Boom! The
hits just keep comin’: COVID-19 pandemic, police brutality/racial injustice
protests, extreme heat, smokey air from wildfires…and a very bullish stock
market!
Each day I’m
awoke to news of weather (recent heat wave disproved “coldest winter was summer
in SF”), Flex Alerts (rotating power outages in evenings, due to reliance on
sun and wind power), air quality index (mostly unhealthy), more evidence of
climate change, COVID-19 data (though underreported due to statewide backlog),
street protests, etc.
And when I
log-on to Blogger, I’m awoke to New Blogger (default) that is supposed to make
it easier to use on mobile devices. But I do not post using my cell phone’s
small screen. For past couple of months, I’ve been sending
feedback to Google to please keep Legacy Blogger’s What-You-See-Is-What-You-Get
(WYSIWYG) interface, or fix New Blogger interface, which is so buggy and
slow. I want Blogger to stay Old=Reliable.
Awoke
to ageism
In December
2019 (before COVID-19 pandemic seemed so long ago!), University of Michigan surveyed U.S. residents age 50 to 80: more than 80% reported experiencing
ageism, yet they still held positive views on aging with 88% feel more
comfortable being themselves, and 80% have a strong sense of purpose. Almost 6 months
since World Health Organization (WHO) declared COVID-19 pandemic, ageism also has gone viral…time for an
updated survey?!
According to
March 2020 report by Centre for Better Ageing, 1 in 3 people in U.K. reported
experiencing ageism.
Last month’s California
for ALL Ages: Virtual Town Hall on Combatting Ageism & Promoting Equity
gave me a better understanding of SF’s Reframing Aging campaign, #EndAgeismSF. Funded by SF Department of Disability & Aging
Services (DDAS) and Metta Fund, this campaign is tailored to SF’s diverse
population of adults age 60+: 53% speak a primary language other than English
(materials also offered in Spanish and Chinese), 29% live with a disability,
and 12% identify as LGBTQ; 44% identify as Asian/Pacific Islander, 39% White,
10% Latinx and 6% Black.
Launched last fall, SF Reframing Aging is a three-phase campaign:
1. Awaken people to ageism, focusing on
ages 30-50
2. Help older adults recognize implicit
ageism and connect with aging resources
3. Foster intergenerational connections
in community and workplace
Phase 1’s
awakening campaign was based on April 2019 surveys of people age 30-50, who
held mostly “positive views” about older adults in response to what words come
to mind when you think of older adults? Wisdom/wise were common themes in word
cloud.
However, when
asked what words come to mind when you think of becoming older yourself?
“More negative words” appeared, suggesting unconscious bias?
In October
2019, SF Reframing Aging launched its website and #NeverGetsOld posters on bus shelters and
light poles, as well as postcards and buttons.
Community Living Campaign’s Senior Beat profiled people featured
in campaign, “Reframing Aging – ‘Older ≠ Lesser’: City embarks on effort to
squash aging stereotypes”:
·
Leadership
never gets old: Retired youth counselor helped families overcome
‘disconnectedness’ (age 65)
In these profiles of older people as helpers, men are
associated with leadership and courage, while women are associated with sharing
joy/creativity, caring/passion, and intelligence/determination. Characterizations
that suggest gender stereotypes?
“Never gets old” theme is repeated in Little
Brothers – Friends of Elderly (LBFE)’s website featuring “elder stories” as
part of “This Never Gets Old” series, inviting volunteers to meet “Our elders
come from all walks of life with stories as beautifully diverse as the Bay Area
itself.”
If Phase 1 campaign is intended to “awaken” people
ages 30-50 (millennial, Gen X), guess it’s more relatable to focus on rosy
Third Age (privileged demographic of AARP consumers age 50+ or “more hip seniors”) while
downplaying (marginalizing) the Fourth Age (frailer, more dependent older people).
