Ageism against older adults in the context of the COVID-19 pandemic: an integrative review

Silva, Marcela Fernandes; Silva, Diego Salvador Muniz da; Bacurau, Aldiane Gomes de Macedo; Francisco, Priscila Maria Stolses Bergamo; Assumpção, Daniela de; Neri, Anita Liberalesso; Borim, Flávia Silva Arbex

doi:10.11606/s1518-8787.2021055003082

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Review • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003082 copy

Ageism against older adults in the context of the COVID-19 pandemic: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To report the main results of studies on prejudice, stereotyping, and age-based discrimination (ageism) in the context of the COVID-19 pandemic.

METHODS

This is an integrative review of the literature on ageism in the context of the COVID-19 pandemic, conducted between May and June 2020, with data collected from the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Web of Science (Thompson Reuters), Scopus (Elsevier Science), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and Scientific Eletronic Library Online (SciELO).

RESULTS

Twenty-one publications addressing ageism during the pandemics, its origins, consequences, and ethical and political implications were analyzed. All publications were theoretical with a critical/reflexive approach, being 90,5% opinion articles (n = 19) and 9,5% research (n = 2). The main findings indicate criticisms regarding resources allocation and intensive care based exclusively on age. The results also highlight the impacts of social isolation, the use of technologies and social media, and intergenerational relationships within the COVID-19 scenario.

CONCLUSION

According to most publications, although ageism has always been present, it became more evident during the COVID-19 pandemic as a form of discrimination against older adults. “Ageist” discourses may exert a negative influence in older adults’ lives, causing severe social and psychological impacts.

Aged; Ageism; Health of the Elderly; Geriatrics; Coronavirus Infections; Social Discrimination; Prejudice; Stereotyping; Health Policy; Review

