The challenges of the COVID-19 pandemic are different for different socio-demographic groups, and Medical News Today has zoomed in on how the more vulnerable have been affected by this crisis. For this special section, we concentrate on how older people have been affected by the pandemic.
Within this special section , we discuss the effect of the pandemic on another group which is sometimes overlooked: older adults.
This article looks at ways in which older adults have taken the brunt of the pandemic from the possibility of contracting a more severe form of COVID-19 to the dangers of isolation and mental illness.
Old age and preexisting health conditions
By itself, the COVID-19 disease had affected older people harder than other age groups.
Older people are more likely to already have underlying disorders like cardiovascular disease , diabetes, or respiratory disease — comorbidities that we already know increase the risk of extreme COVID-19 and COVID-19 death. Additionally, a potentially weakened immune system makes it more difficult for older adults to ward off infection.
The effect on the older adults is also clear. According to April 2020 data from the World Health Organization (WHO), more than 95 per cent of COVID-19 deaths occurred among people over the age of 60, and more than half of all deaths occurred among people over the age of 80.
For example, in Sweden, 90 percent of COVID-19 deaths were among people over the age of 70.
In March, the Chinese Centers for Disease Control and Prevention provided data showing an overall COVID-19 case fatality rate of 3.6% for adults in their 60s, 8% for those in their 70s and 14.8% for people 80 years and older.
“Older adults are at a slightly higher risk of serious disease following COVID-19 infection,” Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said in a press briefing to the WHO, adding:
“Supporting and protecting older people living alone in the community is everyone’s business.”
COVID-19 deaths in care homes
While the wider community will also be concerned with the health and well-being of older people, there are epicenters to the current crisis, and nursing homes are one such place alongside hospitals.
The United States Centers for Disease Control and Prevention ( CDC) warns that “nursing home populations are at the greatest risk of being affected by COVID-19,” not only compounding the danger to the elderly but also placing care staff at danger.
The New York Times (NYT) collected recent data showing that in the U.S., at least 28,100 residents and workers have died from an infection with SARS-CoV-2 in a nursing home or in another long-term care facility for the elderly.
Overall, more than a third of all COVID-19 deaths in the U.S. occur in long-term care facilities, including residents and workers, — that is, 35 percent.
“While only 11 percent of the country’s cases occurred in long-term care facilities,” the writers of the NYT study claim, “the COVID-19-related deaths in these facilities account for more than one third of the country’s pandemic deaths.”
The situation is also looking serious in other parts of the world. Researchers collected data from the London School of Economics (LSE), UK, indicate that most COVID-19-related deaths occurred in nursing homes.
In Belgium, for example, 53% of the country’s entire number of COVID-19 deaths occurred in care homes.
- In Canada, this proportion was 62%.
- In France, the figure ranges from 39.2–51%.
- In Spain, 67% of all COVID19 deaths occurred in care homes.
- In the U.S., nearly 60% of all care home-related COVID-19 deaths occurred in the state of New York.
The risk of spreading the latest coronavirus in care homes and harming both staff and patients is compounded by the fact that most of the cases reported by physicians were asymptomatic in these environments.
For example, in Belgium 72 percent of COVID-19 diagnosed staff at the time showed no symptoms; neither did 74 percent of the residents who tested positive for the new coronavirus.
The U.S. federal government is not keeping track of this evidence, given such alarming figures. Holding away key nuanced information on who the pandemic most seriously affects is in the way of guiding resources where people most need them.
“It is difficult to battle and control this virus unless we know where it is located,” David Grabowski, a Harvard Medical School professor of health care policy, told NBC News.
Prof. Grabowski added that knowing this knowledge would help predict when the next outbreak will occur; other NGO advocates agree that knowing which nursing homes have the highest number of cases will help states focus resources where the greatest need is.
Living with dementia during COVID-19
At least half of the older people living in these care facilities have Alzheimer’s disease or other types of dementia, which makes it difficult to control potential infections with the current coronavirus, according to the CDC.
One of the specific challenges people living with dementia and similar forms of cognitive impairment face is that they may find it difficult to understand the dangers of infection. They can even fail to follow safety precautions, such as hand washing or physical distancing.
Those who care for people with dementia and contract the virus may also stop seeking treatment or hospitalization because they can not afford to leave their elders alone
On the other hand, people with dementia themselves who have COVID-19 and need hospitalization may avoid this because they fear that when it comes to receiving medical resources and care, they may fall at the bottom of the ladder due to hospital triage protocols.
In addition , people may be discouraged from obtaining medical care for dementia themselves as they begin to display symptoms; memory clinics are closing down, as seeing new patients is considered to be more dangerous than not having a dementia diagnosis for certain people.
