The COVID-19 pandemic would be a wake-up call for America, advocates for the elderly predicted: incontrovertible proof that the nation wasn't doing enough to care for vulnerable older adults.
The death toll was shocking, as were reports of chaos in nursing homes and seniors suffering from isolation, depression, untreated illness, and neglect. Around 900,000 older adults have died of COVID to date, accounting for three of every four Americans who have perished in the pandemic.
But decisive actions that advocates had hoped for haven't materialized. Today, most people -- and government officials -- appear to accept COVID as a part of ordinary life. Many seniors at high risk aren't getting antiviral therapies for COVID, and most older adults in nursing homes aren't getting updated vaccines. Efforts to strengthen care quality in nursing homes and assisted living centers have stalled amid debate over costs and the availability of staff. And only a small percentage of people are masking or taking other precautions in public despite a new wave of COVID, flu, and respiratory syncytial virus (RSV) infections hospitalizing and killing seniors.
In the last week of 2023 and the first 2 weeks of 2024 alone, 4,810 people 65 and older lost their lives to COVID -- a group that would fill more than 10 large airliners -- according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)
"It boggles my mind that there isn't more outrage," said 66-year-old Alice Bonner, PhD, RN, senior adviser for aging at the Institute for Healthcare Improvement. "I'm at the point where I want to say, 'What the heck? Why aren't people responding and doing more for older adults?'"
It's a good question. Do we simply not care?
I put this big-picture question, which rarely gets asked amid debates over budgets and policies, to healthcare professionals, researchers, and policymakers who are older themselves and have spent many years working in the aging field. Here are some of their responses.
The pandemic made things worse. Prejudice against older adults is nothing new, but "it feels more intense, more hostile" now than previously, said Karl Pillemer, PhD, 69, a professor of psychology and gerontology at Cornell University.
"I think the pandemic helped reinforce images of older people as sick, frail, and isolated -- as people who aren't like the rest of us," he said. "And human nature being what it is, we tend to like people who are similar to us and be less well disposed to 'the others.'"
"A lot of us felt isolated and threatened during the pandemic. It made us sit there and think, 'What I really care about is protecting myself, my wife, my brother, my kids, and screw everybody else,'" said W. Andrew Achenbaum, PhD, 76, the author of nine books on aging and a professor emeritus at Texas Medical Center in Houston.
In an environment of "us against them," where everybody wants to blame somebody, Achenbaum continued, "who's expendable? Older people who aren't seen as productive, who consume resources believed to be in short supply. It's really hard to give old people their due when you're terrified about your own existence."
Although COVID continues to circulate, disproportionately affecting older adults, "people now think the crisis is over, and we have a deep desire to return to normal," said Edwin Walker, 67, who leads the Administration on Aging at HHS. He spoke as an individual, not a government representative.
The upshot is "we didn't learn the lessons we should have," and the ageism that surfaced during the pandemic hasn't abated, he observed.
Ageism is pervasive. "Everyone loves their own parents. But as a society, we don't value older adults or the people who care for them," said Robert Kramer, 74, co-founder and strategic adviser at the National Investment Center for Seniors Housing & Care.
Kramer thinks boomers are reaping what they have sown. "We have chased youth and glorified youth. When you spend billions of dollars trying to stay young, look young, act young, you build in an automatic fear and prejudice of the opposite."
Combine the fear of diminishment, decline, and death that can accompany growing older with the trauma and fear that arose during the pandemic, and "I think COVID has pushed us back in whatever progress we were making in addressing the needs of our rapidly aging society. It has further stigmatized aging," said John Rowe, MD, 79, professor of health policy and aging at Columbia University's Mailman School of Public Health.
"The message to older adults is: 'Your time has passed, give up your seat at the table, stop consuming resources, fall in line,'" said Anne Montgomery, 65, a health policy expert at the National Committee to Preserve Social Security and Medicare. She believes, however, that baby boomers can "rewrite and flip that script if we want to and if we work to change systems that embody the values of a deeply ageist society."
Integration, not separation, is needed. The best way to overcome stigma is "to get to know the people you are stigmatizing," said G. Allen Power, MD, 70, a geriatrician and the chair in aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada. "But we separate ourselves from older people so we don't have to think about our own aging and our own mortality."
The solution: "We have to find ways to better integrate older adults in the community as opposed to moving them to campuses where they are apart from the rest of us," Power said. "We need to stop seeing older people only through the lens of what services they might need and think instead of all they have to offer society."
That point is a core precept of the National Academy of Medicine's 2022 report . Older people are a "natural resource" who "make substantial contributions to their families and communities," the report's authors write in introducing their findings.
Those contributions include financial support to families, caregiving assistance, volunteering, and ongoing participation in the workforce, among other things.
"When older people thrive, all people thrive," the report concludes.
Future generations will get their turn. That's a message Kramer conveys in classes he teaches at the University of Southern California, Cornell, and other institutions. "You have far more at stake in changing the way we approach aging than I do," he tells his students. "You are far more likely, statistically, to live past 100 than I am. If you don't change society's attitudes about aging, you will be condemned to lead the last third of your life in social, economic, and cultural irrelevance."
As for himself and the baby boom generation, Kramer thinks it's "too late" to effect the meaningful changes he hopes the future will bring.
"I suspect things for people in my generation could get a lot worse in the years ahead," Pillemer said. "People are greatly underestimating what the cost of caring for the older population is going to be over the next 10 to 20 years, and I think that's going to cause increased conflict."
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