Successful aging = “positive” stereotypes
SF’s campaign is based on FrameWorks Institute’s
Reframing Aging initiative, which
seeks to “connect representations of successful aging to the implementation of
effective social policies” that enable older adults to remain physically active
(“vibrant”) and autonomous (“independent”).
Though FrameWorks doesn’t define “successful aging,”
sure sounds like Rowe & Kahn model of successful aging: ability to maintain
low risk of disease or disability, high mental and physical function, and
active engagement with life. Like
escapist AARP Movies for Grown-Ups, with characters who never seem to grow up
or develop beyond romance-seeking sorority sisters in Book Club (2018)
and aspiring cheerleaders in age 55+ community in Poms (2019). Almost like regression to adolescence or younger
phase, as in headline “This Stanford Scientist Can Make You Feel And Think Younger: Interview With Dr. Laura Carstensen.”
“If you look across the world across the 60 countries that have been studied, the peak age of happiness tends to be about 82…your neurochemistry shifts…You realize you've gotten through all these things that were stressing you out. If you make it to 82, you know you've managed you're okay!”—Daniel Levitin, PhD, age 62 (20 more years to peak happiness!), “A neuroscientist lays out the keys to aging well,” PBS Newshour (Jan. 11, 2020)
The
self-help (sometimes anti-aging) book industry has been appealing to this
Boomer demographic ad nauseam, with titles like Daniel Levitin’s Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives
(2020), and Nir Barzilai’s Age
Later: Health Span, Life Span, and the New Science of Longevity (2020)
includes chapter on “Making 80 the New 60”! This month’s American Federation
for Aging Research (AFAR) Live Better Longer: Secrets of Superagers Zoom
discussion featured Dr. Barzilai, who shared “fascinating case studies of those who live past 100 and the
inspiring scientific discoveries that show we can mimic some of their natural
resistance to the aging process.” His “superagers” included value investor Irving Kahn, who died at 109 (one month after
his son Donald’s sudden death at 79) and his older sister Helen Reichert, who
also lived to 109 (just 7 weeks shy of becoming a supercentenarian) and had
multiple careers in fashion; both smoked, and Helen said her 4 doctors who told
her to stop died.
Media love to report on supercentenarians, like
113-year-old Lucy Mirigian, 1918 flu pandemic survivor who hopes to make it
through COVID-19 pandemic by following SF health orders, staying in SF home
that she bought in 1952. The world’s oldest married couple, 110-year-old Julio Cesar Mora Tapia and 104-year-old
Waldramina Maclovia Quinteros Reyes married for 79 years and going strong, shared
COVID-19 pandemic advice: “follow the rules
with respect and love the life.”
I
can’t help but compare flattering portrayals of successful agers to the “positive”
stereotype of Chinese model minority raised by Tiger Mom, which has been
criticized as racist and masking real difficulties such as poverty and related
ills. If a group is doing so well on its
own, no need for government policies to pay attention? If we want care for frail older people, share their stories!
Healthy
aging = functional ability
Where are the more complex stories about what people lose/gain from becoming frail and vulnerable? Part of the answer may lie with successful aging’s
compression of morbidity ideal: postponing chronic illness/functional loss for
short period near time of death. In the dominant biomedical model, this
frailty, vulnerability, chronic illness, functional loss, etc. appear as undesirable
“negative” stereotypes of aging. Yet,
this is part of the diversity of old age, including many of my clients who are
seen and heard by me. Not to be
Debbie Downer, I think there’s more potential for deeper character development
when faced with challenges, at any age, if we are honest with ourselves: who am I as a human being when
confronted with loss of functional ability? In a capitalist society, what is my
value when considered less or no longer “productive”? Dignity (inherent worth)
is devalued when greed prevails (as love of money is the root of all evil, 1
Timothy 6:10). EndAgeism should include
EndAbleism!
Gerontologists roughly divide old age into three groups: young-old (65-74), middle-old (75-84), and oldest-old (85+);
in 2011, U.S. Census Bureau changed the definition of oldest-old to 90+ because Americans are living longer. Gerontologists also understand that rather
than chronological age, the more
important distinction is functional ability (performing activities of
daily living that require cognitive and physical well-being).
