Age Advocacy on Twitter Over 12 Years

Abstract

Background and Objectives

Discussions on age-related issues have begun taking place in earnest, but exactly what dominates public consciousness about these issues is a topic that has yet to kindle scholarly attention. This study analyzes tweets uploaded by age advocacy organizations that have attracted the highest levels of engagement on Twitter.

Research Design and Methods

We collected 403,426 tweets from 53 accounts. These tweets were posted over 12 years, from 2009 to 2021. After applying our exclusion criteria and collating the top 1% of tweets with the highest levels of engagement, 2,054 tweets were retained for analysis. Both inductive and deductive approaches informed our qualitative content analysis.

Results

Five themes emerged. “Issues Related to Alzheimer’s Disease or Dementia” (Theme 1) formed the majority of tweets (62%; N = 1,278). Theme 2 “Rising Health Care or Retirement Costs” was the second largest theme (25%; N = 506). Seven percent of the tweets were on “Reframing Aging and Combating Ageism” (Theme 3; N = 138). “Matters Affecting Caregivers” surfaced in Theme 4 (4%; N = 81). Two percent of the tweets were on “Intersectional Concerns” (Theme 5; N = 51).

Discussion and Implications

As age advocacy organizations step up to engage the public constructively in matters regarding later life, there is a compelling need to quell public anxiety about old age and to sensitize society to the struggles confronted by older adults. In undertaking the range of activities needed to do so, age advocacy organizations should consolidate efforts even as they rethink existing strategies to effectuate change.

Age advocacy, Medicalization of aging, Prescription drug costs, Reframing aging, Social media

With the world currently at a demographic transition—the proportion of the population over 60 years is expected to rise from 12% to 22% between 2015 and 2050 (World Health Organization, 2021)—building equitable infrastructures for older persons is of prime importance. Although the general tenor of discourse on population aging tends to be one of pessimism, advocates of older persons contend that an aging society can be immensely beneficial so long as public institutions and infrastructure adapt in ways that accommodate the changing demographic make-up (Lindland et al., 2015).

As principal players in the lobbying of the rights of older people, age advocacy organizations have ventured into social media to raise awareness of matters affecting this group. Even as discussions on age-related issues have begun taking place in earnest, exactly what dominates public consciousness about these issues is a topic that has yet to kindle scholarly attention. The goal of this study is to analyze tweets uploaded by age advocacy organizations that have attracted the highest levels of engagement on Twitter. Specifically, we conduct a qualitative analysis to identify the most prominent issues vis-à-vis aging.

Work to advocate for the interests of older persons first secured a footing in the 1920s and circled around issues pertaining to pension (Hudson, 2004). Advocacy efforts picked up as the field of gerontology gained momentum, being driven primarily by concerns regarding the mental, physical, social, and economic well-being of older adults (Hinrichsen et al., 2010). In 1958, Ethel Percy Andrus started the American Association of Retired Persons, more commonly known as the AARP (Day, 2017). 1961 saw individuals from various academic and professional disciplines in the gerontological field influencing public policy at the first White House Conference on Aging (Hinrichsen et al., 2010). This seminal event culminated in a series of federal and state initiatives geared toward improving the lives of older persons, such as the Older Americans Act, Medicaid, and Medicare (Moody, 1988). In 1969, gerontological luminary Robert Butler coined the term “ageism” (Butler, 1969). By the 1970s, a professional advocacy and policy network had been set up for older persons (Hudson, 2004). As of now, there are numerous organizations aimed at safeguarding the interests of older Americans, and many have turned to social media to better engage the public (Ng, Indran et al., 2022a).

The rise of social media has made it easier for advocacy organizations to capture public attention, engage stakeholders, and mobilize adherents. At the same time, the production of prodigious amounts of information has led to the creation of an extremely competitive digital environment. As different types of content vie for the much-coveted attention of users who typically have limited information-processing capacities (Guo & Saxton, 2018), certain topics manage to attract more attention than others and serve as a barometer of where the public interest lies. With regard to population aging, advocacy organizations upload content on a suite of issues such as health care, long-term care, retirement, and ageism. Our study operationalizes the concept of “engagement” as a proxy for where public attention is concentrated. In particular, we select posts on Twitter that have obtained the highest levels of engagement, meaning content which audiences have reacted to and connected with the most (Kim et al., 2017).

