Ageism reflects negative (incorrect) attitudes held by many people in society toward the elderly, who are seen as frail and vulnerable [1]. These ageist attitudes often lead to unfair treatment and denial of employment and social opportunities, resulting in the emergence of mental health issues among the targets of ageism [2]. Ageism has become even more pronounced in the COVID-19 era.
Response to the COVID-19 pandemic has included various social distancing measures including reducing non-essential travel, working from home, and cancelling social gatherings; in short, staying home as much as possible. This is all done in order to ‘flatten the curve’, a term widely used in media, meaning social distancing will prevent the health system from being overburdened and thus, unable to handle all COVID-19 patients. These past several months of dealing with the COVID-19 pandemic have increased these mental health issues, as the ‘frail’ and ‘vulnerable’ elderly have been a focus of ‘protection’, meaning increased isolation, resulting in even poorer mental health.
Adults 60 years old and over have been recognized as a high-risk group for COVID-19 because of their higher mortality rate. Studies have found that the mortality rate jumps from 8.2% for people aged 50-59 to 11% for those between 60 and 69 years of age, and it is even higher for those over 70 [3] [4][5]. Nursing homes and care facilities for the elderly are especially vulnerable, becoming infection clusters, as reported in news from around the world [6][7]. Governments have stressed that in the hope to protect their senior citizens from infection, reducing contact is necessary. Nevertheless, prolonged social distancing can result in unintended consequences for the mental wellbeing of those residents.
While many studies that have focused on pathological explanations in dealing with COVID-19 have pointed out the importance of the immune system [8][9], the media has perpetuated generalisations about age because some older adults have chronic health conditions which inevitably weaken their immune systems [10]. However, the key idea is the compromised immune system, not the chronological age. There are various risk factors, such as cancer or diabetes, which can adversely affect the immune system, regardless of age [11][12].
People over the age of 60 have been lumped into one group, labelled frail and vulnerable, regardless of the health of each individual, which spans a wide spectrum. The group is portrayed in the media as susceptible and vulnerable; hence, needing intense social distancing. The age of the group, rather than the condition of each individual, is the sole criteria that is used in determining what, if any, social distancing measures should be followed. Such a uniform standard is now widely associated with the sometimes misconstrued images of frailty and dependence, reinforcing ageism during the pandemic [13].
Simply classifying the entire group of older people as vulnerable based on age indirectly weakens their rights as well as makes them expendable. In early March 2020, news in Italy reported that because the health system had reached its capacity due to the surge of infections, doctors suggested that medical resources be prioritized for younger patients over older patients [14][15][16]. This type of news shows that the public assumes that all older adults fall into the same group of frailty and are less worthy of being saved. Furthermore, discrimination toward old people also occurred as misleading information posted on social media said that COVID-19 was a disease affecting Baby Boomers (i.e. #boomeremover), further reinforcing the idea of the frailty of the age [17]. These two examples vividly show the danger ageism can lead to. Through this type of generalization, older adults as a category are discriminated against, devalued, and victimized.
Ageism is not only prevalent in Western contexts: it can also be found across Asian societies [18][19]. Economic advancement in East Asia and Southeast Asia has led the demographic changes in several of these societies, including declining fertility and longer life expectancy, and societal values have also gradually been influenced by Western ideas, which indirectly shaped the more accepting attitudes towards delaying marriage and the formation of nuclear families [20][21]. These macro-level changes in demographic structures and family attitudes have affected capacities and preferences of the traditional practices of support from children to their aging parents. Increasingly, more older adults are finding that they cannot rely so much on the family support that tradition dictates. They face exclusion from work and health resources, and they are labelled as frail and a burden [22][23][24].
COVID-19 has revealed the unequal effects on different social groups based on their socioeconomic resources as the social distancing measures and prolonged economic impacts have intensified the disadvantages for groups with limited financial resources and precarious work or housing conditions [25]. Older adults in Asia, with limited financial and medical resources, face difficult challenges in securing jobs, social support and accessing medical services [26][27]. This means that older Asians face a higher risk of being excluded from the disrupted labour market and of being excluded from the overburdened health care system during this period of time.
