AN AGE OF VULNERABILITY

In a post–COVID-19 society, what must we do to reduce old-age vulnerability to illness and death? The answer may surprise you.

BY JEANETTE LEARDI

The past two years have been a radically demanding time for us all. We’ve been wearing masks, socially distancing, getting vaccinated, and adjusting to constantly evolving guidelines—making these changes in our behavior in the hope of emerging from this dangerous period and reentering “normal” life.

But how normal will it be, really? Or rather, how normal should it be? Among the many lessons the pandemic is teaching us, one big one is that we must rethink how we view—and treat—the older adults in our lives.

People over age 65 are most susceptible to contracting COVID-19. While that age group composes only 16% of the U.S. population, it has suffered 80% of all COVID deaths, 40% of which have occurred among long-term care residents.

The fact that older adults are more vulnerable to the effects of the virus is to be expected, given the natural process of aging and the biological changes our bodies undergo as we age. Our arteries begin to harden, we lose brain volume, muscle mass, and bone density. In addition, we’re more likely to have one or more chronic illnesses such as heart disease, cancer, arthritis, diabetes, and dementia. And regarding COVID, our immune systems become less responsive to outside threats. Clearly, we’re more biologically vulnerable.

WE’RE ALL VULNERABLE

But let’s rethink the concept of vulnerability. Aren’t all people biologically vulnerable in different ways at different stages of life? Surely babies and young children are. But so are teenagers, whose underdeveloped cerebral cortex can make them prone to mood swings, poor judgment, and potentially dangerous impulsive behavior. Young and middle-aged adults are vulnerable, too, to physical and mental illnesses caused by the stresses of sleep deprivation, workplace injury, infertility, and alcohol and drug abuse.

The problem with our culture’s perception of age is that while we know there are many positive traits to being a child or an adult, we mistakenly believe that physical deterioration and mental decline are inevitable and are the only conditions elders experience, and so we conclude that there’s no upside to aging.

But we’re very wrong. Through diet, exercise, sleep, and stress management, it’s more than possible to maintain relatively healthy bodies in our later years. Plus, there are many psychological assets to growing older. If we keep our brains challenged and engaged with the world, we can develop new skills, increase our emotionally stability, problem solve more efficiently, grow our social networks, and expand our wisdom. We can continue to contribute to society as mentors, leaders, innovators, experts in our fields, and keepers of the flame.

THE REAL PROBLEM: AGEISM

There’s only one thing that holds us back and keeps us vulnerable—and it’s not our age. It’s how our culture insists on rejecting aging. We demand that older adults maintain the exact same capacities, desires, and values as people “in their prime.” And so anti-aging messages abound in the form of ads for Botox, wrinklereducing creams, and hair dyes. Old-age jokes fill late-night show monologues that wouldn’t otherwise contain racist, sexist, ableist, or homophobic ones. Older adults are far more likely to experience hiring, training, and retention discrimination in the workplace. As a society, we fear and dread becoming old and do whatever we can to distance ourselves from people in their later years, which can lead us to marginalize and neglect them.

Consider how older adults have been treated during the pandemic. Early on, many nursing homes that were struggling to keep infection rates down weren’t provided with enough effective personal protective equipment (PPE). Given the shortages, some media and politicians even suggested that older adults sacrifice themselves so that younger people could survive.

And recently, hospitals flooded with unvaccinated patients have been forced to adopt “crisis standards of care” that include age as an independent criterion for deciding how likely a person will survive, and providing the likeliest ones with necessary treatment.

THE ANSWER: IMPROVE SOCIETY

As we envision the new normal for a post–COVID-19 world, let’s ask ourselves this: What must we do to reduce old-age vulnerability to illness and death?

Taking good care of our bodies and minds is only a fraction of the solution. The main solution to ageing well is found in the determining social factors of race, ethnicity, gender, geography, education, income, and access to adequate housing, health care, transportation, and other services. And most of these are often beyond a person’s individual control.

For example, in 2021, women on average earn 82 cents for every dollar a man makes and are more likely than men to be caregivers for family members. As a result, their lifetime Social Security earnings are less, which can affect how well—or not— they age. People living in rural areas, or making a minimum wage, or having a disability may lack access to reliable transportation, healthy foods, and greater job opportunities. And all of these challenges are compounded for people of color.

So much of what older adults experience throughout this pandemic, and throughout life in general, could be prevented in the future by truly understanding how much of the quality of later life is determined by these social, nonindividual, non-biological effects.

When it comes to older adult vulnerability, it’s up to all of us to eliminate the widespread ageism that promotes it. We can 1) Educate ourselves about the benefits, as well as the challenges, of living many years; 2) Call out age prejudice and discrimination whenever and wherever we encounter them; and 3) Become role models of empowered aging, whatever stage of life we inhabit.

