Seniors’ health at significant risk due to self-isolation, loneliness
Lillian Mehr, 94, lives alone in a second-floor apartment in Bellevue, as she has for more than 30 years. Her age puts her at risk during the COVID-19 pandemic, and her stairs make some everyday challenges difficult even in normal circumstances.
These are not normal circumstances.
She has two sons, one in Rochester, N.Y., and one in San Francisco, who are calling regularly to check in, but who can’t visit because of the pandemic. “I’m usually still able to fend for myself, but this situation is new,” she said.
Eight out of 10 COVID-19-related deaths reported in the U.S. have been adults ages 65 or older. The Centers for Disease Control and Prevention has advised all seniors to stay home as much as possible and avoid contact with people who are sick. Ms. Mehr said she doesn’t receive many visitors, as she mostly keeps up with friends online.
She can still joke about recent shortages of toilet paper: “My friend tells me the sales of bidets have skyrocketed.”
For now, the Allegheny County Area Agency on Aging is sending a young woman to help Ms. Mehr with her laundry. A friend’s daughter phoned a grocery store to have food delivered to Ms. Mehr’s door.
Thousands of other seniors in the region will have to rely on community and institutional support during this crisis to ensure that basic needs such as food, laundry and medicine are met. But there’s another danger: Health and aging organizations are deeply concerned about the effects that social distancing has on seniors.
“We should be worried about this right off the bat,” said Dr. David Nace, chief medical officer of UPMC’s Senior Communities, of the loss of interaction.
“This will have negative effects cognitively, physically and emotionally,” he said. “It can accelerate cognitive decline, increase confusion especially for dementia patients and negatively affect behavior.”
Community need
According to a 2012 study about the health of older adults, published in the Journal of the Royal Society of Medicine, “Lonely or isolated older adults are at greater risk for all-cause mortality,” and “The effect [of loneliness or isolation] is greater than that of other well-established risk factors for mortality such as physical inactivity and obesity, and comparable with cigarette smoking.”
“There’s a reason enemy combatants in the military are isolated to break them down,” said Kurt Emmerling, deputy director of the Allegheny County Area Agency on Aging, which provides services and advocacy for older adults in the region.
“Isolation increases depression and can decrease cognitive function.”
The agency typically coordinates with several senior centers in the area to provide community meals and gatherings, but all group activities are halted, and the meal service is adapting rapidly to a delivery-only format to reduce contact among seniors. At the moment the agency plans to provide approximately 100 meals per day to seniors via takeout, but this likely will increase.
(Seniors in need of food or other resources should contact the Allegheny County Area Agency on Aging’s SeniorLine at 1-800-344-4319.)
Aging agencies in other southwestern Pennsylvania counties such as Butler and Washington have instituted-similar policies, banning gatherings but adapting meal services and reaching out to at-risk seniors by phone to maintain contact and mitigate some of the effects of isolation.
The Butler agency has reached out to more than 8,000 people to assess who might need regular check-in phone calls and food assistance.
Dr. Nace advised that the risk is similar across different settings, whether a senior lives at home or in assisted living or a nursing home. He added that those who live at home may be a bit more resilient if they have a special attachment to the space, and they may have more room to walk around, but the effects will still happen.
Nursing homes
Roughly one in five seniors in America lives in an assisted living facility, and the remainder live alone, with family or in retirement communities. According to the CDC, there are 1.7 million nursing home beds in the country, and 1.5 million are occupied. In Pennsylvania, the governor has instituted a no-visitor policy for all state correctional facilities and nursing homes.
A study published in the History of Human Sciences journal in 2015 about infection prevention and control states there is a direct conflict between quality of life and isolation practices to curb infection rates, with patients interviewed describing being isolated as “horrible” and like “holding a person prisoner.”
Baptist Homes Society in Mt. Lebanon and Scott offers independent living, skilled nursing care and assisted living options. Marilyn Walsh, director of marketing and public relations, said her facilities are setting up a schedule for seniors to video conference with families using apps such as FaceTime or Skype.
Baptist Homes has restricted visitation except in certain end-of-life situations, but families and friends can drop off items. The organization has a chaplain on staff to assist in last rights.
“We’re also setting up one-on-one time for staff and residents to interact over puzzles, reading books, listening to music, whatever they like to try and keep them positive and upbeat,” Ms. Walsh said.
Staff and tech-savvy seniors are also posting to social media to try to stay connected.
HCR ManorCare, a national senior living company with locations in Pittsburgh, has adopted similar practices and activities ranging from printing coloring pages for adults, to deliberate reminiscing time with staff and playing trivia games.
St. Barnabas Health System has restricted all visitation at this time, including clergy in end-of-life situations, but is providing all residents the option to video chat with family members.
Mitigating risk
Ellen Whyte, a geriatric psychiatrist at the UPMC Benedum Geriatric Center, isn’t immediately concerned that people will tip into cognitive decline.
“I’m more worried about vulnerable seniors with depression, as their depression may be compounded through the quarantine,” she said, adding that UPMC Western Psychiatric Hospital and other facilities are switching to video conferencing and counseling.
She advised the public to increase contact and to set up a schedule to talk over the phone. Dr. Whyte said it can be challenging to notice symptoms of depression remotely, but people should be on the lookout for general symptoms such as loss of sleep or appetite or lack of interest in valued activities.
She said that for patients with dementia, there isn’t clear evidence that isolation will dramatically worsen symptoms.
In the interest of mitigating some of the isolation issues, Mr. Emmerling suggested churches and places of worship create phone trees to keep in touch with seniors in their community. He recommends talking to people about their interests, their kids, their pets, not just whether they’re ill, and asking if they need anything.
UPMC has increased the purchase of iPads for its assisted living communities, facilitating video chats for family members and then cleaning the devices after each use. Dr. Nace also said that old-fashioned letter writing can create good community.
Some families are even visiting relatives and holding “window visits” to raise loved ones’ spirits.
“We know that people with depression have a higher mortality rate, and people with delirium have a higher mortality rate,” Dr. Nace said. “The decision to limit visits is not one we take lightly. Phone calls can make such a tremendous difference to those involved in community settings.”
For her part, as a former musician, Ms. Mehr spends her time watching concerts on YouTube and keeping in touch with friends online.
“I do crossword puzzles like mad,” she said. “The woman who helps with laundry brings me my crossword, and that’s really keeping me sane.”