At present, little is known about what characterizes public thinking where old age is concerned. Past studies have paid more attention to how older adults are stereotyped (Ng et al., 2015) or to societal perceptions of what an aging population entails (Ng & Lim-Soh, 2021). Two studies conducted by the FrameWorks Institute concluded that the lay opinion of the aging process is decidedly fatalistic (Lindland et al., 2015; Sweetland et al., 2017). Later life is often pathologized as a period of inevitable deterioration as well as a loss of independence. Beliefs that contemporary social structures are unconducive for older Americans also guide public evaluations on old age. For example, the geographical dispersion of families means that not all older adults will receive direct social support from their family members. Additionally, financial struggles of the present economic landscape are seen as more acute than in the past, with many believing that the Social Security system has been mismanaged by the government and will no longer be reliable for future generations of older persons (Lindland et al., 2015).

Our study is significant in two regards. Conceptually, this study is one of the first to use social media to explore what issues dominate public attention with regard to later life. Related studies have examined how the public makes sense of aging in America (Lindland et al., 2015; Sweetland et al., 2017). Other social media analyses in the field of gerontology have focused on the prevalence of ageist content online (Ng & Indran, 2022b; Ng, Indran et al., 2022b). By winnowing out the tweets that have amassed the highest levels of engagement on Twitter, our study takes stock of what age-related matters resonate most with the general public. In terms of practical significance, this study offers insight into what concerns bombard the public as well as what issues have yet to enter the collective conscience, thus laying the groundwork for more effective advocacy.

This study seeks to answer the following research questions: Is there a concentration of public attention on certain age-related issues? What issues are these, and which ones have gained less traction?

Method

Data Set

In line with an earlier study on online age advocacy (Ng, Indran et al., 2022a), we referred to various sources to compile a list of organizations (Rodriguez, 2020; West Virginia Bureau of Senior Services, 2021). Thereafter, we checked whether these accounts had a presence on Twitter. To build a more extensive list of accounts, we looked through the list of followers of these accounts and identified other organizational accounts with large followings via a snowball sampling method. The organizations were eventually selected based on the following inclusion criteria: (a) based in North America; (b) dedicated to serving the needs and interests of older persons specifically; and (c) had at least 1,000 followers on Twitter at the time of analysis. A total of 53 organizational accounts met the inclusion criteria. These organizations include the AARP, the National Council on Aging, and the American Geriatrics Society.

We retrieved the data using the Twitter API (Application Programming Interface; Twitter API v2: Early Access, 2021), which was accessed via Twitter’s Academic Research Product Track (Tornes & Trujillo, 2021). The Twitter API v2 full-archive search endpoint allows for the programmatic access of public tweets from the complete archive dating back to the first tweet in March 2006 when the Twitter platform was launched. Compared to what was achievable with the standard v1.1 API, the v2 API affords users a higher monthly tweet cap and access to more precise filters (Barrie & Ho, 2021).

For this study, tweets (N = 403,426) collected covered a 12-year period, from July 17, 2009 to October 8, 2021, the start date being the earliest a tweet from these accounts was uploaded, and the end date being a week after October 1, which the United Nations General Assembly has designated as the International Day of Older Persons (United Nations, 2021). All posts that were “retweets” (N = 118,454) were excluded because they were not original content uploaded by the organizations and, therefore, subject to other variables which affected the extent to which they were engaged with. Likewise, tweets with zero engagement (N = 80,065) were excluded. Finally, due to possible glitches in the API at the time of data collection—there were inaccuracies in the number of “likes” received by certain posts—a few tweets (N = 2) had to be excluded. Upon applying the aforementioned exclusion criteria, the data set contained 204,905 original tweets. We then retained approximately the top 1% of tweets with the highest levels of engagement, resulting in a final data set of 2,054 tweets posted from October 9, 2014 to June 1, 2021. Figure 1 provides a flowchart of the data collection process.

Figure 1.

Process of collating tweets uploaded by age advocacy organizations with the highest levels of engagement.

Measurement of User Engagement

Following Twitter’s data dictionary (Twitter API v2 Data Dictionary, 2021), we used the sum of the following metrics to determine an engagement score: “likes” (i.e., the number of times a tweet has been liked by other users), “retweets” (i.e., the number of times a tweet has been retweeted), “quote tweets” (i.e., the number of times a tweet has been quoted by other users), and “replies” (i.e., the number of times a tweet has been replied to).

