"In times of public emergency, social truths are revealed. The coronavirus crisis is one such emergency, and it reveals that the lives of the elderly appear to matter less and, in some cases, are even deemed disposable."1 - -Shir Shimoni, PhD-C

Readers will receive this issue of the Journal of Geriatric Physical Therapy in the summer of 2020, as coronavirus infection and coronavirus disease-2019 (COVID-19) mortality rates continue to rise in many parts of the United States and around the world. Older adults are especially vulnerable and hard-hit, particularly those in congregate living, and homes where adult children cannot work remotely. Health care professionals and paraprofessionals, including physical therapists (PTs) and physical therapist assistants (PTAs), risk their own health and safety, as they continue to provide services to these older adults. Other PTs/PTAs are furloughed and financially stressed, as less essential and elective services take a back seat to critical care needs. Geriatric rehabilitation researchers, who devote their careers to producing the evidence that informs high-quality clinical care, find their laboratories empty and investigations stymied as socially distancing older adults are unable to participate in nonessential studies for the foreseeable future. This is no ordinary time, and this is not a typical Editor's Message. No "business as usual" message would be adequate to speak to the readers of this Journal, who care deeply about the health and well-being of older adults, as the coronavirus pandemic unfolds.

This genuine concern for and commitment to the welfare of older adults is not shared by all, however. Responses to the pandemic have revealed the persistence of terrible ageism in our society.2-4 Negative ageist messages in remarks by public figures and media communications range from merely grossly offensive to frankly dangerously immoral. The more subtle ageist messages seek to reassure younger people about their own (relatively) lower risk by saying, in effect, "Don't worry, it's mostly the old and infirm who will die."5 These sorts of messages wrongly imply that most older adults are not strongly connected to and deeply loved by their younger family members and friends, that no one would-or even should-care if older adults suffer and die. These messages treat older people as dispensable, disposable, and burdensome.6 They normalize the horrific premature loss of tens of thousands of older adult lives as quite acceptable, and nothing to worry about, as long as younger people, ostensibly more worthy of additional years of life, are safe (they are not).

Other, more overtly ageist messages shock our moral sensibilities. One elected official commented that, in effect, older adults ought to gladly sacrifice their lives to allow commerce to proceed uninterrupted.7 Even worse are messages indicating that a mass die-off of older adults would be a welcome occurrence. The coronavirus "could be quite useful to get rid of hospital bed-blockers," remarked a former government official,8 while an economic analyst noted that the pandemic is doing us all a great service by "culling elderly dependents."9 One online coronavirus meme has labelled COVID-19 the "Boomer Remover";10 pretty funny, right?

Fortunately, these negative ageist messages are being assertively countered by bold and positive remarks from other public figures, health care professionals, and older adults advocating for themselves. "My mother is not expendable, and your mother is not expendable," said one Governor: "We're not going to accept a premise where human life is expendable."11 Speaking at another Governor's press conference, a prominent epidemiologist articulated their mutual position that every life is worth saving, regardless of age.12 The World Health Organization issued a statement warning against COVID-19 age discrimination,13 and the US Department of Health and Human Services Office of Civil Rights issued a bulletin saying, "Persons with disabilities, with limited English skills, and older persons should not be put at the end of the line for health care during emergencies."14

Geriatricians are speaking up to advocate for the older adults they serve. Louise Aronson, MD, wrote, "Everyone can help create a less ageist culture and improve individual institutions ... Keeping older people uninfected and alive shouldn't be the country's only goal for this vulnerable group, nor should it be once the pandemic passes. After all, living in a society that values your well-being and basic humanity matters, too."2 Michael Wasserman, MD, argues in support for the individual agency of older adults to make their own choices. He posits that every older adult should have an advanced directive, and that an older individual's wishes as expressed in their advanced directive should be respected.15

Perhaps the most powerful pro-aging messages come from older adults themselves. "When did elderly people like me become disposable?" queries Professor Emeritus Paul Socken.16 He asks us to reflect on the very nature of our society and its values: "What lack within us gave rise to the discussion of the disposability of the elderly?" In a now viral post, 90-year-old artist Varda Yoran penned a challenge: "Our lives, our dreams, our productivity don't end when we turn 65, an age that society decided was 'old enough.'" Yoran continued, "As long as I'm still creative and surrounded by the love of family and friends, as long as I still enjoy life, nobody has the right to write me off."17

The Journal of Geriatric Physical Therapy is the official journal of APTA Geriatrics, whose empowering motto is "Age On." This positive message stands in clear opposition to any notion that older adults are less worthy of life and ought to gladly, as the poet Dylan Thomas wrote, "go gentle into that good night."18 All those committed to the health and well-being of older adults should "rage, rage" against the appalling ageism revealed during this pandemic. Our advocacy is needed now more than ever.

Editor's note: Readers should know that this Editor's Message in no way refers to the tragically difficult individual triage decisions made by doctors and nurses on the front lines of this pandemic who are faced with critical resource shortages. Many of the authors cited herein stated this same sentiment explicitly.

Leslie Allison, PT, PhD, Editor

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