AGEISM: AN INSIDIOUS PANDEMIC
At the end of July, one of the UK’s national papers published an article claiming the government had made ‘secret plans’ four years ago to deny the elderly hospital care.
In the event of a severe flu pandemic, it reported, over-seventies could be refused hospital treatment as a strategy to alleviate pressure on the NHS.
Instead, these patients would be offered support in nursing homes for ‘end of life pathways.’
Put bluntly, medics could be authorised by the health secretary to prioritise patients based on probability of survival as opposed to clinical need.
The UK government’s response to the article was that these were purely theoretical scenarios in pandemic planning documents and that they had never informed policy or the government’s response to the COVID 19 pandemic.
Some might disagree.
Sacrificing one part of society to save the rest is an abhorrent concept to most of us. It is exactly this dilemma I chose for my novel The Waiting Rooms, set during an antibiotic resistance crisis, where no one over seventy gets access to new antibiotics. If they become ill, they are sent to hospitals for the elderly, nicknamed The Waiting Rooms: hospitals where no one ever gets well.
I had hoped such a concept would remain fictional. Yet those living and working in care homes and hospitals during the early stages of the coronavirus pandemic have their own stories to tell.
The COVID care home scandal will doubtless comprise a major part of the public inquiry into the UK government’s handling of the COVID pandemic.
Bereaved families will want to know why an estimated 25,000 patients were discharged from hospitals to care homes without any coronavirus testing to free up beds in hospitals, following government guidance in March last year. And why it took until the 15th April for coronavirus testing to be deemed necessary before hospital discharge.
Panorama gathered data from 39 hospital trusts, which showed three-quarters of people discharged up until that point were untested.
By early May 2020, according to Public Health England figures, a third of care homes in England had reported outbreaks of coronavirus. Between April and May, care home deaths peaked at over 3.5 times the expected average compared to previous years.
As for testing in care homes, it would take until the 7th June for every care home housing residents over-65 to be offered testing, and another month after that for the introduction of regular testing in care homes to be announced, let alone delivered.
“It is as if care home residents were seen as expendable. Despite thousands of empty beds they were de-prioritized when it came to getting access to hospital care, and had blanket do not resuscitate orders imposed on them without due process.
Such abuses are deeply disturbing.”
During an investigation by Amnesty International, care home managers and staff described “a complete breakdown” of systems in the first six weeks of the pandemic response. They spoke of waiting to receive guidance, struggling to access adequate amounts of PPE, and of having no access to testing, despite having to manage infected patients urgently discharged from hospitals.
Staff and relatives told Amnesty International how sending residents to hospital was discouraged or outright refused. In addition, at the peak of the coronavirus pandemic, some care homes were asked by local GP surgeries or Clinical Commissioning Groups to place blanket do not resuscitate orders on their residents, to keep hospital beds free.
The results of their investigation were compiled into a report last October: As If Expendable: The UK Government’s Failure to Protect Older People in Care Homes during the COVID-19 Pandemic
But underlying these reports is a more insidious issue that involves all of us. One that I deliberately set out to explore when I started writing my novel, way before the coronavirus pandemic. Our attitudes to the elderly.
Age discrimination is a global problem, with the lowest levels of respect for older people in high income countries. The actress and producer Frances McDormand calls it ‘a cultural illness’: there is something wrong with how our society views age.
Research shows the COVID pandemic has only made things worse.
Ageist stereotypes about older people’s frailty and value to society have prejudiced the way some COVID policies have been designed and delivered. In addition, the deluge of negative rhetoric on social media at the start of the pandemic reinforced dangerous biases and assumptions that alienated the elderly even more.
“Older chronological age is indeed a risk factor for COVID infection, disease severity, and mortality. However, older people are not just a homogenous group of defenceless people in need of protection.”
A report by the World Economic Forum: COVID and Longer Lives: Combating ageism and creating solutions, published last October, claims that the pandemic has not only hurt older people in terms of their physical health but it has also damaged their mental health through ageist attitudes and increased loneliness and isolation, a subject I touched on in another blog last year: What Can We Learn From Life in Lockdown?
The WEF report also highlights the damaging effects of such biases on older people’s livelihoods, especially in lower and middle-income countries, with lockdowns and social distancing further reducing their ability to earn an income.
“Stereotypes, prejudice and discrimination based on age enhance existing inequalities and prevent effective countermeasures. The assumption that all older people are frail or dependent is not only inaccurate but also harmful... Undervaluing the economic contributions of older adults and considering them a burden on economies is another form of ageism. ”
We have to find a way to get beyond these prejudices. Just as we are battling sexual and racial discrimination, we need to overhaul our assumptions and generalisations to battle age discrimination: against the young and the old, and foster what WEF calls ‘intergenerational solidarity’.
In short, we need to connect with each other as individuals, and on much more meaningful terms than age.
“Ageism tends to paint all older adults as the same. The reality is that older persons are diverse and have several different identities. They are more than their age.”
My debut novel, The Waiting Rooms, set in the aftermath of an antibiotic crisis, is available as an audiobook, e-book or good old-fashioned paperback and you can find out more here.