Tweet Content Coding

Consistent with past research (e.g., Sipocz et al., 2021), the codebook was designed through both inductive and deductive modes of reasoning (Armat et al., 2018). In inductive content analyses, codes are derived directly from the data (Hsieh & Shannon, 2005). Conversely, analyses informed by a directed or deductive approach begin with the identification of an initial set of codes based on past research (Hsieh & Shannon, 2005). We employed both inductive and deductive approaches to make sure certain pertinent assumptions guided the analysis while also aware that new categories would surface inductively (Armat et al., 2018).

To develop a preliminary codebook, we first identified a set of categories based on prior literature. The content analysis was subsequently conducted in several stages, with each tweet read twice by two researchers trained in gerontology to ensure familiarity with and immersion in the data (Hsieh & Shannon, 2005). The aim of the first reading was to confirm the validity of the initial set of categories, as well as to generate codes systematically across the entire data set. Each researcher modified the codebook independently until all variables were refined and clearly defined. Examples of codes derived deductively include defying age stereotypes, celebrating aging, reframing aging (Sweetland et al., 2017), and Medicare and Social Security (Lindland et al., 2015). Examples of codes that emerged inductively include the sacrifices of caregivers, the financial cost of dementia, prescription drug pricing, the Graham–Cassidy health care amendment, and older lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ) adults. During the first reading, a new category was added whenever a post featured a particular trait that could not be suitably coded into any of the existing categories and which was recurrent in the data. For instance, we added a category called “caregivers” when economic contributions of caregivers were mentioned in a post. Other codes which were subsequently put into this category include the RAISE (Recognize, Assist, Include, Support, and Engage) Family Caregivers Act and the invisibility of caregivers. During the second reading, the two coders had frequent discussions where any discrepancies were reviewed and adjudicated to ensure rigor in the analysis. At this point, the two coders discussed what the codes meant, verified the relevance of the codes to the research question, and identified areas of significant overlap to finalize the coding rubric.

The percentage agreement between the two raters was 96.5% with a weighted Cohen’s kappa of 0.92 (p < .001), indicating high interrater reliability. To identify potential themes, connections were made across the codes. We then refined the themes to ensure they were internally homogeneous (i.e., coherent within themes) and externally heterogeneous (i.e., distinct from each other; Bengtsson, 2016). Five themes emerged from the whole process, and the frequency of each theme was identified postanalysis. The themes are summarized in Table 1. Table 2 details the number of tweets posted by each organization according to theme.

Table 1.

Themes With the Most Engagement on Twitter

Theme	Sample tweets
1. Issues Related to Alzheimer’s Disease or Dementia (62%)	“#Every66Seconds someone develops Alzheimer’s. RT in support of all those who are living with this disease.”
	“Alzheimer’s is the only cause of death among the top 10 in America that can’t be prevented, cured or even slowed. #ENDALZ #SharetheFacts.”
	“Largest increase ever in federal Alzheimer’s research funding has been signed into law. Thank u advocates! #WeDidIt!”
2. Rising Health Care or Retirement Costs (25%)	“Americans are sick and tired of paying the highest prices in the world for their prescription drugs—and continuing to see price increases on the medications they need. RT if you agree: It’s time for #FairRxPricesNow.”
	“Health care bill hits older Americans hard with higher costs, less coverage. Tell @SenCoryGardner: Vote NO! #NoAHCA.”
	“Protect retirement security from federal overreach!”
	“Enough chatter. We need the candidates to give us a real plan for Social Security. #takeastand.”
3. Reframing Aging and Combating Ageism (7%)	“We have 12 people we’d like you to meet. Each of them pushes boundaries, helping to change our collective understanding of what it means to grow older. #InfluenceAging.”
	“We’re bombarded with negative stereotypes about aging every day. You aren’t ‘too old’ for anything. #DisruptAging.”
4. Matters Affecting Caregivers (4%)	“Tell your Senators to support family caregivers by passing the RAISE #FamilyCaregiversAct!”
	“November is #NationalFamilyCaregiversMonth. Honor a caregiver by sharing why you admire him or her”
	“Family caregivers are not compensated—they provide $470 BILLION in care. @SenatorCollins #futureofcaregiving”
5. Intersectional Concerns (2%)	“Trump Admin seeks to ERASE #LGBT elders from national aging survey. SAGE says ‘NO!’ We hope you do to. Learn more: https://t.co/LyzEL1DPBLhttps://t.co/Zd9l2qsnmX.”
	“Age discrimination disproportionally affects the #unemployment of older #women. Women age 50–64 experience longer periods of #unemployment than other groups. #agediscrimination https://t.co/Bje6ZmoAve @policydeb @JeanAccius @timeuse @TheEIU https://t.co/Qqh5znPYk3.”
	“8 hours. 700,000 meals. Day #1 packing meals on the National Mall = complete! #EndSeniorHunger.”

