In March 2022, the Canadian Medical Association Journal published recommendations for equitable COVID-19 pandemic recovery in Canada. The recommendations omited issues relevant to older adults. Below, the response we wrote to the recommendations for equitable COVID-19 pandemic recovery in Canada.
Worldwide, including in Canada, health and social service professionals, researchers, decision-makers, politicians and citizens must learn from the challenges posed by the COVID-19 pandemic. To guide policymaking, Persaud and colleagues published their recommendations for an equitable COVID-19 pandemic recovery in Canada. Based on its findings from systematic reviews, this MAP Task Force to Promote Health Equity during Pandemic Recovery made 13 valuable recommendations related to income, housing, intimate partner violence, childhood, access to health care, and racism. As noted in Patrick’s, no recommendations are provided for social care for older adults. This omission is profoundly shocking and, albeit unintentionally, indicative of ageism. Defined as positive or negative stereotypes (thoughts), prejudices (feelings), and discrimination (actions or behaviors) based on perceived age,, ageism is a phenomenon that can be self-directed, interpersonal, or institutional, as well as conscious (explicit) or unconscious (implicit). Of all population groups, older adults were most disproportionately affected by the pandemic, which exacerbates manifestations of ageism,,. In the context of COVID-19 and given the investment in health care resources, it is cleat that society places a lower value on the lives of older adults,. Ageism definitely merits a 14th recommendation in Persaud and colleagues’ guidelines.
We strongly recommend reflection and action on multiple prior studies that outlined approaches to addressing discrimination against older adults and other manifestations of ageism (ungraded statement).
Before the COVID-19 pandemic, many studies documented the harmful effects of ageism, such as increased loneliness, isolation and depressive symptoms,, decreased health,,,,, and reduced life expectancy. Specifically, in their systematic reviews including over 7 million participants across five continents, Chang and colleagues  demonstrated the detrimental impact of ageism on older persons’ health occurring simultaneously at the structural and individual level. Given the importance of this phenomenon and its effects upon health and relevance to health equity, the World Health Organization (WHO) launched the Global Campaign to Combat Ageism  and calls for actions  (Appendix 1). Because of its importance, the high likelihood of benefit, and support from a vast body of indirectly related information, an ungraded statement should be made on ageism, as suggested by Persaud and colleagues  for racism. According to the WHO and Mikton and colleagues, ageism is an important social determinant of health that has been largely neglected to date. Ageism is widespread and affects billions of older adults (>50% of the population of the world has ageist attitudes), recommendations on ageism are crucial for equitable COVID-19 pandemic recovery in Canada and actions must be taken now to give older adults greater consideration.
Mélanie Levasseur, O.T., Ph.D.,1,2 Occupation: Full professor and researcher; email: Melanie.Levasseur@USherbrooke.ca
Alan A. Cohen, Ph. D.,1,2,3 Occupation: Full professor and researcher; email: Alan.Cohen@USherbrooke.ca
Martine Lagacé, Ph. D.,4 Occupation: Full professor and researcher; email: Martine.Lagace@UOttawa.ca
Carine Bétrisey, Ph. D.,1,2 Occupation: Postdoctoral researcher; email: Carine.Betrisey@USherbrooke.ca
Mingxin Liu, B. Sc.,1,2,3 Occupation: Master student in research in biochemistry; email: Mingxin.Liu@USherbrooke.ca
- Université de Sherbrooke, Sherbrooke, QC, Canada
- Research Centre on Aging, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada
- Research Centre CHUS Hospital, Sherrooke, QC, Canada,
- University of Ottawa, Ottawa, ON, Canada
Mélanie Levasseur, O.T., Ph.D.
Research director and full professor, School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada; email: Melanie.Levasseur@USherbrooke.ca; Phone number: +1 819 821-8000 #72927
Researcher, Research Centre on Aging, CIUSSS de l’Estrie-CHUS
Associated researcher, Primary Health Care and Social Services University Institute & Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS)
Mélanie Levasseur is a Canadian Institutes of Health Research (CIHR) New Investigator (#360880; 2017-2022) and a Fonds de la recherche du Québec Santé (FRQS) Senior Researcher (#298996; 2021-2025). Alan A. Cohen is a FRQS Senior Researcher and founder / CEO of Oken Health. Carine Bétrisey received a postdoctoral scholarship from the Research Centre of Aging and the Mitacs Accelerate program.
