Do We Simply Not Care About Old People?
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The covid-19 pandemic would be a wake-up call for America, advocates for the elderly predicted: incontrovertible proof that the nation wasn’t doing enough to care for vulnerable older adults.
The death toll was shocking, as were reports of chaos in nursing homes and seniors suffering from isolation, depression, untreated illness, and neglect. Around 900,000 older adults have died of covid-19 to date, accounting for 3 of every 4 Americans who have perished in the pandemic.
But decisive actions that advocates had hoped for haven’t materialized. Today, most people — and government officials — appear to accept covid as a part of ordinary life. Many seniors at high risk aren’t getting antiviral therapies for covid, and most older adults in nursing homes aren’t getting updated vaccines. Efforts to strengthen care quality in nursing homes and assisted living centers have stalled amid debate over costs and the availability of staff. And only a small percentage of people are masking or taking other precautions in public despite a new wave of covid, flu, and respiratory syncytial virus infections hospitalizing and killing seniors.
In the last week of 2023 and the first two weeks of 2024 alone, 4,810 people 65 and older lost their lives to covid — a group that would fill more than 10 large airliners — according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)
“It boggles my mind that there isn’t more outrage,” said Alice Bonner, 66, senior adviser for aging at the Institute for Healthcare Improvement. “I’m at the point where I want to say, ‘What the heck? Why aren’t people responding and doing more for older adults?’”
It’s a good question. Do we simply not care?
I put this big-picture question, which rarely gets asked amid debates over budgets and policies, to health care professionals, researchers, and policymakers who are older themselves and have spent many years working in the aging field. Here are some of their responses.
The pandemic made things worse. Prejudice against older adults is nothing new, but “it feels more intense, more hostile” now than previously, said Karl Pillemer, 69, a professor of psychology and gerontology at Cornell University.
“I think the pandemic helped reinforce images of older people as sick, frail, and isolated — as people who aren’t like the rest of us,” he said. “And human nature being what it is, we tend to like people who are similar to us and be less well disposed to ‘the others.’”
“A lot of us felt isolated and threatened during the pandemic. It made us sit there and think, ‘What I really care about is protecting myself, my wife, my brother, my kids, and screw everybody else,’” said W. Andrew Achenbaum, 76, the author of nine books on aging and a professor emeritus at Texas Medical Center in Houston.
In an environment of “us against them,” where everybody wants to blame somebody, Achenbaum continued, “who’s expendable? Older people who aren’t seen as productive, who consume resources believed to be in short supply. It’s really hard to give old people their due when you’re terrified about your own existence.”
Although covid continues to circulate, disproportionately affecting older adults, “people now think the crisis is over, and we have a deep desire to return to normal,” said Edwin Walker, 67, who leads the Administration on Aging at the Department of Health and Human Services. He spoke as an individual, not a government representative.
The upshot is “we didn’t learn the lessons we should have,” and the ageism that surfaced during the pandemic hasn’t abated, he observed.
Ageism is pervasive. “Everyone loves their own parents. But as a society, we don’t value older adults or the people who care for them,” said Robert Kramer, 74, co-founder and strategic adviser at the National Investment Center for Seniors Housing & Care.
Kramer thinks boomers are reaping what they have sown. “We have chased youth and glorified youth. When you spend billions of dollars trying to stay young, look young, act young, you build in an automatic fear and prejudice of the opposite.”
Combine the fear of diminishment, decline, and death that can accompany growing older with the trauma and fear that arose during the pandemic, and “I think covid has pushed us back in whatever progress we were making in addressing the needs of our rapidly aging society. It has further stigmatized aging,” said John Rowe, 79, professor of health policy and aging at Columbia University’s Mailman School of Public Health.
“The message to older adults is: ‘Your time has passed, give up your seat at the table, stop consuming resources, fall in line,’” said Anne Montgomery, 65, a health policy expert at the National Committee to Preserve Social Security and Medicare. She believes, however, that baby boomers can “rewrite and flip that script if we want to and if we work to change systems that embody the values of a deeply ageist society.”