Table 2.

The Number of Tweets Posted by Each Organization According to Theme

Organization	Theme					Total
	1	2	3	4	5
AARP	13	10	63	2	5	93
AARP Advocates	8	471	2	32	6	519
AARP Black Community	1	4	2		2	9
AARP Foundation			5		15	20
AARP International	3	3	47	2	4	59
AARP Livable Communities			1			1
AARP Research			3		1	4
Age Strong Commission			1			1
Age Wave			3			3
Aging2.0			1			1
Alliance for Retired Americans		11				11
Alzheimer’s Association	1,253	6	1	45	4	1,309
American Geriatrics Society			1			1
Booming Encore		1				1
Disrupt Aging			1			1
Diverse Elders Coalition			1			1
National Council on Aging					4	4
Next Avenue			4			4
Old People Are Cool			2			2
Services & Advocacy for LGBT Elders (SAGE) USA					10	10
Total number of tweets	1,278	506	138	81	51	2,054

Notes: AARP = American Association of Retired Persons; LGBT = lesbian, gay, bisexual, transgender.

Results

Summary of Insights From Content Analysis of Tweets

A total of five themes emerged from our content analysis of 2,054 tweets. “Issues Related to Alzheimer’s Disease or Dementia” (Theme 1) formed the majority of tweets (62%; N = 1,278). Theme 2 “Rising Health Care or Retirement Costs” was the second largest theme (25%; N = 506). Theme 3 “Reframing Aging and Combating Ageism” was found in 7% of the tweets (N = 138). “Matters Affecting Caregivers” surfaced in Theme 4 (4%; N = 81). Theme 5 “Intersectional Concerns” featured in 2% of the data set (N = 51). See Table 1 for a summary of the themes and sample tweets associated with each theme.

Breakdown of Tweets Posted by Each Organization

Most of the tweets in Theme 1 came from the Alzheimer’s Association (N = 1,253). The organization with the most tweets in Theme 2 was the AARP Advocates (N = 471). Most of the posts in Theme 3 were from the AARP (N = 63), and most of those in Theme 4 came from the Alzheimer’s Association (N = 45). The AARP Foundation had the most tweets in Theme 5 (N = 15). See Table 2 for a detailed breakdown.

Issues Related to Alzheimer’s Disease or Dementia (Theme 1; 62%)

More than half of the tweets were about Alzheimer’s disease. A large number of these posts featured anecdotal accounts from individuals whose family members had been diagnosed with the neurodegenerative condition. Individuals paid homage to these family members, for instance, by describing them as having “epitomized grace and class,” or for having been exemplars of “moral character, creativity, and spirit.” These anecdotal accounts were frequently used as a segue to invite the Twitter audience to participate in the fight to raise awareness of Alzheimer’s disease, “‘I shine a light for my brilliant and loving father who [sic] we lost to Alzheimer’s [sic] almost a year ago. Who knew this would be our last photo together?’ Join Tara in honoring someone you love on #TheLongestDay to shine a light on the fight to #ENDALZ.”

Many users discussed the emotionally debilitating experience of watching a loved one suffer from Alzheimer’s disease. A case in point would be the following tweet that an organization reposted, “Until you have someone close to you with Alzheimer’s [sic], it’s tough to understand the toll it takes.”

A handful of tweets highlighted the ubiquity of Alzheimer’s disease, for example, by pointing out that “#Every65Seconds [sic] someone in the United States develops Alzheimer’s [sic]” and that “more than 5 million Americans” live with the condition. There was also content that highlighted the economic toll wrought by the condition. One such post mentioned that Alzheimer’s disease “costs taxpayers $22 million” and is the “most expensive disease in the United States.” A few underlined how women with the condition far outnumber men, with nearly two thirds of those diagnosed being women.

Content in this theme was uplifting at times. One user commented that Walk to End Alzheimer’s—an annual event to raise awareness and funds for Alzheimer’s care—represents a “silver lining” to the harrowing reality of the disease. The same tweet stated that while an effective treatment may prove elusive, “there are like-minded people coming together to raise money to find [one].”

