1. Why are older adults at risk for serious illness from COVID-19?
We don’t know the exact reasons why COVID-19 is so harmful to older patients but we know from those who have not recovered from COVID-19 around the world, more than half were older patients. This is why people over 65 are considered a high-risk population. Although we are not certain, there are some normal aging changes that may play a role in what we are witnessing.
- As we age, our immune system ages as well (immunosenescence) and is not as quick to respond to a virus like COVID giving the virus more of an opportunity to spread within the body, especially the lungs.
- Immunosenescence may explain why older patients may not mount a fever as quickly as younger patients and present with other symptoms such as sudden change in mood or inability to pay attention. This can delay recognition of infection.
- As we age the part of our lungs (cilia) that help remove foreign particles like viruses slow down. The theory is this allows the virus to penetrate the older lung more easily. This also supports the theory behind why a smaller amount of virus (viral load) getting to the lungs is worse for older patients.
- Finally, as we get older we may have accumulated more health conditions that make us vulnerable to viruses.
These differences highlight the need for younger adults to practice “social distancing”, since although they may have a milder or even asymptomatic infection they can pass the virus to the older adults with worse consequences.
2. What steps can older adults take to protect themselves from getting sick from COVID-19?
The virus that causes COVID-19 is spread through droplets in the air that are generated when someone coughs or sneezes. The virus can also live for many hours on solid surfaces such as clothing, counters, and doorknobs. Therefore, one of the critical steps older adults can take to protect themselves from getting infected is to avoid being in situations where they are around other people – this is the “social distancing” that public health experts have been recommending. Another critical step to protecting one’s self and one’s loved ones is to practice careful hand hygiene.
- Avoid contact with people who are sick, or who may have been exposed to the virus.
- Avoid leaving your home as much as possible.
- If going outside for essential tasks such as getting food or medications, try to stay at least 6 feet apart from other people.
- If someone delivers food or a package, have them leave it at the door for you to pick up once they have left. You can wave and thank them behind a window, try not to pick it up in person where there is person to person contact. Please don’t invite them in to thank them, you will be able to do this over the phone and in the near future once the pandemic subsides.
- If you think you may need medical attention, before going in person to your doctor’s office, try calling and seeing if your doctor can help you over the telephone.
- Clean your hands with alcohol-based soap or hand sanitizer every time you walk into your home or a new space.
- Avoid touching your face (eyes, nose, mouth) with unwashed hands.
- It is also important to incorporate daily physical activity while at home (see question 6). Simple chair stands from a hard back chair with arms can go a long way. There is a risk of remaining inactive while indoors, which can lead to loss of muscle and mobility. This loss can set up an older adult for worse outcomes should they experience an illness in the future (like COVID-19)
- Tips for Dementia Care
- CDC Advice for Older Adults
- If there are family or other supports to assist with shopping and other outside errands, now is the time to rely on them. Boston supermarkets are opening senior-only shopping hours
3. How can family members, neighbors and caregivers help protect older adults in their lives?
Support older adults in social distancing:
- Do not have in-person contact with an older adult if you have been exposed to coronavirus or have possible symptoms.
- Be mindful to stay six feet apart at all times.
- Avoid hugging and touching or shaking hands.
- Wash your hands with an alcohol-based soap or hand sanitizer before any in-person contact with an older adult.
- Self-care for the caregiver. It is critical for caregivers to also balance their care needs too so they can continue to support their older relative.
Prepare for a quarantine:
- Make sure the individual has enough food at home for at least a 14 day period.
- Make sure the individual has enough medication at home for at least a 14 day period; consider checking if they can switch their prescriptions to a 90 day supply and consider using a mail order pharmacy.
- Consider getting medications pre-packaged in a blister pack from the pharmacy, for older adults who require help from other people in setting up their pill boxes.
- Have a backup caregiver, if possible, in case a primary caregiver gets quarantined.
- If possible, supply the individual with activities that can keep them mentally engaged during a quarantine such as books (large print, if needed), movies, or other projects.
- Confirm that the individual has hearing aid batteries for at least two weeks if needed.
Be proactive about staying connected:
- Reach out daily with video technology, calls, or emails.
- Develop a schedule of telephonic or other virtual check-ins among family, friends, and neighbors for an older adult.
- Check with your landlord or local community whether there are older adults who are socially isolated. Many may be too afraid to reach out for help, but are in need for assistance with traveling outside for supplies. Even calling and socializing with an older adult is very beneficial, as social isolation carries its own risks.
