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Reframing Aging: A Podcast with Patricia D'Antonio


The COVID pandemic brought to light many things, including how society views older adults. Louise Aronson wrote a piece in the NY Times titled “‘Covid-19 Kills Only Old People.’ Only? Why are we OK with old people dying?”.  The ageist viewpoint she was rallying against was also brought to light in a study of ageism in social media.  When looking at those tweets that were related to older adults and covid, more than 1 in 10 tweets implied that either the life of older adults was less valuable or that it downplayed the pandemic because it mostly harms older adults.

So on today's podcast we are going to talk about the initiative to “Reframe Aging” with Patricia D'Antonio.  Patricia is a geriatric pharmacist, and the Vice President of Professional Affairs at the Gerontological Society of America (GSA).  

The Reframing Aging initiative is a national effort, led by GSA and supported by Archstone Foundation, uses an evidence-based approach to communicating more effectively about older adults.  There are a variety of resources available, including research reports,  an online toolkit, and free instructional videos, to help us talk about our work in geriatrics and aging.

For information about the Reframing Aging Initiative, please check out their webpage www.reframingaging.org.  In particular, check out these two helpful resources on their website:



  


You can also find us on Youtube!

 

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TRANSCRIPT

Eric: Welcome to the GeriPal podcast. This is Eric Widera.

Alex: This is Alex Smith.

Eric: And Alex, I see two familiar faces. Who do we have on our podcast with us today?

Alex: Welcoming to the podcast we have Trish D'Antonio who is Vice President of Policy and Professional Affairs at the Gerontological Society of America and Project Director of the Reframing Aging Initiative. Welcome to the GeriPal podcast, Trish.

Trish: Thank you.

Alex: And we have Ken Covinsky who pretty much needs no introduction. Repeat guest host at the GeriPal podcast and Professor of Medicine UCSF Division of Geriatrics. Welcome back to the GeriPal podcast, Ken.

Ken: Thanks for having me back.

Eric: And we're going to be talking about reframing aging, why it's important, what is it, how should we be thinking about talking about aging maybe differently, but before we do, Trish, do you have a song request for Alex?

Trish: I do. I like the birthday song from the Beatles.

Eric: And why is that?

Trish: Well, a couple reasons. One, I think it's important for us to celebrate our birthdays, especially as we're talking about aging, right? We're all aging, we should all celebrate birthdays. The other thing is that as we're doing our work in reframing aging one of the places where you can see ageism, just right out there are birthday cards. And so what I often do when I'm presenting is I ask people to think about birthday cards they might have sent recently, think about birthday cards they received and I have a couple birthday cards that I show for just examples of how we really perpetuate ages tropes in birthday cards. So I thought, let's celebrate birthdays.

Alex: That's great. All right. Well, I went a little electrified for this so we'll see what happens.

Alex: (singing)

Eric: Cool. I feel like you've got to smash the guitar now. [laughter]

Ken: No, it's awesome.

Trish: Thank you so much. That was great. Thank you.

Eric: Okay, Trish, reframing aging. How did you get interested in this from a personal perspective, and maybe from a GSA perspective too?

Trish: Sure. So I'm a pharmacist by training, Board Certified Geriatric Pharmacist. I've worked in aging most of my career. So older people are very important to me, I worked as a consultant pharmacist and started in college in pharmacy school. So how we respect older people has always been very important to me. And when the Reframing Aging Initiative started with the Leaders of Aging Organizations, so there are now 10 national organizations. The CEOs came together and said, "What's the piece that's holding us back that's common across all of our organizations?" And really what it was was the problem of ageism in policy, right?

Trish: So we can't get policy across because policymakers, not overtly, but we know that we all have implicit bias, and that implicit bias around aging is preventing us from getting our message across and getting our system straightened out. So that's how we got started in it. The research started back in 2014, 2013. So it's really been a fascinating progression for Reframing Aging.

