Tagged Elderly

When Patients Choose to End Their Lives

For some, the decision to die is more complicated than a wish to reduce pain.

At a time when so many are dying against their will, it may seem out of sync to discuss the option of having a doctor help people end their lives when they face intolerable suffering that no treatment can relieve.

It’s less a question of uncontrollable physical pain, which prompts only a minority of requests for medical aid in dying, than it is a loss of autonomy, a loss of dignity, a loss of quality of life and an inability to engage in what makes people’s lives meaningful.

Intractable suffering is defined by patients, not doctors. Patients who choose medical aid in dying want to control when they die and die peacefully, remaining conscious almost to the very end, surrounded by loved ones and able to say goodbye.

Currently, nine states and the District of Columbia allow doctors to help patients who meet well-defined criteria and are on the threshold of dying choose when and how to end their lives. The laws are modeled after the first Death with Dignity Act, passed in Oregon in 1997.

A similar law has been introduced repeatedly, and again this January, in New York. Last year, Maryland came within one vote of joining states that permit medical aid in dying. Diane Rehm, the retired National Public Radio talk show host, says in a new film she created on the subject, “Each of us is just one bad death away from supporting these laws.”

Most people who seek medical aid in dying would prefer to live but have an illness that has in effect stripped their lives of meaning. Though often — and, proponents say, unfortunately — described as “assisted suicide,” the laws hardly give carte blanche for doctors to give people medication that would end their lives quickly and painlessly. The patient has to be terminally ill (usually with a life expectancy of less than six months), professionally certified as of sound mind, and able to self-administer the lethal medication without assistance. That can leave out people with advanced dementia or, in some cases, people with severe physical disabilities like those with amyotrophic lateral sclerosis (A.L.S., or Lou Gehrig’s disease).

A desire to broaden access to medical aid in dying prompted Ms. Rehm to create the film “When My Time Comes” to air on public television starting April 8. (A free livestream of the film preview and discussion will be available on April 8, at 12:45 p.m. Eastern, at weta.org/WhenMyTimeComesFilm.) The film follows the 2020 publication of Ms. Rehm’s book of the same title, subtitled “Conversations About Whether Those Who Are Dying Should Have the Right to Determine When Life Should End.” Both the book and film were inspired by the protracted death in 2014 from Parkinson’s disease of John Rehm, her first husband, to whom she was married for 54 years.

Mr. Rehm, then living in Maryland, could no longer stand, feed or toilet himself, but his doctors could not legally grant his plea to help him die quickly. Instead, the only recourse he was given was to refuse all food, liquid and medication, which ended his life 10 days later.

This is still the only option doctors can legally “prescribe” for the overwhelming majority of Americans who live in the 41 states that have yet to pass a medical aid-in-dying law. The approach does indeed work, but it’s not an acceptable choice for many dying patients and their families.

Ms. Rehm said her goal is that no patient should have to suffer the indignity her husband experienced at the end of his life. She described his death as “excruciating to witness,” even though after about two days the absence of food and water is usually quite tolerable for the patient.

Dr. Jessica Nutik Zitter, a palliative care physician at Highland Hospital in Oakland, Calif., said in an interview, “The concept of medical aid in dying is gaining acceptance, but it takes a while for people to be comfortable with it. Doctors are trained to just keep adding technology to patient care regardless of the outcome, and withdrawing technology is anathema to what we’re taught.”

As a result, doctors may convince dying patients and their families to accept treatments “that result in terrible suffering,” said Dr. Zitter, author of the book “Extreme Measures: Finding a Better Path to the End of Life.” In her experience, a fear of losing control is the main reason patients request medical aid in dying, but when they have access to good palliative care, that fear often dissipates.

Only a third of patients who qualify for medical aid in dying actually use the life-ending drugs they get, she said, explaining that once given the option, they regain a sense of autonomy and no longer fear losing control. In a study of 3,368 prescriptions for lethal medications written under the laws in Oregon and Washington state, the most common reasons for pursuing medical aid in dying were loss of autonomy (87.4 percent); impaired quality of life (86.1 percent), and loss of dignity (68.6 percent).

Of course, many doctors consider medical aid in dying contrary to their training, religious beliefs or philosophy of life. Dr. Joanne Lynn, a geriatrician in Washington, D.C., who is not a supporter, said the emphasis should be on providing better care for people who are very sick, disabled or elderly.

“We should resist medical aid in dying until we can offer a real choice of a well-supported, meaningful and comfortable existence to people who would have chosen a medically assisted death,” Dr. Lynn said. “There’s currently no strong push for decency in long-term care. It’s not a real choice if a person’s alternative is living in misery or impoverishing the family.”

Barbara Coombs Lee, president emerita of Compassion & Choices, a nonprofit organization in Portland, Ore., that seeks to expand end-of-life options, said, “The core principle of medical aid in dying is self-determination for someone who is terminally ill.”

Still, Ms. Lee, the author of “Finish Strong: Putting Your Priorities First at Life’s End,” said that there are options for the majority of dying patients who still lack access to an aid-in-dying law. In addition to voluntarily refusing to eat and drink, everyone has the right to create an advance directive that stipulates the medical circumstances under which they would want no further treatment.

For example, people in the early stages of Alzheimer’s disease could specify that when they reach a certain stage — perhaps when they no longer know who they are or recognize close relatives — they do not want to be treated if they develop a life-threatening infection.

Leaving such instructions when a person is still able to give them “is a gift to the family, relieving loved ones of uncertainty,” Ms. Lee said. She suggested consulting the website compassionandchoices.org for tools that can help families who want to plan ahead.

Walking and Other Aerobic Exercise May Aid the Aging Brain

Older people with mild cognitive impairment showed improvements in brain blood flow and memory after a yearlong aerobic exercise program.

Brisk walking improves brain health and thinking in aging people with memory impairments, according to a new, yearlong study of mild cognitive impairment and exercise. In the study, middle-aged and older people with early signs of memory loss raised their cognitive scores after they started walking frequently. Regular exercise also amplified the healthy flow of blood to their brains. The changes in their brains and minds were subtle but consequential, the study concludes, and could have implications not just for those with serious memory problems, but for any of us whose memories are starting to fade with age.

Most of us, as we get older, will find that our ability to remember and think dulls a bit. This is considered normal, if annoying. But if the memory loss intensifies, it may become mild cognitive impairment, a medical condition in which the loss of thinking skills grows obvious enough that it becomes worrisome to you and others around you. Mild cognitive impairment is not dementia, but people with the condition are at heightened risk of developing Alzheimer’s disease later.

Scientists have not yet pinpointed the underlying causes of mild cognitive impairment, but there is some evidence that changes in blood flow to the brain can contribute. Blood carries oxygen and nutrients to brain cells and if that stream sputters, so can the vitality of neurons.

Unfortunately, many people experience declines in the flow of blood to their brains with age, when their arteries stiffen and hearts weaken.

But the good news is that exercise can increase brain blood flow, even when exercisers are not moving. In a 2013 neurological study, the brains of physically active older men showed much better blood saturation than those of sedentary men, even when everyone was quietly resting. The greater brain blood flow in people who exercise also is associated with better scores on tests of memory and thinking than among sedentary people.

But these studies generally focused on people whose brains and cognition were relatively normal. Exercise bulked up, for them, what already was reasonably sound. Far less is known about whether physical activity similarly benefits the blood flow, brains and thinking of people who are starting to experience more serious memory loss.

So, for the new study, which was published this month in the Journal of Alzheimer’s Disease, researchers at the University of Texas Southwestern Medical Center in Dallas and other institutions asked a group of 70 sedentary men and women, aged 55 or older and diagnosed with mild cognitive impairment, to start moving more.

They first brought everyone into the lab and tested their current health, cognitive function and aerobic fitness. Then, using advanced ultrasounds and other techniques, they measured the stiffness of their carotid artery, which carries blood to the brain, and the amount of blood flowing to and through their brains.

Finally, they divided the volunteers into two groups. One began a program of light stretching and toning exercises, to serve as an active control group. The others started to exercise aerobically, mostly by walking on treadmills at the lab, and then, after a few weeks, outside on their own. The exercisers were asked to keep their exertions brisk, so that their heart rates and breathing rose noticeably. (They could swim, ride bikes or do ballroom dancing if they chose, but almost everyone walked.) The control group kept their heart rates low.

Everyone in both groups worked out three times a week at first, for about half an hour and under supervision. They then added sessions on their own, until after six months, they were completing about five workouts most weeks. This program continued for a year, in total. About 20 volunteers dropped out over that time, mostly from the walking group.

Then the volunteers returned to the lab for a repeat of the original tests, and the researchers compared results. To no one’s surprise, the exercise group was more fit, with higher aerobic capacity, while the stretchers’ endurance had not budged. The aerobic exercise group also showed much less stiffness in their carotid arteries and, in consequence, greater blood flow to and throughout their brains.

Perhaps most important, they also performed better now than the stretch-and-tone group on some of the tests of executive function, which are thinking skills involved in planning and decision-making. These tend to be among the abilities that decline earliest in dementia.

Interestingly, though, both groups had raised their scores slightly on most tests of memory and thinking, and to about the same extent. In effect, getting up and moving in any way — and perhaps also interacting socially with people at the lab — appeared to have burnished thinking skills and helped to stave off accelerating declines.

Still, the researchers believe that over a longer period of time, brisk walking would result in greater cognitive gains and less memory decline than gentle stretching, says Rong Zhang, a neurology professor at UT Southwestern Medical Center, who oversaw the new study.

“It probably takes more time” than a year for the improved brain blood flow to translate into improved cognition, he says. He and other researchers are planning larger, longer-lasting studies to test that idea, he says. They hope, too, to investigate how more — or fewer — sessions of exercise each week might aid the brain, and whether there might be ways to motivate more of the volunteers to stick with an exercise program.

For now, though, he believes the group’s findings serve as a useful reminder that moving changes minds. “Park farther away” when you shop or commute, he says. “Take the stairs,” and try to get your heart rate up when you exercise. Doing so, he says, may help to protect your lifelong ability to remember and think.

A Nursing Home’s Mission to Vaccinate Its Hesitant Staff

Almost all of the residents at Forest Hills of D.C. got their initial Covid-19 shots in January. But nearly half of the staff there had declined. Would an effort to change their minds succeed?

WASHINGTON — The Covid-19 vaccine had finally come to Forest Hills of D.C., a nursing home in a prosperous neighborhood of the nation’s capital, but there was a problem. Though nearly all of the home’s residents agreed to get the shots, nearly half its 200 staff members declined.

Tina Sandri, the chief executive, vowed not to let those numbers stand.

Over the next two months, rounding out the most bruising year of her long career in elder care, Ms. Sandri tried everything. She bombarded employees with text messages containing facts about the science behind the vaccines. She assigned a popular young worker to try to sway reluctant colleagues as an “influencer.” She set up a giant screen to show a television special that the Black actor and director Tyler Perry made to fight vaccine hesitancy — on a continuous loop, no less. Most of all, she worked to understand their concerns.

“You really have to listen to each person’s story and address it from that standpoint, so they feel, ‘This is a workplace that cares about me,’” she said.

Three months after the nation’s health care workers were among the first Americans to be eligible for the lifesaving new vaccines, long-term care facilities across the country continue to face a similar daunting challenge. The federal program that sent vaccinators from Walgreens and CVS into tens of thousands of nursing homes and assisted living residences has by one measure been strikingly successful, inoculating nearly all of the vulnerable residents of the facilities. Deaths in nursing homes have plummeted since the program began in late December.

But reaching the mostly low-wage employees of the facilities has proved far more difficult. A poll by The Washington Post and Kaiser Family Foundation conducted from Feb. 11 to March 7 found that half of the workers at nursing homes had yet to get even a first shot, and only 15 percent of that group said they definitely planned to.

At Forest Hills, the workers who turned down the vaccine during the center’s first vaccination event in early January included nurses, certified nursing assistants, members of the kitchen and activities staffs, and a security officer. Most were Black, reflecting the overall makeup of the home’s work force; many were immigrants from African countries, such as Nigeria, Liberia and Cameroon.

Ms. Sandri’s goal was to persuade — not pressure — them. But she found there was not one unifying story behind their refusal, and no straightforward message that helped to convince them.

She ruled out some tactics deployed by other nursing homes, including offering gift cards, bonuses or extra vacation days to employees who agreed to get the vaccine; Ms. Sandri considered those incentives inappropriate and called them “bribes.”

“We’re doing this because we care,” she said. “To dilute that message with other things is almost patronizing to people’s intellect.”

The vaccinators from Walgreens would come back twice more — in early February and early March — and Ms. Sandri had dozens of minds to change. By her count, there were still 92 employees who needed the shot.

Tina Sandri, right, chief executive of Forest Hills of D.C., receiving her vaccine shot. She wanted the first day of vaccinations to feel like a party, she said.
Tina Sandri, right, chief executive of Forest Hills of D.C., receiving her vaccine shot. She wanted the first day of vaccinations to feel like a party, she said.
Mariah Proctor, a security guard at Forest Hills, said her mother had said to her about the vaccine: “You don’t know the ingredients. You know nothing.”

January

Ms. Sandri, 57, a yoga and outdoors enthusiast whose manner is at once bustling and soothing, had arrived at Forest Hills only in May, replacing a predecessor who left after the coronavirus had taken hold.

Three residents at Forest Hills had died from the virus and 17 others had become ill, along with 45 members of the staff — a less devastating toll than at many other nursing homes, but still an ordeal. Another resident would die in February, after a flurry of cases over the holiday period.

For the first vaccination event, on Jan. 4, Ms. Sandri laid out snacks, took lots of pictures and played upbeat music — “the cookout kind!” — aiming to create a partylike atmosphere that could help people feel the hope and promise of getting immunized.

When Mariah Proctor, a security guard, arrived for her shift that day, she encountered the festive buzz — and the persistent question between colleagues: “Are you getting it?”

Her answer was no. A conversation with her mother, who she said had never taken her for vaccinations for fear of putting anything besides healthy food in her children’s bodies, had cemented her decision.

Ms. Proctor, 24, said her mother had told her: “You don’t even know what that is. You don’t know the ingredients. You know nothing.”

After the disappointing vaccination turnout that first day, and with morale dipping and emotions fragile as the pandemic wore on, Ms. Sandri changed her approach. She had been holding “huddles” with different departments to explain the science of the vaccines, but now, instead of continuing to load people with facts, she focused on asking them: What information do you need? What is your concern?

Miles Lee has been serving as an influencer of sorts at Forest Hills, talking to his co-workers about their feelings or offering to look up information for them about the vaccine.
Ms. Sandri reviewing the “Heroes of Hope” wall depicting staff members who have been vaccinated.

February

Ms. Proctor was taking a break from her shift with Deborah Childs, a colleague from the payroll department who had also refused the vaccine, when the vaccinators from Walgreens came back on a snowy day in early February.

This time, Ms. Childs agreed to get the vaccine.

“I looked up the company and, you know, I found out that they’ve been doing research on mRNA for over 10 years, so that made me feel a little bit better,” she said, referring to the molecule that is the active ingredient in the Moderna vaccine that Walgreens is offering.

She was still a little scared, especially after reading about a doctor in Miami who had developed a rare blood disorder days after getting the Pfizer shot and died two weeks later. Still, she said: “I’m ready to get back to my life. And I know that this is probably one of the ways that we’re going to get back to being normal.”

Ms. Proctor was wavering. “My emotions are everywhere,” she said. She had been watching co-workers who had received their shots and asking them how they felt. “I would say that I am educating myself a little more now, versus just saying, ‘I don’t want to do it,’” she said.

Yet, she ended up refusing the shot again that day.

She wasn’t afraid of needles — she had multiple tattoos, she said, laughing. So what was holding her back?

“Having a bad reaction, or not being able to adjust to it at all,” she said.

She had also heard some frightening things — even though she suspected they weren’t true. “I heard someone say the first couple of people who took it for the trial died,” she said. “I’m not going to believe those things, but you do keep them in the back of your head and it makes you scared.”

Still, Ms. Sandri’s efforts seemed to be paying off. Forty-eight more workers decided to get their first shot that day.

For those who remained unvaccinated, Ms. Sandri had four weeks to change their minds.

March

Janice Johnson, director of nursing and infection prevention at Forest Hills, checking on staff members on vaccination day.
Staff members waiting their turn for the shot.

Across the country, vaccine hesitancy was receding — a Pew poll conducted in late February found that 30 percent of Americans said they would probably or definitely not get vaccinated, down from the 39 percent who said the same in November. The poll also found that far more Black Americans were willing to get the vaccine than they were before, but Ms. Sandri did not find that to be true among the African immigrants on her staff.

For them, the half-hour Tyler Perry video that had been playing on repeat on a giant screen in the multipurpose room did not seemed to resonate.

Ms. Sandri, who is of Chinese descent, began to understand. “I’m Asian, but I’m not Japanese or Thai or Indian, and they are very different people,” she said. “Until we understand cultural sensitivities beyond the major skin color groups, we’re not going to be successful at reaching herd immunity levels with some of those subsets.”

She started planning to have her director of maintenance, an African immigrant who has been vaccinated, to talk to reluctant peers about his experience and their concerns, and to find leaders of local African churches who might be willing to do the same.

She also doubled down on what she believed was working best: listening to and addressing the concerns of her employees one by one — what she called a “time-intensive, conversation-intensive, case-by-case uphill climb.”

The key, she said, was to tailor her message to what would resonate most with each person.

“For analytical people, we provided data on number of cases, number of people in trials, percent of people who experience an immune response,” she said. “For relationship-based thinkers, we asked if they had any vulnerable friends or family members, and how having or not having the vaccine might impact the relationship.”

Still, as the date of the third vaccination event approached in early March, Ms. Proctor was tired — of the pandemic and the long loss of freedoms, but also of hearing every day at work about the importance of getting the shot. Ms. Sandri, whose office was just around the corner, stopped by frequently to chat and gently raise the benefits of being vaccinated.

“It feels a little — almost like peer pressure,” Ms. Proctor said.

At times, she envied people who worked outside health care, suspecting they were not being barraged with information about the vaccine in quite the same way. Yet, she had come to appreciate that the vaccine was a commodity that most people her age — and most people in general — did not have access to yet. Getting vaccinated, she told herself, could help protect her sister who lived with her. It would also protect her when she returned to her second job — bartending — and made long-delayed trips to Puerto Rico and Jamaica later in the year.

By March 8, the day of the final event at Forest Hills, she was close to talking herself into rolling up her sleeve. At Ms. Sandri’s urging, she had watched the Tyler Perry special and an online town-hall-style forum for workers at nursing homes about the vaccine, organized by the Black Coalition Against Covid-19.

“It gave me a little more confidence,” she said. “I don’t know anyone in my immediate circle that took the vaccine yet, and it just makes me feel like if no one else has done it, then maybe I should.”

Despite working to convince herself of the vaccine’s benefits over recent days, Ms. Procter grew concerned as she was about to get vaccinated. Ms. Sandri was there to reassure Ms. Proctor before her shot.
Ms. Childs, who was at first hesitant about getting the vaccine, received her second dose this month. “I’m ready to get back to my life,” she said. “And I know that this is probably one of the ways that we’re going to get back to being normal.”

The final tally

Fifteen minutes before her shift ended, Ms. Proctor made her way to the home’s all-purpose room — normally the sight of bingo games and movie nights — and took off her jacket. Scanning the consent form with its daunting questions — Have you ever had a severe allergic reaction to something? Do you have a bleeding disorder or weakened immune system? — made her feel “leery,” she said.

Still, she got the shot. As she lingered in an easy chair afterward, Ms. Sandri fluttered in to check on her, gently touching her bare arm.

“I don’t have any thoughts, really, besides wondering how I’m going to feel — that’s my main concern,” Ms. Proctor said. By the end of the day, 18 more co-workers, along with Ms. Proctor, had joined the ranks of the partly or fully vaccinated. They now make up 79 percent of the staff at Forest Hills.

“I’m ready to do cartwheels down the hallway,” Ms. Sandri said, noting that Forest Hills had surpassed the goal set by the American Health Care Association, a trade group, to vaccinate 75 percent of the nation’s nursing home work force by the end of June.

