Recovering from the COVID-19 Pandemic: A Focus on Older Adults

ABSTRACT

As we look toward recovery from the COVID-19 pandemic, we overview challenges to be minimized, including economic setbacks, health and well-being effects, and highlighted ageism, racism, and classism. We articulate opportunities to be seized, including increased comfort with technology and online platforms; stronger family and intergenerational connections, renewed energy to combat social isolation; more respect for self-care and time management; increased awareness about the importance of advance directives; and, potentially, increased interest across disciplines to work on issues of aging society. Ongoing efforts to improve policies and programs for longer, healthier lives might now be more productive, as we communicate to consumers, public officials, and everyday citizens who may be more aware of what isn’t working, what is at stake, and what might be improved.

KEYWORDS:

• Coronavirus
• pandemic
• recovery
• ageism
• COVID-19

Although it is not clear what our lives will look like over the next few months, we can anticipate what challenges and opportunities are emerging as a result of this pandemic. If we articulate these challenges and opportunities, we might move more quickly to minimize the negative outcomes of the spread of COVID-19 and maximize positive changes that might be possible. In that spirit, we identify and discuss challenges and opportunities arising from the COVID-19 pandemic with hopes that all of us – researchers, educators, practitioners, advocates, providers, government bureaucrats, and elected officials – will redouble our engagement in research, advocacy, policy, and program development to improve our aging society in ways that benefit people across the life course.

Challenges to be mitigated

A series of challenges have arisen in the wake of the COVID-19 pandemic, including economic setbacks and adverse health and well-being effects. At the same time, the COVID-19 pandemic has placed a spotlight on the deleterious effects of deep-seated ageism, sexism, and racism on older Americans.

Economic setbacks

Older adults will have a harder time reentering the workforce

People of all ages are currently affected by the record-breaking unemployment rates brought on by COVID-19-related business closures. Unemployment rates are projected to reach a high of 32.1% by the end of the second quarter, according to the St. Louis Federal Reserve Bank, with about 50 million Americans being unemployed. This is higher than the unemployment rate during the Great Depression (Faria-e-Castro, 2020). When the unemployment situation stabilizes, we expect to see what we have seen in the past: that although younger workers might fare worse with initial job loss, older workers will fare worse in reentering the workforce. In fact, after the recession in 2008, adults age 62 years and older were the least likely age group to become reemployed once they lost their jobs; and they were also more likely to retire earlier than planned and quit their job search within 9 months of becoming unemployed (Johnson & Butrica, 2012). Age discrimination plays a role here because in the face of large numbers of job applicants, employers can apply more arbitrary selection criteria when making hiring decisions and may be more influenced by negative age stereotypes (Neumark & Button, 2014).

Older adults have lost retirement savings

The effects of income loss and financial market declines on retirement savings are yet unknown, but it is clear at this moment that retirement savings accounts have taken a hit (Singletary, 2020). Older workers may be reconsidering when they will retire, and some people in retirement may feel the need to reenter the workforce. Before the pandemic, the trends toward later retirement, transitional work, and encore careers were underway, and people were working longer – both because they wanted to and because they needed to. But now, more of us will “need to” to make up for lost income and savings. Efforts to modify workplace environments, policies, and practices to support longer working lives will be more important than ever.

Just as older workers may need to work longer, organizations may need to cut budgets to survive and regain financial footing in the recovery period. Older workers have been and will continue to be at risk for age discrimination in the workplace. Older workers experience bias in training and advancement opportunities; and given higher salaries and health insurance costs, they often experience pressure to retire early (Olson, 2017). Thus, workplace solutions must address the age discrimination that puts older workers at higher risk of depression, health declines, and job dissatisfaction (Marchiondo et al., 2019).

Health and wellbeing effects

Older adults have experienced disruption in usual services

During this crisis, shelter-in-place orders and the closing of organizations have prevented many people from having their preexisting physical, emotional, and social needs met through aging network services and the health-care system. Many of the agencies that “serve vulnerable seniors are scrambling to adjust and minimize potential damage” (Graham, 2020). For example, Area Agencies on Aging and home-delivered meals programs are working to fill the gaps created when senior centers and congregate meal programs shuttered. At the same time, volunteer drivers, many of whom are older adults, cannot fulfill their assignments because they are self-isolating. These changes to nutrition programs can cause older adults with a limited budget to rely on processed foods, making it difficult to achieve adequate nutrition. Alterations in diet can lead to complications with underlying health conditions (Goger, 2020). As another example, home care agencies are struggling to retain clients and workers because both groups are opting out of routine care arrangements in fear of contracting the virus. This lack of attention to personal care, medication management, and nutrition will lead to deterioration of health and the need for more supportive services in the long term (Kwiatkowski & Nadolny, 2020).

