Taking care of our routes: the elderly in the time of COVID-19

This article was exclusively written for The European Sting by Mr. Harman Singh Bhatia, a second year psychiatry resident and Ms. Purva Shah, an intern doctor, both of them at Baroda Medical College and SSG Hospital, India. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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Our elders, as shown in The Giving Tree by Shel Silverstein, form the eternally strong and culturally significant roots of our civilisation that has spread its branches into various walks of life. However, in times of crisis, like the ongoing Covid-19 pandemic, the elderly population is the most affected. 95% of deaths due to this novel virus occurred in those older than 60 years.¹ While case fatality rates (CFR) vary from less than 1 to 7% across countries, the CFR for patients older than 80 years goes up to 15%.^2,3 Following are some of the many reasons why elderly population bears the brunt of this pandemic in terms of anxiety, stress, and mental health abnormalities.^1,3

• Due to physiological changes of ageing, they have a weak immune system and consequently, a higher susceptibility to falling ill.⁴
• Higher prevalence of co-morbidities makes them liable to more hospital visits than the general population where they face sub-standard care since most of the best resources in hospitals are directed towards fighting Covid-19.
• A high incidence of disabilities in this population not only makes them dependent on caregivers but also elevates their exposure to the virus through use of wheelchair, crutches, stairway railings et cetera.⁵
• Cognitive decline and dementia in old age leads to non-acceptance of changes in lifestyle as required during lockdown.
• Those living in nursing or retirement homes are at a greater risk of infection as a result of crowding in closed spaces while those living alone and dependent on retirement pension for their livelihood face a whole array of problems that come with poverty.
• They face stigma and neglect from certain caregivers and sometimes, are left to fend for themselves in case the caregiver is quarantined.
• They aren’t able to access online services like e-banking, online shopping, telemedicine, social media, and video calling due to which they are pushed into social isolation and deprived of important and relevant information.
• As a consequence of a shortage of ventilators and effective medicines, these resources are channelled towards healthier and younger demographics. The psychological welfare of doctors who have to send them back without treatment is equally at risk if not more.²

So what can we do to alleviate if not completely eradicate the ill-effects of this pandemic on the mental health of the geriatric population?

• Ask them about their day, ask them if they’ve been feeling ill, explain the effect of Covid-19 pandemic and rules of lockdown to them calmly, patiently, clearly, and if needed, repeatedly. Organise old photos, share old stories, learn new recipes from them, and try to keep them engaged in household activities.⁶
• Help them become techno savvy! Download essential applications on their phone related to healthcare and credible information about current affairs. Teach them how to video call their near and dear ones because as Dr. Kluge correctly asserted,”physical distancing is not social isolation.”¹
• Through telemedicine, doctors can follow-up patients with long term illnesses and also solve their doubts regarding their health without the need for hospitalisation.
• As neighbours of old people, you can fetch groceries, medicines, and other items of everyday use for them.
• Caregivers can create customised care plans to not only reduce emergency visits and improve medical management but also, improve their overall state of mind.⁷ Having a structured routine and performing mild exercises at home go a long way to keep their minds fresh and free of ailments.

Our elders, our giving trees, continue to burn themselves to give us warmth in the form of retired doctors, army men, and nurses coming to the frontline to fight against SARS-CoV-2. In this hour of need, ‘ok boomer’ has got to transform into ‘take care boomer.’ References

1. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/4/supporting-older-people-during-the-covid-19-pandemic-is-everyones-business
2. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30165-X/fulltext
3. https://www.weforum.org/agenda/2020/03/coronavirus-covid-19-elderly-older-people-health-risk/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3582124/
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266513/
6. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-caregiving-for-the-elderly
7. https://www.cdc.gov/aging/publications/features/caregivers-month.html

About the authors Harman is a second year psychiatry resident at Baroda Medical College and SSG Hospital, India. As an undergraduate, he secured top positions in quizzes of various specialties like dermatology, biochemistry, and microbiology. Always empathetic to the suffering of his patients, he tries to provide a wholesome care and believe that customised treatment is the norm of the day. He is deeply interested in how obsessive compulsive disorder (OCD) is being rationalised by the ongoing pandemic and aims to get to the root of this situation. He is also performing a research study at his set-up to compare the quality of life and caregiver burden between Schizophrenia and Depressive Disorders. Purva is an intern doctor at Baroda Medical College and SSG Hospital, India. She worked under Dr. August Lynne to find a relationship between lipids and the progress of Alzheimer’s disease. She is the LORE (Local Officer for Research Exchange) in MSAI, IFMSA and the State Joint Secretary in AIMSA (All India Medical Student Association) for the year 2019-20. She has the medical head for a local NGO where they are trying to improve the health and sanitation of slum kids. Having published papers on thyroid disorders and novel diagnostic criteria for anaemia and having secured STS-ICMR, 2019-20, she wishes to dive deep into the world of research.