Hopefully, as we responsibly recover from this time of COVID, we’ll also stop fearing and dreading getting older. The only new normal we should strive to create is one that fully embraces, honors, and supports everyone, regardless of age. Systemic ageism should have no place in it.

That’s a pandemic worth ending, too.

Jeanette Leardi is a Portland-based social gerontologist, writer, editor, and community educator who has a passion for older adult empowerment. She gives popular presentations and workshops in journaling, memoir writing, ethical will creation, brain fitness, creativity, ageism, intergenerational communication, and caregiver support to people of all ages. Learn more about her work at jeanetteleardi.com.

Breaking the Second Arrow

Everyone makes mistakes. How many times have we heard that one thrown at us? “Don’t worry about it. Everyone makes mistakes.” But we do worry, don’t we? Because it’s not that simple. It’s easy to say it. Easy to be the one doing the forgiving. But if you’re the one who broke the antique vase, the one who misplaced the car keys and made everyone late, it’s not so easy. I know. I have.

Attention Deficit Disorder. I’ve spent my whole life apologizing. “Sorry I’m late.” “Sorry I misplaced that important paperwork.” “Sorry I lost focus in the meeting.” When I’m not sorry, I’m frustrated. Why can’t I, just once, leave the house without having to go back for what I forgot? It’s exhausting, but that’s life. Or so I thought. Recently I’ve made a new friend, and now I know there’s another way.

Keoki is a Buddhist, in training to be a Reverend, with a responsibility to counsel those in crisis and the authority to perform weddings. The first time I saw him, he was wearing a T-shirt with a logo depicting two arrows, one whole, the other in the process of being broken by a pair of strong hands. Here’s the life-changing message of the second arrow: At its heart, it’s a simple Buddhist concept. If you’re wounded by an arrow, do you tend to the wound, or do you shoot yourself with a second arrow?

Whether it’s a big thing, like a serious injury or the loss of a loved one, or something small like being late for an appointment, we all deal with misfortune. It’s a part of being human. These inevitable misfortunes are the first arrow, the one that comes out of nowhere and wounds us. There’s nothing we can do about that arrow.

Once the first arrow has struck, we begin to tell ourselves stories about it. “If only I had done this, or hadn’t done that.” “ I’m such an airhead. It’s no wonder I never married.” These stories we tell are the second arrow, further wounding us when we would be better served by working to heal the damage caused by the first arrow. We need to be wary of that second arrow, even when the misfortune is not of our own making. Sometimes the stories we tell are not about blame, but about the terrors awaiting us in the future. “This injury might mean I’ll never play golf again.” “This headache could be the first sign of the same kind of brain cancer my mother died from.” In the words of 19th century poet John Boyle O’Reilly, “We fear the things we think, instead of the things that are.” We hold the second arrow in our own hands. All too often, we choose to aim it at ourselves and let it fly, but we can make another choice. We can choose to break it. We can catch ourselves in the act of creating stories, and remind ourselves that they are stories and nothing more. We can let go of, “What if,” and “If only,” and replace them with my friend Keoki’s favorite phrase, “Right now, it’s like this.”

How to Leave Fears and Regrets Behind Forever By W. R. SHAW Photo of Keoki by Grace Beecher

W. R. Shaw lives and writes in the Pacific NW. When she’s not writing, she’s often found rescuing rattlesnakes from yards and rural highways.

BRACE

YOURSELF

ORTHODONTICS AT ANY AGE BY PRISCILLA CHARLIE HINCKLEY

In 1970, I missed the first two classes of my junior year in high school because I was getting braces on my teeth that morning. The next day, trying to explain my absence, I struggled to speak through a painful and ugly mouthful of metal. I think I was drooling. Two years later, though, my teeth looked great. That didn’t last.

“If you want to retain post-orthodontic positioning, you need to wear some sort of retention for life. That’s a key fact,” says Seattle dentist Dr. Frank Calvo. If you don’t, he adds, “There tends to be a memory, and the teeth will migrate back to where they were.”

Dr. Calvo knows that quite well. He also wore braces as a teenager and, like most of us back then, he wasn’t told to continue using a retainer. At 62, he’s doing it all again, this time with Invisalign®. There’s no age limit on orthodontic work, and it’s not just about aesthetics.

“Everybody thinks that they just want a pretty smile,” says orthodontist Dr. Greg Vaughn. But misaligned and crowded teeth, he says, “can affect the function of your bite, the wear pattern of your teeth. It can lead to fractures, root canals, loss of teeth, and gum infections.”

