Publications
Isolating Older People Is Not the Solution
2020
Ruth Finkelstein
In an interview with Chris Farrell for Next Avenue (published in Forbes July 3), Brookdale executive director Ruth Finkelstein rejected recent proposals to institute “targeted lockdowns” of older people, based on COVID-19 fatality rates, to allow others to restart the economy. Such plans are immoral and they will not work, she said, either to get the economy vibrant again or to contain the virus. They are also bad for the health and well-being of older adults.
Dr. Finkelstein elaborates on those comments:
First, isolating older adults won’t let the economy get back to normal. Older adults are an important part of the economy: they are workers, business owners, and consumers—and they provide caregiving and household support that allows other family members to return to their jobs.
Second, isolating older adults won’t contain the virus. The disproportionate fatality rate of the virus among older adults is overstated because it is strongly influenced—statistically—by the outbreaks in long-term care facilities. These account for 45% of all deaths in the United States and 55% to 64% of deaths among adults 65 and older, and reflect the combination of very old age, multiple illnesses, and poor infection control in a congregate setting. The fatality rate is much lower for people 65-74—the majority of older people in the workforce—than for those over 85. Underlying conditions pose a greater risk for death than age alone.
Furthermore, isolating older adults won’t protect the many other workers at risk for infection and poor outcomes from COVID. Risk factors for infection include a person’s occupation, race, and ethnicity. A heightened risk of fatality once infected is associated with numerous health conditions (such as obesity and high blood pressure) and demographic characteristics (such as being Black, Brown, or male) that are associated with social and environmental disadvantages including discrimination, crowded housing, low-wage employment, and inadequate health care access and quality. Rushing to figure out whom to blame—whether as vector, villain, or victim—is unhelpful, just as it was during the HIV/AIDS crisis. Then, misguided panic that focused on homosexuals, Haitians, heroin users, and hemophiliacs (the “four H’s”) delayed recognition of HIV’s disproportionate impact in communities of color, among other problems.
Third, isolating older adults is harmful. Indefinite isolation is bad for physical, mental, and emotional health and well-being. Abundant research links loneliness and social isolation with higher risks for depression, coronary heart disease, stroke, dementia, and premature mortality.
What will work to reopen the economy: “Universal precautions” for COVID-19. Just as HIV taught health care providers to use gloves and other safety measures when handling anyone’s blood, the only way to keep all workers safe from COVID is to assume everyone is infected. Making schools and workplaces safer is what we were supposed to be doing, as a society, during this “pause,” in addition to caring for the sick and setting up the systems for testing, tracing, and isolation. The details vary by site and should come from infectious disease and occupational health specialists, but minimum components of “universal precautions” appear to be wearing masks, installing much better air filtration systems when work must be done indoors, redesigning work processes that allow people to be physically distant in the workplace, and expanding the availability and effectiveness of remote work.
This is what we should be doing instead of developing mathematical models that imagine the effects of blotting out different categories of people. Isolating older adults will impede the success of reopening the economy, will fail to prevent harm from COVID-19, and will damage the well-being of those it seeks to protect.