Written by Morgan Van Vleck, MSW candidate and Masters Research Fellow in Aging, Harvey A. Friedman Center for Aging
At the intersection of age and race, it becomes clear that older adults of color are struggling the most when it comes to adverse effects of the COVID-19 pandemic. According to data from the CDC, a combination of age and race indicates high-risk groups when it comes to both COVID-19 infection and deaths of excess due to disruptions caused by the pandemic. It is common knowledge at this point that COVID-19 is dangerous for older adults: those 65 and up account for only 10% of infections but 42.6% of hospitalizations. Among older adults, the hospitalization and death rates are significantly higher for those who are Black, Hispanic, and Indigenous. Older adults of color not only have a higher risk for contracting the virus, but a higher risk for adverse reactions and a higher risk of being impacted by the disruption COVID-19 has caused in the medical system.
Occupational exposure is a risk factor that affects older adults of color, particularly Black and African American older women who are overrepresented in the front-line workforce. Therefore, sheltering-in-place is a privilege that is not extended to many Black older women, putting a population already at-risk for serious COVID-19 infection in a position where they are likely to be exposed to the virus. Before the pandemic, people of color were more at risk for comorbidities that result in serious COVID-19 infection. This, in combination of greater risk for exposure, has resulted in a much greater instance of fatal infection for older Hispanic, Black, and Indigenous people. Furthermore, before the pandemic, people of color were less likely to have insurance than their white counterparts, resulting in much lower health care utilization. This issue has been exacerbated by the strain COVID-19 has had on the medical system, resulting in greater deaths of excess among people of color according to data from the CDC.
The greater risk displayed for people of color among older populations is likely a result of the effects of ageism and racism on personal, institutional, and structural levels. Personal effects of racism and ageism might be displayed in a lack of prompt attention to symptoms, less frequent access to experimental treatments, and rationing of care. Personal effects of racism specifically might result in distrust of experimental treatments due to trauma caused by experiences of racism. Institutional impacts of racism and ageism show up in norms within the medical profession that lead to false beliefs about the health of people of color and older adults and help bolster power structures that limit the potential for change. Structural indications of racism and ageism are displayed in policy decisions that create disproportional access to medical care, education, and wealth. Data genocide is another consequence of structural racism in the United States, which has been observed by the Urban Indian Health Institute in the underreporting of Indigenous deaths due to COVID-19. According to the Human Rights Watch, the Anti-Asian rhetoric surrounding COVID-19 from public figures and politicians has also fueled racialized violence and harassment toward Asian Americans and Pacific Islanders in the United States and across the world. More must be done by public health professionals and those in the medical field to work against these effects of ageism and racism.
How can we do better in the short term?
- PPE and other supplies for congregate living, including skilled nursing, prisons, universities, and assisted living
- Better outreach to older adults living at home, potentially spearheaded by primary care physician groups, elder care services, or hospital systems
- Aggressive vaccination campaigns with targeted messaging for older adults, minority adults, and adults whose first language is not English
- Empathetic attention to distrust of vaccine for Black St. Louisans and St. Louisans of color
What can be done in the long term?
- Public health emergency plans for congregate living and dedicated task forces for vulnerable groups
- Increased movement towards “belonging” in healthcare philosophy; many were left behind in the pandemic and future care should be more holistic and home-based for older adults
- Faster and easier vaccination implementation, with more accessibility by eliminating complicated forms, including online forms that require access to the internet, and phase requirements that neglect the needs of vulnerable groups
If you are interested in getting involved with efforts to reach Black St. Louisians and St. Louisians of color with information about the vaccine, Prepare STL is looking for people to get involved in their Community Health Champion program, which will implement a peer-based education program to reach people in the St. Louis area with information about the vaccine and PPE. You can read more about PrepareSTL here and their Community Health Champion program here. If you would like to learn more about this topic, Dr. Karen Joynt Maddox, MD, MPH, gave a talk on the compounding risk of age and race for COVID-19 that you can watch here.