As we witnessed the fertility rate in the U.S. reaching another record low in 2020, the U.S. is joining other countries in becoming an aging society . It is projected that by 2030, one-fifth of the Americans will be 65 or over . The older adults will outnumber children for the first time in U.S. history . However, despite the shifting population structure, the concept of “ageism” is still a new idea for many. Now, more than two years into the COVID-19 pandemic, scholars suggest the pandemic has revealed and exacerbated the embedded ageism in our society and particularly, in the healthcare industry.
Ageism, according to the World Health Organization (WHO), “refers to the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or oneself based on age” . Most often, the subjects of such stereotyping and discrimination are the older adults in our society. According to research conducted in 2010, 11.4% of the respondents in a study experienced at least one type of the most common abuse (emotional, physical, sexual abuse as well as potential neglect), yet few cases were reported to related authorities . The number is even more staggering when we look at the healthcare industry: a study published in 2015 demonstrated that approximately 20% of older adults report experiencing age-related discrimination . This is frequently evidenced in the U.S. by overgeneralizing older adults as vulnerable, unproductive, lacking cognitive abilities and requiring constant healthcare services .
Manifestations of ageism can occur when healthcare professionals’ attitudes toward older adults are guided by conscious or unconscious discrimination, or, as seen during the pandemic, refusal to provide life-saving treatment opportunities simply because of one’s age . For instance, in the official document on recommendations for allocating medical resources released by the Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva (SIAARTI; Italian Society of Anesthesia, Analgesia, and Intensive Care), the guideline explicitly suggests healthcare providers to “set an age limit for the admission to intensive care”, and that “the presence of comorbidity and functional status must be carefully evaluated in addition to age” .
Generalization of older adults as frail or despondent, for example, could also lead healthcare professionals to either over-prescribe treatment plans that may be expensive and unnecessary, or provide insufficient care and discriminating suggestions on treatment plans. For example, despite the higher prevalence of breast cancer among older women compared to that among younger women, several studies have found that physicians conduct breast examinations for older adults on a much lower frequency, while having a tendency to suggest modified radical mastectomy to older women .
What healthcare workers often ignore is that the older adults is probably the most diverse population group ,as individuals differ in race, ethnicity, gender, physical and mental health and socioeconomic status . Jumping to conclusions means overlooking individual situations, and the belief that older patients lack cognitive abilities may exclude patients from decision-making, which undermines their rights and autonomy. Such neglection and maltreatment are then likely to lead older adults to feel they are undeserving of health services or discourage them from seeking treatment in the future.
As older adults are portrayed as the main target of the virus, younger generations feel a sense of power and invincibility which may further stimulate discrimination towards older adults. Politicians often employ a dichotomous division of population solely based on chronological age, which creates an even deeper split between younger and older generations. For example, Boris Johnson, the prime minister of the United Kingdom, explicitly advised older adults to self-isolate for a period of four months while other age groups could continue with normal daily life. The #boomerremover hashtag, which promotes devaluing comments toward older adults, trended on social media platforms . A Twitter analysis found that among 18,128 tweets related to COVID-19 and older adults in March 2020, almost one quarter of them had “ageist or potentially offensive content toward older adults” . The prevalent ageism in public discourse embodies the idea that older adults are more expendable and can be sacrificed for younger generations’ wellbeing and perpetuates the generalization that all older adults belong to a monogamous group that is defenseless in the face of the pandemic. Meanwhile, there is also the sense that older adults are a strain placed on younger generations who, under such narratives, are described as sacrificing their own freedom to save the older generations on social media.
So do older adults really burden our society? When we look at economic statistics, numbers say otherwise. The 50-plus age cohort now contributes 40% of the U.S. Gross Domestic Product (GDP) each year, while contributing “$745 billion worth of unpaid activities such as volunteering and caregiving” . People in these age groups also contribute to tax revenue, job sustainability, and the less measurable aspects that have to do with their life experiences and wisdom. Nevertheless, age-related discrimination cost the U.S. economy a potential $850 billion in GDP in 2018, because those older than 50 years old often face additional barriers even when they wish to remain or re-enter the labor force . Yet, quite ironically, the Elder Justice Act, which was enacted into law in 2010 with the intention to address elder abuse and ageism in general, has received less than 10% of the funding that was authorized, leading to a further failure in funding Adult Protective Services .
Despite lingering ageism that pervades public opinions and healthcare systems, many have expressed optimism toward positive changes . The COVID-19 pandemic has encouraged the search for innovative treatment, development of new technologies and, hopefully, healthcare reform. Combating ageism requires both personal efforts and institutional changes. Active collaborations between individuals and industries are crucial for constructing a respectful environment for every person.
Edited by: Isa Lee
Illustrated by: Sue Lee