With the federal program ending soon, the city’s health department had agreed to provide doses for anyone in nursing homes who still needed them.

“Everyone’s fears are real, whether or not they are grounded in science or in something they believe right now,” Ms. Sandri said, recounting what she had learned from her staff over the past few months. “Beliefs change with time or new knowledge, so we have to ride it out. Listen hard, don’t judge and let them move at their own pace.”

Kenny Holston contributed reporting.

Getting to Yes: A Nursing Home’s Mission to Vaccinate Its Hesitant Staff

Almost all of the residents at Forest Hills of D.C. got their initial Covid-19 shots in January. But nearly half of the staff there had declined. Would an effort to change their minds succeed?

WASHINGTON — The Covid-19 vaccine had finally come to Forest Hills of D.C., a nursing home in a prosperous neighborhood of the nation’s capital, but there was a problem. Though nearly all of the home’s residents agreed to get the shots, nearly half its 200 staff members declined.

Tina Sandri, the chief executive, vowed not to let those numbers stand.

Over the next two months, rounding out the most bruising year of her long career in elder care, Ms. Sandri tried everything. She bombarded employees with text messages containing facts about the science behind the vaccines. She assigned a popular young worker to try to sway reluctant colleagues as an “influencer.” She set up a giant screen to show a television special that the Black actor and director Tyler Perry made to fight vaccine hesitancy — on a continuous loop, no less. Most of all, she worked to understand their concerns.

“You really have to listen to each person’s story and address it from that standpoint, so they feel, ‘This is a workplace that cares about me,’” she said.

Three months after the nation’s health care workers were among the first Americans to be eligible for the lifesaving new vaccines, long-term care facilities across the country continue to face a similar daunting challenge. The federal program that sent vaccinators from Walgreens and CVS into tens of thousands of nursing homes and assisted living residences has by one measure been strikingly successful, inoculating nearly all of the vulnerable residents of the facilities. Deaths in nursing homes have plummeted since the program began in late December.

But reaching the mostly low-wage employees of the facilities has proved far more difficult. A poll by The Washington Post and Kaiser Family Foundation conducted from Feb. 11 to March 7 found that half of the workers at nursing homes had yet to get even a first shot, and only 15 percent of that group said they definitely planned to.

At Forest Hills, the workers who turned down the vaccine during the center’s first vaccination event in early January included nurses, certified nursing assistants, members of the kitchen and activities staffs, and a security officer. Most were Black, reflecting the overall makeup of the home’s work force; many were immigrants from African countries, such as Nigeria, Liberia and Cameroon.

Ms. Sandri’s goal was to persuade — not pressure — them. But she found there was not one unifying story behind their refusal, and no straightforward message that helped to convince them.

She ruled out some tactics deployed by other nursing homes, including offering gift cards, bonuses or extra vacation days to employees who agreed to get the vaccine; Ms. Sandri considered those incentives inappropriate and called them “bribes.”

“We’re doing this because we care,” she said. “To dilute that message with other things is almost patronizing to people’s intellect.”

The vaccinators from Walgreens would come back twice more — in early February and early March — and Ms. Sandri had dozens of minds to change. By her count, there were still 92 employees who needed the shot.

Tina Sandri, right, chief executive of Forest Hills of D.C., receiving her vaccine shot. She wanted the first day of vaccinations to feel like a party, she said.
Tina Sandri, right, chief executive of Forest Hills of D.C., receiving her vaccine shot. She wanted the first day of vaccinations to feel like a party, she said.
Mariah Proctor, a security guard at Forest Hills, said her mother had said to her about the vaccine: “You don’t know the ingredients. You know nothing.”

January

Ms. Sandri, 57, a yoga and outdoors enthusiast whose manner is at once bustling and soothing, had arrived at Forest Hills only in May, replacing a predecessor who left after the coronavirus had taken hold.

Three residents at Forest Hills had died from the virus and 17 others had become ill, along with 45 members of the staff — a less devastating toll than at many other nursing homes, but still an ordeal. Another resident would die in February, after a flurry of cases over the holiday period.

For the first vaccination event, on Jan. 4, Ms. Sandri laid out snacks, took lots of pictures and played upbeat music — “the cookout kind!” — aiming to create a partylike atmosphere that could help people feel the hope and promise of getting immunized.

When Mariah Proctor, a security guard, arrived for her shift that day, she encountered the festive buzz — and the persistent question between colleagues: “Are you getting it?”

Her answer was no. A conversation with her mother, who she said had never taken her for vaccinations for fear of putting anything besides healthy food in her children’s bodies, had cemented her decision.

Ms. Proctor, 24, said her mother had told her: “You don’t even know what that is. You don’t know the ingredients. You know nothing.”

After the disappointing vaccination turnout that first day, and with morale dipping and emotions fragile as the pandemic wore on, Ms. Sandri changed her approach. She had been holding “huddles” with different departments to explain the science of the vaccines, but now, instead of continuing to load people with facts, she focused on asking them: What information do you need? What is your concern?

Miles Lee has been serving as an influencer of sorts at Forest Hills, talking to his co-workers about their feelings or offering to look up information for them about the vaccine.
Ms. Sandri reviewing the “Heroes of Hope” wall depicting staff members who have been vaccinated.

February

Ms. Proctor was taking a break from her shift with Deborah Childs, a colleague from the payroll department who had also refused the vaccine, when the vaccinators from Walgreens came back on a snowy day in early February.

This time, Ms. Childs agreed to get the vaccine.

“I looked up the company and, you know, I found out that they’ve been doing research on mRNA for over 10 years, so that made me feel a little bit better,” she said, referring to the molecule that is the active ingredient in the Moderna vaccine that Walgreens is offering.

She was still a little scared, especially after reading about a doctor in Miami who had developed a rare blood disorder days after getting the Pfizer shot and died two weeks later. Still, she said: “I’m ready to get back to my life. And I know that this is probably one of the ways that we’re going to get back to being normal.”

Ms. Proctor was wavering. “My emotions are everywhere,” she said. She had been watching co-workers who had received their shots and asking them how they felt. “I would say that I am educating myself a little more now, versus just saying, ‘I don’t want to do it,’” she said.

Yet, she ended up refusing the shot again that day.

She wasn’t afraid of needles — she had multiple tattoos, she said, laughing. So what was holding her back?

“Having a bad reaction, or not being able to adjust to it at all,” she said.

She had also heard some frightening things — even though she suspected they weren’t true. “I heard someone say the first couple of people who took it for the trial died,” she said. “I’m not going to believe those things, but you do keep them in the back of your head and it makes you scared.”

Still, Ms. Sandri’s efforts seemed to be paying off. Forty-eight more workers decided to get their first shot that day.

For those who remained unvaccinated, Ms. Sandri had four weeks to change their minds.

March

Janice Johnson, director of nursing and infection prevention at Forest Hills, checking on staff members on vaccination day.
Staff members waiting their turn for the shot.

Across the country, vaccine hesitancy was receding — a Pew poll conducted in late February found that 30 percent of Americans said they would probably or definitely not get vaccinated, down from the 39 percent who said the same in November. The poll also found that far more Black Americans were willing to get the vaccine than they were before, but Ms. Sandri did not find that to be true among the African immigrants on her staff.

For them, the half-hour Tyler Perry video that had been playing on repeat on a giant screen in the multipurpose room did not seemed to resonate.

Ms. Sandri, who is of Chinese descent, began to understand. “I’m Asian, but I’m not Japanese or Thai or Indian, and they are very different people,” she said. “Until we understand cultural sensitivities beyond the major skin color groups, we’re not going to be successful at reaching herd immunity levels with some of those subsets.”

She started planning to have her director of maintenance, an African immigrant whohas been vaccinated, to talk to reluctant peers about his experience and their concerns, and to find leaders of local African churches who might be willing to do the same.

She also doubled down on what she believed was working best: listening to and addressing the concerns of her employees one by one — what she called a “time-intensive, conversation-intensive, case-by-case uphill climb.”

The key, she said, was to tailor her message to what would resonate most with each person.

“For analytical people, we provided data on number of cases, number of people in trials, percent of people who experience an immune response,” she said. “For relationship-based thinkers, we asked if they had any vulnerable friends or family members, and how having or not having the vaccine might impact the relationship.”

Still, as the date of the third vaccination event approached in early March, Ms. Proctor was tired — of the pandemic and the long loss of freedoms, but also of hearing every day at work about the importance of getting the shot. Ms. Sandri, whose office was just around the corner, stopped by frequently to chat and gently raise the benefits of being vaccinated.

“It feels a little — almost like peer pressure,” Ms. Proctor said.

At times, she envied people who worked outside health care, suspecting they were not being barraged with information about the vaccine in quite the same way. Yet, she had come to appreciate that the vaccine was a commodity that most people her age — and most people in general — did not have access to yet. Getting vaccinated, she told herself, could help protect her sister who lived with her. It would also protect her when she returned to her second job — bartending — and made long-delayed trips to Puerto Rico and Jamaica later in the year.

By March 8, the day of the final event at Forest Hills, she was close to talking herself into rolling up her sleeve. At Ms. Sandri’s urging, she had watched the Tyler Perry special and an online town-hall-style forum for workers at nursing homes about the vaccine, organized by the Black Coalition Against Covid-19.

“It gave me a little more confidence,” she said. “I don’t know anyone in my immediate circle that took the vaccine yet, and it just makes me feel like if no one else has done it, then maybe I should.”

Despite working to convince herself of the vaccine’s benefits over recent days, Ms. Procter grew concerned as she was about to get vaccinated. Ms. Sandri was there to reassure Ms. Proctor before her shot.
Ms. Childs, who was at first hesitant about getting the vaccine, received her second dose this month. “I’m ready to get back to my life,” she said. “And I know that this is probably one of the ways that we’re going to get back to being normal.”

The final tally

Fifteen minutes before her shift ended, Ms. Proctor made her way to the home’s all-purpose room — normally the sight of bingo games and movie nights — and took off her jacket. Scanning the consent form with its daunting questions — Have you ever had a severe allergic reaction to something? Do you have a bleeding disorder or weakened immune system? — made her feel “leery,” she said.

Still, she got the shot. As she lingered in an easy chair afterward, Ms. Sandri fluttered in to check on her, gently touching her bare arm.

“I don’t have any thoughts, really, besides wondering how I’m going to feel — that’s my main concern,” Ms. Proctor said. By the end of the day, 18 more co-workers, along with Ms. Proctor, had joined the ranks of the partly or fully vaccinated. They now make up 79 percent of the staff at Forest Hills.

“I’m ready to do cartwheels down the hallway,” Ms. Sandri said, noting that Forest Hills had surpassed the goal set by the American Health Care Association, a trade group, to vaccinate 75 percent of the nation’s nursing home work force by the end of June.

With the federal program ending soon, the city’s health department had agreed to provide doses for anyone in nursing homes who still needed them.

“Everyone’s fears are real, whether or not they are grounded in science or in something they believe right now,” Ms. Sandri said, recounting what she had learned from her staff over the past few months. “Beliefs change with time or new knowledge, so we have to ride it out. Listen hard, don’t judge and let them move at their own pace.”

Kenny Holston contributed reporting.

In a Role Reversal, Asian-Americans Aim to Protect Their Parents From Hate

Earlier in the pandemic, Ellen Lee offered to bring her parents groceries, to protect them from catching the coronavirus while shopping. They refused. Now when she asks, it’s because she’s worried they might get assaulted when they’re out running errands.

“They want to be independent,” said Ms. Lee, 44, a Chinese-American journalist and mother of three. “The way they see it, they are the parent, and their job is to take care of me.”

Her parents, who are in their mid-70s, told her they’re taking precautions, going to satellite Chinatowns in San Francisco rather than the main one and popping in and out to fetch delicacies such as egg tarts and roast duck. “They’ll turn it around on me, and say, ‘You’re the one who should be scared,’” she said, after they pointed out that her neighborhood might be unsafe because an elderly Chinese-American man was robbed and killed a few miles away from her Oakland hills home.

In the wake of recent shootings in Atlanta by a white gunman that left eight dead — six of them of Korean or Chinese descent — and surging attacks against Asian-Americans across the country, families have grappled with how to talk to their elders about protecting themselves.

Of the more than 18 million Asian-Americans in the United States, roughly three-quarters of adults were born abroad, according to William H. Frey, a demographer who is a fellow at the Brookings Institution and professor at the University of Michigan who analyzed data from the Census Bureau’s 2019 American Community Survey. That’s because of both historical immigration policy and recent immigration trends.

Generational and cultural gaps make conversations about race and violence difficult with their American-born and raised children and grandchildren, who may not fluently speak the native language of their elders.

Be candid and direct, said Anni Chung, chief executive of Self-Help for the Elderly, a service provider in San Francisco’s Chinatown. “You can say: ‘I worry about you. If you have to run to the bank, will you let me know? I’ll take time off. If you go to the grocery, let me accompany you,’” she said. “Offer to help. They might not accept it, but the care and attention will please them.”

Ms. Chi, of Fremont, Calif., talked with her relatives about the recent rise in attacks on Asian-Americans.Carolyn Fong for The New York Times
Ms. Yi and the others imagined a victim’s final worry: “‘What about my babies? Who will take care of them?’”Carolyn Fong for The New York Times

Asian-American adults may be looking out for their elders while struggling with the recent attacks themselves. Emily Chi, a 31-year-old Korean-American in Fremont, Calif., noted how quickly Asian-Americans came together after the Atlanta shootings, with online fund-raising, critical historical analysis and other efforts. But she’s also grieving. She planned to attend a vigil in Oakland focused on the victims. “Let’s make sure they aren’t erased,” Ms. Chi said. “Let’s not forget them, before we skip to action.”

In her conversations with her grandmother, aunt and mother, they all imagined a victim’s final worry: “‘What about my babies? Who will take care of them?’” Ms. Chi said. “We see their names, we see their faces, and you feel like it could be you,” she said of the Asian-Americans killed. “It could be your grandmother.”

Small-business owners may have already suffered vandalism and other crimes firsthand. “Honor the first generation’s experience with violence — if you ignore it, the conversation will end,” said June Lee, executive director of the Korean Community Center of the East Bay.

But at the same time, give them context for understanding hate crimes, especially if they’ve come from racially homogeneous countries, she said. Explain the systemic issues behind what might seem like a random killing. “They also need to know their rights,” she said. “Asians are known for their silences, but silence isn’t a virtue in this situation. We have to speak up.”

Such conversations are a fraught yet tender rite of passage that reverses the traditional parent-child dynamic; parents who want to remain independent may brush off their children’s concerns for their safety.

If the elders are hierarchical in their thinking, and prefer advice from someone they consider their equal or in a position of higher standing, adult children could consider enlisting their doctor, pastor, or someone else in the community they trust, said Lia Huynh, a San Jose therapist who specializes in Asian-American issues.

“Asian-Americans have always been told, ‘Don’t make waves; don’t speak up,’” she explained. “Now things are coming to the surface, the feelings we had to stuff down for many years. People can feel alone, wondering, ‘Am I the only one dealing with this?’”

But they are not alone. About 42 percent of Asian-Americans say that Asian people in this country face “a lot” of discrimination, according to a recent Pew survey conducted before the killings in Atlanta.

The organization Stop AAPI Hate — which began tracking violence and harassment against Asian-Americans and Pacific Islanders in the United States in 2020 — received reports of 3,292 cases that year; in 2021, until the Atlanta shootings, 503 cases had been reported.

“We see their names, we see their faces, and you feel like it could be you,” Ms. Chi said of the Asian-Americans killed. “It could be your grandmother.”
“We see their names, we see their faces, and you feel like it could be you,” Ms. Chi said of the Asian-Americans killed. “It could be your grandmother.”Carolyn Fong for The New York Times

In November, while out walking her dog early one morning in Oakland, Calif., Deanne Chen, a 31-year-old Taiwanese-American, was mugged at gunpoint. Her assailant, who was Black, bear-hugged her from behind, shoved her to the ground, and flashed his gun at her. After she handed over her phone, he and his accomplice drove off. In the weeks that followed, the Oakland Police Department noted an uptick in violent robberies, with suspects targeting Asian and Latino communities.

When she told her parents what happened, she emphasized that she did not want Black people to be racially profiled. “I had to explain that one bad individual doesn’t represent an entire community. I asked them, ‘Holistically, what do you think creates crime?’” Ms. Chen said.

With the latest — and continuing — attacks against Asian-Americans, she added, “I don’t want this to be an opportunity for Blacks and Asians to get pitted against each other.”

She’s shared practical safety tips with her parents, telling them to remain vigilant when getting in and out of their car or unloading groceries. They’ll mention how their friends say they should watch out for each other and how their friends say they’re scared to go shopping. Her parents “don’t talk about their feelings, but will talk about everyone else’s. Which is a very Asian thing,” Ms. Chen said. “I know the fear is there.”

And yet, her mother also surprised her, calling the police in Atlanta “incompetent” and stating that their “racial bias” made everything worse for the victims. “I didn’t realize my mom was so woke!” Ms. Chen said with a laugh.

However, her parents would never admit that she might have influenced their opinion. “The trick is making them think it was their idea,” she said. “If you have the conversation in small, different ways, over time they start to read the news through the lens you provide them, and they come to their own conclusion.”

Ask a lot of questions, suggests Ener Chiu, of the East Bay Asian Local Development Corporation. “Ask them how they feel, and what we can do to help them feel safe.”

As more seniors get vaccinated, he encourages them to gather in groups again, whether in parks, recreation centers, or elsewhere, and in time, become “actively engaged” in their community. “People won’t feel so isolated, carrying their pepper spray, ‘you against the world,’” Mr. Chiu said.

Recent events have galvanized some older Asian-Americans such as Ms. Lee’s parents, the ones who insisted on going grocery shopping.

Usually, her father texts her photos of wild turkeys and deer wandering the streets of their retirement community in the suburbs east of San Francisco. The other day, though, he sent a picture from a neighborhood protest, with her mother holding up a cardboard sign, “Stop Asian Hate.”

“Up until now, my parents have not felt heard except in ethnic media,” Ms. Lee said. “They complain, but they wonder who is listening. Now there’s a groundswell of energy, not only from other Asian-Americans, but allies, too.”

Vanessa Hua is the author of “Deceit and Other Possibilities,” “A River of Stars” and the forthcoming novel “Forbidden City.”

How Two Lonely Generations Are Helping Each Other Heal

Young adults and the elderly were especially isolated in the pandemic. There are efforts underway to help connect them.

The pandemic is not just making many of us sick, it is making virtually all of us lonelier, according to a Harvard report based on a national survey of 950 Americans issued in February.

The loneliest people, as a group, are young adults. About half of 18- to 25-year-olds reported that not a single person in the past few weeks had “taken more than a few minutes” to ask how they are doing in a way that seemed genuinely caring. The second loneliest demographic appears to be the elderly, said the report’s lead researcher, Richard Weissbourd, a psychologist who teaches at the Harvard Graduate School of Education.

Dr. Weissbourd believes that the young and the old would feel a lot less isolated if they had more contact with one another. But the pandemic has largely kept these generations apart, weakening a bond that researchers say is critical for the well-being of both.

“The elderly have so much to share with young people — wisdom about love, work, friendship, mortality and many other things,” Dr. Weissbourd said. “And young people have so much to share with the elderly about a rapidly changing world — not just technology, but new and important ways of thinking about race and racism, justice, sexuality and gender and other critical issues.”

One thing that elders are expert in is how to thrive during hard times, according to Karl Pillemer, a gerontologist at Cornell University. Last April he initiated the Cornell Crisis Advice Project in which seniors — many of whom had lived through wars, epidemics and the Great Depression — offered wisdom to the young on how to deal with the current pandemic.

The elders emphasized that today’s troubles are temporary and will pass, Dr. Pillemer said. To better cope with current restrictions, they frequently recommended relishing the small things in life — a cup of coffee in the morning, a brightly colored bird on the lawn. “Paying special attention to these ‘microlevel’ events, the elders reported, lifts them up daily,” he said.