The passing of the Building Our Largest Dementia Infrastructure for Alzheimer’s Act into the law was celebrated as a “major milestone.” Similarly, the fact that more funds had been earmarked for research on Alzheimer’s disease was hailed as a sign of progress: “WE DID IT! A $300 million increase in Alzheimer’s [sic] & dementia research funding at the @NIH.” Politicians like Chuck Schumer and Rosa DeLauro earned plaudits for their “leadership in securing additional fund[ing]” for dementia-related research. Likewise, various high-profile celebrities, including Samuel Jackson, Rita Wilson, and Seth Rogen, were commended for championing the cause.

Rising Health Care or Retirement Costs (Theme 2; 25%)

Tweets belonging to this theme alluded to how the cost of growing older in America has shot up precipitously, particularly in the areas of health care and retirement. Key issues that were brought up include escalating drug prescription prices, proposed health care bills, and Social Security.

Health care

Using hashtags such as #FairRxPricesNow and #StopRxGreed, many posts deplored the continual price hikes in prescription drugs and how Americans pay some of the “highest prices in the world” for these drugs. Posters denounced the pharmaceutical industry for profiteering at the expense of older adults, enjoining the industry to prioritize #PeopleOverProfits through reforms in drug pricing. Politicians were frequently targeted in these tweets, as advocacy organizations insisted they “do their job” to make “prescription drugs more accessible and affordable.”

Many tweets drew attention to the financial stress experienced by older adults, indicating that “more than half (58%) of Americans [sic] 50 and older are concerned they won’t be able to afford prescription drugs over the next few years for themselves or their families.” Some even held that it was not uncommon for older people to alter their medication regimes out of financial necessity. One organization quoted a study that discovered that 47% of respondents had “delayed filling or not [gotten] a prescription filled.”

Another major topic pertained to the American Health Care Act (AHCA) of 2017, otherwise known as “Trumpcare.” Occasionally accompanied by the hashtag #DontRationMyCare, tweets about this topic decried the bill as “price goug[ing] older Americans with an age tax, decreasing coverage and undermining preexisting condition protections.” The “mention” feature was frequently employed to assign culpability to specific congressional members for “turn[ing] their backs” on older persons by voting for a bill that would strip away health coverage.

Like the AHCA bill, the Graham–Cassidy health care amendment was lambasted for being particularly injurious to older persons in that it would “raise costs, lower coverage and devastate millions of Americans,” especially “older Americans with preexisting conditions.”

Social Security and Retirement

The notion that Social Security is “a hard-earned benefit and a promise that must be kept” was brought up repeatedly. Tweets on this topic opposed the proposition to cut Social Security as a way to reduce the country’s ballooning federal deficit, maintaining that the program “doesn’t contribute one dime to the deficit.” There were also calls for former presidential hopefuls like Donald Trump and Hillary Clinton to “#TakeAStand on Social Security” even as they canvassed for votes, as well as for the public to “hold every congressional candidate accountable to keep Social Security strong for current and future retirees.”

One tweet seconded Senator Cory Booker’s point on the need for “a plan to deal with retirement security,” saying that nobody’s “grandfather [should] lose their pensions because the people who manage[d] those pensions made terrible mistakes.”

Reframing Aging and Combating Ageism (Theme 3; 7%)

Tweets under this theme depicted later life as a period to be celebrated. One characterized old age as a time of “possibilities.” Some uploads were motivational in nature and served to remind the Twitter audience that nobody is ever “too old for anything.” Other tweets urged society to reevaluate its ageist beliefs. For instance, in response to a news article about a 94-year-old who filed a patent application on a new type of battery, an organization tweeted about the need to dispense with the myth that “creativity and innovation belong to the young.”

At times, organizations venerated famous personalities as successful agers. George Takei, an actor, was described as “breaking more barriers at 78 than most people at 28.” One post included a video of a statement made by another actor, Dick Van Dyke, in which he shared that “old age can be wonderful” and, in fact, has been the “best time of [his] life” despite the widespread “fear of getting old.” An actress, Sharon Stone, was applauded for her “unapologetic” eschewal of socially constructed notions of old age. Loretta Lynn, a singer, was praised for “owning” her old age as she equated “getting older” with “getting better.”

There were many tweets that magnified the achievements of older adults. Julianne Moore, Viola Davis, and Bill Murray were some celebrity figures who were congratulated for winning prestigious awards. Ninety-year-old Johanna Quaas was singled out for defying age stereotypes as she clinched the title of “world’s oldest gymnast.”

