; Nemiroff, [<reflink idref="bib51" id="ref6">51</reflink>]). According to the World Health Organization (WHO, [<reflink idref="bib74" id="ref7">74</reflink>]), ageism refers to the ' ... stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) directed towards people [or oneself] on the basis of their age' (p. 2). In this study, age-related stereotypes, prejudices (including interest in working with older adults) and discrimination will represent outcomes of ageism (Burnes et al., [<reflink idref="bib13" id="ref8">13</reflink>]; Chonody, [<reflink idref="bib17" id="ref9">17</reflink>]; Gallo, [<reflink idref="bib25" id="ref10">25</reflink>]). Globally and in HSS, older adults are more likely than younger adults to experience discrimination, including inequitable treatment such as unwillingness to treat, diminished quality of care, and overlooking diseases seen as a natural part of the aging process (Nemiroff, [<reflink idref="bib51" id="ref11">51</reflink>]). These experiences are caused by stereotypes and the idea that intervening in the later life is a waste of resources. Older adults are also less likely to receive adequate screening tests and preventive care, more often excluded from clinical trials, and treatment options are withheld, all of which increase their risk of negative health outcomes (Burnes et al., [<reflink idref="bib13" id="ref12">13</reflink>]). Such exclusion may explain the lack in quality and resources, and ineffectiveness of treatments.</p> <p>To counter ageism in HSS, training of professionals is of the utmost importance. Ageism can have negative repercussions on students' acquisition of knowledge and communication and behavioral skills (Willard & Crandall, [<reflink idref="bib72" id="ref13">72</reflink>]). To provide an optimal learning context, and better prepare HSS professionals for geriatrics, the proper environment and adequate tools are necessary, to develop students' knowledge and skills, and their interest in, and attitudes toward, the older population (Gallo, [<reflink idref="bib25" id="ref14">25</reflink>]; Nemiroff, [<reflink idref="bib51" id="ref15">51</reflink>]). Their training should address negative biases and increase students' knowledge about older adults and aging, and develop their skills toward building positive relationships with this population (Chonody, [<reflink idref="bib17" id="ref16">17</reflink>]; Nemiroff, [<reflink idref="bib51" id="ref17">51</reflink>]).</p> <p>Although multiple interventions during training of HSS professionals were evaluated for their effectiveness in countering ageism (Chonody, [<reflink idref="bib17" id="ref18">17</reflink>]; Martínez-Arnau et al., [<reflink idref="bib46" id="ref19">46</reflink>]), it is not clear how the key contextual elements of the interventions were integrated, and how they trigger the results. According to Burnes and colleagues (Burnes et al., [<reflink idref="bib13" id="ref20">13</reflink>]), three types of interventions may counter ageism, i.e., education, intergenerational contact, and their combination. <bold>Educational interventions</bold> consist of courses, lectures, or other methods to increase students' knowledge about older adults and aging. This knowledge is aimed at countering stereotypes and portraying a realistic vision of older adults and aging. Involving a variety of contexts and themes (e.g., reverse mentoring on digital competencies, virtual exchanges on daily life concerns), <bold>intergenerational contact</bold> is an activity for learning about the other generations through interactions, as supported by the intergroup contact theory (Pettigrew & Tropp, [<reflink idref="bib55" id="ref21">55</reflink>]). During training of HSS professionals, intergenerational contact allows students to recognize the heterogeneity of older adults and develop relationships with them in an environment other than a medical setting. The <bold>combination</bold> of educational and intergenerational contact interventions favors the transfer of theoretical content to real experiences. For example, the intergenerational service-learning consists of including community or public service (e.g., friendly visits, project design for community partners) in one course, to allow students to better understand its content by applying it in practice (Roodin et al., [<reflink idref="bib60" id="ref22">60</reflink>]). It also includes preparation to offer this service, and time for reflection on experiences. Compared to separate interventions, combined interventions demonstrated slightly better positive effects on stereotypes and prejudices (Burnes et al., [<reflink idref="bib13" id="ref23">13</reflink>]), and have a greater impact on women and adolescents or young adults. These interventions were also the most often used for changing student prejudices (Chonody, [<reflink idref="bib17" id="ref24">17</reflink>]), and interventions based on empathy were the most effective in improving their attitudes toward older adults (Martínez-Arnau et al., [<reflink idref="bib46" id="ref25">46</reflink>]). However, none of these previous reviews investigated how changes in ageism occurred, i.e., how contexts triggered mechanisms leading to the outcomes.</p> <p>To better counter ageism during HSS student training, it is essential to extend, and deepen the understanding of their interventions. To fill this gap in knowledge on how interventions work, and not merely which outcomes should be modified, such knowledge is highly needed to shed light on conditions for, and barriers to, achieving the greatest effects. This study thus aimed to provide a comprehensive understanding of the most effective interventions to counter ageism toward older adults in undergraduate HSS students, under which circumstances, how, and with what outcomes.</p> <hd id="AN0178024897-3">Method</hd> <p>To reach this objective, a five-step realist review was used (Pawson et al., [<reflink idref="bib53" id="ref26">53</reflink>]). Providing rich explanations to guide decisions, this theory-based approach synthesizes existing evidence in descriptions of contexts (C), mechanisms (M), and outcomes (O) (Wong et al., [<reflink idref="bib73" id="ref27">73</reflink>]).</p> <hd id="AN0178024897-4">Identifying the review question</hd> <p>Through knowledge users, older adults, and researchers, the following question was identified: What interventions to counter ageism among HHS students generate outcomes on age-related stereotypes, prejudices (including interest in working with older adults), and discrimination, to what extent or under what circumstances, how and why? Interventions were classified as education, intergenerational contact, and a combination of both.</p> <hd id="AN0178024897-5">Searching for evidence</hd> <p>Articles identified by Burnes et al. ([<reflink idref="bib13" id="ref28">13</reflink>]) (since 2000) were first selected, and then updated and improved using key concepts on interventions (Table 1) in six databases (Figure 1). The search also considered the Scientific Watch of the Research Chair on mistreatment of older adults and included a manual search of the references of reviews and selected articles.</p> <p>Graph: Figure 1. Prisma flow diagram.</p> <p>Table 1. Search strategy.</p> <p> <ephtml> <table><thead><tr><td>ID</td><td>Concepts</td><td>Relevant key words</td></tr></thead><tbody><tr><td>1</td><td>Ageism</td><td>Ageism, agism, ageist, agist, age discrimination, age prejudice, age stereotype, self-perceptions of ageing, self-perceptions of aging, age identity</td></tr><tr><td>2</td><td>Older adults</td><td>Aged, aging, ageing, old age, frail elderly, elder*, seniors, older adult, older adults, older person, older persons, older people</td></tr><tr><td>3</td><td>Discrimination</td><td>Social exclusion, social rejection, social acceptance, stereotyped behavior, social perception, age identification, self-perception, prejudice, stereotyp*, stereotyping, social discrimination, intergenerational relations</td></tr><tr><td>4</td><td>Intervention<sup>a</sup></td><td>Education, age education, aging education, action, actions, prevention, intervention, interventions, campaign, intergenerational</td></tr><tr><td>(#1 OR (#2 AND #3)) AND #4</td></tr></tbody></table> </ephtml> </p> <p>1 <sups>a</sups>Addition to the search strategy of Burnes et al. ([<reflink idref="bib13" id="ref29">13</reflink>]).</p> <p>Studies were included if they: 1) documented the outcomes of interventions to counter ageism in adults aged 65 and over; 2) targeted undergraduate HSS students (medicine, nursing, occupational therapy, physical therapy, psychology, social work); and 3) were peer-reviewed articles, doctoral theses or book chapters published in English or French from January 2000 to December 2020, i.e., just before the start of the Global campaign to combat ageism launched by the WHO. Because generally referring to interventions specifically adapted to these situations, studies were excluded if they targeted a specific health condition. Similarly, studies focusing on specific populations such as migrants or intra-family relationships were also excluded.</p> <hd id="AN0178024897-6">Selecting and appraising studies and extraction</hd> <p>Supervised by a researcher, 9 other people were involved in this step: 3 in the selection and 8 in the extraction (including 2 from the selection). Articles were independently selected by 2 people: a postdoctoral researcher, a research assistant or a student in the master's program in occupational therapy. Six other students, the postdoctoral researcher and the research assistant analyzed and extracted data on the C, M, and O of interventions (Table 2) using a guide and a lexicon. Throughout the extraction, the team conducted frequent standardization meetings and made continuous adjustments to the guide.