In the whirlwind of Covid-19 media coverage, there has been a notable emphasis on older people. Given that we are several weeks behind the curve of the Italian experience, it is encouraging that the official Irish statements have been clear on the need to protect and support the most vulnerable in our society.
For the public, it can be challenging to tease out practical strategies to respond to the pandemic, both for older people themselves and also for their adult children, friends and, in some cases, carers. This is not surprising, because one of the hallmarks of ageing is a huge divergence in abilities and capacities.
While older people are not more susceptible to becoming infected with Covid-19 than younger people, they are more likely to suffer more significant effects and have a higher death rate. Even here, we need perspective – even over the age of 80, most older people will survive a Covid-19 infection.
It is clear that as we age we have an interest in avoiding being infected, while not losing sight of the importance of maintaining health and wellbeing in other ways.
Some of Covid-19’s increased impact on older people is due to the presence of one or more underlying conditions, such as diabetes, heart conditions, cancer, frailty, or treatments that render the immune system less effective. It is really a focus on these conditions rather than age that should set the tempo for activities and contact with others, as well as treatment strategies in hospital.
The whole population has to share the task of following the measures outlined by the National Public Health Emergency Team. These include a ban on indoor meetings of more than 100 people, a recommendation that people work from home where possible – an increasing proportion of older people continue to work – social distancing, cough and sneeze etiquette, and hand-washing with soap and water, which is more effective than hand sanitiser.
A key challenge of social distancing is to ensure that it does not mean isolation. It should not preclude walking for exercise, shopping, religious observance or visiting a limited circle of family, all the while exercising social distancing and frequent hand-washing. You don’t need to shut yourself off from public life: just be vigilant when you enter it.
For those without underlying conditions mentioned above and who are well, attendance at religious services – with the precautions that most denominations have undertaken, such as no collection baskets – is a source of community and solace in challenging times.
Some further precautions are worth noting. Nurseries and schools are closed but older people should not assume the responsibility of child-minding, as it is thought that this led to a spike in cases in Italy. Equally, given the Irish diaspora, family members who have visited from other countries should think twice before visiting in person.
For the more vulnerable, limiting contact judiciously is key, and this applies both at home and in nursing homes, while seeking to use technology and other means in a supportive manner. The use of Facetime and similar apps on iPads, large phones or other pads can usefully augment telephone calls. Less tech-ready older people might appreciate initiation into these, and also the broad range of satellite ad cable TC channels covering as cooking, travel and religious services, among others.
Equally, for those more vulnerable older people, family and friends should help in stocking up on supplies, medication and liaising with health services when clinics may be stretched or cancelled. Many hospitals are planning telephone contact for clinics where this can be usefully implemented.
Nursing homes can present a challenge, particularly if the older person has dementia and benefits from family contact. Although restrictions have been placed on most nursing homes – for example, sensibly not permitting children, groups or those who are unwell – it is expected that family members and nursing homes will come to an agreement on the optimal arrangement for each resident.
Older people should also take heart that all hospitals in Ireland are using this time to prepare contingency plans for increased activity, with fantastic input from staff. They should also be reassured that there is developing discussion to ensure that if resources become very stretched that ethical decision-making will be based on recognised prognostic factors without discrimination based on age.
Funding for home, community and rehabilitation care may suffer significantly as resources are redirected to tackling the crisis. Yet they may be doubly necessary for those suffering post-Covid-19 debilitation.
Older people, and all of us as future older people, need to maintain vigilance and pressure that we regain and develop key support for independent and optimal ageing throughout and after the pandemic.
Professor Des O‘Neill is a consultant geriatrician and director of the Centre for Ageing, Neuroscience and the Humanities, Dublin