My mom died this month. Alone. She died alone. Like thousands of other seniors, Covid isolation contributed to my mom's decline and death. It was a personal tragedy for my family, reflecting our national catastrophe.
My mom was a victim of both Alzheimer’s disease and the Covid pandemic. Alzheimer’s was the direct cause of her death. But the months of isolation led to her rapid decline. She didn’t have to die so soon. She should not have died alone. And I will forever regret her loneliness in her final months. I’ll always be angry that I couldn’t be with her as she was dying.
Isolation and loneliness are seriously damaging for older people, particularly those with Alzheimer’s disease. First, people who are less socially engaged and more lonely are likely to develop Alzheimer’s disease and other forms of dementia (Lara et al., 2019). Second, for older people, loneliness increases the likelihood of death (Perissinotto, et al., 2012). Loneliness is particularly likely to contribute to early death in people with Alzheimer’s disease or other forms of dementia (Olaya et al., 2017). The combination of loneliness and dementia is particularly deadly.
Unfortunately, older adults are also very likely to be socially isolated and feel lonely. A variety of factors contribute to this (Cohen-Mansfield, et al. 2016). For example, older people are less physically able to go out and engage in activities. As we age, we lose friends and family members. Older adults often end up living alone. Hearing loss also contributes to isolation and loneliness. When you experience hearing loss, you can be lonely even when in a group of friends and family. Tracking a conversation becomes difficult with hearing loss. For these reasons, older adults are often advised to move to community living opportunities. They are also advised to have their hearing tested and get hearing aids. These types of changes can decrease loneliness, increase happiness, forestall dementia, and increase longevity (Livingston et al., 2017).
All of this made the Covid pandemic a perfect storm for older adults. The risk of death from Covid is higher for people in older age groups. Covid has burned through many elder living facilities, leading to thousands of deaths. (See this report in the New York Times tracking Covid deaths in senior living facilities.) Covid infections in senior living centers have accounted for only 7% of cases in the United States. But these cases have resulted in 40% of deaths due to Covid.
So let me tell you about my mom against this backdrop of loneliness, isolation, and Covid. My mom’s assisted living center shut its doors in early March. I supported that decision. Covid was already spreading in nearby senior living facilities. To reduce the chance that any resident become infected, they closed their doors to visitors. To reduce the spread if someone was infected, they stopped serving meals in the dining hall. Instead, each resident received their meals in their rooms. The care team was masked and instituted new protective protocols. Eventually everyone, both residents and members of the care team, was tested. But the doors remained closed. Given the death rate for older people, this was the correct decision. Just this morning, our local news carried a story of another local senior care facility with an outbreak of Covid and multiple deaths.
Suddenly my mom was isolated. Prior to Covid, someone from the family visited my mom almost every day. We took her for walks. We brought meals. We took her out for ice cream. Our puppy became her favorite member of the family during our visits in the last two years. (You can see a picture of my mom with our puppy.)
Starting in March? No more visitors. We tried to balance this with frequent video calls. But video calls are hard. Maybe you’ve noticed this. Tracking a conversation is more difficult. Getting the timing right is often disrupted. And there’s no eye contact. Videocalls disrupt so many aspects of our conversations. But it was better than nothing. For the first month of calls, this mostly worked. But my mom quickly started showing more problems tracking the calls. She would zone out while Zooming. She wouldn’t look at the screen. Since she had Alzheimer’s, tracking a conversation was always difficult. But now it was impossible.
I watched my mom decline over video calls. She quit walking. She gradually stopped eating. She lost weight and strength. She was disappearing during each subsequent call. I cried after every single one.
Without our visits, she was less likely to move, get up, or walk even short distances. We generally would encourage my mom to walk some with us. But with Covid? No one was there walking with her every day. The staff tried, I know. But they were never as successful getting her to do things as our family.
When we visited, we often brought food or walked her to the dining room for a meal. People are social eaters. If you’re at a table with food in front of you and people around you eating, you will join in. My mom was always a happy social eater. But now she was asked to dine alone. Many of her meals went untouched. Again, the staff tried. But my mom, like other people with Alzheimer’s, had already lost interest in food (other than ice cream). The lack of social interaction meant she stopped eating. We watched her lose weight over the months of videocalls.
Within two months of social isolation caused by the pandemic, my mom was showing serious decline. She lost weight, quit walking, and nearly stopped eating. The staff was concerned. Her doctor had multiple virtual check-ins. But there was no disease to cure: She was lonely. And loneliness is deadly.
By late August she was bed-bound. No longer could the staff get her to move to her chair. She would say a few words, but not many on our calls. Her eyes were often closed during our calls as she lay resting in bed. She stopped eating and started having problems swallowing. Early in September, my mom left us. And she died alone.
Here’s my critical point: My mom is not unique. People isolate to avoid the disease, sometimes in a facility, sometimes at home. But the isolation and loneliness have their own problems. Death by isolation and loneliness has become far too common during the pandemic. In a recent report, the Washington Post noted that there have been thousands more deaths among people with dementia than expected based on previous years. The Post writers also noted that people with dementia are showing more rapid declines as well. My mom is an instance of this national problem. Our personal tragedy is being repeated all over our country every day.
The choice we faced, and that others face, feels impossible. Isolate your mom to protect her from the risk of Covid, but then the isolation and loneliness may kill her. Or keep visiting, knowing that she may catch Covid. And Covid is definitely a killer.
But it doesn’t have to be this way. We could have kept my mom healthier and happier longer. If people will follow public health recommendations—wear a mask, remain physically distanced, wash your hands; if our systems can make fast reliable testing easily and frequently available; and if we track and trace cases, with this type of support, we could be more confident that we won’t transmit Covid to the most vulnerable. We can still make these changes. By doing so, we may save someone else’s mother.
My mom is gone. I will always miss her. I will always be sad that I couldn’t be there with her over the last several months. And I will always be angry that our country did not do a better job of controlling Covid-19. But we could start doing a better job now. And maybe you won’t have to go through the experience of having your mom die alone.
Lara, E., Martín-María, N., De la Torre-Luque, A., Koyanagi, A., Vancampfort, D., Izquierdo, A., & Miret, M. (2019). Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies. Ageing research reviews, 52, 7-16.
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.
Olaya, B., Domènech-Abella, J., Moneta, M. V., Lara, E., Caballero, F. F., Rico-Uribe, L. A., & Haro, J. M. (2017). All-cause mortality and multimorbidity in older adults: The role of social support and loneliness. Experimental Gerontology, 99, 120-126.
Perissinotto, C. M., Cenzer, I. S., & Covinsky, K. E. (2012). Loneliness in older persons: a predictor of functional decline and death. Archives of internal medicine, 172(14), 1078-1084.