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The Lost Generation
How are the Covid deaths of older Americans affecting life in the U.S.? Brian McGarry on vulnerability, bereavement, and ageism in the pandemic.
Among the more than 800,000 Americans now dead of Covid-19three-fourths have been 65 or older, with the virus having killed one-in-100 older Americans over the past two years. The pandemic may have deprived people of experiences at every stage of life—including students who’ve fallen behind during crucial stages of their education—but for older people, it’s taken years that time can no longer really compensate for. Many Americans are mourning older family members this holiday season, and many elderly people who’ve survived the pandemic are now living with the lingering effects of disruption, isolation, and loss. What do these tolls mean for American society?
Brian McGarry is an assistant professor in the Department of Medicine at the University of Rochester. According to McGarry, the pandemic has amplified some of the worst effects of getting older—the experiences of losing people your own age, feeling vulnerable, worrying about your own mortality, and even dealing with the effects of ageism in American life, both directly from people and indirectly in public policies. It’s also accelerated these effects at a time when life expectancy for most groups of Americans has been increasing and many have begun looking to retire later, effectively prolonging middle age. For those in need of long-term care and for their loved ones, McGarry says, the last two years have raised new questions about how they want to address vulnerability and need later in life—and the American healthcare system’s capability of addressing them.
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Graham Vyse: Has there ever been a situation like this in America before, when so many elderly people have died so quickly from a single cause?
Brian McGarry: Not in my lifetime or my parents’ lifetime. Early in the pandemic, we looked to the Spanish flu of 1918 as a model of what to expect. This is a pivotal moment in history.
Vyse: How has the pandemic affected different segments of older Americans?
McGarry: A lot of the fatalities have been among the “oldest old,” people 85 and older. People 65 to 74 have had substantial fatalities, too. We can’t talk about the devastation the virus brought without talking about nursing homes, which in many ways have been the epicenter of the pandemic. They’re the perfect environment to spread infectious respiratory disease. You have an old, vulnerable population, often physically disabled with multiple chronic conditions. Typically people in nursing homes are there because they can’t live at home independently anymore.
Meanwhile, most nursing homes in the U.S. are old buildings, somewhat institutional, often with shared rooms and shared bathrooms and communal dining spaces. These buildings probably don’t have the best ventilation either. Nursing-home residents were very much at a disadvantage from the outset of the pandemic and there were substantial deaths among them.
It’s difficult to get entirely accurate statistics, because the population of nursing homes isn’t static, but one estimate we’ve looked at suggests that roughly one in 10 nursing-home residents has died. That’s the real devastation of a particular group of people—and of a group that’s historically been marginalized in U.S. policy discussions about where to put public resources.
More from Brian McGarry at The Signal:
The pandemic has come into a world where life expectancies for most segments of the U.S. population have been increasing. The age of retirement has been getting later. There’s been a shift in when people see themselves transitioning from middle age to being a senior citizen. When the virus arrived, we said people over 65 were at high risk and needed to take extra precautions. That group was targeted early on for social isolating and distancing, even from their families, which was probably a real shock to the system. We experienced this with my own parents, who are in their early seventies and didn’t view themselves at all as being vulnerable. There were widespread ramifications in short-term loss—such as missing family holidays and gatherings. Those were hard for everyone, but they’re harder when you’re more regularly reminded that your days on earth are finite, when you’ve started asking how many Christmases you have left, and you’re told you have to be on Zoom with your grandkids.”
A lot of older people also rely on what we refer to as “informal care.” Sometimes it’s a spouse who lives with someone who has some level of disability and needs help, but oftentimes it’s someone outside the house. People getting informal care from outside the house face questions: Do I keep having someone come in and help me with daily living? Am I taking a risk if I do that? Should we be wearing PPE? Going without these services leads to deteriorating physical abilities and a loss of independence. Even those older people who managed to avoid getting Covid still face a serious potential for bad health effects, and I don’t know that we have a great grasp on just how bad those effects are.”
As we calculated how to handle the pandemic in America—and what risks we were willing to live with throughout it—we generally made decisions that allowed older adults to bear the brunt of it, including with their lives. To me, there’s an analogy to World War II or the Vietnam War—a particular age cohort losing a lot of people in a catastrophic event. Here it’s happening further along the age spectrum, which is part of why some people have decided it’s okay—because it’s closer to the expected end of these lives. I’ve actually heard criticism of focusing on the protection of vulnerable populations in the late stages of life: “Everyone dies from something.” But dying from a painful respiratory disease—isolated in a nursing home or in a hospital away from your loved ones—is not a humane way to die. Having to say goodbye over an iPad isn’t something you’d wish on your worst enemy. It’s not just about the potential years of life lost. It’s about experiencing dignity at the end of your life.”
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