4. What should the elderly do if they get sick with COVID-19?
If you think you might have COVID-19, call or have a family member call your doctor’s office right away. Many people with COVID-19 develop a mild illness and can recover in their homes. However, because older adults are at increased risk for becoming severely ill and needing hospitalization, they may need to check in more frequently. Please come up with a plan with your health care provider if you begin to feel sick.
If you live in close contact with another older adult, be sure to ask your health care provider for advice on how to protect that person from becoming sick.
Remember, the symptoms of COVID-19 can mimic other viral and bacterial infections, and it is not known whether someone truly has COVID-19 unless he/she is tested. If the symptoms are mild, regardless of testing the best measure is to stay home with adequate supports, so please call your doctor. If the older individual has high fevers, becomes confused (a state called delirium), is struggling to breathe, or has other severe symptoms, then he/she should call 911 as these could represent more serious disease.
Massachusetts COVID emergency line: Call 2-1-1
Massachusetts COVID emergency website
Medical Emergency: Call 9-1-1
5. How can older folks stay connected with people in their life as they take these precautions?
There is good evidence that loneliness and isolation can worsen your health. In the current COVID-19 outbreak, older adults and their loved ones will need to balance the risks of getting exposed to the virus against the risks of isolating themselves.
A few suggestions for how to maintain social connections without increasing risk of getting infected:
- Schedule daily phone calls with loved ones.
- Make a list of friends or family members you have lost touch with; pick one person a day to reach out to by letter or email.
- Look into using video technology (ex: Skype, FaceTime, Google chat, Zoom) to connect with friends and family.
- Pick a buddy and learn a new skill together remotely; there are a plethora of online resources (youtube is a great place to start) for learning a new skill such as playing an instrument, cooking, crafting, learning a foreign language and many others).
- Engage in online education; many free or paid resources exist that offer remote learning on a wide variety of topics
- The Institute on Aging offers a free 24/7 Friendship Hotline: 1 800 971 0016 that you can reach out to, for a friendly voice.
- Free telephone conversations (around wellness, education, discussion topics, music reviews, live performances, click here.
6. What advice would you give to older adults to stay optimistic and hopeful during this crisis?
- Don’t underestimate your life experience—you have endured other challenges in your life and you can bring pieces of that wisdom to this situation.
- Expressing gratitude can help you stay connected and give you a positive mindset. Try writing down 3 things for which you are grateful before you go to bed.
- Keep connecting with others via telephone, video conferencing, and other “physically distant” methods.
- Mindfulness is awareness that arises through paying attention on purpose in the present moment without judging the experience. Mindfulness has been shown to have many benefits, such as reducing stress, depression, anxiety, sleep issues, and others.
- Anything can be done mindfully—this includes walking while paying close attention to your body and your surroundings, paying close attention while you eat a meal without distractions, praying, and many other daily actions.
- If you use apps on your iPhone or Android smartphone, try some apps such as Insight Timer, Headspace, or Calm.
- You can find free meditations and mindfulness practices on the Internet—try UCLA’s Guided Meditation resource
- Movement is a very important component of stress reduction. Make sure to stand up and walk at least once per hour. Yoga and tai chi are great ways to move mindfully and reduce stress. Many yoga studios are offering online memberships so that you can practice yoga in the safety of your home.
- Make sure that your caregiver is also taking care of themselves as they need to stay healthy to care for you.
7. Final thoughts?
Although most people who contact COVID-19 experience a mild illness and then recover, the worse case scenario is that someone could develop a pneumonia severe enough to require admission to the ICU and intubation (a breathing machine). While many people would want to be put on a breathing machine if their lungs were failing, many others would not. If you have not done so already, reach out to your care provider to discuss what your wishes would be if you were sick enough to require a breathing machine.
There is a document you can fill out called a Medical Order for Life Sustaining Treatment (MOLST) that gets your wishes down in writing and makes sure they are respected and followed in case of an emergency where you would be unable to express them yourself.
Some additional resources you can look at when deciding what your health care wishes would be in the case of an emergency are listed below:
Division of Aging, Brigham and Women’s Hospital
Dr. Shoshana Streiter
Dr. Julia Loewenthal
Dr. Clark Dumontier
Dr. Laura Frain
Dr. Houman Javedan