








































Graduate Student Journal of Psychology                                                                             Copyright 2


Graduate Student Journal of Psychology                                                                             Copyright 2006 by the Department of Counseling & Clinical Psychology  
2006, Vol. 8                                                                                                                          Teachers College, Columbia University                          ISSN 1088-4661 
 
 
 

The Effects of Patient Age and Diagnosis on Perceived Necessity of 
Psychological and Medical Treatment by Young Adults 

 
Julie Blundon, Jessica Neubauer, Kristin Candan, Jacqueline Mesnik, and Janet A. Sigal 

Fairleigh Dickinson University 
 

Perceptions of and attitudes towards the elderly as related to the perceived necessity of treatment 
for physical and psychological symptoms were examined. Eighty participants from undergraduate 
classes at a medium-sized university in the northeastern United States were randomly assigned to 
read one of four vignettes, which were identical with the exception of the age (30 and 80) and diag-
nosis (Major Depressive Episode and arthritis) of the vignette character. Contrary to original hy-
potheses, participants reported that it was more important for an 80-year-old to obtain medical 
treatment than a 30-year-old. When analyzing the importance of obtaining psychological treatment, 
no statistically significant differences were found based on the age of the character. Medical treat-
ment was universally rated as more important regardless of the age of the character in the scenario. 

 
 

Ageism has been defined as the deliberate or subcon-
scious discrimination based on age (Lachs & Boyer, 2003). 
Discrimination can manifest itself as a lack of available 
services as well as overall negative attitudes towards the 
elderly. A review of the literature suggests that this discrep-
ancy, especially its relationship to the delivery of mental 
health services and its impact upon this population, has not 
been adequately measured. However, it is apparent that 
negative stereotypes of the elderly exist in both the general 
population as well as in the professional world (e.g., doctors 
and psychologists). “Ageism is so firmly embedded within 
the social fabric of U.S. culture that few people even ques-
tion the fact that age is considered a legitimate reason for 
limiting access to health care and productive employment” 
(Pasupathi, Carstensen, & Tsai, 1995, p. 160). 
Negative perceptions of the elderly vary depending on the 
population surveyed. However, in general, these percep-
tions are that the elderly are not open-minded or flexible, 
not sexually active, not useful members of the community, 
and not bright or alert (Praseedom, Tube, Vourdas, Rafnar, 
& Woodfield, 1999). It has also been suggested that ageism 
is so ingrained in our society that psychological research is 
biased against elderly subjects in their under-representation 
and in the assumption of their homogeneity as a group 
(Schaie, 1993). A meta-analysis by Kite and Johnson 
(1988) revealed that attitudes towards older people were 
more negative than attitudes towards younger people across 
all rating dimensions. The most extreme negative results 
were found in ratings of physical attractiveness and compe-
tence. Results from more recent studies, however, indicate 

 
Correspondence concerning this article should be addressed to 
Julie Blundon, T-WH01-1, Psychology Department, Fairleigh 
Dickinson University, 1000 River Road, Teaneck, NJ 07601;  
e-mail: julieblundon@hotmail.com. 

that differences between evaluations of older and younger 
people were smaller than past research would suggest. In 
fact, it appears that younger people hold a variety of posi-
tive, negative and neutral beliefs about older people (Slot-
terback & Sarnio, 1996). 
 

Attitudes of College Students Towards the Elderly 
 

Schmidt and Boland (1986) examined the multitude of 
stereotypes college students report towards the elderly. 
They found that the term “old person” elicits both positive 
and negative stereotypes depending on the type of elderly 
person the student is referencing. For example, a student 
may think of his beloved grandparent, and consequently 
describe an “old person” as warm, caring and generous. On 
the other hand, the phrase “older person” may bring to mind 
thoughts of a sick, elderly neighbor who could be seen as 
miserly, incompetent and needy. The study found that 
stereotyping of the elderly is likely to occur at a more spe-
cific level (e.g., grandparent vs. elderly neighbor) because 
“the elderly” is not a homogeneous group and thus draws 
many different descriptions. Therefore, ageism may be 
more directed at the elderly who are perceived to represent 
negative stereotypes than towards those who represent posi-
tive ones (Schmidt & Boland, 1986). 

With the exception of the previous study, the attitudes 
of college students towards the elderly have been found to 
be consistently negative over time (Schwalb & Sedlacek, 
1990). Slotterback (1996) has argued that negative percep-
tions of the elderly are the result of generational influences. 
For example, younger adults view those from a previous 
generation as different from themselves, not only because 
they are older, but because of the historical context in 
which they developed. Operating under a generational in-
fluence, young people would likely find it difficult to relate 

33 



BLUNDON ET AL. 
 

