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Tanzina Vega: I wanted to talk to you about ageism in the era of COVID-19 specifically. According to a new report from the World Health Organization, one in two people globally hold ageist views. Those are stereotypes of older and younger people based on their age and they have long-term social health and economic consequences, but there's some generations that get left out of conversations about age-ism.

One of them is my own generation X or dare I call us the middle-aged. In 2019 we here at The Takeaway, checked in with folks in their40s to see how they were managing the stresses of being a so-called sandwich generation. In some cases, caring for their own children while also caring for their elderly family members.

If the mid-life juggle was real before the pandemic, I checked in on Twitter this week to see how my fellow middle-aged years have been holding up during the pandemic. Some of them said the pandemic had added to the stresses of mid-life while others said the pandemic had allowed them to find strength in community with others, but ageism isn't limited to those in their 40s. Here's what you had to say about some of your own experiences.

Speaker 1: I've recently turned 60 and relocated to a suburb outside the Tampa, Florida area. I have experienced tremendous ageism for the first time in my life. It has been very difficult for me to find work even though jobs are plentiful. I recently eliminated any information about my age on my resume which actually got me a call. At one job interview after looking at the license and seeing my age, I was asked if I could actually walk up the stairs.

Speaker 2: Yes, age is a stigma, both before and after the pandemic, someone on Facebook didn't like my comment. Looked at my page and retorted with, "First time on Facebook, grandad," being disrespected is the impact. Currently, I'm working on the new nuclear putdown.

Speaker 3: When I look back, I realized that I had never met the interviewer or my boss in-person before I was offered the job and started. I wonder how many of them were surprised when I showed up. I'm 66 now I still need to find a job because I can't afford to retire.

Speaker 4: Now people are saying, "Well, let's get the older people out of the job market. People should retire so that the younger people can work," but why shouldn't we have jobs? We have to live too.

Speaker 5: Once upon a time, I was a showstopper, a major babe, tall blonde, lovely young. Everywhere I went people-- Or mostly men noticed me how I moved, what I said, what I needed, what I wanted. Then I grew old. I grew invisible. Overnight I disappeared. No one answers when I ask a question. I enter a room, no one sees me. I don't mind. Now I don't mind, but I'm going to tell you. I did once a whole yes, I did mind when it first happened. It comes as a shock. You wake up one day and you're invisible and the transition takes a little adjusting, but now I'm 72 years old and I've had plenty of time to get used to it. I think I've got a handle on this whole invisible thing. Think about this.

If you're a woman and you have your own savings account, checking account, if you receive the same wage as men for doing the same work that those men do, if you were able to fill a birth control prescription without some man telling you it's okay, if you're able to play hockey, basketball, or soccer without getting permission, if you're employed as a lawyer or a clergywoman, a plumber, or an iron ore miner and you can't imagine ever being denied the right to do any of those things. If you can do any of that, you should be thanking an old invisible woman, but when you do so, and I hope you do, don't make a big deal out of it. Don't draw attention to yourself when you do it, please we're invisible and we like it that way.

Tanzina: I hear so many of you callers and I can identify with a lot of what you're saying. Thanks to everyone who left a message. Remember you can always share your thoughts with us by recording a voice memo and emailing it to us at takeawaycallers@gmail.com and though ageism has existed long before the COVID-19 pandemic, sad to say, the past year has exposed just how serious and widespread the impact of ageism can be on everything from physical and mental health of older people to the economy at large. I'm joined now by Dr. Sharon Inouye, professor of medicine at Harvard Medical School and director of the Aging Brain Center at Hebrew SeniorLife. Dr. Inouye thanks for joining us.

Dr. Sharon Inouye: Hello, Tanzina, delighted to be here.

Tanzina: Also, with us as Dr. Louise Aronson, professor of geriatrics at the University of California San Francisco and author of Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life. Dr. Aronson, welcome to the show.

Dr. Louise Aronson: Great to be here. Thank you.

Tanzina: Dr. Aronson, may I start by calling you Louise and asking you about a new report from the world health organization that sounded the alarm about ageism as a human right, and a public health issue. Was there anything that stood out to you? To me, what stood out was that one in two people have ageist views.

Dr. Aronson: I think actually what stood out to me was that, that low.

