What COVID-19 Means for the Future of Aging
Insights from four experts at the Milken Institute Future of Health Summit
Are there any silver linings for the future of aging coming out of COVID-19? And what lessons have we learned from the pandemic that could improve the health of older — and younger — Americans?
A panel of experts and I, as the moderator, looked for answers at the recent virtual Milken Institute 2021 Future of Health Summit panel: COVID-19 and the Future of Aging. (The Milken Institute is a nonprofit, nonpartisan think tank.) Our panel helped kick off the two-day event, featuring more than 200 speakers and 1,000 participants. You can watch our session on the summit's site and read highlights here.
"I'm hoping this pandemic redefines what we mean by 'We're all in this together.'"
"I'd like to think that the pandemic is pushing us, forcing us to reframe, redefine and reconfigure what kind of society we want," said panelist Fernando Torres-Gil, director of UCLA's Center for Policy Research on Aging. "Certainly the pandemic brought out that many populations were at great risk — whether from COVID, the lack of access to medical care, social isolation — and certainly impacted older adults at a disproportionate level."
But, Torres-Gil added, he also thought the pandemic "gives us some potential silver linings or opportunities which will hopefully cause us to rethink what do we mean by 'essential?' Who are the essential members of society that have been invisible for so long?...So many segments of society have been invisible, but during the pandemic were critical to the functioning of society."
The Milken Institute Health Summit Panelists
And, he added, "my hope, and one of the great silver linings, is that we began to realize that everyone matters and we need and want to reconstruct both the social safety net and its social contract…I'm hoping this pandemic redefines what we mean by 'We're all in this together.'"
Joining Torres-Gil on the panel: Richard Ashworth, CEO of Tivity Health (whose company includes the SilverSneakers fitness programs for older adults); Trent Stamp, CEO of The Eisner Foundation (focused on programs uniting the generations) and Lauren Dunning, director of the Milken Institute Center for the Future of Aging.
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Torres-Gil, Ashworth and Stamp were among the Milken Institute Center for the Future of Aging's Advisory Board members who wrote Next Avenue articles about COVID-19 and the Future of Aging from October 2020 through March 2021; the Milken Institute just released the series as an online report.
The Future of Summit panel focused on four themes that came up in our series of articles: COVID-19 and older adults; ageism; technology and intergenerational connections. "They suggested critical areas of opportunities for additional focus," Dunning said.
When we began, I asked our audience to tell us in one word what they thought would be the biggest societal change that will persist post-pandemic.
The answers were revealed in the Word Cloud below and you'll see the most popular ones were: "work," "telehealth," "digital" and "flexible." Of course, "Zoom" came up, too.
COVID-19 and Older Adults
I noted that, according to the Centers for Disease Control and Prevention, eight in 10 deaths from COVID-19 were among people over 65.
"The medical community is continuing to try and figure out what are other factors that were driving the morbidity and mortality rates coming out of COVID-19," said Ashworth. "And one factor is chronic disease. Preventable conditions — things like obesity — don't happen overnight. They're the result of a lack of routine health care, of not having health foods and other socioeconomic factors that cause some of the inequity in access to care or behaviors."
Ashworth said that increasing the proportion of people who have medical insurance and a primary care doctor "would solve a lot of our problems."
African Americans, Hispanics, Asian Americans, Pacific Islanders, Native Americans in immigrants "are facing tremendous economic and social disparities and despair in the pandemic," Torres-Gil said.
"We saw that especially older minorities — in particular, Black and brown — were really facing vulnerable situations. If they were in the poorly funded publicly financed Medicaid skilled nursing facilities, which were poorly staffed with low-wage workers and therefore poor quality care, they were more vulnerable to the ravages of COVID," Torres-Gil added.
Dunning noted: "So many of our experts [in the Next Avenue articles] highlighted the urgency of the need for investment in geroscience research, given the disproportionate harm inflicted by the pandemic on older adults and communities of color."
Torres-Gil said two concepts in the new California Master Plan on Aging he helped create might be helpful over the long term: Looking at aging through an equity lens and taking an intergenerational approach.
"Ageist messages were front and center during the pandemic," said Dunning.
He said younger members of Asian, Latino and African American communities are "at great risk in their future longevity precisely because of the lack of good, healthy aging options, healthy eating options, healthy exercise options. And we're going to find that the growing incidences of obesity and diabetes among young Black and brown and ethnic individuals means that as they get older, they will be at greater risk for a variety of chronic conditions."