WHO launched Decade of Healthy Ageing: “the
process of developing and maintaining the functional ability that
enables well-being in older age. Functional ability is about having the
capabilities that enable all people to be and do what they have reason to
value.” Healthy Ageing replaced Active Ageing
(“process of optimizing opportunities for health, participation and security in
order to enhance quality of life as people age”).
“As people grow older and develop age-related
diseases, two of the most common, feared, costly, yet least understood
impairments are the loss of mobility and cognition (the ability to think and
make decisions). These often mark the onset of frailty and decline… the most
effective interventions, including age-friendly home renovations and exercise,
can take place in your home or community.”—Geriatrician Lewis A. Lipsitz, MD,
“When IΚΌm 84: What Should Life Look Like in Old Age?” Journal of the American Geriatrics
Society (Mar. 9, 2020)
In Crip
Camp: A Disability Revolution (2020) documentary, Neil Jacobson talked
about the hierarchy (layers of social privilege) in disability types, with polio on top because “they looked more
normal” and cerebral palsy at the bottom; when he met his future wife Denise,
who also had cerebral palsy, his parents asked “why can’t you find a polio?”
Similarly, in ageism, there appears to be a hierarchy with “successful” or
Third Agers on top, and frailer Fourth Agers at bottom – and people with progressive,
degenerative disease like Alzheimer’s and related dementias at the very bottom,
often hidden in locked units and vulnerable to bullying/abuse by higher
functioning people, or fate of “zombie apocalypse.”
Ageism/Ableism
in Fourth Age
“Not all old lives
suffer ageism's blows equally. If the residents of 55+ communities, planned
neighborhoods geared toward younger retirees, were dying at the same rate as
people in nursing homes, responses would likely take on a greater sense of
urgency. The ubiquity of coronavirus-related nursing home deaths reflects a
particular permutation on ageism — discrimination not only against old age but
also against dependency in old age, most typified by the cognitive limitations associated
with dementia.” –Lynn Casteel Harper, “America's deadly ageism: How COVID-19 exposes prejudice against the elderly and dementia
patients,” Salon (May 15, 2020)
One wonders if stigmatization of the Fourth Age and long-term care (LTC) facilities enabled neglect of frail older people, exacerbated by COVID-19 pandemic.
FrameWorks
Institute’s Finding the Frame: An Empirical Approach to Reframing Aging and
Ageism (2017) recommended these approaches to framing frailty:
·
Make the case for policies and programs
that can prevent or reduce late-life frailty, so society can “reap the
benefits of the momentum of experience and wisdom that we accumulate as we age”
·
“remind the public that a just society
takes responsibility for equal protection of all Americans, …neglecting
the needs of frail Americans is an instance of structural ageism”
FrameWorks
cautioned to avoid “sympathetic senior trap” which runs risk of framing all
older people as vulnerable and tends to evoke paternalistic thinking, as
opposed to systems-level thinking that can lead to policy solutions; use
storytelling to focus more on explaining than describing.
Literary
gerontology (e.g., Julian Barnes’ The Lemon Table collection of short
stories about old age) allows more insightful perspectives on aging in
narratives that reflect awareness of increasing frailty/vulnerability, create
meaning of one’s life trajectory, and contribute to wisdom when life lessons
are shared.