Tanzina: Wow. Okay.

Dr. Aronson: Yes. Ageism is so ubiquitous. It's so baked into all of us, even those of us who do anti-ageism work who work with older people that I actually found that to be a low number. It is also one of the biggest, perhaps at this point, especially with LGBTQ rights of the last few decades, the biggest internalized ism. We have all sorts of movements about, "We're here, we're Black is beautiful, fat rights."

There's so many different groups that have said, "Look, we have a right we're fully human." The age movement, despite the gray Panthers in the '60s and many other movements since then is not quite there and we see ageism in people of all ages, somewhat about the young, but more commonly about the old.

Tanzina: Sharon. I was going to ask you a similar question to help us define ageism because sometimes when I talk about it on social media, there will be people, as we heard our callers earlier, people who are 40, 50, and older, who are really talking about things like age discrimination at work, et cetera, but then there are people who are under 30, who say they experienced ageism, how do we define it?

Dr. Inouye: Sure. The Oxford English dictionary actually defines it as prejudice or discrimination on the basis of age. That can occur at all ages and young people definitely experience ageism getting excluded from the opportunity to apply for jobs or to do advocacy based on their age, but I wanted to call out how the WHO in there I report defined ageism because I really loved it and they talked about stereotypes, how we think, prejudice, how we feel, and discrimination, how we act towards others or towards ourself based on age.

I think Dr. Aronson mentioned that self-stereotypes are how we feel about ourselves as we age, I think is also a huge problem thinking that we're not valued and the pandemic has really shown a light on blatant ageism and negative attitudes that were openly expressed that older adults are expendable.

Tanzina: I was going to say, while there are instances of ageism among younger people. I think where we really start to see some of these more pernicious outcomes is among older people, as we heard at the top of the show. Louise, let's talk a little bit about how the pandemic may have-- We know it's exacerbated so many things in this country and across the world, in terms of economics, in of social issues, how has the pandemic exacerbated ageism, especially here in this country?

Dr. Aronson: Such a good question. I actually give an hour-long talk on this with some regularity.

Tanzina: I'm going to listen to that at some point because I'm fascinated by the topic.

Dr. Aronson: Yes, it's absolutely fascinating. It actually hues to the three elements of ageism, when the term was coined by Dr. Inouye and my predecessors Dr. Bob Butler in 1969, he talked about prejudicial attitudes towards older people, old age and aging, discriminatory practices, and institutional practices and policies that perpetuate stereotypes and we've seen all of these. One example is that when I give talks and it doesn't matter whether I'm speaking to young people, old people or somebody, people in between are a mixed audience, I say, "What percentage of American older adults live in nursing homes?" I will get answers that can range from 40% to 80%.

The truth is it's 1%. One of the distortions has been talking about the slaughter in nursing homes as if that's all old people. It's ironic because people can simultaneously, and this is how insidious ageism is, think all old people live in nursing homes and look at Nancy Pelosi, age 80 up until Kamala Harris's election as vice president, the most powerful woman in America now, still the second most powerful, take a look at Joe Biden-

Tanzina: Who is in her, 50s, right? Kamala Harris.

Dr. Aronson: Yes, she's in her 50s so depending on when ageism starts, I will say I've noticed in the bathrooms of our institution when one used to be there, that there are all kinds of studies and once you're over 50, you seem to have aged out of anybody's interest.

Tanzina: I'll note that for the upcoming few years that I have loved in my 40s. Yes, thank you.

Dr. Aronson: I'm like, "Wait, you're no longer care about me." There's been that, but there's also-- We saw the episodes of clotting in children, and of course, that matters, but it's quite rare, by contrast, we had evidence from Italy and China as early as a year ago, February and we have abundant published evidence for different presentations of COVID in older adults, including a different threshold for fever and the CDC, state health departments and local health departments have not adopted that although they put on their websites, they have huge sections about children.

The risk for an older adult with those presentations is 7,900 times that of a child between the ages of five and 17. The risk is so much higher, but they have these built-out websites about kids and adults. They have almost nothing about older people. It really is everywhere you look and that sends insidious messages that old people don't matter.

Tanzina: Sharon, how does race, class, gender, culture, how do all of these variables factor into the experience of aging in the United States?

