Shielding elders from COVID-19 | Daily News

Shielding elders from COVID-19

Dr. Ganewatta works as a Consultant Physician attached to the Health Ministry. Additionally, she obtained required qualifications in Geriatric (Elderly Care) Medicine from the Royal College of Physicians, London and comprehensive on-the-job training at the Geriatric Medical Ward in Queens University Hospital, London, UK.

In this article, she shares her expert opinion with the Daily News from her apt academic and clinical know-how regarding the subject.

Q. What are the key impacts of COVID-19 pandemic on older persons?

A. All age groups are at risk due to the COVID-19 pandemic; yet, available evidence indicates that older persons and those with underlying medical conditions are at a higher risk of serious illnesses. Serious illnesses mean that persons with COVID-19 may require hospitalization, intensive care, or a ventilator to help them breathe, or they may even die. Often, chronic health conditions are more prevalent in old age, increasing the risks of said complications of COVID-19.

According to world statistics, the persons who are over 80 years have a five-fold greater risk of death compared to the average rate. An estimated 66 percent of people aged 70 and over have at least one underlying chronic medical condition, placing them at increased risk of severe illness from COVID-19. Available data from China show that approximately 80 percent of deaths in the country occur among adults aged 60 years and over. And the World Health Organization has reported that over 95 percent of fatalities due to COVID-19 in Europe have been identified in elders over 60 years.

As this can lead to a life-and-death situation, it is a must to follow the precautionary guidelines given by the Health Ministry.

Q. What are underlying medical conditions that make them more vulnerable?

A. When people get older, they acquire multiple chronic medical illnesses and also become frail. Both lead to low immunity for any acute infection not only for COVD-19. A virulent and highly infectious disease such as COVID-19 definitely invades the elderly population and causes higher mortality and morbidity.

Based on what we know at this time, people with the following various medical conditions are at an increased risk for severe illnesses from COVID-19. Some of them are, Type 2 diabetes mellitus, Chronic Obstructive Pulmonary Disease (COPD), Chronic kidney disease, Obesity with Body Mass Index of 30 or higher, immuno-compromised states like solid organ transplant and cancers, and serious heart conditions such as heart failure and coronary artery disease. Not only that, undernutrition is also a risk factor which is fairly a common problem among older people.

Q. What are the steps that could be taken to reduce the risk of contracting COVID-19?

A. By now, almost everyone knows this. However, most of the public in Sri Lanka currently do not follow correct instructions as they are under a false sense of security, since only a low number of cases are reported. It is important to understand, in a global pandemic situation, especially when neighbouring countries are suffering heavily from this disease, we all, including older adults, should continue to take precautions to protect from contracting the disease. The best way to protect yourself and to help reduce the spread of the virus that causes COVID-19 is to limit your interactions with other people as much as possible.

Wear masks properly. Maintain social distancing as much as possible. It is paramount important to continue the correct way of handwashing frequently.

Q. Can you explain other issues that confront elders apart from the above-said life-and-death situation?

A. Other than its immediate health impact, the pandemic is also putting older people at greater risk of poverty and unemployment; dramatic impact on their wellbeing and mental health, the trauma of stigma and discrimination lead to social isolation. Those broader effects are less visible but no less worrisome. It is also reported that there are many instances of neglect and abuse in institutions and care facilities. As a doctor who has an interest in providing special care for the elderly, I have experienced the said problems which are unrelated to COVID-19 among this vulnerable group, frequently in our setup. Listing the grievances of such elders is very pathetic. However, that is our moral responsibility to satisfy them and suggest apt solutions within our framework. In the face of life-threatening pandemics, older persons face challenges in accessing medi­cal treatments and healthcare as well. Those who are having disabilities and chronic conditions may experience further difficulties in accessing healthcare and become more marginalised.

Mainly this will affect their social and economic wellbeing and, it not only has an impact on their health but also on their lives and safety.

Older persons may rely on multiple income sources, includ­ing paid work, savings, financial support from families and pensions, all of which may be in jeopardy because of the pandemic. Therefore, the pandemic may significantly lower older persons’ incomes and living standards.