Torres-Gil raised this question: "What can we do now to work with the youth to give them a better opportunity for healthy aging and a longer longevity?"
"Ageist messages were front and center during the pandemic," said Dunning. "And it became clearer than ever that older adults experienced bias in their daily interactions, health care, workplaces, across the board."
The Milken Institute Center for the Future of Aging has noted that a Twitter analysis of more than 18,000 tweets in March 2020 showed that about a quarter of all tweets could be considered ageist.
"We certainly saw during the pandemic tremendous ageist attitudes and approaches to how we address health and long-term care, as well as vaccinations," said Torres-Gil. "But let us also add there was ableism, where we saw discrimination against those who had some level of disability, whether it was cognitive, visual, hearing or physical."
One of the great challenges for society, he added, "is how do we inform, educate and convince younger cohorts in society that they too will be old someday…so we can avoid what we saw in the pandemic — that older persons and persons with disability were seen as expendable."
Torres-Gil, who's 73, then spoke personally, telling the audience that he is a polio survivor. "We discovered like thirty years after those of us got the polio infection that the virus had long-term effects that never went away. And now my generation of polio survivors are facing what we call 'post-polio syndrome — many of the symptoms are coming back. "
So, he said, "how do we educate younger persons to realize that maybe you were young and invincible, maybe you survived a COVID-19 infection, but in twenty, thirty, forty years, we don't know if it's going to have long-term repercussions as we are seeing with polio survivors."
Dunning noted that "we've all felt the impact of the increased reliance on technology during COVID-19 — from ordering groceries online to making telehealth appointments." Indeed, the percentage of older adults who participated in a telehealth visit went from 4% in 2019 to 30% in June 2020.
So, the pandemic accelerated those shifts toward a more digital future. And while there's great promise in that, we need to focus on narrowing that digital divide, so we don't leave anybody behind," Dunning noted. Today, 34% of people on Medicare who are living below the federal poverty level have no internet usage.
Also, Dunning said, "we need to focus on solutions that accommodate things like hearing, visual and cognitive impairments."
Ashworth said his company saw COVID-19 breaking the myth that older adults are technology-averse. "We're seeing a significant amount of folks engaging with us digitally and virtually," he noted. But, he added, we need to expand broadband to many rural communities lacking access to the internet.
Social Isolation and Intergenerational Connections
Nearly a quarter of adults 65 and older were considered socially isolated before the pandemic and during COVID-19, social isolation among older adults increased. More than half of adults 50 and older reported social isolation in the pandemic, I said.
"Social isolation has really serious impacts on physical health and well-being, including the risk of premature death," said Dunning.
"The pandemic made social connection really hard," said Ashworth, who noted the fitness centers with SilverSneakers programs had to close their doors early on. "So, we pivoted to virtual fitness," he noted.
While many older adults have taken to virtual exercise programs and are now returning to fitness centers, a recent Tivity Health survey found that only 12% of its members said that over the next three months they plan to return to the same level of exercise they had before the pandemic.
"That means a significant amount are saying, 'Hmmm, I'm not really sure what I'm going to do," Ashworth said.
One potential antidote to ageism, Dunning said, is intergenerational connection. In fact, when we polled our audience to see which strategy they thought would be most critical for reducing social isolation post-pandemic, a striking 66% said "in-person, intergenerational programming."
Stamp responded: "When we get older and younger people in the room together to see each other's shared visions and challenges, good things can happen."
Dunning said that in her Center's articles for Next Avenue, "our experts advocated for the creation of fostering of intergenerational workforce initiatives, community spaces and living arrangements and all the ways we can connect to enhance collaboration among the generations."
Stamp agreed, saying it's important to invest in intergenerational programs that foster empathy. "We've known for a long time that the two groups in our society that are the loneliest are the young and the old," he said.
But, Stamp added, "It's important to acknowledge upfront that we very intentionally segregated the generations in this country over the past century. There's not biological, nothing natural about separating our generations. We did it on purpose."
The United States, he added "created mandatory retirement ages and Social Security to get older workers out of the workforce; we created schools where we wanted single-age groups; we created housing communities where we didn't want any kids in them."
It's going to take "an intentional effort on our society to bring folks back together," said Stamp.
That means, he added, "We need to embrace and normalize the idea of older volunteers in classrooms. We need to embrace and celebrate children in retirement communities…We need to find that the contributions of every generation in our workplace have value and we need to build multi-generational teams that can learn from each other. There's a thirst for this generativity."