34 

to the wartime mentality of elderly adults who grew up with 
few material possessions. 

Slotterback and Sarnio (1996) investigated whether the 
assessment of negative attitudes towards the elderly was 
affected by the type of instrument used (a rating task vs. an 
open-ended task) and the type of attributes assessed (cogni-
tive, personal-expressive, and physical). They found that 
negativity was most apparent in open-ended tasks and when 
rating physical characteristics of the elderly. 

McConatha, Schnell, Volkwein, Riley, and Leach 
(2003) examined undergraduates’ discrimination towards 
older adults using the Anxiety About Aging Scale, which 
highlights four dimensions of ageism: fear of old people, 
psychological concerns, changing physical appearance, and 
fear of losses. Cultural differences in attitudes toward aging 
also were investigated, as the study included participants 
from both the United States and Germany. Results indicated 
significant differences between the American and German 
samples in three of the anxiety subscales, as well as gender 
differences in the raters. German participants reported 
greater fear of old people, more psychological concerns 
about aging, and more fear of losses associated with aging 
than did American participants. Additionally, both Ameri-
can and German women scored significantly higher than 
male participants on items regarding concerns about physi-
cal appearance. 
 
Ageism in Health and Mental Health Service Providers 
 

The underutilization of mental health services in the 
elderly population may be a function of ageism on the part 
of mental health providers (Gatz, Karel, & Wolkenstein, 
1991). Many service providers lack training with the geriat-
ric population and have negative expectations concerning 
treatment effectiveness with this group (Gatz & Pearson, 
1988). James and Haley (1996) found some evidence of age 
bias in a sample of 371 psychologists who responded to 
detailed vignettes of a client presenting with symptoms of 
depression. However, they found stronger evidence of 
health bias regardless of client age, meaning that healthier 
clients were viewed more positively. This suggests that 
mental health service providers, psychologists in particular, 
have more negative attitudes towards physically ill indi-
viduals as opposed to healthier individuals, regardless of 
age. Such a bias may have implications for service delivery, 
considering the common presentation of depression and 
other psychological disorders with concomitant health prob-
lems in the elderly. 

The negative attitude concerning treatment outcome of 
elderly patients is not confined to the mental health com-
munity. Uncapher and Arean (1999) found that physicians 
are less likely to treat suicidal ideation in older patients. 
These findings were based on a study in which 215 primary 
care providers rated a vignette of a suicidal, depressed pa-
tient. The only difference between the vignettes was the age 
of the patient and employment status. The physicians rec-
ognized depression and suicidal risk in both the adult and 

geriatric vignette, but reported less willingness to treat the 
older patient. Physicians reported that the suicidal ideation 
on the part of the older patient was both normal and ra-
tional. Therefore, doctors were less willing to use therapeu-
tic strategies to treat older patients and did not believe that 
psychiatrists or psychologists should be consulted.  

Grant (1996) discussed specific biases that may be pre-
sent in health care workers, which can be partly explained 
by both a lack of education concerning geriatric health is-
sues and a lack of exposure to elderly patient populations. 
These biases include providing disabling support (as op-
posed to enabling support) as well as managing symptoms 
(as opposed to promoting health) when working with geriat-
ric populations. These biases on the part of health care 
workers have led to increased dependence and less aggres-
sive treatment plans. 

 
Cultural Differences in Perceptions of the Elderly 

 
Studies of family relationships in Asian American cul-

tures have found that the majority of adolescents and col-
lege-age students espouse the values of deference and re-
spect towards their family elders. White American teenag-
ers and college students do not display the same level of 
reverence for the elderly as their Asian American counter-
parts (Ying, Coombs, & Lee, 1999). White American ado-
lescents instead tend to separate and individuate, and to 
focus primarily on their own goals as opposed to those set 
forth by their families. Ying and colleagues (1999) also 
found that Asian American adolescents (Chinese, Japanese 
and Korean) tend to maintain the Eastern orientation of 
valuing the opinion of the elderly despite the American 
cultural emphasis on autonomy and independence. This 
positive perception of the elderly seems to be an integral 
part of the Asian American cultures and provides a signifi-
cant contrast to White Americans’ mixed perceptions of the 
older population. 

