The hidden cost of keeping older adults safe from COVID-19

Nancy Nelson is pretty sure her dad gave in to loneliness and stopped fighting. Richard Mueller, 93, had been without visits from family members for nearly a month when he died April 10, as care facilities barred visitors in response to the pandemic.

“I am giving up,” he told her. “I don’t know if I will ever see you again.” He was crying, she said.

The world has a great deal still to learn about COVID-19, the respiratory infection that’s forced millions to self-isolate. But it was clear very early that the illness takes an especially steep toll on those 60 and older, compared to the average younger person without a complicating factor like diabetes or heart disease. COVID-19 has been referred to cruelly as a “boomer remover.”

So older adults have been sternly warned to isolate. In most families, adult children are staying physically distant from their parents and making sure youngsters — seldom seriously harmed by the disease but probably able to spread it — don’t get too close. Facilities, from clinics and hospitals to senior residential living communities and nursing homes, have banned visitors outright.

That means the research on keeping older people safe from this coronavirus butts heads with decades of knowledge about loneliness.

Isolation creates many health issues, increasing both anxiety and depression, Dr. Gail Saltz, associate professor of psychiatry at New York-Presbyterian Hospital’s Weill Cornell School of Medicine, told the Deseret News. “Loneliness definitely affects immunity, it affects the cardiovascular system. One can become physically ill from ongoing, intense feelings of loneliness. So it’s important to reach out to older people and connect with them and help them to stay connected to others,” Saltz warned.

Not everyone who is isolated feels lonely, said Linda S. Edelman, associate professor at the University of Utah College of Nursing. It is also true that people can be surrounded by others and feel intense loneliness.

But few doubt COVID-19 has increased both isolation and loneliness for older adults, including those who like Mueller found new friends in assisted living or other congregate settings. Nationwide, face-to-face interaction in such settings is limited to staff who might bring meals or check vital signs, but might not stay long because of increased workloads and a realistic fear of passing on undiagnosed illness.

Nor is COVID-induced loneliness solely an institutional issue. Older adults living on their own in the community have no staff, just sometimes-harried adult kids and grandkids who are trying to be present while maintaining a physical distance to protect their loneliest family members from a potential killer.

Edelman thinks social distancing has perhaps been especially hard on older adults who live independently, but are sociable and used to getting in their cars and going places if they want. “They are being asked to not be independent, but to be lonely and bored,” she said.
“What I am afraid COVID is doing is taking that majority of older adults who are not isolated and not lonely and moving them into that very vulnerable group that is both,” Edelman said. “Isolated and lonely is a terrible place to be.”

Is the cure as bad as the condition society’s trying to protect older adults from? In cases where people lose their will to live, it could be. “I don’t think we will actually know until the pandemic’s over,” Edelman said.

How much people suffer from being isolated is partly determined by genetics, but the physical and psychological impact is still quantifiable, they said. Loneliness depresses the immune system, hampers sleep quality and contributes to impulsive behavior and substance abuse. It may be a factor in dementia. “There are real consequences to balance with the need to stop COVID-19,” Edelman said.

Source: Lois M. Collins; May 1, 2020; Deseret News