Seniors at Risk: A Thin Line Between Social Distancing and Isolation

In pre-pandemic times, Karen McNeil would visit her 77-year-old mother at a Toronto-area nursing home twice a week. She’d pop in every Wednesday and Saturday, usually with a Tim Hortons coffee and sometimes a little chocolate, her mom’s favourite.

But last Saturday morning, McNeil arrived with her tray of coffee to find the nursing home closed to visitors. A sign posted on the locked door explained that, due to the COVID-19 outbreak, only those who needed to see dying loved ones would be admitted.

McNeil,  who works as a hospital imaging technologist, “totally got it.” Still, she couldn’t help feel a sting of regret. Her mom, Patricia Coleman, has poor hearing and dementia, so explaining her absence over the phone would be tricky.

“I wish I had known there would be no visitors allowed. I would have come sooner,” she said. “I would have been able to tell my mom myself that it would be the last time I would be able to see her for a while.”

McNeil knows staff has informed residents of the situation, but she hopes someone reminds her mother every day in case she forgets. “I don’t want her to be fearful but I worry she won’t know why I’m not coming or that she’s thinking that it’s my choice not to come.”

Protecting seniors from COVID-19 – particularly those with other medical conditions – has naturally become a civic priority. From Wuhan to Milan, Madrid to Muskoka, the virus has appeared to be an ageist pathogen, striking the elderly with the most severe forms of illness and the highest rates of death.

But efforts to safeguard seniors are also raising difficult dilemmas. How do we distance ourselves from society’s most vulnerable without isolating them? How do we convince older adults to change if they don’t want to give up their active or social lifestyles? How do we stop them from feeling shut out while they’re shut away?

This week, for instance, the daughter of an 81-year-old man on lockdown inside the B.C. nursing home where six people have died of COVID-19 told the Canadian Press: “It’s very, very isolating. Most people have nobody to talk to, and they’re beside themselves. Some of them are crying, some of them are desperate, some are begging for somebody to spend time with them and talk to them.”

Mental health consequences

Dr. Nathan Stall, a geriatrician with the Sinai Health System in Toronto, said one of the things that worries him most about the pandemic is “the mental health consequences.”

“Don’t get me wrong, these measures for social distancing are absolutely essential, but we have to make sure that we’re protecting our older adults against the long-term consequences,” Stall said on a call-in show hosted by ZoomerMedia and CARP this week after a caller questioned the full impact of social restrictions.

“Being an older gentleman who recently lost his wife, I am beginning to worry about social isolation,” he said on the show. “You can’t seem to make a connection with people anymore. You start mistrusting people. Everyone you meet, you worry about whether they might give you the disease or not, so my concern is how far do we go with this social isolation?”

Watch theZoomer call-in show on COVID-19 here

 

Dr. Roger Wong, a clinical professor of geriatric medicine at the University of British Columbia, said in a telephone interview that social distancing may be tough for some older adults to accept: “Many seniors are fiercely independent and lead very active lives and, for many, this represents not just a change but a loss – a loss of their freedom and independence, and some will regard this as a major loss.”

For these reasons, some seniors may resist the changes, and some may find themselves in arguments with adult children or other family members worried over their seeming indifference or lack of compliance. But Wong recommended people treat resistant seniors with compassion and understanding.

“To seniors, losses are not new. Some have experienced the loss of a spouse or a job, through retirement they’ve lost their work, or they’ve lost friends,” he said. So if people approach the social-distancing conversation with that in mind, people may be able to find common ground without conflict. Especially, says Wong, if it’s made clear that everyone is facing an unprecedented time of sacrifice and uncertainty.

With a pandemic that’s predicted to last months, not weeks, Wong stresses it’s crucial for people to “physically protect seniors” yet also to realize that “social distancing should not mean social isolation … Social isolation and loneliness can have negative effects on their health, and we know that.”

Loneliness is a killer

In fact, research suggests loneliness is a killer. Studies show it can lead to depression and a raft of serious physical ailments. A 2018 study from Ipsos/Cigna found loneliness had the same impact on mortality as smoking 15 cigarettes a day – making it more lethal than obesity. It’s a risk that could prove to be an epidemic in its own right in these days of COVID-19, when an estimated 93 per cent of older Canadians live in their own homes.

Wong recommends people start finding ways to stay connected with the seniors in their lives right away, and not to delay any efforts to make sure older adults “stay socially engaged.” Keep in touch regularly by phone, he said, or turn to technology to participate in video conferencing with seniors, if that’s feasible. “Many seniors are very tech-savvy, and tech could be a conduit to connecting people, and that should happen now.”

He raised the possibility of people organizing online events, hosted through social media platforms, in which seniors might perform or share their talents in art or music and that other seniors could attend virtually.

For those less technologically inclined, he recommended people send seniors packages, perhaps old photo albums as a form of “reminiscent therapy,” which could generate conversation about old times. If it’s followed up by a call, “then you have visual and voice.”

“We need to think outside the box,” said Wong. “We need to get creative.”

He applauded, for instance, the various grocery stores, supermarket and drug store chains across Canada starting to offer seniors exclusive shopping hours. The intention is to reduce the infection risk to older adults and other vulnerable populations by reserving an early morning shopping time for them, when stores have been freshly cleaned, and crowds are thinner.

Wong said it’s also heartening to see people supporting seniors by shopping for them and delivering groceries, so long as they are maintaining physical distance and practising good personal hygiene. It’s a gesture of kindness people should continue to make, so long as they are feeling well. “If anyone has the slightest doubt about their health, they should stay away.”

And if everyone is feeling well, Wong said people “should try to make use of open spaces … go for a walk or arrange a visit in the park … not in big groups but one or two at a distance.”

During the recent CARP/Zoomer call-in show, Dr. Sohail Gandhi, president of the Ontario Medical Association, also reminded seniors that maintaining social distance does not mean they have to be shut-ins.

“It’s really important to recognize that this does not mean that you’re going to sit at home and watch TV all day because all that will happen is that your health is going to deteriorate by doing that,” said Gandhi. “You should go outside and go for a walk, particularly if you’re fortunate enough to be in areas that aren’t very crowded. I think it’s okay for you to exercise regularly and do all the preventative stuff that we’ve talked about before … Get some fresh air. It’s good for your soul.”

Gandhi, who spends part of his practice caring for the elderly in long-term care homes, realizes not all seniors have the option to walk outside, and he knows too well what they’re missing in this time of COVID-19.

“It is remarkable to me just how much they light up when their family comes or their friends come … you can see this light bulb go on and they smile, and they’re just different people when people visit,” he said. “So I’m hopeful that this period of social distancing going on right now will be time limited … but social isolation is something absolutely critical to deal with … so reach out to older adults. Ask them how they are doing. Check in.”

People are finding creative ways to get around the visiting ban, with a Nova Scotia nursing home clearing out a ground-floor office and adding a phone so residents can sit by a big window and talk to family members who can sit on chairs set up outside.

Since her regular visits were suspended, McNeil has been thinking up new ways to connect with her mother. This week, she mailed her mom an old-fashioned newsy letter, and included photos of the grandchildren. Next week, instead of coffee, she plans to make a large sign and hold it up outside of her mom’s bedroom window, which happens to face the parking lot. “You know, just something for her to see that says, ‘We love you!’ “

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