Let Ageism Bite the Dust During COVID

Op-Ed: Let Ageism Bite the Dust During COVID — Don’t take the statistics to mean that all seniors are compromised

Angela Rossetti, M.B.E., M.B.A.

COVID-19 has exposed many deadly fissures in American healthcare. From inadequate personal protective equipment and unavailable testing to the more heinous differentials in deaths based on race, many cracks in American preparedness and response have glaringly emerged.

Among these and other deeply disturbing facts is the disproportionate toll that COVID-19 has taken on the elderly. The CDC reports that during the week of April 18, 2020, the current peak of American deaths, COVID-19 claimed nearly 13,000 deaths in people over 65. A more recent report, spanning Feb. 12 to May 18, indicated that 75%-80% of all COVID-related deaths were in this age group.

With numbers like these, it is easy to conclude that COVID-19 is a disease of the elderly. But a deeper look at the numbers tells a more complex story.

Only 7% of deaths listed COVID-19 as the only cause of death. On average, in each case there were 2.5 additional co-morbidities that contributed to death. Unfortunately, it is the elderly who are more often saddled with co-morbidities that predispose to a fatal course of COVID-19, but the elderly are not alone. Chronic respiratory disease, cardiovascular conditions, and malignancies affect younger cohorts of Americans as well as those over 65. For example, where 30% of current smokers over 65 have COPD, 25.8% of those ages 55-64 do, and 17.1% of those 45-54 do as well.

However, because of the higher frequency of comorbid conditions in the elderly, governments have had to make hard choices. As of March 17, the over65 population was the first to go into lockdown in California. On the other side of the country, in re-opening Connecticut, those over the age of 65 are advised to “stay home and safe” and out of hair salons. In either locale, the “disappearing” neighbor or the “shaggy-haired” are revealing their age and society’s perception of them.

California Gov. Gavin Newsom and Connecticut Gov. Ned Lamont used appropriate data and caution in their efforts to protect the vulnerable. But sociologically speaking, seniors’ early disappearance from society and now unkempt re-emergence are telltale signs of the belief that all seniors are compromised.

In 2005, CMAJ published what has now become known as “the Frailty Index.” This index ranks the health risk of seniors based on their biologic fitness. The Index uses a scale of 1-7 to rate the health of the elderly, with the first cohort described as robust, active, energetic, and fit for their age and the last, near terminal.

The Frailty Index has been in widespread use in Canada for a decade and a half. Perhaps it is time that American healthcare took a look at it, too. Although there are many horrible COVID-19 deaths among the elderly, there are many, many examples of biologically fit seniors in our midst, from National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, 79, fighting the pandemic, to New York Gov. Andrew Cuomo, 62, making the hard decisions for his state.

One size does not fit all in healthcare. There are fit individuals 65 and older without pre-existing conditions, and younger individuals sadly compromised by any number of diseases. As with other statistical measures, getting under the numbers and looking at all the facts may help one more “ism” -- ageism -- disappear. It is time for this often-overlooked “ism” to bite the dust, not the population it describes.

As appeared in Medpage Today on July 14, 2020.