Old age and COVID-19

Much of the discourse on COVID-19 has been about older people being at high risk. The Lancet Voice speaks to Professor Thomas Scharf, president of The British Society of Gerontology about how COVID-19 is affecting age discrimination and loneliness.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Jessamy: Hi, this is Jessamy. 

Gavin: And this is Gavin. 

Jessamy: And we're doing another Quickfire podcast on older people and COVID 19. We've been speaking to the president of the British Society of Gerontology about their recent statement. which suggests that we shouldn't just be looking at the chronological age of patients but more about the physiological aspects of them.

Gavin: It's a really interesting topic generally especially when you think that so much of the discussion generally in the media is about how COVID 19 specifically affects older people but that's, old people is such a blanket term as used by the news media and I think it's a really interesting topic.

interesting point to talk about that, it's not just the number that's worth considering, it's the underlying health conditions all that kind of stuff. 

Jessamy: Exactly. And I think the British Society of Gerontology, one of their major points is that, this sort of Messaging and narrative about old people being much more vulnerable is not necessarily helpful.

One of the largest studies that's been out is of over a thousand people from China that was published in the New England Journal of Medicine. And actually the median age of patients was 47 years old there. Now obviously they have a different demographic. But it's not just the elderly people that are at risk of this disease.

And I think one of the major points that come out from the British Society of Gerontology statement is that sort of almost 1 million people over the age of 70 provide unpaid care, including one in seven women in their 70s and one in five people aged between 70 and 85. So that's over 1. 5 million people volunteer in their communities.

So this is a group of people that provide enormous wealth. and care to our society, and a sort of blanket statement on chronological age is not helpful to them, and also not very helpful in terms of communicating risk to the rest of the population. 

Thomas: My name's Thomas Scharf, I'm Professor of Social Gerontology at Newcastle University, and I'm also currently President of the British Society of Gerontology, and my work focuses primarily on social aspects of aging with a focus on questions around advantage and disadvantage in later life.

Jessamy: And how particularly has the British Society of Gerontology been preparing, dealing, what are the thoughts about COVID 19 and elderly people that you're representing? 

Thomas: I guess like all organizations in society, we've been following very closely the developments of the coronavirus and in particular thinking about the ways in which this has been represented in society.

policy and also in media discourse around aging. So what we are concerned with in particular is the public messaging that focuses on chronological age as being the key source of a policy response to tackle the epidemic. 

Jessamy: And what you mean by that, presumably for maybe non medics listening, is that there's this difference between a chronological age and your kind of physiological age that you can be quite young, but perhaps have lots of comorbidities that may make you a higher risk person that is older, but perhaps is fitter and has less comorbidities.

Thomas: I think that's a really important point, is thinking about the way in which chronological age, whether you take that at the age of 70, 80 or above, that this is not really the best indicator always of people's health status or their so called vulnerability, that by blanket By identifying older people, in the UK case, initially as seven tier movers, being especially vulnerable, this creates risks for Older people, in the sense that it portrays all older people as being equally prone to ill health and comorbidities, but also sends out the really dangerous message that people under the age of 70 are at much less risk from, of ill health, of catching the coronavirus.

And that really is an incredibly damaging message for society. Thank you. 

Jessamy: I think that's true and that's certainly been borne out in the Italian experience and in the London experience at the moment, where we're seeing a lot of fit young healthcare workers who are susceptible to COVID 19 and ending up in very dire straits on intensive care units.

Thomas: Clearly we have to be really aware of the risks posed to people of all ages who catch the virus. One of the concerns in the British Society of Gerontology is that frontline workers, whether these are health workers, people in the social care workforce, emergency services, but also informal family carers, friends are being inadequately protected.

So there are really real questions about who has access to protective equipment and whether This extends also to people who are providing really important hands on care outside of formal care settings, but in the home and in the community, including in the challenging circumstances faced by care homes.

Jessamy: So if I'm taking it right, then you think that the messaging of this kind of older age group that are high risk for COVID 19 is the wrong way to go about it, really, because it's taking the focus onto an age group, which may not necessarily be higher risk than other people, but also creates a divide between old and young.

Thomas: I think what we're saying is that Age on its own is not the right criterion to be focusing on, that we need to be looking at people in the round and thinking about the wider contributions that people make regardless of age. And for people working in social gerontology, of course, this difficulty of the messaging falls into a long and increasing history where there's a focus on conflict between generations.

And we see that in terms of the language around Brexit, around the housing market, increasingly around the affordability of the health and welfare state. And what we now have layered onto this is the focus of that separates out younger people and older people in terms of risks posed by COVID 19. And I think what we need to be doing is planning much more for cohesion between generations in the sense that, our society only functions when young and old are working together, that we need less division and much more cohesion in society.

