There’s no question that ageism and ableism—the early assumption that the virus killed “only” the old and the ill—underlie the lax global response to COVID19. This means there’s never been a more urgent time to speak out against them. Old School has the tools you need. Today’s newsletter suggests three home-grown ones to start with.
This article was first published by the PBS site NextAvenue, which named me their Influencer of the Year in Aging in 2016–and which deleted the last paragraph after it was posted.
Why is coronavirus spreading across the US? Not because a virulent virus jumped from an animal into a human. Not because of China, or selfish youngers and clueless olders. COVID is spreading because the virus is new and contagious and because we live under a system that picks profit over people at every turn. The pandemic has exposed our shredded social safety net as never before, and a hospital system crippled by decades of cost-cutting, underfunding, and chronic understaffing by underpaid workers to benefit profiteering corporations.
This is playing out nakedly on Twitter at the moment. The hashtag #NotDying4WallStreet is trending as people recognize the implications of President Trump’s calls to end the lockdown soon, which infectious disease experts strongly recommend against. #GrandparentsShould is trending too, in response to the suggestion that grandparents should sacrifice themselves for the good of the economy. (Sample tweet: #GrandparentsShould stop voting for Nazis who want to kill them off to give the stock market a boost.)
Never have ageism and ableism been so glaringly exposed.
We olders are more at risk from COVID19. That’s biology, not bias. Our immune systems are weaker, our lungs less elastic, and we’re more likely to have underlying conditions—such as heart disease, lung disease and diabetes—that make us more vulnerable to other illnesses and slower to recover. This doesn’t mean that the day someone turns 65, they’re at higher risk. It also says very little about what any given individual is up against when it comes to getting sick or getting better. Underlying health plays a much bigger role than age does. And while older people do have more health issues, plenty are in excellent health and plenty of young people are immune-suppressed and/or live with chronic disease.
The most dangerous manifestation of ageism during the pandemic is the suggestion of an age limit for medical treatment, so it won’t be “wasted.” A public health emergency can indeed make it necessary to allocate resources by health status. That’s triage. I wrote earlier, “Allocating resources by age, under any circumstances, is not triage. It is ageism at its most lethal.” I’ve since come to understand that when hospitals get completely overwhelmed, as has happened in Italy and is likely in the US very soon, people on the front lines have to make hideous decisions, very fast, about which of the many people in dire condition are likely to benefit most from getting, say, the only available ventilator. These decisions involve a complex ethical calculus, delineated in this Ars Technica article and this GeriPal podcast. Age is way quicker to assess than health status, and advanced age is a clear disadvantage under these circumstances. Boom. Such decisions are tragic, horrible, wrong, and—under these conditions—sometimes necessary. I sure don’t envy the heroic people making them in hospitals today.
In every other context, it’s up to the rest of us to push back against every form of social bias. Are testing and outreach prioritizing men over women, white people over people of color, youngers over older, cis people over trans? Are we including the most exposed—not just olders but people with disabilities and those who are homeless or incarcerated—in our efforts? We are engaged in a massive collective experiment to protect the vulnerable, whoever they turn out to be. It’s high-stakes, and it’s as intersectional as it can get. We are truly all in this together.
Let’s also ditch the generational finger-pointing and place the blame where it belongs. If we didn’t have a government controlled by corporate interests like Big Pharma and insurance companies, and it had invested in decent healthcare for all, supported public hospitals, not fired the scientists trained to deal with outbreaks, gave a damn about the most vulnerable, and not ignored the coronavirus threat for months, there might be enough ventilators to go around.
I don’t know which person in this video is more annoying, the college kid saying, “If I get corona, I get corona. I’m not going to let it stop me from partying,” or the 93-year-old dissing the partiers: “They think they know it all. They think they’re better than children were years ago.” Both are foolish. The people protesting that it’s Gen Z crowding Florida beaches aren’t much better. “We Millennials are not at Spring Break. We’re at home yelling at our Boomer parents,” who won’t stay home because:
- they have “faith over fear;”
- they only watch Fox News and think the epidemic is a hoax;
- they’re not “elderly” and need to prove it by going out and about. (Let’s hear it for age denial of the lethal variety!)
