Gerontological Social Work and COVID-19

Calls for Change in Education, Practice, and Policy from International Voices

Michelle Putnam, Huei-Wern Shen, Michelle Putnam, Huei-Wern Shen

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000436181
• Edition: 1
• Topic: Scienze sociali
• Subtopic: Gerontologia

The novel coronavirus and the resultant COVID-19 pandemic have disproportionately affected older adults in terms of the number of lives lost, concerns about safety of institutional and home and community-based care, the impact of isolation and seclusion, and the ability to participate and engage in meaningful and contributory activities. The pandemic has uncovered layers of ageism that are embedded in societies globally and challenges us all to address the pervasive individual, institutional, and structural biases that permit age-based discrimination. Within the interdisciplinary field of gerontology, social workers lead organizations, provide direct services and supports, facilitate community engagement and participation, and deliver therapeutic interventions among other roles and activities that facilitate positive outcomes for older adults and their families.

In Gerontological Social Work and COVID-19: Calls for Change in Education, Practice, and Policy from International Voices, scholars, practice professionals, and other stakeholders reflect on the initial months of the pandemic. They articulate immediate needs the pandemic has created and uncovered, and further identify directions the field must go in to meet the moment and prepare for the future ahead.

This book was originally published as a special issue of the Journal of Gerontological Social Work.

Part I
Commentaries on Gerontological Social Work’s Response to COVID-19

The Consequences of Ageist Language are upon us

Clara Berridge

and Nancy Hooyman

ABSTRACT

The COVID–19 pandemic has highlighted the ease in which ageist language is employed and ageist stereotypes are used to characterize older adults. These are harmful and display an impressive lack of future thinking – as younger and middle-aged adults who use this language and forward these concepts also hope to live long lives. The disproportionately negative outcomes for older adults in this pandemic in part, reflect social and economic inequalities that are manifest throughout the life course of marginalized groups including persons of color. They also reflect major problems with institutional living be it in prisons or nursing homes. Social workers and allied professionals can work to address these manifestations of ageism in part by employing inclusive language – as advised by the Reframing Aging Project, working to build and support strong intergenerational relationships, working to eradicate social and economic disparities at all life stages, and advocating for a more critical look at institutionalization of older adults.

“if you guys know any uh, uh, the elderly, any older people that may need help, please call them, check on them, see if they need anything … Not an old, help an old person, uh, yeah, help an elderly uh person, yeah, ok.”

-Jimmy Fallon, The Tonight Show: Home Edition, March 19 (00:35–00:58)

When Jimmy Fallon stumbled over his description of the population experiencing higher mortality rates from COVID-19, it was a telling moment. One of us is a baby boomer and the other a millennial-Gen X cusper. As gerontologists in the city where the virus first touched down in the U.S., we were concerned by the widespread use of “the elderly” in the media because it undermines cross-generational solidarity.

Referring to the elderly as a homogenous mass is ageism, attributing characteristics to all members of a group because of the shared trait of age. We offer three distinct reasons for not using “the elderly” in the context of the pandemic:

• (1) It turns people off, stokes generational conflict, and is not specific, causing confusion in public health messaging.
• (2) It masks racial disparities in access to health care and underlying health conditions that impact outcomes of COVID-19.
• (3) This ageist language plays into age- and disability-based triage policies in hospitals.

We address counterproductive language and draw on the research-based national Reframing Aging Initiative to suggest how best to talk about these issues, while acknowledging the potential hollowness that “we are all in this together” in the face of disparate impacts of the pandemic as well as the need for structural changes to benefit the essential direct care workforce.

After our Governor Jay Inslee issued recommendations for people 60+ to be the only groups to isolate at home, media reports rarely identified this specific age category, but instead only referenced “seniors” or the “elderly.” Five years ago, the editor of this journal announced the replacement of “the elderly” with “older adults” and required qualification when “vulnerable” is used. The Journal of Gerontological Social Work was ahead of others in avoiding these vague and problematic descriptors (Putnam, 2015). Now, the American Geriatrics Society requires authors to use precise age ranges (Lundebjerg, Trucil, Hammond, & Applegate, 2017).

During a public health crisis, such clarity is particularly urgent. A 62- or 67-year-old who reads “senior” or “the elderly” may not think the guidelines apply to them. But that’s not really an issue of denial or internalized ageism on their part. The older adult population refers generally to people 65+, covering more than one generation and age cohort, so it makes sense that we ’ d confront language issues when attempting to describe this very large and diverse population. The population age 65–115 is more heterogeneous than any other age group (Lowsky, Olshansky, Bhattacharya, & Goldman, 2014), from marathon runners to people living with severe emphysema, so it is not surprising that people resist direction based on an arbitrary chronological marker. “The elderly” is what our colleague Wendy Lustbader calls an empty category. That is, people don ’t identify with this word. “The elderly” is associated with frailty and accompanying paternalism. Berridge recently pointed out in The Atlantic that “The fact that people don ’t often voluntarily relate to this term is a strong reason to not apply it to them” (Pinsker, 2020).

As disability justice activist Lydia X.Z. Brown notes in their blog on ableist language, discussions of language should include critique of the larger system of oppression (Brown, 2014). Ageism is discrimination against older people due to negative and inaccurate stereotypes. It can limit a person’s opportunities for meaningful employment (Kita, 2019) and other forms of productivity and negatively affect health (Adler, 2013). It also masks dramatic racial inequities among older adults that lead to a disparate incidence of heart and lung diseases – risk factors for serious illness and mortality from COVID-19 (Jordan & Oppel, 2020).

