25 March, 2020

Life within the cocoon: Supporting older people through COVID-19

As the impact of the COVID-19 coronavirus is being felt across society, and may be causing particular anxiety to our older population, Dr Declan Lyons, Dr Declan Donoghue, and Dr Syed Naqvi take us through some ways that we can support older people through the ongoing period.

Tags:   older adult   family   carers  

Feeling the impact of the virus

An unprecedented level of societal anxiety around the unfolding coronavirus pandemic has gripped many of us, as we eagerly consume and anticipate the next morsel of scientific detail or grim statistic about the global impact of the virus.

Feeling the impact of the virus

One cohort reported to be particularly affected by the impact of COVID-19 is older people. Recently, older people, even if they are asymptomatic or displaying no symptoms of the virus, have been advised to consider isolating themselves from other members of the community, particularly younger people who might be carriers of coronavirus. Due to their advanced age and greater preponderance of underlying medical conditions, older people appear to be more vulnerable to develop severe illness associated with this virus.

We can instinctively speculate that quarantine is an unpleasant experience for those who undergo it, owing to the effects of separation from loved ones, loss of freedom and uncertainty over health status, never mind the inevitable boredom. Strictly speaking, quarantine is the separation and restriction of movement of people who have been potentially exposed to a contagious disease to ascertain if they become unwell, thereby reducing the risk of them infecting others. The term "isolation" refers to the separation of people who are diagnosed with a contagious condition from persons who are not sick, yet the two terms are frequently used interchangeably.

With this in mind, what advice and psychological support can family members, friends or healthcare professionals provide our senior citizens to mitigate these negative effects of lengthy periods of movement restriction and self-isolation?

Make self-care a priority

Boredom and isolation predictably cause distress for human beings, who are inherently programmed to be socially connected.

Make self-care a priority

Taking self-care seriously in the context of a transmissible community infection is as important as airline safety. In that scenario, we are metaphorically compelled to fit our own oxygen mask first, before being able to take care of others. Basic self-care, such as maintaining a good routine and sleep hygiene and minimising alcohol and other over-indulgences, is not selfish, but may be a very useful way to maintain a healthy immune system.

Stepping up the management of any chronic condition, such as chronic obstructive pulmonary disorder (COPD) or depression, may be especially prudent to avoid a cascade of insult to mind and body from poorly managed illness of any kind. Now is the time to take inhalers correctly or improve diabetic control. Vitamin D supplements may be important to discuss with your primary care doctor for those who staying indoors for prolonged periods, and exercise is important to avoid complications associated with immobilisation.

A regular exercise regime is vital for everyone and may be very easy to implement, even within the confines of one’s home, through seated exercises, exercise equipment or walking circuits of one’s garden or corridors. Outdoor exercise in public places, whilst maintaining physical distance, may also be possible during different phases of the quarantine, but is likely to be at the discretion and advice of public health authorities.  

Minding the mind

Flattening the spike of psychological distress associated with COVID-19 may be easier for older adults, as opposed to younger people, as our seniors anecdotally have perhaps greater reserves of self-sufficiency and memories to contextualise the present crisis.

Minding the mind

Reframing the experience as a therapeutic hibernation, allowing quiet reflection and meditation, can be useful but, undoubtedly, the closure and temporary unavailability of community services will be challenging for many.

Filling the time productively and focusing on tasks that bring a sense of achievement, pleasure and closeness to others can instill a sense of satisfaction and prevent an accumulation of guilt; it could be the time to undertake an online course or learning programme, to learn a new language or to rediscover the joys of reading. Having background music to fill the void associated with too much silence can inhibit brooding and rumination which otherwise can excavate and reactivate excessive regret and negativity.

Equally, simple tasks that we have postponed, such as decluttering or cleaning, can finally be tackled, if we are otherwise fit and healthy during the quarantine, to help us reassure ourselves that we have made the most of the enforced isolation.

Journaling about our feelings during isolation, as well as our hopes when the quarantine is over, can be very therapeutic. We may have special insights about our own circumstances that can only emerge in times or relative solitude, and committing these feelings to paper or hard drive can help us articulate and formulate new aspirations and strategies to get the most out of our remaining years.     

Embracing technology

Embracing technology

Healthcare professionals, friends and family should encourage older people to have a working mobile phone, which should be seen as a necessity and not a luxury. It may be the only way to communicate with essential services, such as a local medical practice or pharmacy. Personal security is also enhanced by technological devices and innovative products, and vulnerable older people need to be perpetually wary of scamming and cold callers calling to the doorstep offering help.

With these considerations in mind, family members may make yet another attempt to encourage older family members to embrace technology, not least to activate a remotely accessible social network, which is vital to maintain for long-term as well as short-term mental wellbeing. Tablet devices may be less intimidating for older people to learn basic computing skills on and easier to operate. The availability of messaging services and social media to keep in touch with and be reassured by loved ones may be an incentive to finally learn to use the plethora of devices that are in circulation.

Having WiFi networks that are robust and reliable can therefore be seen as an essential service to communicate directly with loved ones and reduce feelings of isolation and panic. Telephone support from GP surgeries and other services, such as community psychiatric teams and public health, can also be a means of supporting people experiencing quarantine, by providing regular monitoring and official updates about quarantine practices and advice.

Considering the reality, not stereotypes

Despite the public discussion of older people and those with pre-existing medical conditions in general constituting an ‘at-risk group’, the stereotype of frailty and infirmity being inevitably associated with old age may rear its head during this crisis. This should not stick, considering, for example, the recruitment campaign aimed at retired healthcare workers in many contries.

Considering the reality, not stereotypes

Older, experienced clinicians are being targeted in droves and enticed to return to the frontline, with little reference to personal risk or chronological age. The reality of the situation is that, in time of national crisis, older workers are a considerable asset, bringing experience, perspective, wisdom and skills to bear in solving virtually any calamity they find themselves immersed in. This should be fully appreciated by society, however, without the need for older people to keep having to prove themselves by repeatedly emerging from the shadows of retirement.

If older healthcare workers could be retained in ‘the system’ in even part-time teaching or mentoring roles and appropriate late career structures, and if incentives and modes of upskilling were developed, we may be better prepared to face future global health threats.

This piece was written by Dr Declan Lyons, Consultant Old Age Psychiatrist at St Patrick's Mental Health Services (SPMHS),Dr Declan Donoghue, Registrar in Psychiatry at SPMHS, and Dr Syed Naqvi, Registrar in Psychiatry at SPMHS.   

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