Some young people are selfish and some are saints. The same, of course, is true of their elders. Many olders are healthy as horses, while many youngers are immunocompromised. Heroes of all ages are putting their lives on the line in clinics and hospitals around the world. Ethics and education and circumstance and culture and countless other factors shape behavior far more than age does. (See Helpful Diagram Below, the product of a fit of frustration earlier this week.)
Why is it so urgent to avoid old-vs.-young ways of framing this crisis? Because finger-pointing undermines the solidarity we need now—more than ever before in human history—across age, class, and borders. As that Washington Post article points out, “What happens next depends largely on us—our government, politicians, health institutions and, in particular, 328 million inhabitants of this country—all making tiny decisions on an daily basis with outsize consequences for our collective future.” The future of the entire world, that is.
According to the Centers for Disease Control and Prevention (CDC), older people and people with underlying health conditions are about twice as likely to “develop serious outcomes” from the COVID19 coronavirus—get really sick and possibly die—as younger and otherwise healthier people.
One reason is that older immune systems are less able to fight off infections. Lungs also deteriorate, becoming less elastic and resilient over time, and like the seasonal flu, COVID19 is a respiratory virus. And olders are more likely to have underlying conditions—such as heart disease, lung disease and diabetes—that make us more vulnerable to other illnesses and slower to recover.
This doesn’t mean that the day someone turns 65, they’re at higher risk. It also says very little about what any given individual is up against when it comes to getting sick or getting better. Underlying health plays a much bigger role than age does. And while older people do have more health issues, plenty are in excellent health and plenty of young people are immune-suppressed and/or live with chronic disease.
Being old doesn’t make you more likely to spread the virus either, any more than being ethnically Asian does. Yet some people have been avoiding contact with people who “look a bit Chinese.” Hello, racism! Where does ageism enter in? In suggestions, mostly on social media, that since “only old people” have been dying from this coronavirus in significant numbers, the rest of the world needn’t be too worried about it. Even worse, in suggestions of setting an age limit for medical treatment, so it won’t be “wasted” on people less likely to survive. A public health emergency can indeed make it necessary to allocate resources by health status. That’s triage. Allocating resources by age, under any circumstances, is not triage. It is ageism at its most lethal.
In some quarters the AIDS epidemic was considered divine retribution for sinful behavior. Shamefully, many of those most at risk, already marginalized by homophobia and racism, were overlooked and even left to die. Doing the same to those marginalized by ageism—the corrosive belief, at its ugly heart, that to age is to lose value as a human being—is just as reprehensible. It is not ethical, or legal, to allocate resources by race, gender, or sexual orientation. Doing so by age is equally unacceptable. Period.
No one deserves to be sick. Everyone deserves respect and care. Viruses infect everyone. Humans shouldn’t discriminate either. The way we respond to a challenge, especially a fearsome one, shows who we truly are, as individuals and societies. There’s nothing like a global pandemic to prove that we’re all in this together. Let’s act like it, in solidarity across age, race, and borders.
March 17th postscript: Since writing this post, I’ve come to understand that when hospitals get completely overwhelmed, as has happened in Italy and is likely in the US very soon, people on the front lines have to make hideous decisions, very fast, about which of the many people in dire condition are likely to benefit most from getting, say, the only available ventilator. Their job is to save as many lives as possible. Age is way quicker to assess than health status, and advanced age is a clear disadvantage under these circumstances. Boom. Such decisions are tragic, horrible, wrong, and—under these conditions—necessary. I sure don’t envy the people making them. If we didn’t have a government controlled by corporate interests like Big Pharma and insurance companies, and it had invested in decent healthcare for all, supported public hospitals, not fired the scientists trained to deal with outbreaks, gave a damn about the most vulnerable (not just olders but people with disabilities and/or substance abuse problems and/or who are homeless and/or incarcerated) and not ignored the coronavirus threat for months, far fewer people would now be at risk. Capitalism kills.
