Lapses In Care And Social Isolation Is As Devastating As The Virus Itself

The novel coronavirus continues to rage through America, with the total cases standing at more than 210,000 and the death toll at over 5,000. It is without question that our seniors–those 65 years of age or older–will bear the brunt of the health consequences of COVID-19 and the projected American death toll of up to 240,000 this year.

It is now well known that seniors have a much higher chance of dying from the coronavirus than young people. Across the world, one in seven seniors infected with the virus dies from it. In New York City, they make up more than 70 percent of all COVID-19 deaths. However little light has been shed on COVID-19’s indirect impact on the 47 million seniors living in the U.S. While tens–if not hundreds–of thousands of American seniors will succumb to this virus, numerous others will suffer effects as a result, specifically:

• Lapses in necessary care. The surge of COVID-19 demand on our health care system means delaying valuable preventive and maintenance care; and
• Social isolation. The necessary societal strategies for blunting the surge (social isolation and shelter-in-place) mean that seniors will experience more social isolation and difficulties accomplishing basic daily activities, like getting groceries and medications.

Both of these developments will increase illnesses and death among seniors during and after this pandemic.

Chronic conditions don’t go on hiatus for a pandemic

As the pandemic makes its way across the nation, seniors will continue to experience unrelated heart attacks, strokes, cancer, complications from diabetes, and other non-communicable diseases (annually about 5 million seniors die in the U.S).

Seniors have traditionally relied on outpatient visits with health care providers to obtain preventive care, as well as maintenance care for their chronic diseases, such as hypertension and diabetes. Unfortunately, many of these necessary, but non-emergent, visits are rightfully being postponed to minimize provider and patient exposure to COVID-19. As a result, seniors are likely to experience greater morbidity from preventable diseases, such as stroke and heart attack, as well as exacerbation of their chronic conditions that were better-maintained in the pre-COVID-19 era. Many health systems are rapidly deploying telehealth to replace traditional office visits, yet seniors are the least likely to benefit from them due to their low technological adoption rates.

Health impacts of social isolation

In addition, COVID-19 will exacerbate the epidemic of social isolation among seniors, 14 million of whom live alone. Numerous studies suggest that social isolation leads to more sickness and deaths later in life. Socially isolated seniors experience more rapid progression of heart disease and dementia and are more likely to die compared to those with high levels of social support. Tragically, research suggests that social isolation has the same effect on health as smoking 15 cigarettes a day.

Shelter-in-place orders and suspension of non-essential services further compromise seniors with limited transportation options. They are more apt to experience challenges in accomplishing basic activities required to stay healthy, such as getting groceries, picking up medications, and staying active. Worse yet, there is no end in sight for social distancing measures as public health experts project that they may be necessary intermittently for the next 18 months.

The collective “we” can help

It is imperative that we, as a society, come together and mobilize now to help seniors weather this COVID-19 storm. We must proactively care for their health needs, connect with them socially, and talk to them about end-of-life wishes.

We must begin by reaching out to the seniors we know and help them understand the exquisitely high risk of death with a COVID-19 infection and the importance of staying at home. We should also anticipate that seniors will face more challenges with accessing care when they do become sick, and ensure that they know whom to call, any time of the day and night, seven days a week.

We must also take a hands-on approach to manage seniors’ chronic medical illnesses and try to prevent them from getting sick from preventable causes. Health care providers need to proactively call those seniors most likely to get sick, treat at the earliest signs of worsening disease, and address any barriers to health, such as the inability to pick up medications. We should invest in creative ways to meet the health needs of seniors, including senior-friendly telehealth devices and platforms, and in-home care delivery models.

We also need to socially engage with seniors. Simply talking on a phone with a caring stranger can reverse the ill effects of social isolation. States like California have established a hotline to address senior loneliness and to connect them with local services. In addition to connecting with seniors over the phone, assisting with grocery and medication pick-up could help them stay healthy and stay alive.

Lastly, it’s more important than ever to have end-of-life conversations with our parents and grandparents–and for health care professionals, with our elderly patients. Over the last several years of caring for the elderly, I cannot count the number of times family members told me, “I don’t know what to do, we have never talked about what he (or she) would want in this situation.”

In this current public health crisis, where seniors face a higher risk of dying and the medical resources to care for the sick are more limited than ever, it is imperative that we have these difficult but necessary conversations with our loved ones and patients. It is vital that we understand the type of care they want to receive–and how they would want to die–if they were to fall gravely ill. This New York Times article may be a helpful resource in this discussion.

Seniors will be the most vulnerable to, and most impacted by, this unprecedented pandemic sweeping through the world. We must do everything we can to help them weather through this storm, stay healthy, and in the worst of situations, plan for a dignified death. We can each start by simply picking up the phone and reaching out with support to our senior neighbors, family members, and patients. A simple phone call can mean the difference between life and death in the COVID-19 era.

Jason Bae is an internal medicine physician and medical director, Prealize Health.

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