A previous article in this series, by Alisoun Milne,
demonstrated forcefully how the government’s responses to the COVID-19 pandemic
have scandalously exposed to grave risks care home residents and staff (Milne,
2020). That this was a conscious act
of government policy, leading to thousands of unnecessary deaths, reveals,
among other things, how deeply rooted ageism is in British society. Ageism also underpinned the long term neglect
of residential and nursing homes, the vast majority of residents of whom are
frail older people, and the cuts that were forced on them by austerity
policies. This is not to argue that ageism is the only factor behind the
government’s mishandling of the pandemic. A fuller account would include
underfunding and the long term privatisation of the NHS, the neoliberal prioritisation
of private contractors over public bodies, the finance-led reorganisation of
the national virus testing service, as well as sheer incompetence and a wilful,
insouciant failure to learn lessons from other countries. None the less ageism
has played a major role.
The starkest
indicator of ageism is to be found in the huge loss of life among older
people. The overall death rate is
monstrous and dwarfs the German total by a factor of 6-7 times (and Germany has
a larger population) but, among people diagnosed with COVID-19, those aged 80
or over are seventy times more likely to die than those aged under 40. It is predicted that more than 50 per cent of
deaths from the virus will be care home residents (Laing, 2020). The total of such deaths was 34,000 by mid-June,
ten times the level in Germany. In other
words, the highest death toll from the pandemic has taken place among a very
vulnerable population, but one which was in settings that could, and should,
have been protected. The Health
Secretary’s ‘protective ring’ was pure PR fantasy and never existed. Just the opposite in fact, rather than being
protected, care home residents were needlessly exposed to fatal risks by the
forced discharge of older people from hospitals without the stipulation of a
negative test for coronavirus, or indeed without any test at all (Iacobucci,
2020).
Thus
protection for the NHS was bought with the lives of those most vulnerable to
infection. Not surprisingly, therefore,
the majority of deaths from COVID-19 have not taken place in hospitals but in
care homes. In the last 2 weeks of April
three-fifths and two-thirds respectively of coronavirus deaths took place in
care homes, and less than a quarter in both weeks in hospitals. For the week ending 12 June the figures were
66.5% (care homes) and 19.5% (hospitals) (ONS, 2020). As well as these deaths directly attributable
to COVID-19 the ONS reports 9,429 unexpected extra deaths among people with
dementia in April, in England, and 462 in Wales – 83% and 54% higher than
usual. Anecdotal evidence from
charities, such as the Alzheimer’s Society, plausibly points the finger at the
loss of contact with family and friends.
The President of the ADASS used more measured terms than this scandal
warranted:
A key lesson is that a pandemic
response that focused on emptying acute hospital beds without considering the
impact on social care had huge consequences; prioritising PPE and testing for
hospitals, with social care as an afterthought, was not right. (Bullion, 2020,
p.2)
The woeful
neglect of care homes, resulting in huge unnecessary loss of life, is the
result of institutional ageism – a situation in which people are systematically
discriminated against by policies, practices or attitudes on the basis of their
age (Bytheway, 1995). So too is the fact
that staff working in these homes are underpaid, under-trained and
under-valued. The policy of ‘herd immunity’
exposed those in care homes to danger and was only discontinued when the
predicted loss of life was regarded as too risky in political terms. That such a policy could be instigated in a democratic
society emphasises the deeply ingrained nature of ageism.
The government’s response to the
pandemic has made frequent use of negative stereotyping of older people. For example the idea that everyone over the
age of 70 should be isolated, when the reason for the close statistical
association between COVID-19 and late old age is the prevalence of
multimorbidity (two or more chronic conditions), not age per se. The prevailing belief that multimorbidities
are an inevitable part of being old is itself rooted in ageism – a belief often
internalised by older people themselves.
As argued below, if resources were devoted to preventing chronic
conditions, instead of simply accepting them as inevitable, the lives of
millions of people, now and in the future, could be transformed (Walker, 2018). The frequent references to ‘underlying
conditions’ among virus victims reinforces this ageist belief in the
inevitability of chronic ill health, and also minimises the loss of life as these
older people were expected to die soon anyway.
The search for a vaccine against
COVID-19 is itself imbued with ageism, because there is no reference to the
lowered immunity, or immunosenescence, experienced by many people in advanced
old age. This causes much lower than
average vaccine receptiveness. For
example annual influenza vaccines have only 30-40% effectiveness among very old
people with multimorbidities. Thus, if
vaccine research is not accompanied by work on how to raise immunity levels,
such as the use of geroprotector drugs, the most vulnerable will not be
protected.
As well as unambiguous institutional
ageism the pandemic has thrown up plenty of examples of its more compassionate,
benevolent or well-meaning form. For
example the widespread stereotyping of older people as vulnerable and dependent
homogenises millions of people and thereby glosses over the many
intersectionalities and huge inequalities among them – divisions, such as
ethnicity, which have a direct bearing on susceptibility to COVID-19 (Public
Health England, 2020). As Eleni
Skoura-Kirk (2020) has pointed out, there is also an element of ‘othering’
in some of this apparently benign ageism.
If we want to emerge from the
pandemic as a more socially just society there has to be a concerted national
attack on all forms of ageism, wherever they reside. Rooting out ageism should form one part of a
complete transformation in our approach to ageing and older people – a new
national ageing strategy. Its starting
point would be a recognition that ageing is lifelong. Despite the great preponderance of virus
deaths among older people it is not chronological age but health,
ethnicity and socio-economic status that are the main causal factors. Older people in general are not vulnerable, it
is the preventable chronic conditions associated with later life that cause
vulnerability. A huge national effort is
needed to prevent those multimorbidities, along with a rejection of the ageist
assumption that they are part and parcel of growing old. Given lifelong ageing, prevention means
embracing all ages, young and old. The
key measures include the promotion of physical and mental health; major
reductions in income and health inequalities; ending prejudice; rapid
improvements in air quality; fair access to nutritionally beneficial food; and
the transformation of the NHS from an acute care service to a public health one
focused on prevention. A new national ageing
strategy must rescue the social care sector from decades of neglect and 10
years of deep spending cuts. It should
be combined with health care, provided on the same free at the point of use
basis, operated as a public service, be well funded, and in terms of quality
and staffing accorded parity with the NHS.
If such a strategy had been in place,
with a competent government in power, the UK’s response to the pandemic would
have been very different, with far fewer deaths among older people and their
carers, paid and unpaid. As many as
30,000 lives might have been saved.
Prof. Alan Walker, University of Sheffield
E-mail: a.c.walker@sheffield.ac.uk
References
Bullion, J. (2020) Preface to ADASS Coronavirus Survey
2020, Association of Directors of Adult Social Services: www.adass.org.uk/media.796/adass-coronavirus-survey-report-2020-no-embargo.pdf
Bytheway, B. (1995) Ageism, Milton Keynes, Open
University Press.
Iacobucci, G. (2020)’Covid-19: Care home deaths in England
and Wales double in four weeks’, British Medical Journal, 369, m1612.
Laing, W. (2020) www.laingbuisson.com/wp-content/uploads/2020/06/covid-story_v4.pdf
Office for national Statistics (2020) Number of deaths in
care homes notified to CQC, England, London, ONS, 23 June.
Public Health England (2020) Disparities in the Risk and Outcomes of COVID-19,
London, PHE.
Walker, A. (2018) ‘Why the UK Needs a Strategy on Ageing’, Journal
Of Social Policy, Vol. 47, No. 2, pp. 253-273.
Doi.org/10.1017/S0047279417000320