</p> <p>Table 2. Characteristics of the 63 studies included in the realist review, by type of intervention.</p> <p> <ephtml> <table><thead><tr><td>Study<sup>a</sup></td><td>Study design</td><td>Participants<sup>b</sup></td><td>Intervention<sup>c</sup></td><td>Mechanisms<sup>d</sup></td><td>Outcomes<sup>e</sup></td></tr></thead><tbody><tr><td><italic><bold>Education</bold></italic></td><td /><td /><td /><td /><td /></tr><tr><td>Barrett and Pai (<xref ref-type="bibr" rid="bibr5">2008</xref>) USA</td><td>Descriptive</td><td>Sociology IG: 57/55.0% < 30; 45.0% ≥ 30</td><td>1 semester (5 discussions) Online Sociology of aging course: asynchronous discussions (cultural view of OA, ageism, sketches of OA)</td><td>Course challenged own attitudes tw aging & OA; sociological perspective on aging linked to personal experiences; enjoyment of activity</td><td>↑ P (38.6%) → P (61.4%)</td></tr><tr><td>Boswell (<xref ref-type="bibr" rid="bibr9">2012</xref>) USA</td><td>Pre-experimental</td><td>Nursing, psychology IG: 43/18–37</td><td>1 semester University Gerontology education course (changes across adult lifespan)</td><td>Course promoted accurate aging knowledge</td><td>↑↑ S ↑↑ S & P ↑↑ P ↑↑ I</td></tr><tr><td>Brand et al. (<xref ref-type="bibr" rid="bibr10">2016</xref>) AUS</td><td>Pre-experimental & descriptive</td><td>Nursing, medicine IG: 10/20–34</td><td>1 session (45') University Reflective learning (photo-elicitation technique, safe learning space, group discussions); interprofessional groups</td><td>Visual medium fostered reflection & encouraged STU to recognize unexplored assumptions about OA; active learning approach that engaged STU in personal & professional meaning making</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑ P → P (empathy) ↑↑ I<sup>#</sup></td></tr><tr><td>Briscoe (<xref ref-type="bibr" rid="bibr12">2004</xref>)* USA</td><td>Pre-experimental</td><td>Nursing IG1: 21/27.8 (6.3) IG2: 20/28.0 (6.5) CG1: 35/28.0 (5.7) CG2: 28/30.5 (6.2) (1: pre/posttest; 2: posttest)</td><td>1 semester University Gerontology nursing course (physiological, psychological & social needs in aging; aging as normal process, health promotion)</td><td><italic>Course did not adequately address misconceptions about aging; > clinical experiences in IG (observation of frail, sick OA may have reinforced stereotypes)</italic></td><td>→ S ↑↑ I<sup>#</sup> (IG & CG)</td></tr><tr><td>Can Gür and Yilmaz (<xref ref-type="bibr" rid="bibr14">2020</xref>) Turkey</td><td>Randomized control trial</td><td>Nursing IG: 61/18–41 CG: 62/18–41</td><td>8 weeks (16 sessions x 60') University & STU residences Mindfulness-based empathy training (aging, communication, empathy, mindfulness, meditation, active listening); role playing, model learning</td><td>Mindfulness meditation promoted awareness of present moment without judgment, showing compassionate feelings</td><td>↑↑ P ↑↑ D</td></tr><tr><td>Cottle and Glover (<xref ref-type="bibr" rid="bibr19">2007</xref>) USA</td><td>Pre-experimental</td><td>Medicine, education IG: 253/17–35</td><td>1 semester University Lifespan human development course (physical, cognitive & social development, 20% about OA)</td><td>Course decreased individual lack of understanding of aging <italic>STU relied more heavily on physical characteristics of an individual to define someone as being old</italic></td><td>↑↑ S ↑↑ P → P (age at which someone is old)</td></tr><tr><td>Cummings et al. (<xref ref-type="bibr" rid="bibr20">2006</xref>) USA</td><td>Quasi-experimental</td><td>Social work IG: 81/28.4 (8.7) CG: 80/28.4 (8.7)</td><td>2 semesters University Infused gerontology content (discussions, readings, exercises, videos); web site</td><td>More exposure to aging content improved aging knowledge</td><td>↑↑ S → P (anxiety) ↑↑ I<sup>#</sup></td></tr><tr><td>de la Rue (<xref ref-type="bibr" rid="bibr21">2003</xref>) AUS</td><td>Descriptive</td><td>Nursing IG: 9/20–25</td><td>24 weeks (4 sessions) University Participatory action research: exploring attitudes tw ageism, issues arising out of practicing ageism (critical reflective journal), solutions & prevention of ageism</td><td>Confronting impact of the self-identification of personal fears of own aging; > awareness of how ageism affects professional practices; reflective journal allowed critical reflection to develop changes</td><td>↑↑ D<sup>#</sup></td></tr><tr><td>Fisher et al. (<xref ref-type="bibr" rid="bibr24">2018</xref>) UK</td><td>Quasi-experimental & descriptive</td><td>Medicine IG: 37/NM CG: 47/NM</td><td>8 weeks (3 sessions x 45') University & hospital Teaching program as part of hospital-based practice module; challenges use of pejorative terms relating to OA (video, case studies, discussions)</td><td>Module promoted understanding of the complexity associated w/OA in hospital <italic>Attitudes influenced by perceived behavioral control, subjective norms & external environmental influences</italic></td><td>↑↑ S<sup>#</sup> → P (tw OA) ↑↑ I<sup>#</sup> ↑↑ D<sup>#</sup></td></tr><tr><td>Harper (<xref ref-type="bibr" rid="bibr29">2007</xref>)* USA</td><td>Quasi-experimental</td><td>Nursing IG: 21/20–49 CG: 21/20–43</td><td>13 weeks Online Gerontological nursing course; affective learning (affective problem, progression, analysis, strategy, interface design)</td><td>Course challenged misconceptions & beliefs about aging & OA; emphasized ageism issues</td><td>↑↑ S ↑↑ S & P ↑↑ P</td></tr><tr><td>Kim et al. (<xref ref-type="bibr" rid="bibr34">2017</xref>) USA</td><td>Pre-experimental</td><td>Social work IG: 72/25.2 (6.9)</td><td>1 session (45') University Course (ageism, optimistic perspectives of aging, productive aging concept)</td><td>Lecture promoted reorganization of own perceptions of aging (optimistic perspective), reversing – attitudes tw OA: focus on OA competencies > than limitations</td><td>↑↑ P</td></tr><tr><td>Lester (<xref ref-type="bibr" rid="bibr37">2019</xref>)* USA</td><td>Randomized control trial</td><td>Psychology IG: 29/18–25 CG: 31/18–25</td><td>1 session (20') University Course (age-based stereotypes, mindfulness & acceptance), exercises</td><td>Mindfulness exercise promoted awareness of ageist ideas; education to confront ageism</td><td>↑↑ S & P</td></tr><tr><td>Macdonald (<xref ref-type="bibr" rid="bibr43">2018</xref>)* (study 1)<sup>w</sup> USA</td><td>Randomized control trial</td><td>Psychology IG1: 92/18–30 IG2: 92/18–30 IG3: 104/18–30 CG: 111/18–30</td><td>1 session (3 readings) Online 3 articles to read: stereotypes about OA (IG1), stereotypes about careers working w/OA (IG2), or both themes (IG3)</td><td>Readings that addressed stereotypes about OA promoted > aging knowledge & + perception of OA <italic>Interrelated stereotypes, difficult to challenge only one aspect</italic></td><td>↑↑ S (IG3 > IG2) → S (− age S) ↑↑ S & P → P (anxiety) ↑↑ I (IG1 > IG3)</td></tr><tr><td>Madrigal et al. (<xref ref-type="bibr" rid="bibr45">2020</xref>)<sup>x</sup> USA</td><td>Pre-experimental & descriptive</td><td>Nursing IG: 27/18–25</td><td>1 session (video of 56') University FaceAge video art installation: immersive video (genuine IGC in a documentary; experiences, self-identify, intimacy, memory in aging)</td><td>Video promoted + perception of aging & expanded awareness of aging; see the individual, not only their age; video fostered changes in attitudes tw OA <italic>Video affirmed fears about aging</italic></td><td>↑↑ P<sup>#</sup> ↑↑ P → P (tw aging) ↓↓ P<sup>#</sup> (anxiety) ↑↑ D<sup>#</sup></td></tr><tr><td>Merz et al. (<xref ref-type="bibr" rid="bibr49">2018</xref>) USA</td><td>Quasi-experimental</td><td>Gerontology course IG: 34/18.0 (0.5) CG: 44/18.1 (0.4)</td><td>1 semester University Interdisciplinary gerontology course (lectures, representations, discussions, quizzes, reflection, mandatory community project)</td><td>Course w/both + & - aspects of aging covered promoted balanced representations of aging <italic>- aspects may have confirmed prejudices; attitude tw aging may be related to stable personality traits; STU may be too young to worry about their own aging</italic></td><td>↑↑ S → P (tw aging, anxiety)</td></tr><tr><td>Miron et al. (<xref ref-type="bibr" rid="bibr50">2021</xref>)<sup>$</sup> USA</td><td>Pre-experimental</td><td>Nursing IG: 43/21.3 (3.9)</td><td>9 weeks University Gerontological coursework (readings, lecture, discussions; healthy aging, age-related changes, chronic conditions)</td><td>Course activities promoted perceptions of humanness of OA with impact on attitudes tw OA</td><td>→ S & P↑↑ P↑ D (professional experience)→ D (personal experience)</td></tr><tr><td>Olson (<xref ref-type="bibr" rid="bibr52">2003</xref>) USA</td><td>Quasi-experimental</td><td>Master (MSW) & Bachelor (BSW) in social work IG: 33 MSW/22–51 & 13 BSW/20–26 CG: 33 MSW/22–54 & 17 BSW/19–50</td><td>5–6 weeks University Curriculum module in gerontological social work (practice w/OA & family; gerontology social work education needs; psychosocial & psychotherapeutic intervention w/OA)</td><td><italic>MSW may have more crystallized prejudices (maturity & experience); Interest in a client group may be dissipated w/exposure to reality of practice</italic></td><td>↑↑ P (BSW) ↑ I (BSW)</td></tr><tr><td>Ragan and Bowen (<xref ref-type="bibr" rid="bibr57">2001</xref>)<sup>y</sup> USA</td><td>Pre-experimental</td><td>Psychology IG1: 33/20.0 (2.8) IG2: 33/20.0 (2.8) IG3: 33/20.0 (2.8)</td><td>1 week (video & 2 × 