How does the COVID-19 pandemic affect older adults?

The challenges of the COVID-19 pandemic are different for various socio-demographic groups, and Medical News Today has zoomed in on the ways in which this crisis has affected the more vulnerable ones. In this Special Feature, we focus on how the pandemic has affected older adults.

As part of a new series of features, MNT has looked into how the pandemic affects women’s reproductive rights, people that may find themselves in an abusive relationship, as well as the mental health of people of color and those belonging to an ethnic minority group.

In this Special Feature, we examine the impact that the pandemic has had on another group that gets frequently overlooked: older adults.

From the likelihood of developing a more severe form of COVID-19 to the risks of isolation and mental health problems, this feature looks at ways in which older adults have taken the brunt of the pandemic.

Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.

Old age and preexisting health conditions

The COVID-19 disease, in itself, has hit older adults harder than other age groups.

Older adults are more likely to already have underlying conditions such as cardiovascular disease, diabetes, or respiratory illness — comorbidities that we now know raise the risk of severe COVID-19 and COVID-19-related death. In addition, a likely weaker immune system makes it harder for older adults to fight off infection.

As a result, the impact on older adults is notable. According to World Health Organization (WHO) data from April 2020, more than 95% of COVID-19 deaths were among people over 60 years of age, and more than half of all deaths occurred in people of 80 years-plus.

In Sweden, for example, 90% of the deaths from COVID-19 were among people more than 70 years of age.

The Chinese Centers for Disease Control and Prevention offered data in March showing an average 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 above.

“Older adults are at a significantly increased risk of severe disease following infection from COVID-19,” said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe in a WHO press briefing, who added:

“Supporting and protecting older people living alone in the community is everyone’s business.”

COVID-19 deaths in care homes

While the wider community should indeed be preoccupied with the health and well-being of older adults, there are epicenters to the current crisis, and nursing homes, alongside hospitals, are one such place.

The United States Centers for Disease Control and Prevention (CDC) warn that “nursing home populations are at the highest risk of being affected by COVID-19,” compounding not only the risk for older people but also placing care workers at risk.

The New York Times (NYT) gathered recent data showing that in the U.S., at least 28,100 residents and workers have died from a SARS-CoV-2 infection in a nursing home or in another long-term care facility for older people.

Overall, more than a third — that is, 35% — of all COVID-19 deaths in the U.S. occur in long-term care facilities, comprising residents and workers.

“While just 11 percent of the country’s cases have occurred in long-term care facilities,” say the authors of the NYT report, “deaths related to COVID-19 in these facilities account for more than a third of the country’s pandemic fatalities.”

In other parts of the world, the situation looks dire, too. Data collected by researchers at the London School of Economics (LSE), in the United Kingdom, suggest that the majority of 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 danger of the new coronavirus spreading in care homes, and affecting workers as well as residents, is amplified by the fact that most of the cases doctors confirmed in these environments were asymptomatic.

In Belgium, for example, 72% of staff diagnosed with COVID-19 showed no symptoms at the time; neither did 74% of the residents who had tested positive for the new coronavirus.

Despite these alarming figures, the U.S. federal government are not keeping track of this data. Withholding key nuanced information about whom the pandemic is affecting hardest is in the way of directing resources where people need them the most.

“It’s impossible to fight and contain this virus if we don’t know where it’s located,” David Grabowski, a professor of healthcare policy at Harvard Medical School, told NBC News.

Prof. Grabowski added that knowing this information could help predict where the next outbreak will be; other NGO advocates agree that knowing which nursing homes have the highest number of cases can help states direct resources where the need is the greatest.

Living with dementia during COVID-19

According to the CDC, at least half of the older adults living in these care facilities have Alzheimer’s disease or other forms of dementia, which makes it more difficult to contain possible infections with the new coronavirus.

One of the specific challenges for people living with dementia and similar forms of cognitive impairment is that they may have difficulty understanding the dangers of infection. Also, they may forget to follow safety precautions, such as washing their hands or practicing physical distancing.

Those who care for people with dementia and have contracted the virus may also avoid seeking treatment or being hospitalized because they cannot afford to leave their elders alone.