At the same time, support services are jeopardized, the health-care system has narrowed its focus to managing COVID-19 cases, meaning other health-care appointments and procedures are being delayed. Regular checkups, non-urgent provider visits, and elective procedures are being canceled, putting older patients at higher risk of worsening health deterioration (Graham, 2020). Compounding this situation are concerns that when medical care is more readily available, there will be backlogs of needed surgeries, screenings, checkups, and appointments, further straining the system and delaying routine care.

Older adults may have lasting emotional effects from increased isolation and anxiety

Social isolation and loneliness have been linked to negative physical and mental health outcomes, such as increased depression and anxiety symptoms (National Academies of Sciences, Engineering and Medicine, 2020) and increased risk of hypertension, cardiovascular disease, obesity, cognitive decline, and death (National Institute on Aging, 2019). Even before this period of sustained social distancing, social isolation was disproportionately affecting older adults because of diminished social networks, living arrangements, and transportation limitations (National Academies of Sciences, Engineering and Medicine, 2020). During this pandemic, older adults have received stricter directives on social distancing, as they were one of the first groups encouraged to stay home. Older adults who have experienced a prolonged period of isolation may encounter health effects that long outlast their time in quarantine. The impact of this period of isolation on future physical and emotional well-being of older adults is yet to be determined.

Older adults who have contracted the coronavirus may have increased health vulnerabilities

Currently, data indicate that most people who contract COVID-19 will see a full recovery, but the long-term effects of the illness are not fully understood, particularly for patients who need more intensive care (Schumaker, 2020). It is probable that these ongoing complications will disproportionately affect older people who have been sicker and more likely to die from virus-related complications. People who require the use of ventilators are more likely to experience damage to the lungs or a longer recovery period – and not all will return to full functionality. Additionally, researchers are concerned that COVID-19 may be associated with cardiac injury, as preliminary data indicate that COVID-19 may cause heart damage in patients with and without previous heart problems (Shi, 2020).

Ageism, racism, and classism

Older adults may experience stronger internal and external ageism

The crisis has revealed engrained ageism and age-stereotyping in this society. Attitudes and actions in response to this pandemic have been attributed to reduced concern about and value attributed to older people: countries were slow to respond because ONLY old people were at risk; treatment and mitigation protocols have been more adequately developed for children and youth in certain hospitals; and saving the economy may be more important than saving these older lives. We have heard an old phrase “thinning the herd” and the new phrase “#boomerremover.” Fears of the need to ration resources in hospitals led the Office for Civil Rights to issue a statement to prevent lifesaving medical care from being administered on the basis of age (Fink, 2020).

There has been an outcry by aging advocates about this ageism and concerns that we will experience setbacks in efforts to confront the image of old age as a state of frailty, vulnerability, and less value. Dr. Louise Aronson also points out internalized ageism may be strengthened because some older adults themselves have resisted identifying as at-risk because it means they are acknowledging the reality of their age (Aronson, 2020). We will have to regain any hard-won advances in reducing the external and internal ageism exacerbated in this pandemic.

Older adults of color and those with lower socioeconomic status are at increased risk for physical and economic challenges caused by COVID-19

As we enumerate these challenges, we are aware of not only the ageism, but also the racism and classism that is highlighted by this pandemic. Older African-Americans, with higher rates of morbidity and less access to health care going into this crisis, are dying at higher rates when they contract the illness (Evelyn, 2020). Less well-educated older workers are less likely to be able to work from home and their paycheck may depend on them being in service jobs with increased exposure to the virus (Goldbaum, 2020). Low-income older adults have less access to computers and online technologies that have eased the burden of isolation for so many people (Choi, 2013). Intergenerational living arrangements undertaken for economic survival might present solutions for childcare during this period of homeschooling, yet grandparents do not have options to social distance and self-care in these circumstances.

Opportunities to be seized

Despite challenges stemming from the COVID-19 pandemic, opportunities for improving the lives of older adults may arise from this crisis. These opportunities pertain to increased connectivity through technology, family, and intergenerational relationships and to improved quality of life by reducing social isolation, increasing self-care and management, and improving awareness of advanced directives and other legal documents. Finally, there may be opportunities to address the shortage of professionals specializing in the field of aging.