March 22 postscript: A fascinating and nuanced New York Times article about the ethics of medical rationing, and a terrific GeriPal podcast in which two doctors break this down in the light of the current crisis.
This guest post is by Brittany Denis, PT, DPT, CPT-RES, a physical therapist, movement coach, and educator who empowers clients through the aging process with mindful movement. She inspires all adults to bring a growth mindset to aging. You can find her writing over or contact her over through her website.
“It was then that I saw what had been right in front of me my entire career: that the experiences of older people in our health care system are indicative of how current medical care is broken for all of us,” -Louise Aronson, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life
The longer I work in healthcare, the more blatant ageism I encounter throughout the system. I’ve had patients who have been told they can’t get stronger because of their age, that they will live in pain forever due to their arthritis, and that they shouldn’t stay active because they might fall. These are all examples of false statements spread by authority figures that cause harm.
And taking it a step further, older adults are discriminated against if they use an assistive device to walk, even by their medical providers. It’s automatically assumed all older adults are hard of hearing, causing people to shout at them. They get called “cute” or are addressed by demeaning names such as “honey” or “sweetie.” Again, all examples of ageist stereotypes being propagated by the very people who should know better.
But, this is a reflection of an issue that’s larger than healthcare. Much of the ageism we encounter within the medical community stems from the ageism that runs rampant throughout society.
The Shortage of Providers for Older Adults
And our first indication of the ageism issue in healthcare is how few providers want to specialize in medicine for older adults. And that translates into poor quality of care for this age group. Older adults are a specialty population in medicine, but not for the reasons most people think.
As Louise Aronson, a gerontologist highlights in her book Elderhood, older adults make up 16% of the population but over 40% of hospitalized adults. Patients over the age of 65 are the group most likely to be harmed by medical care.
According to the American Geriatric Society, it’s estimated that there are almost 3,600 full-time practicing geriatricians. But for adequate care for the 14 million older adults living today, we need at least 20,000 practicing geriatricians. The gap between availability and demand is wide, despite geriatricians reporting the highest job satisfaction among physicians.
In the few years I worked as a physical therapist in a skilled nursing facility, I saw the implications of this day in and day out. The lack of knowledge among healthcare providers about how to properly treat older adults leads to two major issues. Older adults are being over-treated and under-treated at the same time.
As medical providers, we are trained to identify problems and treat them. Which is difficult for problems that don’t have obvious solutions. Medications and surgical interventions are obvious, these are solutions with more guidelines and indications. But this translates into over-medicating older adults.
The solutions that are often most essential and translate into the best outcomes, like access to a community, adequate transportation, physical mobility, and healthy meals are issues that aren’t so easily solved.
So they go overlooked. Most of the solutions for these issues are not even offered because of the difficulty in implementing them and the lack of reimbursement for such services. And this is where this mistreatment of older adults harms all of us. We limit access to the most impactful services, despite their relatively low cost compared to expensive medical treatments. We’ve deemed these issues as too complicated to solve because they are not as simple as prescribing medication.
“Too often old age itself is blamed for realities created by our choices and policies.” -Louise Aronson, Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life
The Promotion of Aging Myths Within Healthcare
The second indication of the issue with ageism throughout healthcare is the rampant promotion of aging stereotypes from healthcare providers treating older adults.
At the start of this article, I mentioned examples of false statements spread by healthcare providers to their patients. It’s harmful and untrue to tell someone their strength can’t improve just because they are 80-years-old. The reality is that we start to see strength declines as early as age 30 or 40. Improving strength is a matter of practice and repetition, which can happen at any age.