Database	Journal	Author(s), publication year	Title	Type	Objectives	Results^a / Contents^b
PubMed, Web of Science	Journal of Clinical Nursing	Brooke et al., 2020¹⁸	Older people and COVID-19: isolation, risk and ageism^b	Editorial	It addresses social isolation, risks, and ageism during COVID-19.	Biased, negative, and implicitly devaluing discourses contribute for older adults to feel useless, burdensome, and valueless, diminishing their social opportunities and making them vulnerable to negative social and health outcomes, especially isolation and loneliness.
PubMed, BVS, Scopus, Web of Science	Journal of the American Medical Directors Association	Cesari et al., 2020²⁴	COVID-19 in Italy: Ageism and decision making in a pandemic^b	Editorial	It criticizes ethical and clinical guidelines regarding the allocation of scarce intensive care resources based on the age criterion during the COVID-19 pandemic in Italy.	Conducts driven only by the number of years lived configure ageism. Critical and rapid decision-making in older people’s health require parameters more robust than age, including frailty, comorbidities, and functional status.
PubMed, Web of Science	Journal of the American Geriatrics Society	Jimenez-Sotomayor et al., 2020²⁵	Coronavirus, ageism, and twitter: an evaluation of tweets about older adults and COVID -19^a	Qualitative research	It analyzes tweets related to older adults and COVID-19 to identify of age-based discrimination content.	Almost a quarter of the tweets analyzed (21.1%; n=74) addressed age-based discrimination content or was potentially offensive to older people, designated as “boomers.” The comments diminished the value of older adults’ lives or minimized COVID-19 hazards for affecting this age group.
PubMed	Geriatrics	Petretto et al., 2020²⁶	Ageing and COVID-19: what is the role for elderly people?^b	Editorial	It addresses the role of older adults in the context of COVID-19 and highlights the risks of ageism from the Italian experience.	Older adults’ greater vulnerability to coronavirus increases the risk of ageism, and actively performing roles during the pandemic reduces such risk. As a result of ageism, older adults may face major barriers in accessing healthcare and support. Protecting older adults from infection is important, but so is respecting and supporting them in this complex situation.
PubMed, Web of Science	Journal of Aging & Social Policy	Morrow-Howell et al., 2020²⁷	Recovering from the COVID-19 Pandemic: a focus on older adults^b	Article – Perspective	It discusses the challenges (including ageism) and opportunities arising from the COVID-19 pandemic based on the experience of older adults.	The COVID-19 pandemic revealed that ageism and old age-based stereotypes contributed to abandoning older adults and neglecting their needs. Memes and hashtags that disseminate the idea of eliminating or getting older adults out of the way depreciate them and validate the virus by stimulating a reduced public expenditure with this age group – deemed as unproductive, dependent, and expensive.
PubMed	Age and Ageing	Fraser et al., 2020²⁸	Ageism and COVID-19: what does our society’s response say about us?^b	Commentary	It stresses the ageism arising from the COVID-19 pandemic and discusses how older people are misrepresented and devalued in the current public discourse around the pandemic.	The current public discourse around COVID-19 misrepresents and devalues older people. At first, the pandemic was not taken seriously and was portrayed by the public discourse as only dangerous for older adults. This narrative might explain the social resistance in following public health recommendations. Ageism has reached a new level with memes and hashtags that talk about killing or eliminating older adults, represented as vulnerable and helpless beings whose death by the virus was predicted and inevitable.
PubMed, Scopus	Asian Journal of Psychiatry	Banerjee, 2020²⁹	‘Age and ageism in COVID-19’: elderly mental health-care vulnerabilities and needs^b	Note to the Editor	It addresses ageism and age vulnerability in the COVID-19 pandemic and the need for promoting mental healthcare and the well-being of older adults.	The impact of the pandemic may be greater in older adults, given they are aware of their vulnerability and may self-neglect. Ageism may lead to elder marginalization and abuse, fostering functional dependence and decreasing well-being.
PubMed	Journal of Gerontological Social Work	Berg-Weger et al., 2020³⁰	COVID-19 Pandemic: Workforce implications for gerontological social work^b	Article	It addresses four issues that became more pronounced with the pandemics: ageism, technology, social isolation and loneliness, and interprofessional practice, considering workforce implications for gerontological social work with COVID-19.	Different ageist conducts were demonstrated throughout the pandemic, including the lack of protocols for older adults and gerontological content in the curricula of health professions providing care to older adults, inequalities in resources allocation, derogatory references to older adults, and relief for this age group presenting more risk of mortality.
PubMed, Web of Science	Journal of Gerontological Social Work	Swinford et al., 2020³¹	Applying gerontological social work perspectives to the coronavirus pandemic^b	Commentary	It analyzes three gerontological perspectives of social assistance during the COVID-19 pandemic.	The older population heterogeneity challenges ageism and the age-based stereotypes that emerged with COVID-19. Ageism notions are based on harmful stereotypes that reduce a group extremely heterogeneous into a single cohort based on their age. Rejecting ageist discourses and reinforcing arguments to support older adults and workers, volunteers and caregivers, are important measures, as well as actively promoting efforts to foster solidarity between generations.
PubMed	International Psychogeriatrics	Ayalon, 2020¹⁷	There is nothing new under the sun: ageism and intergenerational tension in the age of the COVID-19 outbreak^b	Commentary	It addresses the relation between ageism and intergenerational tension in the COVID-19 pandemic.	Older adults were the main affected and less compliant with social practices implemented during the pandemic. All older adults were placed in a same homogeneous, vulnerable group, disregarding the heterogeneity of aging and reinforcing ageism, which sparks disagreements between different generations.
PubMed	The Journals of Gerontology	Ayalon et al., 2020³²	Aging in times of the COVID-19 pandemic: avoiding ageism and fostering intergenerational solidarity^b	Editorial	It expatiates on how ageist discourse can affect all generations.	The pandemic provoked a parallel outbreak of ageism. The media depicted older adults as a fragile group, made of powerless people, unable to contribute to society. Incorporating these stereotypes may be detrimental for both older adults and young people, during their own aging. Physical distancing must not imply social distancing, and relationships between generations must be strengthened. The concept of risk group should take into account other factors besides age, such as chronic diseases and frailty.
