Home and alone, we need to reach out
Even more than at start of pandemic we must connect with the elderly
As a family doctor working in East Toronto, I care for about a thousand people, but during this COVID-19 pandemic, I’ve been worrying most about my older patients.
The terrible tragedy striking older people in long-term care facilities is an awful failure of our society. But the vast majority of our older adults still live in our community, many of them now isolated and on their own.
As a physician, I think about the whole patient — their dayto-day lives, who is a part of their household and who is most alone and in need of support.
I have phoned around two hundred of my older patients, starting from oldest at age 99 to youngest at age 70, to find out how they were coping at home alone. How were people handling self-isolation? I wanted to know how people were getting groceries and medication. I asked about dealing with loneliness. I inquired about anxiety and mental health, and checked on current medical conditions.
These calls were a profound experience for me. I found people were all staying home and being vigilant. They were getting groceries and medication refills dropped off by adult children and neighbours. Friends were calling to check in. The half that use computers and Wi-Fi were getting more tech savvy, setting up video chats with friends and family.
Several patients had rearranged furniture to make small tracks at home so they could walk in their apartments instead of their parks and neighbourhoods. Those already housebound have similar routines. Those used to active lives are having to make bigger adjustments.
The majority are coping well, turning to books and music, games, and movies. Those lucky enough to have a garden are outside working on them. Still others are climbing the walls, itching to get out.
I could tell that anxiety levels are high, and people dealing with mental health issues were having a particularly hard time. With several of them, we talked about watching less COVID-related media, particularly before bed. I think this is true for all of us: avoid COVID updates before bed.
In those first two weeks, a few people who were suffering at home wondered whether their health issues warranted calling our office or going to the hospital. One patient with a history of cancer had suffered through several days of abdominal pain, managing the symptoms at home and hoping it would go away. In fact, urgent abdominal imaging and management were needed.
Another patient noticed numbness in their arm and face, as well as tightness in the chest. They wondered if this was anxiety brought on by the COVID crisis. In fact, they needed to get to the hospital fast to find out if this was a heart attack. Getting them on the phone meant we could arrange the urgent care needed.
Everyone was glad to be called and have a conversation. We worked through a few medical issues and organized follow up calls. A few were surprised to get a call. They were feeling in good health and they wanted to thank everyone on the frontline.
But now more than a month in, we are starting to see two types of collateral damage of COVID-19. People have been waiting patiently at home, putting off medical issues. They are scared to come to our medical clinics or to hospitals. Some people are getting acutely ill from non-COVID issues, and end up delaying assessment because they are scared. People are still getting sick with serious medical issues like heart attacks, stroke, acute abdominal pain. But they are staying at home longer trying to bear the pain because they are frightened to go to the hospital.
Many others have chronic issues like diabetes, high blood pressure, and heart disease that are not being monitored in the same way during the pandemic. People suffering with chronic pain have no access to the things that help them cope — physiotherapy, massage therapy, exercise programs.
Other people are waiting for their delayed investigations, procedures and surgeries to get rebooked. And at home, mental health issues are accelerating with less access to mental health supports, more isolation, financial stress, and existential worry.
The messaging around COVID-19 is essential. But it risks making people feel alienated from their health-care teams. Older people are among our most frequently cared for patients because of their complex medical and social issues.
Our patients age 70 and above might be reticent to come forward at this time, in a very Canadian “I don’t wish to bother you” kind of a way. We must stay home and protect each other. But it should not mean feeling alone and without support.
Having reached out at the beginning of the pandemic to one of my patients to check-in, they now call in weekly to tell me, “I am still fine, and I am still bored.” And I am heartened to hear this news of staying well and staying connected in spite of the boredom.
We are now in a new phase of the pandemic. We need to connect with our older patients now even more than at the beginning of this crisis. Care must continue to keep people as well as we can both physically and emotionally.