Integration, not separation, is needed. The best way to overcome stigma is “to get to know the people you are stigmatizing,” said G. Allen Power, 70, a geriatrician and the chair in aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada. “But we separate ourselves from older people so we don’t have to think about our own aging and our own mortality.”
The solution: “We have to find ways to better integrate older adults in the community as opposed to moving them to campuses where they are apart from the rest of us,” Power said. “We need to stop seeing older people only through the lens of what services they might need and think instead of all they have to offer society.”
That point is a core precept of the National Academy of Medicine’s 2022 report Global Roadmap for Healthy Longevity. Older people are a “natural resource” who “make substantial contributions to their families and communities,” the report’s authors write in introducing their findings.
Those contributions include financial support to families, caregiving assistance, volunteering, and ongoing participation in the workforce, among other things.
“When older people thrive, all people thrive,” the report concludes.
Future generations will get their turn. That’s a message Kramer conveys in classes he teaches at the University of Southern California, Cornell, and other institutions. “You have far more at stake in changing the way we approach aging than I do,” he tells his students. “You are far more likely, statistically, to live past 100 than I am. If you don’t change society’s attitudes about aging, you will be condemned to lead the last third of your life in social, economic, and cultural irrelevance.”
As for himself and the baby boom generation, Kramer thinks it’s “too late” to effect the meaningful changes he hopes the future will bring.
“I suspect things for people in my generation could get a lot worse in the years ahead,” Pillemer said. “People are greatly underestimating what the cost of caring for the older population is going to be over the next 10 to 20 years, and I think that’s going to cause increased conflict.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Taking A Trip Through The Evidence On Psychedelics
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In Tuesday’s newsletter, we asked you for your opinions on the medicinal use of psychedelics, and got the above-depicted, below-described, set of responses:
- 32% said “This is a good, evidence-based way to treat many brain disorders”
- 32% said “There are some benefits, but they don’t outweigh the risks”
- 20% said “This can help a select few people only; useless for the majority”
- 16% said “This is hippie hogwash and hearsay; wishful thinking at best”
Quite a spread of answers, so what does the science say?
This is hippie hogwash and hearsay; wishful thinking at best! True or False?
False! We’re tackling this one first, because it’s easiest to answer:
There are some moderately-well established [usually moderate] clinical benefits from some psychedelics for some people.
If that sounds like a very guarded statement, it is. Part of this is because “psychedelics” is an umbrella term; perhaps we should have conducted separate polls for psilocybin, MDMA, ayahuasca, LSD, ibogaine, etc, etc.
In fact: maybe we will do separate main features for some of these, as there is a lot to say about each of them separately.
Nevertheless, looking at the spread of research as it stands for psychedelics as a category, the answers are often similar across the board, even when the benefits/risks may differ from drug to drug.
To speak in broad terms, if we were to make a research summary for each drug it would look approximately like this in each case:
- there has been research into this, but not nearly enough, as “the war on drugs” may well have manifestly been lost (the winner of the war being: drugs; still around and more plentiful than ever), but it did really cramp science for a few decades.
- the studies are often small, heterogenous (often using moderately wealthy white student-age population samples), and with a low standard of evidence (i.e. the methodology often has some holes that leave room for reasonable doubt).
- the benefits recorded are often small and transient.
- in their favor, though, the risks are also generally recorded as being quite low, assuming proper safe administration*.
*Illustrative example:
Person A takes MDMA in a club, dances their cares away, has had only alcohol to drink, sweats buckets but they don’t care because they love everyone and they see how we’re all one really and it all makes sense to them and then they pass out from heat exhaustion and dehydration and suffer kidney damage (not to mention a head injury when falling) and are hospitalized and could die;
Person B takes MDMA in a lab, is overwhelmed with a sense of joy and the clarity of how their participation in the study is helping humanity; they want to hug the researcher and express their gratitude; the researcher reminds them to drink some water.
Which is not to say that a lab is the only safe manner of administration; there are many possible setups for supervised usage sites. But it does mean that the risks are often as much environmental as they are risks inherent to the drug itself.
