Protecting our elders

COVID-19 has had devastating effects on older people. The pandemic shows us that building back better must be about creating inclusive, healthy societies for all ages

23rd October 2020

A resident of a nursing home near Barcelona, Spain touches hands with relatives, separated by a window. Older people, particularly those in nursing homes, have been among the hardest hit by COVID-19. © David Ramos/Getty Images

Protecting our elders

COVID-19 has had devastating effects on older people. The pandemic shows us that building back better must be about creating inclusive, healthy societies for all ages

By Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA)

The coronavirus pandemic, with its deadly impact on older people, is a wake-up call. As the world gears up to build back better and greener, we absolutely must use this crisis as an opportunity to fundamentally rethink how we see and treat older people in society. This will be even more pressing as the world’s population is now ageing rapidly: by the year 2050, one in six people globally will be over age 65, compared with one in 11 in 2019.

The coronavirus pandemic has exposed huge fault lines in our societies. It has disproportionately affected the most vulnerable, including the poor, minorities and, especially, older people.

Symptomatic individuals in their 70s are 20 times more likely to need hospitalisation because of COVID-19 than young adults, and after age 60 the risk of death from the disease climbs sharply. Much of the added risk appears biological in nature: older people generally have more underlying medical conditions, which put them at higher danger of severe illness when they catch the virus.

Yet there is a social dimension that is perhaps less visible but no less worrisome. Already before the pandemic, many older people were confined to the margins of society, often living in poverty and isolation, or consigned to long-term care facilities. A culture of ageism had taken hold in many societies, with older people facing pervasive discrimination in healthcare, employment and many other spheres of their lives.

The pandemic has cruelly laid bare the devastating effects of these structural inequalities and deep-rooted biases on older people. These include denial of healthcare, worsening poverty and social isolation, abuse and neglect, as well as the dramatic effects on older people’s mental health and well-being. All of these factors have contributed to the shocking death toll in long-term care facilities across Europe and North America, which accounted for up to 50 per cent of all coronavirus-related fatalities at the peak of the pandemic (even though only up to 1 per cent of the population lives in them).

Yet this huge toll that the pandemic has taken on older people was not inevitable. The data we have reveals vast differences between countries. If we look at fatality rates, for example, we see that in South Korea 25 per cent of people aged 80 or older with confirmed cases of COVID-19 have died, much lower than in many countries in Europe or the Americas. And in Japan, the country with the oldest population in the world, the fatality rate among people in nursing homes is 14 per cent, significantly lower than the rates in comparable countries. Clearly, age alone is not the determining factor. These figures suggest that varying conditions and responses can make a big difference.

The immediate priority remains making sure older people are not left alone during the ongoing pandemic. This requires urgent support to national health and social systems so that they can cope with the crisis. UNFPA, the United Nations sexual and reproductive health agency, together with its partners, is assisting these efforts – for example, by providing protective equipment, guidelines and training for staff in nursing homes, and information materials for older people on how to protect themselves from the virus.

Young volunteers mobilised by UNFPA in several countries have stepped up to help break their elders’ social isolation. In Moldova, for example, where many children grow up with grandparents because their parents are abroad for work, the pandemic provides an opportunity for young people to show gratitude to the older generation and intergenerational solidarity. They check in regularly on older people in their community, spend time with them and offer help in carrying out daily routines.

As governments grapple with increasing trends in ageing, UNFPA is working closely with leaders and partners to revise population policies to ensure that older people’s health, housing, social and financial needs are creatively embedded in national decision-making. In Mauritius, for example, UNFPA recently supported the government in developing a new population policy that pre-positioned the government to support older people when the COVID-19 pandemic arrived.

Beyond the immediate pandemic response, we must accelerate efforts to build societies that protect and ensure the health, inclusion and dignity of people of all ages.

This is not only a human rights imperative, but a precondition for achieving the Sustainable Development Goals and for countries and people to thrive in a world of rapid demographic change. It requires a fundamental shift away from seeing older people primarily as a burden, and towards acknowledging and nurturing the important role they play in society.

Making this shift a reality means enabling people to stay active and healthy, starting from a young age. It means offering life-long learning and opening up employment opportunities and other forms of engagement to older people, as the rigid line between working and retirement age disintegrates. And it means making serious efforts to combat ageism and the low value many societies attach to older people.

An ever-increasing number of countries worldwide are reshaping sectors like health, education, employment and social welfare to be able to better manage and cope with the effects of rapid demographic change while ensuring the rights and choices of an ageing population.

UNFPA and its partners are at the forefront of supporting these efforts in a variety of ways. In countries like Iran and Vietnam, UNFPA assists with developing legal and policy frameworks for creating age-friendly environments. In Georgia, UNFPA programmes are supporting older people in remaining independent, active and involved in the community, learning new skills and passing on their knowledge and expertise to younger generations.

Today’s older generation is an incredibly diverse group, and the cliché of the grey-haired, stooped, cane-carrying older person has little to do with the reality of an increasing number of people. Yet even though more and more people stay healthy and active well into old age, the pandemic has put into stark relief the vulnerabilities of those left behind. The most marginalised older people often face overlapping discrimination and barriers – for example, because they are poor, live with disabilities, are women living alone, or belong to minority groups.

Existing data often lumps all older people together into one category. As Claudia Mahler, the UN Independent Expert on the enjoyment of all human rights by older persons, stated in her report to the UN Human Rights Council: “This lack of significant data and information on older persons is, in itself, an alarming sign of exclusion and renders meaningful policymaking and normative action practically impossible.”

This is why UNFPA launched its COVID-19 Population Vulnerability Dashboard in spring 2020, to highlight where older people are clustered, live alone or have no access to piped water, and to share data on the dramatic differences in COVID-19 health-sector readiness between countries. UNFPA works with governments across the world to strengthen data disaggregation by sex and age, and improve access to data on older people in all their diversity.

Together with the UN Department of Economic and Social Affairs, the World Health Organization and other UN partners, UNFPA is working hand in hand with HelpAge and other civil-society organisations to learn from the pandemic, uncover and address age-based discrimination, and share emerging models of how best to harness intergenerational solidarity.

COVID-19 puts the spotlight on a massive fissure in our common social fabric. We now have an opportunity to rectify past mistakes, listen to the voices of older people themselves, and get serious about the changes that need to happen. If we can make this crisis a turning point, older people and everyone will enjoy a world that is more just and equal – a world of health, well-being and dignity for all ages.

A resident of a nursing home near Barcelona, Spain touches hands with relatives, separated by a window. Older people, particularly those in nursing homes, have been among the hardest hit by COVID-19. © David Ramos/Getty Images