COVID-19 Assaulted the Health and Well-Being of Older People, But Their Resilience Helped Them to Cope

Why was COVID-19 so devastating?

At stake were their lives.

With the onset of the highly contagious COVID-19 coronavirus, older persons found themselves in the crosshairs of one of the most virulent natural disasters of this past century. They heard a chilling and never-ending message. If infected, hospitalization or death was more likely because they were old. They were even more at risk if they had underlying medical conditions.

Perversely, even if they recovered, their bodies sometimes wouldn’t forget. They could subsequently suffer from fatigue, muscle weakness or pain, joint pain, shortness of breath, cough, sleep difficulties, loss of smell or taste, and inflammation of the heart muscle. It could be an unrelenting horror story.

Never mind all their prior efforts to fend off serious cardiovascular, respiratory, diabetes, and cancer ailments. These preventive health and disease management efforts might be for naught if they caught this virus.

Ageism fuels their fears and anxieties

The media heightened the anxieties of older persons. Ageist or discriminatory communications suggested that their high mortality rates were inevitable. They are “elderly” after all, and thus more vulnerable. Furthermore, they were also “expendable” because they “obviously” contribute far less to society than younger populations. Therefore, if hospital beds are in short supply, older persons should have lower admitting priority or be the last to receive ventilators. And economic shutdowns to contain the virus would be unnecessary if older persons were willing to sacrifice (that is, die) to save the economy for their grandchildren.

Some older persons more endangered

It didn’t matter where they lived. Both urban and rural dwellers were similarly at risk of catching this virus. However, the older occupants of long-term care facilities—such as assisted living and nursing homes—were especially vulnerable. Their staff was often contagious, and they performed their duties without protective equipment. In these close-knit group living quarters, it was easier to get infected. These senior care homes were responsible for over 70% of Canada’s COVID-19 deaths and close to 40% of those in the United States.

Older persons were also at greater risk when they lived with younger persons, such as adult children who had returned to their family homes because of employment or educational reasons. These new occupants were less vigilant in their efforts to prevent catching the virus. Although they typically experienced less severe health outcomes than older persons, they were effective spreaders of the virus, even when asymptomatic. African American, Hispanic, and Asian older persons, especially those with lower incomes, were more at risk of contagion because higher shares lived in these multigenerational families and occupied physically cramped dwellings.

Required coping efforts not without downsides

A strict dwelling lockdown was prescribed. Social distancing and sheltering-in-place mandates required older persons to hide out in their homes and avoid public gatherings. To survive, they must become homebound, a depressing label once reserved for very frail persons who can’t venture outside their dwellings. Further adding to their angst were warnings by health experts that they should not have any visitors. By shutting out their outside worlds, most older persons successfully avoided getting COVID-19, but in so doing, they had to endure many other assaults on their “daily life and personal circumstances.”

They still had bad health outcomes

Distressingly, those older persons who escaped from getting the virus still got sick or even died. In their attempts to avoid crowded waiting rooms, they put off their preventive physical checkups and procedures (e.g., shingle vaccines, colonoscopies, cardiovascular screenings, dental hygiene cleanings), follow-up doctor and hospital outpatient visits, and they canceled surgeries considered elective. Sadly, these actions increased the incidence and severity of otherwise detectable or treatable acute and chronic health problems.

They took a financial hit

Older persons—especially women—laid off from their service-related jobs (in retail, food service, hospitality, and travel) were the early casualties of the economic shutdowns designed to stop the virus from spreading. Some held part-time jobs, and they lost salaries that supplemented their retirement or pension incomes. Others were full-time workers, and their layoffs accelerated their retirement decisions. Both groups incurred financial difficulties. The most disadvantaged older persons lived in dwellings where their rents or mortgages were now unaffordable. To avoid foreclosures or eviction, they had to cut back on their other expenditures—especially on food and out-of-pocket health care costs.

More older persons became lonely and depressed

Older persons were afraid to visit even their nearby friends, neighbors, family, and coworkers. Out-of-town family outings and celebrations soon became distant memories. Separated from the essential people in their lives, more older people felt lonely and socially isolated. No longer enjoying those hugs and kisses also took their mental toll. Older persons suffered from higher rates of depression, which contributed to their memory and physical health declines, including cardiovascular problems and reduced immune system function. The most distressed were older persons living alone and lacking access to broadband internet connectivity and social media.