Certain posts extolled the merits of a multigenerational society, proclaiming that “businesses, consumers, and the economy benefit” when age-diverse workforces are embraced. Others adduced statistical evidence to explain that older workers are an asset to the economy, indicating that the “economy missed out on an additional $850 billion to U.S. GDP in 2018” due to age discrimination in the workplace. Another shared that older workers actively challenge stereotypes in the workplace by raking in “higher profit margins” than their younger counterparts.

Matters Affecting Caregivers (Theme 4; 4%)

Several tweets emphasized the invisibility of caregivers and flagged concern over how the struggles of caregivers are oftentimes “unseen and widely ignored.” Others foregrounded their indispensability by calling them “America’s greatest support system” or “superheroes” whose economic contributions amounted to $470 billion in 2017.

Organizations made it a point to shed light on the health effects of caregiving. One stated that caregivers “often see an increase in their own health issues while providing care.” A few honed in on the experience of providing care for those with dementia, noting that “compared [to] caregivers of people without dementia, twice as many caregivers of those with dementia indicate substantial emotional, financial, and physical difficulties.”

Age advocacy groups also expressed satisfaction over legislative inroads that had been made in supporting caregivers. For example, the Senate of the United States was praised for passing the RAISE Family Caregivers Act in 2018.

Intersectional Concerns (Theme 5; 2%)

Content filed under this theme spoke to matters of intersectionality. Organizations delved into the struggles confronted by older adults from the LGBTQ community. These posts highlighted the systemic injustices endured by older LGBTQ adults and demanded that they receive “equal legal protection.” One organization censured the Trump Administration for attempting to “erase” the sexualities of older people from the LGBTQ community after the administration had discarded LGBTQ-related questions in a draft of the annual National Survey of Older American Participants in 2017. This call-out included a statement petitioning for the removal of former United States President Donald Trump. In another post, an advocacy group bemoaned how older LGBTQ adults essentially “pioneered the equality movement more than 50 years ago” and yet continue to suffer from a lack of “comprehensive protection under the law.” Many of these tweets featured a clear call to action exhorting audiences to sign a petition or to direct their grievances at specific politicians.

Besides discussing LGBTQ-related issues, tweets under this theme also stressed the interplay between ageism and sexism. Tweets regarding gendered ageism were more prevalent on International Women’s Day, where organizations would dedicate tweets to older women. One such example is the following: “To all the women who are living with Alzheimer’s or caring for someone with it, we are in continual awe of your strength. Happy #InternationalWomensDay! #ENDALZ.” Other themes looked at how age discrimination “disproportionally” affects older women, as well as the stigma against visible markers of old age: “Calling all #women! Are you comfortable letting your #hair go gray? Going out without #makeup?”

There were tweets that revolved around issues of concern to low-income older adults. These posts mainly focused on the mission to “#EndSeniorHunger” and raised awareness of organizational attempts to donate meals to them. A number of posts also problematized the proposal to cut funding for the Supplemental Nutrition Assistance Program—the country’s largest nutrition assistance program—defending it as integral in helping low-income older persons afford nutritious meals.

Discussion

The objective of this qualitative content analysis was to understand what age-related issues are most salient to the general public. Guided by both inductive and deductive modes of reasoning (Hsieh & Shannon, 2005), we analyzed tweets uploaded by age advocacy organizations that received the highest levels of engagement. We found that the issues of foremost concern to the Twitter community pertained to Alzheimer’s disease or dementia (Theme 1), as well as growing health care or retirement costs (Theme 2). Meanwhile, issues that generated less engagement were about reframing aging (Theme 3), caregivers (Theme 4), and intersectional experiences (Theme 5).

That issues surrounding Alzheimer’s disease dominate public thinking about old age comes as no surprise considering that it ranks as one of the most feared diseases among Americans (MetLife Foundation, 2011). Not only is the condition becoming increasingly prevalent—its incidence is projected to triple from 5.8 million in 2020 to 14 million by 2060 (Matthews et al., 2019)—scientific evidence has also revealed that the disease is invariably fatal, and that no treatments can stop or reverse the course of its progression (Cutler, 2015). Over half of Americans know someone with Alzheimer’s disease (Alzheimer’s Association, 2017) and nine out of ten who do are worried that they or someone close to them will develop the condition (Alzheimer’s Association, 2017). This is a cause for concern, considering that anxiety about contracting Alzheimer’s disease can adversely affect one’s psychological and physical health (Cutler & Brăgaru, 2017). The looming presence of Alzheimer’s disease in the collective psyche may also engender a wider fear of the aging process because old age is the biggest risk factor for the disease (Kessler et al., 2012).