Jessamy: So instead of COVID 19 being a polarizing thing, you think that we might be able to try and use it as a, as something to bring us together generationally, rather than just as a society, young and old. 

Thomas: I would see the pandemic as being an opportunity for society to take a step back and to really think about the importance of collaboration between people of different ages, different sectors in the economy.

That society needs older people who are caring, who are volunteering, who are working. This, we've seen government has asked people to come back to work who've retired from the health and care system, and many older people are actively doing that. Where people are being invited to volunteer, I imagine that it's also, many older people are already volunteering in their communities.

If we didn't have this contribution, we'd be in a much worse position to tackle the crisis. So what we need to do is to be making The need to, for solidarity between young and old, we need to put that to the forefront of our minds and to say, actually, society works really well when different groups work together.

Jessamy: And on that point of volunteering, the government, is now asking for 250, 000 volunteers to help with this scheme of shielding 1. 5 million people who have been told to stay inside for three months. What are your feelings about that? I 

Thomas: mean, in terms of the contributions that are being made by different groups within society, it is often those who've recently retired or have been retired for a number of years, who look for new opportunities to contribute to society in later life once they've left the world of work.

And it's inevitable that These people will also want to contribute now at the time when the nation is really in need of, many tens of thousands of new volunteers. What's important, of course, is that people who are offering their contribution should also be relatively fit and healthy and not put themselves at additional risk.

But that applies regardless of chronological age. That's a contribution that people need to make based on health and their personal situation, irrespective of how old they are. 

Jessamy: And do you feel there's been an element of ageism in this sort of debate and conversation about COVID 19 at a sort of national and international level?

Thomas: What we know, what we've known for a long time from research is that ageism is not only bad for individuals, it's also bad for society as a whole. That there's evidence increasingly that ageism actually damages people's health and well being. And there are risks associated with Government policymaking or with media representations of older people as being vulnerable and disadvantaged that really reinforce the stereotypes, the negative stereotypes around aging and later life.

And we've seen. And some of them, some more extreme views, some really awful comments that challenge older people's rights to exist. So really deeply ageist and stereotypical comments around the epidemic and natural selection, around survival of the fittest, around the deaths of older people as being somehow collateral damage as society pursues its response to what is really a crisis.

And I think as a society we should really not be tolerating these types of views. We also see ageism reflected in other types of response, especially around the necessary focus on social isolation and loneliness. So on the one hand, we'd welcome Communities need to focus on those people who are at risk of loneliness, who are at risk of feeling very isolated as a result of the necessary policy measures that are telling people to stay at home.

But on the other hand, this really reinforces a stereotypical image that is not borne out by the research evidence that older people are especially vulnerable. at risk of being lonely. What the evidence actually shows increasingly is that yes, there's a minority of older people who are lonely, who are at risk of loneliness, but also that loneliness affects people of other age groups, especially young adults.

So in ignoring the research evidence and focusing our attention primarily on older people as being at risk of loneliness, we run the risk of missing those populations who may become really isolated, may feel very lonely as a result of self isolation policies. 

Jessamy: Yeah, so that in fact, loneliness and isolation is an increasing problem in young adults.

And I suppose that kind of brings us on to maybe some of the mental health aspects of self isolation and that affects people across the board, regardless of whether they're old or young. 

Thomas: I, yes, mental health. Outcomes of the epidemic are really important, but they need to draw on the evidence to identify where the input should be from community interventions, from professional interventions of different types.

So it would be entirely wrong to focus societies. energies only on engaging with people 60, 70, 80 and over, since that might ignore those younger people with poor mental health who are unable to access the types of support that they need to address their loneliness, to address their sense of isolation.

Jessamy: That's great Tom, thank you. Is there anything else that you would like to talk about? 

Thomas: I think one of the things that has really come to the fore here, and this is from a research perspective, but as in terms of responding to COVID 19, is the need for testing, right? This is something that the WHO have been saying is that we need to test people.

We need to keep testing them. But also, we would say that you need to test people regardless of age. And we also need to think about tracing. So once we've tested people, we need to trace people's contacts and then also to treat them if they have the symptoms of COVID 19. And this is Something which I think we run the risk of losing sight of is that if we accept that older people are going to catch a disease and that they're likely to die from the disease, then there may be less inclination to trace, to test, to treat.

And really, this is going to, this is going to lead to many more deaths and a much wider Faster spread of the disease now, but it also means that in future, we're not going to be able to draw on good epidemiological evidence to be able to prepare ourselves for future pandemics. So I think this messaging also needs.

To move away from a soul reliance on chronological age. 

Jessamy: So thanks for listening to this podcast again. Please let us know if you'd like to hear anything else that's either Covid Ovid 19 related or not COVID-19 related. Our email is podcast@lancet.com. You can find us on all of your normal podcast playing platforms, and please share us and like us.