In fact, “People 70 and older are happier than others, have higher life satisfaction, a better ability to regulate their emotions and to focus on the positive, whatever happens,” Dr. Pillemer said, an assertion backed up by several studies conducted in recent years. “They have developed an understanding that happiness is a choice, it is something that happens in spite of the outer conditions of life, and not because of them.”

Their opportunities to share this wisdom with children and young adults, however, are limited.

Even before the pandemic, only one in 10 youngsters lived in three-generation households, with both their parents and their grandparents. While that number has increased somewhat in the United States in recent years, largely because of economic factors such as rising housing costs, it is still well below what it was in the early 20th century when multigenerational households were the norm.

“We started the 20th century as one of the most age-integrated societies in the world and ended it as the most age-segregated,” said Marc Freedman, the founder of Encore.org, a San Francisco-based nonprofit that is engaged in projects that bring the generations together.

In traditional societies, grandmothers and older relatives took care of the children while their parents went out to hunt, gather and tend gardens, Mr. Freedman explained. Elders were also the storytellers, who passed down the traditions of the tribe. But the modern world separates people into age-exclusive institutions like schools and colleges for the young and retirement communities for seniors. Social media often further divides the generations into self-selected silos of their own peers. To a large extent “the generational twain stopped meeting,” Mr. Freedman said.

But lately he has seen signs that this is changing. “There’s been a blossoming of creativity in bringing young and old together since the onset of the pandemic,” Mr. Freedman observed. “The young themselves have initiated efforts to check in on elders, and deliver food and prescriptions.”

One such young adult is Ella Gardner, age 18, a freshman at Pomona College in Claremont, Calif. Moved by the isolation of elders who have become housebound during the pandemic, she volunteered with the San Francisco-based nonprofit Mon Ami to shop and do chores for them.

Inspired by the “Finding Your Roots” television series,  Sam Cozolino, age 14, of Los Angeles, is researching his ancestral history.
Inspired by the “Finding Your Roots” television series, Sam Cozolino, age 14, of Los Angeles, is researching his ancestral history.Susan Cozolino

She also extensively interviewed her grandfather on Zoom for an anthropology paper. “I asked him if he was going to get the vaccine and he chuckled and said, ‘I remember back when I was growing up and we had to get the polio vaccine and look at me now, I’m still here,’” Ms. Gardner recalled.

“I’ve always been scared about growing old,” she admitted. “Sometimes I feel like I just want to stay a kid forever.” But her recent increase in contact with older people has made her more relaxed about aging, which she now sees as a natural part of life.

Another young person who has taken advantage of the pandemic to get to know older people better is Sam Cozolino, age 14, of Los Angeles. Inspired by the “Finding Your Roots” television series hosted by Henry Louis Gates Jr., Sam has spent scores of hours recently researching his ancestral history, including contacting long-lost relatives in Italy, with the aim of creating a family tree.

He has especially enjoyed talking on the phone with his paternal grandmother, who told him about her struggles growing up poor in America during the Second World War.

“Her fears during the war are similar to my own fears of going outside during the pandemic,” he said. “But it’s definitely not as bad as having to work two jobs and never having enough money. It really puts what I’m going through into perspective.”

Mr. Nielson, a graduate student, bakes bread and makes vegetarian food for Ms. Bedingfield, a retired civil engineer.Tony Luong for The New York Times
“I feel much less isolated knowing that Michael is nearby,” Ms. Bedingfield said.Tony Luong for The New York Times

Direct contact between the old and the young has been limited as a result of Covid, but there are notable exceptions. The Boston-based nonprofit Nesterly operates a homesharing service where elders with extra rooms are matched with young people seeking affordable housing. In one home share that began during the pandemic, Michael Nielson, a 28-year-old Harvard graduate student from Denmark, is renting space from Laurinda Bedingfield, a 67-year-old retired civil engineer.

Ms. Bedingfield wanted more than a business relationship with her tenant. But she wondered if her desire for friendship would be reciprocated: “I recalled the stupid attitude we had as young baby boomers — don’t trust anyone over 30. So now that I am a senior citizen, I figured that young people would feel the same way and not want much to do with me or any other oldies.”

She needn’t have worried. Mr. Nielson baked bread for her and cooked her vegetarian food. They’ve been taking socially distanced walks together, and after she’s been vaccinated, she plans to teach him photography and art.

“I feel much less isolated knowing that Michael is nearby,” Ms. Bedingfield said. “I have a friend who lives on my property and I can call him any time if I need help.”

Nic Weststrate, professor of educational psychology at the University of Illinois, Chicago, has been conducting research on gay, lesbian, bisexual and transgender elders. He says that older gay people, like everyone, have a need for “generativity,” a need to nurture and care for the future generation — which can be hard to fulfill for those who haven’t brought up children of their own. To help foster this, he has been setting up Zoom calls as part of the LGBTQ+ Intergenerational Dialogue Project, where old and young gay people have been sharing stories and support with one another during the pandemic.

Rain Shanks, a 26-year-old student at the School of the Art Institute of Chicago who grew up in a socially conservative community in Texas, says that before these weekly Zoom sessions, “I never had a relationship with an elder where I felt like I could be an entire person and feel seen with my lesbian identity. Having older folks that I can relate to and be friends with has been healing for me.”

For the elders too, the experience can be healing. “As people approach the end of life they start asking questions like, ‘Was my life worth living, am I at peace with the decisions that I made in my life?’ ” Dr. Weststrate said. “Intergenerational storytelling is a space for elders to narrate their life and in the process come to terms with it and find that sense of peace.”

Coronavirus Reinfections Are Rare, Danish Researchers Report

People over 65 are more likely to experience a second bout with the virus, according to a large study of medical records.

The vast majority of people who recover from Covid-19 remain shielded from the virus for at least six months, researchers reported on Wednesday in a large study from Denmark.

Prior infection with the coronavirus reduced the chances of a second bout by about 80 percent in people under 65, but only by about half in those older than 65. But those results, published in the journal Lancet, were tempered by many caveats.

The number of infected older people in the study was small. The researchers did not have any information beyond the test results, so it’s possible that only people who were mildly ill the first time became infected again and that the second infections were largely symptom-free.

Scientists have said that reinfections are likely to be asymptomatic or mild because the immune system will suppress the virus before it can do much damage. The researchers also did not assess the possibility of reinfection with newer variants of the virus.

Still, the study suggests that immunity to a natural infection is unpredictable and uneven, and it underscores the importance of vaccinating everyone — especially older people, experts said.

“You can certainly not rely on a past infection as protecting you from being ill again, and possibly quite ill if you are in the elderly segment,” said Steen Ethelberg, an epidemiologist at Statens Serum Institut, Denmark’s public health agency.

Because people over 65 are at highest risk of severe disease and death, he said, “they are the ones we are most eager to protect.”

Rigorous estimates of second infections have generally been rare because many people worldwide did not initially have access to testing, and laboratories require genetic sequences from both rounds of testing to confirm a reinfection.

But the findings are consistent with those from experiments in a wide variety of settings: sailors on a fishing trawler in Seattle, Marine Corps recruits in South Carolina, health care workers in Britain and patients at clinics in the United States.

The new study’s design and size benefited from Denmark’s free and abundant testing for the coronavirus. Nearly 70 percent of the country’s population was tested for the virus in 2020.

The researchers looked at the results from 11,068 people who tested positive for the coronavirus during the first wave in Denmark between March and May 2020. During the second wave, from September to December, 72 of those people, or 0.65 percent, again tested positive, compared with 3.27 percent of people who became infected for the first time.

That translates to a 80 percent protection from the virus in those who had been infected before. The protection fell to 47 percent for those over 65. The team also analyzed test results from nearly 2.5 million people throughout the epidemic, some longer than seven months after the first infection, and found similar results.

“It was really nice to see that there was no difference in protection from reinfection over time,” said Marion Pepper, an immunologist at the University of Washington in Seattle.

She and other experts noted that while 80 percent might not seem superb, protection from symptomatic illness was likely to be higher. The analysis included anyone who was tested, regardless of symptoms.

“A lot of these will be asymptomatic infections, and a lot of these will likely be people who have a blip of virus,” noted Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai in New York. “Eighty percent risk reduction against asymptomatic infection is great.”

The findings indicate that people who have recovered from Covid-19 should get at least one dose of a coronavirus vaccine to boost the level of protection, Dr. Krammer added. Most people produce robust immune response to a natural infection, “but there’s a lot of variability,” he said. Following vaccination, “we don’t see variability — we see very high responses in basically everybody, with very few exceptions.”

Experts were less convinced by the results in people over 65, saying the findings would have been more robust if the analysis had included more people from that age group.

“I wish it had actually been broken down into specific decades over 65,” Dr. Pepper said. “It would be nice to know whether the majority of people who were getting reinfected were over 80.”

The immune system grows progressively weaker with age, and people over 80 typically mount weak responses to infection with a virus. The lower protection in older people seen in the study is consistent with those observations, said Akiko Iwasaki, an immunologist at Yale University.

“I think we kind of tend to forget how the vaccines have been pretty amazing in offering protection in this age group, because you can see that natural infection doesn’t confer the same kind of protection,” she said. “This really does emphasize the need to cover older people with the vaccine, even if they have had Covid first.”

The Pandemic Happiness Gap

Mind

The Pandemic Happiness Gap

New surveys show that in the last year, older adults tended to be more positive than younger ones, suggesting that the ability to cope improves with age.

Credit…Nicole Xu
Benedict Carey

  • March 12, 2021, 12:00 p.m. ET

For all its challenges to mental health, this year of the plague also put psychological science to the test, and in particular one of its most consoling truths: that age and emotional well-being tend to increase together, as a rule, even as mental acuity and physical health taper off.

The finding itself is solid. Compared with young adults, people aged 50 and over score consistently higher, or more positively, on a wide variety of daily emotions. They tend to experience more positive emotions in a given day and fewer negative ones, independent of income or education, in national samples (work remains to be done in impoverished, rural and immigrant communities.)

But that happiness gap always has begged for a clear explanation. Do people somehow develop better coping skills as they age?

Or is the answer more straightforward: Do people sharpen their avoidance skills, reducing the number of stressful situations and bad risks they face as they get older?

To test these two scenarios, scientists needed an environment where both older and younger populations were in equally stressful situations.

But “there’s never been a way we could somehow test the effect of extreme stress on this relationship, in any ethical way,” said Susan Charles, a professor of psychology at the University of California, Irvine.

The coronavirus changed that. If the outbreaks across the country through the spring showed one thing clearly, it was that older people have been at much higher risk — both of getting sick and dying of Covid-19 — than the young.

“This was, from the beginning, a threat to older people that they simply could not avoid — and, crucially, it was prolonged stress,” said Laura Carstensen, a psychologist at Stanford University’s Center on Longevity.

A research team led by Dr. Carstensen studied that reality. In April, after the potential scope of the pandemic was apparent, the team recruited a representative sample of some 1,000 adults, aged 18 to 76, living across the country. The participants answered surveys with detailed questions about their emotions over the previous week, including 16 positive states, like relaxed or amused, and 13 negative ones, like guilt or anger.

They also rated the intensity of those feelings. People who said they had been angry over the past week, for example, would see an item asking, “When you felt angry this past week, how angry did you typically feel — a little, somewhat, very, or extremely angry.”

If older people indeed manage their emotions by choosing to avoid stressful situations, the scientists reasoned, then their study should show the happiness gap shrinking, if not disappearing.

Yet their moods remained elevated, on average, compared with those in younger generations, the survey data showed — despite the fact that both groups reported the same stress levels.

“Younger people were doing far worse emotionally than older people were,” Dr. Carstensen said. “This was April, the most anxiety-producing month, it was novel, cases went from nothing to 60,000, there was lots of attention and fear surrounding all this — and yet we see the same pattern as in other studies, with older people reporting less distress.”

In a similar study, psychologists at the University of British Columbia exhaustively surveyed some 800 adults of all ages in the first couple of months of the pandemic — and found the same thing.

“The Covid-19 pandemic has led to an outbreak of ageism, in which public discourse has portrayed older adults as a homogeneous, vulnerable group,” the authors conclude. “Our investigation of the daily life amid the outbreak suggests the opposite: Older age was associated with less concern about the threat of Covid-19, better emotional well-being, and more daily positive events.”

These results hardly rule out avoidance as one means of managing day-to-day emotions. Older people, especially those with some resources, have more ability than younger adults to soften the edges of a day, by paying for delivery, hiring help, staying comfortably homebound and — crucially — doing so without young children underfoot.

One of the few investigations to find no age-related differences in well-being, posted last year, was focused on 226 young and older adults living in the Bronx. In this, New York’s most underserved borough, older people often live with their children and grandchildren, helping with meals, school pickup, babysitting, in effect acting as co-parents. No “age bump” in emotional well-being for them, the researchers found, in part, they concluded, because “the sample was somewhat ‘more stressed’ than average levels nationwide.”

Even with that crucial distinction noted, these studies bolster a theory of emotional development and aging formulated by Dr. Carstensen that psychologists have been debating for years. This view holds that, when people are young, their goals and motives are focused on gaining skills and taking chances, to prepare for opportunities the future may hold. You can’t know if you’ll be any good running a business, or onstage, unless you give it a real chance. Doing grunt work for little money; tolerating awful bosses, bad landlords, needy friends: the mental obstacle course of young adulthood is no less taxing for being so predictable.

After middle age, people become more aware of a narrowing time horizon and, consciously or not, begin to gravitate toward daily activities that are more inherently pleasing than self-improving.

They’re more prone to skip the neighborhood meeting for a neighborhood walk to the local bar or favorite bench with a friend. They have accepted that the business plan didn’t work out, that their paintings were more fit for the den than for a gallery. They have come to accept themselves for who they are, rather than who they’re supposed to become. Even those who have lost their jobs in this tragic year, and face the prospect of re-entering the job market — at least they know their capabilities, and what work is possible.

These differences will be important to keep in mind in the near future, if only to blunt a widening generational divide, experts say. A pandemic that began by disproportionately killing the elderly has also savagely turned on the young, robbing them of normal school days, graduations, sports, first jobs, or any real social life — and shaming them, often publicly, if they tried to have one. Now, in a shrinking economy, they’re at the back of the vaccine line.

“I think the older generation now, as much as it’s been threatened by Covid, they’re beginning to say, ‘My life is not nearly as disrupted as my children’s or grandchildren’s,’” Dr. Charles said, “and that is where our focus on mental well-being should now turn.”

How Exercise Enhances Aging Brains

Phys Ed

How Exercise Enhances Aging Brains

Sedentary, older adults who took aerobic dance classes twice a week showed improvements in brain areas critical for memory and thinking.

Volunteers who participated in pre-pandemic dance classes in Newark, N.J., showed improvements in memory centers in the brain.
Volunteers who participated in pre-pandemic dance classes in Newark, N.J., showed improvements in memory centers in the brain.Credit…Rutgers University
Gretchen Reynolds

  • March 3, 2021, 5:00 a.m. ET

Exercise can change how crucial portions of our brain communicate as we age, improving aspects of thinking and remembering, according to a fascinating new study of aging brains and aerobic workouts. The study, which involved older African-Americans, finds that unconnected portions of the brain’s memory center start interacting in complex and healthier new ways after regular exercise, sharpening memory function.

The findings expand our understanding of how moving molds thinking and also underscore the importance of staying active, whatever our age.

The idea that physical activity improves brain health is well established by now. Experiments involving animals and people show exercise increases neurons in the hippocampus, which is essential for memory creation and storage, while also improving thinking skills. In older people, regular physical activity helps slow the usual loss of brain volume, which may help to prevent age-related memory loss and possibly lower the risk of dementia.

There have been hints, too, that exercise can alter how far-flung parts of the brain talk among themselves. In a 2016 M.R.I. study, for instance, researchers found that disparate parts of the brain light up at the same time among collegiate runners but less so among sedentary students. This paired brain activity is believed to be a form of communication, allowing parts of the brain to work together and improve thinking skills, despite not sharing a physical connection. In the runners, the synchronized portions related to attention, decision making and working memory, suggesting that running and fitness might have contributed to keener minds.

But those students were young and healthy, facing scant imminent threat of memory loss. Little was known yet about whether and how exercise might alter the communications systems of creakier, older brains and what effects, if any, the rewiring would have on thinking.

So, for the new study, which was published in January in Neurobiology of Learning and Memory, Mark Gluck, a professor of neuroscience at Rutgers University in Newark, N.J., and his colleagues decided to see what happened inside the brains and minds of much older people if they began to work out.

In particular, he wondered about their medial temporal lobes. This portion of the brain contains the hippocampus and is the core of our memory center. Unfortunately, its inner workings often begin to sputter with age, leading to declines in thinking and memory. But Dr. Gluck suspected that exercise might alter that trajectory.

Helpfully, as the director of the Aging & Brain Health Alliance at Rutgers, he already was leading an ongoing exercise experiment. Working with local churches and community centers, he and his collaborators previously had recruited sedentary, older African-American men and women from the Newark area. The volunteers, most of them in their 60s, visited Dr. Gluck’s lab for checks of their health and fitness, along with cognitive testing. A few also agreed to have their brain activity scanned.

Some then started working out, while others opted to be a sedentary control group. All shared similar fitness and memory function at the start. The exercise group attended hourlong aerobic dance classes twice a week at a church or community center for 20 weeks.

Now, Dr. Gluck and his research associate Neha Sinha, along with other colleagues, invited 34 of those volunteers who had completed an earlier brain scan to return for another. Seventeen of them had been exercising in the meantime; the rest had not. The groups also repeated the cognitive tests.

Then the scientists started comparing and quickly noticed subtle differences in how the exercisers’ brains operated. Their scans showed more-synchronized activity throughout their medial temporal lobes than among the sedentary group, and this activity was more dynamic. Portions of the exercisers’ lobes would light up together and then, within seconds, realign and light up with other sections of the lobe. Such promiscuous synchronizing indicates a kind of youthful flexibility in the brain, Dr. Gluck says, as if the circuits were smoothly trading dance partners at a ball. The exercisers’ brains would “flexibly rearrange their connections,” he says, in a way that the sedentary group’s brains could not.

Just as important, those changes played out in people’s thinking and memories. The exercisers performed better than before on a test of their ability to learn and retain information and apply it logically in new situations. This kind of agile thinking involves the medial temporal lobe, Dr. Gluck says, and tends to decline with age. But the older exercisers scored higher than at the start, and those whose brains displayed the most new interconnections now outperformed the rest.

This study involved older African-Americans, though, a group that is underrepresented in health research but may not be representative of all aging people. Still, even with that caveat, “it seems that neural flexibility” gained by exercising a few times a week “leads directly to memory flexibility,” Dr. Gluck says.

Romance Blossoms for Seniors During Quarantine

Romance Blossoms for Seniors During Quarantine

For some in assisted living residences, the lockdown has made finding a romantic companion as simple as walking down the hall.

Sam Gallo, 91, and Millie Hathorn, 86, who met met and live together at St. James Place, a continuing care retirement community in Baton Rouge, La., were married Aug. 5, 2020.
Sam Gallo, 91, and Millie Hathorn, 86, who met met and live together at St. James Place, a continuing care retirement community in Baton Rouge, La., were married Aug. 5, 2020.Credit…Collin Richie

  • Feb. 25, 2021, 9:05 a.m. ET

When 91-year-old Sam Gallo and 86-year-old Millie Hathorn got engaged in March 2020, Mr. Gallo, who is deaf from his time as crew chief on jet planes during the Korean War, wrote a letter to his three children. “Only at death is love done,” he wrote. While they both had been married before, he wrote, “love was not done … with us.”

The purpose of the letter was to explain why they wanted to get married at their ages and so quickly, instead of waiting until the pandemic had passed and the families could celebrate together. “What a tragedy it would be to allow a day once earned in gold to fall like water through careless fingers … We accept our golden days are numbered, and we are determined to treasure each one as they are given to us, one by one.”

The couple got engaged last March during the onset of the pandemic. Mr. Gallo then wrote a letter to his children explaining why they were choosing to get married so quickly.
The couple got engaged last March during the onset of the pandemic. Mr. Gallo then wrote a letter to his children explaining why they were choosing to get married so quickly.Credit…Sean Gasser

The Gallos, who use the Ava app to communicate, met and live together at St. James Place, a continuing care retirement community in Baton Rouge, La. Their relationship took a romantic turn in February 2020. They got engaged right after the coronavirus hit the United States, and their love blossomed even amid the pandemic.