LTC
facilities
“By
the way in which a society behaves toward its old people, it uncovers the naked,
and often carefully hidden, truths about its real principles and aims… Many
societies respect the old so long as they are clear-minded and robust, but get
rid of them when they become senile and infirm.”—Simone de Beauvoir, The
Coming of Age (1970)
With
the current #BlackLivesMatter protests and attention to inequities among BIPOC,
wonder if there’s less empathy for LTC residents who are mostly non-Hispanic
white, assuming they benefited from lives of white privilege? Here are
demographic characteristics of LTC residents (based on 2016 data):
·
Nursing homes: 75.6% non-Hispanic white; 43.5%
women; 85.1% age 65+, 43.5% age 85+
·
Assisted living: 81.4% non-Hispanic
white; 70.6% women; 93.4% age 65+, 52.1% age 85+
Just like old
(age), race is socially constructed, as I
was reminded during my stint in LTC facilities serving primarily Jewish
residents, who taught me that they were considered colored/non-white until they
became more assimilated (“becoming white” as they gained sympathy) after
Holocaust, including changing their names (similar to Kahn centenarians Helen
and Peter who “Anglicized” name to Keane) and appearances (rhinoplasty). Residents of Sephardic ancestry mostly identified as
Hispanic. (Pictured above) I invited Aaron
Hahn Tapper, University of San Francisco Jewish Studies Professor and author of
Judaisms: A Twenty-First Century Introduction to Jews and Jewish Identities
(2016), to explore this further with residents, many who felt strongly about
staying in a facility that honored their Jewish identity. I found common ground with Jewish
residents, perhaps due to diaspora, identifying as “outsiders” in adapting to
different environments, including LTC facilities which was their residence but
my workplace.
Yet,
anti-Semitism persists in white supremacy, and Jewish are excluded in proposed
California Ethnic Studies Model Curriculum for high school students (AB 331
limited to African, Asian, Latinx, and Native American identities—similar to AB
1460 for California State University system's undergraduates).
For a more inclusive society, must require gerontology coursework taught by culturally sensitive experts!
For a more inclusive society, must require gerontology coursework taught by culturally sensitive experts!
“Why does this lack of
literacy on aging and health exist? The US educational system should provide
education to the population about gerontology, the study of aging, geriatrics,
and health and disease associated with aging…Not only would it help children
and youth understand their elders’ behaviors and conditions but it also could
promote dignity and a respect for life…
As a society, we can do
a much better job of educating our youth and fostering the skills necessary for
successful aging… Without education that provides knowledge about how to age
successfully and prevent health deterioration, many individuals will be doomed
to becoming increasingly frail, possibly bedridden, and unable to perform basic
functions of life, such as eating and dressing.”—James C. Siberski & Carol
Siberski, “Geriatric Education Today & Tomorrow,” Today’s Geriatric
Medicine (Sep/Oct 2019)
Woops, medicalization
of successful aging—as defined by Rowe & Kahn again—is so pervasive. For people in the Fourth Age who are
frail, optimal aging based on Baltes’ SOC (Selection,
Optimization, Compensation) model might be more relevant. Liang & Luo's harmonious aging model offers a more
diverse, inclusive and less ageist perspective to value old age experience.
Based on a limited analysis in May 2020 by The New York Times, nursing homes where African-American and Latinx made up a significant portion of residents were found twice as likely to have COVID-19 cases than where the population was overwhelmingly white, and regardless of their location, size, government rating; however, this analysis could not determine whether there was racial disparity in rates of illness or death between white and non-white residents due to lack of data. Most direct care workers in LTC facilities are BIPOC. In July, U.S. Senators requested that CDC and CMS collect and publicly report demographic data on COVID-19 cases and deaths in nursing homes.
According to Kaiser Family
Foundation reports, more than 70,000 residents and staff of LTC facilities have died
from COVID-19. And
this is an undercount because the federal government only required nursing homes
to submit data of COVID-19 deaths since May; to correct this, Senate introduced
Emergency Support for Nursing Homes and Elder Justice Reform Act of 2020, which
would require nursing homes to report COVID-19 deaths and other information dating
back to January 1. NY
only reported COVID-19 deaths occurring in nursing homes, but not nursing home
residents transferred to hospitals where they died. Further,
some residents died without being tested for coronavirus. Data from assisted living under oversight of
states is less consistent and harder to come by.
A KQED investigation found that wildfire is a "significant hazard" at 35% of California's 10,000 LTC facilities, while laws governing emergency preparedness are weak and enforcement is lax, and COVID-19 pandemic has disrupted watchdog efforts and further complicated urgent disaster planning.
