Among the many things brought to light during the COVID-19 pandemic is the invisibility of older persons, especially in times of crises. As of September 23, 148,737 of the 188,470 (or 79 percent) of deaths in the United States attributed to COVID-19 by the Centers for Disease Control (CDC) occurred in people ages 65 and older. Certainly, the increased risks to older persons has been made clear, leading to mandatory quarantines of people older than age 65 in several areas.
However, the magnitude of deaths among older person—8 of out 10 deaths—is overshadowed in media reports that focus instead on risks for younger people. We also have seen limited access to treatment options such as ventilators or participation in vaccine trials—more than half of the COVID-19 clinical trials have excluded many older people, despite them being the most at need. All of these issues underscore the notion that older people are not worth the investment.
This devaluation of older people is not unique to COVID-19. Earlier examples include the 2011 earthquake and tsunami in northeastern Japan, where people ages 60 and older made up more than 65 percent of deaths. Although it may seem that this high death rate resulted from Japan’s large proportion of people older than age 60, consider that 60 percent of the deaths from Hurricane Katrina in 2005 were among people in the same age group.
Several reports have identified that older people suffer much higher death rates than younger people in natural disasters, despite comprising a far lower percentage of the population. Even the relatively small but growing percentage of refugees or asylum seekers older than age 60 has been recognized by the United Nations as being overlooked and needing attention. That older people are overlooked in so many catastrophic situations begs the question: How can we do better for a growing proportion of the world’s population?
First, Acknowledge Ageism
One important first step is to acknowledge that ageism undermines views toward older persons. Ageism has been called the last publicly condoned form of discrimination and has been linked to poorer health outcomes for older people because of diminished views toward themselves and negative views of aging by healthcare professionals who may see conditions such as depression as inevitable consequences of growing old.
Ageism is not new, but rather has been systematically practiced and culturally reproduced for centuries. Because ageism is deeply rooted and entwined in Western culture and social structures, it will be difficult but necessary to dismantle. As cultural gerontologist Thomas Cole has explained, the popular Victorian-era motif of the stages of life still frames much of our current thinking about the value placed on different periods of life. In this motif, the stages of life are depicted as a rising and descending staircase, with “middle age” as the highest peak. Preceding stages signify upward growth. Once past middle age, though, one passes “over the hill,” descending downward to what Shakespeare called “dotage and death.”
As such, the staircase image suggests that we do not “grow” old but rather, we “fall” old. This idea of falling downward forms the basis of ageist attitudes and practices that directly influence current views on the value of older lives. It is no wonder people bristle at the thought of aging as there are no cultural models for climbing back up the hill once someone has crossed the midpoint, despite numerous examples of older persons who have done exactly that.
Older Adults Are a Diverse Group
Another important step toward challenging the devaluation of later life is recognizing the heterogeneity among individuals as they age. This is not meant to ignore the fact that increasing age is associated with increasing risk for poorer health outcomes, but rather to highlight that grouping people by age, such as ages 65 and older—a group that could cover four or more decades—gives the illusion of similarity when there is great diversity. Consider Dr. Anthony Fauci, who, at age 79, is a far cry from stereotypical images of most 80-year-olds.
The same can be said for people across the 65-and-older spectrum. The typical Wall Street CEO has a median age of 58 (fewer than 6 percent are younger than age 50). Thirty-seven percent of college faculty members are older than age 55. Even musicians such as Mick Jagger and Keith Richards, who perform in sold-out venues in their late 70s, illustrate that a lot is possible in later life.
In addition to ageist stereotypes are backlashes in social media against older people. Trends such as #BoomerRemover and #DeadfortheDow during the COVID-19 pandemic have reinforced unfounded fears that older people will consume scarce resources such as ventilators at the expense of younger people. By blaming the generations of people ages 65 and older for issues such global warming, racial inequality and other injustices, some have suggested that the loss of older people is “acceptable” and deserved.
‘Age segregation has arguably been a major reason for the high death rate in older persons.’
Of course, not all responses have been negative. There are many well-intentioned programs designed to protect older people from harm. In general, older people are at increased risk for poorer health, precarious housing, food uncertainty and financial instability compared to middle-age people. These risks are magnified in marginalized groups. Programs such as congregate meals, age-segregated housing, transportation and others designed for the “elderly” (a pejorative term) seem to be a reasonable response. However, there are unintended side effects.
Age segregation has arguably been a major reason for the high death rate in older persons and has led to social isolation for people living in such communities. In addition, programs designed specifically for older adults also give the illusion that all older adults need such services, highlighting negative attributes that some experience in later life. While there are people ages 65 and older who need help, the label “senior” may reinforce ageist stereotypes and exclude younger people in need of services.
Shift in Focus to Inclusion Necessary
Moving forward, in response to the current pandemic and other impeding disasters, focus should be placed on better understanding and meeting the needs of all people in the community, including but not limited to those ages 65 and older. The principles of universal inclusion and design, which are part of many age-friendly initiatives, are an important component. The underlying premise is: What is helpful for an older adult with a mobility issue, will be helpful for others across the age spectrum. A ramp rather than stairs at an entryway is helpful for a person using an assistive device, for a parent with a child in a stroller and so on. Plus, such design is non-stigmatizing as it does not single out a particular group.
Also, more emphasis should be placed on inclusion rather than control—designing “with” not “for.” Factors that contribute to high death rates among older persons during natural disasters, for example, include lack of enough finances to evacuate, limited travel resources (e.g., a place to go, available and effective modes of travel) and inability to receive advanced warnings possibly due to technology. It is unclear whether disaster plans considered the unique situations of many older persons. However, including diverse people from across the life course, who represent the communities being served in planning and managing any crisis responses, can ensure better outcomes for all.
Striving for an equitable society means inclusion and opportunities across the life course. Working now to flatten the “staircase curve” by exposing ageist language, images and practices in all levels of society; countering divisive “generational” rhetoric; recognizing that futures exist at all points of life; and developing effective programs informed by the communities they serve will go a long way in bringing aging out from under the shadows.
Kate de Medeiros, PhD, is the O’Toole Family Professor of Gerontology at Miami University in Oxford, Ohio.