Companionship is often found in long-term care facilities. Research published in the Sexuality Research and Social Policy in 2009 found that it was “common” for assisted living residents to have a “continued interest in romantic relationships.” And while intercourse isn’t unheard-of in assisted living, the findings “overwhelmingly revealed that intimate touch, hand holding, and other less physically intense expressions were common.”

But many of these types of facilities have been on lockdowns of late to avoid infection of the coronavirus. At points, residents have been quarantined in their rooms or on their floors. And in some places visitations have been restricted (the Centers for Disease Control advised long-term care facilities to “have a plan for visitor restrictions” and “facilitate and encourage alternative methods for visitation” like video calls).

Senior care housing facilities can be lonely, and with these restrictions, many have feared residents are lonelier than ever.

Some say the opposite is happening though. Some residents may be more inclined to find a romantic companion right now, whether because of the doom and gloom of the pandemic or because of the isolation from friends and family.

“We are seeing more relationship building, some romantic, some friendship,” said Daniel Reingold, president and chief executive of the Hebrew Home at Riverdale in the Bronx said. He said “without question” his residents, who are in the process of getting fully vaccinated, have been more open to love during the pandemic. “What I’m sensing is not that there’s an increased fear of mortality so much that there’s an increased appreciation for love,” he said. “People realizing, I want to have somebody in my life right now. So they’re finding each other.”

For the Gallos, they found each other before the coronavirus hit, but it wasn’t until February 2020 when they spent time together at St. James’s Mardi Gras party that things changed. “After that party, it was as if it had to be that we were together,” said Ms. Gallo, who took her husband’s name. Also after that party, the pandemic hit. But that didn’t stop them from getting to know each other. In fact, it may have helped. Throughout the past year, as restrictions have kept people apart, limited activities and closed cafeterias, they’ve spent as much time together as possible. “We made sure we could spend the same amount of time together and didn’t hide it from anybody, we held hands and sat close to each other, but we did wear masks,” she said.

They were married Aug. 5, 2020.

“We decided because of our age and how we felt, we would get married soon here at St. James, by their chaplain,” Ms. Gallo said. “We couldn’t have family but we had one resident who was my maid of honor and one resident who was his best man. Of course we had all the social distancing and masks. But it worked out beautifully. It was a beautiful day, we had no problems.”

Their children (six total) were disappointed they couldn’t attend the nuptials, but Ms. Gallo said, “they understood that we didn’t want to wait.”

The Gallos contracted Covid-19 in December, “it was mild and we both came out of it really good,” she said. “He took care of me when I needed help, I took care of him when he needed help. There wasn’t a moment I wasn’t right there for him, and he was always there for me.” Ms. Gallo said attitude is key to surviving quarantine, and it’s clear in the way she looks at her experience. “I think it did bring us closer together.”

Now, she said, “there’s no doubt that being with Sam has definitely made the lockdowns and all not so bad.”

Gloria Duncan and Al Cappiello, both 71, shared that the lockdown has had a positive effect on their relationship. “During Covid, she looks after me, I look after her. It’s brought us a lot closer,” Mr. Cappiello said.Credit…The Hebrew Home at Riverdale

At Hebrew Home, Gloria Duncan and Al Cappiello, both 71, who’ve been together for about four years, said the pandemic and quarantining has changed their relationship “for the better.” But keeping their love alive over the course of multiple quarantines has been a challenge. Luckily, it was one the two of them were more than up for.

“I’m on the third floor and he’s on the first, so at times, you could walk around the floor but you couldn’t leave the floor,” Ms. Duncan said via Zoom, Mr. Cappiello by her side. “So he would come up on the elevator and say hi to me and talk to me for a few minutes, he’s in the elevator and I’m out of the elevator, or vice versa.” Mr. Cappiello added, “That’s the best we could do. I would go to the cafeteria and get the things she likes, and go the elevator and bring them to her.”

They have been quarantined separately two or three times over the past year; the longest they went without seeing each other was an unpleasant 14 days. During those times, they would talk on the phone. Other than that, they see each other every day.

“During Covid, she looks after me, I look after her. It’s brought us a lot closer. It’s really a blessing,” Mr. Cappiello said. He doesn’t have any family and Ms. Duncan’s family lives out of state. “It’s been easier having each other during this time,” she added.

They both believe this experience has been a positive one for their relationship, “because we have not been able to see other people, we treasure each other even more,” Ms. Duncan said.

Administrators from all the facilities interviewed for this article have seen a lot of residents stepping up to take care of and support each other in isolation. That includes Amber Court, an assisted living community in Brooklyn, where 76-year-old Jeffrey Miller proposed to 71-year-old Gloria Alexis in August.

Jeffrey Miller, 76, proposed to Gloria Alexis, 71, last August. They are planning for an intimate wedding at Amber Court this spring.Credit…Amber Court of Brooklyn
The couple, who were not in a romantic relationship before the pandemic, fell for each other shortly after the start of the lockdown.Credit…Amber Court of Brooklyn

Before the pandemic, they weren’t even in a romantic relationship. They were just friends. However, after the pandemic hit, Ms. Alexis spent a month in the hospital (for something unrelated to coronavirus, which neither of them have contracted), cut off from Mr. Miller for “too long,” he said. “I was going crazy.” During that time, Mr. Miller said his feelings for her grew stronger.

Sol Bauer, the director of operations at Amber Court, said that the uncertainty of the world around them made Mr. Miller realize he cared for her as more than a friend. “Jeffrey kept on coming in and bothering me and kept asking all of us in the office when she’s coming back,” Mr. Bauer said. “And I eventually said, ‘why do you need to know when she’s coming back? When she’s back, you’ll know.’ And he said, ‘I want to propose to her,’ and he whipped out a box with a diamond ring and a wedding band, and we almost passed out.”

Once they found out when she’d be coming back, the staff helped Mr. Miller plan a perfect outdoor proposal, complete with balloons, roses, and, of course, the ring. “Something told me to do it, it was about time. We’re not getting any younger,” Mr. Miller said.

They are hoping for a spring wedding at Amber Court with friends from the facility. They now live in the same room. As to why the pandemic changed their relationship, Mr. Miller said, “you realize, you don’t want to be by yourself.”

And it’s not just the coupled up residents who are benefiting from these budding romances amid a worldwide pandemic.

Ms. Gallo said, “I feel like here at St. James, we brought a little touch of love and joy to some of the people. We always hold hands when we walk out, and people stop us and say, ‘We love seeing ya’ll, ya’ll make me feel good.’ I think we brought some kind of comfort to some people. I feel we did some good.”

How Meaningful Is Prediabetes for Older Adults?

the new old age

How Meaningful Is Prediabetes for Older Adults?

A new study indicates that the condition might be less of a worry than once believed.

Susan Glickman Weinberg, of Encino, Calif., was told a few years ago during routine tests that she was prediabetic, a diagnosis that puzzled her. “I felt like Patient Zero,” she said. “There were a lot of unknowns.”
Susan Glickman Weinberg, of Encino, Calif., was told a few years ago during routine tests that she was prediabetic, a diagnosis that puzzled her. “I felt like Patient Zero,” she said. “There were a lot of unknowns.”Credit…Jenna Schoenefeld for The New York Times

  • Feb. 23, 2021, 2:30 a.m. ET

A few years ago, routine lab tests showed that Susan Glickman Weinberg, then a 65-year-old clinical social worker in Los Angeles, had a hemoglobin A1C reading of 5.8 percent, barely above normal.

“This is considered prediabetes,” her internist told her. A1C measures how much sugar has been circulating in the bloodstream over time. If her results reached 6 percent — still below the number that defines diabetes, which is 6.5 — her doctor said he would recommend the widely prescribed drug metformin.

“The thought that maybe I’d get diabetes was very upsetting,” recalled Ms. Weinberg, who as a child had heard relatives talking about it as “this mysterious terrible thing.”

She was already taking two blood pressure medications, a statin for cholesterol and an osteoporosis drug. Did she really need another prescription? She worried, too, about reports at the time of tainted imported drugs. She wasn’t even sure what prediabetes meant, or how quickly it might become diabetes.

“I felt like Patient Zero,” she said. “There were a lot of unknowns.”

Now, there are fewer unknowns. A longitudinal study of older adults, published online this month in the journal JAMA Internal Medicine, provides some answers about the very common in-between condition known as prediabetes.

The researchers found that over several years, older people who were supposedly prediabetic were far more likely to have their blood sugar levels return to normal than to progress to diabetes. And they were no more likely to die during the follow-up period than their peers with normal blood sugar.

“In most older adults, prediabetes probably shouldn’t be a priority,” said Elizabeth Selvin, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore and the senior author on the study.

Prediabetes, a condition rarely discussed as recently as 15 years ago, refers to a blood sugar level that is higher than normal but that has not crossed the threshold into diabetes. It is commonly defined by a hemoglobin A1C reading of 5.7 to 6.4 percent or a fasting glucose level of 100 to 125 mg/dL; in midlife, it can portend serious health problems.

A diagnosis of prediabetes means that you are more likely to develop diabetes, and “that leads to downstream illness,” said Dr. Kenneth Lam, a geriatrician at the University of California, San Francisco, and an author of an editorial accompanying the study. “It damages your kidneys, your eyes and your nerves. It causes heart attack and stroke,” he said.

But for an older adult just edging into higher blood sugar levels, it’s a different story. Those fearful consequences take years to develop, and many people in their 70s and 80s will not live long enough to encounter them.

That fact has generated years of debate. Should older people with slightly above-normal blood sugar readings — a frequent occurrence since the pancreas produces less insulin in later life — be taking action, as the American Diabetes Association has urged?

Or does labeling people prediabetic merely “medicalize” a normal part of aging, creating needless anxiety for those already coping with multiple health problems?

Dr. Selvin and her colleagues analyzed the findings of an ongoing national study of cardiovascular risk that began in the 1980s. When 3,412 of the participants showed up for their physicals and lab tests between 2011 and 2013, they had reached ages 71 to 90 and did not have diabetes.

Prediabetes, however, was rampant. Almost three-quarters qualified as prediabetic, based on either their A1C or fasting blood glucose levels.

These findings mirrored a 2016 study pointing out that a popular online risk test created by the Centers for Disease Control and Prevention and the American Diabetes Association, called doihaveprediabetes.org, would deem nearly everyone over 60 as prediabetic.

In 2010, a C.D.C. review reported that 9 to 25 percent of those with an A1C of 5.5 to 6 percent will develop diabetes over five years; so will 25 to 50 percent of those with A1C readings of 6 to 6.5. But those estimates were based on a middle-aged population.

When Dr. Selvin and her team looked at what had actually happened to their older prediabetic cohort five to six years later, only 8 or 9 percent had developed diabetes, depending on the definition used.

A much larger group — 13 percent of those whose A1C level was elevated and 44 percent of those with prediabetic fasting blood glucose — actually saw their readings revert to normal blood sugar levels. (A Swedish study found similar results.)

Sixteen to 19 percent had died, about the same proportion as those without prediabetes.

“We’re not seeing much risk in these individuals,” Dr. Selvin said. “Older adults can have complex health issues. Those that impair quality of life should be the focus, not mildly elevated blood glucose.”

Carol Jacobi, a friend of Ms. Weinberg’s, received a similar diagnosis at around the same time, but did nothing much to reduce her blood sugar.
Carol Jacobi, a friend of Ms. Weinberg’s, received a similar diagnosis at around the same time, but did nothing much to reduce her blood sugar.Credit…Jenna Schoenefeld for The New York Times

Dr. Saeid Shahraz, a health researcher at Tufts Medical Center in Boston and lead author of the 2016 study, praised the new research. “The data is really strong,” he said. “The American Diabetes Association should do something about this.”

It may, said Dr. Robert Gabbay, the A.D.A.’s chief scientific and medical officer. The organization currently recommends “at least annual monitoring” for people with prediabetes, a referral to the lifestyle modification programs shown to decrease health risks and perhaps metformin for those who are obese and under 60.

Now the association’s Professional Practice Committee will review the study, and “it could lead to some adjustments in the way we think about things,” Dr. Gabbay said. Among older people considered prediabetic, “their risk may be smaller than we thought,” he added.

Defenders of the emphasis on treating prediabetes, which is said to afflict one-third of the United States population, point out that first-line treatment involves learning healthy behaviors that more Americans should adopt anyway: weight loss, smoking cessation, exercise and healthy eating.

“I’ve had a number of patients diagnosed with prediabetes, and it’s what motivates them to change,” Dr. Gabbay said. “They know what they should be doing, but they need something to kick them into gear.”

Geriatricians tend to disagree. “It’s unprofessional to mislead people, to motivate them by fear of something that’s not actually true,” Dr. Lam said. “We’re all tired of having things to be afraid of.”

He and Dr. Sei Lee, a coauthor of the editorial accompanying the new study and a fellow geriatrician at the University of California, San Francisco, argue for a case-by-case approach in older adults — especially if a diagnosis of prediabetes will cause their children to berate them over every cookie.

For a patient who is frail and vulnerable, “you’re likely dealing with a host of other problems,” Dr. Lam said. “Don’t worry about this number.”

A very healthy 75-year-old who could live 20 more years faces a more nuanced decision. She may never progress to diabetes; she may also already follow the recommended lifestyle modifications.

Ms. Weinberg, now 69, sought help from a nutritionist, changed her diet to emphasize complex carbohydrates and protein, and began walking more and climbing stairs instead of taking elevators. She shed 10 pounds she didn’t need to lose. Over 18 months, her barely elevated A1C reading fell to 5.6.

Her friend Carol Jacobi, 71, who also lives in Los Angeles, got a similar warning at about the same time. Her A1C was 5.7, the lowest number defined as prediabetic, but her internist immediately prescribed metformin.

Ms. Jacobi, a retired fund-raiser with no family history of diabetes, felt unconcerned. She figured she could lose a little weight, but she had normal blood pressure and an active life that included lots of walking and yoga. After trying the drug for a few months, she stopped.

Now, neither woman has prediabetes. Although Ms. Jacobi did nothing much to reduce her blood sugar, and has gained a few pounds during the pandemic, her A1C has fallen to normal levels, too.

A Different Early-Bird Special: Have Vaccine, Will Travel

A Different Early-Bird Special: Have Vaccine, Will Travel

People over 65 have been among the first in line to receive Covid-19 vaccinations. And they are leading a wave in new travel bookings.

Travel is on the rise among newly inoculated older travelers. The Marker Key West Harbor Resort in Key West, Fla. has resumed an aqua yoga class that was put on hiatus during the pandemic.
Travel is on the rise among newly inoculated older travelers. The Marker Key West Harbor Resort in Key West, Fla. has resumed an aqua yoga class that was put on hiatus during the pandemic.Credit…Mark Hedden for The New York Times

  • Feb. 17, 2021, 5:00 a.m. ET

When the coronavirus hit, Jim and Cheryl Drayer, 69 and 72, canceled all their planned travel and hunkered down in their home in Dallas, Texas.

But earlier this month, the Drayers both received the second dose of their Covid-19 vaccinations. And in March, armed with their new antibodies, they are heading to Maui for a long overdue vacation.

Across the United States, older people have been among the first in line to receive their Covid-19 vaccinations. And among hotels, cruise lines and tour operators, the data is clear: Older travelers are leading a wave in new travel bookings. Americans over 65, who have had priority access to inoculations, are now newly emboldened to travel — often while their children and grandchildren continue to wait for a vaccine. For the silver-haired, it’s a silver lining.

“We’ve very willingly been compliant with masking and social distancing, and have basically lived inside of our bubble here in Dallas,” Mr. Drayer said. “We haven’t been inside a restaurant in a year. So we’re anxious to get out now and do things a little more safely.”

Jim and Cheryl Drayer, retirees and seasoned travelers, at their home in Dallas.
Jim and Cheryl Drayer, retirees and seasoned travelers, at their home in Dallas.Credit…Cooper Neill for The New York Times

At the Foundry Hotel in Asheville, N.C., an 87-room luxury hotel housed in what was once a steel factory for the Biltmore Estate, reservations made with the hotel’s AARP promotional rate were up 50 percent last month. Aqua-Aston Hospitality, a Honolulu-based company with resorts, hotels and condos in its portfolio, reports that senior-rate bookings climbed nearly 60 recent in January.

The Drayers, who have gone gorilla trekking in Africa and done adventure travel in India, Israel and Egypt, admit that their trip to Hawaii, which they booked through the members-only vacation club, Exclusive Resorts, is something of a baby step. (The vacation club reports that more than 50 percent of their current bookings are vacations for members over the age of 65.)

“We’re testing the waters,” Ms. Drayer said. “We didn’t want to end up quarantined in a foreign country or not allowed back in the United States. This felt like a safe place to go, where we were still in the United States.”

That sense of safety is partly because Hawaii, with its mandatory quarantine and contact tracing, has managed the pandemic well. The couple feel confident that if they were to face any health issues while on the island, they wouldn’t be stymied by an overburdened health system.

“We’re traveling to a destination that, by all the numbers, is safer than where we live right now,” said Mr. Drayer. “It feels like our bubble has cracked open a little a bit.”

Alice Southworth, 75, outside her home in McLean, Va., received her first dose of the Covid-19 vaccine and is now planning a trip to Hilton Head Health, a wellness resort in South Carolina.Credit…Alyssa Schukar for The New York Times

Alice Southworth, 75, was also looking for a post-vaccine travel destination in a place that was still taking Covid-19 precautions seriously, and didn’t push her too far out of her comfort zone. A semiretired psychologist, she has continued to see a handful of patients throughout the pandemic, but hasn’t ventured beyond her hometown of McLean, Va., in more than a year. She also hasn’t been able to use an indoor gym or attend her beloved water aerobics classes, so as soon as she received the first dose of the vaccine, she booked a visit to Hilton Head Health, a wellness resort in South Carolina, where she’ll have access to a full range of fitness classes and activities. And when she arrives on March 28, she’ll be fully vaccinated.

Receiving that coveted first shot, she said, wasn’t just a factor in convincing her to book the trip. “It was the whole of the decision,” she said. But even having been immunized, she knows the vaccine is not a magic bullet, and wanted to be sure she was selecting a vacation spot where she trusted sanitation measures and where social distancing would still be possible.

“Hilton Head is a good investment in my own health,” she said, “and it’s a place where I feel I will be safe enough. I’m not going to Rome, you know.”

Older people are more eager to travel in 2021 than other age groups, and also more likely to link the timing of their travel to when they receive their vaccinations, according to a January survey conducted by the travel agency network Virtuoso. In the study, 83 percent of respondents over 77 said they were more ready to travel in 2021 than in 2020, and 95 percent of the same group said they would wait to travel until they received their vaccine (in other age groups, the percentage dipped to 80).

And while some older adults are focusing on short distances and Covid-19 precautions at their destinations when it comes to post-pandemic travel, others are enthusiastically planning to just go big.

“There’s a lot of pent-up desire among seniors, and a sense of life running out,” said Jeff Galak, a professor at Carnegie Mellon University’s Tepper School of Business. “There’s a theory called mortality salience: When your own mortality is brought to mind, behaviors change. We’re going to see upgrades to better cabins on cruise ships, and booking of better hotels.”

For travelers in their 60s, 70s and 80s, said Conor Goodwin, corporate manager of Charlestowne Hotels, the ticking of the clock is another strong motivation to book as soon as an inoculation makes it safe.

“The 65-plus demographic is losing out on their golden years and they’re understandably eager to get back out there,” he said.

The Bristol Hotel in Virginia, which is part of Charlestowne’s portfolio, saw revenue from travelers over the age of 65 increase 179 percent between Dec. 13 and Jan. 22. The French Quarter Inn, in Charleston, S.C., which is also managed by Charlestowne, saw 11 percent more bookings from people over 65 between Jan. 10 and 28 compared Dec. 22 to Jan 9.

Some older travelers are even opting to finally book those big-ticket dream trips. Fernando Diez, who owns Quasar Expeditions, a luxury cruise operator in the Galápagos Islands, says that in December, when frontline health care workers were among the very first Americans to receive vaccines, he saw a wave of requests for trip information from doctors and nurses.