The Global Campaign to Combat Ageism  targets three effective strategies to reduce ageism: 1) Policies and laws to reduce ageism, e.g., legislation that addresses age discrimination, inequality and human rights; 2) Educational interventions to enhance empathy, and reduce prejudice and discrimination by providing accurate information and counter-stereotypical examples that portray a realistic view of aging and highlights the heterogeneity of the older adult population , and using a wide variety of activities such as readings, videos, discussions, role playing, and simulation exercises ,, and 3) Intergenerational contacts and interventions to foster both direct and indirect (e.g., imagined or through others’ experiences) interaction between people of different generations and in various contexts, e.g., leisure, music, art, mentoring, storytelling, and shared sites., Combined interventions, involving both education and intergenerational contacts, seem to be the most frequent and effective approach,,. and foster application of knowledge about actions. The Global Report on Ageism also presents three recommendations for action to counter ageism: 1) invest in evidence-based strategies to prevent and respond to ageism, 2) improve data and research to better understand ageism and how to reduce it, and 3) build a movement to change the narrative around age and aging. Finally, based on two realist reviews, one concerning youths and the other in undergraduate students in health and social services, positively changing stereotypes, prejudices, and discrimination involves: 1) enhancing knowledge about aging and older adults by transmitting realistic and balanced information fostering reflective and critical thinking, 2) improving meaningful and high-quality intergenerational contacts with a broad variety of older adults highlighting their diversity and uniqueness and their competences rather than their limitations, and 3) increasing opportunities to apply knowledge in intergenerational interactions. According to Chonody  and these two realist reviews,, interacting with older adults with disabilities may reinforce of stereotypes and prejudices,,, while healthy seniors may be considered as exceptions and interactions do not have the desired effects. Specifically in youth, interventions must consider the stage of children’s cognitive development or older adults’ perception as unrepresentative of their age group. Countering ageism in youth and health and social services students is essential to ensure an inclusive society and enhance the efficiency and quality of care. As ageism slows recovery from disability, accelerates cognitive decline, and reduces access to health care , and also has a massive impact on individuals and the economy ($1 in every $7 ($63 billion) — spent on health care in the U.S.), research should have a high priority and continue including interventions with the general population. Ageism needs to be fully recognised as a social determinant of health and adressed in order to achieve healthy aging, not just in the immediate post-pandemic context, but for years to come.
 Persaud, N., Woods, H., Workentin, A., Adekoya, I., Dunn, J. R., Hwang, S. W., Maguire, J., Pinto, A. D., O’Campo, P., Rourke, S. B., & Werb, D. (2021). Recommendations for equitable COVID-19 pandemic recovery in Canada. CMAJ : Canadian Medical Association Journal, 193(49), E1878–E1888. doi.org/10.1503/cmaj.210904
 World Health Organization. (2021). Demographic Change and Healthy Ageing—Combatting Ageism. https://www.who.int/teams/social-determinants-of-health/demographic-change-and-healthy-ageing/combatting-ageism
 World Health Organization. (2021). Global report on ageism. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789240016866
 Estabrooks, C.A., Straus, S., Flood, C.M., Keefe, J., Armstrong, P., Donner, G., Boscart, V., Ducharme, F., Silvius, J., & Wolfson, M. (2000). Restoring trust: COVID-19 and the future of long-term care. Ottawa, ON: Royal Society of Canada. https://rsc-src.ca/sites/default/files/LTC%20PB%20%2B%20ES_EN_0.pdf
 Fraser, S., Lagacé, M., Bongué, B., Ndeye, N., Guyot, J., Bechard, L., Garcia, L., Taler, V., CCNA Social Inclusion and Stigma Working Group, Adam, S., Beaulieu, M., Bergeron, C. D., Boudjemadi, V., Desmette, D., Donizzetti, A. R., Éthier, S., Garon, S., Gillis, M., Levasseur, M., Lortie-Lussier, M., Marier, P., Robitaille, A., Sawchuk, K., Lafontaine, C., & Tougas, F. (2020). Ageism and COVID-19: what does our society’s response say about us? Age and Ageing, 49(5), 692–695. https://doi.org/10.1093/ageing/afaa097
 Lichtenstein, B. (2021). From “Coffin Dodger” to “Boomer Remover”: Outbreaks of Ageism in Three Countries With Divergent Approaches to Coronavirus Control. Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 76(4), e206–e212. https://doi.org/10.1093/geronb/gbaa102
 Vervaecke, D., & Meisner, B. A. (2021). Caremongering and Assumptions of Need: The Spread of Compassionate Ageism During COVID-19. Gerontologist, 61(2), 159–165. https://doi.org/10.1093/geront/gnaa131
 Levy, B. R., Provolo, N., Chang, E., & Slade, M. D. (2021). RESEARCH Negative Age Stereotypes Associated with Older Persons’ Rejection of COVID‐19 Hospitalization. Journal of the American Geriatrics Society, 69(2), 317–318. https://doi.org/10.1111/jgs.16980
 Fakoya, O. A., McCorry, N. K., & Donnelly, M. (2020). Loneliness and social isolation interventions for older adults: A scoping review of reviews. BMC Public Health, 20(1), 129. Doi:10.1186/s12889-020-8251-6
 Han, J., & Richardson, V. E. (2015). The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: A longitudinal examination of age discrimination. Aging & Mental Health, 19(8), 747-755. doi:10.1080/13607863.2014.962007
 Kim, H., Thyer, B. A., and Munn, J. C. (2019). The relationship between perceived ageism and depressive symptoms in later life: Understanding the mediating effects of self-perception of aging and purpose in life, using structural equation modeling. Educ Gerontol, 45(2), 105-119. doi:10.1080/03601277.2019.1583403.
