In my last post, I wrote about the regrettable tendency to act as though older people and people with disabilities form two separate groups. When groups within companies don’t share information or knowledge, it’s called a “silo mentality.” It reduces efficiency and compromises the culture. Siloing is just as damaging in the social justice sphere, where it fosters disconnection and marginalization.

Swapping silos for intersectionality

The antidote is to think and act intersectionally—a clumsy word for a powerful idea. Black feminist Kimberlé Crenshaw coined the term intersectionality in the 1970s, to address the ways that different forms of oppression—like racism, sexism and ageism— interact and combine to undermine us all. It’s also a way of thinking about the relationship between identity and power: how people and institutions use identity—old, for example, or disabled, or fat, or Muslim, or crazy—to confer or withhold advantage. In Crenshaw’s words, in an article called “Why Intersectionality Can’t Wait,” “intersectionality isn’t just about identities—race, gender, class—but about the institutions that use identity to exclude and privilege.”

These relationships explain why the poorest of the poor, everywhere in the world, are old women of color. Add disability to the mix, and vulnerability increases even more. It’s why, as Crenshaw wrote, “We simply do not have the luxury of building social movements that are not intersectional, nor can we believe we are doing intersectional work just by saying words.”

Many humanitarian efforts leave people with disabilities behind.

A vivid example came my way this week in an eloquent article by Kate Bunting, the CEO of HelpAge USA called “Putting inclusion into practice.” A term that came out of disability rights, inclusion means giving people with disabilities (PWD) full access to society, whether it means providing closed captions or building wheelchair ramps or simply inviting PWD into the conversation.  Inclusion is core to HelpAge’s mission to improve the lives of the world's poorest olders, and Bunting wants it to be a mainstream humanitarian priority.

We’re not there yet, because we don’t collect much information on older people and what data we do collect isn’t broken down by age or disability. Without data, we can’t design programs with those populations in mind. “What this translates to in practice,” she writes, “are distribution centers reachable only by those who can walk there; food only for those capable of digesting it; and emergency warnings understood only by those who can see and hear.” During wartime or emergencies, this makes PWD, many of whom are older, the last to receive resources and the first to die.

The global discussion of gender-based violence omits older women.

Guess who else is underrepresented in data collection? Older women (because they face both sexism and ageism—hello, intersectionality). “Women over 50 have long been ignored both statistically and anecdotally —as if there is a magical age that means a woman is no longer vulnerable to violence and discrimination,” writes Bunting in another powerful post called “#MeToo has no age limit.” No longer reproductively useful, women over 49 are systematically excluded from studies of gender-based violence and health. Again, the lack of information makes it impossible to create interventions that address their needs, even though violence against older women— physical, sexual, and emotional—is an urgent health and human-rights issue. As Bunting points out, women over 50 make up nearly a quarter of women around the world, their share of the population will only grow, and many live in developing countries where social or legal recourse is inadequate or nonexistent.

Governments and organizations are beginning to heed the HelpAge call: “Remember to include older women. Remember them in your work. Remember them in your policy objectives. Remember them in your development programming,” Bunting writes. “They have said, ‘Me too.’ We just haven’t been able to hear them because we never asked.”

None of us are free until all of us are free.

What can the rest of us do? Bust out of our silos. Ask honestly whether we’ve been reaching out to those with less privilege, to people who don’t look like us, or live far away, or don’t seem to have much in common with us. At heart, there’s only “us.” I used to say that ageism was the only form of discrimination that affects everyone, but in fact all oppression burdens us all. Like the T-shirt says, “None of us are free until all of us are free.”

A movement against ageism is underway. If we want it to leave no one out—to be genuinely inclusive—it has to engage people at the margins of society, the ones that people in power deliberately overlook because they can get away with it. It’s no surprise that queer women of color are leading the charge. They’re the ones, in the words of Rutgers professor Brittney Cooper, “who meld race, gender and queer politics into an expansive, inclusive, and just vision of the world.” That world is better for all of us. It’s the world I want to inhabit and that I’m learning to work towards. As a white woman of privilege not used to abandoning her comfort zone, I have a long way to go.

People with disabilities come in all ages, and almost all of us encounter some change in physical or mental capacity as we grow old. Yet, as I wrote in this substantial post, “We act as though old people never become disabled and disabled people never grow old.” Academics and policymakers approach disability and aging as separate fields, as Ann Leahy observed in this post for the International Network for Critical Gerontology (daunting name, terrific resource). Why? Because people in the aging field are understandably leery of seeming to equate aging and disability, and because, as Leahy noted, disability activists tend to be younger and mainly focused on issues that affect people of working age. Because we’re short-sighted and we’re all prejudiced.

This does none of us any favors, something I want to address in a new talk I’m working on. Here’s the passage-in-progress. Comments and critiques very welcome.