Young, Jeong, Knight, and Benton (1999) examined 
the differences in familism values (in which the family 
takes precedence over individual interests) and attitudes 
toward caregiving among Korean, Korean American, and 
White American dementia caregivers. They found that Ko-
reans reported the highest level of distress associated with 
caregiving, followed by Korean Americans and White 
Americans. A possible explanation for these results may be 
related to the correlation between familism and distress; 
higher ratings of the importance of family were correlated 
with higher levels of anxiety and depression concerning the 
caretaking of demented elders. It can be postulated that the 
more interdependent a family, the more distressing it is for 
one of the family members to fall ill and require care. 

 

The Present Study 
 

The research reviewed clearly demonstrates the pres-
ence and impact of ageist attitudes in our society. There is 



EFFECT OF PATIENT AGE AND DIAGNOSIS ON TREATMENT 
 

35 

some evidence suggesting that ageism plays a role in the 
perceptions of symptom severity, decisions regarding 
whether or not to treat geriatric patients, and the quality of 
care that is received. However, there is a need for further 
research in order to better understand those areas in which 
ageist attitudes most severely influence treatment decisions, 
particularly in terms of the perceived necessity of clinical 
services. This line of study could have direct implications 
for the training of health care professionals working with 
older adults and general treatment planning for geriatric 
patients.   

The present study explores not only the attitudes of a 
college student population towards the elderly, but how 
such attitudes impact upon the perceived necessity of psy-
chological and mental health treatment for elderly individu-
als. Three hypotheses were tested. The first is that subjects 
will rate treatment necessity higher for the younger charac-
ters presented in the vignettes, regardless of the type of 
condition (medical vs. psychological). Second, psychologi-
cal treatment will be rated as less important than medical 
treatment, regardless of the age. Third, the perceived social 
value of the elderly will be influenced by the country of 
origin and culture of the respondent. The overarching pur-
pose of this study was not to examine how malleable ageist 
attitudes may be in response to an intervention, but rather 
how such attitudes are expressed in terms of perceived need 
for treatment. 

 
Method 

 
Participants 
 

Participants were 92 undergraduate students enrolled in 
classes from a variety of disciplines at a medium sized uni-
versity in the northeastern United States. A manipulation 
check was conducted to test participants’ recall of the age 
and possible diagnosis of the individual in the vignette, and 
the 12 participants who failed the check were not included 
in the final analyses. Participants ranged in age from 17 to 
33, with a median age of 18. Twenty-nine (36.3%) of par-
ticipants were male; 51 (63.8%) were female. The majority 
of participants were Caucasian (36.3%), followed by Afri-
can American (20%), Asian (17.5%), Latino (12.5%), and 
Caribbean American (5%). 

 
Materials 
 

Two vignettes featured an individual presenting with 
symptoms indicative of a Major Depressive Episode as 
classified by the Diagnostic and Statistical Manual of Men-
tal Disorders, Fourth Edition (DSM-IV, 1994). These symp-
toms included sleep disturbances, lack of interest in usual 
activities, lack of energy, trouble with concentration, and 
lack of appetite. The other two vignettes portrayed an indi-
vidual experiencing the symptoms of arthritis. Symptoms 
included severe joint pain, fatigue, lack of agility, and lack 

of concentration. In each of these two conditions, the vi-
gnettes were identical with the exception of the age of the 
person being portrayed; the individual described in the vi-
gnette was either 30 or 80 years old. The sex of the vignette 
character was not specified so as to eliminate gender of the 
vignette character as a confounding variable. 

Participants were randomly assigned to one of four 
conditions: a 30 year-old individual experiencing symptoms 
of arthritis; a 30 year-old individual experiencing symptoms 
consistent with a major depressive episode; an 80 year-old 
individual experiencing symptoms of arthritis; and an 80 
year-old individual experiencing symptoms consistent with 
a major depressive episode. All participants completed four 
Likert-type questionnaire items created for this study that 
focused on the importance of seeking medical and psycho-
logical treatment, as well as symptom severity for the indi-
vidual described in the vignette. The four questions were: 1) 
“How likely is it that Pat will receive medical treatment?”; 
2) “How important is it that Pat receive medical treat-
ment?”; 3) “How likely is it that Pat will receive psycho-
logical treatment?”; and 4) “How important is it that Pat 
will receive psychological treatment? For the two items 
addressing the likelihood that the vignette character will 
seek medical or psychological treatment (questions 1 and 
3), the Likert scale ranged from 1 (completely unlikely) to 7 
(completely likely). The Likert scale for the two questions 
regarding the importance of seeking medical or psychologi-
cal treatment (questions 2 and 4) ranged from 1 (not at all 
important) to 5 (extremely important). 