Social isolation and loneliness among older adults may be intensified during COVID-19 due to ageism. Social isolation, by definition deprives people of social contact and activities, leading to loneliness, which can negatively affect mental wellbeing and increase the likelihood of physical disabilities and the onset of dementia [28][29]. The concern over older adults’ social isolation is warranted, as the lockdown forces them to curtail contact with friends and family [30]. The banning of family visits and postponement of activities means lack of contact and curtailment of social support [31]. Because clusters have been found in care facilities [32][33], banning visitors has been used as a preventive measure to slow down the spread.
However, this is particularly hard on older residents. With no clear end date in sight, loneliness may trigger worse mental, physical and cognitive health [34]. Older adults living by themselves are more likely to experience loneliness and declining life satisfaction than are those who live with family members (especially children) [35][36]. Adding ageism to the mix can accentuate and accelerate the negative impacts of social isolation and economic hardship resulting from social distancing. The ageist rhetoric in social media can intensify the stereotype toward older adults. Studies have found that the silver generation can easily sense biased views, affecting their self-image, and internalization of these feelings combined with the facts of social isolation in turn influence their social connections and access to the support and opportunities they should have [37][38], spiralling into even greater feelings of loneliness and isolation [39].
Ageism can sneak into discussions on finding solutions to cope with social distancing among older adults. The idea of using digital technologies as an alternative to stay connected has been widely promoted and discussed [40]. However, the sudden pandemic has exacerbated the digital ‘divide’ between the older and younger generations. Older adults who are unfamiliar with digital applications before COVID-19 were directly and immediately cut off from their social and physical worlds, while those who knew how to use that kind of technology may feel less isolated, but social distancing still requires that they use them almost exclusively for all social contact [41]. That is, there was a wide spectrum in how capable and comfortable older adults are with digital applications without properly understanding their social needs. Discussions tainted by ageism ideas focused heavily on how ill-equipped all older adults were or how resistant their attitudes were, devaluing their capabilities and resilience [42]. Getting factual evidence about older adults’ use of digital applications would eliminate ageist ideas.
This is the time for us to readjust to the proper understanding of the ageing process and to challenge our stereotypes of labelling older adults. Ageism through media and at workplaces only confirms the negative discriminatory attitudes toward aging. Institutional changes and societal awareness are required, especially during this pandemic [43][44]. Community initiatives that aim to provide social connections have provided important aide to older adults, as have digital art and leisure activities [45][46]. For example, in Singapore, to combat social isolation, SilverGood formed by artists and citizens has been providing regular art opportunities, physical activities and hobby ideas through Facebook and YouTube [47]. There is also the Buddy Project, where volunteers man phones to check up on older adults living alone or who want to talk to someone [48]. These initiatives have targeted different social groups of older adults to provide various social connections and support without framing them into one category.
It should be remembered, how we treat our older citizens reflects on how we are going to be treated as we age. Ageism during COVID-19 has been challenging for older adults around the globe. Only with strong social consciousness to stop the stereotypes and to see the diverse spectrum of older adults, just as with younger adults, can we provide more opportunities and support with the respect and dignity they deserve.
Banner image by Rod Long on Unsplash
[1] Minichiello, Victor, Jan Browne, and Hal Kendig. “Perceptions and Consequences of Ageism: Views of Older People.” Ageing and Society 20, no. 3 (May 2000): 253–78. https://doi.org/10.1017/S0144686X99007710.
[2] E.-Shien Chang et al., “Global Reach of Ageism on Older Persons’ Health: A Systematic Review,” PLOS ONE 15, no. 1 (January 15, 2020): e0220857, https://doi.org/10.1371/journal.pone.0220857.
[3] Robert Verity et al., “Estimates of the Severity of Coronavirus Disease 2019: A Model-Based Analysis,” The Lancet Infectious Diseases 20, no. 6 (June 1, 2020): 669–77, https://doi.org/10.1016/S1473-3099(20)30243-7.