There is an abundance of evidence that race and experiences of discrimination negatively impact health outcomes, and the ways in which COVID-19 differentially harms Black, Latinx, and Native people are painfully visible. In a recent discussion for Social Work Today,V. Nikki Jones outlines reasons why the pandemic is hitting African Americans in the U.S. especially hard, including barriers to the social determinants of good health (economic stability, education, social and community context, health and health care, and neighborhood and built environment). She explains that these are linked to cultural memory and historical trauma. Another key factor is African Americans' role in what is now referred to as the essential workforce, built on a history of economic exploitation (Jones, 2020). In a Working Paper published by the Harvard Center for Population and Development Studies in April, Jarvis Chen and Nancy Krieger report findings from county level data that “people living in the most impoverished, crowded, and racially and economically polarized counties are experiencing substantially elevated rates of COVID-19 infection and death,” including a 6-fold greater rate of death for populations living in counties where 61–100% of the population is of color than those living in counties where less than 17.3% of the population is of color (Chen & Krieger, 2020).

As with other forms of oppression, ageism has a tendency to naturalize inequities. Vulnerability becomes biological and acceptable. It’s important to ask in what ways vulnerability is socially constructed. At the time of publishing, one-third of coronavirus deaths in this country have occurred among nursing home residents and workers (Yourish, Lai, Ivory, & Smith, 2020). While older adults as a whole are more vulnerable to negative outcomes from the virus, either because of age-associated changes to their immune systems or because of underlying conditions (The American Federation for Aging Research, 2020), those who are living in these facilities are made far more vulnerable by the arrangement of aggregate care provided in close quarters – often without private rooms and in understaffed conditions. Further, there has been loud outcry by prison abolitionists and reformers about unsanitary and cramped conditions faced by people incarcerated in prisons and jails and thus more vulnerable to the virus (Li & Lewis, 2020). Incarcerated individuals, including those over age 55, are disproportionately Black and Latinx people who are likely to have faced years of health care disparities, compounding their risk for contracting and experiencing negative effects of COVID-19.

Comorbidities are often consequences of social determinants of health. As such, hospital triage during the pandemic is problematic when it is based on comorbidities that influence expected survival. Others have described how ageism pairs with ableism to potentially deprioritize people in line to receive life-saving care (Kukla, 2020; Ayalon, Chasteen, Diehl, et al., 2020). In a recent panel on disability and COVID-19 (Student Disability Commission, 2020), philosophy scholar Joe Stramondo points out that the disability paradox – in which nondisabled people would rate one’s quality of life lower than disabled people do – isn ’t a paradox at all, but rather, a consequence of disability stigma. And these ideas about quality of life get translated into triage policies. Stramondo also observes, as disability justice activists have, that our capitalist economy’s emphasis on productivity underlies beliefs about the value of peoples’ lives. Stramondo explains, “In practice our elders and disabled people are ware-housed in nursing homes and other institutions. In more theoretical terms this kind of thing happens because of beliefs about people not being productive enough within a capitalist society.” In gerontology, we see this appeal to productivity and independence reflected in the productive and successful aging discourses (Berridge & Martison, 2018; Martinson & Berridge, 2015).

The intergenerational tensions stoked by this pandemic have intensified, with millennials and baby boomers sparring over who was crowding Florida beaches and who doesn’t need to be instructed by their children to stay home (Schulman, 2020). Having others repeatedly tell them what to do angers some older adults and makes some feel stigmatized. The fear underlying adult children’s concern for parents – who they are not yet prepared to lose – is also legitimate. Millennials would benefit from understanding how ageism is at play when they interfere with their parents’ autonomous decision making. That feeling of disrespect and paternalism can be painfully familiar and touches a nerve because it reeks of ageism. Cross-generational learning teaches us not to be shortsighted: In the next pandemic, millennials may find themselves in the vulnerable category (Yong, 2020).

Othering language like “the elderly” positions older people as a separate social group apart from “the rest of us.” But this conflicts with our interdependent lives and cross-generational care experiences. Twenty percent of U.S. households are multigenerational (Fry, 2019), and 3 million older adults are raising grandchildren (Allen, 2018; Pittman, 2015). The language of ageism also interferes with collective action for core principles (nondiscrimination, equality) and the greater good (Eligon & Burch, 2020; Ne’eman, 2020). It doesn’t help when geriatricians and other experts in the health sciences use “the elderly” in media interviews. Jane Aronson’s NY Times op-ed draws attention to overlooked ageist policies (Trump’s deregulation of the nursing home industry) and the pervasive ageism underlying cruel “boomer remover” memes, but she inadvertently invokes othering when using “the elderly” in the same piece (Aronson, 2020). If the media and expert interviewees used a stronger message of collectivity, generational tensions might be eased. Older adults are more likely to act upon the public health imperative of self-quarantine when presented in terms of risks faced by adults of all ages who have compromised immune systems or underlying lung or heart conditions, not just those of a certain age (Kukla, 2020).

The consequences of ageist language are upon us, but we can address counterproductive language choices. The Gerontological Society of America promotes the Reframing Aging Project recommendations to use older people instead of “senior” and “the elderly” and use inclusive “we” and “us” terms (FrameWorks Institute). This dynamic project is posting language suggestions every few days for reporting on COVID-19 to help everyone “amplify the values of justice, i...