Eric: Yeah, I started fellowship in 2005 and I remember sometime after 2005, between that and the start of the Reframing and Aging Initiative, man, the amount of times I've heard the word silver tsunami. Oh my god, we have this silver tsunami that's going to crash down. And this was from geriatric leaders in our field trying to advocate we need more support, because there is a silver tsunami coming and trying to scare everybody into doing something. And it sounds like it did not do what we wanted it to do and maybe scared people away from doing anything.

Trish: You raise a good point there, because I think one of the things as this project moved from the research to how do we get it out into the field, you think about this and we started with the aging advocates and aging experts because we're our own worst enemy. And that silver tsunami, this storm is coming, the individualistic stories really what we know from that research is those are the things that make people say, like they'll, "No, that's not something that we can solve. Let's go to something else. Right? So what do you do when a tsunami comes? You run. What do you do when there's a storm? You go for shelter."

Trish: And so those types of messages really start to work opposite what you think. And in the research aging experts, we think everybody thinks about aging and embraces aging, right? But really, what we learned was the public doesn't think much about aging and they certainly don't think about age discrimination until you actually bring it up with them. So we really wanted to start with aging, the aging community, the aging network, at the research level, at the clinician level, at the community based organization levels, to be able to get people to think about their communication strategy, right?

Trish: So this isn't put up a billboard or by a bumper sticker and everything's going to be solved. But really, what's your communication strategy, so that you can bring people along to advance policies and that could be policy here in Washington, DC, where I'm from or that could be policy in the health care facility that you're working in as we think about approaches to older people and aging.

Eric: And can you give us some examples of what are some evidence based strategies around reframing? A, what the heck is reframing? And can you give us some examples?

Trish: So a couple things. So reframing aging is a long term strategy. We know that this is like I was saying just now, it's not a billboard campaign that everybody's going to next week get it and move forward, right? So it's a long term strategy. It's evidence based, we took some time with our research partner the Frameworks Institute to conduct the research to see what we knew, see what we had. And it's designed to get the public to understand the contributions of older people to society and the importance of supporting that moving forward. One of the things we learned in the research when I said about the public not talking about aging and not thinking about aging, the way we do, there're some videos, and it's really... I'm glad that we're recording this, because then I can use my hands and show you.

Trish: One of the issues even when we interview people and they may look like the age that we're talking about for reframing around aging, right? And age discrimination. People push away, they actually, like you see in this video when they're interviewed about what their thoughts of aging are there's this subliminal, "Well, other people are aging. I'm not old, other people are old, right?" So it gets to that, how old is old? "10 years older than me." Right? So I think that's the one piece. The strategies that we tried to teach, so we tested values that might get people to think more productively about aging, right?

Trish: So we know that there are cognitive shortcuts that we all have to take to process everything that comes to us every day, right? So all these inputs, we process all of this. And we had shortcuts that when somebody says the word aging, we start to think about something already. Our goal is we know that we have unproductive cognitive models and we have productive cognitive models. So what the research did was test what are those productive models to get people to move forward and think more... This is not Pollyanna, but think more positively around about aging.

Trish: So when I talk about that we tested, we interviewed over 12,000 people, right? So Frameworks conducted these interviews. Some of that research looked at what does the public think about aging? What do we as aging experts think about aging? Once we move from there, we then started to say, "Okay, how do we create that frame that gets people to think more positively to support and recognize that we are all aging and policies in aging benefit us all, right? Because we are all aging."

Trish: The next thing I think that we looked at that's important to talk about is how to create a narrative. How to tell the story and it's not just any story that you want to tell often people want to tell their individual story which might be good when you're talking amongst yourselves, but if you're trying to get policy change, you want to talk about that systemic concrete solution. So we have values that we tested what people would hear, and it would generate that productive model. Why should you value that? What are the metaphors there that make you understand that story? And then what are the concrete solutions to that story?

