INSIGHT: Respecting our Elders
What gets left out in national discourse about older people and COVID-19?
Over the past year, the dominant attitude towards older people has been: “we’re worried about them dying.” Attention-grabbing headlines and public discourse, especially early in the pandemic, constantly reinforced the tie between older people, COVID-19, and the possibility of death. To an extent, this concern makes sense: the CDC states that COVID-19 poses a greater risk of severe illness, hospitalization and death for those over the age of 65. But when older adults are only viewed as vulnerable to disease and reliant on others, a more nuanced portrait of old age during the pandemic becomes impossible.
The effects of COVID-19 on older populations are not limited to being at-risk; the pandemic has also exacerbated preexisting challenges. Though social distancing and lockdowns have affected all segments of the population, they have caused some older people to experience loneliness or isolation and have diminished support networks. The pandemic’s toll on mental health is integral to understanding the experiences of older people during this time. Older people that were disconnected from the digital world pre-pandemic may have struggled to access important services in the past year, including food resources, vaccine registration or access to medical care. A striking 10 percent of adults over 60 live on the brink of food insecurity; the pandemic has only aggravated this issue.
The problems older people face during the pandemic are very real. But when the media casts those over 60 into one group, it implies that their experiences and health are interchangeable. Sarah Lowe, assistant professor at the Yale School of Public Health, cautioned against this inclination, emphasizing that older people are “a heterogeneous group and it’s hard to really speak to them as a monolith.” Doing so perpetuates ageism, the pernicious effects of which cast a shadow on nearly all older people, downplaying their independence and value to society.
Moreover, ageism overshadows the unique experiences and perspectives of older people. Studies have found that older folks are better at coping with difficult events and maintaining physical activity during the pandemic. Though they may face struggles and challenges, talking with and valuing older people can elucidate important life lessons and coping skills. In a year unlike all others, we have the chance to reevaluate our relationship with old age and embark down a path of intergenerational solidarity as the healing and recovery begin.
SOCIAL ISOLATION’S IMPACT
Concerns about contracting COVID-19 have been omnipresent this last year, affecting people of all ages. Social distancing, lockdowns and curfews have been ubiquitous facets of the pandemic lifestyle. Adherence to these rules has been essential from a public health standpoint, but has left some feeling socially isolated and lonely. Examples of younger people breaking social distancing guidelines en masse abound on the internet, perhaps due media outlets framing the pandemic as one that only older people are susceptible to. Ageist rhetoric impacts social behavior and compliance with social distancing, and older people who are social distancing more strictly than the rest of the population may experience heightened feelings of isolation.
Assistant Professor Lowe, who researches the long-term mental health effects of traumatic events, mentioned different factors that could cause increased feelings of social isolation among the older population. For those living in nursing homes, being unable to see loved ones as frequently as they used to could contribute to feelings of social isolation. Those who are living in their own homes had more independence that allowed them to handle the difficulties of the pandemic autonomously. But Lowe also pointed out that those living independently may also feel the effects of social isolation more acutely due to the significant disruption to their social lives.
Before the pandemic, my grandparents, Jo Greathouse and Tom Graff, led active social lives. But since the pandemic began, they have been largely alone in their home together. “I was depressed,” Greathouse said. “I did feel like it was Groundhog Day, like recycled anxiety over and over.” Though she didn’t mention ageism as something she experienced or that bothered her, Greathouse said that the pandemic was the first time she felt like a “senior citizen”—a phrase she hates. “I felt like I got slow,” Greathouse said, lamenting that she didn’t feel like she got anything done.
Lowe described how the “social mobilization and deterioration model” that is in disaster literature could apply to the unfolding pandemic. This model refers to how communities rally together at the onset of traumatic events. During this time, “people feel a strong support and this protects against mental health problems,” she said. “But over time, after the trauma happens, the support networks can deteriorate or are less available.”
Even for those with robust networks of family and friends, the pandemic has complicated some older people’s ability to get the support they need.
Addie Raucci and her husband Lou live in Branford, Connecticut. Lou has lived with Parkinson’s disease for over twenty years and now also suffers from Parkinson’s-related dementia. Addie is her husband’s full-time caretaker. Every day she carefully administers his medications, bathes and feeds him, does balance, speech and swallowing exercises from YouTube with him, and tries to also provide mental stimulation for him.
Before the pandemic, Addie took her husband to an adult day care twice a week where he could participate in exercise classes and music therapy. During this time, Addie could get some errands done or even just go for a walk. Over concerns of COVID-19, she stopped bringing Lou to the day care center. Not only does this mean that Addie doesn’t get a break, but the change in her husband’s mood has been noticeable. She said, “The worst part, though, is he had no stimulation, only me.”
Since they have both been vaccinated, Addie now feels more comfortable taking him to the adult daycare center. “He likes to be around people and he was losing that,” she said. “Two weeks into the medical daycare and I can see the change already. I mean, nothing’s going to take his disease away, but I can see that he’s so happy when I drop him off.” Addie reports that since his return to the center two weeks ago, she can see “a difference in his personality already, which is good,” she at least has those few hours to herself.