There isn’t anything about aging that limits us from improving, but we’ve been instilled with the belief that this isn’t true. The truth is that you can build muscle, learn new skills, and continue to grow well into your later years.
Healthcare providers tend to miscalculate risk v. benefit, leading them to tell their older adult patients to limit situations in which they “might fall”. And most of the time this advice is recommended without performing a physical fall screening to identify an at-risk patient before offering advice.
While it’s true that falls do become more common as we age, it has more to do with behavior change that comes along with aging. And that behavior change is often caused by ageist beliefs. We limit our activity a little every year because of some misguided belief that we are “too old to…”.
The truth is that frailty isn’t inevitable. You may develop arthritis as you age, but it doesn’t mean you have to live a life of limited mobility and pain. You might fall, but we all fall at some point. The benefits of staying active outweigh the risk of falling. Your physical health can continue to improve with age so long as you continue to practice. And this is what we should be hearing from our healthcare providers.
What You Can Do
“Unlike other prejudices such as racism and sexism… ageism is unique in targeting our future selves.” –Ashton Applewhite
So where does this leave us? Changes within healthcare are needed at the levels of systems and policy, but change is also dependent on changing individual beliefs. It’s up to all of us to start to change the culture of ageism, not just in healthcare but in all settings.
So here’s where to start.
1. Educate Yourself on Ageism
It’s hard to identify ageism if we don’t understand what is true of aging and what are aging myths. Learn more about changes that come with aging and how aging is viewed in our society.
Reading more about aging and ageism is a good start. I recommend Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life by Louise Aronson, This Chair Rocks: A Manifesto Against Ageism by Ashton Applewhite, and Dynamic Aging by Katy Bowman to challenge your perception of aging.
2. Identify Your Own Aging Bias
Whether or not we want to admit it, we all live with some kind of aging bias. And it’s difficult to shed these misguided beliefs when we live in a society that promotes “anti-aging”.
Start to observe your own thoughts on aging and see if they are in alignment with the reality of aging. Are they mostly positive or negative thoughts? We can’t start to resolve the systemic issues of ageism until we learn to recognize our own ageist beliefs.
3. Create Learning Moments with Others
We can’t solve a problem we aren’t talking about. So it’s important to move the conversation beyond researching, learning, and identifying our own internal beliefs.
It can be difficult, but calmly correct others who are spreading misinformation on aging or ageist beliefs. Most people aren’t aware they are causing harm. Approach these situations carefully and try to help others learn through discussion.
Solving the broader issues of ageism starts at the individual level. Both the young and the old need to be on board because ageism impacts us all. More voices are needed in this space to facilitate change. So learn what you can, identify your own ageist beliefs, and be an advocate for yourself within the healthcare system.
I’m spending two months in the Bay Area this winter, making myself at home in the western outpost of the Home for Superior Women (read the book!), getting to know my four left coast grandchildren better, and being a Fellow at the Institute for the Future in Palo Alto. One of the signs in the institute’s big storefront windows features this quote from futurist Jim Dator: “Any useful statement about the future should at first seem ridiculous.”
How’s this for a useful statement about the future? “Thinking all older people are the same will be as absurd as thinking all younger people are the same.” It’s from an animation made by EveryAGE Counts, Australia’s terrific national anti-ageism campaign, asking us to imagine a world without ageism. Because we age at different rates—physically, cognitively, and socially—the longer we live, the more different from one another we become. This fact takes a lot of people by surprise, but it’s anything but ridiculous. It’s science: in nerdspeak, heterogeneity is the defining characteristic of old age.
If there’s one age stereotype about olders I wish I could banish, it would be that “the elderly” belong to some homogenous group when nothing could be further from the truth. All stereotypes are ignorant and wrong, of course, but this one—the mother of them all, so to speak, when it comes to aging—is particularly damaging and misinformed. As I put it in my TED talk, “We tend to think of everyone in a retirement home as the same age—“old”—when they can span four decades. Would you ever think that way about people between age 15 and age 55?” Yet youngers are far more alike. The older the person, the less their age tells us about what they’re interested in or capable of.
