Thinking about the elderly

One of the first responses to the pandemic was a proportionate response of lockdowns

As a general practitioner, what struck me most in the following months was the unappreciated vulnerability of the elderly. Many stayed inside due to fear; others ventured on as if nothing was happening (also a reflection of vulnerability); still others were restricted either because of their physical ailments or because they were in homes. We need to take stock, learn from experiences and think out a plan which would help the elderly and those looking after them cope better since the future is still unclear.

While the generosity of society was indeed felt, with groceries and medicines being delivered and those living in flats also had some comfort in each other. However, fear and for others loneliness crept slowly on many and as doctors we had to deal with depressions and stress. The media certainly played its important part; many found much comfort in the daily mass. Many appreciated the Archbishop for his simplicity, short and to-the-point homilies and his devotion to the cause. Television can play an important role of communication. 6.30pm programmes for children are not; children have social media today. We coped as much as we could. Of course, we made mistakes. This was and continues to be a learning process. But now is the time for some reflective practice.

For example, a patient in a home had to be sent to hospital three times in the first three months. Each time he recovered he was sent to the Msida home for two weeks’ quarantine. The people there were nice but the place had no internet – the 87-year-old used to communicate with his family and also pass the time. The tragedy was that it all was in vain. The home was locked down as the virus became epidemic. People were transferred. Foreign care workers living in tight quarters with many others working in different environments were coming and going into these homes – perhaps hotel accommodation on a longer-term basis can be arranged for these people, whom we are too quick to blame.

It would be appropriate that government and NGOs get together to formulate coherent plans. We can learn a lot even by listening to the people who work in these places. When I visited one of these homes to see patients, I noticed increased depressed states, worrying, anxiety, anger at not being able to leave the room to go even to the common areas to chat and of course the reduced visits from relatives. In one instance anger and confusion turned to violence with severe bruising to the victim. Perhaps we need to take note which signs are on the rise and how we can help these people to cope. Perhaps it is time to integrate primary mental health into primary care in a coherent manner.

Although in fairness an attempt was done by the Minister for Health, this was with regard to follow-up on patients and not actually primary care. Another attempt involving a re-thinking of pathways will help primary care physicians to cope and be ready for mental health issues in such current situations. Clearly it is the elderly who are suffering the most in this regard. Private family doctors can involve community nurses, health care workers and if need be psychologists to be in touch regularly with patients, even if by telephone, if they are given the appropriate support.

On a wider scheme one has to assess prevention rather than cure. Locally the Health minister would have had the airports shut down immediately. Prof. Gauci was right when she said that the virus could have been avoided in Malta. What is more concerning is how the WHO did not use the Precautionary Principle when there were enough red flags showing the danger of the virus when it was still in China. While it is true that the WHO’s guidelines to countries for pandemics is showing solidarity, interpreting solidarity, as always is tricky. Many heard with incredulity the WHO communication basically saying that the virus is not understood, there will be a pandemic, people will die, but we need to show solidarity. The advice was to keep airports open! Is this the role of WHO? Then later it supported shutdowns. Many people were asking why allow it to happen deliberately? That is why people lose faith in organisations! As a matter of fact, EU countries, in imminent danger, ignored the same EU advice to concur with the WHO. Later precautionary measures followed suit. We did show solidarity with each other notwithstanding the closing of borders. Nobody suffered any hunger. I am quite certain that this will not be the first virus we will have to deal with. While no one can judge decisions in good faith; people will judge our future actions.

The maxim taught about elders is “more life to years than years to life”. Although encouraged to leave home for daily walks, many were overwhelmed by fear and some simply could not. Together we can find ways to make their lives better. For example, short visits from relatives using the usual precautions, like masks and sanitizers, can be encouraged. We can also help them to go out for walks if they cannot.

Conversely, we hardly have an option to keep our teens inside – more input from education is needed here. They hardly practice social distancing and we know it. So, allowing some slack for the elderly is possible. The social burden of our elderly rests on us – the answer cannot be isolation – especially in homes. This is not public health any longer but the health of the public (more on this in a future article), when a utilitarian measure has to move to a more principled and individual approach.

Looking at a more positive angle, this global “warning” has given us a breath of fresh air showing us how clear our waters and skies could be, how much less traffic we can have by using the technology we have at our disposal. We suddenly did away with a lot of paperwork when just a few months before people were complaining to me that they had to go in person to deliver a form for a driving licence renewal.