25' discussions) University Information (IG1; video on myths & realities of aging); reinforcement (IG2; same video, 1st discussion to encourage challenging beliefs; 2nd discussion on how video changed attitudes); Campus life (IG3; same video, 1st & 2nd discussions about events at university, reinforcement of topics related to video)</td><td>Information promoted changes in attitudes (reinforcement necessary to maintain changes); knowing that in 2<sup>nd</sup> discussion, attitudes changes would be discussed & praised may have caused thinking about information & investing effort to change</td><td>↑↑ P</td></tr><tr><td>Sarabia-Cobo and Castanedo Pfeiffer (<xref ref-type="bibr" rid="bibr64">2015</xref>) Spain</td><td>Pre-experimental</td><td>Nursing IG: 222/21.6 (NM)</td><td>1 semester (150 hours) University Aging nursing course (health & disability in OA, person-centered practice); simulated cases, active & participative methodologies, face-to-face & online</td><td>Course content increased knowledge (challenging stereotypes); course effective in increasing + attitudes tw OA</td><td>↑↑ S ↑↑ P</td></tr><tr><td>Silver et al. (<xref ref-type="bibr" rid="bibr65">2016</xref>) CAN</td><td>Pre-experimental & descriptive</td><td>Humanities studies, health & mental health studies, mathematics & sciences IG: 51/19–25</td><td>13 weeks University Gerontology course (aging, health care, cognitive function, financial well-being, physical mobility, social support, longevity); readings, guest speakers (professionals in long-term care)</td><td>Course improved awareness of variety of aspects linked to aging (challenges, enjoying life), OA contribution to society; course exposed opportunity to positively influence expectations of aging & mental health</td><td>↑↑ S<sup>#</sup> ↑↑ P</td></tr><tr><td>Snyder et al. (<xref ref-type="bibr" rid="bibr66">2008</xref>) USA</td><td>Pre-experimental</td><td>Social work, psychology, sociology IG: 107/25.7 (7.8)</td><td>4 weeks University Gerontological module (aging, intimacy among OA, longevity, psychological, social & financial issues, working w/OA); reflection upon own values, fears & biases, case studies, video, discussions</td><td>Module improved knowledge about aging & OA, changing attitudes & stimulating interest in aging-related work</td><td>↑↑ S ↑↑ S & P ↑↑ I</td></tr><tr><td>Varkey et al. (<xref ref-type="bibr" rid="bibr70">2006</xref>) USA</td><td>Pre-experimental & descriptive</td><td>Medicine IG: 84/78.3% 20–25, 21.7% 26+</td><td>1 session (180') University Modified aging game (medication, loss of status, semi-independent living, long-term care facility living); simulation, experiential learning, groups w/facilitators</td><td>Activity improved awareness of challenges faced by OA & more realistic view of aging</td><td>↑↑ S<sup>#</sup> ↑↑ P ↑↑ I</td></tr><tr><td>Whatley and Castel (<xref ref-type="bibr" rid="bibr71">2020</xref>) USA</td><td>Quasi-experimental & descriptive</td><td>Psychology, civic & environmental engineering IG: 29/NM CG: 32/NM</td><td>10 weeks University Psychology course on successful aging (changes > declines, happiness, memory, habits); active discussions, readings, own experiences w/OA, small group activities</td><td>Active discussions promoted relating information to oneself & drawing on own experiences & existing knowledge; seeing OA as more active & engaged (less focused on physical changes) <italic>More rigid beliefs about mental health in OA</italic></td><td>↑↑ P<sup>#</sup> ↑↑ P</td></tr><tr><td>Wurtele and Maruyama (<xref ref-type="bibr" rid="bibr75">2013</xref>) USA</td><td>Pre-experimental</td><td>Psychology & allied health professions IG: 106/18–52</td><td>1 semester University Lifespan human development course (lecture on late adulthood, information to counter stereotypes); discussions on activities of OA & ageism, exercises</td><td>Comparing activities of OA & STU fostered confrontation of – stereotypes of aging <italic>Vision of late adulthood years as retiring from life: focusing on leisure more than productivity</italic></td><td>↑↑ S → P (tw OA)</td></tr><tr><td>Yamashita et al. (<xref ref-type="bibr" rid="bibr76">2018</xref>) USA</td><td>Quasi-experimental</td><td>Aging-related or general education courses IG: 80/< 45 CG: 40/< 45</td><td>1 semester (3 × 50' video & discussions) University 3 life story videos (aging-related documentaries) & discussions</td><td>Videos improved knowledge of aging & understanding of OA experiences <italic>More direct experience w/OA required for changing attitudes; maintained social distance w/OA</italic></td><td>↑↑ P → P (comfort) → D (distance)</td></tr><tr><td><italic><bold>Intergenerational contacts</bold></italic></td><td /><td /><td /></tr><tr><td>Breck et al. (<xref ref-type="bibr" rid="bibr11">2018</xref>) USA</td><td>Descriptive</td><td>Human development & family studies, pharmacy, health studies, communicative disorders, psychology IG: 26/21.8 (2.0) OA com-dw</td><td>1 semester (243 sessions, 289 hours) OA center & lifelong learning institute Reverse mentoring (mutual support): STU help OA using technological devices; STU gain skills in teaching & working w/OA; dyads</td><td>Meaningful interactions promoted bonds between generations (common values & interests), appreciation of diversity & uniqueness of OA; interactions challenged stereotypes (OA as support for community); activity promoted interest in rethinking the way OA are perceived in society</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑↑ D<sup>#</sup></td></tr><tr><td>Chase (<xref ref-type="bibr" rid="bibr15">2010</xref>) USA</td><td>Randomized control trial</td><td>Developmental psychology course IG: 23/19–28 CG: 20/19–24 OA com-dw</td><td>6 weeks (6 × 1+ e-mail) Online E-mail pen pal project: asynchronous communication outside of class; assigned topics (in-depth sharing, exploring similarities & differences); dyads</td><td>IGC fostered getting to know each other & forging deeper relationships (more personal & open communication); high-quality experiences w/OA & common activity increased + attitudes; getting to know active & involved OA widened the view of aging</td><td>↑↑ P</td></tr><tr><td>Gelman (<xref ref-type="bibr" rid="bibr27">2012</xref>) USA</td><td>Descriptive</td><td>Social work IG: 17/22–49 OA centers, nursing homes, social day treatment programs, housing agencies, case management services</td><td>1 year Community partners Gerontological practicum</td><td>Interest in pursuing gerontological work inspired by strong supervision, exposure to a continuum of care & level of functioning (realistic picture), & sense of making a difference; individualization & humanization of OA allowed changes to stereotypes, prejudices & feeling connection</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑↑ I<sup>#</sup></td></tr><tr><td>Lu et al. (<xref ref-type="bibr" rid="bibr15">2010</xref>) USA</td><td>Quasi-experimental & descriptive</td><td>Medicine IG: 46/21–33 CG: 91/21–33 OA com-dw</td><td>1 year University Senior teacher education partnership program (extracurricular program to interact with active & independent OA); dyads</td><td>Program helped to view OA holistically (looking beyond body to consider social & physical environment), functionally independent & socially active; frequent informal interactions promoted empathy & respect for OA</td><td>→ S (aging & OA knowledge) ↑↑ P<sup>#</sup> ↑↑ P (IG & CG) ↑↑ I</td></tr><tr><td>Steward et al. (<xref ref-type="bibr" rid="bibr67">2021</xref>)<sup>$</sup> USA</td><td>Pre-experimental & descriptive</td><td>Social work IG: 31/26.9 (NM) OA retirement community</td><td>1 session (60') University Intergenerational lifelong learning initiative (courses taught by STU or by OA; creative & physical activities)</td><td>New learnings about OA through activities (lively OA, physical abilities & engagement): shifted perceptions of aging & less likely to avoid OA</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑↑ I<sup>#</sup> ↑↑ D</td></tr><tr><td><italic><bold>Combined</bold></italic></td><td /><td /><td /><td /></tr><tr><td>Adelman et al. (<xref ref-type="bibr" rid="bibr1">2007</xref>) USA</td><td>Descriptive</td><td>Medicine IG: 311/24 (NM) OA com-dw</td><td>1 session (240') University EDU introduction to older patient module (ageism, communication w/OA patients; film, theater pieces); IGC interview w/OA, group discussions w/OA, peers & professors; small groups</td><td>Opportunity to learn about OA patient's identity (surprise & delight seeing vital OA), acknowledgment of unique personhood promoting reflection on preconceptions; theater fostered seeing ageist behavior & observing how it interfered w/diagnosis</td><td>↑↑ P<sup>#</sup> ↑↑ I<sup>#</sup></td></tr><tr><td>Alford et al. (<xref ref-type="bibr" rid="bibr2">2001</xref>) USA</td><td>Quasi-experimental & descriptive</td><td>Medicine IG: 204/NM CG: 200/NM OA older professors</td><td>2 semesters (6 sessions) University & OA residences EDU geriatrics continuity of care track course (didactic presentation about OA & aging); IGC visit to OA, reflection questions</td><td>Frequent contacts with healthy OA improved comfort w/OA; shifted view about physical decline in aging w/combined class sessions & relationships w/OA</td><td>↑↑ S ↑↑ P<sup>#</sup> ↑↑ P ↑ I</td></tr><tr><td>Andreoletti and Howard (<xref ref-type="bibr" rid="bibr3">2018</xref>) USA</td><td>Pre-experimental & descriptive</td><td>Adult development & aging course IG: 50/21.6 (2.3) OA assisted-living community</td><td>2 semesters (2 × 3 sessions x 60–75') University & assisted-living facility ISL WISE program: EDU aging course; IGC