2.1. Study population

A cross-sectional survey was conducted from April 15–30, 2025, in 45 communities in Zigong City, Sichuan Province, China. The sample size was estimated using the formula , where Z_a/2 was set at 1.96 (corresponding to a significance level of 0.05), represented the population standard deviation, and E represented the width of the confidence interval. Based on preliminary survey results from patients meeting the inclusion and exclusion criteria, the estimated σ was approximately 10. To ensure high precision in the research findings, the confidence interval width was set at ±1 unit. Substituting these values into the formula, it was determined that approximately 384 patients would need to be surveyed. Considering a 10% rate of invalid samples, the final sample size required was calculated to be 422 patients.

Inclusion criteria: Age ≥ 60 years; no intellectual disability and able to complete the questionnaire independently; voluntary participation with informed consent.

Exclusion criteria: History of psychological or psychiatric illness within the past three months; participation in other psychological research studies.

2.2. Ethics approval and consent to participate

This study was approved by the Ethics Committee of Zigong Fourth People’s Hospital (approval number: EC-2023–073) and conforms to the National Statement on Ethical Conduct in Human Research (2016). The study was conducted in accordance with the Declaration of Helsinki. All participants provided written informed consent to participate in the study. All interviews and surveys were conducted in private settings to ensure participant comfort and confidentiality. Participants were informed that their participation was entirely voluntary and that they could withdraw from the study at any time without any consequences. All collected information was processed anonymously to protect participant privacy.

2.3. Survey instruments

2.4. Data collection method

The research team provided detailed introductions to the study background, objectives, and methods to community residents’ committees and healthcare service center staff. During the survey period, community-dwelling older adults independently completed and anonymously submitted the questionnaires, which were collected on-site. For individuals with severe physical disabilities or visual/auditory impairments, research staff assisted in completing the questionnaires through an interview format.

2.5. Quality control

Prior to the study, all research staff underwent systematic training in theoretical knowledge and practical skills, including standardized greetings for participants, strict adherence to inclusion/exclusion criteria, and uniform assessment standards for questionnaire completion. During the survey, leading questions or suggestive responses were avoided. Two researchers reviewed and screened all collected questionnaires, excluding those with incomplete data, multiple corrections, or unclear handwriting. The statistical analysis of survey data was reviewed by a statistician to ensure the scientific validity and accuracy of the results.

2.6. Statistical methods

Data from the questionnaires were double-entered into Epidata 3.0 by two researchers and analyzed using SPSS 25.0 and R. Descriptive statistics were used for categorical data (frequency) and continuous data (mean ± standard deviation).

LASSO regression was employed to select variables associated with perceived ageism. This method applies L1 regularization to shrink coefficients and select variables, effectively preventing multicollinearity and enhancing model generalizability. Variables with non-zero coefficients from LASSO were included in multiple linear regression analysis to assess their independent impact on perceived ageism. Before multiple linear regression, multicollinearity was assessed using variance inflation factors (VIF), with any variable having a VIF > 10 being excluded. Bootstrap resampling (1000 iterations) was used to assess the stability of regression coefficients, with narrow 95% confidence intervals (excluding zero) indicating stable estimates. All analyses were conducted at a significance level of P < 0.05.

3.1. General Information of survey participants and LASSO-based variable selection for perceived ageism symptoms

In this survey, a total of 500 questionnaires were distributed, and 495 were collected. Among the 495 collected questionnaires, 5 had multiple and repeated corrections, 4 had illegible handwriting, and 2 had incomplete information. After discussion by the project team, these 11 questionnaires were excluded. Ultimately, 484 valid questionnaires were collected, with an effective response rate of 97%. To ensure the reliability of the study conclusions and the precision of the overall parameters, the project team decided to include all 484 valid questionnaires in the statistical analysis.

Among the 484 community-dwelling older adults, there were 223 individuals aged 60–69, 170 individuals aged 70–79, and 91 individuals aged ≥80. The sample included 275 males and 209 females. The mean score on the Perceived Ageism Questionnaire was 16.68 ± 3.70. The LASSO (Least Absolute Shrinkage and Selection Operator) analysis identified educational level, employment status, number of medications taken, primary caregiver, vision function, hearing function, source of health information, and self-rated communication ability as variables significantly associated with perceived ageism among community-dwelling older adults. For details, please refer to Table 1, Variables Selected by LASSO Analysis for Assessing Perceived Ageism Among Community-Dwelling Older Adults, and Fig 1, LASSO Coefficient Pathway for Variables Assessing Perceived Ageism Among Community-Dwelling Older Adults.The plot displays the coefficient trajectories of candidate predictors as the penalty parameter λ increases. At the optimal λ selected via 10-fold cross-validation, eight variables retained non-zero coefficients: educational level, employment status, number of medications, primary caregiver, vision function, hearing function, source of health information, and self-rated communication ability.