A KQED investigation found that wildfire is a "significant hazard" at 35% of California's 10,000 LTC facilities, while laws governing emergency preparedness are weak and enforcement is lax, and COVID-19 pandemic has disrupted watchdog efforts and further complicated urgent disaster planning.
On
August 25, California DPH updated evolving visitation guidance to require LTC
facilities to permit ombudsman to enter, subject to screening for fever and
COVID-19 symptoms and wearing mandatory PPE.
During this COVID-19 pandemic, would be interesting
to take a survey to find out how many people wish to age in place? How many
desire to move into LTC facilities? How many current residents in nursing home
and assisted living facilities want to remain where they are? How many desire to
leave, if presented with viable home and community-based options?
California Master Plan for Aging (MPA) paused for few months due to pandemic, then
resumed via Zoom, with public input and recommendations due next month so
Governor can issue MPA by December 2020.
This pandemic, given its disproportionately deadly impacts on older
people, has made it more urgent to get recommendations “right,” particularly to
address systemic inequities, even if this slows the process. Where the current MPA stands, as of August 11 Stakeholder Advisory Committee meeting, is
same old, same old complex and fragmented system that is difficult to navigate.
During this pandemic, the existing system allowed insurance companies to post record profits by collecting premiums from consumers who postponed in-person care; must read Amanda Holpuch’s “US health insurers doubled profits in second quarter amid pandemic,” The Guardian (Aug. 14, 2020). We sorely need a system that puts people care above profits! Advocates have called for reform of payment and regulatory system to redesign Long-Term Supports and Services (LTSS) with stronger investment in Home and Community-Based Services (HCBS).
During this pandemic, the existing system allowed insurance companies to post record profits by collecting premiums from consumers who postponed in-person care; must read Amanda Holpuch’s “US health insurers doubled profits in second quarter amid pandemic,” The Guardian (Aug. 14, 2020). We sorely need a system that puts people care above profits! Advocates have called for reform of payment and regulatory system to redesign Long-Term Supports and Services (LTSS) with stronger investment in Home and Community-Based Services (HCBS).
California
Alliance for Retired Americans (CARA), Gray Panthers and Senior &
Disability Action (SDA) recommended:
· statewide universal
LTSS system that is affordable to all, covers all who need it, covers all care
and supports needed, as long as needed
· this LTSS
system could be integrated in a single-payer Medicare for All, a social
insurance program that is funded by a progressive tax on the wealthy and big
corporations in combination with a payroll tax, and that includes provisions to
invest in training, recruitment and retention of workforce needed to fill the
estimated need of 600,000 to 3 million additional paid LTC workers.
Germany and Japan have universal LTC insurance. In Japan, 14% of COVID-19 deaths were in LTC facilities,
compared with more than 40% in U.S., despite a lower proportion of U.S. elders
living in LTC facilities. In addition to national LTC insurance, Japan benefits
from cultural values prioritizing elderly care, lower rates of diabetes and
obesity that are risk factors for COVID-19 deaths.
Reframing Aging in health
care
This
month’s Gerontological Society of America (GSA) webinar, Reframing Aging: A Primer for Health Care Professionals, focused on communication choices to talk about older people and health equity. The examples related to “successful agers”
who are productive as essential workers/volunteers and caregivers.
·
When
people think health outcomes are only about individual choices, carefully
attend to attribution of responsibility: tell systems stories, leave no
space in communication to blame marginalized groups instead of inequitable
systems; example – “When thinking about higher number of deaths among older
Black people and Latinos, we need to think about why people get sick in the
first place. Who still has to leave
their home to work, who has to leave a crowded apartment, get on crowded
transport, and go to a crowded workplace? The privilege of working from home is
not available to everyone.”
·
When
people only hear about older people’s vulnerability, tell other
stories about older people’s experiences during the pandemic; example – “States
such as New York and Florida issued calls for retired medical professionals to
return to work, and tens of thousands volunteered to do so. Likewise, many older people are caregivers for
family members who are frail, disabled, or cognitively impaired.”