In their Seattle and Bellevue orthodontic practice, Dr. Vaughn and his wife, Dr. Paola Leone, see patients ranging from five to 87 years old. “There’s no age that’s not the right age to do something that’s important for you,” says Dr. Leone.

Orthodontic treatment works by using continual pressure from braces or aligners, over time, to move teeth. Depending on the complexity of the problem to be treated, patients may choose options such as metal braces (smaller and more comfortable than in the past); ceramic, tooth-colored braces; lingual braces, which go behind the teeth; or clear aligners that go over the teeth. Invisalign®, the original clear aligner, is the most common, and there are other brands as well. The orthodontist will determine whether patients are eligible for specific options.

Dr. Leone says that most of their adult patients choose Invisalign®; It opens the door, she says, for

people who didn’t want to be treated. “It’s much less intrusive for their life schedule,” says Dr. Vaughn. “There are no food restrictions, and they can take them out for a party.” Also, most people can’t tell you’re wearing them.

Key to success with Invisalign® is patient motivation and compliance. The aligners should be worn for about 22 hours a day during treatment and must be taken out to eat or to drink anything other than water. Patients need to brush and floss before putting them back in. Treatment generally takes 12 to 24 months, but it is possible to speed up the movement of teeth. At their practice, Drs. Leone and Vaughn offer photobiomodulation, which uses infrared light to facilitate bone remodeling on a molecular level. “We use it on some of our more complicated aligner treatments,” says Dr. Leone. “Patients are truly grateful for shortening treatment time.” And, she says, that helps increase compliance.

Orthodontic treatment is the centerpiece for success in both health and aesthetic results. Before doing cosmetic or restorative work such as veneers or implants, Dr. Calvo looks at the entire picture to come up with the least invasive plan. It often starts with realigning teeth, and for that, he sends patients to a specialist.

“We evaluate the current condition,” says Dr. Vaughn. “The dentist will send someone to us and we may have to do something like idealize the space so there can be implants.”

When restoration and repair are needed, it can be a team approach between orthodontists, dentists, periodontists, and endodontists. “We’re the quarterbacks,” says Dr. Vaughn. “We’re the guy who pours the foundation for the house. You don’t want to add a beautiful kitchen if the foundation isn’t right, and you can run into problems if the bite isn’t right.”

Orthodontic work can prevent costly and painful procedures later on. Kathy Herigstad, of Seattle, had some crooked teeth as a child, but her parents couldn’t afford braces. Seven years ago, at 56, her dentist expressed concern that crowded teeth were causing early signs of gum inflammation and bleeding. And that could lead to gum transplants to save her teeth.

“I didn’t care so much about the cosmetics of it, but when it started to become an issue with gum erosion, it was time,” says Herigstad. “I didn’t want to end up in the periodontist’s office and have a lot of expensive work to save my teeth.”

She chose Invisalign®. Her practitioner scanned her mouth, making a 3D impression in a digital format for a custom fit. For the next year and a half Herigstad always carried a small travel kit with a tiny toothbrush, paste, and floss. She also learned to keep her aligner case with her at all times, after wrapping the aligners in a napkin and nearly throwing them away at a restaurant. It was all part of making a commitment, she says. “When you enter into it, it’s like a marriage with your mouth.”

She spoke with a bit of a lisp at first, but after about a month, Herigstad barely noticed she was wearing the aligners. Now, at 63, her gums are safe. And the aesthetics are great, too. “It really opened up my smile more. I hadn’t realized how self-conscious I was about that overlapping and crowding of my teeth. It gives me more confidence.”

The price for orthodontic treatment can range from approximately $3,500 to as much as $9,000, depending on what needs to be done. And, interestingly, those fees haven’t increased much in decades. “My parents paid the same amount for my braces, in 1972, as my orthodontist charges now,” says Dr. Calvo.

If you’re thinking about dental work, Dr. Calvo suggests that you look at your smile in photos, figure out what you don’t like and want to change, then ask your dentist about options. Don’t hesitate to get a second opinion.

When choosing an orthodontist, look for a practitioner who is comfortable treating older adults. Ask your dentist for a recommendation. Be prepared to commit to whatever treatment you choose, including wearing your retainer. The result will be worth it.

“It will make you look younger and healthier,” says Dr. Calvo. “And you actually are.”

“THERE’S NO AGE LIMIT ON ORTHODONTIC WORK, AND IT’S NOT JUST ABOUT AESTHETICS.”

Priscilla Charlie Hinckley has been a writer and producer in Seattle television and video for 35 years, with a primary interest in stories covering health and medicine, women’s and children’s issues, social justice, and education. She enjoys taking a lighthearted approach to serious topics.