Trish: So the narratives that tested well, are ingenuity and justice, right? So Americans, and this was tested in the United States, right? So this is not going to be something that you take to Europe or Asia the same way, right? Because there's different ways that different cultures approach aging, right? This is really cultural here that we're talking about. The two narratives when you use those productively we're able to see and in the testing, we were able to see that people started to understand why it was important to think about aging in a certain way.

Trish: So I'm doing a lot of talking. There's some when we tested, we learned that the public thinks about aging right as it's incomplete. It's like you're either on a cruise, you have this life of earned leisure and retirement or you're decrepit, right? You're feeling old and everybody's walking with a cane and there's that term of frailty that clinically, I don't think... It's not a clinical frailty, it's just a term that's come into the vernacular, where we just assume people are sick and old and decrepit.

Eric: So I guess, one question is, when I think about reframing too of aging what comes to my head when people talk about that is, let's not focus on yeah, older adults with disability living in nursing homes. Let's get those pictures of older adults running a marathon, doing a triathlon. We want to reframe aging to, hey, it's not all about disability and cognitive issues with dementia, it's about there are most older adults are not living in nursing homes. So let's reframe it on those. Is that part of the reframing message?

Trish: No. No. We talk about the swamp of public opinion and those are some of the things, the super senior, the 80 year old that's jumping out of an airplane, right? And so if we're all doing that or everybody's in a nursing home and they can't. I think what we're trying to say is that we're trying to create the communication strategy so that we can meet the needs of older people where they are, right? In a just society, we make sure that systems are in place, so that a person in a skilled nursing facility has the resources that they need, so that they can be living their best life, right?

Trish: When you are someone who is 80 years old, and you're living in the community, and you're active we are talking about how we all need to recognize that momentum that that person has and how they can contribute to society, right? There's still that opportunity to contribute to society.

Trish: Age alone, the chronological number, I mean, you all work in geriatrics, we all talk about this chronological age alone is not the reason that anybody has any issue that they might have. And really getting people to think about the diversity and the heterogeneity of the older adult population is really part of this fall as we're talking about... And how you can use some language to get people to think about that a little bit differently, again, queuing those models that our community is well served by intergenerational interactions.

Eric: And it sounds like part of this is focusing on some of the positive aspects like the positive aspects of the intergenerational community and older adults bring into that community.

Trish: Yeah. Particularly when you have people who are thinking about aging just being decrepit, right? You want to make sure that everybody thinks about aging as a diverse community.

Eric: And it sounds like part of this is this focusing on some of the positives rather than focusing on some of the vulnerabilities. Is that right?

Trish: I wouldn't say we don't... So we would recognize the vulnerability and what are the systems or what are the policies that need to be in place to support someone with their vulnerability? Right? So that's what I meant more about when someone's in a nursing facility, making sure that they have the resources that need to be available or somebody who's taking advantage of home and community based services. How are those systems? How are we getting supports for those systems and recognizing that that helps someone in what we would call frailty, right? In their need. Right, in a just society, we make sure that that's available.

Ken: So Trisha, I think this is really interesting work that I think you're doing. And I think it's really, I'm glad ETSA and ATS are really thinking about how the public approaches aging, but can I share with you one thing that maybe makes me just a little bit uncomfortable?

Trish: Yeah.

Ken: Is when reading this I was thinking that it's really important to know how the public approaches aging, but I had a little bit of a feeling, are we reacting too much to in fact, attitudes that are explicitly ages? So that for example, it's true that age is just a number. And it's very important that people of all ages be able to contribute. But it's also important that people of all abilities be able to contribute so that we... And so I fear a little bit that we hide away from some of the truths that are uncomfortable for people. So that, for example, it's very important, the public understand that there's a lot of vibrant older people. There's people in their 80s and 90s, who as we were saying are playing tennis.