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Table 1. Variables Selected by LASSO Analysis for Assessing Perceived Ageism Among Community-Dwelling Older Adults.

https://doi.org/10.1371/journal.pone.0330254.t001

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Fig 1. LASSO Coefficient Pathway for Variables Assessing Perceived Ageism Among Community-Dwelling Older Adults.

https://doi.org/10.1371/journal.pone.0330254.g001

3.2. Multivariate analysis results: Impact of key predictors on perceived ageism based on LASSO-selected variables

Perceived ageism scores were used as the dependent variable, and the independent variables selected by LASSO analysis were included in the multiple linear regression model. Before conducting the multiple linear regression analysis, collinearity diagnostics were performed on the variables selected by LASSO. The tolerance of each model was > 0.1, and the variance inflation factor (VIF) was < 10, indicating no multicollinearity among the variables [8].

The results of the multiple linear regression analysis showed that educational level, hearing function, and vision status were significant predictors of perceived ageism among community-dwelling older adults. Detailed results are presented in Table 2 Multivariate Linear Regression Analysis of Perceived Ageism Among Community-Dwelling Older Adults.

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Table 2. Multivariate Linear Regression Analysis of Perceived Ageism Among Community-Dwelling Older Adults.

https://doi.org/10.1371/journal.pone.0330254.t002

4.1. Perceived ageism among community-dwelling older adults are at a moderate level

Our study investigated the prevalence of perceived ageism among 484 community-dwelling older adults across 45 communities in Zigong City, with a mean perceived ageism score of 16.68 ± 3.70. Given the lack of an internationally recognized standard for categorizing the severity of perceived ageism, we employed a percentage conversion method; with the maximum possible score on the Perceived Ageism Questionnaire being 40, the mean score of 16 translates to 40% (16/40), indicating that perceived ageism among this population are at a moderate level. This finding is lower than the 45.9% reported by Araujo et al [9]. in their study of older patients receiving treatment in a hospital setting. This discrepancy may stem from the distinct social interactions, psychological support, and role expectations present in community versus hospital environments.

Firstly, community settings offer older adults a richer array of social interactions and a broader social network. Within communities, older adults can actively participate in collective activities at senior centers, engage in daily conversations with neighbors, and maintain frequent contact with family members, thereby gaining emotional support and a sense of belonging [10]. This active social participation enhances their psychological resilience, enabling them to better cope with potential ageism and thus reducing their perception of ageism. In contrast, hospital environments are relatively closed-off, with older patients primarily interacting with healthcare providers and fellow patients, resulting in a more limited social scope [11]. Moreover, these patients often experience significant physical discomfort and psychological stress, which may heighten their sensitivity to ageism.

Secondly, community environments are generally more inclusive of older adults. Community services and facilities are typically designed to better meet the actual needs of older individuals, such as accessible facilities and community medical points, which provide convenience and support, reducing feelings of neglect due to physical capabilities or social roles [12]. Conversely, the medical processes and operational rhythms in hospitals may not be as accommodating to older patients. For instance, complex registration systems, long waiting times, and the potential disregard for patients’ opinions can exacerbate their sense of helplessness and discrimination [13].

Lastly, societal expectations of older adults differ between community and hospital settings. In communities, older adults are regarded as integral members of families and society, with their experience and wisdom respected. This positive role expectation helps to boost their self-esteem and sense of self-worth [14]. In hospitals, however, older adults are more often seen as individuals in need of care, which can lead to a sense of psychological marginalization.

Despite the lower prevalence of perceived ageism in community-dwelling older adults compared to those in hospital settings, the psychological impact of these symptoms should not be underestimated. Therefore, we recommend that healthcare providers and trained community workers conduct early screening and assessment of perceived ageism among community-dwelling older adults and establish a comprehensive and systematic clinical response framework to mitigate the psychological and physiological harm caused by perceived ageism and enhance the quality of life for older individuals.

4.2. Higher Educational Level Is Associated with Lower Perceived Ageism Risk Among Community-Dwelling Older Adults

Our findings indicate that older adults with higher educational attainment are less likely to perceive ageism in community settings. This association may be attributed to the impact of education on cognitive abilities, social participation, and psychological resilience. Firstly, higher education often correlates with stronger cognitive and information-processing skills. This enables older adults to more rationally assess instances of ageism in society. They can better comprehend the societal structures and cultural contexts that foster age-related stereotypes and use critical thinking to counteract these biases, thereby reducing their susceptibility to perceived ageism [15].