Increased connectivity

Older adults have improved their technology skills and gained experience using online platforms

Before this pandemic, there was a steady growth in the number of tech-savvy older people. It was documented that 75% of people over 65 years of age go online every day; between 2013–2017, smartphone ownership increased by 24% in adults over 65 (Nash, 2019). Motivation and opportunities to learn were growing and then social distancing and sheltering in place created a “sink or swim” moment for many reluctant or unskilled users. Research has shown that older adults are eager to learn technology skills and are particularly motivated to use these skills when they see a need for it (Boulton-Lewis, 2006). We saw the need: video-conferencing to carry on our work, ordering groceries, taking exercise classes online, and talking to family members and health-care providers. This has been an opportunity for older adults to get more comfortable using technology and for community and health-care providers to offer remote programming. We are in a better position for programs and people alike to connect online even after social distancing measures are lifted (Finn, 2020).

Familial and intergenerational connections have grown stronger

Many families are finding that the pandemic has encouraged them to more regularly communicate. In the absence of regular family dinners and celebrations, we are missing these interactions and appreciating their importance. There are numerous stories of family and neighbors connecting. For example, The New York Times recently published a story about a grandmother speaking with her grandson more and two grandparents recording their voices reading bedtime stories to their young grandchildren (Conger, 2020). Although there is a concern that younger adults may harbor resentment to older adults whose vulnerability led to social distancing, sheltering in place, and economic decline, it is common to see younger people creating opportunities to help older adults in need of ongoing social contact or grocery shopping. Numerous intergenerational programs have emerged, like Students to Seniors, a program where students and older adults engage in virtual conversations, or Zoomers to Boomers, an intergenerational grocery delivery service.

Improved quality of life

There may be renewed energy to combat social isolation

We entered this pandemic with respect to the negative effects of social isolation and with the emergence of programs to increase social connections (National Academies of Sciences, 2020). The coronavirus pandemic has increased momentum in this arena. Numerous news and resource sites focus on the risks and consequences of social disconnection and present strategies for combatting isolation. The coronavirus has shed light on this longstanding concern with a new sense of urgency, and there seems to be a sincere investment in decreasing isolation and loneliness moving forward.

Older adults are gaining more respect for self-care and time management

The outbreak may be changing how we think and act toward our own physical and mental health. Multiple sources are calling attention to the importance of schedules, sleep, diet, exercise, and social connection, and self-care skills are surfacing as truly important on a daily basis. Further, we are learning firsthand about what gives us meaning and purposeful engagement. Separated from jobs, professional connections, volunteer and grandparent roles, and routine social gathering, we are learning how to use time; according to Joe Coughlin, this is a “fire drill,” a trial run for how we might spend our time in retirement (Coughlin, 2020).

There is increased awareness about the importance of advance directives and other legal documents

Despite pleas from legal and health-care professionals, we entered this pandemic with only about half of Americans having had end of life conversations with loved ones, and only 27% with formal documentation (Hamel, 2017; Newcomb, 2020). In March, the requests for a common advance planning tool called “Five Wishes” saw a tenfold increase (Aleccia, 2020). In addition, there are a number of general and COVID-19 specific end-of-life planning resources that were developed and can be accessed for free through sites like Respecting Choices and The Conversation Project. Many people now have a better understanding of the importance of clearly communicating preferences and decisions and are taking steps to start this process. We can find ways to sustain this movement.

Expanded workforce specializing in aging

There may be an upswing in interest among professionals across disciplines to work with older adults and issues of public health

COVID-19 has highlighted both the resiliency of the older adult population and the challenge to ensure that this large and diverse population can access the resources, information, and services they need. We may have the opportunity to address the long-standing problem that not enough people are coming into professions that serve older adults and address issues of an aging society (Foley, 2018). Because of the range of career options and capacity to make an impact, students and professionals across multiple disciplines (physicians, nurses, psychologists, social workers, health administrators, public health professionals, nonprofit managers, etc.) may express more interest in working on issues of an aging society.

Conclusion

The challenges we are facing can be expected, and in fact, none of them are new. Our state and regional agencies on aging, private and nonprofit agencies, advocacy organizations, and universities have been grappling with these issues in one form or another for years. But now, it seems our efforts to improve policies and programs for longer, healthier lives might be more productive, as we communicate to consumers, public officials, and everyday citizens who may be more aware of what isn’t working, what is at stake, and what might be improved. Further, we can hope that the spotlight thrown on the inequalities experienced by disadvantaged people during this crisis will bring a stronger commitment to working toward social justice and health equity.

Key points

• We must minimize negative outcomes of COVID-19 and maximize positive changes that might be possible.

• Older adults have lost retirement savings and reentering the job market will be difficult.

• Physical and mental health may be compromised even after the pandemic is over.

• This crisis has spotlighted engrained ageism, racism, and classism.

• Positive changes can come from increased levels of technology use, self-care, and time management.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.