Finally, the Social Value of the Elderly Scale of the 
Aging Opinion Survey, developed by Kafer, Rakowski, 
Lachman, and Hickey (1980), was used as an additional 
measure to assess participants’ perceptions of elderly indi-
viduals. This measure is comprised of fifteen Likert-type 
questionnaire items covering several content areas, includ-
ing the contribution of elderly individuals to the community 
(e.g., “After retirement one should not have much influence 
in public policy making”) and general perceptions of eld-
erly individuals (e.g., “Old people usually interfere with 
their adult-children’s child-rearing practices”). The Likert 
scale for each item ranged from 1 (completely disagree) to 
5 (agree completely). 

 
Design and Procedure 
 

The study used a 2 (age of character in vignette: 30 
years old vs. 80 years old) X 2 (diagnosis: major depressive 
episode vs. arthritis) design. Participants were told that they 
would be participating in a study regarding perceptions of 
people. The age and diagnostic condition of the character 
were not identified as significant variables. After providing 
informed consent, participants were randomly assigned to 
one of four vignette conditions (see Table 1). Participants in 
all conditions were asked to read a short vignette and an-
swer four Likert-type questionnaire items. Next, partici-
pants were asked to complete the Social Value of the Elder- 



BLUNDON ET AL. 
 

36 

Table 1 
Number of Participants Per Condition 

 
Age of        Diagnosis of        Number of participants 

       character        character                (n) per condition 
 

           30 Depression            24 
           30  Arthritis            20 
           80 Depression            21 
           80  Arthritis            15 

 
ly Scale of the Aging Opinion Survey and three short ma-
nipulation check items. Finally, participants were asked for 
demographic information and debriefed. 

Results 
 

Univariate analyses of variance (ANOVA) revealed a 
statistically significant difference regarding the perceived 
importance of medical treatment across the four groups. 
Specifically, the respondents believed that it was more im-
portant for an 80 year-old individual to obtain medical 
treatment than a 30-year-old regardless of the presenting 
symptoms (F = 6.877, p = 0.011). No statistically signifi-
cant differences were found between the ages of the vi-
gnette character and the perceived importance of obtaining 
psychological treatment. On average, the importance of 
obtaining medical treatment, regardless of whether a Major 
Depressive Episode or arthritis was depicted in the vignette, 
was rated as a 4.11 on a five-point Likert scale (1 = not at 
all important, 5 = extremely important). On the same scale, 
the importance of obtaining psychological treatment was 
rated, on average, as 3.08. These results were seen regard-
less of the age of the character. 

Given symptomatology consistent with a diagnosis of a 
major depressive episode, the average ratings of the impor-
tance of obtaining medical and psychological treatment 
were examined as a function of the age of the individual 
portrayed in the vignette (see Table 2). The average rating 
of the importance of obtaining medical treatment was 3.54 
for the 30-year-old character, and 4.17 for the 80-year-old 
character. The average rating of the importance of obtaining 
psychological treatment was 3.38 for the 30-year-old char-
acter, and 3.33 for the 80-year-old character. No statisti-
cally significant differences were found between these rat-
ings (see Figure 1). 

Table 2 
Perceived Importance of Treatment, 
Symptoms of Major Depressive Episode 

 
Age 30        Age 80 

 
Medical treatment    3.54        4.17 
Psychological treatment    3.38        3.33 

 

0

1

2

3

4

5

Medical Psych

Age 30
Age 80

 
Figure 1. Perceived importance of treatment for vignettes with 
symptoms of Major Depression 
 

For those vignettes in which arthritic symptoms were 
depicted, the average rating of the importance of obtaining 
medical treatment as a function of vignette character’s age 
was 4.35 for the 30-year-old character, and 4.60 for the 80-
year-old character (see Table 3). The average rating of the 
importance of obtaining psychological treatment was 2.60 
for the 30-year-old character, and 2.87 for the 80-year-old 
character. No statistically significant differences were 
found between these ratings (see Figure 2). 

 
Table 3 
Perceived Importance of Treatment, 
Symptoms of Arthritis 

 
Age 30        Age 80 

 
Medical treatment    4.35        4.60 
Psychological treatment    2.60        3.33 

 

0

1

2

3

4

5

Medical Psych

Age 30
Age 80

 
Figure 2. Perceived importance of treatment for vignettes with 
symptoms of arthritis 
 

Expecting some difference by ethnicity of respondent 
in terms of social value of the elderly, total scores on the 
Social Value of the Elderly Scale were tabulated and aver-
aged across the ethnic backgrounds of the respondents. 
Caucasians had a mean score of 43.41; African Americans, 
41.69; Caribbean Americans, 9.50; Latinos, 42.00; and 
Asians, 42.43. An ANOVA revealed no statistically signifi-
cant differences among the ethnic groups in terms of the 
averaged total scores on this measure of ageist attitudes.  