Ken: But it's also true that almost the vast majority of people at some stage of their life are going to have a period of really significant physical or cognitive disability. That the vast majority of people are not going to escape this and is the fact that the public is uncomfortable with that very basic truth, so that dissuade us from really talking about that. And because I guess there's another part of me that feels like, I want to talk about the 80 year old playing tennis, but I don't feel that 80 year old needs my help, per se. And I don't feel that they're the people most in need of the advocacy of the GSA. That it's the 80 year old who's suffering from cognitive decline and the 80 year old in a nursing home whose work care models are just so awful and the respect of society is just so missing, that those are the people who actually need our advocacy.

Trish: So that's a good way that to frame some of this. And I think the importance of the Reframing Aging Initiative when we talk about it as being a communication strategy, is to help give you the tools to advocate for aging across the continuum. So if I was actually taking the time and providing the training right now, I'd spend some time on what are some of the perceived notions of the public as to why somebody might be in a certain situation and to blame on the individual, as opposed to what are the systemic solutions for us to get there. So what are the systemic solutions for us to be sure that systems are... That there are plans, programs in place that when someone is first recognized with cognitive impairment that we don't have an ageist approach to that, that says, "There's nothing we can do for you, you have cognitive impairment," when we all know that there are things that can be done for someone and that those programs need to be continued to be supported.

Trish: So I think our advocacy is across the board. I think what we learned is the public has this, it's an on offer one and zero thought about this. You're either the guy who's jumping out of the airplane or playing tennis or you're the guy who's got cognitive decline and there's nothing we can do for you and we all know there are things that can be done, and we need to continue to advocate. And by trying to integrate some of this communication strategy it takes some time, but we believe that and the research shows us that that change will happen. Some of it is getting at all of our implicit bias. Right? I often talk about there are older people, older adults who will say, "I have a pain in my back, oh, it's just because I'm 75." And I often talk about, "Yes, you are 75, yes, you have a pain in your back. You need to get to your clinician and talk to them about this because we need to figure out what the solution is for you. Right?"

Trish: So that gets a little bit more individualism. But we also know in certain diseases, if you're over the age of 65 or 70, right? Majority of people won't treat that, right? What happens in cancer at times depending on someone's chronological age as opposed to how they are physically and mentally, right? It's different, right? When I'm talking to those of us in geriatrics, we get it.

Trish: It's getting out to everybody else. But starting in the aging community was the best way to do this because we can all continue to frame, we can all continue to employ these strategies to help get people to move forward. And that's really our goal. So we do not deny that there is disability, that there is frailty, what we're saying is in a just society, we create the system so that people have the resources that they need. I always go back to how much we invest in the Older Americans Act programs compared to other types of products. And we don't invest that much funding in those programs, yet those programs can help us even in our clinic work, right? Because we know that we get people that are getting their nutrition, we have people that are getting the home and community based services that they need. So it's kind of that it's looking at that aging continuum.

Ken: Well, yeah, I like the way you're phrasing this, but I'm also thinking of the imagery that's often used. And this is true with the higher level at all the major aging organizations. Is that when there's a picture of an older person it's often a picture of a very older person swimming, sometimes even running. And I kind of feel that we're afraid of the older person using a walker or a wheelchair. And I mean, so how do we balance? I guess, part of this is... But how do we... On the one hand, we want the public to realize, no, not every 75 year old needs a walker or a wheelchair.

Ken: But also, I guess my problem in clinic, though, is not the 75 year old who doesn't need a walker, but wants one anyways. My problem is the 75 year old who's falling and because of ages, the attitudes in society feel stigmatized by a walker. So doesn't do this really basic thing that could protect them and make their life so much better, so-

Eric: And I think a great example of that was Nature Aging just came out. So new publication, great articles on ageism in the developed world, ageism how we think about it, ageism how it relates to elder mistreatment. And the picture on the cover was an older adult running a marathon, crossing the finish line which felt a little bit like okay, that's one way we can say that okay, age is you people can run these marathons. But it felt a little bit discongruent with what I was reading in these papers.

