Your questions, answered "I haven't heard specific recommendations for senior mask wearing for those of us who are basically healthy. Are we in the same group as 'immunocompromised'?" — Doris in New York Being over 65 on its own doesn't make you immunocompromised. This term typically refers to people living with chronic health conditions or taking certain medications that prevent their bodies from mounting a proper immune response — for example, people with untreated HIV or organ transplant patients who take immunosuppressant drugs. That said, age is a risk factor for severe covid-19. The older you are, the higher your risk. As we grow older, it gets harder for our bodies to fight off infections and build up a robust response to vaccines. Dietary, emotional, environmental and physical stressors accumulate over the years and "eventually lead to chronic illnesses and overburdening of the immune and other detoxification systems of the body," said Alicia Arbaje, a Johns Hopkins doctor specializing in senior health, told me. There's no one age or cutoff after which the immune system weakens, Arbaje noted; people under 65 can experience this as well. Eighty percent of adults 65 and older have at least one chronic health condition such as hypertension, diabetes or heart disease that puts them at higher risk for severe illness, according to the National Council on Aging, an advocacy group for older Americans. Sixty-eight percent have two or more chronic conditions. Vaccines and boosters go a long way in protecting against severe illness, hospitalization and death, even in these high-risk patients. But breakthrough infections happen, and evidence shows they're harder on seniors than younger people. A Kaiser Family Foundation review of hospital data from last year found that 69 percent of breakthrough infections that required hospitalization occurred in people ages 65 and older. That's a disproportionately large share compared to the rest of the vaccinated population, the review found. So, with all that in mind, should seniors keep masking up even though infections are subsiding and government officials say most Americans don't need to right now? Yes, Arbaje told me. "It makes sense to keep it simple: Masks are a good idea when being indoors in crowded spaces or when being in close contact with people outside of your household," she said. "This applies to folks of any age, because again, it is not about age, but rather about the person's individual accumulation of stressors that makes one more or less vulnerable to illness." Kathleen Cameron, a public health expert at the National Council on Aging, agreed that seniors should consider masking up in those same settings. She also urged seniors to consult with their doctors about what their personal risk is like, and to share their opinions with friends and family about what they want to do. Everyone's risk tolerance will vary, Cameron said, but those who want to mask up need not feel self-conscious if others around them aren't covering up. "It's personal preference, it's your comfort level," she told me. "You shouldn't feel ashamed or different if you're wearing a mask in a place where others aren't wearing masks. You need to protect yourself and do what's right in your own personal situation." If you're on the fence about whether to wear a mask, Cameron suggested checking the CDC website for information on what virus transmission is like in your county. For areas with low transmission, the CDC recommends wearing a mask based on your personal preference. Seniors in places where transmission is medium or high should mask up and take other health precautions. It's important to note, too, that masking is just one of many steps seniors can take to keep themselves safe and healthy. Vaccines, as always, offer the best protection. Cameron and Arbaje also recommended staying active, eating well, managing chronic health conditions, and staying connected to the community. | 
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