When talking about nursing home
residents, Reframing Aging refers to “high risk” as code for
frailty/vulnerability. To meet the
challenge when encountering people who are fatalistic about health outcomes for
older people, find balance between urgency and efficacy; example – “Nursing
home populations are at a high risk of being infected by – and dying from – the
coronavirus. COVID-19 is known to be
particularly lethal to adults in their 60s. A strong infection prevention and
control program, however, can protect residents and healthcare personnel.”
Finally, if people dismiss ageism as a
serious issue, FrameWorks advises us to talk about intersectionality
instead of comparing “isms”; example – “Older people are diverse in many
ways including race, ethnicity, socioeconomic status, disability, sexual
orientation and gender identity. Addressing marginalization and discrimination
in the pandemic must focus on these sources of inequity as well as age.”
Takeaways
from International Federation on Ageing Virtual Town Hall – COVID-19 and
Older People: Opportunities to Combat Ageism:
·
Caregivers
and those who work alongside older people experience ageism first hand in health
care settings, and are important advocates against ageism.
·
Interventions
include intergenerational programs; older people modeling “positive ageism”; using “appropriate” language like “older people”
instead of ageist terms like “elderly” or “seniors” that segregate older people
This year’s OCA Summit: Resilient
Communities, freely made online, included program on COVID-19 and Our
Elders, with Isabel Tom, author of The Value of Wrinkles: A Young
Perspective on How Loving the Old will Change Your Life (2020), and Denny Chan, senior
attorney with Justice in Aging and former OCA intern, discussing
their grandparents’ influence and their respective work in LTC facilities and health
care advocacy, particularly on behalf of older adults who may be reluctant to speak
up about experiencing age discrimination, which leads to underreporting.
Words
matter (but no consensus)
Because
“words have the power to hurt and heal,” San Francisco State University
Journalism Professor Rachele Kanigel published The Diversity Style Guide
to help writers with the latest word choices when communicating about diverse communities in the constantly changing
language space. Here’s what she offered for words relating to age:
·
boomer: describes person born during
post-World War II baby boom between 1946 and 1964. Boomers and boomer generation are
preferred over baby boomers, which is perceived as condescending.
·
elderly: use sparingly, appropriate only in
generic phrases that do not refer to specific individuals. “If the intent is to
show that an individual’s faculties have deteriorated, the Associated Press
Stylebook recommends citing a graphic example and attributing it to someone.”
·
older: preferred descriptor for people in later
life
·
senior, senior citizen: use
sparingly; preferred term is older adults
In Ageism in America (2006), geropsychiatrist Robert N. Butler and
Anti-Ageism Taskforce at the International Longevity Center did not include baby
boomer, elderly, old, senior, senior citizen in list of ageist terms (p. 22); used
“baby boomers” 8 times in text (not including references); mostly used “older
person” and occasionally “old person.” Word choices have always been important tools in advocacy, and more so in this "New Ageism" during COVID-19 pandemic.
American Medical Association style guide allows: “Because the term elderly connotes a stereotype, avoid using it as a noun. When referring to the entire population of elderly persons, use of the elderly may be appropriate (as in the impact of prescription drug costs on the elderly, for example).” Are strong objections to using the term elderly in frailty context a denial of Fourth Age?
As part of the Leaders of Aging Organizations (LAO)
Collaborative that partnered with FrameWorks Institute’s Reframing Aging
initiative, GSA and American Geriatrics Society (AGS) adopted specific word choice recommendations in their publications’ style
guides.
· Refer to persons age 65+ using these preferred terms: older persons, older people, older
adults; AGS also includes using older patients, older individuals, or the older
population.
·
Avoid using these
terms: seniors, elderly, the aged. AGS
also includes avoiding aging dependents, old-old, young-old, and similar
“other-ing” terms connote a stereotype.
