Understanding stigma in later life asthma: a mixed methods scoping review with an intersectional lens

Asthma is a chronic respiratory condition with effective pharmacological treatments; however, poor adherence, particularly the overuse of short-acting β2-agonists (SABA) and underuse of inhaled corticosteroids, remains a persistent challenge. Stigma may influence self-management behaviours, yet its impact in asthma, especially among older adults, is underexplored. Health-related stigma, defined as stereotyping, prejudice, or discrimination directed toward individuals based on a health condition, may interact with age-related factors such as comorbidity, generational attitudes toward illness, and historical experiences of asthma stigma. We conducted a scoping review following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. Six databases (Medline OVID, Embase, Emcare, PsycInfo, Scopus, and CINAHL) were systematically searched for studies examining stigma in asthma, with a focus on older adults. This was supplemented by a grey literature search using Google. Titles and abstracts were screened independently by two authors, followed by full-text review and data extraction using a customised template. Findings were synthesised narratively, and stigma and ageism were approached as sensitising concepts. Eighteen empirical studies involving participants from diverse cultural contexts, and two reviews, were included. Stigma was commonly reported, particularly among individuals with severe asthma or frequent symptoms, and was primarily associated with medication use. Stigma manifested across four key domains: emotional impact, behavioural adaptations, identity disruption, and social withdrawal. While age-related considerations were evident, few studies explicitly examined these experiences in older adults. Intersectional influences including cultural background, age-related biases, and gender were acknowledged in some studies but rarely analysed in depth. Stigma influences asthma management across emotional, behavioural, and social domains, affecting adherence, wellbeing, and healthcare engagement. This review identifies a critical gap in understanding the lived experiences of older adults with asthma and underscores the need for age-specific, intersectional research and tailored interventions to address stigma and improve outcomes, with implications for health promotion, self-management support, and reducing stigma-related barriers to care in older adults.