Dr. Inouye: Tanzina, that's a really great question. There's really no question that age-ism definitely intersects with and exacerbates other forms of disadvantage, including those related to sex and race and social-economic status and disability. There's been a number of studies that have shown older women, especially women of color, experience more discrimination and more adverse health impacts than other groups and also disabled adults have suffered tremendously during the pandemic and older adults are also more likely to be disabled. Another example of that type of double blow that can be encountered due to the intersection of these groups.

Tanzina: Louise, as I'm thinking about the most recent part, if you will, of this pandemic, everybody is talking about getting vaccine appointments and one of the things that upset me personally at the very beginning when vaccines began to be distributed was just how difficult it was for people who didn't have a technical facility. Again, I don't want to assume that older people don't have facility with smartphones and technology, but some older people just didn't have access to it.

Some of them, it was a very confusing roll-out, especially here in New York, there were multiple websites, you needed multiple hours of the day to do that and it felt deeply unfair to particularly older people who may not have had the time or the experience needed to set those up. Is that an example of ageism, if you will? Is that a way that we, particularly during the pandemic did not really think hard enough about our most vulnerable?

Dr. Aronson: I think so, we have a digital economy and you're just right. A majority of older people use devices. Do they use them a bit differently? Yes, they are by definition not digital natives, and anybody who says, "Oh, that makes your average 90-year-old lame," I feel sorry because they are creating a future in which when they are 90, whatever the next thing is, they're going to be considered a lesser human. We all tend to do this with jokes about music, et cetera. There are also all kinds of overlapping prejudices. People who are lower-income and lower-income people are more likely to be people of color, are less likely to have broadband access, for example, rural populations, less likely the oldest old.

Now, one of the great things about the pandemic has been how many older people who thought, "Oh, maybe that ship sailed without me I'm not going to do it," have gotten on Zoom and done that for exercise classes and socialization, but when you have a one-size-fits-all approach to vaccination, you inevitably leave out people and you generally leave out the most marginalized. There was a great study by Mary Bassett from Harvard in October of last year looking at mortality differences in people aged 75 to 84. Blacks were 800 times more likely to die of COVID than whites and Latinx populations, 500 times more likely.

When we talk about the pandemic as affecting people based on age or race, we actually forget the intersectionality that is actually what makes us uniquely human. I think a single roll-out is really problematic. We've also seen in my state of California, it sounds like in New York as well that the government made a one approach strictly digital, pretty complex according to most people and allowed and forced counties to do all the same work in each location about figuring out how to deal with populations who are universal of people without access.

This includes some of the higher-risk people like farmworkers. It's not just the older people. When you do a disservice to one disadvantaged population, you tend to harm lots and lots of others. I heard about a friend at a place last week in Napa County, which has lots of farmworkers, farmworkers didn't show up, and instead of outreach to them probably in Spanish, they sent out a digital call and lots of young, healthy white people showed up.

Then when there was a line, many blocks long, instead of pulling people out by zip code and age, which would enable you to pick the people most deserving and everybody needed to show an ID, which would have given that information, they just did first come first served, and that just goes counter to everything we know would be useful and yet the counties probably weren't given that guidance.

Tanzina: To that point, Louise what's interesting is as people begin to get vaccinated the elderly were prioritized in many places. There've been reports about how older people are starting to travel again, older people can hug their grandchildren, the elderly brigade it can come to save many of us who are still waiting for vaccines and other things.

I think it's a fascinating moment to watch and as you said, people going on Zoom and really attempting to adapt to this moment. I would love to close by hearing Sharon, any thoughts that you have on what we need to do as a society to get past this idea that anyone over a certain age is just irrelevant.

Dr. Inouye: Yes, definitely Tanzina. I think we need to focus to improve our health care systems as a major thing that was uncovered during the pandemic and making systems that are age-friendly and there's a big movement of age-friendly hospitals sponsored by the Institute for Healthcare Improvement that I think would take us a big step in that direction. I think involving geriatricians and people with expertise in aging in helping to find the solutions is really important.

At a policy level, I think it's so important to be aware and to include aging on the agenda. Biden's COVID health equity task force does not include an aging expert. There's 12 members and there's really diverse representation of a lot of racial and ethnic groups, of children, of indigenous tribes, of disabled LGBTQ, et cetera, but there is no aging expert on it. Also, it links with six additional federal agencies, but again, none of them tasked directly with aging.

