Shai Held: The staggering, heartless cruelty toward the elderly
For example, earlier this month, the medical-center leadership announced that they had developed special clinical protocols for children and adults with COVID-19. To my knowledge, protocols for elders, the most vulnerable group, still don’t exist. This isn’t a UCSF-specific practice; it’s standard throughout the country. American medicine lumps elders in with adults, despite abundant evidence that drugs and diseases behave differently in older bodies. Additionally, health-screening procedures for visitors were put into place at our children’s hospital at the start of March, while similar procedures weren’t implemented for our adult hospital until two weeks later. You could argue that the children’s hospital is smaller and thus easier to manage; you could also surmise that protecting adults and elders was less of a priority, despite the greater risk of hospitalization and death those groups face.
Transgressions like these are minor in the face of global calamity, but we’re seeing similar decisions being made nationally. With each one, this country loses precious time to take the actions that will limit contagion and save the most lives, old and young: screening those at highest risk to limit spread; documenting the predictably different early symptoms in older people; and creating care pathways that offer options to patients for whom aggressive medical treatment would only prolong suffering and not prevent death.
Let me be perfectly clear: I’m not witnessing the actions of malicious, underperforming people. On the contrary, UCSF leadership has been heroic and selfless, working around the clock to provide the best care possible to those with COVID-19 while protecting other patients and staff. Ironically—no, tragically—that noble intent reveals just how entrenched and pervasive ageism is in American health care. It’s baked into how the field approaches education, research, and the most fundamental procedures, structures, and policies.
Medical schools devote months to teaching students about child physiology and disease, and years to adults, but just weeks to elders; geriatrics doesn’t even appear on the menu of required training. The National Institutes of Health mandated the inclusion of women and people of color in medical research in 1986, but it didn’t issue a similar mandate for elders until 33 years later, in 2019. “The bias is so implicit, it goes unnoticed,” one of my colleagues said of ageism in the American COVID-19 response and in medicine generally. But when you start to pay attention, you see it everywhere.
Read: How the pandemic will end
Take for example, the way my state tracks deaths from the flu, one of the most common and deadly infections. Even though older people are far more likely to die from it, until 2018, the California Department of Public Health counted flu deaths only for children and adults under 65. The main explanation given to the San Francisco Chronicle was that recording the far higher number of elder deaths would be too expensive and time-consuming. The problem is that when the impact of disease in a population is unknown, there’s little incentive to develop treatments tailored to that group’s needs. When the affected population is elders, the problem is especially bad: As we’ve already seen with the current crisis, many people say that elders are dying anyway and tend to blame old age itself for their deaths—not a flawed system.