In
a Journal of Geriatric Physical Therapy editorial, a group of physical
therapists recommended that the term “elderly” disappear (as done with bygone
terms like senile, demented, and aged) because it is ageist, “stereotyping older folks as sick,
frail, and physically dependent.”
Connotations
In Finding the Frame: An Empirical Approach to Reframing Aging and Ageism (2017),
FrameWorks Institute’s researchers found a continuum of competence associated
with different labels given to people in later life, from least competent
(e.g., frail, can’t use computers) to most competent (e.g., independent,
wise): senior, elder, senior citizen, older person, older adult. While acknowledging older adult as the current
preferred term among progressive voices in the aging field, this term was
associated with someone in their mid-50s. To advance policies for people older
than that, FrameWorks recommended use of term older person, which was
associated with someone in late 60s.
In Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life (2019), UCSF geriatrician Louise Aronson recognized term Senior (chapter 10) under Adulthood, and terms Old, Elderly and Aged (chapters 11, 12, and 13) for distinct groups of old age under Elderhood. In Life (chapter 1), she described her visit to UC Berkeley Professor Guy Micco’s class, where medical students associated elder with respect, leader, experience, power, money, knowledge – suggesting greater competence, contrary to research by FrameWorks Institute (which placed elder as "least competent" after senior)?!
Is elderly simply a derivative from adding suffix -ly to elder?
According to Free Dictionary’s usage note for “elderly,” its use as a noun is relatively neutral, denoting a group of people in advanced age; however, its use as an adjective has a range of connotations that go beyond denotation of chronological age:
“On the one hand it can
suggest dignity, and its somewhat formal tone may express respect: sat next to
an elderly gentleman at the concert. On the other hand, it can imply frailty or
diminished capacity, in which case it may sound condescending: was stuck in
traffic behind an elderly driver.”
California Department of Aging refers to “elderly”
population. In
geriatric programs, “the elderly” refers to older people who experience frailty
(geriatric syndrome), as in On Lok’s Program of
All-Inclusive Care for the Elderly (PACE for “frail, community-dwelling
elderly individuals” age 55+ who are eligible for nursing home care) and Acute Care for the Elderly
(ACE) units in hospitals “ideally suited”
for “Adults 70 and older requiring hospitalization.” (Note: UCSF’s ACE uses Acute Care for Elders.)
Outside of medical settings, “the elderly” refers to older people who need personal care assistance with activities of daily living (e.g., Residential Care Facilities for the Elderly) and/or risk losing basic needs (e.g., Legal Assistance to the Elderly “who are at risk of losing their housing, healthcare or income, or are victims of physical or financial abuse.”).
However, Miami University Gerontology Professor Kate de Medeiros stated, the term the elderly “should be retired for good – a blanket label that demeans an entire demographic group as frail and vulnerable based only on chronological age.” Similarly, Successful Aging columnist Helen Dennis suggested, “Since ‘elderly’ may suggest an image of decline rather than vitality, it may be timely to eliminate that term and instead use ‘elder.'”
Senior, when used as an adjective, appears to be ok: Senior Community Service Employment Program, Senior & Disability Action (advocacy group); senior care/center/discount, etc. In 2014, National Senior Citizens Law Center changed its name to Justice in Aging, with tagline “Fighting Senior Poverty through Law.” Senior as noun referring to person remains commonplace, such as Community Living Campaign’s tagline “Cultivating connections to help seniors and people with disabilities age and thrive at home”; Meals on Wheels SF “allows thousands of seniors to live in their homes with dignity and independence as long as possible”; Self-Help for the Elderly provides “care for seniors to promote their independence, dignity and self-worth.”
Senior
Citizen is less
commonly used, though National Senior Citizens Day on August 21, has
maintained its name since its 1988 proclamation by 77-year-old President Reagan.
Also, in August 2020 issue of The
Gerontologist, Jung Shin Choi wrote how senior cohousing community (SCC)
“reduces the level of public expenditures for senior citizens” (p.
984).