EFFECT OF PATIENT AGE AND DIAGNOSIS ON TREATMENT 
 

37 

Discussion 
 

Contrary to our hypotheses, no evidence of ageist atti-
tudes were found in this sample, as seen by the lack of dif-
ference in perceived need for psychological treatment 
across age groups. In regard to medical treatment, respon-
dents rated importance of obtaining care as more important 
for elderly individuals, which is suggestive of non-ageist 
attitudes in this population. As predicted, the overall per-
ceived need for psychological treatment was less than the 
perceived need for medical treatment when controlling for 
diagnosis. In fact, looking specifically at those participants 
who received psychological disorder vignettes, medical 
treatment was seen as more important than psychological 
treatment. It is possible that participants did not fully under-
stand the psychological treatment options available, or per-
ceived the somatic complaints associated with the major 
depressive episode to necessitate medical interventions. 

No overall differences were found on total score of the 
Social Value of the Elderly Scale based on ethnic back-
ground of the respondents. Because the current study did 
not investigate why respondents answered in terms of ne-
cessity of treatment, future research focused on positive or 
negative reasons for treatment would be warranted. For 
example, examining whether viewing the elderly as being 
in greater need of medical care is based on something posi-
tive (such as honoring elders) or something negative (such 
as the elderly as being frail) would further clarify ageist or 
non-ageist attitudes. 

The current findings are important, as they suggest an 
absence of ageist attitudes in this sample. They may indi-
cate that the trend, noted earlier, of college-aged people 
viewing the elderly in a negative light, may be changing. 
However, it may be more likely that the heterogeneity of 
this sample is indicative of the heterogeneity of the envi-
ronment from which the participants were drawn, and that 
the immersion in such an environment fosters an overall, 
general attitude of acceptance and tolerance. Should this be 
the case, our subjects would be less prone, as compared to 
individuals from a more homogeneous environment, to en-
gage in discriminatory actions and beliefs, and might be 
less inclined to exhibit ageist attitudes. Certainly more re-
search is needed to explore whether being a member of a 
heterogeneous population disinclines one to prejudice and 
discriminatory tendencies.  

Additionally, while medical and psychological treat-
ment were both rated as important, medical treatment was 
universally rated as more important regardless of diagnosis. 
This finding suggests the need for the education of caregiv-
ers and the community at large regarding the efficacy of 
psychological treatment for various psychological disor-
ders. It is possible that this finding reflects a general ten-
dency to treat various psychological conditions with medi-
cation, which is often obtained from a medical professional. 
The abundance of advertisements for psychotropic medica-
tions in the general media may be contributing to this trend. 
Future research should be focused on exploring the impact 

of such advertisements on the perceived usefulness of psy-
chological interventions for treating psychological condi-
tions given a medically-based alternative.  

The current study has several limitations that may have 
impacted the results and that should be addressed in future 
research. Specifically, the small sample size and small 
number of participants per group limits the conclusions that 
can be drawn from the data, as there was low statistical 
power. Also, the gender of the subject in the vignette was 
ambiguous, and it would be interesting to see how including 
the gender of the patient would influence results. As our 
respondents were generally in the age range of 18 to 20, and 
age of respondent could influence perceptions of the need 
for treatment, a follow-up study should not only replicate 
the current research, but seek to incorporate respondents of 
a more diverse age range. Future research should also ex-
plore the idea that students in different fields (specifically 
those intending to work with elderly populations, such as 
psychology, social work, pre-medicine, nutrition) may be 
less likely to view symptoms of a Major Depressive Epi-
sode as needing medical rather than psychological attention. 
Ultimately, this research can serve as a starting point for 
future research impacting the care that the elderly popula-
tion receives. 

 
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	Table 1
	Number of Participants Per Condition
	Results
	Table 2
	Perceived Importance of Treatment,
	Symptoms of Major Depressive Episode
	Table 3

	Perceived Importance of Treatment,
	Symptoms of Arthritis

	Discussion
	Gatz, M., & Pearson, C. G. (1988). Ageism revised and the
	provision of psychological services. American Psychologist, 43, 184-188.

