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Exposure of latent ageism in virus response highlights need to reform care systems for older people - Irish Independent Feature

Original article posted by The Irish Independent, article by Rose Anne Kenny and Pearse Traynor. Link to article is here

In January 2020, health officials from the Chinese Centre for Disease Control published a large study on COVID- 19 cases. This study confirmed that age was the greatest risk factor for severe complications from the virus.

We already knew that older people have poorer immune systems, so this was hardly a surprise. At the time of the publication, COVID-19 was in its infancy in Europe, the US and Canada. Despite this compelling information from the Chinese study coupled, with the self -evident correlation between age, frailty and severe COVID complications, plans to cater for older people fell far behind those implemented in the acute hospital sector.

Detailed planning for hospitals began in January so they could cope with the escalation of the pandemic. Elective hospital attendances and surgeries were cancelled. This increased bed capacity and nursing capacity.

This contrasts starkly with the nursing home sector. At the end of March, almost 3 months after the Chinese publication, soldiers entered a residential home in Madrid, so it could be disinfected.To their dismay, they found a number of residents who had been abandoned and others who were dead. Some of these residents had been in the care facility for over six years. This was their home.In Montréal, in late April, authorities entered a residential home to find residents left soiled and malnourished, after caregivers fled the premises following 31 deaths in a few weeks.

In Ireland, Spain and Italy deaths in residential homes account for 54%, 57% and 53% respectively.

As late as April 29th, there was no official record of COVID deaths in the US nursing home sector. In the United Kingdom, we still don’t know how many have died. In France, former Minister for women, Monique Pelletier, criticized the ‘incomprehensible and inhumane’ manner in which residents in nursing homes are being treated.

So, what happened to the nursing home sector worldwide that led to such high death rates from COVID-19?

First, most homes are under private ownership with no overarching clinical governance. Second, the physical infrastructure in some the nursing homes did not lend itself to sufficient infection control. Third, the a rapid increase in the number of sick patients put pressure on an already insufficient workforce.

That was compounded when staff themselves became ill. Four, contract cleaning staff and agency nurses, moved between nursing homes, facilitating the rapid spread of infection. Finally, all around the world, nursing homes couldn’t get access to enough PPE, which often was sent to hospitals.

In Ireland, there has been significant focus on the banning of visitors and if this was done too late. The ‘lockdown’, residents confined to their rooms and all visitors banned, including spouses, siblings, partners. This meant residents’ only contact with the outside world was through methods often alien to them. Skype and FaceTime might be second nature to us, but not necessarily to patients in a nursing home.

To make matters worse, this virtual communication was being facilitated by overworked nursing staff. The ‘lockdown’ has caused guilt, anguish, fear, frustration and worry for relatives and friends.

Patients enter nursing homes for many reasons but most often because their nursing needs means they cannot be cared for at home. But living there has two aspects – there is the nursing part and the home part. Too often we focus on nursing and forget that we’re supposed to make the environment as close as possible to a home. This becomes an almost insurmountable task in the face of a nationally understaffed, undervalued and poorly paid sector. Banning all visitors did not take this into account for the 25,000 people who live there.

However, there is a deeper issue at play here: ageism.

Ageism is the most prevalent type of ‘ism’ in society. Ageism impacts all aspects of our lives, including cultural and institutional aspects which determine policies and legislation. Examples of this are the definition of ‘premature death’ as occurring before aged 70, ‘dependency ratios’ which use 60 years of age as a cut off for dependency and a mandatory age of retirement. Ageism is particularly prevalent in health care systems. Respiratory illnesses, such as COVID-19, are constant reminders of ageism within the health care sector.

As a professor of medical gerontology, I am regularly asked whether there is evidence that the ageist response to the nursing home sector during COVID-19 was intentional. I am loathe to say so, and to my knowledge there is no evidence of this. Systems were overwhelmed by the pandemic and other areas were deemed at higher risk than the nursing home sector. But perhaps there may have been a latent ageist attitude.

We will all grow old. We have, as a society, and as individuals, internalised ageist perceptions. We must act now to ensure that everything recounted above does not become our reality.People who perceive themselves as old or have negative perceptions of ageing, on average, die seven years earlier than individuals who have a positive attitude towards ageing. Creating positive attitudes towards ageing will extend your life and all our lives.

An EU Commission report published at the end of 2019, entitled ‘Transforming the Future of Ageing in Europe’, which I co-chaired, details what must be done to deliver ‘ageing in place’. We know what to do. We need to start doing it.

With COVID exposing the flaws in the nursing home sector, we can no longer ignore the problems. It’s time to act. Recently, on the Late Late show, the Taoiseach, Leo Varadkar, committed to a review of all care systems for older citizens. This is a welcome statement. There is good evidence that ‘ageing in place’, where people stay in their own homes or place of choice, is a better option than institutionalisation.

Let us cast out the old attitudes and redundant policies and implement a new, intelligent, kinder evidence- based model, fit for purpose for current and future generations.