If I could choose one fact about aging to plant in every head, it would be this one: the longer we live, the more different from each other we become.
That heterogeneity is of course the source of many headaches, making it incredibly difficult to calibrate pension and retirement eligibility fairly, for example. What if the key to equitable solutions were to take age out of the equation? Peg financial assistance to socioeconomic status, for example, and support with caregiving to physical and cognitive capacity—not age. Of course people will always game the system, social change is slow, and policy is a blunt instrument, but it’s worth thinking about. While you’re at it, spread the word: the longer we live, the more different from each other we become.
This guest post is by Shannon West, a 68-year-old fitness professional working to empower older women to see their potential, and a music blogger who believes older musicians are often the ones on the cutting edge. This is her spin on a viral social media post that struck her as suggesting that older women should resign themselves to the fact that their best days were over, so she “took a shot.” Shannon lives in Jacksonville, FL, and can be reached at ShannonWest0201 [at] gmail [dot] com.
To all my female friends who have passed our cultural expiration date which by now I think is…like…25. (see Amy Schumer’s brilliant “Last F***able Day” video). We get told we are at that age where we see wrinkles and are destined to have saggy muscles and put on extra body fat. We read it in a women’s magazine see it on TV so it must be true. Right? We see cute 25-year-olds, especially in movies, TV shows, and other media, because there are so few multidimensional roles for older women. So we reminisce, because we have been told that our 20s are the last decade in our lives where we can be attractive, fashionable, and adventurous. We have been told that the synonym for vibrant, engaged, forward thinking, healthy, adventurous, empowered, and creative is “young” even though those qualities are actually available to everybody. We hear that we should consider qualities like wisdom and experience the lesser cards we are dealt as we drift into invisibility, even though both are valuable and some of us are still a long way from getting the “wisdom” part down, although our life experiences have definitely given us a sense of accomplishment, perspective, and confidence in our ability to navigate the messy unpredictability that life brings.
Many of us see ourselves as warriors in the quiet and survivors. It’s time to let go of the quiet and engage our warrior spirit in the act of questioning everything our youth-obsessed culture has told us about growing older and actively seeking change on both a personal and political level. It is time to ask why we feel bad about getting older and why we see our growth and years of experience as a process of decline and increasing limitations. Who made these rules? Who said we had to live under them? Should we honor the wishes of advertising agencies and the “anti-aging” industry that create and exploit our fear of aging into a multibillion dollar industry? Should we take as truth research that says we must become sedentary and rapidly decline at a specific birthday when it was conducted in a previous century on older adults whose life experiences were so different from ours today?
We need to actively combat ageism and age stereotyping, first by looking inward and seeing how we are affected personally. Is what we are being told really our personal truth? Are we being pressured to limit our vision of who we are? Then we have to actively challenge ageism everywhere—in the workplace, in our relationships, in what we are told about how we dress and how we “should” wear our hair, in how we take care of our bodies, in how we move through the world. We may choose to ease into elderhood in the traditional way or we may choose to run an Ultra at 65. The path you choose is the path that is fine for you. It is the ability to create and walk our own path instead of being forced onto someone else’s idea of what our path should be that matters. We have the skills to do this. We were the ones who grew up with “girls don’t”. We didn’t listen to that. “At your age” is the new “Girls don’t.” We don’t have to listen to that either. Start on Ashton Applewhite’s groundbreaking This Chair Rocks website, and be sure to check out the Resources area.
A recap of last month’s extraordinary speaking tour of Australia, a bad metaphor, and a call to action. (It’s a new year and a new decade, after all.)
I’m barely back from a tour of Australia sponsored by EveryAGE Counts, their terrific national anti-ageism campaign. It was fascinating to look from another continent at how views on age and age bias are changing around the world.
