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COVID-19 and Older Adults

Part 1: When social distancing meets social isolation.

Photo by Alex Boyd on Unsplash
Source: Photo by Alex Boyd on Unsplash

By Laura Shannonhouse, Mary Chase Mize, Matthew Fullen, Jamie Aten, and Michael Porter

Millions of older adults across the U.S. struggle with loneliness, isolation, and lack of regular companionship. Chronic loneliness negatively affects both physical and mental health outcomes, and can even be lethal. Researchers have found social isolation and loneliness are twice as likely as obesity to be harmful to both physical and mental health, and lack of social connection may heighten health risks as much as having an alcohol use disorder, or smoking 15 cigarettes per day. Prevailing psychological theory suggests that when people feel like a burden and they don’t belong, their risk of suicide increases. For socially isolated older adults, this risk pathway can become lethal. In our ongoing study of 493 homebound, isolated older adults, 13% exhibited serious suicide risk, including 2.4% who said it was “likely” they will attempt suicide someday.

But what happens when social isolation is combined with the new need for social distancing? In the current pandemic, socially isolated older adults have been flooded with messages from the media that, “elders with underlying medical conditions are most at risk of death from COVID-19,” “hospitals will be overrun,” and “health care will be scarce.” Social distancing interventions may be needed for up to 18 months to avoid multiple outbreak peaks until a vaccine can be developed for COVID-19. Although social distancing is designed to #flattenthecurve and protect the most vulnerable, an unintended consequence is that distancing can further isolate older adults who may already be at risk for loneliness or social disconnection.

Due to the pandemic, even access to health care is limited, which may exacerbate feeling vulnerable, isolated, and alone. Older adults know about the global shortage of ventilators and are seeing in real-time Italian health care providers prioritize the lives of younger and healthier persons. One can understand how, when faced with these stark realities, homebound older adults can feel further isolated, hopeless, and in need of mental health services. Even older persons who have been actively engaged with their community are also experiencing isolation since many senior centers have closed. Those normal avenues for socialization and linkage to services are now increasingly unavailable in order to protect the physical health of seniors.

The ensuing mental health strain caused by social distancing only compounds the problem since mental health care has historically been difficult for older adults to access. Mental helping professions have not prioritized working with older adults; for example, only 1.2% of psychologists describe geropsychology as a specialty area. Due to Medicare regulations last updated in 1989, there are 200,000 Licensed Professional Counselors (LPCs) that are restricted from working with older adults and people with long-term disabilities, even during the current crisis. The lack of available mental health services means that social isolation and loneliness may persist.

When social isolation, social distancing, and systemic health care restrictions are combined, there are unfortunate consequences for older adults. During the March 19 AARP tele-town hall, a person described the grief and distress of not being able to be with their actively dying parent, due to a lockdown at the nursing home. Although palliative exemptions have been added to quarantine guidelines care, these are dealt with locally on a case-by-case basis. The forced separation of that parent and child during such sacred time will unfortunately not be a singular experience during this crisis.

These are interesting times when everyone is facing the challenge of maintaining physical distance while trying to remain socially connected to friends and loved ones. For certain older adults with a history of social isolation and loneliness, the current phase of social distancing may be dangerous. But there is hope! Now that many of us are sitting at home, why don’t we put that time to good use? We challenge you to step up and share your time. Stay tuned for Part 2 to learn ways we can use our time to promote life among older adults.

*This work was supported by the Department of Health and Human Services (HHS), via the Association for Community Living (ACL) Grant #: 90INNU0010-01-00. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of HHS.

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