While in the short term this cost-benefit reasoning made sense, doctors are increasingly worried that as the pandemic spreads, more people may develop dementia and not receive the care they need.
Pandemic exposes ageism, gaps in care
Some have suggested that ageism — that is, a discriminatory attitude towards older people — may have contributed significantly to the harmful effects COVID-19 has on the health and longevity of older adults.
For example, Joan Costa-Font, an associate professor at LSE’s health policy department, suggests that countries that tend to view their elders more respectfully have implemented physical distancing measures more promptly, even though such measures have primarily impacted younger people’s social lives.
“Differences in social perceptions underpin the social environment in European countries where we have observed delays in policy interventions, such as lockdown, (which are detrimental to the social lives of younger cohorts), and why countries like China implemented more stringent measures.”
– Joan Costa-Font
However, it is worth remembering that other countries have not opted to have a lockout, for example, Japan, where there is a practice of honoring the elders.
According to the same speaker, “a delayed lockdown implementation isn’t the only way we expose the low social importance of older people.”
In several European countries, the COVID-19 pandemic has also shown how poorly funded and disorganized long-term care facilities are. For example , in the UK, a government study using genome tracking to investigate the spread of outbreaks has only recently discovered that temporary staff spread SARS-CoV-2 unwittingly among care homes as the pandemic grew.
As a result of this revelation, some politicians have said the pandemic “brutally exposed how insecure, undervalued, and underpaid care work is,” with all contributing to the pandemic being “the prevalence of zero-hour contracts, high vacancy rates, and high staff turnover.’
Additionally, “In the absence of adequate formal care, older people are cared for informally by family members (or go with unmet needs). Reliance on informal treatment explains the pandemic ‘s early spread in countries with stronger family relations such as Italy , Spain, China and Korea, “Costa-Font says.
The author continues to stress the especially serious effect of quarantines on older people who prefer to live alone and require more treatment.
“In many countries, carers were forced to reside with older people in need to reduce the likelihood of contagion. Yet while older people have less disabilities, they are more likely to be left behind, with unmet needs.
In addition, other authors analyzed the age portrayal of older adults in social media, reflecting a similar attitude of indifference by dismissing hashtags on twitter (such as referring to COVID-19 as the # boomerremover) and other memes.
Combined with policy responses, an ageist attitude has a range of negative effects on older adults, including leading to social isolation , loneliness and an increase in elder abuse.
Mental health and elder abuse
Loneliness is a known factor that has a negative effect on the mental health and well-being of a person, and some older adults were already at a higher risk of having it. Degrading health or the death of partners and friends can hinder the maintenance of a healthy social circle.
Nevertheless, this risk of isolation rises with the pandemic and the quarantine.
“Loneliness is a dynamic, subjective emotion, felt as a feeling of distress and frustration linked to a lack of connectedness or communality with others,” Joanne Brooke and Debra Jackson explained in a paper published in the Journal of Clinical Nursing.
The authors go on to highlight the importance of loneliness and social isolation for mental and physical health.
“The acknowledgment of social isolation and loneliness of older people is essential and paramount due to the detrimental impact on their physical and mental health, which has been recognized for over two decades. Social isolation and loneliness increases older people’s risk of anxiety, depression, cognitive dysfunction, heart disease, and mortality.”
— Joanne Brooke and Debra Jackson
Moreover, emerging reports have shown that lockdowns increase the risk of maltreatment among older people.
Throughout the pandemic, older adults became much more reliant on their caregivers, and in a trend similar to that which increased domestic violence levels, some caregivers used the pandemic to further exercise power and abuse.
Elder abuse tends to occur more frequently in communities lacking the resources for mental health or social care. The perpetrators of the abuse also tend to have mental health problems, and report resentment with their informal care duties.
According to a recent paper published in the journal Aggression and Violent Behaviour, people who experience “older abuse” are more likely to develop mental health problems such as depression, high stress and self-neglect — conditions that can only be made worse by lockdowns.
Generally, lockdowns mean that more elders are stuck with their abusers, that some victims of violence are voluntarily put in a caregiving position, and that, as a result, there is a greater need for mental health services and community support.
However, paradoxically, the funds and staff for these services have been slashed — now, when they are most needed.
While some countries acknowledged that they “failed to protect [their] elderly people,” and in doing so failed “society as a whole,” others, like the U.S. or the U.K., still have to make the necessary adjustments.
This can be seen from the pandemic ‘s effects on the mental and physical wellbeing of older people, governments in many countries have yet to follow the advice of the WHO — that we don’t forget that protecting our elders is “the business of all.”