COSMETIC THERAPY FOR THE ELDERLY 143 Is the enhanced self perception that occurs with cosmetic use due to looking more physically attractive or due to feeling more cared for after cosmetics have been applied? Cosmetics provide an excellent vehicle both for enhancing attractiveness and conveying that care, time, and trouble are being taken to improve appearance. Either explanation is possible but it is likely that both are contributing to the positive changes that occur. The results of greater improvement in attitude towards make-overs for the passive make- over as opposed to the training group may be related to the idea that the elderly respond more positively to the feeling that another is caring for them. Kastenbaum (14) has emphasized that elderly individuals who take good care of their skin are more likely to develop a positive psychological cycle. This theme has been developed further by Graham and Jouhar (15). Looking better engenders positive feed- back from associates, reinforcing self esteem and improving societal contacts. Why did the attractive benefit less than the unattractive? It may be because of the operation of a "ceiling" effect, i.e., that there is less room for improvement when the starting level is higher with respect to both appearance and psychological well being. The fact that the low p.a. group did improve more than the high p.a. group also indicates that more than a placebo effect is operating. In our previous study (12) we found that the attractive and unattractive elderly usually used cosmetics to about the same degree. Thus, we cannot attribute the greater degree of benefit in the low p.a. group to the fact that they normally use little. Nonetheless, we gained the impression that the unattractive were not as skillful in their use of cosmetics and were clearly not enhancing their appearance as much as they could be. This is compatible with the frequent observation that it is the low p.a. individuals who usually benefit most strikingly from make-overs in term of their appearance changes. Since the beneficial effects seem to apply much more strongly to the unattractive and their self perception is significantly less favorable along a number of important dimen- sions (12), it seems likely that this difference could be narrowed by various cosmetic strategies, including training by professionals, make-overs, group cosmetology, etc. Thus, some of the social problems associated with aging might be alleviated. Few other studies have previously looked at middle-aged or elderly persons in relation to attractiveness. There are notable exceptions (17, 18, 19,20). Aging is inevitably as- sociated with deterioration in attractiveness. The changes tend to be negative and are viewed by many with fear and revulsion. By using cosmetics to counteract numerous signs of cutaneous senescence, the aged should reap benefits in multiple social and psychological dimensions. This concept may have widespread applications which so far have received scant attention. Connor et al. (16) found that older persons were judged less favorably as job applicants. However, they suggest that this kind of bias may not be due to age per se rather, one decisive factor may be whether the person is attractive or not. The policies and attitudes toward the aged, therefore, have to be reexamined to determine the extent to which a deteriorated, uncared-for appearance influences "ageism." In so far as the "what is beautiful is good" stereotype has been shown to apply with equal force to the elderly, we see an important role for cosmetics in improving the lot

144 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS of the elderly. Others will perceive them more positively this should feed back to their self-esteem, eventually generating more healthy and positive patterns of social behavior. We encountered a variety of attitudes of the elderly towards cosmetics in recruiting subjects for this study many did not use make-up and did not particularly like the idea. Still, they were willing to participate for the sake of promoting scientific research. Many expressed concern that they might look too artificial or frivolous, in a way that might be thought "inappropriate" for their age. They were generally relieved and pleased when the cosmetician gave them a natural and not excessively made-up ap- pearance. These anxieties about the social implications of cosmetic usage often stemmed from the attitudes prevailing during their younger years. Those who were open-minded about participating in an experiment with facial make- up that might not only improve their appearance but their psychological well being as well, tended to benefit most. A few made up their minds that they would not be open to dramatic changes at their stage in life and these tended to benefit less. All too often aged individuals accept their appearance and state of health as an act of fate which one should not try to moderate. Often this has the force of superstition and long-standing religious beliefs which view cosmetics as unseemly manifestations of vanity. "Vanity of vanity. All is vanity." (Ecclesiastics). We observed particularly striking benefits with the hospitalized individuals since their initial mood state was, not surprisingly, relatively low this points to yet another group where cosmetic practice may favorably influence health and well-being. In post-surgical cases there is almost always a need for a psychological boost, for a little extra care to speed along the recovery. For the mentally ill, who often tend to neglect their ap- pearance, there is evidence that appearance can influence the kind of help and attention they receive (21). Cosmetic therapy as an adjunctive therapy would be expected to aid recovery from emotional illness (22). Make-overs could also be very helpful in other areas of negative appearance. For ex- ample, great benefits can be realized by those with various disfigurements and discol- orations, scars of all kinds, hyper- and hypo-pigmentation (especially vitiligo), and hemangiomas (port wine stains). In these cases, cover-up/masking cosmetics are par- ticularly valuable. The psychological benefits of "cosmetic therapy" for individuals with such disfigurements need to be demonstrated with objective data. The important psychological and social benefits which can accrue from cosmetic pro- cedures need to be disseminated among geriatric physicians and among the elderly themselves. ACKNOWLEDGEMENTS We are grateful to Elizabeth Arden, Inc. for Glenn Roberts who conducted the cosmetic make-overs, and for supplying the cosmetic products. We also thank Dr. Carl Silver of Drexel University for statistical advice. REFERENCES (1) J. A. Graham and A. J. Jouhar, Cosmetics considered in the context of physical attractiveness: A review, Int. J. Cos. Sci., 2, 77-101 (1980).