Culture Linked to Increasing Ageism During COVID-19: Evidence From a 10-Billion-Word Corpus Across 20 Countries.

OBJECTIVES: Older adults experience higher risks of getting severely ill from coronavirus disease 2019 (COVID-19), resulting in widespread narratives of frailty and vulnerability. We test: (a) whether global aging narratives have become more negative from before to during the pandemic (October 2019 to May 2020) across 20 countries; (b) model pandemic (incidence and mortality), and cultural factors associated with the trajectory of aging narratives. METHODS: We leveraged a 10-billion-word online-media corpus, consisting of 28 million newspaper and magazine articles across 20 countries, to identify nine common synonyms of "older adults" and compiled their most frequently used descriptors (collocates) from October 2019 to May 2020-culminating in 11,504 collocates that were rated to create a Cumulative Aging Narrative Score per month. Widely used cultural dimension scores were taken from Hofstede, and pandemic variables, from the Oxford COVID-19 Government Response Tracker. RESULTS: Aging narratives became more negative as the pandemic worsened across 20 countries. Globally, scores were trending neutral from October 2019 to February 2020, and plummeted in March 2020, reflecting COVID-19's severity. Prepandemic (October 2019), the United Kingdom evidenced the most negative aging narratives; peak pandemic (May 2020), South Africa took on the dubious honor. Across the 8-month period, the Philippines experienced the steepest trend toward negativity in aging narratives. Ageism, during the pandemic, was, ironically, not predicted by COVID-19's incidence and mortality rates, but by cultural variables: Individualism, Masculinity, Uncertainty Avoidance, and Long-term Orientation. DISCUSSION: The strategy to reverse this trajectory lay in the same phenomenon that promoted it: a sustained global campaign-though, it should be culturally nuanced and customized to a country's context.

Ethics in Narrative Health Interventions.

The thrust of narrative medicine is that patients and communities construct stories that guide their lives and give meaning to both health and illness. The responsibility of health care practitioners, therefore, is to learn how to read these local narratives to provide care that is relevant to an individual or community. Given the recognition that interaction must be tailored to the subjective experiences of patients and their communities, can there be universal ethical standards in the treatment of illness? We argue that the constructed nature of patient experiences does not pose a threat to making ethical clinical judgments. The solution to this dilemma requires that the traditional distinction between objectivity and subjectivity be eschewed by clinicians in favor of establishing dialogue with patients. Narratives are never created alone and are therefore not esoteric. Listening carefully to patients' stories is an ethical practice that can be fostered in health care settings. Subjectivity can be embraced by clinicians without jeopardizing ethical or evidence-based patient care.

Rural Health Care and an Ethics of Familiarity.

This commentary focuses on the narratives written from a variety of voices describing the unique challenges and rewards faced in rural health care. The authors speak from various areas of the country and from many professions including medicine, nursing, social work, and ethics and reflect the experiences of learners, new graduates, and long-time practitioners. The authors also represent people who were raised in rural environments and those who are from more urban settings. The commentary includes a discussion of some major themes from the rural bioethics literature that are reflected in these very personal narratives. The themes include lack of resources; overlapping relationships; resiliency; the need for partnerships and collaboration; and creativity. The commentary will also explore the dichotomy between learners and experienced practitioners and the possible missing voice of practitioners who could not tolerate the challenges and who left rural practice.

Roles of Graphic Pathographies in Clinical Training.

Although graphic pathographies have recently been recognized as playing an important role in medical care, they have not been formally incorporated in many medical school curricula. In this paper, I discuss current applications of graphic pathographies in medicine as well as some potential ethical and epistemological challenges that can arise when using these narratives. Health professionals and medical educators should understand when, why, and how to use graphic pathographies with the goal of enhancing medical education and patient care.