discussions w/OA; equal status, common interests & goals; small groups</td><td>Meaningful interactions w/variety of OA promoted appreciation & understanding of diversity within OA (realistic picture); topics to focus on similarities & differences w/OA; stereotypes challenged without having to talk about age</td><td>↑↑ S<sup>#</sup> ↑↑ S & P → P (anxiety)</td></tr><tr><td>Augustin and Freshman (<xref ref-type="bibr" rid="bibr4">2016</xref>) USA</td><td>Descriptive</td><td>Health care administration IG: 24/21–30 CG: 12/21–30 OA adult day care center, residential facility</td><td>10 weeks (20+ hours & 60' orientation) Adult day care center & residential facility ISL: EDU (management, communication, OA diversity; case studies, group discussions); IGC games, discussions, videos; equal status, cooperation, common goals & authority support, quality & meaningful; small groups, dyads</td><td>Course promoted disconfirmation of stereotypes (e.g., physical health); + experiences in a care delivery setting fostered empathy & comfort w/OA; envisioning own aging process increased + attitudes tw OA & interest in working w/OA</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑↑ I<sup>#</sup> ↑↑ D<sup>#</sup></td></tr><tr><td>Beling (<xref ref-type="bibr" rid="bibr6">2003</xref>) USA</td><td>Randomized control trial</td><td>Physical therapy IG: 21/30.3 (NM) CG: 19/28.6 (NM) OA community services (wide spectrum of OA)</td><td>1 semester (EDU & 32 hours IGC) University & community partners ISL: EDU geriatric rehabilitation course (video, team projects, discussions); IGC community service w/preparation & reflection (journal, discussions)</td><td>Course challenged misconceptions about OA individual characteristics & social aspects of aging; experiential component necessary to improve both aging knowledge & attitudes tw OA</td><td>↑↑ S ↑↑ P</td></tr><tr><td>Bernard et al. (<xref ref-type="bibr" rid="bibr7">2003</xref>) USA</td><td>Quasi-experimental</td><td>Medicine IG: 117/23.6 (NM) CG: 108/24.9 (NM) OA com-dw</td><td>4 semesters (4 sessions: 90' IGC & 90' debriefing; 120' EDU) University & neutral location ISL senior mentor program: EDU (lectures, debriefing, discussions in class); IGC structured interviews w/healthy OA (lifestyle, activities); dyads</td><td>Beneficial effect of exposure to healthy OA</td><td>↑↑ P</td></tr><tr><td>Chen and Walsh (<xref ref-type="bibr" rid="bibr16">2009</xref>) Taiwan</td><td>Randomized control trail</td><td>Nursing IG: 100/18–19 CG: 96/18–19 OA long-term care institutions</td><td>9 weeks (8 sessions x 120') University & long-term care institutions EDU (communication guidelines, discussions on reflection questions); IGC creative-bonding intervention (art); dyads; encouragement to spend extra time w/OA</td><td>Connections provided by creative approach; art activities initiating interactions & bridging gap among generations</td><td>↑↑ P ↑↑ D</td></tr><tr><td>Corwin et al. (<xref ref-type="bibr" rid="bibr18">2006</xref>) USA</td><td>Descriptive</td><td>Medicine IG: 36/27.9 (NM) OA com-dw</td><td>4 years (4 × 4–6 sessions IGC) University & OA residences Senior mentor program: EDU geriatric knowledge & competencies (physiology of aging, behavior changes); IGC OA mentoring STU; dyads</td><td>Program helped change stereotypes w/awareness of aging as personal, individualized process (diversity) & importance of + attitude tw aging; fostered + experience & mutual learning; integration in clinical setting</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup></td></tr><tr><td>Dorfman et al. (<xref ref-type="bibr" rid="bibr22">2003</xref>) USA</td><td>Quasi-experimental & descriptive</td><td>Social work, aging studies, health & leisure & sport studies, nursing IG: 13/NM CG: 34/NM OA nursing home, semi-independent living apartments</td><td>1 semester (EDU & 4 visits x 240') University & community partners ISL EDU introductory social work gerontology course (biological, social & psychological aspects of aging); reflective journals, presentation; IGC community service (friendly visits, reminiscence, oral history); dyads</td><td>Contacts w/OA promoted understanding (reality of aging) & challenged stereotypes about OA in nursing homes; discussions w/peers allowed comparison of, & reflection on, experiences</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑ P ↑↑ I<sup>#</sup></td></tr><tr><td>Ferrario et al. (<xref ref-type="bibr" rid="bibr23">2007</xref>) USA</td><td>Descriptive</td><td>Nursing IG: 17/23 (NM) CG: 117/25.6 (5.8) OA com-dw, care retirement centers</td><td>1 year (EDU & 6× home visits w/OA) University & community partners & OA residences EDU advanced education in aging (normal changes in aging, successful aging; communication, patient care management, critical thinking); IGC health teaching, basic physical assessments w/OA</td><td>Coursework & clinical experiences w/healthy OA contributed to increase + attitudes tw OA; role modeling of pro-aging attitudes (focused on + aspects)</td><td>↑↑ P<sup>#</sup></td></tr><tr><td>Gardner and Alegre (<xref ref-type="bibr" rid="bibr26">2019</xref>) CAN</td><td>Descriptive</td><td>Public health IG: 191/NM OA residences</td><td>12 weeks (12 × 180' & 1 × 120' simulation) University & OA residences ISL through their eyes project: EDU reflection journal, aging simulation; IGC developing healthy communities (intergenerational teams to identify age-friendly elements & opportunities for change; interview, observation); dyads</td><td>Preconceived notions challenged, awareness of internalized stereotypes (see similarities over differences); social awareness (empathy) of difficulties experienced by OA promoted perceptions & behavior changes; research-based, community-engaged & critical project fostered confidence in communicating & relating to OA</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> ↑↑ D<sup>#</sup></td></tr><tr><td>Genoe et al. (<xref ref-type="bibr" rid="bibr28">2013</xref>) CAN</td><td>Descriptive</td><td>Therapeutic recreation IG: 6/NM OA com-dw</td><td>10 weeks (10 × 50') University Intergenerational learning seminars in therapeutic recreation aging course: EDU (demography, ageism, diversity, physical, cognitive & psychological well-being, long-term care); IGC mutual learning, readings, in-depth discussions, OA life stories; common goal, authority support</td><td>Face to face contact fostered better understanding of each other; seminars held in less structured environment than usual allowed STU to have greater input in discussions; engaging discussions around leisure activities helped build rapport on similarities & differences between generations</td><td>↑↑ S<sup>#</sup> ↑↑ P<sup>#</sup> → I<sup>#</sup></td></tr><tr><td>Hernandez and Gonzalez (<xref ref-type="bibr" rid="bibr30">2008</xref>) Spain</td><td>Pre-experimental</td><td>Sport & exercise science IG: 79/19.0 (0.9) CG: 100/19.0 (0.9) OA com-dw (slight depression)</td><td>32 weeks (32 × 55') Council social center ISL EDU before IGC (lectures; psychology of life-span development; practical classes on movement programs for OA); IGC recreational activities (games w/physical exercises & relaxation); small groups</td><td>Interaction w/OA tended to improve attitudes tw OA <italic>Interaction w/OA based on a deficiency (negative stereotype related to OA mobility) may improve stereotypes</italic></td><td>↑ S</td></tr><tr><td>Holroyd et al. (<xref ref-type="bibr" rid="bibr31">2009</xref>) CAN</td><td>Pre-experimental</td><td>Nursing IG: 179/58.4% ≤ 25, 41.6% 26+ OA long-term care institutions (complex chronic illnesses)</td><td>4 years (EDU & 2 × 220 hours practicums) University & long-term care institutions & acute medical & surgical settings ISL nursing curriculum: EDU (courses on gerontological concepts); IGC practicums</td><td><italic>Minimal opportunity for practice experiences w/healthy OA; practicums w/OA requiring high level of nursing care</italic></td><td>→ P (tw OA) ↓ P (right after practicums)</td></tr><tr><td>Jeste et al. (<xref ref-type="bibr" rid="bibr32">2018</xref>) USA</td><td>Pre-experimental</td><td>Medicine IG: 134/NM OA geropsychiatric inpatient unit</td><td>8–12 weeks each program University & geropsychiatric inpatient unit ISL EDU research training programs (aging, mental health); research mentors (bioethics, publication, successful aging); IGC clinical geriatrics exposure</td><td>Improved attitudes w/exposure to aging-related research & successful aging (focus on healthy aging) & personal exposure to OA; role modeling of mentors (optimism for improvement in OA well-being)</td><td>↑↑ S & P ↑↑ P ↑↑ I</td></tr><tr><td>Kalisch et al. (<xref ref-type="bibr" rid="bibr33">2013</xref>) USA</td><td>Descriptive</td><td>Child development & family relations, social work, gerontology IG: 102/21.5 (NM) OA assisted-living facilities, associations, nursing homes</td><td>2 semesters (2 × 12 hours w/OA & EDU) University & community partners ISL EDU introductory gerontology course (journal writing, discussions w/peers); IGC games, walks, discussions; dyads</td><td>IGC gave a concrete view of OA, combating negative messages from peers & media regarding aging & OA; opportunities for reflection, self-awareness & changing prejudices</td><td>↑↑ P<sup>#</sup></td></tr><tr><td>Laks et al. (<xref ref-type="bibr" rid="bibr35">2016</xref>) USA</td><td>Pre-experimental & descriptive</td><td>Medicine IG: 74/NM OA com-dw</td><td>14 weeks (14 × 60' EDU & 14 × 60'-240' IGC) University & community partners ISL service-learning in communities of OA program; EDU course (ISL theory, cultural sensitivity, health education, ageism); lecture, discussions, reflection & group activities; IGC visits to community services (needs assessment, educational project design, feedback, project delivery)</td><td>Wide variety of communities encountered pushed STU to compare different people & see diversity in aging <italic>Lack of attitude change may reflect program's topics of focus</italic></td><td>↑↑ S<sup>#</sup> ↑ P → P (empathy) ↑↑ I</td></tr><tr><td>Leedahl et al. (<xref ref-type="bibr" rid="bibr36">2019</xref>) USA</td><td>Pre-experimental</td><td>Human development & family studies, pharmacy, health studies, communicative disorders, psychology IG: 26/21.8 (NM) OA center</td><td>1 semester (EDU & 289 hours mentoring) University & OA center & lifelong learning institute ISL Cyber senior® reverse mentoring model; EDU gerontology courses (aging & health) & training session (working w/OA, teaching skills); IGC individual sessions (mentors for OA on technological issues), matching program (dyads, based on interests & capabilities), or drop-in sessions (participating to lifelong learning institute sessions w/short time assistance)</td><td>Program promoted understanding of scholarly concepts using real-world applications</td><td>↑ P</td></tr><tr><td>Leung et al. (<xref ref-type="bibr" rid="bibr38">2012</xref>) China</td><td>Randomized control trial</td><td>Medicine, nursing IG: 48/20.4 (2.2) CG: 55/21.0 (2.2) OA com-dw</td><td>10 weeks (10 × 60–120' & EDU & sharing session) University & other sites ISL EDU workshop (communication skills, aging); IGC diverse activities (learning about reality of aging & OA) & sharing session at the end; dyads</td><td>Importance of frequent interactions between generations to understand aging issues & having less – attitudes tw OA</td><td>↑↑ S ↑↑ P</td></tr><tr><td>Lytle and Levy (<xref ref-type="bibr" rid="bibr40">2019</xref>) (Study 1)<sup>z</sup> USA</td><td>Randomized control trial</td><td>Aging course & courses without aging content IG1: 86/19.7 (1.9) IG2: 86/19.7 (1.9) IG3 94/19.7 (1.9) CG: 88/19.7 (1.9) No OA</td><td>1 session Online Positive education about aging & contact experiences model; EDU aging course (IG1; accurate information about aging), IGC (IG2; description of + IGC = extended contact), or both (IG3)</td><td><italic>Providing information on aging may increase aging anxiety as STU thought about aging process; extended contact may not be as effective as direct contact</italic></td><td>↑↑ S (IG1 > IG3) → S & P ↑↑ P → P (anxiety & interaction w/OA) → D</td></tr><tr><td>Lytle et al. (<xref ref-type="bibr" rid="bibr42">2020</xref>) USA</td><td>Pre-experimental</td><td>Non-gerontology or developmental course IG: 14/20.4 (1.2) OA technology services</td><td>11 weeks University & online & community partners Instapals model; EDU (aging, ageism; videos, accurate information, experts' answers, discussions, poster on aging); IGC w/Instagram (exposure to + aging role models); dyads & face to face; equal status, cooperative, sharing personal information, authority figures</td><td>Technology facilitated + contacts between generations; aging education provided w/projects whose main purpose was not gerontology</td><td>↑↑ S<sup>#</sup> ↑↑ S ↑↑ P → P (tw OA)</td></tr><tr><td>Lytle et al. (<xref ref-type="bibr" rid="bibr41">2021</xref>)<sup>$</sup> USA</td><td>Randomized control trial</td><td>NM IG: 60/18.1 (0.3) CG: 68/18.1 (0.3) No OA</td><td>2 videos (2× 7;' 1 week between videos) Online Positive education about aging & contact experiences model; EDU video (aging, ageism, stereotypes); IGC video (live action + IGC = extended contact; addressing key components: dyads, equal status, cooperation, interactions facilitated, personal disclosure)</td><td>Effective brief intervention improved aging education, challenged ageist beliefs & showed + IGC (key components)</td><td>↑↑ S ↑↑ S & P ↑↑ P → P (anxiety)</td></tr><tr><td>MacKnight and Powell (<xref ref-type="bibr" rid="bibr44">2001</xref>) CAN</td><td>Pre-experimental</td><td>Medicine IG: 73/21–35 OA geriatricians' caseloads (more active & less cognitively impaired than majority of patients)</td><td>360' (120' EDU & 180' IGC & 60' debriefing) University & OA residences EDU lecture on aging; IGC visiting an OA (experience of aging, challenges, benefits); debriefing session with peers & professional; small groups</td><td><italic>Interactions w/healthy OA (not broad range of patients)</italic></td><td>↓↓ S (denial of aging effects & generalization) → P (tw OA & anxiety) → D (distance)</td></tr><tr><td>Masciadrelli (<xref ref-type="bibr" rid="bibr47">2014</xref>) USA</td><td>Pre-experimental & descriptive</td><td>Social work IG: 47/20–52 OA day centers, assisted living facilities</td><td>1 semester (EDU & 60' interview) University & community partners ISL Gero-Ed BEL program: EDU courses (interviewing skills, lifespan development, aging); IGC oral history interview w/OA; dyads</td><td>Combination of contacts & information learned from listening to OA promoted ability to identify & assess own values & biases on aging & OA</td><td>↑↑ S<sup>#</sup> ↑↑ S ↑↑ P<sup>#</sup> ↑ P ↑ I</td></tr><tr><td>McCleary (<xref ref-type="bibr" rid="bibr48">2014</xref>) USA</td><td>Pre-experimental</td><td>Social work, nursing, allied professions IG: 88/28.4 (NM) OA com-dw</td><td>1 session University EDU 2 documentaries (aging issues); IGC discussion panels with peers, professionals & OA models of healthy aging</td><td>Videos & discussions provided opportunities to see OA in a real way; exposure to OA (quality > frequency) & + view of aging promoted generalizable + attitudes tw OA</td><td>↑↑ S ↑↑ P</td></tr><tr><td>Penick et al. (<xref ref-type="bibr" rid="bibr54">2014</xref>) USA</td><td>Pre-experimental</td><td>Social sciences IG: 44/23.8 OA center, assisted living facilities</td><td>9 weeks (9 × 45') Assisted living facility & OA center ISL meaningful connections program; EDU training session (assisting OA in development, communication skills); IGC small group discussions w/topics (leisure activities, career, relationships, personality, wisdom); facilitator assistants</td><td>Program allowed STU to both provide to OA (e.g., facilitate OA reminiscences, social support) & receive from OA (e.g., insight into aging process, sharing lifelong wisdom), developing common understanding & respect</td><td>↑↑ P → I (community service)</td></tr><tr><td>Powers et al. (<xref ref-type="bibr" rid="bibr56">2013</xref>) USA</td><td>Pre-experimental</td><td>Kinesiology IG: 32/NM OA retirement community</td><td>1 session (50') Continuing care retirement community ISL EDU training session; IGC writing exercise program for assigned OA, intergenerational fitness experience (tests for many OA; feedback to assigned OA)</td><td>Prejudices challenged by interacting w/strong, healthy & productive OA (observation of OA performances)</td><td>↑↑ P</td></tr><tr><td>Redfield et al. (<xref ref-type="bibr" rid="bibr58">2016</xref>) USA</td><td>Pre-experimental</td><td>Nursing IG: 63/22.0 (3.8) OA com-dw (high-functioning)</td><td>1 year (EDU & 4 × 60' visits) Participants' choice ISL OA partnership program; EDU self-study of competency (communication, awareness tw perceptions of aging, normal vs. pathological aging) & group discussions; IGC visits to OA; triads</td><td>IGC w/high levels of functioning challenged stereotypes (realist view) & improved attitudes tw OA; repeated interactions w/OA promoted > comfort w/OA</td><td>↑↑ S ↑↑ P</td></tr><tr><td>Rodgers and Gilmour (<xref ref-type="bibr" rid="bibr59">2011</xref>) NZ</td><td>Pre-experimental</td><td>Nursing IG: 56/18–53 OA care settings</td><td>1 semester (course & 12 days placement) University & OA care settings ISL EDU introductory nursing paper (gerontology theory, lifespan focus w/application to OA); IGC clinical placement</td><td>Program gave opportunities to interact w/OA & develop factual knowledge about aging; education integrated w/positive aged-care clinical placement challenged prejudices</td><td>↑ P</td></tr><tr><td>Rubin et al. (<xref ref-type="bibr" rid="bibr61">2015</xref>) USA</td><td>Pre-experimental & descriptive</td><td>Psychology, biology, pharmacy, nursing IG: 20/21.7 (3.9) OA NM</td><td>14 weeks (5 art classes & 2 × 120' seminars) University & museums & gallery ISL promoting art for life enrichment through transgenerational engagement program; EDU training (aging, stereotypes, own feelings about aging, communication skills) & reflection seminar (group); IGC arts activities, informal socialization (lunch), cultural visits, artwork exhibition</td><td>Art as common interest w/OA = medium to foster positive communication & break down stereotypes; reciprocal relationship (equal status) & collaborative experience promoted opportunities to put aside professional role & engage w/OA on personal level</td><td>↑↑ S<sup>#</sup> ↑↑ S & P<sup>#</sup> ↑↑ P → P (anxiety) ↑↑ I<sup>#</sup></td></tr><tr><td>Ryan et al. (<xref ref-type="bibr" rid="bibr62">2007</xref>) Ireland</td><td>Pre-experimental</td><td>Nursing IG: 94/42.6% ≤20, 57.4% 21+ OA com-dw (healthy & active, identified by STU)</td><td>1 year (120' pre-visit session & 10+ x 45–60' IGC) OA residences ISL EDU pre-visit session (aging, ageism, reading material); reflective journal; IGC discussions w/OA (lifestyle, health, health promotion); dyads</td><td>Contacts w/fit & well OA contributed to positive attitudes tw OA</td><td>↑ P</td></tr><tr><td>Stewart et al. (<xref ref-type="bibr" rid="bibr68">2007</xref>) USA</td><td>Quasi-experimental</td><td>Medicine IG1: 68/NM IG2: 68/NM CG1: 73/NM CG2: 63/NM (Cohort 1: 2004–5; 2: 2002–3) OA com-dw</td><td>1 year University EDU geriatrics curriculum; IGC senior mentor program (intergenerational learning modules & activities); OA mentors for STU; dyads or triads</td><td>Program allowed STU to view their mentors as individuals <italic>STU w/only few stereotypes about OA; influence of context</italic></td><td>↑↑ S (IG2) ↑ S (IG1)</td></tr><tr><td>Willard and Crandall (<xref ref-type="bibr" rid="bibr72">2016</xref>) USA</td><td>Quasi-experimental</td><td>Exercise sciences IG: 10/100% 20–24 CG: 17/12.2% < 20, 88.2% 20–24 OA com-dw, assisted living facility</td><td>16 weeks (30× EDU & 45–60' each IGC) University & community site ISL EDU exercise & aging course (physiological & psychosocial responses & adaptations associated w/exercise in OA; lectures, discussions, reflection journal); IGC combination exercise routine & bingo game (health promotion; equal group status, cooperation & common goals, support from authority, opportunity for friendship)</td><td><italic>Course concepts did not focus on social justice issues; factors related to ageism not formally taught in intervention</italic></td><td>→ S (aging knowledge) ↓↓ S & P</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <sups>a</sups>Authors, year of publication, country.