Scholars have drawn attention to how people with Alzheimer’s disease are heavily stigmatized (Gerritsen et al., 2018). It is, therefore, encouraging that tweets about this disease are receiving high levels of engagement. At the same time, the cultural preoccupation with Alzheimer’s disease necessitates consideration of whether the aging process is becoming increasingly medicalized. For instance, however well-intentioned, tweets that quantify its prevalence—“someone in the world develops Alzheimer’s every 60 seconds”—may detract from the heterogeneity of the older population, in turn perpetuating negative stereotypes that conflate old age and cognitive impairment. By the same token, a fixation with the financially ruinous consequences of Alzheimer’s disease may fortify ageist beliefs about older adults as an economic burden. When internalized by older adults, these negative age stereotypes may lead to poorer health outcomes, such as a reduced sense of self-efficacy and a higher risk of depression (Levy, 2009). Younger people too are not exempt from the effects of negative age stereotypes. Evidence shows that younger individuals who hold more negative age stereotypes are more likely to experience a cardiovascular event in later life than those who hold positive age stereotypes (Levy et al., 2009).

Another major theme of interest concerned the increasingly prohibitive cost of growing older in the United States. Issues under this theme covered two topics: health care and retirement. Regarding health care, a key issue that was brought up repeatedly involved the access to prescription drugs, the prices of which have been on an interminable ascent over the past few decades. Evidence demonstrates that increases in patients’ out-of-pocket costs lead to lower drug adherence, higher mortality, and greater overall health care costs (Chandra et al., 2021). While this crisis in prescription drug pricing affects all age groups, older adults are among the hardest hit. In the United States, more than 85% of those aged 65 and older take at least one prescription drug on a regular basis and over 40% take five or more (McSpadden, 2022). Other issues related to health care costs involved the imposition of an age tax under the proposed AHCA and the Graham–Cassidy Plan, both of which would have hiked the cost of health insurance for older persons (Hickey, 2017).

Concerns regarding retirement and Social Security also attracted high levels of engagement. A poll conducted by Gallop in 2018 found that six in ten Americans were moderately or very concerned about not having enough money in retirement (Saad, 2018). In another poll carried out in 2019, 70% said that the average worker is unlikely to save enough to attain financial security in later life, and 65% said the chances are high that they must work past retirement age to retire comfortably (Oakley & Kenneally, 2019). These sentiments even transcended partisan lines, with 80% of Democrats, 75% of Independents, and 81% of Republicans concurring that a retirement income crisis is festering in America (Oakley & Kenneally, 2019).

Posts about reframing aging and combating ageism unfortunately comprised only 7% of the data set, which signifies that ageism as a social issue has yet to entrench itself in mainstream consciousness. Whereas discussions on issues pertaining to gender and race have taken flight in the United States, there has not yet been a groundswell of support for older people. In fact, a study recently unveiled that those who endorse egalitarian beliefs—specifically those who show support for racial minorities and women—are more prone to discriminating against older persons (Martin & North, 2022). Even more worrying is the finding that age stereotypes in the United States have become more negative over the last two centuries (Ng et al., 2015; Ng & Chow, 2021).

Matters affecting caregivers, older LGBTQ adults, older women, and lower-income adults received little attention. It is well established that each of these groups deals with a unique set of struggles. A significant proportion of those who perform care work suffer caregiver burden (Hopps et al., 2017). Meanwhile, scholars have unearthed important health and economic disparities between older LGBTQ adults and their heterosexual contemporaries (Fredriksen-Goldsen et al., 2013). Older women too often have to navigate the double jeopardy of gendered ageism (Krekula et al., 2018).

Curiously, issues related to Alzheimer’s disease, retirement security, and financial access to health care accounted for the bulk of well-engaged tweets. Perhaps this indicates that when it comes to growing older in America, people tend to be bound by pragmatism, showing greater concern over bread-and-butter issues related to health and financial security (Inglehart, 1997). Reframing aging or combating ageism may represent higher order values that have not deeply penetrated the collective conscience, or which society has limited bandwidth for given the widespread anxiety surrounding materialist issues with a direct bearing on one’s prospects of survival.

This study has several implications. First, it should be noted that most of the tweets about Alzheimer’s disease were uploaded by the Alzheimer’s Association. Because these tweets dominated the data set, staff could consider how to present this condition in a more nuanced fashion. Positive emotional appeals could be incorporated in tweets, such as by describing those with Alzheimer’s disease as still capable of experiencing joy (Van Gorp et al., 2012). The point is not to embellish the negative aspects of the disease, but rather to avoid perpetuating misconceptions of later life as a time of cognitive decline and to ensure public anxiety about the condition does not worsen.