The restrictions on freedom of movement and physical distancing can lead to loneliness, disruption of essential care and support for older per­sons. Prolonged periods of social isolation could have a serious effect on the mental health- such as depression and anxiety. It also affects their social networks such as monthly gatherings in local communities, religious activities and their jobs.

Q. What could be done to prevent or minimize those issues?

A. We just see the tip of the iceberg. To have a better picture of it, we need to create awareness across the community and the elderly population should be very clear about how they can seek help and support safely. During the lockdown period, we were able to provide medicine and follow-up care for the elderly who were unable to attend clinics through the creation of an effective communication and networking system.

As doctors, we need to remain alert about the signs of elderly abuse, both physical and psychological, especially in patients with dementia, stroke and people who are dependent on caregivers.

You can encourage family members, friends and neighbours to keep in touch with older people online or over the phone to reduce social isolation and to provide support safely. Finally, the community, and especially older adults, should be aware of the available facilities and resources during this difficult time.

Q. Can you further explain how old adults could get rid of loneliness?

A. During the last few months when the country went into restrictions due to COVID-19, social interactions were minimum. However, it was also realized that the quality of interactions is not as important as you might imagine. A short text message, a wave from a neighbour or a few words with the postman made big difference in the feeling of isolation in the elderly. Also, knowing latest technology can be an advantage. Video calls and messages via social media reassure that you are not alone.

Having a sense of purpose is also important for overall wellbeing. Maintaining personal hygiene every day, doing activities such as gardening, keeping pets, reading and writing are such enduring pastimes for many isolated older adults. Doing regular physical exercises also improves mental and physical wellbeing.

The practice of simple activities will reduce depression, cognitive decline and importantly, forgetfulness in older adults who are alone.

Q. Any advice for elders?

A. It is important to maintain good nutrition and adequate hydration to boost immunity and overall wellbeing. I would like to advise them to consume fresh fruits and vegetables, and protein-rich foods such as fish, meat, eggs, pulses and legumes. Fruits and vegetables contain a lot of micro-nutrients that are essential for the immune system, bone health and cognitive wellbeing. Protein-rich foods are important to maintain muscle strength and function. All these advantages will have a positive impact on the inbuilt physiological and biological reserve which is the mainstay of fighting against illnesses.

Not only that, the elderly should also attend their routine medical reviews as per the facilities available and adhere to regular medication in order to prevent acute worsening of chronic medical conditions such as high blood sugar levels in diabetes mellitus and strokes in uncontrolled high blood pressure. They will need hospital admissions for acute care and may end up in the hospital due to problems such as infections and falls.

I have already explained the additional benefits of maintaining positive thinking, social networking, new technological knowledge and regular exercises during this lockdown. Also, older people should take maximum precautions to prevent indoor accidents, especially falls and fracture, which carry higher mortality and morbidity than COVID-19. We should remember that, older persons are not just victims of this pandemic. They are also responders.

Q. What do you mean by ‘responders’?

A. Older persons play multiple roles in society as caregivers, health workers, volunteers, community leaders and essential service providers.

Therefore, the voice, perspectives, and exper­tise of older persons in identifying problems and solutions in relation to the COVID-19 pandemic need to be addressed. Those should be sufficiently incorporated into the decision-making process. It is important to harness their knowledge and also to ensure their free, active and meaningful participation in overcoming this crisis and beyond.

Q. As a health professional, can you be happy about the current situation in the country?

A. My genuine and impartial estimation is ‘yes’. Though we are a developing nation, we have a very good healthcare system that has been developing over a period of time which comprises highly knowledgeable and skilled healthcare professionals. During this period, the leadership of the country was able to gather the said health resource network together with other resources such as Security Forces under one umbrella to control this pandemic which was a successful model even much-admired by the World Health Organization.

As a person who directly involved in the crucial times, my honest opinion is all levels of healthcare workers offered their maximum unconditional support as a team while keeping their lives in the verge of ruin even when there was a lack of required ideal safety items such as personal protective equipment. We should thank our citizens for being responsible and adhering to the situation.

At last but not least, considering the present pandemic situation in the world, we should prepare to live with COVID-19 for at least another couple of years. The Government does not have any option other than opening the air and sea gateways of the country in the near future in order to maintain the economy. Therefore, we cannot either relax or neglect the guidelines introduced by health authorities.

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