[4] Jennifer Beam Dowd et al., “Demographic Science Aids in Understanding the Spread and Fatality Rates of COVID-19,” Proceedings of the National Academy of Sciences 117, no. 18 (2020): 9696–9698, https://doi.org/10.1073/pnas.2004911117.
[5] Maria Brandén et al., “Residential Context and COVID-19 Mortality among the Elderly in Stockholm: A Population-Based, Observational Study,” 2020, https://doi.org/10.17045/sthlmuni.12612947.v1.
[6] Adelina Comas-Herrera et al., “Mortality Associated with COVID-19 Outbreaks in Care Homes: Early International Evidence,” Resources to Support Community and Institutional Long-Term Care Responses to COVID-19 (International Long-Term Care Policy Network, 2020), https://ltccovid.org/wp-content/uploads/2020/06/Mortality-associated-with-COVID-among-people-who-use-long-term-care-26-June.pdf.
[7] ABC news, “‘We Haven’t Turned the Corner yet’: Two People Die in Hospital as Victoria Records 270 New COVID-19 Cases,” July 14, 2020, https://www.abc.net.au/news/2020-07-14/victoria-coronavirus-cases-melbourne-270-new-cases/12451968.
[8] Matthew Zirui Tay et al., “The Trinity of COVID-19: Immunity, Inflammation and Intervention,” Nature Reviews Immunology 20, no. 6 (June 2020): 363–74, https://doi.org/10.1038/s41577-020-0311-8.
[9] Susanna Felsenstein et al., “COVID-19: Immunology and Treatment Options,” Clinical Immunology 215 (June 2020): 108448, https://doi.org/10.1016/j.clim.2020.108448.
[10] Sharon Begley, “What Explains Covid-19’s Lethality for the Elderly?,” STAT, March 30, 2020, https://www.statnews.com/2020/03/30/what-explains-coronavirus-lethality-for-elderly/.
[11] Brian Resnick, “Scientists Are Trying to Figure out Why Covid-19 Hits Some Young, Healthy People Hard,” Vox, April 8, 2020, https://www.vox.com/science-and-health/2020/4/8/21207269/covid-19-coronavirus-risk-factors.
[12] Centers for Disease Control and Prevention, “Coronavirus Disease 2019 (COVID-19),” Centers for Disease Control and Prevention, February 11, 2020, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
[13] Liat Ayalon et al., “Aging in Times of the COVID-19 Pandemic: Avoiding Ageism and Fostering Intergenerational Solidarity,” The Journals of Gerontology: Series B, accessed July 25, 2020, https://doi.org/10.1093/geronb/gbaa051.
[14] Abigail Beall, “The Heart-Wrenching Choice of Who Lives and Dies – BBC Future,” accessed July 16, 2020, https://www.bbc.com/future/article/20200428-coronavirus-how-doctors-choose-who-lives-and-dies.
[15] Haven Orecchio-Egresitz, “Faced with Tough Choices, Italy Is Prioritizing Young COVID-19 Patients over the Elderly. That Likely ‘would Not Fly’ in the US.,” Business Insider, accessed July 16, 2020, https://www.businessinsider.com/prioritizing-covid-19-patients-based-age-likely-wont-fly-us-2020-3.
[16] Marco Vergano et al., “Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments in Exceptional, Resource-Limited Circumstances: The Italian Perspective during the COVID-19 Epidemic” (Springer, 2020).
[17] Maria Renee Jimenez‐Sotomayor, Carolina Gomez‐Moreno, and Enrique Soto‐Perez‐de‐Celis, “Coronavirus, Ageism, and Twitter: An Evaluation of Tweets about Older Adults and COVID-19,” Journal of the American Geriatrics Society, accessed July 23, 2020, https://doi.org/10.1111/jgs.16508.
[18] Luo, Baozhen, Kui Zhou, Eun Jung Jin, Alisha Newman, and Jiayin Liang. “Ageism among College Students: A Comparative Study between U.S. and China.” Journal of Cross-Cultural Gerontology 28, no. 1 (March 2013): 49–63. https://doi.org/10.1007/s10823-013-9186-5.