Ken: And I still would have loved to seen in a picture of a smiling 80 year old in a wheelchair that's still actively participating with their family, maybe that they're the church elder who everyone respects to say that both is true. That we have to respect older people wherever they are.

Trish: Exactly. But that's exactly what we're trying to do. And this will take time. One of the things that we know about this is because it's culture change, right? We're trying to change culture. So I often say to my boss, "Thanks, you gave me just a small project that I should be working on." And all of that we have to keep reminding everybody. And so with the aging organizations that are involved the leadership and their boards have to remind their members.

Trish: So Ken, you bring up such great points that I think we have an obligation to continue to point that out. So we're trying to say, "As we reframe aging, we shouldn't be afraid of those types of... We should have a collage of pictures that recognizes the diversity in aging," because I don't think everybody thinks about that that way. And our research sort of bears that out. That the other piece of that and I think you'll start to see some of this often when I'm presenting in front of people, the example that I use when we talk about you'll say well, and I think lay people use the word frailty differently than we do. So I'm really talking about lay people talking about frailty or just in common vernacular.

Trish: When people talk about that and I say, "Well, systems should be there so that a person who needs a wheelchair or a walker has that so they can continue to be part of the community that they live in, they can continue to be part of their family engagements. Like get somebody to graduation right for their grandson or a wedding. Those are important things. Yet, our implicit bias around ageism, might say, "Somebody is a..." First of all, might not have a system for them to be able to get the wheelchair, right? We all know that we have to go through for that. But the second piece is that that person feels like I'm in a wheelchair I can't participate in society like I should.

Trish: We all should embrace that and I think maybe the challenge sometimes for those of us who've worked in aging, as long as we have is we don't get why everybody else doesn't think this way. Right? We are like, "You can do whatever, we can make that happen for you." So I think that's where sometimes people say the positivity might be a little too much and they don't get it yet, but really, I often talk to people about taking... There's an implicit bias test on a Harvard website. I tell people in aging, that they should take it because I think even we would be surprised where we might fall on that implicit bias test. And I was surprised where I fell, I was not over the line for bias, but I was pretty close to the line and I didn't...

Alex: I was over the line I put it on the record.

Trish: You were at the line?

Alex: Yeah.

Alex: An implicit bias against older people and in favor of younger people.

Trish: Yeah. Did you expect that?

Alex: No, well, I wasn't surprised. I mean, that's the point of the implicit bias test, right? That even though I work in combating ageism and in geriatrics and palliative care and that I've picked up the cultural residue and just the images and bombarded with negativity and the birthday cards as you talk about just in everyday speech, it's so incredibly common, it is not at all surprising that I have that bias. Because it's unconscious, it's implicit, it's not something that you can counteract immediately after 40 something years of being exposed to it.

Trish: Do you want to know what's great, though? Our research has shown us that if people become aware of their implicit bias, so we have some research where we asked subjects... We ask people, I don't want to say subjects. It was research, but we asked people, what their impressions of aging were. And you should see some of their responses. I mean, it's very like, "Oh, I don't want to get old. It's not easy to getting old."

Trish: But there were some statements that were reframed, interviewed them five minutes after and it was amazing some people are just like, "Oh, yeah, in aging, we can be part of the community," and just making people aware of that with a well reframed message can get them down the path and we have some research that's published in one of our journals that showed how this works. Now, takes time. This is not going to be an overnight thing, but quite honestly, if we don't do this now, where are we going to be in 10 years, right?

Trish: So we're all going to be sitting there saying, "Remember that research somebody did, it never moved into practice." And that's where we are is trying to get this into practice.

Ken: Trish, and this is fascinating. So I'm going to ask you, one of the things I found really fascinating about this discussion is your reports talk a lot about the use of language, and I struggled with this and going back and forth. So I'm going to pose a question and this might seem well, just a touch hospital, it's not intended to. And it's not just, it's directed at Eric and Alex too because you're both editors and fans. So here's my point.