Others are more inherent to the drug itself, such as adverse cardiac events for some drugs (ibogaine is one that definitely needs medical supervision, for example).
For those who’d like to see numbers and clinical examples of the bullet points we gave above, here you go; this is a great (and very readable) overview:
NIH | Evidence Brief: Psychedelic Medications for Mental Health and Substance Use Disorders
Notwithstanding the word “brief” (intended in the sense of: briefing), this is not especially brief and is rather an entire book (available for free, right there!), but we do recommend reading it if you have time.
This can help a select few people only; useless for the majority: True or False?
True, technically, insofar as the evidence points to these drugs being useful for such things as depression, anxiety, PTSD, addiction, etc, and estimates of people who struggle with mental health issues in general is often cited as being 1 in 4, or 1 in 5. Of course, many people may just have moderate anxiety, or a transient period of depression, etc; many, meanwhile, have it worth.
In short: there is a very large minority of people who suffer from mental health issues that, for each issue, there may be one or more psychedelic that could help.
This is a good, evidence-based way to treat many brain disorders: True or False?
True if and only if we’re willing to accept the so far weak evidence that we discussed above. False otherwise, while the jury remains out.
One thing in its favor though is that while the evidence is weak, it’s not contradictory, insofar as the large preponderance of evidence says such therapies probably do work (there aren’t many studies that returned negative results); the evidence is just weak.
When a thousand scientists say “we’re not completely sure, but this looks like it helps; we need to do more research”, then it’s good to believe them on all counts—the positivity and the uncertainty.
This is a very different picture than we saw when looking at, say, ear candling or homeopathy (things that the evidence says simply do not work).
We haven’t been linking individual studies so far, because that book we linked above has many, and the number of studies we’d have to list would be:
n = number of kinds of psychedelic drugs x number of conditions to be treated
e.g. how does psilocybin fare for depression, eating disorders, anxiety, addiction, PTSD, this, that, the other; now how does ayahuasca fare for each of those, and so on for each drug and condition; at least 25 or 30 as a baseline number, and we don’t have that room.
But here are a few samples to finish up:
- Psilocybin as a New Approach to Treat Depression and Anxiety in the Context of Life-Threatening Diseases—A Systematic Review and Meta-Analysis of Clinical Trials
- Therapeutic Use of LSD in Psychiatry: A Systematic Review of Randomized-Controlled Clinical Trials
- Efficacy of Psychoactive Drugs for the Treatment of Posttraumatic Stress Disorder: A Systematic Review of MDMA, Ketamine, LSD and Psilocybin
- Changes in self-rumination and self-compassion mediate the effect of psychedelic experiences on decreases in depression, anxiety, and stress.
- Psychedelic Treatments for Psychiatric Disorders: A Systematic Review and Thematic Synthesis of Patient Experiences in Qualitative Studies
- Repeated lysergic acid diethylamide (LSD) reverses stress-induced anxiety-like behavior, cortical synaptogenesis deficits and serotonergic neurotransmission decline
In closing…
The general scientific consensus is presently “many of those drugs may ameliorate many of those conditions, but we need a lot more research before we can say for sure”.
On a practical level, an important take-away from this is twofold:
- drugs, even those popularly considered recreational, aren’t ontologically evil, generally do have putative merits, and have been subject to a lot of dramatization/sensationalization, especially by the US government in its famous war on drugs.
- drugs, even those popularly considered beneficial and potentially lifechangingly good, are still capable of doing great harm if mismanaged, so if putting aside “don’t do drugs” as a propaganda of the past, then please do still hold onto “don’t do drugs alone”; trained professional supervision is a must for safety.
Take care!
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The Four Pillar Plan – by Dr. Rangan Chatterjee
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Dr. Rangan Chatterjee, a medical doctor, felt frustrated with how many doctors in his field focus on treating the symptoms of disease, rather than the cause. Sometimes, of course, treating the symptom is necessary too! But neglecting the cause is a recipe for long-term woes.
What he does differently is take lifestyle as a foundation, and even that, he does differently than many authors on the topic. How so, you may wonder?