</item> <item>3 <sups>b</sups>Field of academic education of students (STU), sample size by group (IG = intervention group; CG = control group), age in years, minimum-maximum or mean and standard deviation, characteristics of older adults (OA) involved (com-dw = community-dwelling); NM = not mentioned.</item> <item>4 <sups>c</sups>Duration of the intervention, number and duration of sessions (' = minutes) when mentioned, location, content and setting (EDU = educational intervention; IGC = intergenerational contacts intervention; ISL = intergenerational service-learning).</item> <item>5 <sups>d</sups>Mechanisms explaining positive outcomes; <emph>in italic: mechanisms explaining negative outcomes</emph>; w/= with; tw = toward.</item> <item>6 <sups>e</sups>Outcomes: S = stereotypes (aging knowledge, favorable or unfavorable stereotypes tw aging or OA); P = prejudices (aging anxiety, favorable or unfavorable attitudes toward aging or OA, empathy, comfort w/OA); I = interest in geriatric career (working w/OA, providing care to OA); D = discrimination (favorable or unfavorable behavior w/OA, behavioral intentions, social distance w/OA); ↑↑ = significant quantitative or qualitative positive change/decrease of ageism; ↑ = tendency toward positive change (not significant)/decreased ageism trend; → = no change; ↓↓ = significant quantitative or qualitative negative change/increase of ageism; ↓ = tendency toward negative change (not significant)/increased ageism trend; # qualitative result; ≤ less; ≥ more; + = positive; - = negative.</item> <item>7 <sups>w</sups>No change in outcomes at follow-up (1–2 weeks).</item> <item>8 <sups>x</sups>Change at follow-up (4 weeks): ↑↑ P became ↑ P.</item> <item>9 <sups>y</sups>↑↑ P became → P for IG1 & IG2.</item> <item>10 <sups>z</sups>Changes at follow-up (1 week): ↑↑ S (IG1 > IG3) became ↑↑ S (IG2 > IG3), → S & P became ↑↑ S & P, ↑↑ P became → P.</item> <item>11 *Doctoral dissertation.</item> <item>12 <sups>$</sups>First published earlier in an advance access publication version or online version.</item> </ulist> <hd id="AN0178024897-7">Analyzing and synthesizing data</hd> <p>Also supervised by the researcher, 2 of the students screened the extraction table line by line to highlight and categorize similar or significant C, M, and O. The O were summarized according to whether evaluative studies showed an increase, decrease or status quo in stereotypes, prejudices and discrimination measured. In descriptive studies, the O were based on the analysis of the participants' discourse and changes authors have observed in the perception of aging, older adults and their interactions with this population. Validated by the postdoctoral researcher, tables and figures summarized results for the C-M-O configurations for the three types of interventions.</p> <hd id="AN0178024897-8">Drawing conclusions</hd> <p>To highlight mechanisms for countering ageism, conclusions were drawn for each type of intervention. Finally, comparisons with other reviews and studies helped develop recommendations for future interventions.</p> <hd id="AN0178024897-9">Results</hd> <p>Of the 63 documents (Figure 1), 59 (93.7%) were peer-review articles and 4 (6.3%) were dissertations. The majority were published after 2010 (38; 60.3%), including 25 (39.7%) after 2015, and came mainly from the USA (48; 76.2%; Table 2). A third (21; 33.3%) followed a pre-experimental design, 11 (17.5%) were descriptive, and 9 (14.3%) others used a pre-experimental and descriptive design. Nine (14.3%) studies used a randomized control trial design, and the other studies (13; 20.6%) used a quasi-experimental design, with some including a descriptive design (Table 2). The 63 studies focused on 62 interventions: 25 (39.7%) used educational strategies, 5 (7.9%) intergenerational contact and 33 (52.4%) both (Table 2). Two studies documented the same intervention, i.e., positive education about aging and contact experiences (PEACE) model, but with different participants.</p> <p>A total of 166 outcomes were studied in all documents without including follow-up (Table 3), with between 1 and 5 outcomes being considered in each document. Only 4 (6.3%) studies incorporated a follow-up measure, using the same measuring tools (Lu et al., [<reflink idref="bib39" id="ref30">39</reflink>]; Lytle & Levy, [<reflink idref="bib40" id="ref31">40</reflink>]; Madrigal et al., [<reflink idref="bib45" id="ref32">45</reflink>]; Ragan & Bowen, [<reflink idref="bib57" id="ref33">57</reflink>]) (Table 2). These outcomes have been measured in various ways, mainly with questionnaires (e.g., choosing between polar adjectives, statements to evaluate, frequency of interactions scales), but also observations, interviews or group discussions. Almost half of the outcomes concerned only prejudices (75; 45.2%), followed by stereotypes (43; 25.9%; Table 3). Prejudices were also the main outcome positively modified by all types of intervention (55; 33.1%). A majority of outcomes quantitatively or qualitatively (117; 70.5%) changed, or presented a tendency (15; 9.0%) toward decreasing ageism. Although less studied, intergenerational contact had the greatest success in countering ageism considering the proportion of measures exhibiting significant, or a trend toward, improvement in the different components of ageism (14/15; 93.3%), followed by combined interventions (67/84; 79.8%), and educational interventions (51/67; 76.1%; Table 3).</p> <p>Table 3. Outcomes of the 63 studies included in the realist review, by type of intervention.</p> <p> <ephtml> <table><thead><tr><td /><td>EDU<sup>a</sup></td><td>IGC<sup>a</sup></td><td>EDU & IGC</td><td>Total</td></tr><tr><td /><td>↑↑</td><td>↑</td><td>→</td><td>↓↓</td><td>↑↑</td><td>↑</td><td>→</td><td>↑↑</td><td>↑</td><td>→</td><td>↓</td><td>↓↓</td><td>n (%)</td></tr></thead><tbody><tr><td>S</td><td>13</td><td /><td>2</td><td /><td>3</td><td /><td>1</td><td>20</td><td>2</td><td>1</td><td /><td>1</td><td>43 (25.9)</td></tr><tr><td>S & P</td><td>5</td><td /><td>1</td><td /><td /><td /><td /><td>4</td><td /><td>1</td><td /><td>1</td><td>12 (7.2)</td></tr><tr><td>P</td><td>17</td><td>2</td><td>10</td><td>1</td><td>6</td><td /><td /><td>24</td><td>6</td><td>8</td><td>1</td><td /><td>75 (45.2)</td></tr><tr><td>I</td><td>8</td><td>1</td><td /><td /><td>2</td><td>1</td><td /><td>6</td><td>2</td><td>2</td><td /><td /><td>22 (13.3)</td></tr><tr><td>D</td><td>4</td><td>1</td><td>2</td><td /><td>2</td><td /><td /><td>3</td><td /><td>2</td><td /><td /><td>14 (8.4)</td></tr><tr><td>Total n (%)</td><td>47 (28.3)</td><td>4 (2.4)</td><td>15 (9.1)</td><td>1 (0.6)</td><td>13 (7.8)</td><td>1 (0.6)</td><td>1 (0.6)</td><td>57 (34.4)</td><td>10 (6.0)</td><td>14 (8.4)</td><td>1 (0.6)</td><td>2 (1.2)</td><td>166 (100)</td></tr><tr><td>By type</td><td>67 (40.4)</td><td>15 (9.0)</td><td>84 (50.6)</td><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>13 EDU = educational intervention; IGC = intergenerational contacts intervention; S = stereotypes; P = prejudices; I = interest in geriatric career; D = discrimination; ↑↑ = significant quantitative or qualitative positive change/decrease of ageism; ↑ = tendency toward positive change (not significant)/decreased ageism trend; → = no change; ↓↓ = significant quantitative or qualitative negative change/increase of ageism; ↓ = tendency toward negative change (not significant)/increased ageism trend.</item> <item>14 <sups>a</sups>Columns with no outcomes have been removed.