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
Thank you, Kate for bringing this to light. Ageism has been alive and well for awhile in our country. As someone who would be considered elderly by the definition, I have been subjected to denigration, called a dinosaur, and now, told my life is not worth as much as someone younger than I. My experience, knowledge, life wisdom, and health are not factored into the equation of who will get care, or even protected during COVID-19. Only my age is and I will likely be triaged out of care. It does not matter if I still have a vibrant research program, or am actively training new healthcare providers, or can still compete on horseback. Only my age is considered. How sad that we are considered “throw-aways” in favor of those who may yet live longer, but may not contribute in ways we “elderly” still can. Where is the justice in that?
Excellent analysis. Using age as a criterion of health risk and human value is one of the most prevalent and stealthy attitudes in healthcare today. My colleagues have no problem denying treatment for a 79 yo like Fauci, but would bristle at any suggestion of withholding lifesaving treatment on a 30yo diabetic,with alcoholic cirrhosis and hepatocellular carcinoma complicating COVID-19. Our society values images. The image of youth transcends reality. Sadly ,it is image and perception that influence real decisions.
I want at age 92, while aging in place, to offer myself voluntarily to participate in a Covid-19 trial. I volunteered similarly WWII Army Air Corp before there was a US Airforce.
The defense of my nation and the free world is still my goal for voluntarily accepting the increased risk of an aging-in-place trial since a successful trial is the only long-term solution to a problem even larger than WWII.
If I lose my life in the process, I will pray that a younger person’s life will be saved, a young person having a whole life yet to live. I certainly have had a full life with 5 children, 26 US Letter patents and even had a practiced Stealth Technology incident that kept the Russian aircraft out of the US this year, the Russians never detecting our F-22 stealth fighter.
The US obviously needs more elderly for trial.
At age 92 my trial risk is high, and I accept the risk.
David W. Young
Ageist attitudes are an unfortunate issue to tackle these days with the compounding issues that are surrounding the older adult community. The fact that hashtags like “#BoomerRemover” exist is repellant and abhorrent. As a caregiver for seniors, I hope that my peers and other adults take the time to educate themselves about what older adults want, how we can best care for them, and how we can best support them during this time. Do the individuals using these pejorative and discriminatory terms visit their parents? Do they understand the gravity of the situation at hand? What if you were instructed to remain in the confines of a 400 square foot apartment to live your life for the time being, with no end date? What if your agency was taken away? What if you had your car keys taken away, and had to bring your pet into an animal shelter because your assisted living facility does not allow for pets?
Older adults are some of the most interesting people that I have ever met. They are wonderful, vibrant, kind, and full of love. Some adults believe that they know what is best for their parent, but have not taken the time to simply ask them, “what do you want?” and “how can I help you get there?” These simple questions can help us get to know one another, to transcend ageist attitudes, and to become more accepting of one another.
As a vibrant woman, who happens to be over 65, I resent the prevailing sentiment that I should “just stay home” during the Covid-19 pandemic. This message is merely the latest example of the ageism that is rampant throughout our youth-oriented culture, where those who are “older” are viewed as an inconvenience and shuffled to the margins of society. I hope this crisis becomes a catalyst for societal change in which the value of all Americans are appreciated.