[19] Chang, E.-Shien, Sneha Kannoth, Samantha Levy, Shi-Yi Wang, John E. Lee, and Becca R. Levy. “Global Reach of Ageism on Older Persons’ Health: A Systematic Review.” PLOS ONE 15, no. 1 (January 15, 2020): e0220857. https://doi.org/10.1371/journal.pone.0220857.”
[20] Yeung, Wei-Jun Jean, Sonalde Desai, and Gavin W. Jones. “Families in Southeast and South Asia.” Annual Review of Sociology 44, no. 1 (2018): 469–95. https://doi.org/10.1146/annurev-soc-073117-041124.
[21] Raymo, James M, Hyunjoon Park, Yu Xie, and Wei-jun Jean Yeung. “Marriage and Family in East Asia: Continuity and Change.” Annual Review of Sociology 41 (2015): 471–492.
[22] Chang et al., “Global Reach of Ageism on Older Persons’ Health,” PLOS ONE, 15, 1. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220857
[23] Heeran Chun et al., “Does the Experience of Discrimination Affect Health? A Cross-Sectional Study of Korean Elders:,” Asia Pacific Journal of Public Health, October 30, 2013, https://doi.org/10.1177/1010539513506602.
[24] R. Yamato, “Changing Attitudes towards Elderly Dependence in Postwar Japan,” Current Sociology, 54, no. 2 (March 1, 2006): 273–91, https://doi.org/10.1177/0011392106056746.
[25] Myers, Joe. 2020. “5 Things COVID-19 Has Taught Us about Inequality.” World Economic Forum. August 18, 2020. https://www.weforum.org/agenda/2020/08/5-things-covid-19-has-taught-us-about-inequality/.
[26] Jenna Gibson, “South Korea’s Elderly Face Unique Challenges From COVID-19,” The Diplomat, June 4, 2020, https://thediplomat.com/2020/06/south-koreas-elderly-face-unique-challenges-from-covid-19/.
[27] Marcela Suazo and Wassana Im-Em, “This Is Not the Time to Neglect Our Older Generation,” Bangkok Post, April 13, 2020, https://www.bangkokpost.com/opinion/opinion/1898465/this-is-not-the-time-to-neglect-our-older-generation.
[28] Tessa Morgan et al., “Social Connectedness: What Matters to Older People?,” Ageing & Society, undefined/ed, 1–19, https://doi.org/10.1017/S0144686X1900165X.
[29] Emilie Courtin and Martin Knapp, “Social Isolation, Loneliness and Health in Old Age: A Scoping Review,” Health & Social Care in the Community, 25, no. 3 (2017): 799–812, https://doi.org/10.1111/hsc.12311.
[30] Ezra Klein, “Coronavirus Will Also Cause a Loneliness Epidemic,” Vox, March 12, 2020, https://www.vox.com/2020/3/12/21173938/coronavirus-covid-19-social-distancing-elderly-epidemic-isolation-quarantine.
[31] Alison Rahn, “Banning Visitors to Aged Care during Coronavirus Raises Several Ethical Questions – with No Simple Answers,” The Conversation (blog), April 15, 2020, https://theconversation.com/banning-visitors-to-aged-care-during-coronavirus-raises-several-ethical-questions-with-no-simple-answers-134663.
[32] Comas-Herrera et al., “Mortality Associated with COVID-19 Outbreaks in Care Homes: Early International Evidence.” Resources to Support Community and Institutional Long-Term Care responses to COVID-19, https://ltccovid.org/wp-content/uploads/2020/06/Mortality-associated-with-COVID-among-people-who-use-long-term-care-26-June.pdf
[33] Anne Connolly, Suzanne Dredge, and Clare Blumer, “Health Department Confirms 17 Nursing Homes with Coronavirus Cases,” Text, ABC News, April 2, 2020, https://www.abc.net.au/news/2020-04-02/coronavirus-cases-which-nursing-homes-with-covid-19/12111294.
