Why are we OK with old people dying?
By Louise Aronson
Dr. Aronson is a professor of medicine at the University of California, San Francisco.
“Not just old people: Younger adults are also getting the coronavirus,” a news network declared on its website last week. The words seemed to suggest that Covid-19 didn’t matter much if it was a scourge only among the old.
Even if the headline writer had no such nefarious intent, many people seemed surprised that two-thirds of the Americans known to be infected were under 65, according to the federal Centers for Disease Control, and that younger adults around the country also have become critically ill. After all, we kept hearing that 80 percent of the infected Chinese who died were age 60 and older and that the average age of death from the disease in Italy is 81.
No one wants young people to die. So why are we OK with old people dying?
Of course, we all will die, and since the ventures of the rich and famous to indefinitely extend life have so far come up short, death in old age is the best outcome available to us.
But most old people are not dying. Not only are the “old” getting older, but the risk of death in the next year for a 70-year-old man is just 2 percent, and an 80-year-old woman has only a 4 percent likelihood of dying in the coming year, according to the Stanford economist John Shoven. Comments such as “They’re on their way out anyway” are therefore more than colossally insensitive; they’re also colossally inaccurate.
And they harm all of us. Some countries responded slowly to the coronavirus threat because they deemed it a condition primarily lethal to old people “less worthy of the best efforts to contain it,” the World Health Organization’s director general, Dr. Tedros Adhanom Ghebreyesus, noted recently. That some of the national leaders abiding by this assessment are themselves in the highest risk group is testament to one of the fundamental truths of ageism: that it is pervasive among old people themselves in ways that threaten both personal and national health.
The news and social media have been full of similarly counterproductive messages, even cruel memes such as “Boomer Remover,” a descendant of last year’s dismissive and condescending “OK, Boomer.”
This matters in the era of Covid-19 because in a culture that persists in ignoring the last century’s huge gains in longevity and the obvious differences between young and much older adults, we are unable to address the needs of older Americans. It matters because the isolation necessary for slowing the rate of contagion will also cause irreparable harm to their health and have both short- and long-term economic effects. And it matters because when we accept the second-class citizenship of an entire category of human being, we set a precedent for treating others with the same disregard.
The effects of this isolation are being seen throughout the country. On Twitter, a young woman in Oregon described being called over to a car at her supermarket where a couple in their 80s sat scared to go inside lest they become infected; they handed her $100 to do their shopping so that they wouldn’t starve. One of my geriatrics colleagues who cares for people in assisted living facilities in the San Francisco Bay Area told me one patient had commented that his current living situation was “like being in solitary confinement and we have no idea for how long.” A photo picked up by many news outlets shows a Connecticut man holding a sign outside his wife’s nursing home window that said: “I’ve loved you 67 years and still do. Happy anniversary.”
Isolation and neglect add to a history of systematic injury. The Trump administration didn’t just eliminate the federal office of pandemic preparedness and dismiss or drive away scientists and experts at all levels of government; it also moved to decrease nursing home oversight and infection-control regulations. Meanwhile, although I could cite abundant data on the poor quality of many nursing homes and on the ubiquity of loneliness, neglect and mistreatment, and I could note that the facility in Kirkland, Wash., that responded so slowly to a lethal contagion had a top government rating, it is more compelling to simply ask: If you don’t already live in a nursing home, are you looking forward to the time when you can move into one?
If your answer is no — mine certainly is — then here are some facts to consider as we shape our national response to this pandemic: One-third of American infections have occurred in people aged 65 and older, demonstrating a significantly disproportional impact, since that group makes up just 16 percent of the population. (And this assumes we are recognizing all cases; one can easily imagine the people who succumbed quickly in places where no one would think twice about the death of a frail, sickly old person.)
Older people represent 45 percent of Covid-19 hospitalizations, 53 percent of intensive care unit admissions and 80 percent of deaths. Meanwhile, this country’s two most prominent medical journals have published articles exclusively about Covid-19 in children but no articles specifically devoted to the disease in old people.
Fortunately, the needs of the elderly are beginning to get more political and media attention. The Trump administration, recognizing that going into hospitals and clinics for nonurgent but needed appointments put the elderly at unnecessary risk for coronavirus infection, lifted restrictions on telephone and video conferences for Medicare beneficiaries. Social media abounds with stories and images of people paying for an old person’s groceries, delivering food, writing letters, playing music outside nursing homes. There are so many ways to help while still maintaining social distance.
If this pandemic gets as bad as the worst predictions, we may eventually have to offer palliative care to people who might have survived with intensive care. As medical experts have noted, the primary criterion for rationing should be a negligible chance of survival whatever a patient’s age. At the same time, while weeks on a ventilator are damaging to patients young and old, an elderly person’s chance of meaningful recovery from that kind of physical trauma is small.
But there is also this: When we look at people as nothing more than amalgams of age and diagnosis, we miss their humanity. Last week in my clinic, I met an 87-year-old with heart, kidney, spine, blood and joint disease — the sort of patient some doctors refer to as a “train wreck.” What is too often missed when such words are used are the other facts of that patient’s life: that she only recently retired from her leadership position at a local service agency, that she had me laughing out loud several times during our visit, that her friends and family describe her as the strongest person they have ever met.
We can choose to either diminish our elders or support them. When we care for them, we not only are affecting the lives of people now but also are shaping our own futures.
Louise Aronson is a professor of medicine at the University of California, San Francisco, and the author of “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.”