Since Jan. 1, however, 70 percent of his booking inquiries have come from guests over the age of 65 — in previous years, that number was closer to 40 percent. Most inquiries are for travel from June onward.

“Most of them say they’ve been vaccinated, and they’re comfortable now traveling to a destination like Ecuador and the Galápagos,” Mr. Diez said. “The vaccination gives them the confidence to travel to a remote spot.”

And Lauren Bates, founder and owner of Wild Terrains, a women-only tour operator with itineraries in Mexico, Portugal and Argentina, said she was stunned when bookings in December and January — for trips starting as soon as May 2021 — were 40 percent higher than in January 2020, and three-quarters of the women who booked in that time were over the age of 55.

“We’re seeing a lot of women in their 60s and 70s booking trips with friends,” she said.

Public health experts call for caution, however, reminding seniors that even when they have received both doses of their Covid shots, the recommendations for masking and social distancing remain the same.

“The vaccine is still not 100 percent effective, and if you’re living basically in a sea of virus, it’s good to be very careful even though you’ve been vaccinated,” said Dr. Manfred Green, director of the public health program at the University of Haifa in northern Israel. “We’re still not sure if someone who is vaccinated could acquire the disease without getting sick, meaning the virus would be with them and they could transmit it to someone else.”

And all older travelers should choose destinations where hospitals have not been overburdened by the pandemic, Dr. Green said, because vaccinated or not, older Americans are more likely to suffer from non-Covid-related health issues.

The tourism industry, battered by the pandemic, is now getting a much-needed boost from this new surge. Hotels and resorts, which have faced record-low occupancy throughout the pandemic, are wholeheartedly embracing the fresh wave of travelers, with many rolling out new programming and features geared toward their oldest demographic.

Instructor Peter Rogers, above, teaching aqua yoga at the Marker Key West Harbor Resort. The yoga class, which can relieve joint pain and arthritis, has been popular with older guests.Credit…Mark Hedden for The New York Times

At the Marker Key West Harbor Resort, which sits on two lush acres in the Florida Keys, transactions from guests over the age of 55 were 70 percent higher in January 2021 than in December 2020, translating to a 41 percent increase in spending.

Allie Singer, its director of sales and marketing, said the jump is almost certainly coming from newly vaccinated seniors.

The resort responded by bringing back programming that had taken a hiatus during the pandemic but was popular with older visitors in the past, including aqua yoga — which can relieve joint pain and arthritis — and a 5 p.m. “welcome reception” on the resort’s pool deck with appetizers and live music.

“It’s very attractive to the senior crowd at that hour,” she said.


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People With Dementia Are Twice as Likely to Get Covid, Huge Study Finds

People With Dementia Are Twice as Likely to Get Covid, Huge Study Finds

The analysis of nearly 62 million electronic medical records in the U.S. also found that Black people with dementia were at an even greater risk.

Lynda Hartman, 75, visited her 77-year-old husband, Len Hartman, who lives with dementia, in a hug tent outside an assisted living center in Louisville, Colo., this month.
Lynda Hartman, 75, visited her 77-year-old husband, Len Hartman, who lives with dementia, in a hug tent outside an assisted living center in Louisville, Colo., this month.Credit…Thomas Peipert/Associated Press
Pam Belluck

  • Feb. 9, 2021, 7:00 a.m. ET

People with dementia had significantly greater risk of contracting the coronavirus, and they were much more likely to be hospitalized and die from it, than people without dementia, a new study of millions of medical records in the United States has found.

Their risk could not be entirely explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home and having conditions like obesity, asthma, diabetes and cardiovascular disease. After researchers adjusted for those factors, Americans with dementia were still twice as likely to have gotten Covid-19 as of late last summer.

“It’s pretty convincing in suggesting that there’s something about dementia that makes you more vulnerable,” said Dr. Kristine Yaffe, a professor of neurology and psychiatry at the University of California, San Francisco, who was not involved in the study.

The study found that Black people with dementia were nearly three times as likely as white people with dementia to become infected with the virus, a finding that experts said most likely reflected the fact that people of color generally have been disproportionately harmed during the pandemic.

“This study highlights the need to protect patients with dementia, especially those who are Black,” the authors wrote.

Maria Carrillo, chief science officer of the Alzheimer’s Association, which runs the journal that published the study, Alzheimer’s and Dementia, said in an interview, “One of the things that has come from this Covid situation is that we should be pointing out these disparities.”

The study was led by researchers at Case Western Reserve University who analyzed electronic health records of 61.9 million people age 18 and older in the United States from Feb. 1 through Aug. 21, 2020. The data, collected by IBM Watson Health Explorys, came from 360 hospitals and 317,000 health care providers across all 50 states and represented a fifth of the American population, the authors said.

Rong Xu, a professor of biomedical informatics at Case Western and the senior author of the study, said there had been speculation about whether people with dementia were more prone to infection and harm from Covid-19.

“We thought, ‘We have the data, we can just test this hypothesis,’” Dr. Xu said.

The researchers found that out of 15,770 patients with Covid-19 in the records analyzed, 810 of them also had dementia. When the researchers adjusted for general demographic factors — age, sex and race — they found that people with dementia had more than three times the risk of getting Covid-19. When they adjusted for Covid-specific risk factors like nursing home residency and underlying physical conditions, the gap closed somewhat, but people with dementia were still twice as likely to become infected.

Experts and the study authors said the reasons for this vulnerability might include cognitive and physiological factors.

“Folks with dementia are more dependent on those around them to do the safety stuff, to remember to wear a mask, to keep people away through social distancing,” said Dr. Kenneth Langa, a professor of medicine at the University of Michigan, who was not involved in the study. “There is the cognitive impairment and the fact that they are more socially at risk,” he said.

Dr. Yaffe said there could also be a “frailty element” to people with dementia, including a lack of mobility and muscle tone, that could affect their resilience to infections.

Dr. Carrillo noted that coronavirus infection was associated with an inflammatory response that has been shown to affect blood vessels and other aspects of the circulatory system. Many people with dementia already have vascular impairment, which may be compounded or amplified by Covid-19.

Indeed, the study authors subdivided patients by the type of dementia listed in the electronic records and found that people designated as having vascular dementia had a greater risk for infection than people designated as having Alzheimer’s disease or other types.

But Dr. Langa and Dr. Yaffe cautioned that there was significant overlap between types of dementia. Many patients have both Alzheimer’s pathology and vascular pathology, they said, and physicians who are not specialists may not distinguish subtypes in providing codes for electronic records.

In examining the risk of hospitalization and death for Covid patients with dementia, the researchers did not adjust for demographics like age or whether they lived in nursing homes or had underlying medical conditions. They found that Covid patients with dementia were 2.6 times as likely to have been hospitalized during the first six months of the pandemic as those without dementia. They were 4.4 times as likely to die.

Black people with Covid-19 and dementia were significantly more likely to be hospitalized than white people who had both diseases. The authors did not find a significant difference in the mortality rate for Black and white coronavirus patients with dementia, although they wrote that the number of deaths analyzed, 170, might be too small to provide a solid conclusion about that.

Experts noted that one limitation to the study was that researchers did not have access to socioeconomic information, which could provide increased understanding of patients’ risk factors.

Dr. Langa also noted that the data reflected only people who have interacted with the health care system, so it doesn’t include “more isolated and poorer patients that have a harder time getting to doctors.”

Consequently, he said, the study may be “an underestimate of the greater Covid infection risk for those with dementia.”

Remote Learning Isn’t Just for Kids

Remote Learning Isn’t Just for Kids

New online tools and an array of remote classes and programs are ramping up education and training for adults.

Credit…James Yang

  • Feb. 9, 2021, 5:00 a.m. ET

This article is part of our new series, Currents, which examines how rapid advances in technology are transforming our lives.

Deb Livingston, a former business consultant, was always curious and eager to learn just about anything.

“When the pandemic hit, I was confined at home and found myself diving into online exploration,” said Ms. Livingston, 61. She discovered GetSetUp, an interactive website that delivers virtual education to older adults.

Even former chief executives like Jeff Mihm, a Miami resident who led Noven Pharmaceuticals, sometimes need a new life direction.

After resigning from his corporate post, Mr. Mihm, 55, decided to go back to school — virtually, because of the pandemic — and enrolled in the University of Texas’s Tower Fellows program in September. “I have a love of learning, and it was an opportunity to step back, study and explore,” he said.

The internet has empowered adult learners by providing new online tools to ramp up education and training. “The need for workers to keep pace with fast-moving economic, cultural and technological changes, combined with longer careers, will add up to great swaths of adults who need to learn more than generations past — and faster than ever,” said Luke Yoquinto, a research associate at the M.I.T. AgeLab and co-author of “Grasp: The Science Transforming How We Learn.”

By 2034, the number of adults age 65 and older will outnumber those under the age of 18, according to the Census Bureau. “That growth of older age demographics will translate to new demand for enrichment in the form of digital education,” Mr. Yoquinto said. “I would say that, for both good and ill, older demographics are going to serve as a proving ground for learning technologies in the coming years.”

Adult education, however, is “the Wild West” of education technology, according to Mr. Yoquinto. There are many outlets experimenting with ways to get a handle on the online adult education marketplace, including community colleges and universities, for-profit learning platforms, workshop providers and nonprofit organizations.

The new platforms are also opening doors to more adults. “There are already tons of people who, once upon a time, by dint of age or circumstance, wouldn’t traditionally have gotten the chance to partake in education, but can now sign up for free online courses,” Mr. Yoquinto said. Participants can choose a class here and there, without strapping on a backpack and heading to campus or signing up for expensive degree programs.

Virtual learning has become “the great equalizer,” said Gene O’Neill, the chief executive of the North American Veterinary Community, which provides continuing education for veterinarians around the world. “Because of virtual learning, veterinary professionals everywhere, even in remote, undeveloped countries, can learn from the world’s most renowned leaders and virtually participate in conferences,” he said. “This puts learning on an equal platform for everyone regardless of geography, income or time constraints.”

Ms. Livingston’s goal was to improve her skills so she could become a paid teacher on the GetSetUp platform, which offers classes — all taught via Zoom by teachers older than 50 — on skills from professional development to technology, health, wellness and hobbies like photography. There’s even a new class about registering for a Covid-19 vaccine, given the difficulties many people have faced. There are three membership levels, starting at free and topping out at $20 a month for unlimited access.

“The nature of work is changing,” said Neil Dsouza, GetSetUp’s chief executive and co-founder. “The traditional way of designing training and reskilling is a long, drawn-out program where you get a certificate or a degree. By the time you get that certificate, the skill is already outdated. We’re changing that model.”

Ms. Livingston, who lives in York, Pa., signed up to learn how to use Zoom to host classes, how to manage and lead an online class and how to teach Google Classrooms. “Seniors everywhere were in lockdown and were eager to learn and connect,” she said.

Because she’s interested in cooking and eating healthy meals, Ms. Livingston eventually began teaching classes such as “Great Dinners in 30 Minutes or Less,” “Healthy Eating on a Budget” and “Healthy Desserts That Are Delicious, Too.”

In January, Oasis, a nonprofit educational organization, launched Oasis Everywhere, with a menu of online classes on subjects from art to writing. Senior Planet, a unit of Older Adults Technology Services, or OATS, is a nonprofit resource for people 60 and older that offers courses and lectures.

OATS was founded in 2004 in New York City as a community-based project for older adults focused on tech education. Since then, it has expanded to over 200 locations in five states, serving urban and rural communities. But last year it was forced to pivot in response to the pandemic. “We taught hundreds of in-person classes before the virus forced the closure of Senior Planet locations in March,” said Tom Kamber, the founder and executive director.

That’s when his team pulled together and, within weeks, launched a fully digital set of courses and programs that have rapidly expanded its reach to its primary audience — a global community of anyone 60 and older.

Beyond Senior Planet, OATS launched Aging Connected, which aims to get one million older adults online. It provides tablets, along with training and technical support, to 10,000 older residents of New York City Housing Authority communities.

“I really wanted to create a program that would be able to get older adults to use technology and give them the kinds of training and support in environments where they could succeed,” Mr. Kamber said.

While older adults are continuing to learn new skills, they also are starting new businesses. In 2019, research from the Kauffman Foundation, a nonpartisan group supporting entrepreneurship, found that more than 25 percent of new entrepreneurs were ages 55 to 64, up from about 15 percent in 1996.

Online courses are riding that start-up wave. GetSetUp, for example, offers courses on running an e-commerce marketplace, starting a business from home and building a website.

Other offerings for entrepreneurs include Blissen, a three-month virtual boot camp for entrepreneurs over 50, and the AARP Foundation’s Work for Yourself @50+, which offers free webinars and workshops.

But all these online opportunities are not possible without access to the internet. “While there’s a rising passion for knowledge, people are getting excluded from the educational process in this country because they’re not online,” Mr. Kamber said. Based on a research report OATS recently released in partnership with the Humana Foundation, nearly 22 million Americans over the age of 65 lack broadband access at home.

“The good news, though, is the level of sophistication of online education is increasing and more access is coming to rural communities,” Mr. Kamber said. “It’s a brave new world of learning for people, and that gives me hope.”

For Ms. Livingston, that means continuing to take and teach classes at GetSetUp.

“Learning at any stage of life is what stimulates creativity and joy,” she said. “So much energy emerges from connecting the dots, having ‘aha’ moments and gaining skills. I love that I can help others keep their zest for life and help myself in the process.”

In Line for Vaccination, and Not Getting Younger

Ruth Ann Platt of Gainesville, Ga., received her second dose of the Moderna Covid-19 vaccine after spending seven months in her room. Now, she said, “I would love to find someone who plays a good game of pinochle.”
Ruth Ann Platt of Gainesville, Ga., received her second dose of the Moderna Covid-19 vaccine after spending seven months in her room. Now, she said, “I would love to find someone who plays a good game of pinochle.”Credit…Nicole Craine for The New York Times

In Line for Vaccination, and Not Getting Younger

Residents and workers at long-term-care facilities are high-priority candidates for the Covid-19 vaccine. But many are still waiting.

Ruth Ann Platt of Gainesville, Ga., received her second dose of the Moderna Covid-19 vaccine after spending seven months in her room. Now, she said, “I would love to find someone who plays a good game of pinochle.”Credit…Nicole Craine for The New York Times

  • Feb. 5, 2021, 11:59 a.m. ET

Ruth Ann Platt, watching the news on television about effective vaccines for the coronavirus, couldn’t wait for them to reach her nursing home in Gainesville, Ga. “I thought it was a great thing from the get-go,” she said.

When Ms. Platt, 88, moved into New Horizons Lanier Park last year after surgery for a fractured femur, the facility had already instituted harsh restrictions to contain Covid-19 outbreaks. “I’ve lived in this room for seven months,” she said.

She has yet to share a meal with another resident, attend a concert or take an art class. The hair salon has remained closed, she said, so “pretty soon I’ll be Rapunzel.” She is tiring of video chats as a substitute for visits with her children, grandchildren and eight great-grandchildren.

Happily, she received her second dose of the Moderna vaccine last month. New Horizons, part of the nonprofit Northeast Georgia Health System, opted out of a federal partnership that relies on CVS and Walgreens to serve long-term-care facilities. Using its own pharmacy and nurses, it began vaccinating residents quickly, starting Dec. 29.

Now, Ms. Platt said, “I would love to find someone who plays a good game of pinochle.”

The report card for vaccination in long-term-care facilities, whose residents supposedly stood at the front of the line, shows a mixed performance.

Nationally, almost 3.4 million long-term-care residents and staff members have received at least one shot, the Centers for Disease Control and Prevention reported on Thursday; close to 800,000 had gotten two.

Walgreens pharmacists prepared to administer a Covid-19 vaccine to residents at King David Center for Nursing and Rehabilitation in Brooklyn last month.
Walgreens pharmacists prepared to administer a Covid-19 vaccine to residents at King David Center for Nursing and Rehabilitation in Brooklyn last month.Credit…Yuki Iwamura/Reuters

By mid-January, Medicare data showed that cases in long-term-care facilities had dropped by almost 46 percent compared with four weeks earlier, reflecting the decline in cases across the country but probably also the impact of vaccination.

But experts and advocates, noting that an estimated five million people live or work in long-term care, have expressed intense frustration at the slow initial rollout. “There’s been nothing warp speed about long-term care,” said David Grabowski, a health policy researcher at Harvard Medical School.

They also worry about the even more sluggish rate at assisted-living facilities and about workers who are suspicious of vaccination.

Last fall, the Trump administration contracted with the two big pharmacy chains, which agreed to hold three clinics at each facility: first dose, second dose and one to catch any stragglers missed earlier.

The pace of vaccination has picked up substantially. Walgreens increased the number of doses it was administering, from 165,000 in December to 1.3 million last month. It has completed the first doses at all 5,529 of the nursing homes it contracted with and expects to deliver the second doses by Feb. 25 and to complete third visits by mid- to late March.

Similarly, CVS, which has the larger program, has delivered first doses to all of the 7,822 nursing homes it is serving and about 77 percent of the second doses.

Company executives emphasized that while the Centers for Disease Control and Prevention prioritized long-term care for vaccination, individual states determined when programs began.

“We were actually planning for a national rollout on the same date,” said Chris Cox, senior vice president for pharmacy business at CVS. “We were ready to go.” But while nearly all states activated nursing home clinics on Dec. 21 or 28, most didn’t launch assisted living clinics until January, often weeks later.

The virus didn’t wait. Infections in long-term care reached a peak in December, according to a Kaiser Family Foundation analysis; so did deaths, in many states. Although long-term-care residents and staff members account for just 5 percent of the nation’s Covid-19 cases, they represent 37 percent of the deaths.

With a swifter response, “we could have had more nursing home residents vaccinated more effectively four to six weeks earlier,” said Dr. Michael Wasserman, a geriatrician and past president of the California Association of Long Term Care Medicine. “That’s a lot of deaths that could have been prevented.”

Future business students may scrutinize this plan for years. “This was never going to be easy, with 30,000-plus facilities and millions of residents and staff,” Dr. Grabowski said. “States and the federal government were happy to push this over to the private sector.”

Early on, facility administrators grappled with cumbersome consent forms, a problem that has since been resolved. CVS and Walgreens executives also report having to contact some facilities multiple times simply to schedule clinics.

Administrators, for their part, questioned the three-visit plan. How would these clinics reach staff members who worked night and weekend shifts? Or newly admitted residents, those returning from hospitals and those who were discharged after only one dose? The C.D.C. is reportedly working on a transition plan.

Moreover, although the chains post updated numbers daily, “we don’t have the level of information we’d like, even now,” said Tricia Neuman, executive director of the Program on Medicare Policy at Kaiser Family Foundation. The aggregate numbers don’t show which facilities the companies visited or the proportions of residents and staff members they vaccinated.

Residents have responded enthusiastically. The C.D.C. has estimated that during the program’s first month, in nursing homes with clinics, a median 77.8 percent of residents received their first doses.

“People who live in nursing homes would do just about anything to reconnect with the outside world and the people they love,” said Dr. Kathleen Unroe, a geriatrician at the Indiana University School of Medicine who also practices at Northwest Manor, a nursing home in Indianapolis.

One of her patients initially had doubts. “I didn’t want to be a guinea pig,” said Norma Ware, 86. “I’m not crazy about shots, anyway.” But after conversations with her family and “a very friendly nurse,” she received both doses and became a believer.

The bigger problem: a reluctant staff. The C.D.C. reported that at nursing homes with clinics, only a median 37.5 percent of staff members were vaccinated in the first month.

Vaccinating a resident at the King David nursing home facility in Brooklyn.Credit…Yuki Iwamura/Reuters

Other health care workers have also shown hesitance. But in nursing homes, particularly, many workers are women of color, familiar with longstanding inequities in health care and mistrustful of the medical establishment.

“They were poorly paid and overworked before the pandemic,” Dr. Grabowski said, noting that the workers had also faced shortages of personal protective equipment and adding: “They didn’t get paid sick leave or hazard pay. So now we’re saying, ‘You need to get vaccinated.’ I’m not surprised that many are saying, ‘Wait a minute, why?’”