Ageism feeds ableism (prejudice against people with disabilities), and vice versa.

Disability and aging are different. They also overlap in important ways. Both olders and people with disabilities encounter discrimination and prejudice. And both groups face stigma. Many olders refuse to use wheelchairs or walkers, even when it means never leaving home. My uncle wouldn’t use a white cane even when he grew completely blind, preferring to rely on the kindness of strangers and taxi drivers. After breaking a bone in her foot, a not-yet-forty-year-old friend likewise declined a cane, deferring to crutches because they signal “injured,” not “old” or “disabled.” Cognitive impairment is even more stigmatized.

Being older or having a disability doesn’t keep us from being ageist or ableist. Age cooties! Handicapped people make me uncomfortable! That’s how prejudice works: it frames the other group—what we think of as the other group, that is—as alien and lesser than ourselves. This defies common sense, because people with disabilities come in all ages, after all, and most of us, if we live long enough, will encounter changes in physical or mental capacity. Ignoring the overlap also rules out collective activism.

We have a lot to learn from the activists who in the 1970s and ‘80s reframed the way we see disability. They changed it from an individual medical problem into a social problem—bingo!—and then demanded integration, access, and equal rights. We share the same goal: a culture that rejects narrow definitions of “productivity” and attractiveness, finds meaning within limitations—the bull looks different—and takes a realistic and inclusive view of what it means to be human. Let’s join forces.

What affliction do Americans fear most? Alzheimer’s disease. I’m one of them, unless so many bones give out that I have to be carried around in a shovel. But facts comfort me. Abundant new data shows that our fears are way out of proportion to the threat—and that those fears themselves put us at risk.

Fact #1: Dementia rates are falling.  As I reported last April, the likelihood of you or me developing dementia has dropped—significantly—and people are getting diagnosed at later ages. That’s despite a surge in diabetes among older Americans, which significantly increases the risk. Numbers remain high—an estimated four million to five million Americans currently have dementia—but that number pales in comparison all the people who are worried about getting it, and about aging in general. Why is that important?

Fact #2: Worrying about dementia—and about getting older—is itself a health risk. We've known for some time that attitudes towards aging affect how the mind and body function at the cellular level. New research published on February 7^th in the prestigious Public Library of Science journal confirms that finding, reporting that people who associate old age with becoming useless or incompetent are more likely to develop dementia than people with a more positive outlook.

Scientists consider a gene called ApoE to be the primary genetic risk factor in late-onset Alzheimer’s disease, yet many who carry it never develop dementia. How come? Could environmental—and therefore modifiable—factors play a role?  The new study, led by Yale’s Becca Levy, worked with a group of 4,765 people over age 60 who were dementia-free at the start, more than a quarter of whom carried the gene. Levy and her team interviewed them regularly over the course of four years, asking them to rank their feelings to prompts such as, “The older I get the more useful I feel.” They found that people with more negative attitudes were twice as likely to develop dementia. In other words, positive age beliefs confer protection against cognitive decline—even among people who are genetically predisposed to the disease.

Both experimental and longitudinal research show that stress, which links to dementia, may be the mechanism. Levy's team found that positive attitudes about aging can reduce stress and help us cope with ageist messages that bombard us from the media and popular culture. People assimilate cultural beliefs from early childhood on, and as these stereotypes become more relevant over time, we tend to act as though they were accurate, creating self-fulfilling prophecies. (More here about Levy’s theory of stereotype embodiment.) Positive beliefs (e.g. late life is inherently valuable, old age is a time of growth and development, olders contribute to society) help keep us healthy by buffering stress and prejudice: the effects of ageism. Negative beliefs (e.g. it’s sad to be old, old people are ugly, aging means becoming a burden) make us vulnerable to disease and decline.

It’s time for an anti-ageism public health campaign.

We’re stuck with our genes, but not with our behaviors or attitudes. Interventions work. Last year New York Times science reporter Gina Kolata described the decline in dementia rates as "what seems to be a long-term trend, despite researchers’ failure to find any effective way for individuals to protect themselves from Alzheimer’s, the most common form of dementia.” That is no longer the case.

Reputable researches are careful not to overstate their findings, but the scientists behind this new study note that that their findings have far-reaching social implications. In personalized medicine, for example, education could bolster positive attitudes in people at higher risk of developing dementia. On a broader scale, as Levy points out, the research “lays a foundation for creating a public health campaign to beat back against ageism and negative beliefs about aging.” I’ve been making this case for years.

No matter how you feel about the longevity boom, or just about hitting that next big birthday, everyone wants olders to stay as healthy as possible for as long as possible. Imagine the benefits to health and human potential of replacing negative stereotypes about age and aging with more nuanced, positive, and accurate portrayals. The 65+ population of the US is expected to double by the year 2030. Let’s get cracking!