</item> </ulist> <p> <bold>Educational</bold> interventions used mainly courses dealing with aging and older adults (e.g., the aging process, successful aging, ageism, working with older adults), and various activities, such as discussions, videos, role playing, meditation, and reflective journals (Table 2). These interventions mostly occurred during one or two sessions at the university or online. Stereotypes and prejudices of HSS students were challenged (Figure 2) by the transmission of realistic information about aging and older adults, highlighting balanced representations and sometimes an optimistic perspective of aging. Gradually, students developed a better understanding of aging, and saw the uniqueness, humanity, and contributions to society of older adults, by focusing on their competencies instead of their limitations. Those changes were facilitated through interventions like discussions, active learning strategies and visual media, e.g., videos, photos, or sketches of older adults (Figure 2). Presenting notions of healthy aging also triggered a role modeling mechanism allowing students to see aging in a more positive way (Jeste et al., [<reflink idref="bib32" id="ref34">32</reflink>]). Moreover, the use of reflective strategies promoted the identification of stereotypes and prejudices in HSS students, linked knowledge to their experiences, and increased their awareness of how ageism can impact their professional activities. However, the mechanisms were occasionally hampered by obstacles, for example courses that did not adequately address stereotypes and prejudices in HSS students (Briscoe, [<reflink idref="bib12" id="ref35">12</reflink>]), or those with information confirming them without confrontation or deconstruction, like reading or listening to age-based stereotypes, as well as hearing about older adults' fears about aging (Lester, [<reflink idref="bib37" id="ref36">37</reflink>]; Madrigal et al., [<reflink idref="bib45" id="ref37">45</reflink>]) (Figure 2). Because external influences (Fisher et al., [<reflink idref="bib24" id="ref38">24</reflink>]) or personality traits (Merz et al., [<reflink idref="bib49" id="ref39">49</reflink>]) might crystallize stereotypes and prejudices, direct experiences with older adults were required to initiate changes (Yamashita et al., [<reflink idref="bib76" id="ref40">76</reflink>]).</p> <p>Graph: Figure 2. Synthesis of the contexts, mechanisms, and outcomes of interventions to counter ageism.</p> <p> <bold>Intergenerational contact</bold> interventions involved group or dyad discussions, mentoring or practicums, and occurred mostly in the university, older adults' organizations or online, over periods varying from one day-long session to one whole year of intervention (Table 2). Meaningful, high-quality interactions promoting in-depth sharing between students and older adults, and exploring similarities and differences, were facilitators triggering changes in ageism (Figure 2). In getting to know each other and seeing the diversity and uniqueness of older adults, stereotypes, and prejudices of HSS students about aging and older adults were challenged. Mutual support, such as mentoring, and common activities also positively influenced stereotypes and prejudices (Figure 2). Exposing HSS students to older adults with a range of care needs and different levels of functioning fostered a wider view of aging and a realistic perception of older adults. Finally, interactions between students and older adults outside the school setting lessened prejudices (Breck et al., [<reflink idref="bib11" id="ref41">11</reflink>]; Figure 2).</p> <p>Interventions <bold>combining education and intergenerational contact</bold> occurred at the university, in older adults' organizations, in medical settings, or in artistic sites (e.g., museums, art galleries), over periods varying from one day-long session to four whole years of intervention (Table 2). Some interventions were carried out partially or entirely online. The majority (20/33; 60.6%) followed an intergenerational service-learning model (Table 2). As for other types of intervention, combined interventions showed similar facilitators that triggered mechanisms and changed stereotypes, prejudices, and discrimination, with additional aspects (Figure 2). For example, combined interventions fostering critical thinking, with peer discussions and debriefings between or after interactions with older adults, facilitated the deconstruction of internalized stereotypes and prejudices (Figure 2). Conditions for intergenerational interactions were also more detailed in studies documenting combined interventions (Table 2). Face to face contact, including equal status, cooperation on common interests, with support from an authority, and fostering personal disclosure, promoted greater knowledge of older adults' identity in HSS students (M; Figure 2). The importance of support from an authority was however mitigated, while corroborated in some studies (Augustin & Freshman, [<reflink idref="bib4" id="ref42">4</reflink>]; Corwin et al., [<reflink idref="bib18" id="ref43">18</reflink>]; Lytle et al., [<reflink idref="bib42" id="ref44">42</reflink>]; Willard & Crandall, [<reflink idref="bib72" id="ref45">72</reflink>]), others advised more informal interactions (Gardner & Alegre, [<reflink idref="bib26" id="ref46">26</reflink>]; Rodgers & Gilmour, [<reflink idref="bib59" id="ref47">59</reflink>]; Table 2). Moreover, while many studies insisted on meaningful, quality intergenerational contact to foster changes, some also highlighted the importance of contact frequency as a facilitator, increasing students' comfort in interacting with older adults and getting to know them (Adelman et al., [<reflink idref="bib1" id="ref48">1</reflink>]; Leedahl et al., [<reflink idref="bib36" id="ref49">36</reflink>]; Figure 2). Finally, studies with combined interventions emphasized that being in contact with healthy older adults allowed HSS students to challenge their own stereotypes and prejudices, and to adopt a more positive view of aging. While the studies with intergenerational contact interventions alone did not mention obstacles to changes in ageism, those with combined interventions did (Table 2). For example, mechanisms for change (Figure 2) were occasionally hampered by intergenerational interactions that involved disabilities (e.g., in clinical settings), or those with insufficient heterogeneity of older adults. Additionally, indirect contact (i.e., witnessing other people's intergenerational contact) was not as effective as direct contact with older adults in initiating changes in the ageism displayed by students (Lytle & Levy, [<reflink idref="bib40" id="ref50">40</reflink>]).</p> <hd id="AN0178024897-10">Discussion</hd> <p>The aim of this realist review was to provide a comprehensive understanding of which interventions are the most effective in countering ageism toward older adults among undergraduate HSS students, under which circumstances, how, and with what outcomes. Although all types of interventions succeeded in countering ageism, combinations were the most effective against stereotypes, and intergenerational contact had the greatest effects on prejudices, confirming results from previous reviews (Burnes et al., [<reflink idref="bib13" id="ref51">13</reflink>]; Chonody, [<reflink idref="bib17" id="ref52">17</reflink>]; Martínez-Arnau et al., [<reflink idref="bib46" id="ref53">46</reflink>]). According to the C-M-O configurations newly highlighted in the present review, transmitting realistic, balanced information about aging and older adults along with educational interventions helped HSS students to identify and challenge their stereotypes and prejudices, and develop a general view of aging and greater knowledge about older adults, results also found in younger populations (Bétrisey et al., [<reflink idref="bib8" id="ref54">8</reflink>]). In some situations, transmission of knowledge about aging however increased students' anxiety, confirming stereotypes (Madrigal et al., [<reflink idref="bib45" id="ref55">45</reflink>]). These mechanisms should be further explored whether explained by the components of the interventions or the characteristics of the individuals. Active and reflective learning, including critical thinking, promoted HSS students' awareness of their bias, and how ageism can affect their professional activities (de la Rue, [<reflink idref="bib21" id="ref56">21</reflink>]). Among the promising initiatives identified, simulations and role playing can lead students to develop empathy toward older adults by putting themselves in their shoes (Martínez-Arnau et al., [<reflink idref="bib46" id="ref57">46</reflink>]; Samra et al., [<reflink idref="bib63" id="ref58">63</reflink>]). Educational strategies also used role modeling as a mechanism, in which positive or healthy aging was explained to HSS students and supported by mentors or instructors adhering to these views, reducing students' stereotypes and prejudices (Ferrario et al., [<reflink idref="bib23" id="ref59">23</reflink>]; Jeste et al., [<reflink idref="bib32" id="ref60">32</reflink>]; Kim et al., [<reflink idref="bib34" id="ref61">34</reflink>]). As they have a direct influence on students (Martínez-Arnau et al., [<reflink idref="bib46" id="ref62">46</reflink>]), future interventions should target educators, professionals, and institutions.