While I was in Oz, the #OKBoomer meme broke the internet—ageland’s little corner of it, at least. One accelerant was the use of the phrase in Parliament by a young New Zealand politician, Chloë Swarbrick, to rebut an older colleagues after the man heckled her during a speech about the climate crisis. As Swarbrick explained in a subsequent essay in the Guardian, the remark was an “off-the-cuff, albeit symbolic of the collective exhaustion of multiple generations set to inherit ever-amplifying problems in an ever-diminishing window of time.”
Every generation points fingers at the one that came before it and finds fault with the generation that follows (“kids these days”). But young people are coming of age at a time of profound uncertainty, in anxious times we look for scapegoats, and they do have it harder than their parents did. I was born in 1952, right in the middle of the bulge in the proverbial python. Youngers have many reasons to envy my generation’s extreme demographic good fortune, and it is tempting to frame us as the enemy. The song that started it all described boomers as racist, fascist Trump supporters with bad hair. It’s tempting to rise to that hateful bait—ageism cuts both ways—or to go on the defensive. Then everyone loses, and the planet smolders. Bushfires destroyed millions of acres during my few weeks in Australia.
The old are not the enemy and age is not the issue. As historian Holly Scott pointed out in the Washington Post, the problem with #OKBoomer is that “generational divides distract from deeper questions of power.” And privilege. The issue is inequality, which does not discriminate by age. What stands between us and a more equitable world are the structures and systems that benefit from oppression—racism, sexism, ageism and all the rest—because prejudice pits us against each other in order to maintain the status quo. Like auto workers in the US competing against auto workers in Mexico instead of organizing for better wages, pitting young against old is a time-honored tactic used to divide people who might otherwise unite to change things.
OK, boomers: it’s time to reach across the “generational divide,” itself a myth promoted by the mainstream media. It’s time to really listen to what youngers have to say and figure out how to work together. It’s time to act like ancestors—because the stakes have never been higher.
This guest post is by Barbara Lynn Kail, Associate Professor at Fordham University Graduate School of Social Service. She has taught social welfare policy for over 20 years there. She also currently collaborates with Perre Tarres Faculty of Social Education and Social Work in Barcelona. This permits her to follow another passion, the antiageism movement and current developments in Spain. Please send any questions or comments to her at email@example.com.
Generation Z’ers, could I please have a few minutes of your time.
I’ve only recently become aware of the term “OK Boomer,” after reading an article in the Style section of the New York Times.
Both our generations seem to be engaging in the worst aspects of ageism. In fact, “ok boomer” seems to have polarized us even further. One radio host compared it to the n-word, while the New York Post asks why Gen Z hates Boomers. Is this, as the New York Times says, a declaration of war?
You rightly protest that members of my generation are :
- Destroying the world as we know it with our environmental policies.
- Using money and power to maintain the status quo and a privileged position.
- Hurting future generations through selfishness and short-sightedness.
- Not to be trusted.
In short, we Boomers just don’t “get it.”
Well, these accusations sound really familiar. As a Boomer, I vividly recall charging my parents’ generation with :
- Destroying the world with nuclear bombs and our foreign policy in Viet Nam. We are on the eve of destruction!
- Using blatant racism and sexism to ensure those who had money and power held on to it…
- at the expense of our generation and future generations – the Greatest Generation was not so great.
- Breaking our trust… anyone over thirty!
I too engaged in gross generalizations, and Mom and Dad were never going to “get it.”
Boomers, at least some of us, may honestly “get” where you Gen Z’ers are coming from. In many respects your concerns are my concerns and have been since I was a teenager. Engaging in wholesale characterizations of each generation causes us to miss an opportunity to join forces. Just for starters – we can offer experience in grass roots organizing and building a social movement; you have honed the use of social media to a fine art. Recognizing the destructiveness of ageism could go a long way. Together, we could focus our efforts far more effectively and fight those of any generation who are afraid of change and revel in a status quo that is truly not sustainable.
Please tell me, ok boomer!