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COVID-19 and the Future of Aging: The Outlook for Age-Friendly Health Systems

Why this proponent is optimistic about how we'll think about care for older adults

By Terry Fulmer, PhD, RN, FAAN

Editor’s note: This article is the 19th in a weekly joint series on COVID-19 and the Future of Aging from the Milken Institute Center for the Future of Aging and Next Avenue. The articles are Q and As with thought leaders in fields ranging from health care to retirement planning to intergenerational relationships. (The John A. Hartford Foundation, headed by this week's featured thought leader Terry Fulmer, is a funder of Next Avenue.)

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Credit: Adobe

What has the pandemic shown us about ageism in health care, what needs to change and what can philanthropy do to push progress?

Ageism is one of many long-standing problems in both health care and society that the COVID-19 pandemic has revealed in a glaring light. Our colleagues at the FrameWorks Institute and the National Center on Elder Abuse have written that the pandemic is 'pushing Americans' cultural bias against older people to new heights.'

As a nation, we have willfully ignored the plight of staff and residents in nursing homes and long-term care.

This year, we have seen stereotyping, prejudice and discrimination based on age — for example, with the harsh social media hashtag #BoomerRemover that perpetuates the idea that older people are expendable. The Milken Institute's Nora Super with James Appleby of the Gerontological Society of America forcefully stated that age should not be used as the sole criteria to deny medical treatment.

The crisis in nursing homes can also be viewed through the lens of ageism. As a nation, we have willfully ignored the plight of staff and residents in nursing homes and long-term care. Long-term services and supports are inadequately funded, disconnected from the health care system and extremely vulnerable to pandemics and other disasters. 

We all have a role in calling out ageism, and philanthropies like ours are supporting efforts such as the Leaders of Aging Organizations' Reframing Aging Initiative, which is creating easy-to-use messages that counter ageist attitudes. This project plus Reframing Elder Abuse and the new Reframing Nursing Homes initiative are a call to action for how to embrace an aging society.

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You've been working hard to expand the growth of age-friendly health systems. How has the pandemic affected this and what do you think the future holds for age-friendly health systems?

The pandemic has exposed many dysfunctions in the health care system, and we have seen an accelerated interest in our work to improve the care of older adults.

The Age-Friendly Health Systems movement is a powerful solution that is flourishing. More than 1,900 hospitals, medical practices, convenient care clinics and long-term care organizations are participating in Age-Friendly Health Systems action communities led by the Institute for Healthcare Improvement (IHI). All are committed to delivering health care that meets our specific needs as we age, and the focus is on what matters most to us as people, not just as patients.

Age-friendly care uses the 4Ms Framework — a set of care practices focused on what Matters to older adults (goals and preferences), Medication, Mentation (memory and mood) and Mobility (being able to move around safely). An Age-Friendly Health System ensures age-friendly care for every older person in every setting.

Isolation, brought on by fear of contagion, social distancing and visitation restrictions in the pandemic has accelerated the use of age-friendly 4Ms telehealth visits to review medications, check on mental health and provide guidance on exercise and staying mobile. The focus on "what matters" has taken on heightened relevance. The increased risk of serious illness and incapacitation for older adults during COVID-19 has underscored the importance of discussing and documenting care goals and preferences.     

I'm optimistic that the Age-Friendly Health Systems movement will fundamentally change the way we think about continuity of care for older adults and their families. With leaders like IHI, the American Hospital Association and the Catholic Health Association of the United States, along with CVS Health MinuteClinic, the American Geriatrics Society, state and federal government agencies and many others, we anticipate thousands more sites joining the age-friendly care movement.  

COVID-19 has been a challenge unlike almost any in our lifetimes, and the problems revealed are not new.

What impacts from COVID-19 do you foresee for philanthropic institutions committed to supporting healthy aging in the years ahead?

I predict there will be a reprioritization and even deeper commitment to critical areas: namely nursing homes, home-based medical care and age-friendly public health systems. Philanthropic investments in these areas can help prevent needless deaths and accelerate best care practices.


Eliminating health care disparities and achieving equitable outcomes for older adults across diverse racial and ethnic communities is an area where we will see intensive effort to overcome the inequities of today. Diversity, equity and inclusion must be made a top priority.  

COVID-19 has been a challenge unlike almost any in our lifetimes, and the problems revealed are not new. By working together, we can use lessons from this pandemic and create a future that is age friendly and free of ageism.

Terry Fulmer, PhD, RN, FAAN
Terry Fulmer, PhD, RN, FAAN, a Next Avenue Influencer in Aging, is President of The John A. Hartford Foundation in New York City, a national philanthropy dedicated to improving the care of older adults. Dr. Fulmer is nationally and internationally recognized as a leading expert in geriatrics and the topic of elder abuse and neglect, and her vision is catalyzing the Age-Friendly Health Systems social movement. Read More
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