PubMed, BVS, Scopus	British Medical Journal	Archard et al., 2020³³	Is it wrong to prioritize younger patients with covid-19?^b	Note to the Editor (Opinion)	It explains the reasons why age cannot be a determining factor in deciding which life should be prioritized.	Everyone has the right to live for a certain duration, so that deciding who gets to live based only on age is not right. Moreover, old lives worth just as much as young ones. The key point is employing ethics to avoid having discriminatory and ageistic attitudes – according to which older adults worth less or are less important than young people.
PubMed	Journal of Aging & Social Policy	Ehni et al., 2020³⁴	Six propositions against ageism in the COVID-19 pandemic. ^b	Article (other category)	Based on gerontological knowledge and the ethics of aging, it offers six proposals against the ageism pervading the current reactions to the COVID-19 pandemic.	The pandemics evinced comments on older adults developing the most severe form of COVID-19 and having a greater risk of dying. During the pandemics, many attitudes are based on negative stereotypes of older adults’ health and functioning, devaluing their lives and exacerbating ageism. Considering that, the authors offer six proposals to change such behavior, which will be presented later.
PubMed, BVS	Revista Española de Geriatria y Gerontologia	Tarazona-Santabalbina et al., 2020³⁵	COVID-19, adult mayor y edadismo: errores que nunca han de volver a ocurrir [COVID-19, olderadults and ageism: mistakes that should never happen again]^b	Editorial	It discusses ageist attitudes during the pandemic and what must be done to tackle them.	Decisions made during this health emergency do not justify the devaluation of older people. Geriatrics and gerontology professionals must join efforts to disclose more information and terminate ageism. Older adults must also have access to tests and specialized health teams to avoid such mistakes in the future.
PubMed	British Journal of Anaesthesia	Savulescu et al., 2020³⁶	Equality or utility? Ethics and law of rationing ventilators^b	Editorial	It explains the ethical terms egalitarianism and utilitarianism and how they apply to decisions regarding the allocation of intensive care and mechanical ventilation and the lives to be saved in the pandemic scenario.	Decisions regarding mechanical ventilation should be made by the health team together with the patient and grounded on aspects other than simply age or disability – as this could be jaundiced. Recognizing that people should not be arbitrarily discriminated, the authors suggest using “preventive utilitarianism” to ensure equality, so that the largest number of people would benefit from the greatest good in an equal manner.
PubMed	Journal of Aging & Social Policy	Previtali et al., 2020³⁷	Not only virus spread: The diffusion of ageism during the outbreak of COVID-19. ^b	Article	It addresses ageism diffusion during the COVID-19 pandemic.	Ageism has harmful effects on society and its incidence has increased during the pandemic. Although COVID-19 affects all age groups, older populations have been highlighted by the media. Several social media comments reinforce ageism and, contrary to what has been disclosed, older adults are highly active in society and extremely affected by social isolating measures. Ageist practices during the pandemics reinforce stereotypes and violate human rights, demanding a collective effort to end this.
PubMed	European Cardiology Review	Martínez-Sellés et al., 2020³⁸	Ethical issues in decision-making regarding the elderly affected by coronavirus disease 2019: an expert opinion^b	Opinion article	It expatiates on decisions regarding the older population during the COVID-19 pandemic.	Older adults should be prioritized in preventive measures against coronavirus given they are at higher risk of contamination. Yet, decisions should not be grounded solely on age, but rather consider those more likely to survive. Social isolation incur physical and psychological risks to older adults, not only within their household, but also in hospitals, institutions, and even at wakes.
PubMed	Journal of Aging & Social Policy	Reynolds, 2020³⁹	The COVID-19 pandemic exposes limited understanding of ageism^b	Article	It addresses the lack of knowledge on ageism and its impacts on the ageing process.	With the COVID-19, the lack of knowledge regarding ageism was very evident. An important example of ageism dimensions and constructions in the context of COVID-19 was the case of the Lieutenant Governor of Texas, who said he would give up his own life to save his grandchildren’s generation. Health professionals and caregivers also state unintentional ageist comments. We must implement this biopsychosocial concept within different spheres.
BVS	Cogitare Enfermagem	Hammerschmidt, et al., 2020⁴⁰	Saúde do idoso em tempos de pandemia COVID-19 ^b	Free communication	It addresses, in a reflexive and critical manner, aspects related to older adults’ health in pandemic times.	The pandemic bloomed ageism. Measures aiming to protect older adults during the pandemics reinforced age-based stereotypes. This situation may have negative impacts on family relationships and promote intergenerational conflicts. Despite highlighting the importance of healthcare for older adults, the COVID-19 pandemic also reinforced ageist behaviors, mockery, and judgments. Physical distancing actions should maintain the autonomy and independence of older people.
Web of Science	Journal of Loss and Trauma	Rahman, et al., 2020⁴¹	Defining a ‘risk group’ and ageism in the era of COVID-19^b	Article	It deals with the COVID-19 cumulative incidence, addressing the classification of the group at greater risk, which is not only questionable, but also problematic.	Labeling older adults as a risk group relying entirely on age is a form of ageism that may accelerate social isolation and increase levels of psychosocial pain. Besides age, social, cultural, and contextual factors must be taken into account for formulating these groups. Social media platforms should be used positively to spread facts and avoid panic. The heterogeneity inherent to the aging process must be recognized, and positive attitudes toward older adults must start within our homes and enter digital media.
Web of Science	International Journal of Mental Health and Addiction	Flett, et al., 2020⁴²	Aging and feeling valued versus expendable during the COVID-19 pandemic and beyond: a review and commentary of why mattering is fundamental to the health and well-being of older adults^a	Review and comment	It assesses the protective role of feelings considered important for older people in typical and atypical times, such as the COVID-19 pandemic.	The authors present the concept of “mattering” and its particularities in the older population. All people want to feel important and valued, and this fact is even more pronounced among older adults during the pandemic. Many older adults may feel more vulnerable and helpless as a result of government recommendations and the comments made. Social isolation likewise causes further hazards to the health of this population. Considering that, biased comments on aging should be avoided and measures should be developed to preserve the physical and mental health of older people.

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[1] Correspondence: Marcela Fernandes Silva Rua Tessália Vieira de Camargo, 126 - Cidade Universitária 13083-887 Campinas, SP, Brasil E-mail: marcela.fs91@gmail.com