I think that's a really glaring omission and I'm hoping that something can be done about that. Also, I want to make sure the CDC really includes aspects pertaining to aging on its website. It does not include a typical presentations of COVID, which are extremely common in older adults, as Louise already mentioned, things like delirium should be on that list.

Tanzina: What's something that we should be doing in our personal lives so that we can combat ageism? It feels baked into our culture as people who live in the United States.

Dr. Aronson: Right. I've actually started working on this explicitly with patients because there is fairly good data that internalized ageism harms your health. I was hoping we'd get to this, but I think we're also pandemic-focused. Sharon and I were just texting, if we had a few hours or days, we could really do this justice.

Tanzina: I want to do this topic a lot. We will be peeling back the layers here, but for sure, tell us what your thoughts are on this.

Dr. Aronson: Great. There's pretty good evidence that internalized ageism increases all the same stress hormones that lead to accelerated aging and other settings such as incarceration, such as race-related premature aging. There are things like you will get heart disease seven and a half years earlier, you're less likely to recover well after an illness or injury. You move on with cognitive change much sooner. There's probably a two-fold mechanism for this.

Some of this is the stress hormones circulating in your body at all times. The other is a fatalism that leads people not to try and not to do the health behaviors. We see this playing out in populations that have lost agency versus those that have it in terms of choices they make. There's also, of course, access to healthy food and exercise, but it's really insidious. When I'm discussing this with people, what I'm really careful to do, and I talk about this in my book. I think I was able to write it because I entered my 50s and I was beginning to experience what you just talked about myself and realizing that having spent my career thinking about this.

I was starting to make pretty frequent ageist statements about my own aging because I'm a well-acculturated person. Forgiving ourselves for that, understanding that that is normal, and still combating it because actually, it took me a couple of years, but I've trained myself to be happy about it. I stopped dyeing my hair. There is a joy in watching yourself develop, grow, and change, and a freedom and pride and pleasure with who you are, and exploring that it makes it an adventure.

Now, admittedly, I'm a privileged person so that makes things easier. I did have a moment where I thought of changing jobs, and I thought, "Do I need to dye my hair." I think we have to deal in the real world. There's also a major contradiction in our economy where we say, old people are a drag on society and we don't want old people to work. This also flies in the face of evidence because a Harvard Business Review article some years ago, in the last decade, I believe, looked at all the different ways you could have diverse work teams, and an age-diverse work team led to the most productive teams.

I think it's for the same reasons people get dissed, the immature too quick to act young person. The old person who has certain insights into things, but might take a little longer to learn the new technology. We have strengths and weaknesses that are based on age, but also, and this is equally important based on our generational experiences because history keeps moving forward. We literally bring different things to the table.

My last point on that because I'm taking a lot of air here this is Sharon and I are both crazy passionate, social pointing to the same thing, is that when we set the retirement age 65, the average age of death in America was 67. Now if you make it to your 60s, chances are you're going to your 80s or 90s. We have these extra decades. I'm not saying I would want to work the 70, 80 hour weeks I'm working currently when I get to that stage. I already feel more tired I'm 57.

Do I want to keep working? Yes, we know that people who work have a greater sense of purpose and self and are healthier. Plus retirement appears to have been an epiphenomenon in the 20th century. Wealthier people have the option of continuing to work. They love what they do, and it's important, see Pelosi, Biden, et cetera. Poor people frankly, have to survive. We cannot have a society that leads to all old people in poor houses, as has happened in most countries across history. We have developed to the point where we don't need to do that anymore.

Tanzina: We don't need to do that and yet I think there are, at least, since in the workplace, I think this plays out pretty, pretty often. Sharon, I'd love to hear your thoughts on this because I think there's a sense as you mentioned, Louise that first of all, retiring at 65 is a luxury for a lot of people because of the fact that our lives don't end at 70. Many people and because of the way American society is structured are having to work whether they want to or not, quite frankly. They have mortgages to pay, they have a wealth gap to narrow, frankly, especially if you're Black or brown in this country.