Rather than look first at exercise and diet, he starts with “relax”. His rationale is reasonable: diving straight in with marathon training or a whole new diet plan can be unsustainable without this as a foundation to fall back on.
Many sources look first at exercise (because it can be a very simple “prescription”) before diet (often more complex)… but how does one exercise well with the wrong fuel in the tank? So Dr. Chatterjee’s titular “Four Pillars” come in the following order:
- Relax
- Eat
- Move
- Sleep
He also goes for “move” rather than “exercise” as the focus here is more on minimizing time spent sitting, and thus involving a lot of much more frequent gentle activities… rather than intensive training programs and the like.
And as for sleep? Yes, that comes last because—no matter how important it is—the other things are easier to directly control. After all, one can improve conditions for sleep, but one cannot simply choose to sleep better! So with the other three things covered first, good sleep is the fourth and final thing to fall into place.
All in all, this is a great book to cut through the catch-22 problem of lifestyle factors negatively impacting each other.
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Live Long, Die Short – by Dr. Roger Landry
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First know: “die short” is not about your height—although on average, short people do live longer, partly because insulin-like growth factor (IGF-1) promotes both tallness and accelerated DNA damage (thus, aging and cancer), and partly because if someone is very tall, it can cause circulatory problems, and without a nice easy flow of blood through the brain, bad things happen (such as accumulation of harmful detritus in the brain, and increased stroke risk too).
Next know: “die short” is, in this book, actually about shortening the decline at the end of life. Sometimes people say “I don’t want to live 10 years longer; they’ll be the 10 most miserable years”, but in fact if we look after our health, we will be healthy for perhaps >9.5 of our last 10 years, while an unhealthy person may just get their expected “10 most miserable years” 10 or 20 years earlier (and then die).
So, in short (so to speak), it’s about increasing healthspan.
To enjoy the longest and healthiest healthspan, Dr. Landry offers 10 tips. We’ll not keep them a secret; they are:
- Use it or lose it
- Keep moving
- Challenge your brain
- Stay connected
- Lower your risks
- Never act your age
- Wherever you are, be fully there
- Find your purpose
- Have children in your life
- Laugh to a better life
Each of these has a chapter devoted to them, in section 2 of the book (section 1 is about what we know about healthy aging, and section 3 is about where we go from here).
You’ll notice that one item not generally found on such lists is “have children in your life”; to be clear, they don’t have to be your children, and/but they do have to be actual current children; any now-grown-up progeny aren’t what’s being talked about here (wonderful as they may be, any support role they may play gets filed under “stay connected” instead).
The style is mostly impersonal pop-science with occasional personal anecdotes, and the book’s formatting (many subheadings within chapters) makes it easy to read a bit at a time, if that’s your preference. There’s a modest, but extant, bibliography.
Bottom line: if you’d like to stay younger as you get older, this book goes into a lot of detail about 10 ways to do just that.
Click here to check out Live Long, Die Short, and live long, die short!
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Get Fitter As You Go
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Dr. Jaime Seeman: Hard To Kill?
This is Dr. Jaime Seeman. She’s a board-certified obstetrician-gynecologist with a background in nutrition, exercise, and health science. She’s also a Fellow in Integrative Medicine, and a board-certified nutrition specialist.
However, her biggest focus is preventative medicine.
What does she want us to know?
The Five Pillars of being “Hard to Kill”!
As an athlete when she was younger, she got away with poor nutrition habits with good exercise, but pregnancy (thrice) brought her poor thyroid function, other hormonal imbalances, and pre-diabetes.
So, she set about getting better—not something the general medical establishment focuses on a lot! Doctors are pressured to manage symptoms, but are under no expectation to actually help people get better.
So, what are her five pillars?
Nutrition
Dr. Seeman unsurprisingly recommends a whole-foods diet with lots of plants, but unlike many plant-enjoyers, she is also an enjoyer of the ketogenic diet.