Second, the AARP Advocates should persist in its dogged determination to push for meaningful reforms in prescription drug pricing. The organization’s latest victory is the Inflation Reduction Act of 2022, a legislation that will help millions of Medicare enrollees better afford prescription drugs (Bunis, 2022). As progress continues to be made on this front, the AARP must ensure that drug prices are kept affordable for as many older adults as possible.

Third, considering how posts related to reframing aging and combating ageism made up a small fraction of the data set, there is a need for age advocacy organizations to double down on ongoing outreach efforts (Ng & Indran, 2022a, c, d). While progress has been made on an international level—in 2016, the gravity of ageism impelled all 194 member states of the World Health Organization to call for a global campaign to eliminate ageism—micro-level awareness on the issue appears to be lagging. Being the organization with the most tweets in the third theme, the AARP should continue fronting this movement to combat ageism. For a more unifying impact, the AARP, with its huge follower base, could retweet content posted by other organizations with the same mission. Importantly, in their endeavor to reframe aging, organizations should be mindful not to idealize later life, but to instead present old age as a period with both gains and losses.

Fourth, as the demand for caregivers continues to skyrocket on the back of an aging population, issues related to caregivers certainly warrant greater conversation (Ng & Indran, 2021a, b). The AARP Advocates and the Alzheimer’s Association should continue expressing their appreciation for caregivers on social media. Furthermore, these organizations could remind audiences that most will eventually transition into the role of either a caregiver or a care recipient to encourage more solidarity with existing caregivers. Collaborations with interest groups that promote the well-being of caregivers, such as the National Alliance for Caregiving and the American Caregiver Association may prove worthwhile as well.

Finally, it is vital that the struggles of marginalized communities are not left unacknowledged. A more targeted approach in advocacy efforts could be adopted by the AARP Foundation as well as Services & Advocacy for LGBT Elders (SAGE) to prevent members of these communities from falling through the cracks. These organizations could also work with larger ones to educate the public on issues faced by older adults from marginalized populations.

There are a handful of limitations to this study. First, as each account from which the tweets were derived had a different number of followers, many of the tweets came from accounts with more followers. Nonetheless, the fact that these accounts managed to attract the most followers might imply that the causes they represent resonate most with the public. Second, it was not within the scope of this study to explore how discourse on various issues changed over time. On a related note, although our data set covers tweets posted over a 7-year period, discussions on certain issues may have only begun taking place in recent years. For instance, the initiative to reframe aging is still fairly nascent, which could account for there being only 7% of tweets related to it. Third, findings from this study captured only a snapshot of public opinion on age-related issues. To gain insight into what matters resonate most with the public, future studies could consider analyzing news media (Giest & Ng, 2018; Ng, 2018, 2021; Ng, Lim et al., 2020; Ng et al., 2021; Ng, Chow et al., 2022; Ng & Lim-Soh, 2021; Ng & Tan, 2021a, b) through big data analytics (Giest & Ng, 2018; Ng, 2018; Ng & Tan, 2021b) or conducting surveys (El-Muttardi et al., 2005; Ng, Allore et al., 2020; Ng et al., 2016; Ng & Levy, 2018; Ng & Rayner, 2010). Fourth, we did not have information on the profile of users interacting with the tweets. It may be those who are middle-aged or older who are engaging with age-related content the most, which would suggest a need for a broader societal-level conversation on how to optimize the lives of older adults.

Conclusion

The goal of advocacy is to spark change in attitudes, behaviors, and policies. As age advocacy organizations step up to engage the public constructively in matters regarding later life, there is a compelling need to quell public anxiety about old age and to sensitize society to the struggles confronted by older adults. In undertaking the range of activities needed to do so, age advocacy organizations should consolidate efforts even as they rethink existing strategies to effectuate change.

Funding

We gratefully acknowledge support from the Social Science Research Council SSHR Fellowship (MOE2018-SSHR-004). The funder had no role in study design, data collection, analysis, writing, and decision to publish.

Conflict of Interest

None declared.

Acknowledgment

We are indebted to L. Liu for preprocessing the data.

Data Availability

All data analyzed in this study are publicly available at https://www.twitter.com. This study was not preregistered.

Author Contributions

R. Ng designed the study, developed the methodology, analyzed the data, wrote the article, and acquired the funding. N. Indran coanalyzed the data and cowrote the article.