Commemorating Older Americans Month

May is Older Americans Month, and as President Biden stated in his May 3rd proclamation: “During Older Americans Month, we celebrate older Americans and the key role they play in sharing the wisdom and experience that inform today’s decisions and actions, and fostering the connection and engagement that build strong, resilient communities. And, we recognize our responsibility to ensure that every American has the opportunity to age with dignity.”

Of particular relevance to the Academy’s work, President Biden also committed to “ensuring older adults are central in our country’s recovery efforts.” This commitment includes the Administration’s plans to substantially increase funding for home- and community-based services under Medicaid.

Concern for older Americans has played a key role in shaping policy more broadly, including driving the development of social insurance programs over the decades, such as Social Security in 1935, and Medicare in 1965. This is not at all limited to this country; aging is a global concern. The World Health Organization (WHO) recently issued a Global Report on Ageism. Brought to my attention by new Academy Board Member Debra Whitman, Executive Vice President of Policy, Strategy and International Affairs at AARP, this WHO report provides a sweeping examination of the impact that age discrimination has on international economies and societies. Below is a brief summary of the report’s findings and implications for the U.S., as well as updates on the Academy’s major initiatives in relation to older Americans.

Global Report on Ageism (World Health Organization)

A concept first identified by the late gerontologist Dr. Robert Butler, the WHO report describes ageism as the use of age “to categorize and divide people in ways that lead to harm, disadvantage and injustice and erode solidarity across generations.” Addressing ageism a key element of the United Nation’s 2030 Agenda for Sustainable Development, a blueprint for “building a future of peace and prosperity for all on a healthy planet.”

The WHO notes that ageism is “widespread in institutions, laws, and policies across the world.” This report aims to:

• Raise awareness about the global nature, scale, impact and determinants of ageism directed against both younger and older people;
• Draw attention to the need to prevent ageism, to promote and protect the realization and enjoyment of all human rights for all persons and to present effective intervention strategies;
• Call for action across sectors and stakeholders.

The WHO report identifies stereotyping (thoughts), prejudice (feeling), and discrimination (actions) as ways in which ageism manifests itself, and points out how ageism affects both old people (those aged 50 and older) and young persons: “Older people have been often seen as uniformly frail and vulnerable, while younger people have been portrayed as invincible, or as reckless and irresponsible.”

Three intertwined and mutually reinforcing forms of ageism are delineated in the report: institutional; interpersonal; and self-directed. Institutional ageism refers to the laws, rules, social norms, policies, and practices of institutions that unfairly restrict opportunities and systematically disadvantage individuals because of their age. Interpersonal ageism arises in interactions between two or more individuals, while self-directed ageism, which is closely linked to the other two forms, occurs when ageism is internalized and turned against oneself.

According to the WHO report, “ageism is to an extent, different from other ‘-isms,’ such as racism or sexism,” because “ageism involves bias against a moving target” in that people “belong to different age groups at different times,” and that “everyone is susceptible to experiencing it.” It also notes that “ageism and ableism are closely intertwined in ways that can often result in mutual reinforcement.” (Ableism is defined as stereotypes, prejudice and discrimination against people with disabilities.) While distinct, ageism sometimes intersects with other –isms, such as “gendered ageism” – “differences in ageism faced by women compared with men.” Similar intersections affect widows, older Black gay men, and lesbians, among others.

Finally, the WHO report categorizes ageism as “an important, and hitherto neglected, social determinant of health,” identifying “polypharmacy” – the simultaneous use of multiple drugs – as “widespread among older people…with negative consequences.” One policy critique is directed at the use of the dependency ratio (the number of older people/the number of working-age adults), which it characterizes as “another instance of ageism as, in effect, it assumes that all older people are dependent” – implying that they are a burden for younger productive people to carry. The report reminds us that “older persons have also made important contributions to the (COVID-19) crisis response, as health workers and caregivers.”

Among the report’s recommendations are that nations invest in “evidence-based strategies to prevent and tackle ageism” and “improve data and research to gain a better understanding of ageism and how to reduce it.” Most importantly, the report describes three strategies to reduce ageism: policy and law; educational activities; and intergenerational contact interventions. All three strategies are relevant to our Academy, which is working to identify policies that address age discrimination and inequality and to disseminate those findings, as well as facilitate the intergenerational transfer of knowledge via our leadership development programs.

