Novel Coronavirus & Elderly People – A Geriatrician’s Perspective
Ever since the first reported case of Novel Coronavirus (COVID-19) in Wuhan, China on 31st December 2019 and the World Health Organization (WHO) declaring it as a Public Health Emergency of International concern on 30th January 2020, this pandemic has spread to all the countries of the world within a matter of few months.
This COVID-19 pandemic has brought about an unprecedented fear, anxiety and uncertainty among all of us, but especially among the elderly population. The main reason for this is that worldwide major proportion of deaths related to this pandemic are seen in the senior citizens. As of 27th April 2020, India has more than 27,000 diagnosed cases of COVID-19. As per the latest data shared by Ministry of Health and Family Welfare (MOHFW), elderly people, aged 60 years and above, accounted for 63% of deaths in our country.
Why are the elderly more vulnerable to Coronavirus?
With advancing age, there is a decrease in the physiological as well as functional reserves. Immunity levels decrease with age, which makes the elderly vulnerable to infections. Moreover, many senior citizens also have underlying comorbidities (Multimorbidity) like diabetes, hypertension, cholesterol issues, asthma, COPD, cardiac issues, kidney disorders, parkinson disease, stroke and cognitive impairment; to name a few.
Many elderly also have mobility issues, which decreases their functionality. Some elderly couples are by themselves, with their kids staying in foreign countries. Many are not technologically savvy. This leads to isolation and things become very difficult.
The decrease in the physiological reserves leads to a state known as Frailty, which leads to increased vulnerability and compromised ability to cope with everyday or acute stressors. Sarcopenia, a condition characterized by progressive and generalized decrease in skeletal muscle mass also adds to this problem.
Moreover, recovery from any disease is usually slower and more complicated, associated with severe Deconditioning.
What are the symptoms of the disease?
As depicted in this picture, the most common symptoms are fever, easy fatiguability, dry cough and shortness of breath.
But many elderly people can present with atypical symptoms like delirium, altered behaviour , new loss of smell or taste or sudden decrease in functionality, to name a few.
A high degree of clinical suspicion should be kept in mind by the treating doctors when dealing with such senior population.
If you are 60 years and above, what can you do to protect yourselves?
The main point to take into consideration is that presently there is neither any vaccine nor any effective treatment available for COVID-19 infection. Therefore, it is of utmost importance to take precautionary measures, which needs a sort of change in behaviour on all of our parts.
Practice social distancing: stay within your house and avoid unnecessary visitors. Avoid going to your building podium/park/roads for a walk. A better alternative is to remain as much actively mobile in the house as possible and do some light exercise or yoga at home. Don’t leave home unless absolutely necessary, request your neighbors to shop for your groceries and medicine refills. The same can be delivered to your place by calling the helpline numbers. if there is an absolute need to go out, then always wear a mask before leaving your home and follow other measures mentioned below.
Adequate hygiene practices: follow frequent hand washing with soap and water for at least 20 seconds, especially before meals and after using toilet. Avoid frequently touching your face with hands. Ensure use of separate hand towels for the elderly.
Disinfect surfaces: frequently clean and disinfect frequently touched surfaces, furniture’s and objects like doorknobs, spectacles, hearing aids, walkers or canes.
Seek medical help: if there is persistent fever or cough or breathlessness, then consult with your doctor, preferably on telephone to seek further guidance as to what is to be done. Another option is to visit the hospitals which have dedicated fever clinics to screen your symptoms and triage accordingly.
Appropriate medication use: the elderly should be adherent to all the prescription medications. Their underlying medical conditions like diabetes, hypertension, asthma, etc., should be kept under control with these medicines. At the same time, they should refrain from using over-the-counter medicines and self-prescribing certain medicines like chloroquine or hydroxychloroquine, which may cause more harm than benefit. Moreover, there are many patients suffering from conditions like Rheumatoid Arthritis who require these medicines and are not able to get it because of unavailability. Always consult with your doctor before considering any new medication.
How can relatives or caregivers help senior members in the family?
We all need to remember that even though social distancing is one of the main preventive measures for this infection, social distancing doesn’t mean social isolation.
But due to multifactorial reasons, unfortunately many elderly feel helpless and may go on to develop anxiety or depression. The key to preventing this is communication. Family members need to interact or call or video chat with the senior members on a regular basis. Also, they can be taught on how to use the different social media apps available.
Caregivers should ensure that the senior citizens are not bed bound most of the times, provide them adequate nutrition, clean their wheelchairs, bed pans, walkers, cane and other surface areas and effectively communicate with the family.
One of the most useful things that the elderly can do is to avoid constantly watching or reading about news pertaining to coronavirus. This will help to decrease the anxiety and other mood disorders.
This social crisis also brings about an opportunity for learning. Elderly people should be encouraged to develop a new hobby like reading or writing or painting or whatever it is to keep their brains mentally stimulated and active.
Many of us have our elderly parents who do not live in the same city as us or we have elderly couples who are our neighbors. A few measures that we, the younger individuals can take or do to support our elderly people to make them feel safe and connected:
- Check on them regularly through phone calls or whatsapp messages
- Cook something for them
- Buy them their daily essentials like milk, vegetables, fruits; if they are not able to
- Ensure that their medical supplies are well stocked up
- Show them how to use video chat using mobiles, tablets or laptops, if they don’t know
- Help them stay in touch with their doctors
- Setup emergency contacts for them in case of need
We all need to remember that we human beings (homo sapiens) are one of the most resilient species alive on this planet. Ever since our existence, we have experienced some or the other form of tragedy or crisis, but we have always prevailed and our species has flourished beyond expectations.
But at the same time, life is not going to be the same again, at least for a few years. There is always going to be a pre-corona and post-corona era. This depends to a great extent on the discovery of potent vaccines and medicines to fight this virus. Till then, the above mentioned preventive measures are our best hope to tide over this pandemic.
Sir William Mulock on his 95th birthday gave a phenomenal speech which summarized his life’s philosophy:
The best of life is always ahead, always further on.
Dr. Endicott Peabody in his address to the young children quoted,
“Progress is the law of nature. It moves in long waves, but does not necessarily follow straight lines through centuries. Sometimes there are setbacks and reverses, dark periods of trials and confusion. Sometimes there are supreme tests of courage, endurance and resolve. But in the end the world always rights itself… and mankind moves ahead again…“
A few lines from Sadhguru’s latest book Death: An Inside Story comes to My mind in these moments:
People think that death is a tragedy. It is not. People living their entire lives without experiencing life is a tragedy…
Last but not the least, we all should also keep in mind and respect all those brave doctors, nurses, paramedical staff, police, sanitation workers and all other people who are selflessly fighting this battle against an invisible enemy and trying to save the lives of others, without any regards for their own and also to honor the sacrifices made by their families. I sincerely Hope that this pandemic also brings an end to the violence on the doctors and the healthcare facilities, in our country, once and for all…
Disclaimer: The author of this article is a qualified MD Geriatrician, presently consulting in various hospitals in Mumbai, India. All the views expressed here are in line with the recommendations by various healthcare organizations of national and international repute.
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