Ken: An example and you can push back the hostility at me. You can tell me I'm totally wrong about this. So here's my question, for years I had papers in Jags, one of the favorite words I like to use in Jags was elders. I described my population in my study as elders. And I'm not allowed to use elders anymore. So my plea to you as I always thought elders was a term that really engendered...like it's a term I used just a few minutes ago on that search elders. It's a term that really reflected profound respect for older people.

Ken: But now in my papers in Jags, journals with the American Geriatric Society for our listeners who aren't familiar. Now in my papers in the leading geriatrics journal, I have to say older adults, because that did better in focus groups and surveys of older people. So I guess my question for you is, am I wrong to ask to get elders back or am I just being silly and Pollyanna and not understanding the need to use terms and the way they're perceived by the public? And that I'd be saying back to myself, if I can use a term that there's more comfort with, that gets the same point across that I use it?

Alex: Ken, I thought you were going to go there, you got to go there. It's a good analogy.

Trish: So I have some response to this, but and Nancy Lundebjerg and I worked very closely together and work very well together. I don't know if you want to answer from the perspective of Jags first and then I can talk about what the research really taught us and why we're moving forward in that language, it's up to you.

Eric: Why don't you start off Trish?

Trish: Okay. So here's what the research told us and I think it was one thing that everybody could grasp concretely, when the research first came out and we're trying to figure out what does this all mean? So we tested the words, seniors, older people, older adults, elderly and elders. And we ask across the age continuum, what does that mean to you? When we talk about competence, seniors and elderly test very low on competence, right? So if we're trying to get people to break this concept of ageism referring to people, as seniors in our language might not always help us.

Trish: When we tested that language and asked about... The other piece was how old is this person? Right? So when you say older person, older adult, well, guess how old older adults are? Anywhere from 45 to 55. So that's where I'm getting-

Eric: I pretty sure my 12 year old son would call me an older adult.

Trish: Yeah, I mean and rightly so, right? You're an older adult. So thinking about how you can make sure that people are thinking, right? You're getting that cognitive model where you need to go older people and you'll hear me say older people or older person a lot more.

Trish: That being said, I've said this publicly, in many places, "I am not the word police," because you could change the word senior to older people and I don't think it'd be your paper and I'm not saying it would be anybody's research paper that would get published. But if what's behind that is still ages or is still not really adopting the framework and the principles that we're trying to get across, doesn't matter, right?

Trish: So that's one thing that's really important. That being said, we know when the research is published, and starts to look at how we can cue productive models for people to think about that research in a way that even when it is a research about frailty and disability, we could get people to start to think about what are those systemic solutions, right? Kind of what I explained earlier. That's where clinicians start to pick that up and model the language, that's where the press starts to pick that up and model the language. That's where it starts to come into the public.

Trish: So that's why it was really important for us almost at the outset was, "Well, if you could get the research to change, all right, let's talk with the AMA publishers. Let's talk with the APA, American Psychological Association and even talking with the Associated Press," to get them to start to get this language this bias free language into their style manuals. Now, it's in the style manual. Is everybody using it yet? No, it's going to take some... This is again, this is this long term change.

Trish: So honestly, I do. I mean, I get up and I say, "I'm not the word police. I can't be the word police. Right? There's a whole world." What I can do is call things out when I hear an ageist message, right? And if you're using the word senior, if you're using the word older people but it's still accompanied by an ageist message that's all of our opportunity to call that out and say, "That's a little bit ageist there. Let's talk about that, what does that mean?" So because and it was a small part of the research, but we thought it was an important part to get out there because words do matter, right?

Trish: I mean, you're prolific writer you know you sit there and think about some of those words all the time and how you put them in there. Now, if you're in a community that uses elder as a term of respect, that should be used, right? So nobody's saying don't use the word, elder when it's a term of respect. If it's a term not being used well to get people to get past their biases about age and aging, then I would say, "Well, think about that word."