[34] Marcia G. Ory and Matthew Lee Smith, “Social Isolation: The COVID-19 Pandemic’s Hidden Health Risk for Older Adults, and How to Manage It,” The Conversation, accessed July 24, 2020, http://theconversation.com/social-isolation-the-covid-19-pandemics-hidden-health-risk-for-older-adults-and-how-to-manage-it-141277.
[35] Vivian W. Q. Lou and Jimmy W. Ng, “Chinese Older Adults’ Resilience to the Loneliness of Living Alone: A Qualitative Study,” Aging & Mental Health 16, no. 8 (2012): 1039–46, https://doi.org/10.1080/13607863.2012.692764.
[36] Hana Ko et al., “Gender Differences in Health Status, Quality of Life, and Community Service Needs of Older Adults Living Alone,” Archives of Gerontology and Geriatrics, 83 (July 1, 2019): 239–45, https://doi.org/10.1016/j.archger.2019.05.009.
[37] Hannah J. Swift et al., “The Risks of Ageism Model: How Ageism and Negative Attitudes toward Age Can Be a Barrier to Active Aging,” Social Issues & Policy Review 11, no. 1 (January 2017): 195–231, https://doi.org/10.1111/sipr.12031.
[38] Sharon Shiovitz-Ezra and Ohad Parag, “Does Loneliness ‘Get under the Skin’? Associations of Loneliness with Subsequent Change in Inflammatory and Metabolic Markers,” Aging & Mental Health, 23, no. 10 (October 3, 2019): 1358–66, https://doi.org/10.1080/13607863.2018.1488942.
[39] Joanne Brooke and Debra Jackson, “Older People and COVID-19: Isolation, Risk and Ageism,” Journal of Clinical Nursing 29, no. 13–14 (2020): 2044–46, https://doi.org/10.1111/jocn.15274.
[40] Linda Poon and Sarah Holder, “The ‘New Normal’ for Many Older Adults Is on the Internet,” Bloomberg City Lab, May 6, 2020, https://www.bloomberg.com/news/features/2020-05-06/in-lockdown-seniors-are-becoming-more-tech-savvy.
[41] Ayalon, Liat, Alison Chasteen, Manfred Diehl, Becca R. Levy, Shevaun D. Neupert, Klaus Rothermund, Clemens Tesch-Römer, and Hans-Werner Wahl. “Aging in Times of the COVID-19 Pandemic: Avoiding Ageism and Fostering Intergenerational Solidarity.” The Journals of Gerontology: Series B. Accessed July 25, 2020. https://doi.org/10.1093/geronb/gbaa051.
[42] Nancy Morrow-Howell, Natalie Galucia, and Emma Swinford, “Recovering from the COVID-19 Pandemic: A Focus on Older Adults,” Journal of Aging & Social Policy 32, no. 4–5 (July 3, 2020): 526–35, https://doi.org/10.1080/08959420.2020.1759758.
[43] Megan Ching, “Older Workers Vulnerable to Rising Tide of Retrenchment as Ageist Mindsets Persist,” Commentary, Channel News Asia, July 25, 2020, https://www.channelnewsasia.com/news/commentary/singapore-older-workers-retrenchment-long-term-unemployment-12956670.
[44] Michael Skapinker, “Will Ageism Get Worse in the Post-Pandemic Workplace?,” Financial Times, May 28, 2020, https://www.ft.com/content/9eb440b6-4519-43a3-aba9-99b87926dd74.
[45] Morrow-Howell, Galucia, and Swinford, “Recovering from the COVID-19 Pandemic.”
[46] Shannon Hebblethwaite, Laurel Young, and Tristana Martin Rubio, “Pandemic Precarity: Aging and Social Engagement,” Leisure Sciences 0, no. 0 (June 24, 2020): 1–7, https://doi.org/10.1080/01490400.2020.1773998.
[47] Our Better World, “SilverGood – Bringing Online Cheer to the Elderly,” May 20, 2020, https://www.ourbetterworld.org/series/humankind/story/silvergood-activities-elderly.
[48] Agelessonline, “Want a Buddy?,” accessed July 25, 2020, https://www.agelessonline.net/want-a-buddy/.
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