There are many things, or a woman or a single parent. I can say that at my age, as a new and single parent, I keep thinking, "My God now I'm definitely going to have to work into my 70s." There does appear to be at least institutionally from a lot of workplaces. A lot of younger employees, I would say that older folk, i.e people over 40, 45 need to just get out of the way and that's get out of the way in terms of leadership. Get out of the way in terms of taking up job space. I think that's unfortunate because it pits two generations against each other. How do we solve for that thinking, Sharon?

Dr. Inouye: Yes. Tanzina, can you hear me okay? There's a huge amount of background noise.

Tanzina: I can hear you fine. Control room can you hear Sharon okay? Okay, yes, you're fine.

Dr. Inouye: Sorry about that. I think the workplace issues are extremely important and extremely challenging. I think there was a huge amount that can be done in terms of retraining older adults or having them apply their experience and expertise in different ways. There's so much they have to contribute, as Louise mentioned. There's so much that they can contribute and I think just forcing them out is a very short-sighted and ultimately not wise decision on the part of the employers.

Tanzina: Sharon, isn't there room at-- I think the idea and I was very surprised to hear what you said about the Biden administration's COVID Task Force not having someone there who represents, the aging, and given everything that we've seen with the pandemic. Also, just isn't there a case to be made for having that type of representation? I feel like a lot of companies are saying, "Okay, well, let's bring in only young people at the top or we'll start cutting people's employment lives off at 40, 45 years old." I wish we could get to a place where we can value both younger perspectives and older perspectives at the table at the same time.

Dr. Inouye: Yes, absolutely. I totally agree with that. There's actually been economic studies done by, for instance, Harvard economist, David Bloom, who has shown that older workers have the potential to bring billions of dollars into the US economy. It's unwise to exclude them based on age for so many reasons. They actually will enhance the workplace. As Louise said, there's better productivity, there's better products developed, more efficiency if you include older workers.

I think there really has to be a change in that. I think that part of the problem is it's coming from the negative stereotypes that are just propagated everywhere about ageism. In the media you don't often see very realistic or sympathetic portraits of older adults. You too often see them portrayed as baddie or forgetful or not vital human beings.

Tanzina: God forbid, boomers.

Dr. Inouye: Boomers, exactly. The whole boomer term has become a negative term, portraying someone who's closed-minded or resistant to change. I think developing intergenerational ties and connections is so important. The more we can do that, and the more we can build that I think it will make a difference.

Tanzina: We should all have friends from multiple generations.

Dr. Aronson: Definitely.

Tanzina: Thanks to you both so much for joining us. I could talk about this topic for as long as I'm sure you guys could talk about it to me. Hopefully, we will be revisiting this in the future. It's something that I find very, very important and something that I think this country has to figure out. Dr. Sharon Inouye is a professor of medicine at Harvard Medical School, and Dr. Louise Aronson is a professor of medicine at the University of California, San Francisco. Thanks to you both for joining us about this important topic.

Dr. Inouye: Thank you.

Dr. Aronson: Thanks for covering it.

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Speaker 6: I haven't experienced ageism yet, but I'm about to be 45 years old, everybody always thinks I'm like 15 years younger. So I'm sure the years are going to start catching up to me anytime now. When that happens, the ages will probably follow. I'm expecting it to kick in pretty soon, but I've had a good run, so I have no complaints.

Michelle: Hi, my name is Michelle and I'm from New York. I feel that I see ageism every single day. As an older adult, I feel that I am invisible to advertisers unless the advertising is for me to get rid of my wrinkles, cover up my brown spots, provide for my funeral, or perhaps get a reverse mortgage. I feel that the stereotype senior is being portrayed as unattractive, that's why we need the wrinkle cream. We're not very well off. Our funeral could possibly be a burden on our family. We fall a lot, we're clumsy, hard of hearing in confidence, forgetful. We need a lot of medications. We're very unaware of all of these problems.

The message I get is that we are unattractive nuisances, someone has to take care of. To watch these ads that are directed at me, you would think I have completely different needs than everyone else. I must not shop, buy cars, go out to eat, go on any vacations because no one targets my age group for those ads. I don't know why our culture treats older adults this way. Everyone ages, we all add on the years, and even the "okay, boomer" generation will not be able to stay young forever.

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