Given that being Lou’s sole caretaker is a demanding around-the-clock role, Addie had previously found a lot of comfort in going to a support group for caregivers. But now, with the group meetings held over Zoom, Addie doesn’t feel like participating. Her house is small enough that Lou can hear her from any room, which doesn’t give her the mental or physical space to discuss the struggles of caretaking. She also finds Zoom difficult to work with and when possible, prefers communicating with people in person. She shared that both she and Lou are lonely and miss spending time with their friends. “Talking is one thing,” she said. “But in person is just so much better. People can put a hand … on your shoulder or something that just makes you feel comforted.”
DISCONNECTED FROM RESOURCES
Beverly Kidder is the Vice President of Community Programs at the Agency on Aging of South Central Connecticut, or AOASCC, and she talks to many older people who are managing the difficulties of social isolation and loneliness during the pandemic. The AOASCC provides a myriad of services, including support for older individuals to enable them to live at home, community services, advocacy, and programs to support healthy lifestyles. It has continued to offer these services during the pandemic, including new offerings to meet the unique challenges of the pandemic.
From the calls that Kidder has taken from people phoning into the AOASCC, she has noticed two different camps of older people. The first camp she identified was a portion of elderly people who were socially isolated before the pandemic. This included people who may have already lost loved ones or partners, or whose friends may have been unable to visit them before the pandemic. She noticed that this group did not report feeling more socially isolated than they were before COVID. The people of the second elderly camp were typically between 60 and 75 years old and previously had active peer-based support networks. These individuals felt more cut off from the world during the pandemic because the limitations to social interaction caused a much more dramatic change in their lives. For technologically illiterate members of this group, “that whole sense of being alone is magnified,” Kidder said.
Though she has worked with the elderly for over 20 years, she was still struck by their lack of access to the “information highway” when the pandemic began. Internet connectivity is a “dividing point between being able to function independently in the community,” she said. Kidder maintained that the pandemic did not create the lack of access to information, “but [it did] reveal how bad it is for older adults.” Without easy access to information, the elderly are left deserted and disoriented, especially during times of crisis.
Additionally, she blamed the “ageist attitude” that assumes that “old people can’t learn new things” for the elderly’s lack of access to the information highway. She also mentioned that older people face diverse difficulties in connecting with the internet and technology, including internet connection in their homes, the recurring cost of internet, ownership of technology, and the skills required to take advantage of these tools.
When the pandemic began, she noticed that calls into the agency from older folks were about twice as long as usual “because you had to get through providing reassurance before you could get to dealing with [the problem].” Many of the older people feared shopping in grocery stores but did not have anyone who could shop for them. And since many did not have internet access, they were unable to schedule grocery deliveries. For low-income elders, the pandemic posed new challenges to obtaining a nutritious diet. Before the pandemic, some low-income elders would visit food pantries and soup kitchens to supplement their groceries after skimping on fresh and nutritious foods for cheaper, preserved, low-quality alternatives at the grocery store.
When the pandemic hit, they no longer had this option. Older people existed along the poverty line before, but many more of those who did not have a way to access online resources when the pandemic began were pushed towards the brink of going hungry.
Some of them called into the AOASCC fearful of where their next meal would come from. Kidder noted that the problem with older adults experiencing hunger is multi-faceted. Many did not want to shop in-person for fear of catching the virus. At the same time, some older folks did not have access to the free food offered at food pantries or did not know how to use technology to take advantage of grocery-shopping services. “When the pandemic hit… within a week we had hungry people that had no food and didn’t know what to do,” she said. The AOASCC worked quickly to establish a grocery shopping program and supplemental food source for people that needed it, but the pandemic highlighted the underlying problem of food insecurity and lack of access to technology for the elderly.
THE EFFECTS OF AGEIST RHETORIC
Becca Levy, professor of public health and psychology at school of public health, studies the effects of age stereotypes, in particular the way that older people are portrayed in different cultures. “We have found in our research that negative stereotypes can lead to a number of detrimental health outcomes in older people,” she said in an interview. “We have found in our studies that older individuals who have taken in more of the negative age stereotypes of their culture tend to be more likely to develop depression, anxiety and suicidal ideation.” Notably, Levy found that positive age-stereotypes had the opposite effect and often led to emotional and physical benefits.
Levy says that pervasive negative stereotypes about older people predate the pandemic. “We know that children as young as age three or four have already assimilated the negative age stereotypes of their culture and then they are reinforced over time,” she said. Some recent findings suggest that roughly 82 percent of Americans who are 50 years or older experience ageist rhetoric, actions or stereotyping.
This ageist rhetoric, and its impact, has intensified during the pandemic. Studies have found that negative messages and stereotypes of aging have proliferated online during the pandemic through memes and social media messages. The influence of negative age stereotypes goes beyond the mental health impact of the messaging. One of Levy’s recent studies found that older individuals who hold negative age stereotypes were more likely to believe that older people who are severely ill with COVID-19 should avoid hospitalization. This finding helps partially explain why some older individuals with COVID-19 avoided hospitals and passed away at home in the past year.