Eric: And go ahead, Alex.

Alex: I was just going to say, one of the earliest posts... Oh, I guess it wasn't that. 2012, I wrote a blog post for GeriPal elders, older, adult seniors, language matters. And the idea behind this is I wrote a paper in a prominent journal for a small Massachusetts Medical Society titled, We Should Routinely Offer to Discuss Prognosis With Elderly Patients. And I was interviewed by a reporter for the USA Today who's in her 70s. And she grilled me about the use of the term elderly.

Alex: And she said, "When does a person become elderly? What is elderly?" And I said, "It's a term of respect." And then she said, "But when does person become older adult?" And then I flipped the question and I asked her, "You are the writer for USA Today who writes about geriatrics issues, what term do you use?" And she said, "I never use the term elderly. My readers don't respond to older adults, either. They don't want to be older. We prefer the term senior.

Trish: That's interesting.

Alex: So she has a reasoned argument behind why she preferentially uses a term senior which in a different focus group research context, you found was not as favorably viewed.

Alex: So I think there's no reason... I agree with your underlying argument that we need to address ageism when the language is used in an ageist manner and the underlying attention brings ages connotations. But there are multiple meanings of many of these words. And we need to be aware of their origins, ideologies and how they're used. Ken, you look like you want to say something.

Ken: Yeah, well, you remind me that I think you've had this on one of your prior podcasts, our colleague Louise Aronson, basically, in her writings have said, the one thing that's unique about ageism as a prejudice is that it's prejudice against their future sounds. That we all expect to reach there. So that it raises this fascinating question is that, so when your reporter says, "I don't use elderly, because my readers don't like it," is that the right response? My readers don't like to think of themselves as growing older and do we sort of say like, "Well, okay. Well, I won't talk about that."

Ken: Or should we say, "Well, guess what, you're going to be getting older and you know what and maybe you don't want to talk about it, but your mother is getting older and your grandparents are getting older and we do a terrible job taking care of them as they develop those needs. And maybe we should talk about it a little bit more, so."

Trish: One of the things that I do when I'm writing is I actually quantify or qualify the age group I'm talking about. And when people ask me to review something they've written for Reframing Aging, if they say older people, I say, "Well, what age group are you talking about? People over the age of 80, people over the age of 75, people from 65 to 75. So be specific, talk about so that the reader gets the picture in their mind instead of trying to guess what you mean."

Trish: Now, my guess is when you're writing for a clinical journal, like Jags you're defining those age groups, but come back to that. I mean, that's often one way that you can ensure that there's not much guests in there, there's still going to be a guess of what the picture is depending on how we framed 65 to 75 because we know that there's a diversity in that age population too. But it does get people a little bit more to the age group that you're thinking about, you're being specific about it. So that's one thing that I do recommend when people are trying to figure out how to do that communication.

Eric: A little off topic of where we are now, I'm just wondering, as you look back to the last year with COVID, how have we done with... I feel like COVID has really shown the rest of the world what we kind of knew before. We ignore long term care patients, we don't have a lot of support for frail older adults, adults with disability. It's just not something our society or our healthcare systems spend any time or attention to. How do you think we've done as far as reframing in the last two years or examples, if you think frames that just did not work?

Trish: So I think about March and April and all of a sudden when... So we have trained people nationally around Reframing Aging. And then we also have colleagues that we have trained locally. So that's part of... So people in the northeast area in New Hampshire, and Massachusetts, and Rhode Island and some folks in San Antonio and Colorado, have all kind of embraced this philosophy, and they're moving forward in their communities. And we started getting calls, I work at a hospital system, and they're making decisions based on chronological age only. What can I do? How can I help? And I can imagine that you may have heard this in some settings as well, we know that there were policymakers who came out and said, "I'm over the age of 70, that's okay, you don't have to worry about me, I want you to take care of kids," which is noble in some ways for that individual. But that's not a systemic solution.

