The consequences of socially isolating seniors

As social creatures, humans are naturally hardwired to seek companionship and social connection, but COVID-19 is forcing people to adapt to a new reality anchored by social distancing and isolation.

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Social distancing is critical to managing the coronavirus pandemic, as it will help flatten the curve and prevent the United States health care system from collapse. But for seniors, social isolation already poses a health threat. Social isolation increases the risk of cardiovascular, autoimmune, neurocognitive and mental health problems, on top of any pre-existing conditions. Combine this with an increased susceptibility to the coronavirus and the elderly find themselves in exceedingly dangerous waters.

“They’re very worried. They’re scared. Even though everyone is worried and frightened, the numbers do speak for themselves: The elderly are at highest risk,” said geriatrician Carmel B. Dyer, M.D., executive director of the Consortium on Aging at The University of Texas Health Science Center at Houston (UTHealth). “They are more likely to have multiple chronic diseases, so that also puts them at risk. … Loneliness suppresses the immune system, but so does aging. When you couple those two, I worry about people being able to fight off infection. It’s a double whammy.”

A recent analysis of COVID-19 in the United States released by the Centers for Disease Control and Prevention  showed that adults 65 and older represented 31 percent of cases, 45 percent of hospitalizations, 53 percent of ICU admissions and 80 percent of deaths. Adults 85 and older were among the highest percentage of severe outcomes—indicating that age increases the risk of serious disease and death.

“Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres [sic], and places of worship,” wrote Richard Armitage in a recently published Lancet paper. “Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded.”

Assisted living facilities and senior care centers have closed their doors to visitors and non-health care workers to protect the health and safety of their residents and comply with federal mandates.

“It was extremely hard to make those phone calls,” said Amy Shields, CEO of St. Dominic Village, a senior care community in Houston. “But I have found that even though it is extremely hard for a great deal of [families] to not come visit their loved ones, they also understand why we’re doing it.”

“Defensive cocooning”
For Phil and Matilde Geren of the Heights neighborhood in Houston, it has been difficult not seeing their daughter and son-in-law, who live nearby.

“We’re accustomed to seeing them face-to-face very regularly,” Phil said.

Phil, 80, and Matilde, 76, have been stocking up on food, freezing home-cooked meals and deep cleaning every surface in their home since March 14 in preparation for social distancing. They installed a high efficiency air filter that removes dust and allergens, as well as an ultraviolet air purifier that prevents the spread of airborne pathogens and microorganisms.

“We go outside for the newspaper and I’m busy doing things around the house—like cleaning up the patio and cleaning the outdoor furniture—but we have elected not to interface with other people,” Phil said. “We stay away from the postman. We just haven’t been around other people.”

When they do venture outside to go to the grocery store, they protect themselves by wearing masks and gloves.

“We take it very seriously because we’re in the high mortality group,” Phil said.

The couple refuses to call their new way of life “quarantine.” Instead, they refer to it as “defensive cocooning.”

Since social distancing began, the Gerens and their two daughters—the one who lives nearby in Houston and another who lives in San Diego, California—have been sharing a lot of photos as “proof of life.”

“We’re trying to put a little sense of humor into this,” Matilde said.

“Humor is a big part of our lives and not being able to interface directly really cuts down on the amount of humor you can share,” Phil added. “For me, that’s one of the biggest sacrifices: Not being able to joke and respond quickly back and forth.”

Seniors turn to social media
With the mounting stress of an uncertain time, many have turned to social media to fill the void of physical social interaction.

Initially, Phil was resistant to social media, but being physically disconnected from family and friends has given him a newfound appreciation for online engagement.

“This has made me more aware of the value of things like Facebook, which I’ve always considered to be an invasion of privacy or a voyeurism or maybe an exhibitionism that I don’t choose to participate in,” Phil said. “But being able to maintain your contact with your support group is phenomenally important nowadays. The social media stuff that we have at our disposal now, such as WhatsApp and Facebook, make it possible for us to really interface electronically whenever we want.”

But Phil admitted that “it’s not anything like the value of a face-to-face visit.”

Although technology cannot entirely match in-person interaction and engagement, people are utilizing platforms such as FaceTime, Zoom and Skype to connect with others in a more meaningful way than before.

Dyer recommends having virtual meals together, streaming religious services and participating in free online exercises to keep the body and mind healthy while staying connected with loved ones.

“We all need to be very grateful that we live in a time when so much technology is available to us,” Dyer said. “We have to take advantage of this.”

While technology is a great way to stay connected virtually, Rheeda Walker, Ph.D., professor of clinical psychology at the University of Houston, suggests a more old-fashioned approach. She encourages people—particularly seniors—to write about their experience during this global pandemic as a way to ease the anxiety and loneliness of social separation.

“That’s helpful for them and helpful for the families because it’s documentation of this really crazy time in life,” Walker said.  “It would be so powerful for the rest of our society to have. For them, it gives them the opportunity to leave a legacy and continue to contribute.”

No one knows when the pandemic will abate, but staying connected and optimistic are as important for survival as staying home.

“Try to keep as positive an attitude as possible, and think of the good times,” Matilde Geren said. “Hopefully, there will be more good times to come.”