Navigating
COVID-19
According to SF Department of Public
Health (DPH) COVID-19 data
tracker based on 386,827 test results
reported: 9,494 positive cases and 83 deaths (65% male; 51% age 81+, 20% age
71-80, 16% age 61-70, or 87% of deaths age 60+; 35% Asian, 28% Latinx, 19%
White, 10% Black; 1% homeless).
Caveat: Due to this month’s statewide reporting failure to account
for more than 300,000 cases, COVID-19 testing and case data were underreported
and still being verified. State DPH
Director resigned after revelation of this backlog, which impacted ability of
local public health departments to receive lab results to investigate and
contact trace.
Effective today, California’s reopening scheme now assigns a color tier (similar to AirNow Quality) for each county’s risk level based on rate of new cases per 100,000 residents per day (7-day average with 7-day lag) and %age of positive COVID-19 tests (no longer using hospitalizations as risk indicator): purple “widespread”; red “substantial”; orange “moderate”; and yellow “minimal.”
However, SF
is playing it safer by continuing to base reopening decisions on 5 key public health
indicators, also based on colors indicating where we are in relation to
targets: red (far off); orange & yellow (not meeting); and green
(meeting). SF has never met 90% goal for
contact tracing, which is why I think enforcement of preventive measures
(masking, distancing) is needed.
While out in public, I’ve taken photos of all
ages violating masking orders (just like how I’ve taken photos of staff smoking
outside health centers, in violation of SF ordinance), but SF is not taking
enforcement actions against individuals.
Residents in highly politically polarized countries like U.S. (52%) and U.K. (54%) expressed the greatest dissatisfaction over their governments’ handling of COVID-19 pandemic. Polarization results in each side getting “stuck” in tribal warfare, where people don’t have to critically think about their own bias and examine facts, easier to spout zero-sum arguments like save/sacrifice economy v. human lives? It takes thoughtful consideration of data, science, facts, risk analysis from different disciplines (that assign different meanings to words!) to figure out reasonable adaptations so economy can operate safely and while protecting lives. In the meantime, we’re all vulnerable but frail older people are more vulnerable to severe COVID-19 as well as policies that continue to isolate them in LTC facilities. Need to get “unstuck” and move forward!
At this
month’s Gray Panthers meeting, Arlie Hochschild discussed bridging the
political divide between progressives and conservatives, based on her book, Strangers in Their Own Land: Anger and Mourning on the American Right (2018). She wrote her book following Trump’s election to U.S. Presidency,
and now he is seeking re-election in an even more polarized nation. Older white voters might determine the
Presidential election again. As a self-described “liberal” Berkeley
sociologist, Arlie has acknowledged that the far left can be less tolerant of
hearing and learning world views that differ from their own. She suggested American Exchange Project, a domestic “study abroad in
your own country” which has been adapted for virtual experiences during this pandemic.
Sadly, many
college campuses are coddling students who demand safe spaces and cancel
culture, prioritizing feelings over thinking about topics that “trigger” discomfort
to their self-esteem. How about
reading Hillbilly Elegy: A Memoir of a Family and Culture in Crisis
(2016) for insider’s perspective by J.D. Vance, who was mentored by Tiger Mom?
How about more intergenerational engagement? Also, simulation exercises might
teach empathy, like teens who dressed as grandmas to buy alcohol, so
store clerks would not ask them to show IDs; one teen reported that one store
owner was worried she wouldn’t be able to carry the bottles herself.
While physically stuck indoors until smoke clears, I remain thoughtfully awoke.
While physically stuck indoors until smoke clears, I remain thoughtfully awoke.
“Treat others as human beings
Have a generous interpretation of their views
Allow them to clarify before shaming
Don’t judge their motive or group they’re in
Treat others the way you would like to be treated
This leads to understanding
Above all, practice humility
When arguing with a fool, make sure they’re not
doing the same thing”
--John Dickerson,” Learn to argue better,” CBS
News (Sep. 7, 2018)