Trish: So I think what we really learned was ageism was on steroids. Right? And the piece to that, that I think what's really important is, so we talk about that don't get to that fatalism, right? You don't want to talk about a tsunami, and we still don't want to do that. But you have to recognize the urgency in a pandemic, right? So we have to recognize that at the same time that we're recognizing the efficacy, right? That we have to have systems in place for all of us as we age. Right? And that for me, having worked in aging, as long as I had, it was just, I could not believe that I was hearing some of these policy statements that were coming out just based on age alone.

Trish: So I think we tried to do a lot of work to give people tools to be able to communicate and recognize that the importance of services for older people of the need for paying attention for nursing homes and paying attention for assisted living facilities, making sure that there were systems that recognize just how we should be paying attention to all of it, right? All of it. So the people that are employed in those facilities, as well as the people that live in the facilities. And I think we're coming along now, but at the beginning, I don't know how you guys felt, but I really recognized why this program that we're doing is important to reframe aging and I think before that, I probably thought of it as it's important and it's part of a test that we do in an aging society.

Trish: With COVID, I felt like I had to work extra hard to make sure that people understood that in a just society, we value all members of the society. And that was pretty intense. Really, I was blown away about some of the comments that I heard that were truly ages and people didn't think anything about it. And we had the responsibility to go out there and call them out on it and I think we tried. I think we learned from this and what we can do better. And I think it's given us more opportunity to be able to be in front of people now, so.

Eric: Yes, there's definitely this sense of and people actually say, "Oh, it's just older adults in nursing homes who are dying we shouldn't be closing the economy doing everything because they were going to die anyways."

Alex: Closing schools. Giving vaccines to older adults rather than school teachers. Ken, did you want to jump here about this? Jump in here?

Ken: No, I mean, I'm really glad you're bringing this up. And I think I should have said from the time I'm really grateful for organizations like GSA and AGS during this year of COVID, who have really called attention to just the profoundly terrible things that happen to older people. And I think, this really COVID's really illustrated the point of the fore need to be respectful of older people of wherever they are. Just the older person who we want to help stay healthy, but really realizing that even for healthy older people, social isolation, can have devastating effects. And they're just horrendous things that have happened in nursing homes and assisted living during the past year.

Trish: But, we had to end on a high note, right?

Eric: Yeah. I was trying to figure out how to throw in the word Happy birthday into COVID ageism issues. We did not end on a high note with that, but right, that's part of the reframing. We should be acknowledging the issues, the vulnerabilities, the problem. But we should also be highlighting potential solutions, right? Not that there's this silver tsunami and we should all run away, but there is a diversity in older adults and how their background where they're coming from, there is intersectionality, between all of these isms as well and potentially throwing out some solutions or things that we can do to move forward. Is that right?

Ken: And I think one of the things that I mean, I saw in your reports that's really important here is that you emphasize that the positive part about this is it doesn't have to be this way, that you point out that a lot of what's negative stereotypes happens because of the way we structure care, and the lack of help and assistance we give older people. So that a lot of what is perceived as negative does not actually have to be that way.

Trish: Exactly. Exactly. And that's where I think we can look at what are the systemic solutions as people who work in the aging field, what are those systemic solutions and get policymakers whether they're in institutions individually or policymakers in the state and local governments or in our national dialogue. That's where it's really important to get it there, so we can get those solutions for people as they age, as we age, not as they as we age. All right.

Eric: Well, that seems like a much better way to end this podcast. Trish, a big thank you for joining us, but before we end, Alex, do you want to give us a little bit more of The Beatles?

Trish: Thank you so much. This was a great experience. Thank you.

Eric: Thank you, Trish. Thank you, Ken, for joining us as well. Big thank you to Archstone Foundation for your continued support of our podcast and Reframing Aging project and to all our listeners supporting the GeriPal podcas. Good night, everybody.

Alex: Good night.

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