While keto-enthusiasts say “carbs are bad” and vegans say “meat is bad”, the reality is: both of those things can be bad, and in both cases, avoiding the most harmful varieties is a very good first step:
Movement
This is in two parts:
- get your 150 minutes of moderate exercise per week
- keep your body mobile!
See also:
Sleep
This one’s quite straightforward, and Dr. Seeman uncontroversially recommends getting 7–9 hours per night; yes, even you:
Mindset
This is key to Dr. Seeman’s approach, and it is about not settling for average, because the average is undernourished, overmedicated, sedentary, and suffering.
She encourages us all to keep working for better health, wherever we’re at. To not “go gentle into that good night”, to get stronger whatever our age, to showcase increasingly robust vitality as we go.
To believe we can, and then to do it.
Environment
That previous item usually won’t last beyond a 10-day health-kick without the correct environment.
As for how to make sure we have that? Check out:
Want more?
She does offer coaching:
Hard To Kill Academy: Master The Mindset To Maximize Your Years
Take care!
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Endure – by Alex Hutchinson
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Life is a marathon, not a sprint. For most of us, at least. But how do we pace ourselves to go the distance, without falling into complacency along the way?
According to our author Alex Hutchinson, there’s a lot more to it than goal-setting and strategy.
Hutchinson set out to write a running manual, and ended up writing a manual for life. To be clear, this is still mostly centered around the science of athletic endurance, but covers the psychological factors as much as the physical… and notes how the capacity to endure is the key trait that underlies great performance in every field.
The writing style is both personal and personable, and parts read like a memoir (Hutchinson himself being a runner and sports journalist), while others are scientific in nature.
As for the science, the kind of science examined runs the gamut from case studies to clinical studies. We examine not just the science of physical endurance, but the science of psychological endurance too. We learn about such things as:
- How perception of ease/difficulty plays its part
- What factors make a difference to pain tolerance
- How mental exhaustion affects physical performance
- What environmental factors increase or lessen our endurance
- …and many other elements that most people don’t consider
Bottom line: whether you want to run a marathon in under two hours, or just not quit after one minute forty seconds on the exercise bike, or to get through a full day’s activities while managing chronic pain, this book can help.
Click here to check out Endure, and find out what you are capable of when you move your limits!
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Workout Advice For Busy People
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Hampton at Hybrid Calisthenics always has very sound advice in his uplifting videos, and this one’s no exception:
Key tips for optimizing workouts without burning out
“We all have the same 24 hours” is a folly when in fact, some of us have more responsibilities and/or other impediments to getting things done (e.g. disabilities).
A quick word on disabilities first: sometimes people are quick to point out Paralympian athletes, and “if they can do it, so can you!” and forget that these people are in the top percentile of the top percentile of the top percentile of human performance. If you wouldn’t disparagingly say “if Simone Biles/Hussein Bolt/Michael Phelps can do it, so can you”, then don’t for Paralympians either 😉
Now, as for Hampton’s advice, he recommends:
Enjoy short, intense workouts:
- You can get effective results in under 30 minutes (or even just a few minutes per day) with compound exercises (e.g., squats, pull-ups).
- Focus on full-body movements also saves time!
- Push closer to failure when possible to maximize efficiency. It’s the last rep where most of the strength gains are made! Same deal with cardiovascular fitness, too. Nevertheless, do take safety into account in both cases, of course.
Time your rest periods:
- Resting for 2–3 minutes between sets ensures optimal recovery.
- Avoid getting distracted during rest by setting a timer to stay focused.
- 10almonds tip: use this time to practice a mindfulness meditation. That will greatly reduce the chance of you becoming distracted.
Remember holistic fitness:
- Fitness isn’t just about exercise; diet, sleep, and stress management are equally important for your fitness as much as for the rest of your health.
- Better sleep and reduced stress will help you exercise more consistently and avoid junk food.
Address burnout:
- If feeling too exhausted to apply these tips, focus on getting better rest and reducing stress first.
- Taking a short break to reset can help in the long run.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- How To Do High Intensity Interval Training (Without Wrecking Your Body)
- How To Rest More Efficiently (Yes, Really)
Take care!
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