</p> <p>During intergenerational activities, the C-M-O configurations showed that meaningful and high-quality contact with older adults allowed HSS students to acquire a more realistic comprehension of aging and a greater understanding of older adults' reality. As explained by the intergroup contact theory (Pettigrew & Tropp, [<reflink idref="bib55" id="ref63">55</reflink>]), quality of interactions is favored with equal status, a common goal, cooperation, and support from an authority, and in-depth sharing. In addition to quality contact, frequent interactions (4–6-time in 8–24 months) helped students in knowing older adults, being comfort in exploring similarities and differences among generations, and initiating changes in stereotypes and prejudices (Alford et al., [<reflink idref="bib2" id="ref64">2</reflink>]; Augustin & Freshman, [<reflink idref="bib4" id="ref65">4</reflink>]; Redfield et al., [<reflink idref="bib58" id="ref66">58</reflink>]). Further research should explore effective frequency of intergenerational contact. Interactions with older adults with varying health status were important for the effectiveness of interventions to trigger change mechanisms (Alford et al., [<reflink idref="bib2" id="ref67">2</reflink>]; Bernard et al., [<reflink idref="bib7" id="ref68">7</reflink>]; Ferrario et al., [<reflink idref="bib23" id="ref69">23</reflink>]; Powers et al., [<reflink idref="bib56" id="ref70">56</reflink>]). As supported by Chonody ([<reflink idref="bib17" id="ref71">17</reflink>]), interacting with older adults with disabilities may lead to a reinforcement of stereotypes and prejudices (Holroyd et al., [<reflink idref="bib31" id="ref72">31</reflink>]; MacKnight & Powell, [<reflink idref="bib44" id="ref73">44</reflink>]), while healthy older adults may be considered as exceptions, not leading to the desired effects, as reported in another review (Bétrisey et al., [<reflink idref="bib8" id="ref74">8</reflink>]). Further research should explore how health status in older adults influences the effectiveness of intergenerational contact. Interventions outside the healthcare setting might also lead to more effective outcomes (Lu et al., [<reflink idref="bib39" id="ref75">39</reflink>]; Rubin et al., [<reflink idref="bib61" id="ref76">61</reflink>]). Martínez-Arnau et al. ([<reflink idref="bib46" id="ref77">46</reflink>]) explained that HSS students may be more comfortable getting to know older adults and building deeper relationships in an informal environment. To better guide educators, further comparison of formal and informal settings for intergenerational contact is needed.</p> <p>Finally, based on the present results, recommendations can be made to the HHS students' training managers (Figure 2). To avoid confirming stereotypes and prejudices, it is essential that interventions present positive but realistic aspects associated with aging. Moreover, since encouraging active learning and critical thinking is highly recommended, interventions where knowledge and skills are applied should include debriefing on intergenerational experiences. These interventions must also promote contacts with a diversity of older adults, including healthy people, outside the training context. Ultimately, combining both educational and intergenerational activities remains the best approach to countering ageism among HHS students.</p> <p>To our knowledge, the present study is the first realist review that has considered contexts, mechanisms, and outcomes of interventions to counter ageism among HSS students. Following the RAMESES standards for realist review (Wong et al., [<reflink idref="bib73" id="ref78">73</reflink>]), the present study applied a rigorous methodology to systematically retrieve studies on this topic and, with a standardized extraction method, assured their quality and consistency to present a comprehensive synthesis of both quantitative and qualitative results. Despite a thorough screening process using multiple databases and involving many people, it is possible that relevant documents were not included. Another limitation is the difficulty in clearly identifying the mechanisms explaining the outcomes, as studies are not always explicit, and although a guide and lexicon were used to define the variables theoretically and operationally (according to instruments), and support and standardize their classifications. Exclusion of articles with specific populations may also have influenced the present results and thus limited their generalization. Although the studies selected for this review come from different regions of the world (e.g., USA, Australia, Asia, Europe), stereotypes related to aging and older adults differ according to cultural and geographical factors (Gallo, [<reflink idref="bib25" id="ref79">25</reflink>]). It is therefore essential to adapt the interventions proposed in the present review to the specific context in which they are implemented.</p> <hd id="AN0178024897-11">Conclusion</hd> <p>This realist review brought to light how interventions to counter ageism toward older adults work with HHS students, linking their contexts (facilitators or obstacles), mechanisms, and outcomes. Providing realistic, balanced knowledge about aging and older adults, valuing reflective learning and critical thinking, and promoting meaningful, high-quality interactions with older adults, countered stereotypes, prejudices, and discrimination in HSS students. The C-M-O configurations highlighted the crucial contextual characteristics of interventions that must be considered, using educational, intergenerational contact, or their combination, e.g., information transmitted about aging, health status of older adults, and settings for intergenerational contact. These results are relevant for education institutions wishing to integrate effective interventions to counter ageism in HSS settings. As educators, professionals, and institutions have an important influence on students, it is crucial to raise their awareness of ageism as a widespread phenomenon that has deteriorated the quality of care provided to older adults. Interventions to reduce ageism in society are also needed.</p> <hd id="AN0178024897-12">Acknowledgements</hd> <p>The authors would like to acknowledge Louise Tremblay and Jean-François Cardinal for helping in selecting the studies and for their assistance in extracting data. 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  Data: <searchLink fieldCode="SO" term="%22Educational+Gerontology%22"><i>Educational Gerontology</i></searchLink>. 2024 50(7):565-593.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 29
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Aging+%28Individuals%29%22">Aging (Individuals)</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Older+Adults%22">Older Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Services%22">Health Services</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Services%22">Social Services</searchLink><br /><searchLink fieldCode="DE" term="%22Allied+Health+Occupations+Education%22">Allied Health Occupations Education</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Attitude+Change%22">Attitude Change</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/03601277.2024.2325722
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0360-1277<br />1521-0472
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Ageism might reduce the effectiveness and quality of care in older adults essential with the aging population. Although interventions to counter ageism were carried out among students, no clear integration of their results described the mechanisms underlying their impact. This study aimed to provide a comprehensive understanding of which interventions amongst undergraduate health and social services students are effective, under which circumstances, how, and with what outcomes. A realist review was carried out using 44 keywords in 6 databases. The configurations for contexts, mechanisms, and outcomes were identified for three types of interventions, considering their impact on stereotypes, prejudices, and discrimination toward older adults. In the 63 studies selected, intergenerational contact interventions exhibited the greatest proportion (14/15; 93.3%) of evidence supporting improvement in outcomes of ageism, followed by combined (67/84; 79.8%) and educational (51/67; 76.1%) interventions. Stereotypes and prejudices were challenged by the transmission of realistic and balanced information, as well as through meaningful and high-quality intergenerational contact. Meeting or hearing about a broad variety of older adults in specific conditions also helped to decrease ageism. Results highlighted the importance of seeing diversity and uniqueness in older adults, and their competencies rather than their limitations. Mechanisms were occasionally hampered by obstacles, such as induced anxiety and confirmation of negative aspects of aging. Countering ageism in health and social services students is essential to ensuring high-quality care. In knowing that educators, professionals, and institutions have a direct influence on students, their awareness of ageism should be enhanced by interventions targeting them.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1428607
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1428607
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  BibEntity:
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      – Type: doi
        Value: 10.1080/03601277.2024.2325722
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 29
        StartPage: 565
    Subjects:
      – SubjectFull: Aging (Individuals)
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Older Adults
        Type: general
      – SubjectFull: Health Services
        Type: general
      – SubjectFull: Social Services
        Type: general
      – SubjectFull: Allied Health Occupations Education
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Student Attitudes
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Attitude Change
        Type: general
    Titles:
      – TitleFull: Contexts, Mechanisms and Outcomes of Interventions to Counter Ageism toward Older Adults in Undergraduate Health and Social Services Students: Results of a Realist Review
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            NameFull: Juliane Scott
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            – D: 01
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              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0360-1277
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            – TitleFull: Educational Gerontology
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