On the other hand, people with dementia themselves who have COVID-19 and need hospitalization may avoid it because they fear that, due to hospital triaging protocols, they may fall at the bottom of the ladder when it comes to receiving medical resources and attention.

Furthermore, people may be discouraged from seeking medical attention for dementia itself if they start to display symptoms; memory clinics are shutting, as seeing new patients is perceived to be riskier than for some people not to receive a dementia diagnosis.

While this cost-benefit reasoning made sense in the short term, doctors are becoming increasingly worried that as the pandemic extends, 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 people of more advanced age — may have significantly contributed to the detrimental effects on the health and longevity of older adults with COVID-19.

For instance, Joan Costa-Font, an associate professor at LSE’s department of health policy, suggests that countries that tend to view their elders with more respect have implemented physical distancing measures more promptly, even if such measures primarily impacted the social lives of younger people.

“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 noting that other countries, for example, Japan, where there is a tradition of respecting the elders, did not choose to have a lockdown.

According to the same author, “a delayed introduction of a lockdown is not the only way we reveal the low social value of older individuals.”

The COVID-19 pandemic has also shown how poorly funded, and disorganized long-term care facilities are in several European countries. In the U.K., for example, a government study that used genome tracking to investigate the spread of outbreaks has only recently discovered that temporary staff had unwittingly spread SARS-CoV-2 between 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 “the prevalence of zero-hours contracts, high vacancy rates, and high staff turnover” having all contributed to the pandemic.

Furthermore, “In the absence of affordable formal care, older individuals are informally cared for by family members (or go with unmet needs). Reliance on informal care explains the early expansion of the pandemic in countries with stronger family ties such as Italy, Spain, China, and Korea,” notes Costa-Font.

The author goes on to highlight the particularly severe impact that quarantines have on older people who tend to live alone and need more care.

“In many countries, caregivers have been forced to reside with older people in need to reduce the chance of contagion. But when older people are less disabled, they are more likely to be left on their own, with unmet needs.”

Furthermore, other authors have analyzed the ageist portrayal of older adults in social media, which reflects a similar attitude of indifference through disparaging twitter hashtags (such as referring to COVID-19 as the #boomerremover) and other memes.

An ageist attitude, combined with policy responses, has a range of negative effects on older adults, including leading to social isolation, loneliness, and a rise in elder abuse.

Mental health and elder abuse

Loneliness is a known factor that negatively affects a person’s mental health and well-being, and some older adults were already at a higher risk of experiencing it. Deteriorating health or the death of partners and friends may get in the way of maintaining a healthy social circle.

However, the pandemic and the quarantine heighten this risk of loneliness.

“Loneliness is a complex, subjective emotion, experienced as a feeling of anxiety and dissatisfaction associated with a lack of connectedness or communality with others,” explain Joanne Brooke and Debra Jackson in a paper appearing 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

What is more, emerging reports have shown that lockdowns raise the risk of abuse among older people.

During the pandemic, older adults have become even more dependent on their caregivers, and, in a pattern similar to the one that has raised the rates of domestic violence, some caregivers have used the pandemic to exercise their control and abuse further.

Elder abuse tends to occur more frequently in communities that lack mental health or social care resources. The perpetrators of the abuse also tend to have mental health problems, as well as reporting feelings of resentment with their informal caregiving duties.

According to a recent paper appearing in the journal Aggression and Violent Behavior, people who experience “elder 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.

Overall, lockdowns mean that more elders are trapped with their abusers, that some perpetrators of abuse reluctantly find themselves in a caregiving role, and that, as a result, there is a higher need for mental health and community support services.

Paradoxically, however, the funds and staff for these services have been slashed — now, when they are needed the most.

While some countries have acknowledged the fact that they have “failed to protect [their] elderly,” and in doing so, failed “society as a whole,” others, like the U.S. or the U.K., have yet to make the necessary amends.

As can be seen from the consequences of the pandemic on both the mental and physical health of older adults, governments in several countries have yet to pay heed to the WHO’s advice — that we do not forget that protecting our elders is “everyone’s business.”

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