Secondly, individuals with higher education levels tend to have more extensive social participation and richer social networks. They are more likely to engage in community activities, volunteer services, and cultural learning, which not only enrich their lives but also enhance their sense of social identity and value [16]. Through active social interactions, they can gain more support and understanding, which in turn lowers their sensitivity to ageism.

Lastly, higher education contributes to greater psychological resilience [17]. It instills a stronger sense of self-efficacy and self-esteem, empowering older adults to more confidently express their needs and rights and reducing psychological stress and feelings of discrimination related to age [18]. Therefore, we should extend more care and assistance to older adults with lower educational levels. Proactive assessment of their psychological needs can facilitate early screening of perceived ageism and timely provision of necessary psychological support, as well as actively encouraging family involvement to enhance the sense of existence and respect among older adults, thereby reducing the risk of perceived ageism.

4.3. Vision and (or) Hearing Impairment Are Risk Factors for Perceived Ageism Among Community-Dwelling Older Adults

Our study revealed that older adults with vision and/or hearing impairments have a higher risk of experiencing perceived ageism. This heightened risk is likely due to the multifaceted impact of sensory impairments on social interactions, psychological states, and daily functioning. Firstly, vision and hearing impairments directly affect social interactions. Older adults with vision problems may struggle to recognize facial expressions and body language in social settings, while those with hearing difficulties may find it challenging to engage in conversations [19]. These communication barriers not only increase the likelihood of misunderstandings but also lead to feelings of social exclusion and neglect. For instance, older adults with hearing impairments may frequently interrupt others or misunderstand their intentions due to an inability to hear clearly, resulting in awkward situations and misunderstandings that they may attribute to ageism [20].

Secondly, sensory impairments can have a significant negative impact on psychological well-being. These impairments may lead to decreased self-confidence, feelings of helplessness and dependency, and increased self-doubt [21]. For example, older adults with vision impairments may feel frustrated by their inability to perform daily tasks independently, while those with hearing impairments may experience loneliness due to difficulties in socializing. This psychological vulnerability makes them more sensitive to perceived ageism, amplifying their perception of discrimination. Moreover, long-term sensory impairments can lead to anxiety and depressive symptoms, further reducing their psychological resilience and making them more susceptible to negative evaluations and discrimination from others.

Lastly, older adults with vision and/or hearing impairments face greater challenges in daily life. For example, vision impairments may require additional assistance for mobility, while hearing impairments may cause difficulties in understanding instructions. These daily inconveniences and dependencies may lead them to feel like a burden to others, thereby increasing their perception of discrimination [22]. For instance, an older adult with hearing impairments may feel confused when shopping if they cannot understand the cashier’s instructions, and the cashier’s impatience might be misinterpreted as ageism. These daily struggles can further exacerbate their feelings of being discriminated against.

In summary, the higher risk of perceived ageism among community-dwelling older adults with vision and/or hearing impairments is primarily due to the negative impacts of these sensory impairments on social interactions, psychological states, and daily functioning [23]. To address this issue, we recommend that communities provide targeted support services, such as vision and hearing rehabilitation training, guidance on the use of assistive devices, and early intervention by community-based psychological support groups. Additionally, public education should be strengthened to raise awareness and understanding of sensory impairments in older adults, reducing discrimination stemming from misunderstandings. Furthermore, family members and social workers should offer more support and understanding to help these older adults overcome daily challenges and improve their overall well-being and quality of life.

4.4. Implications for practice and policy

Based on our findings, we propose three mutually reinforcing areas for action. Community health services should integrate brief, routine screening for perceived ageism—particularly targeting older adults with lower education or sensory impairments—and embed clear referral pathways to psychological support. Local authorities can expand vision and hearing rehabilitation programmes, subsidise assistive devices, and train frontline community workers to recognise and counter ageist behaviours. Public health campaigns should leverage inter-generational activities and evidence-based educational materials to reshape societal narratives around ageing. Collectively, these measures can foster age-friendly environments that reduce perceived ageism and enhance older adults’ mental well-being and social participation. Future research should adopt longitudinal designs to assess the long-term impact of such interventions and employ mixed-methods approaches to capture older adults’ lived experiences of ageism in everyday contexts, thereby refining both policy and practice.In addition, to extend the current cross-sectional evidence, future research should adopt longitudinal designs to assess the long-term impact of such interventions and employ mixed-methods approaches to capture older adults’ lived experiences of ageism in everyday contexts, thereby refining both policy and practice.