 Jackson, S. E., Hackett, R. A., & Steptoe, A. (2019). Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing. Lancet Public Health, 4(4), E200-E208. doi:10.1016/S2468-2667(19)30035-0.
 Armstrong, B., Gallant, S. N., Li, L., Patel, K., & Wong, B. I. (2017). Stereotype Threat Effects on Older Adults’ Episodic and Working Memory: A Meta-Analysis. Gerontologist, 57(suppl_2), S193–S205. doi:10.1093/geront/gnx056
 Chang, E. S., Kannoth, S., Levy, S., Wang, S. Y., Lee, J. E., & Levy, B. R. (2020). Global reach of ageism on older persons’ health: A systematic review. PLoS One; 15(1):e0220857. doi: 10.1371/journal.pone.0220857.
 Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity increased by positive self-perceptions of aging. Journal of Personality and Social Psychology, 83(2), 261–270. doi:10.1037/0022-35184.108.40.2061
 World Health Organization. (2021). COVID-19 and the social determinants of health and health equity: evidence brief. Geneva: World Health Organization.
 Officer, A., Thiyagarajan, J. A., Schneiders, M. L., Nash, P., & de la Fuente-Núñez, V. (2020). Ageism, healthy life expectancy and population ageing: How are they related? Int J Environ Res Public Health, 17, 3159. doi:10.3390/ijerph17093159.
 Burnes, D., Sheppard, C., Henderson Jr, C. R., Wassel, M., Cope, R., Barber, C., & Pillemer, K. (2019). Interventions to reduce ageism against older adults: A systematic review and meta-analysis. American Journal of Public Health, 109(8), e1–e9. Doi:10.2105/AJPH.2019.305123
 Christian, J., Turner, R., Holt, N., Larkin, M., & Cotler, J. H. (2014). Does intergenerational contact reduce ageism? When and how contact interventions actually work? Journal of Arts and Humanities, 3(1), 15.
 Drury, L., Abrams, D., & Swift, H. J. (2017). Making intergenerational connections: What are they, why do they matter and how to make more of them. Age UK; London, UK.
 Bétrisey, C., Carrier, A., Cardinal, J.-F., Lagacé, M., Cohen, A. A., Beaulieu, M., Baillargeon, D., & Levasseur, M. (2022). Which Interventions Work with Youths to Counter Ageism Toward Older Adults? Results from a Realist Review. Gerontology & Geriatrics Education. https://doi.org/10.1080/02701960.2023.2210521
 Bétrisey, C., Scott, J., Groleau, M., Caron, C., Yip, K., Bourgault, C., Brisson, C., & Levasseur, M. (2022). Contexts, Mechanisms and Outcomes of Interventions to Counter Ageism Toward Older Adults in Undergraduate Health and Social Services Students: Results of a Realist Review. Submitted for publication.
 Holroyd, A., Dahlke, S., Fehr, C., Jung, P., & Hunter, A. (2009). Attitudes toward aging: Implications for a caring profession. J Nurs Educ, 48(7):374–80.
 MacKnight, C., & Powell, C. (2001). The effect of a home visit on first year medical students’ attitudes towards older adults. Geriatrics Today, 4(4):182–5.
 Martínez-Arnau, F.M., López-Hernández, L., Castellano-Rioja, E., Botella-Navas, M., Pérez-Ros, P. (2022). Interventions to improve attitudes toward older people in undergraduate health and social sciences students. A systematic review and meta-analysis. Nurse Education Today; 110, 1-/6. Doi: 10.1016/j.nedt.2022.105269.
 Levy, B. R., Slade, M. D., Chang, E. S., Kannoth, S., & Wang, S. Y. (2020). Ageism amplifies cost and prevalence of health conditions. Gerontologist, 60, 174–81.