Yet long-term-care workers are vulnerable to Covid-19; they can also transmit the virus as they enter and leave facilities and work second jobs to make ends meet.

At the two New Horizons homes in Gainesville, the medical director, Swati Gaur, has held six staff town halls, in person or online, including one at 2 a.m. for the night shift, and offered rewards like free meals. About half of the workers have been vaccinated, Dr. Gaur said.

“As their colleagues get vaccinated, their friends and peers and co-workers, those numbers will go up,” Dr. Wasserman predicted.

The lagging pace of vaccination in assisted-living facilities, which have also experienced lethal outbreaks, has generated anxiety, too. In some states, only about half of residents have received even a first dose.

Still, by some point in March the majority of long-term-care residents and many staff members are likely to have the protection of vaccines, either Pfizer or Moderna. Then what?

For residents, the top priority is to be able to see — and hug — their families. Geriatricians fear that, for residents, the risks from extended social isolation rival those from the coronavirus.

“We absolutely need to see restrictions loosened up,” said Robyn Grant, director of public policy and advocacy at the National Consumer Voice, which promotes quality in long-term care. “Residents have been suffering. This can’t continue.” Both Medicare and the C.D.C. are said to be preparing guidance on how and when to resume family visits.

Vaccinated residents could also regain contact with one another, gradually returning to communal meals and activities. “The goal is to get these residents out of their rooms,” Dr. Gaur said.

Ms. Platt offered some advice that could hasten that day. “This is no time for fear,” she counseled fellow residents. “Get your shot. Just get your shot and go on with your life.”

Even in Poorer Neighborhoods, the Wealthy Are Lining Up for Vaccines

Even in Poorer Neighborhoods, the Wealthy Are Lining Up for Vaccines

Officials acknowledge that the coveted shots are disproportionately going to white people and that planners’ efforts to course-correct are having limited effect.

Rose Woodside, 93, left, and her daughter, Adora Lee, 70 talking a nurse at a pre-vaccine screening in Washington, D.C. They obtained appointments after the city began giving priority to people in neighborhoods hit hardest by the virus.
Rose Woodside, 93, left, and her daughter, Adora Lee, 70 talking a nurse at a pre-vaccine screening in Washington, D.C. They obtained appointments after the city began giving priority to people in neighborhoods hit hardest by the virus.Credit…Kenny Holston for The New York Times
  • Feb. 2, 2021, 5:00 a.m. ET

WASHINGTON — As soon as this city began offering Covid vaccines to residents 65 and older, George Jones, whose nonprofit agency runs a medical clinic, noticed something striking.

“Suddenly our clinic was full of white people,” said Mr. Jones, the head of Bread for the City, which provides services to the poor. “We’d never had that before. We serve people who are disproportionately African-American.”

Similar scenarios are unfolding around the country as states expand eligibility for the shots. Although low-income communities of color have been hit hardest by Covid-19, health officials in many cities say that people from wealthier, largely white neighborhoods have been flooding vaccination appointment systems and taking an outsized share of the limited supply.

People in underserved neighborhoods have been tripped up by a confluence of obstacles, including registration phone lines and websites that can take hours to navigate, and lack of transportation or time off from jobs to get to appointments. But also, skepticism about the shots continues to be pronounced in Black and Latino communities, depressing sign-up rates.

Early vaccination data is incomplete, but it points to the divide. In the first weeks of the rollout, 12 percent of people inoculated in Philadelphia have been Black, in a city whose population is 44 percent Black. In Miami-Dade County, just about seven percent of the vaccine recipients have been Black, even though Black residents comprise nearly 17 percent of the population and are dying from Covid-19 at a rate that is more than 60 percent higher than that of white people. In data released last weekend for New York City, white people had received nearly half of the doses, while Black and Latino residents were starkly underrepresented based on their share of the population.

And in Washington, 40 percent of the nearly 7,000 appointments initially made available to people 65 and older were taken by residents of its wealthiest and whitest ward, which is in the city’s upper northwest section and has had only five percent of its Covid deaths.

We want people regardless of their race and geography to be vaccinated, but I think the priority should be getting it to the people who are contracting Covid at the highest rates and dying from it,” said Kenyan McDuffie, a member of the City Council whose district is two-thirds Black and Latino.

Alarmed, many cities are trying to rectify inequities. Baltimore will offer the shot in housing complexes for the elderly, going door-to-door.

“The key with the mobile approach is you can get a lot of hard-hit folks at the same time — if we just get enough supply to do that,” said the city’s health commissioner, Dr. Letitia Dzirasa.

Officials in Wake County, N.C., which includes Raleigh, are first attempting to reach people 75 and over who live in nine ZIP codes that have had the highest rates of Covid. “We weren’t going to prioritize those who simply had the fastest internet service or best cell provider and got through fastest and first,” said Stacy Beard, a county spokeswoman.

Fixing the problem is tricky, however. Officials fear that singling out neighborhoods for priority access could invite lawsuits alleging race preference. To a large extent, the ability of localities to address inequities depends on how much control they have over their own vaccine allocations and whether their political leadership aligns with that of supervising county or state authorities.

The experiences of Dallas and the District of Columbia, for example, have resulted in very different outcomes. Dallas County, predominantly Democratic, has been thwarted by the state health department, under the aegis of a Republican governor, which quashed the county’s plan to give vaccines to certain minority neighborhoods first. But Washington was able to quickly course-correct.

D.C. pivots to reach the more vulnerable

Adora Lee, a resident of Washington’s Ward 8, receiving the vaccine. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities,” she said. “This is no joke for us.”
Adora Lee, a resident of Washington’s Ward 8, receiving the vaccine. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities,” she said. “This is no joke for us.”Credit…Kenny Holston for The New York Times

A few days after its 65-and-older population became eligible for the vaccine on Jan. 11, Mr. McDuffie, the city councilman in the District of Columbia, flagged the issue of wealthier residents getting disproportionate access to the vaccine in a call with city officials. Overall, 74 percent of deaths and 48 percent of cases in Washington have been among Black residents, who make up 46 percent of the population; 11 percent of deaths and 25 percent of cases have been among white residents, who make up nearly the other half of the district.

By the end of that week, the city announced a new policy — offering the first day of new appointments to people in ZIP codes with the highest rates of infection and death from the virus. Under the new system, more appointments would be added a day later and people from other neighborhoods could sign up then. The city also quadrupled the number of workers helping people make appointments through its call center, to 200.

But email lists in wealthier neighborhoods lit up in protest.

“It looked like maybe Ward 3 was being punished for being more computer savvy,” said Mary Cheh, a city council member representing the ward, where houses in neighborhoods near American University or the Potomac River routinely sell for more than $2 million. “I was inundated with emails from people who were just really angry about it.”

The day after the policy change, Ms. Cheh wrote to her constituents, citing the data about the shots and saying that “our anxiety to get one right away should not cloud the pursuit of equitable vaccine distribution.”

“When I sent out that note, people said, ‘Oh thank you, I understand now,’” Ms. Cheh said. Still, she called the city’s new system “a very blunt instrument,” and said it would be fairer to base need on an individual’s risk, not an entire neighborhood’s.

Adora Iris Lee, 70, lives in one of Washington’s priority neighborhoods — Congress Heights, part of Ward 8 in the district’s southern area, which is heavily Black and has had the highest number of Covid deaths. She said she still had spent more than three hours on hold, but obtained appointments for herself and her mother, who is 93.

“Being able to call at a time that was designated for us — I felt good about that,” Ms. Lee said. “People who live in Ward 3 and people who live in Ward 8, they’ve got different social realities. This is no joke for us.”

Still, Mr. Jones, of Bread for the City, said that even with the new system, hardly any of the people coming for shots at his clinic were its regular patients. The clinic started reaching out to its regulars and, with the city’s permission, reserved all its first doses for them and for clients of other social service organizations last week.

“It’s not just a case of preserving the spots for people,” Mr. Jones said. “Somehow we’ve got to persuade them to use those spots.”

Showdown in Dallas

A vaccine line at Fair Park in Dallas last month.Credit…Pool photo by Smiley N.

Dallas County’s rollout plans for the vaccine included an inoculation hub in a neighborhood that is largely African-American and Latino. But when the sign-up website went live, the link speedily circulated throughout white, wealthier districts in North Dallas.

“Instead of getting a diverse sampling, we had a stampede of people who were younger and healthier than those who had initially gotten the links,” said Judge Clayton Jenkins, head of the Dallas County Commissioners Court. Observers told commissioners that those in line were overwhelmingly white.

The county commissioners quietly contacted Black and Latino faith leaders in South Dallas, who encouraged constituents to show up for shots without appointments, as long as they offered proof that they were 75 and older.

That plan worked for a day or so.

“Then city council people in North Dallas got calls and the mayor said it would be open to everyone over 75,” Judge Jenkins said. “That led again to a huge stampede of people from the suburbs who had reliable cars.”

John Wiley Price, a Dallas commissioner who represents voters in South Dallas, argued that the 27,000 people who had signed up from 11 vulnerable ZIP codes should be given the vaccine ahead of other neighborhoods. Already, more than 300,000 Dallas County residents had registered; The county was only receiving a weekly allocation of about 9,000 doses.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area

You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.

Probably not. The answer depends on a number of factors, including the supply in your area at the time you’re vaccinated. Check your state health department website for more information about the vaccines available in your state. The Pfizer and Moderna vaccines are the only two vaccines currently approved, although a third vaccine from Johnson & Johnson is on the way.

That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.

Employers do have the right to compel their workers to be vaccinated once a vaccine is formally approved. Many hospital systems, for example, require annual flu shots. But employees can seek exemptions based on medical reasons or religious beliefs. In such cases, employers are supposed to provide a “reasonable accommodation” — with a coronavirus vaccine, for example, a worker might be allowed to work if they wear a mask, or to work from home.

If you have other questions about the coronavirus vaccine, please read our full F.A.Q.

But when Judge Jenkins inquired whether geographical priority would pass muster, state officials said that if Dallas proceeded with the plan, the state would withhold the county’s supply.

According to a state health department spokesman, inoculation hubs had to agree to vaccinate any Texan, because not every county has a site. If Dallas excluded residents by geography, providers would be in breach of contract.

Dallas backed down.

Persuading people to get the shot

A mass Covid vaccination event in Denver on Saturday.Credit…Michael Ciaglo/Getty Images

Even successful efforts to target impoverished neighborhoods are running into another problem. Many Black and Latino people are hesitant to get the vaccine.

In Colorado, 1 of 16 white residents have received the vaccine so far, compared to 1 of 50 Latinos, who comprise 20 percent of the state’s population, according to a Colorado Springs newspaper, The Gazette.

“There are a lot of Chicanos who are like, ‘I want to wait, I have questions, I need some answers,’ ” said Julie Gonzales, a state senator from Denver, who starts her workday sending condolences to constituents, many of them Latino, who have lost family members to the virus.

Public health experts and outreach campaigns need to be attuned to cultural nuances that differ among Latino generations, Ms. Gonzales said. “It’s one thing to speak to an old-school Chicano who has been here for generations versus someone who is concerned about whether I.C.E. can find out their personal information if they try to get the vaccine,” she said, referring to the federal Immigration and Customs Enforcement agency.

A tracking poll by the Kaiser Family Foundation, conducted just before President Biden took office, found that while the share of people overall who wanted to get the vaccine as soon as possible has increased since December, 43 percent of Black adults and 37 percent of Hispanic adults said they wanted to “wait and see how it’s working,” compared with 26 percent of white adults.

When initial statistics in Philadelphia showed that only 12 percent of vaccine recipients were Black, city health officials recoiled. Blindsided by an inexperienced start-up company whose vaccination strategies faltered, health officials also attributed the low numbers to hesitation among city nursing home workers and hospital aides, many of whom are Black.

Now that the city has expanded eligibility, it is hopeful that the distribution will become more equitable. The vaccine is going to residents with high-risk medical conditions, as well as first responders, people who work in public transit and those in retail and food service jobs who come into contact with the public.

“Many of these are people who are paid less, tend to be from communities of color and are at high risk because they are exposed to lots of people,” said James Garrow, a spokesman for the Philadelphia Department of Public Health.

Mixed success as outreach expands

Some cities now provide vaccination pop-up clinics in Black churches. Denver is directing doses to community clinics that serve the underinsured.

Dallas has a new bilingual call center. Still, according to the latest county data, white people, who make up 28.5 percent of Dallas’s population, have gotten 62.6 percent of its vaccine doses.

Even in Washington, D.C., frustrations linger despite clear progress. Last week, city officials announced results of their tweaked distribution plan: Just over half of shots have now gone to residents of neighborhoods given priority, up from 29.6 percent during the first week that older people were vaccinated.

Yet, during a daylong session last week, council members heard pained accounts from people like Janett Gasaway, 77, who still has not been able to get vaccine appointments for herself or her 89-year-old husband. Despite multiple calls — she on their landline, he on his cellphone — on the days that appointments are offered to the most vulnerable ZIP codes, they haven’t succeeded. On Thursday, 1,745 appointments were gone in 18 minutes.

“It is not working,” she said.

‘It’s Numbing’: Nine Retired Nuns in Michigan Die of Covid-19

‘It’s Numbing’: Nine Retired Nuns in Michigan Die of Covid-19

The deaths add to what is becoming a familiar trend in the spread of the virus as it devastates religious congregate communities by infecting retired, aging populations of nuns and sisters.

Nine Roman Catholic nuns died in January of Covid-19 at the retirement home of the Adrian Dominican Sisters in Adrian, Mich.
Nine Roman Catholic nuns died in January of Covid-19 at the retirement home of the Adrian Dominican Sisters in Adrian, Mich.Credit…Mike Dickie/The Daily Telegram, via Associated Press
  • Jan. 29, 2021, 5:48 p.m. ET

The religious sisters who lived in retired seclusion at the Dominican Life Center in Michigan followed strict rules to avoid an outbreak of coronavirus infection: They were kept in isolation, visitors were prohibited and masks were required by everyone on campus.

But after months of keeping the virus at bay, it found its way in.

On Friday, the Adrian Dominican Sisters said nine sisters died in January from Covid-19 complications at the campus in Adrian, about 75 miles southwest of Detroit.

“It’s numbing,” said Sister Patricia Siemen, leader of the religious order. “We had six women die in 48 hours.”

The deaths of the sisters in Michigan has added to what is becoming a familiar trend in the spread of the virus, as it devastates religious congregate communities by infecting retired, aging populations of sisters and nuns who had quietly devoted their lives to others.

Now some of these sisters have been thrust into the public eye, as details about their names, ages and lifetimes of work are being highlighted as part of the national discourse about Americans lost to the coronavirus.

“It is a moment of reckoning with the place that they have in our culture now,” said Kathleen Holscher, a professor who holds the endowed chair of Roman Catholic studies at the University of New Mexico. “Fifty or 60 years ago, they were the face of American Catholicism, in schools and in hospitals.”

Several of the women who died at the Adrian Dominican Sisters campus had been nurses or teachers. Others had dedicated decades of their lives to religious service.

“Americans are being reminded they are older, and still there,” Dr. Holscher said. “But now they are living in these community situations and caring for one another.”

The accounting of the deaths in the nation’s religious congregate communities started in the first half of 2020 as the country broadly began to take note of the deadly transmission of the virus and the lives it took.

Last April, May and June, 13 Felician sisters at the Presentation of the Blessed Virgin Mary convent in Michigan died of Covid-19. They pursued teaching, pastoral work and prayer ministry.

In a suburb of Milwaukee, at least five sisters at Our Lady of the Angels Convent died, starting last April. They worked in parishes, schools and universities, teaching English and music, and ministered to the aged and the poor.

At Notre Dame of Elm Grove, near Milwaukee, eight Roman Catholic sisters, educators, music teachers and social activists died of illnesses related to Covid-19 at a Wisconsin retirement home in December.

“Nuns have been the real grass roots workers of the church,” said Jack Downey, a professor of Catholic Studies at the University of Rochester. “It is really the nuns who people are interacting with on a daily basis. They have made possible Catholic life in the United States.”

“So nun communities passing in this way becomes particularly tragic,” he added.

As the deaths have mounted, the losses have put a focus on the future of these communities in a country where their populations are not only dwindling but rapidly aging.

Michael Pasquier, a professor of religious studies and history at Louisiana State University, said the interest in pursuing an institutional religious life has tapered off since the 1960s, an era of cultural changes that brought more women into the work force. There are now about 40,000 Roman Catholic nuns or sisters in the country — mostly in their mid- to late 70s and older — compared with about 160,000 in the 1970s, he said.

The death toll from the virus, he said, “is a reminder to all of us that the composition and the face of Catholic sisters today is one that is old.”

The losses have highlighted the tendency of the virus to prey on older adults, those with underlying medical conditions and in places where people in close contact, like nursing homes, which have been especially hard hit by the pandemic.

Dr. Holscher said the “poignant or tragic” part of the nuns’ deaths is that, unlike nursing homes, the women forgo a traditional family structure when they enter religious life.

“They don’t have children, don’t have spouses or close family members,” she said. “And they have signed up to be in a position to care for one another.”

Many of the aging congregate orders took precautions early in 2020 to protect their communities. At Elm Grove, the nuns followed federal guidelines about masks and social distancing, and staggered meal times in the communal dining room.

The Dominican sisters imposed similar restrictions, including weekly testing for staff members and sisters, canceling communal meals and in-person prayers, and allowing the sisters to leave only for medical appointments.

“We worked so hard to keep it at bay, because you’re really, you’re pretty helpless once it gets into a building, such as a nursing home,” Sister Siemen said. “The residents are already so vulnerable.”

But on Jan. 14, the order announced there was an outbreak among sisters and workers at the Dominican Life Center, its skilled care center, which had a Covid-19 unit set up for months that had not been used.

The first positive test came on Dec. 20, and several sisters died within weeks, some within a few days of each other.

Sister Jeannine Therese McGorray, 86, died on Jan. 11, and Sister Esther Ortega, 86, died on Jan. 14. Sister Dorothea Gramlich, 81, died on Jan. 21.

Three sisters died on Jan. 22: Sister Ann Rena Shinkey, 87; Sister Mary Lisa Rieman, 79; and Sister Charlotte Francis Moser, 86. The next day, Sister Mary Irene Wischmeyer, 94, and Sister Margaret Ann Swallow, 97, died. The most recent death was this week: Sister Helen Laier, 88, died on Tuesday.

Sister Siemen said that, because of its aging population, the order is accustomed to having to mourn their sisters, but this string of losses has given them a sense of “solidarity with the hundreds of thousands of families who have lost their loved ones to Covid.”

Still, she said that their faith helps them pull through.

“There’s grieving, obviously,” Sister Siemen said but, “as women of faith, we know that passage through this door of death, for us, is not the last passage.”

Filing Suit for ‘Wrongful Life’

the new old age

Filing Suit for ‘Wrongful Life’

More Americans are writing end-of-life instructions as the pandemic renders such decisions less abstract. But are medical providers listening?

When Elaine Greenberg’s husband, Gerald, was diagnosed with early-onset Alzheimer’s, his specific advance directive — comfort measures only — went unheeded at the hospital where he was treated.
When Elaine Greenberg’s husband, Gerald, was diagnosed with early-onset Alzheimer’s, his specific advance directive — comfort measures only — went unheeded at the hospital where he was treated.Credit…Jackie Molloy for The New York Times

  • Jan. 22, 2021, 10:31 a.m. ET

Gerald and Elaine Greenberg married in 1976, as dental students. They practiced on Long Island and in Manhattan and raised two sons. Then in 2010, she noticed that her husband, the math whiz, was having trouble calculating tips in restaurants. “He just didn’t seem as sharp,” she said.

The devastating diagnosis from a neurologist: early-onset Alzheimer’s disease.

“We knew what could be ahead for him,” Elaine Greenberg said. “He didn’t want to lie there with tubes and diapers. That’s not how he wanted to end his life.”

Together, they called a lawyer and drew up advance directives in 2011. “We gave it a lot of thought,” she said. His directive was very specific: If he became terminally ill, permanently unconscious or seriously and irreversibly brain damaged, he wanted comfort measures only. No cardiac resuscitation or mechanical respiration. No tube feeding. No antibiotics.