Older Workers’ Retirement Security

The WHO’s report also examines ageism in the workplace. Based on a systematic review of sixty studies, it found that “employers were less likely to hire older applicants than younger applicants; that once employed, older workers had less access to training; and that those who faced ageism in the workplace were more likely to retire early.” These findings, however, should not be taken to mean that there has been no attention to ageism in the workplace. For example, the 1967 Age Discrimination in Employment Act caused a small positive and significant effect on overall employment for older workers.

Still, older workers face substantial hurdles. As part of our ongoing collaboration with AARP, the Academy’s new Task Force on Older Workers’ Retirement Security, chaired by Academy Member Barbara Bovbjerg, is examining policy options to improve retirement security for older workers who are no longer able to perform their regular jobs.

COVID-19’s Impact on Older Americans

The impact of the pandemic on older persons has been especially devastating. Throughout the world, older people have faced substantially higher case-fatality rates than younger people. This is especially pronounced in the U.S., where more than 80 percent of all deaths from COVID-19 have occurred in people aged 65 and older. According to The COVID TRACKING Project at The Atlantic, less than one percent of America’s population lives in long-term care facilities, but as of March 2021, this small fraction of the country’s population accounted for 35 percent of US COVID-19 deaths. We are also learning more and more about the ongoing impacts of COVID on prior patients.

The final report of the Epidemiology Working Group of the Academy’s COVID-19 Task Force notes:

“One of the likely disabling impacts of COVID-19 is on individuals who have been seriously infected, but have survived after being placed on ventilators. After older individuals have been on ventilators and spent weeks in intensive care units, they have often developed physical debilitation (such as lung, kidney, heart, liver, and circulatory damage), urinary and metabolism problems, blood clotting, difficulty swallowing or breathing, and bedsores.”

In recognition that older persons were more likely to be infected and to suffer severe illness and death, they were prioritized and were among the first groups to receive vaccinations. Despite these efforts, however, approximately one-fifth of Americans aged 65 and older, including many who are frail and homebound, remain unvaccinated, even as all states have made all adults eligible for vaccines.

Other Developments in Aging

Earlier this month, the Associated Press and the NORC Center for Public Affairs Research issued the results of a survey on government policies to help older Americans age at home. The survey found that a majority of Americans “agree that government should help people…age in their own homes, not institutional settings.” Sixty percent of respondents “favor a government long-term care insurance program for all Americans.” (For more information about options to meet the long-term care needs of all Americans, check out the Academy’s new brief on Universal LTSS Programs: Lessons from Germany and Other Countries.)

Meanwhile, the Department of Labor’s Bureau of Labor Statistics (BLS) issued its projections of employment over the current decade last month. Home health and personal care aide is among the fastest growing occupations, which BLS projects to grow at 34 percent from 2019 through 2029, due to the aging of the Boomer population. BLS also noted that the median pay for this job is only $12.15 per hour, or $25,280 per year. (The Academy’s Universal Family Care webinars have also highlighted the critical role of care workers.)

The Academy’s Campaign for Pathways to Economic Security

In addition to its other sobering findings, the WHO report notes that “ageism may increase the risk of poverty and financial security in old age.” It devotes an entire section to the use of campaigns as a strategy to address ageism. A campaign is defined as “purposive attempts to inform or influence behaviors in large audiences within a specified period by using an organized set of communication activities and featuring an array of mediated messages delivered through multiple channels to produce non-commercial benefits to individuals and society.”

The Academy’s recently-launched multi-year Campaign for Pathways to Economic Security is exactly such a purposive attempt. We are engaging a wide range of stakeholder groups in this work, including those organizations that represent the concerns of older Americans, such as: AARP, the Alliance for Retired Americans, Generations United, Justice in Aging, Latinos for a Secure Retirement, the Leadership Council for Aging Organizations, the National Association of Area Agencies on Aging, the National Institute on Retirement Security, Social Security Works, and the Women’s Institute for a Secure Retirement (WISER).

The Pathways to Economic Security Campaign will also encompass the Academy’s work on caregiving and Universal Family Care. As part of our work with the Ford Foundation on the importance of caregiving and the need for a better care infrastructure, stay tuned for a June webinar on universal LTSS, and new resources for advocates and policymakers.