For Older People, Despair, as Well as Covid-19, Is Costing Lives

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Letter by Louise Aronson, New York Times, June 8 2020

‘This is like being in prison.’

Halfpoint Images/Moment, via Getty Images

Earlier this month, a colleague who heads the geriatrics service at a prominent San Francisco hospital told me they had begun seeing startling numbers of suicide attempts by older adults. These were not cry-for-help gestures, but true efforts to die by people using guns, knives and repurposed household items.

Such so-called “failed suicides” turn out to be the most extreme cases of a rapidly growing phenomenon among older Americans as a result of the Covid-19 pandemic: lives stripped of human contact, meaningful activity, purpose and hope that things will get better in a time frame that is relevant to people in the last decades or years of life.

Since late February, the stories from nursing homes and assisted living facilities have been appalling: people dying of neglect; people starving to death; defeated people lying in bed or staring out windows with no hope of reprieve; people with dementia fighting draconian restrictions they cannot understand and being sedated for these “behavioral issues,” sometimes to the point of becoming bedbound and unable to eat.

The director of a local nonprofit assisted living facility reported that after ending “group meals, group indoor and outdoor activities, and visitors” in response to a public health ordinance, more residents have symptoms of depression and suicidal thoughts, more are complaining of weakness and muscle atrophy, and more have had falls.

Even before the pandemic, the numbers of suicides by elders in care facilities were climbing, as a six-month investigation by PBS NewsHour and Kaiser Health News recently reported. And now things are worse — much worse.

Life is better for the 93.5 percent of older adults who live at home — or so we told ourselves until the suicides began. After all, although they are advised to stay home, they can choose whether to do so, or take a walk or ride a bike. Those with digital literacy and the resources for internet service can avail themselves of virtual activities.

Of course, as in all age groups, the already advantaged have more options. Poorer people are less likely to have access to safe walks or digital solutions, and they are more likely to live in smaller apartments or homes. And increasing numbers of older Americans live alone.

And while older people can go out, most aren’t. Many are terrified by the risk of death from Covid-19 for those of advanced age. Others are dutifully following local and national guidance to stay inside.

The problem with this approach to Covid-19 is that it assumes that the coronavirus is the only threat to health and well-being. Every day the fallacy of this assumption becomes more apparent.

“If there were some end to this that I could look forward to, it would be more bearable,” an eloquent septuagenarian wrote me. “I look ahead to a year or more and I am devastated … Those authorities seem to have no indication of what such a future means for some of us.”

An acquaintance tells me, “My mother thinks my grandmother died of a broken heart.”

On a podcast, a chaplain describes how for two or three years an adult son took his elderly mother for dialysis. When the Covid-19 pandemic began, he wasn’t allowed to accompany her. The staff said they’d never seen her that way. She never went back. She wouldn’t go without him. Her death certificate lists kidney failure as her cause of death.

A Twitter friend writes, “My dad … was moved into a memory care home last fall, and was greatly comforted by having his one trusted home aide with him there ‘visiting’/caregiving every day. Since quarantine took effect, he is not doing well at all … his level of agitation and decline — and agitation/confusion — seems inhumane.”

He died earlier this month. He did not have Covid-19, but he surely died as a result of this pandemic.

The challenge for us, as individuals and as a society, is that two contradictory realities are simultaneously true. Our approach to pandemic containment works, but our approach to pandemic is causing suffering, eroding physical and mental health, and increasing the deaths of old people.

Last week, a patient who lives alone in two rooms said to me, “This is like being in prison — a nice prison with food and shelter — but a prison. It’s like solitary confinement. I am totally cut off. My memory is getting worse. I never had this problem before …”

Our approach to the pandemic is typical of medicine and public health. Until fairly recently, articles in medical journals would detail the benefits of treatments, but few considered their harms.

What might we do differently?

Some solutions are simple: Wear the right kind of mask in the right way when outside and recognize that wearing one is about having consideration and respect for the people around you. Similarly, respect physical distancing limits with everyone you pass.

Whatever your age, make contact with the older people in your life, both to offer your help and companionship, if wanted, and to ask for theirs. The human need for daily structure and purpose knows no age boundaries. Grandparents can be put in charge of the school day from afar while parents work. Older people with time and means and digital skills can make support calls to other elders to provide everything from conversation to technical support. Often the best teacher is a person who knows where the learner is coming from.

Multiple generations can join family or friend “social pods” to create larger groupings that offer new interpersonal opportunities and practical support. Such pods can be part of our gradual reopening and are most likely safe if participants rigorously adhere to public health measures.

Anyone feeling that their days are too empty or dull can get active or political. You can volunteer for one of the many social service or health organizations serving elders, particularly those in poorer communities, especially those of color where social inequities are multiplicative. You can also call or write or tag Congress and demand testing and personal protection equipment for elder care facilities or investigation of the ways the nursing home lobby has achieved policies that harm elders and their hired caregivers.

Nursing homes and assisted living facilities should provide small group walks with masks and social distancing, use outdoor places for socially distanced conversation and exercise and ensuring all residents have digital access to family and friends.

We should all be asking why we can’t create safe streets and businesses for all ages so that protecting elders from the ravages of Covid-19 doesn’t require impoverishing their lives.

Each of these steps offer not only practical help but something at least as important: Hope that life will improve in the not too distant future.

Louise Aronson is a professor of medicine at the University of California, San Francisco, and the author of “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” a finalist for the 2020 Pulitzer Prize in general nonfiction.

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