Gerald Greenberg died in 2016 at Montefiore New Rochelle Hospital in Westchester County — and a recent lawsuit brought by his widow charges that when he was unresponsive and near death from sepsis, the hospital and an attending physician there failed to follow his directive.

The suit alleges that they also disregarded a New York State MOLST — medical orders for life-sustaining treatment — form and his spouse’s explicit instructions to a doctor who called to seek her guidance.

Medical records show that her husband received antibiotics and other unwanted treatments and tests. The suit charges that he survived for about a month in the unresponsive state that he had sought to avoid. (A Montefiore spokesman said the hospital could not comment, given ongoing litigation.)

“They made the end of his life horrible and painful and humiliating,” Dr. Greenberg said. “What’s the sense of having a living will if it’s not honored?”

Lawsuits charging negligence or malpractice by hospitals and doctors typically claim that they have failed to save patients’ lives. More recently, though, some families have sued if providers failed to heed patients’ documented wishes and prevented death from occurring.

“In the past, people have said, ‘How have we harmed you if we kept you alive?’” said Thaddeus Pope, a professor at the Mitchell Hamline School of Law in St. Paul, Minn., who follows end-of-life legal cases. “Now, courts have said this is a compensable injury.”

The campaign to persuade people to document end-of-life instructions goes back decades, but it remains an uphill battle. A 2017 analysis of 150 studies, involving nearly 800,000 Americans, found that among those over 65, only 45.6 percent had completed an advance directive, including barely half of nursing home residents.

But recent evidence suggests that those proportions have climbed during the coronavirus pandemic. The crisis has made such questions less abstract and the need to honor documents more urgent.

Dr. Greenberg with Gerald Greenberg and their first grandchild in 2016.
Dr. Greenberg with Gerald Greenberg and their first grandchild in 2016.Credit…via Elaine Greenberg

Patients themselves may bear some responsibility for mix-ups. Advance directives go astray, get locked in desk drawers, become so outdated that designated decision makers have died. Or they use language like “no heroic measures,” so vague that “it’s hard for doctors to comply with,” Mr. Pope said.

The state MOLST or POLST (portable orders for life-sustaining treatment) forms strive to make the decisions concrete by providing detailed documentation of patients’ wishes and functioning as physicians’ orders. Studies in Oregon and West Virginia have demonstrated the forms’ effectiveness, but as several of these cases show, that is not universal.

Sometimes — nobody has tracked how often — institutions overlook the documents in patients’ charts or ignore conversations with health care proxies. Doctors who doubt that a patient actually prefers to die may override the instructions.

“Their attitude is, ‘Nobody was hurt,’” said Gerald Grunsfield, the lawyer representing Dr. Greenberg. “But there was physical hurt, emotional hurt, a lot of hurt.”

In an interview four years ago, Mr. Pope noted that nobody at that point had received compensation from any “wrongful life” suit. Since then, several plaintiffs have received hefty payments, and courts have weighed in as well.

In Georgia, Jacqueline Alicea won a $1 million settlement from Doctors Hospital of Augusta and a surgeon there (from their insurers, more accurately). They had placed her 91-year-old grandmother on a ventilator, disregarding both Ms. Alicea’s instructions as her grandmother’s health care proxy and her grandmother’s advance directive. That meant Ms. Alicea had to eventually order that life support be removed, a wrenching decision.

Settlement amounts often remain confidential, but “we wanted this settlement to be shouted from the mountaintops,” her lawyer, Harry Revell, said. “We wanted it to have a deterrent effect on health care providers who think this isn’t important.”

The Alicea case, already being cited in other lawsuits, may have an impact because after the trial court denied a motion to dismiss it, the state’s Court of Appeals and its Supreme Court both ruled that the suit could proceed. The parties settled on the eve of a trial in 2017.

In Montana, a jury delivered what is believed to be the first verdict in a wrongful life case, awarding $209,000 in medical costs and $200,000 for “mental and physical pain and suffering” to the estate of Rodney Knoepfle in 2019.

Debilitated by many illnesses, Mr. Knoepfle had a do-not-resuscitate order and a POLST form in his records at St. Peter’s Health, Helena’s largest hospital. “He’d suffered more pain than anyone should in a lifetime and was comfortable with going, if it was his time to go,” said Ben Snipes, one of his lawyers.

But a medical team resuscitated Mr. Knoepfle — twice. Tethered to an oxygen tank, he lived another two years before dying at age 69. “The last few months, he was almost incoherent with pain, living in a hospital bed, getting morphine crushed into his pudding,” Mr. Snipes said.

Beatrice Weisman, 83, had been hospitalized after a stroke in 2013 when doctors at Maryland General Hospital found her turning blue and resuscitated her, an action that her advance directive and MOLST form specifically prohibited.

The Weisman family sued and in 2017 received a “satisfactory” sum through mediation, said Robert Schulte, their lawyer. He could not divulge the amount but said it had helped pay for seven years of round-the-clock care, until Ms. Weisman died last October.

The Greenbergs on their wedding day in 1976.Credit…Jackie Molloy for The New York Times

A California case developed differently. Dick Magney had opted for palliative care, and his doctors were complying, until someone reported potential neglect to Humboldt County’s adult protective services agency. The county filed a petition to take over his health care, removing his wife as his decision maker, and ordered that Mr. Magney receive antibiotics he had earlier refused. At one point, the county won temporary conservatorship.

“It just led to him suffering longer,” said Allison Jackson, the lawyer representing Mr. Magney’s wife. Mr. Magney died in 2015.

A state appellate court ruled that the petition to remove Mr. Magney’s wife had been fraudulent. She eventually won more than $200,000 in reimbursement for lawyers’ fees and pursued a federal civil rights complaint, leading to a $1 million settlement from the county. Two lawyers representing the county now face disciplinary charges from the California state bar.

Such awards and rulings, and news coverage, have led more families to seek legal remedies and have encouraged lawyers to take such cases, said Mr. Pope, who is a consultant to the Montana lawyers and a testifying expert witness in the upcoming California disciplinary hearings.

Now similar suits are pending in Georgia, Maryland and New Jersey, in addition to two malpractice cases that Mr. Grunsfeld has brought against Montefiore in New York.

Lawyers for Montefiore have moved to dismiss the Greenberg suit; even if the court allows it to go forward, resolution could take years. But Dr. Greenberg and her sons are in it for the long haul, she said.

During the month her husband survived, after his directive would have permitted him to die, he lay unconscious, diapered, in restraints and moaning in pain, she recalled.

“He tried to make choices, and his choices weren’t respected,” Dr. Greenberg said. “I don’t want anyone else to go through what we went through.”

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A Colonoscopy Alternative Comes Home

A Colonoscopy Alternative Comes Home

An at-home test for colon cancer is as reliable as the traditional screening, health experts say, and more agreeable.

Credit…Karlotta Freier

  • Jan. 11, 2021, 1:40 p.m. ET

Most Americans who are due for a colon cancer screening will receive a postcard or a call — or prompting during a doctor’s visit — to remind them that it’s time to schedule a colonoscopy.

But at big health care systems like Kaiser Permanente or the federal Veterans Health Administration, the process has changed. Patients who should be screened regularly (age 50 to 75) and who are of average risk, get a letter telling them about a home test kit arriving by mail.

It’s a FIT, which stands for fecal immunochemical test. The small cardboard mailer contains equipment and instructions for taking a stool sample and returning the test to a lab, to detect microscopic amounts of blood. A week or so later, the results show up on an online patient portal.

Five to 6 percent of patients will have a positive test and need to schedule a follow-up colonoscopy. But the great majority are finished with colon cancer screening for the year — no uncomfortable prep, no need to skip work or find someone to drive them home after anesthesia, no colonoscopy.

Last spring, when the coronavirus pandemic closed many medical facilities and postponed nonemergency procedures, this approach suddenly looked even more desirable.

“We know that from March to May, colon cancer screenings fell by about 90 percent,” said Dr. Rachel Issaka, a gastroenterologist at the University of Washington and the Fred Hutchinson Cancer Research Center. Although testing has resumed, she said, “we’re still not back to where we were.”

Yet colon cancer represents the third-highest cause of cancer deaths, after lung cancer and, tied for second place, breast and prostate cancer. Unlike those, colon cancer can be prevented with early detection.

With many older adults trying to avoid hospitals and surgical centers, even as their risk of colon cancer rises with age, an at-home test provides an alternative to colonoscopy — one that is both safer, with a lower risk of complications and Covid-19 exposure, and does as good a job.

“If your doctor tells you a colonoscopy is better, that’s not accurate,” said Dr. Alex Krist, chairman of the U.S. Preventive Services Task Force, an independent expert panel that reviews evidence and issues recommendations. “The data show the tests are equally effective at saving lives.”

The Task Force is updating its guidelines for colon cancer screening and this year will likely recommend lowering the age at which it should begin, to 45. But the recommendations on the upper end will remain unchanged: Based on strong evidence, adults up to age 75 should be screened regularly.

Beyond that age, the disadvantages begin to mount. The Task Force says the benefit of screening 76- to 85-year-olds is small, and that the decision should be an individual one, reached in consultation with a doctor.

Colon cancer develops slowly, explained Dr. James Goodwin, a geriatrician and researcher at the University of Texas Medical Branch in Galveston. Patients at older ages, who typically contend with several other diseases, may not live long enough to benefit. “You cause more harm than good,” Dr. Goodwin said.

The advice to stop screening isn’t always popular with patients. “People don’t like to hear about not living very long,” he said. But with colonoscopy, he noted, “you go through an unpleasant experience — or an unpleasant experience followed by an unpleasant diagnosis and unpleasant treatment — for something that, if you’d never known about it, wouldn’t cause you harm.”

Even if a test eventually finds colon cancer, surgery plus chemotherapy, the standard treatment, could itself endanger a frail older person. “I would be heavily biased against anyone getting a screening, of any sort, over age 80,” Dr. Goodwin said.

Although Americans still rely mostly on colonoscopy, his research has shown that for many older people, that test is overused, either because of the patients’ ages or because they are tested too frequently.

Yet screening is simultaneously underused. In 2018, according to the Centers for Disease Control and Prevention, only about 70 percent of adults were up-to-date on colorectal cancer testing. About one-fifth of those 65 to 75 had not been screened as recommended. Among those 50 to 65, where lack of Medicare or other insurance probably contributed, only about 63 percent were appropriately screened.

The Task Force has found several kinds of screening tests effective, but the ones used most for people at average risk are colonoscopy, at a recommended 10-year interval, or FIT annually.

A newer entry, an at-home test sold under the brand name Cologuard that detects blood and cancer biomarkers in stool, may be used every three years, but a study found it to be less effective than most other methods and far more expensive than FIT.

When screening is recommended, how does FIT stack up against colonoscopy?

Higher-risk patients — including those who have had colon cancer or parents or siblings with colon cancer, those with inflammatory bowel disorders like Crohn’s disease, and those who have had abnormal previous tests, including multiple or large polyps — should seek out a colonoscopy, often on an accelerated schedule. The procedure involves inserting a viewing instrument through the anus to directly visualize an anesthetized patient’s colon.

A colonoscopy offers one distinct advantage: if the gastroenterologist spots polyps, growths that over time could become cancerous (although most don’t), these can be removed immediately. “You’re preventing cancer, snipping out the things that could lead to cancer,” Dr. Goodwin said. After a negative colonoscopy, patients don’t need another for a decade.

But the procedure’s complications increase with age, although they remain low; the most serious, a perforated colon, requires hospitalization. Cleaning out the bowel on the day before the procedure, in preparation, is disruptive and disagreeable, and Dr. Goodwin notes that older patients sometimes experience cycles of diarrhea and constipation for weeks afterward.

Rural residents may find traveling to a facility difficult. The use of anesthesia means that every patient needs someone to drive or escort them home afterward. The prospect of spending two to four hours in a facility, even one using rigorous safety measures, will cause some older adults to postpone testing because of Covid-19 fears.

The FIT, which is far more widely used in other countries, avoids many of those difficulties. A marked improvement over earlier at-home stool tests, it requires a sample from one day instead of samples from three, and imposes no food or drug restrictions. A positive result still calls for a colonoscopy, but the great majority of patients avoid that outcome.

Why do so many Americans still undergo colonoscopies, then? “There’s a large financial incentive for people who do colonoscopies to do colonoscopies,” Dr. Goodwin said, so patients may not hear much about the alternatives.

“Many of my own patients are surprised to learn that there’s another way,” said Dr. Krist, also a family physician at Virginia Commonwealth University. “As they age, they want less invasive methods” and may be happy to switch.

Wider adoption of FIT could also save patients and insurers, notably Medicare, a boatload. The home test, which is available through several manufacturers, generally costs less than $20; a colonoscopy can easily exceed $1,000.

Moreover, with personalized messages to patients and follow-up reminders to return the kit, FIT use can result in more people being screened. That could prove important when the Preventive Services Task Force lowers the recommended age to 45, which would add 22 million Americans to the list of people advised to undergo colon cancer screening. Their needs, plus a backlog of patients who postponed tests during the pandemic, could swamp gastroenterology practices.

“If a provider doesn’t bring up” the possibility of an at-home test, Dr. Issaka said, “patients should feel empowered to ask about it.” Colon cancer screenings, of any type, “are considered non-urgent,” she said. “But they’re not optional.”

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Pressure Grows for States to Open Vaccines to More Groups of People

Pressure Grows for States to Open Vaccines to More Groups of People

Some states are already expanding eligibility to people 65 and over, even though millions of people the C.D.C. recommends go first — health care workers and nursing home residents — have yet to get shots.

Gov. Ron DeSantis of Florida, right, during vaccinations at the John Knox Village nursing home in Pompano Beach, Fla., last month.
Gov. Ron DeSantis of Florida, right, during vaccinations at the John Knox Village nursing home in Pompano Beach, Fla., last month.Credit…Marta Lavandier/Associated Press
Abby Goodnough

  • Jan. 9, 2021, 12:00 p.m. ET

Just weeks into the country’s coronavirus vaccination effort, states have begun broadening access to the shots faster than planned, amid tremendous public demand and intense criticism about the pace of the rollout.

Some public health officials worry that doing so could bring even more chaos to the complex operation and increase the likelihood that some of the highest-risk Americans will be skipped over. But the debate over how soon to expand eligibility is intensifying as deaths from the virus continue to surge, hospitals are overwhelmed with critically ill patients and millions of vaccine doses delivered last month remain in freezers.

Governors are under enormous pressure from their constituents — especially older people, who vote in great numbers and face the highest risk of dying from the virus — to get the doses they receive into arms swiftly. President-elect Joseph R. Biden Jr.’s decision, announced Friday, to release nearly all available doses to the states when he takes office on Jan. 20, rather than holding half to guarantee each recipient gets a booster shot a few weeks after the first, is likely to add to that pressure.

Some states, including Florida, Louisiana and Texas, have already expanded who is eligible to get a vaccine now, even though many people in the first priority group recommended by the Centers for Disease Control and Prevention — the nation’s 21 million health care workers and three million residents of nursing homes and other long-term care facilities — have not yet received a shot.

On Friday afternoon, New York became the latest state to do so, announcing that it would allow people 75 and over and certain essential workers to start receiving a vaccine on Monday.

But reaching a wider swath of the population requires much more money than states have received for the task, many health officials say, and more time to fine-tune systems for moving surplus vaccine around quickly, to increase the number of vaccination sites and people who give the shots, and to establish reliable appointment systems to prevent endless lines and waits.

Some states’ expansions have led to frantic and often futile efforts by older people to get vaccinated. After Florida opened up vaccinations to anyone 65 and older late last month, the demand was so great that new online registration portals quickly overloaded and crashed, people spent hours on the phone trying to secure appointments and others waited overnight at scattered pop-up sites offering shots on a first-come first-served basis.

Similar scenes have played out in parts of Texas, Tennessee and a handful of other states.

Still, with C.D.C. data suggesting that only about a third of the doses distributed so far have been used, Alex M. Azar II, the health and human services secretary, told reporters this past week: “It would be much better to move quickly and end up vaccinating some lower-priority people than to let vaccines sit around while states try to micromanage this process. Faster administration would save lives right now, which means we cannot let the perfect be the enemy of the good.”

Boxes of Moderna’s vaccine were prepared for shipment at a distribution center in Olive Branch, Miss., last month.
Boxes of Moderna’s vaccine were prepared for shipment at a distribution center in Olive Branch, Miss., last month.Credit…Pool photo by Paul Sancya

The C.D.C. guidelines were drawn up by an independent committee of medical and public health experts that advises the agency on immunization practices; it deliberated for months about who should get vaccinated initially, while supplies were still very limited. The committee weighed scientific evidence about who is most at risk of getting very sick or dying from Covid-19, as well as ethical questions, such as how best to ensure equal access among different races and socioeconomic groups.

Although the committee’s recommendations are nonbinding, states usually follow them; in this case, the committee suggests that states might consider expanding to additional priority groups “when demand in the current phase appears to have been met,” “when supply of authorized vaccine increases substantially” or “when vaccine supply within a certain location is in danger of going unused.”

Dr. Kevin Ault, an obstetrician at the University of Kansas Medical Center who serves on the advisory committee that came up with the C.D.C. guidelines, said that it was reasonable for states to start vaccinating new groups before finishing others, but that they should be careful about exacerbating inequities and biting off more than they can chew.

“Obviously if you’re going to vaccinate that group you need to have a well-thought-out plan in hand,” he said, referring to the over-65 population. “Having people camping out for vaccine is less than ideal, I would say.”

He added, “We put a lot of thought and effort into our guidelines, and I think they are good.”

After the first vaccines were given in mid-December, a dichotomy emerged between governors who were adhering precisely to the guidelines and others who moved quickly to populations beyond health care workers and nursing home residents.

Until Friday, Gov. Andrew M. Cuomo of New York, a Democrat, had threatened to penalize hospitals that provided shots to people who are not health care workers. By contrast, Gov. Ron DeSantis of Florida, a Republican, traveled to retirement communities around his state to emphasize the importance of getting people 65 and older, who number more than five million there, immunized fast.

“In Florida we’ve got to put our parents and grandparents first,” Mr. DeSantis said at The Villages, the nation’s largest retirement community, just before Christmas.

Gov. Andrew Cuomo of New YorkCredit…Andrew Kelly/Reuters
Gov. Mike DeWine of OhioCredit…Tony Dejak/Associated Press
Gov. Greg Abbott of TexasCredit…Eric Gay/Associated Press
Gov. Larry Hogan of MarylandCredit…Jonathan Ernst/Reuters

Decisions on how soon to expand eligibility for the shots have not fallen neatly along partisan lines.


Covid-19 Vaccines ›


Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Gov. Larry Hogan of Maryland, a Republican, announced Tuesday that he would immediately switch to what he called the “Southwest Airlines model” for vaccine allocation, referring to the airline’s open seating policy. “We’re no longer going to be waiting for all the members of a particular priority group to be completed,” he said, “before we move on to begin the next group in line.”

Gov. Mike DeWine of Ohio, a Republican, urged patience in a news briefing Tuesday as he declined to estimate when the state would start vaccinating people beyond the first priority group, known as “1a.”

“We’re asking every health department, ‘Don’t go outside 1a, stay within your lane,’” he said, adding about the vaccines, “This is a scarce commodity.”

By Thursday Mr. DeWine had set a date for people 80 and older to start getting the vaccine — Jan. 19 — and said he would phase in everyone 65 and older, as well as teachers, by Feb. 8.

The reasons so many doses received by states have not yet been administered to the first priority group are manifold. The fact that vaccination began around Christmas, when many hospital employees were taking vacation, slowed things. More health care workers are refusing to get the vaccine than many of their employers expected, and some hospitals and clinics received more doses than they needed but felt constrained by state rules from giving them to people outside the first priority groups. Some initially worried they could not even offer leftover doses in open vials to people in lower priority groups and let them go to waste.

Frontline health care workers and people age 65 and older waited to be vaccinated at a sports complex in Fort Myers, Fla., last month.Credit…Octavio Jones for The New York Times

And federal funding for vaccination efforts has been slow to reach states and localities: They got only $350 million through the end of last year, a little more than $1 per resident of the country. The economic rescue package that Congress passed in December included $8 billion for vaccine distribution that state health officials had long sought, but the first tranche of it, about $3 billion, is only now starting to be sent out.