Ageism impacts the way that society sees and treats older people at the same time that it affects the way that the elderly feel and see themselves. In an insidious way, ageist attitudes can cause the media to paint older people as a homogenous group or portray them as frail and helpless. At its most extreme, ageism can be propagated through messages and hashtags like #BoomerRemover that circulated during the pandemic that questioned the value of older people’s lives.
WHAT AGEIST RHETORIC LEAVES OUT
The mental health problems and systematic challenges that older people face during the pandemic, in addition to concerns about contracting COVID-19, are serious. At the same time, it is worth noting that the pandemic did not unilaterally create many of these problems. Despite these challenges, some studies show that older people are uniquely equipped to deal with challenges.
“Considering the state of the literature [on] the aging population, older people tend to be very resilient to these types of events,” Lowe said. Throughout their lifetimes, older people “have garnered strategies to promote their mental health, via their social networks, via individual resources like a sense of hope and purpose.” She said she doesn’t think the COVID-19 pandemic will be an exception.
My other grandmother, Nancy McCulloch, knew that since she was living alone, figuring out how to cope “was going to be a matter of mental and emotional survival.” She said she decided to commit to a few daily routines: going outside for a walk or hike, practicing the piano, and staying in touch as much as possible with friends and family. These three things were what kept her afloat in the long months. “Moving and being in fresh air really lifts my spirits,” she said. “I always come back feeling energized.”
Although good coping skills are not necessarily unique to older people, Kidder said that the experience and self-knowledge honed over an entire lifetime are extremely valuable. If you live to be old, “you have had experiences in your life that are difficult, and you have figured out how to develop coping skills and bounce back,” she said.
McCulloch has a letter her maternal grandmother wrote to another relative; in the letter, her grandmother writes about her husband’s death in the 1919 influenza, leaving her to raise her two children on her own. “She was an example for me … of what I like to think of as grit,” McCulloch said. “Kind of pulling yourself together, looking at your options, and making the best plan you can.”
The older people I interviewed all expressed gratitude for how fortunate they were compared to others. Both Greathouse and Raucci mentioned how much joy it brought them to see people walk in their neighborhood through their front window. “I felt like we could live vicariously through them,” Raucci said. Greathouse similarly noted that having “a window to the world, looking out” helped her and her husband throughout the pandemic. She said, “It didn’t feel like we were so alone, just the two of us, because there was always this little parade going on.”
All of them conveyed that they increasingly prized communion with the natural world. “I made friends with crows in the winter,” Addie said. She noted that she used to chase them away with a broom, but said, “I started reading up on them and when we [her and Lou] discovered how intelligent they are, I had to make amends.” Greathouse was glad that the pandemic began during the springtime, saying, “I just remember having a sense of how beautiful nature was. It was just alive. That made me feel so great.”
If the story of older people during COVID-19 is not as simple or negative as it initially appears, then why does the media portray older people as vulnerable and passive members of society? One possible answer is that ageist rhetoric and mindframes are influencing both media and society. Kidder believes that outright ageism is one of most normalized discriminatory practices — pointing to the birthday card aisles in grocery stores filled with cards that mock older people. “Ageism in our society is so big and affects particularly low income and minority elders tremendously, because they already have other things on their plate that make life difficult,” she said.
She believes that “if there’s any good that comes out of the pandemic,” it may be “raised awareness” of the many difficulties older people face. The problems older people encounter during a pandemic and beyond are not inevitable. In recognizing the ageism in popular media today, society has the opportunity to reevaluate the ways in which ageism has more subtly influenced the media and perspectives on aging in general. Increased awareness of the diverse challenges older people confront provides the chance to improve systems and address the root causes of older people’s problems including poverty, connectivity and ageism.
Though negative age stereotypes have been particularly rampant in the past year, Levy said there are ways for older individuals to protect themselves from the negative effects of stereotypes. “Becoming aware of the portrayals and then questioning them are definitely important strategies,” she said. “It is also helpful to think about positive older role models, and older people that defy the negative age stereotype.” In a previous study she conducted, older individuals who hold positive associations with aging are shown to live 7.5 years longer than those who hold more negative views of aging.
Society stands to gain a lot when older people are adequately taken care of and valued. “The older generation has already been through a lot,” Lowe said. “They’ve been through wars, the AIDS crisis, and 9/11, and they’ve endured. So, I think we can learn from them, how they coped with these other major historical crises.”
Though McCulloch worries about how people in other countries with less access to a vaccine will fare in the upcoming months, her life has gotten better as spring approaches and vaccines have rolled out where she lives in Missoula, Montana, and beyond. She said, “In my little world it feels like things are definitely a lot brighter.”
The Rauccis are also looking forward to the weather warming and the gradual reopening of the country now that they are both vaccinated. “We’re managing,” Addie said. “But it’s going to be a lot better now that it’s getting warm. It was hard. It was a very hard winter.” She said that Lou is feeling hopeful and looking forward to growing tomatoes in their garden and that “he’s grateful we got through it.”
Looking ahead, Greathouse is hoping to get her spizzerinctum back—which is a real word my great-grandmother used to use, she told me, that means “vim, energy and ambition.” As the country reopens, vaccines are administered and communities begin to heal, the hope is that everyone gets their spizzerinctum back.