Bioethics Forum Essay

A Covid-19 Side Effect: Virulent Resurgence of Ageism

Of all the “isms,” ageism is arguably the hardest to address because old age is neither a valued stage of life nor an identity that many claim. The coronavirus pandemic may have made that effort even harder.

The Centers for Disease Control and Prevention has identified three groups at higher risk for contracting severe illness from the Covid-19: people age 65 or over, people living in long-term care facilities such as nursing homes, and anyone with an underlying medical condition such as people with heart disease, diabetes, liver disease or several other chronic conditions. While this information is important, it may have inadvertently created a backlash of ageist practices. Consider the reader comments on a recent New York Times article on how to convince your older parents to protect themselves against the virus. One person wrote:

Well, realistically, what do they have to look forward to? What do they have to live for? Say, they get sick? Most doctors won’t take Medicare patients. So, it’s bankruptcy? Try being bankrupt when you’re very old. Homelessness? Try that one on for size. Lodged in an assisted living facility, reduced to being a virtual prisoner? There are only so many games of Bingo that you can play. It’s a place where they wait to die anyway? Or, a “retirement” home? Where they wait for the end. For the stroke that eviscerates them? The Conoravirus quickly killing them would be doing them a favor, in a way. As it is, doors close in their faces because of their advanced age.

Sadly, this sort of sentiment seems to be shockingly common now.

How we talk about “old”–what is old, who is old, am I old–reveals attitudes about aging. The language of “old” is negative, evasive (e.g., “You’re 80 years young”), and/or condescending (e.g., “Old people are cute”). People who don’t consider themselves to be “old” refer to “them” as a way to distance themselves. Even words like “wise” can be pejorative when indiscriminately applied to all persons in a given age range irrespective of their individual attributes.

Take, for example, “senior citizen,” a marketing term of sorts. Originating in the U.S. in the late 1930s, “senior citizen” was a way to brand the new idea of the retiree as holding an honored position within society. It was really more of a ploy to convince older workers to step aside to make room for younger ones. “Senior citizen” is now a term people use to avoid saying “old” although definitions of “old” vary greatly. In the U.S., “old” might be the eligibility age for receiving Social Security retirement benefits (currently age 65). “Senior” living communities are generally open to people 50 and over, the age at which people are assumed to have no household dependents who would need access to community services like schools. Membership eligibility at “senior centers” in the U.S. is also often age 50, though, according to the National Council on Aging, the average member is 75 years old (and female). “Old” in these examples is associated with services or opportunities, not physiology or functional ability. However, we know from decades of research that most people who meet these various eligibility criteria don’t consider themselves to be “old,” although they may consider themselves to be a “senior.”

Perhaps more insidious than “senior citizen,” however, is “elderly.” According to an article by Herbert Covey on the history of terminology to represent older people, although sometimes mistaken as a synonym for “elder,” “elderly” evolved from the tenth century term “eld” (old age or late life). Later, offshoots included “eldfather” (grandfather), “eldmother” (grandmother), and “elder,” which originally meant ancestor or forefather, but later reflected a position of power for wealthy men. By the early 1600s, however, “elderling,” later “elderlie” were terms of contempt toward older persons (“eldress” described a “mean old woman”). Today, “elderly” is applied to various age groups–65 and over, 85 and over, with little to no rationale.

“Elderly” is problematic for several reasons. It is used to label an entire group of people based on chronological age. It is never used as a term of empowerment but rather as one that conveys vulnerability and frailty. It evokes sympathy; paternal, protectionist attitudes evident in phrases such as “our elderly”; and disdain. Although some people might identify as being “senior citizens” (or “seniors”), most people, regardless of age, don’t identify as “elderly” but are identified by others. In the current Covid-19 pandemic, even those age 60 and over have been labeled as “elderly” or “senior” although few would label themselves as such.

Drawing from arguments in gender, race, and disabilities studies, those of us who study aging regard old age as a cultural construction of physiological changes over time. Gray hair is a biological response; viewing gray hair as a sign of decline is a social one. This is not meant to ignore aging or to gloss over the losses that can occur over time as one ages. Although biological changes happen over time to everyone, people age at different rates due to a variety of variables–genetics, lifestyle, access to health care, and so on. To assume that all people within a chronological age range are the same ignores the heterogeneity of people as they age.

Consider, for example, 79-year-old Dr. Anthony Fauci who, among a long list of accomplishments, is a respected physician, immunologist, director of the National Institute of Allergies and Infectious Disease, and advisor to six presidents. I have yet to see him referred to as “the elderly Dr. Fauci” or as “Dr. Fauci, an active senior.” Why? Because he is strong, smart, active, competent–descriptors that are taken for granted in younger people but that have to be “proven” by older people. This observation is not meant to ignore or diminish the fact that Dr. Fauci is at higher risk because of his age. He has said so himself. Instead, it’s important to point out that the majority of people who are age 60 or over are not frail, weak or dependent as the term “the elderly” implies. Yes, they are at increased risks for serious Covid-19 complications, but those risks are raised by coexisting conditions, for people of all ages. It is arguably different to use an age range that has verifiable connections to risk versus vague and potentially demeaning labels like “elderly” or “senior” to identify risk. The former is a scientific association; the latter is a social value.

Kate de Medeiros is professor of gerontology at Miami University in Oxford, Ohio. Twitter: @Kate_on_aging