“There was great funding in the development of these products, great funding in the infrastructure to ship them and get them out,” said Dr. Steven Stack, commissioner of the Kentucky Department for Public Health. “But then there was no funding provided of meaning for administering the vaccine, which is the last mile of this journey.”

The C.D.C. has recommended that a “1b” group consisting of people 75 and older and certain essential workers, including teachers, corrections officers and grocery store employees, be vaccinated next. The second group is much larger, about 50 million people. And the third recommended priority group — people 65 to 74, anyone 16 and older with high-risk medical conditions, and essential workers not already reached — numbers almost 130 million.

Pfizer and Moderna have pledged to deliver enough vaccine doses for 100 million people to each get the two necessary shots by the end of March, and many more in the second quarter. Several other vaccine candidates are far along in the pipeline, and if approved for emergency use here could help ramp up distribution more quickly.

The C.D.C. committee initially considered recommending that a wide range of essential workers get vaccinated before older Americans. Its rationale was that many essential workers are low-wage people of color, who have been hit disproportionately hard by the virus and had limited access to good health care. That sparked a backlash, and several governors, including Mr. DeSantis, quickly made clear they would cater to older people first.

Alex M. Azar, the health and human services secretary, left, and Surgeon General Jerome Adams, right, during a vaccination at George Washington University Hospital on Dec. 14.Credit…Pool photo by Jacquelyn Martin-Pool

Dr. Mark McClellan, who formerly headed the F.D.A. and now runs Duke University’s health policy center, said that while pushing ahead to vaccinate older people and other particularly vulnerable groups would accelerate the overall effort, “we’re going to be missing a lot of higher-risk individuals along the way.”

“I do worry about that becoming uneven in terms of access,” he said during a press briefing, “with lower-income groups, minority groups maybe in a tougher position if we don’t make it very easy for people in these high-risk groups to get vaccinated.”

Dr. Marcus Plescia, the chief medical officer for the Association of State and Territorial Health Officials, said he was surprised to hear federal officials like Mr. Azar and Dr. Jerome Adams, the surgeon general, advocate expanding vaccine access so broadly so soon.

“We didn’t come up with priority populations to slow things down, but because we knew there would be limited numbers of doses,” Dr. Plescia said. “If we try to do this in an equitable, fair way, it’s not going to be as fast as if our only goal is to get vaccine into as many arms as possible.”

Whether or not they are widening access now, governors are ramping up pressure on hospitals to use their allocated doses more quickly. Mr. Cuomo threatened to fine those that did not use their initial allocations by the end of this past week and not send them any more.

Mr. Hogan warned hospitals this past week, “Either use the doses that have been allocated to you or they will be directed to another facility or provider.”

Don’t Let the Pandemic Stop Your Shots

the new old age

Don’t Let the Pandemic Stop Your Shots

Even as older adults await the coronavirus vaccine, many are skipping the standard ones. That’s not wise, health experts say.

Credit…Chris Lyons

  • Dec. 28, 2020, 12:12 p.m. ET

Peggy Stein, 68, a retired teacher in Berkeley, Calif., skipped a flu shot this year. Her reasoning: “How could I get the flu if I’m being so incredibly careful because of Covid?”

Karen Freeman, 74, keeps meaning to be vaccinated against shingles, but hasn’t done so. A retired college administrator in St. Louis, she quipped that “denial has worked well for me these many years.”

Sheila Blais, who lives on a farm in West Hebron, N.Y., has never received any adult vaccine. She also has never contracted the flu. “I’m such an introvert I barely leave the farm, so where’s my exposure?” said Ms. Blais, 66, a fiber artist. “If it’s not broke, don’t fix it.”

While older adults await vaccination against Covid-19, public health officials also worry about their forgoing, forgetting, fearing or simply not knowing about those other vaccines — the ones recommended for adults as we age and our immune systems weaken.

“There’s a lot of room for improvement,” said Dr. Ram Koppaka, associate director for adult immunization at the Centers for Disease Control and Prevention.

Every year, campaigns urge older adults to protect themselves against preventable infectious diseases. After all, influenza alone has killed 12,000 to 61,000 Americans annually over the past decade, most of them 65 or older, and has sent 140,000 to 810,000 people a year to hospitals.

The coronavirus pandemic has introduced another imperative. Those hospitals are filling fast with Covid-19 patients; in many places they are already swamped, their staffs overworked and exhausted.

“Knowing how stressed the health care system is, prevention is key,” said Dr. Nadine Rouphael, a vaccine researcher and infectious disease specialist at Emory University. “When we have record numbers of deaths, why would you go to a hospital for a vaccine-preventable illness?”

Yet the nation has long done a better job of vaccinating its children than its elders. The most recent statistics, from 2017, show that about one-third of adults over 65 had not received a flu shot within the past year. About 30 percent had not received the pneumococcus vaccine.

The proportion receiving the shingles vaccine, a fairly recent addition to the list, has inched up, but by 2018 only 34.5 percent of people over 60 had been vaccinated.

Moreover, Dr. Koppaka pointed out: “When you look deeper, there are longstanding, deep, significant differences in the proportion of Black and Hispanic adults getting vaccines compared to their white counterparts. It’s really unacceptable.”

Close to 40 percent of non-Hispanic whites had been vaccinated against shingles, for instance, compared with fewer than 20 percent of Blacks and Hispanics.

One might expect a group who can recall polio fears and outbreaks of whooping cough to be less hesitant to get vaccinated than younger cohorts. “You’ll probably have a different concept of vaccination from someone who never experienced what a serious viral illness can do,” Dr. Koppaka said.

When it comes to the Covid-19 vaccine, for instance, only 15 percent of those over 65 say they would definitely or probably not get it, compared with 36 percent of those 30 to 49, a Kaiser Family Foundation tracking poll showed earlier this month. (Ms. Stein, Ms. Blais and Ms. Freeman all said they would happily accept the Covid vaccine.)

But for other diseases, vaccination rates lag. Given that older people are more vulnerable to severe illness from them, why the gaps in coverage?

Internists and other doctors for adults don’t promote vaccines nearly as effectively as pediatricians do, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. Older patients, who often see a variety of doctors, may also have trouble keeping track of when they got which shot.

Experts fear that vaccination rates may have fallen further during the pandemic, as they have among children, if older people wary of going to doctors’ offices or pharmacies skipped shots.

Financial and bureaucratic obstacles also thwart vaccination efforts. Medicare Part B covers three vaccines completely: influenza, pneumococcus and, when indicated, hepatitis B.

The Tdap and shingles vaccines, however, are covered under Part D, which can complicate reimbursement for doctors; the vaccines are easier to obtain in pharmacies. Not all Medicare recipients buy Part D, and for those who do, coverage varies by plan and can include deductibles and co-pays.

Still, older adults can gain access to most recommended vaccines for no or low cost, through doctors’ offices, pharmacies, supermarkets and local health departments. For everyone’s benefit, they should.

Here’s what the C.D.C. recommends:

Influenza An annual shot in the fall — and it’s still not too late, because flu season peaks from late January into February. Depending on which strain is circulating, the vaccine (ask for the stronger versions for seniors) prevents 40 to 50 percent of cases; it also reduces illness severity for those infected.

Thus far this year, flu activity has remained extraordinarily low, perhaps because of social distancing and masks or because closed schools kept children from spreading it. Manufacturers shipped a record number of doses, so maybe more people got vaccinated. In any case, fears of a flu/Covid “twindemic” have not yet been realized.

Nevertheless, infectious disease experts urge older adults (and everyone over six months old) to get flu shots now. “Flu is fickle,” Dr. Schaffner said. “It could take off like a rocket in January.”

Tetanus, diphtheria, pertussis. A booster of TD vaccine every 10 years, to prevent tetanus and diphtheria. If you’ve never had the Tdap vaccine — which adds prevention against pertussis — that’s the one you want. Although pertussis, better known as whooping cough, occasionally shows up in adults, newborns are particularly at risk. Pregnant women will ask expectant grandparents to get a Tdap shot. Because it is covered under Part D, a pharmacy is the best bet.

Pneumococcus. “It’s a pneumonia vaccine, but it also prevents the most serious consequences of pneumonia, including meningitis and bloodstream infections,” Dr. Koppaka said.

People over 65 should get the polysaccharide formula — brand name Pneumovax — but there are certain circumstances, such as immune-compromising conditions, to discuss with a health care provider.

Those over 65 may choose, again in consultation with a provider, to also get the conjugate pneumococcal vaccine (brand name Prevnar), which provides some additional protection. If so, C.D.C. guidelines specify which vaccine to take when.

Shingles. Social distancing won’t ward off this disease; anyone who had chickenpox, which is just about every senior, still carries the virus.

“If you live to be 80, you stand a 35 to 50 percent chance of having an episode,” Dr. Schaffner said. “And the older you are when you get it, the more apt you are to get the most serious complication” — lingering nerve pain called post-herpetic neuralgia.

The C.D.C. recommends Shingrix, the highly effective shingles vaccine the F.D.A. approved in 2017, for everyone over 50. The previous shingles vaccine has been discontinued. Get Shingrix even if you had the earlier vaccine, Zostavax, and even if you’ve had shingles — it can recur.

The two required shots, given two to six months apart, can total $300 out of pocket. But Medicare Part D beneficiaries will pay an average of $50 for the pair, said a spokesman for the manufacturer GlaxoSmithKline, and people with private insurance even less.

Hepatitis A and hepatitis B. These aren’t age-related; the vaccines are recommended for people with certain health conditions, including chronic liver disease and H.I.V. infection, or for travelers to countries where the diseases are widespread.

The hepatitis B vaccine is also recommended, at a provider’s discretion, for diabetics over 60 who haven’t been previously vaccinated. Talk to a health care professional about your risks.

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Now That Grandma Has Been Vaccinated, May I Visit Her?

Now That Grandma Has Been Vaccinated, May I Visit Her?

The start of a mass coronavirus vaccination campaign at U.S. nursing homes has brought hope to many families. But it may be a while before restrictions loosen. Here are answers to common questions.

Vera Leip, 88, of Pompano Beach, Fla., received the Pfizer-BioNtech vaccine at the John Knox Village retirement community last week.
Vera Leip, 88, of Pompano Beach, Fla., received the Pfizer-BioNtech vaccine at the John Knox Village retirement community last week.Credit…Joe Raedle/Getty Images

  • Dec. 21, 2020, 4:48 p.m. ET

A watershed moment has arrived for many families: This week health care workers from CVS and Walgreens, under contract from the federal government, will fan out to nursing homes across the country to begin vaccinating residents against the coronavirus. The shots not only will help protect the nation’s elderly and infirm — and the staff who care for them — but they raise the prospect of ending the devastating isolation many residents have felt for months.

Family members are hopeful that before too long, they will return to visiting parents and grandparents, aunts, uncles and other loved ones regularly again. We checked with experts on some common questions.

Will restrictions on visiting be lifted soon?

Probably not in a big way. Restrictions vary by state, and the federal government’s guidance on what it considers safe stands for now. They already allow visits under certain conditions. The Centers for Medicare & Medicaid Services, or C.M.S., recommended in September that outdoor visits with residents be allowed and indoor visits, too, if the facility has been free of cases for 14 days.

Some medical experts have said that those guidelines are too lax and that visits should be severely restricted, even banned. However, some of these experts are now saying that the vaccine changes the equation, somewhat.

“Once all residents are vaccinated, it opens the door for loosening of restrictions,” said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine, a geriatrician and former executive at nursing home chains.

To allow visits, Dr. Wasserman recommends all residents of a nursing home should be vaccinated (unless they have some condition or allergy that would discourage vaccination on medical grounds); all staff members should be vaccinated; the nursing home should have the ability to ensure that visitors test negative for the coronavirus and have been disciplined about wearing a mask in public settings.

Is the vaccine safe and effective for old and frail residents of nursing homes?

The clinical trials of the Pfizer and Moderna vaccine included people over 65, and results showed it to be safe and to work as well in older people as in younger ones.

“This vaccine has gone through testing and clinical trials to ensure it meets the highest safety standards. It also is safe to get if you already had the virus,” says a campaign to encourage people to get the shots by the American Health Care Association and National Center for Assisted Living, a combined trade group representing nursing homes and assisted-living communities.

The lead administrator for C.M.S., Seema Verma, reinforced the confidence in the shot for older patients, including those with health conditions, in a statement last week: “I urge states to prioritize nursing homes and vulnerable seniors in their distribution of the vaccine.”

The point is echoed by Dr. Sabine von Preyss-Friedman, chief medical officer of Avalon Health Care Group, which operates nursing homes, who said the new vaccines appear “safe and effective.”

If restrictions are eased, should I visit right away?

The Pfizer and Moderna vaccines both require two injections — the initial shot and a booster three or four weeks later. Dr. von Preyss-Friedman recommends waiting at least two weeks after the second shot to have a visit.

“You hope these vaccines work, but these are elderly patients,” she said. “You want to err on the side of protection.”

She said that, ideally, the visitor would also be vaccinated as well. Since shots won’t be widely available for a few months, it may be best to wait until you get your vaccine. Until then, she believes nursing homes should consider visits on a case-by-case basis.

Would visitors still need to wear a mask?

Absolutely, medical experts said. This is particularly true if they are not vaccinated, but even after they are vaccinated “until rates in the community go down,” said Dr. Joshua Uy, a geriatrician and associate professor at the University of Pennsylvania Medical School and the medical director of Renaissance Healthcare & Rehabilitation Center, a nursing home in Philadelphia.

Dr. Uy said that he hopes that the federal government would supply enough personal protective equipment so that all visitors and residents could be properly gowned for such visits.

What is being done to encourage nursing home residents to get vaccinated?

The combined nursing-home and assisted-living trade group has started a program aimed at helping nursing homes and other care facilities to explain to residents the essential need to get the vaccine. The campaign, #getvaccinated, notes: “The elderly population has a much higher risk for getting very sick, being hospitalized, or dying from Covid-19. The vaccine has been shown to provide a great deal of protection against serious illness due to Covid-19.”

But the people they love most may have more effective persuasive powers. Families can help, Dr. Uy said, by encouraging their parents and grandparents in nursing homes to get vaccinated.

“The vaccine,” he said, “is going to be our way out.”

Frontline Workers and People Over 74 Should Get Shots Next, CDC Panel Says

Frontline Workers and People Over 74 Should Get Shots Next, CDC Panel Says

The recommendation was a compromise aimed at getting the coronavirus vaccine to the most vulnerable of two high-risk groups.

Director of nursing education Loraine Hopkins Pepe, left, administers the Pfizer BioNTech COVID-19 vaccine to Dr. Richard Fine, head of anesthesiology, at Einstein Medical Center in Philadelphia, PA.
Director of nursing education Loraine Hopkins Pepe, left, administers the Pfizer BioNTech COVID-19 vaccine to Dr. Richard Fine, head of anesthesiology, at Einstein Medical Center in Philadelphia, PA.Credit…Hannah Yoon for The New York Times
  • Dec. 20, 2020, 3:40 p.m. ET

Striking a compromise between two high-risk population groups, a panel advising the Centers for Disease Control and Prevention voted Sunday to recommend that people 75 and older be next in line to receive the coronavirus vaccine in the United States, along with about 30 million “frontline essential workers,” including emergency responders, teachers and grocery store employees.

The debate about who should receive the vaccine in these early months has grown increasingly urgent as the daily tally of cases has swelled to numbers unimaginable even a month ago. The country has already begun vaccinating health care workers, and on Monday, CVS and Walgreens were to begin a mass vaccination campaign at the nation’s nursing homes and long-term care facilities. This week roughly six million doses of the newly authorized Moderna vaccine are to start arriving at more than 3,700 locations around the country, including many smaller and rural hospitals.

The panel of doctors and public health experts had previously indicated it would recommend a much broader group of Americans defined as essential workers — about 87 million people with jobs designated by a division of the Department of Homeland Security as critical to keeping society functioning — as the next priority population and that elderly people who live independently should come later.

But in hours of discussion on Sunday, the committee members concluded that given the limited initial supply of vaccine and the higher Covid-19 death rate among elderly Americans, it made more sense to allow the oldest among them to go next along with workers at the highest risk of exposure to the virus.

Groups of essential workers, such as construction and food service workers, the committee said, would be eligible for the next wave. Members did clarify that local organizations had great flexibility to make those determinations.

“I feel very strongly we do need to have that balance of saving lives and keeping our infrastructure in place,” said Dr. Helen Talbot, a member of the panel and infectious-disease specialist at Vanderbilt University.

Together, the two groups the committee voted to prioritize on Sunday number about 51 million people; federal health officials have estimated that there should be enough vaccine supply to inoculate all of them before the end of February.

Still, as the first week of vaccinations in the U.S. came to a close, frustrations were flaring about the pace of distribution. Some 128,000 shots had been given in the as of Friday, according to a New York Times database tracking vaccinations — a total that was just slightly more than half the number of new cases reported across the country that same day.

This weekend Gen. Gustave F. Perna, who heads the Trump administration’s distribution effort, apologized for more than a dozen states learning at the last minute that they would receive fewer doses next week of the vaccine manufactured by Pfizer than they had expected. Tensions were also broiling in some states over local decisions regarding which health care workers should get their shots immediately and which should wait.

The director of the C.D.C., Dr. Robert Redfield, will review the panel’s recommendation and decide, likely by Monday, whether to embrace it as the agency’s official guidance to states. The panel, the Advisory Committee on Immunization Practices, emphasized that its recommendations were nonbinding and that every state would be able to fine-tune or adjust them to serve the unique needs of its population.

The 13-to-1 vote came as frustrations flared about the pace of vaccine distribution. Some 128,000 shots have been given in the first five days of the vaccine United States, according to a New York Times database tracking vaccinations — just slightly more than half the number of new cases reported across the country on Friday alone. This weekend, Gen. Gustave F. Perna, who heads the Trump administration’s distribution effort, apologized for at least 14 states learning at the last minute that they would receive fewer doses of the vaccine manufactured by Pfizer next week than they had expected. Tensions were also flaring in some states over local decisions regarding which health care workers should get their shots immediately, and which should wait.

In addition to teachers, firefighters and police, a subgroup of the committee suggested that “frontline essential workers” should include school support staff; day care, corrections personnel, public transit, grocery store and postal workers; and those in working in food production and manufacturing. But the group’s official recommendation is not that specific.

Originally, the committee had signaled last month that they had been inclined to let 87 million essential workers receive vaccines ahead of adults 65 and older. Many had expressed their alarm that essential workers, who are often low-wage people of color, were being hit disproportionately hard by the virus and additionally were disadvantaged because of their lesser access to good health care.

general population.”

Falls Are Tied to Social Isolation

Social Isolation May Increase Your Risk of Falls

People who lived alone or who had few social contacts were up to 24 percent more likely to have falls than their socially connected peers.

Nicholas Bakalar

  • Dec. 14, 2020, 2:50 p.m. ET

Living alone or being socially isolated may increase the risk for falls in older people, British researchers report.

Their study, in Scientific Reports, included data on 4,013 men and women, most older than 60, who reported they had fallen, and on 9,285 who were hospitalized after a fall. The scientists used well-validated questionnaires to assign each participant a score on a scale of social isolation ranging from zero to six, with six indicating the fewest social contacts. They were also graded on a similar scale to measure how lonely they felt.

After adjusting for socioeconomic, health and lifestyle factors, they found that people who lived alone were 18 percent more likely to have reported a fall than those who lived with others, and those who scored six on the social isolation scale were 24 percent more likely to fall than those with a score of zero. Scores on the test of loneliness were not associated with falls after adjusting for social isolation and other variables.

The risk of falls resulting in hospitalization was 23 percent higher in people living alone and 36 percent higher among those with the least social contact compared with those with the most.

“The key message is that the elderly socially isolated are at greater risk for falls,” said the lead author, Feifei Bu, a senior research fellow at University College London. “We are encouraging people to look after them more closely, help with daily activities, keep in touch, and so on.”