Their lifestyles were in disarray

COVID-19 not only disrupted the social worlds of older persons. They also had to put on hold some of their most pleasurable and stimulating leisure, educational, recreational, spiritual, and fitness activities. This self-imposed disengagement made them feel anxious, helpless, and no longer in control of their lives. Depressingly, they knew that compared to younger persons, the end of their lives was closer, and it would be more difficult for them to make up for their missed activities and experiences.

They didn’t have enough to eat

Being homebound created other challenges. Older persons had to get their groceries, meals, and other essential needs? Some were disadvantaged because they couldn’t access online internet resources to arrange for home deliveries. Others, such as lower-income elders, had depended on public transit or others driving them, but they feared using these options because of contagion concerns. Others could not rely on the now-closed senior centers and other group dining sites for at least one of their daily meals.

Although older persons could get relief from meals on wheels programs administered by government and nonprofit organizations, even before COVID-19, these programs had long waiting lists. Of course, more well-off seniors took advantage of the many new food delivery services (e.g., Uber Eats, Grub Hub), but these options were often prohibitively expensive.

Consequently, because of COVID-19, an already substantial “food insecure” elder population became larger. One study found that 20% of older New Yorkers now lack reliable access to affordable, nutritious food, compared with 10%, before the pandemic.

Help from family caregivers, not a perfect solution

Physically frail older persons had to make other worrisome decisions. They needed help performing their everyday personal or self-care tasks—such as bathing, eating, dressing, using the toilet, and just getting around. But they feared contagion if they brought help in from outside.

Who should they trust?

They usually relied on caregiving assistance from their families—often their daughters or daughters-in-law. But it was tough for these women to help because they were juggling their own work and family responsibilities to cope with the virus. They also had to make gut-wrenching decisions: help but possibly contaminate or don’t help and risk their loved ones transitioning to an assisted living or nursing home—where virus deaths were raging.

There were other factors to consider. COVID-19 made caregiving physically and emotionally more draining. Helping a father or mother perform their usual tasks—such as shopping, dressing, and negotiating visits with health clinics or dentists—required more vigilance and time than in the past.

It didn’t help that many community daycare programs offering badly needed respite care to stressed-out caregivers had closed their doors for fear of group contagion. Most family caregivers overcame these challenges, though for lack of training and experience, they made mistakes.

But the actions of a few were malicious. Reports of physical, mental, and financial abuse and neglect of older persons by family members have skyrocketed during this COVID-19 pandemic. Most susceptible were socially isolated elders. Physicians and other medical workers often spot abuse, but older persons afraid to leave their homes saw these professionals less frequently.

It was risky to hire home care workers

Older persons unable to rely on their families had to turn to paid home care workers. These ranged from professionally trained nurses and rehab therapists (often helping them recover from a hospital stay) to lesser skilled home or personal care aides (to help them perform their everyday household or self-care tasks).

Once again, older persons had to make hard decisions, especially the poor with more limited options. Even though they needed help to remain independent, they were reluctant to allow workers into their homes and risk infection. They were not tested for the virus and lacked adequate personal protective equipment. In some communities, older persons had even fewer choices because home care workers were in short supply.

Why did some older people do better than others?

Several studies might suggest that I am overstating COVID-19’s negative impact. They point to the resilience of aging adults and their ability to cope with the stresses produced by this virus. They are optimistic for three reasons.

First, compared with younger people, older people better managed or regulated their feelings or emotions. They strived to feel positive about their lives, and they focused less on the downsides of being homebound. They coped by reading more, pursuing earlier hobbies, performing home improvement projects, and binging on TV movies. They spent more time reminiscing about the people and events that made their lives positively matter. They rationalized that solitude may not be so bad— “It is good for creativity, contemplation, relaxation, spirituality and personal growth.”.

Second, for most older persons, coping with the pandemic was not the first time in their lives that they confronted threats to their health or happiness. They had navigated and coped with everyday life traumas before and acquired survival skills that now cushioned them from COVID-19’s assaults.

Al Pacino’s memorable line (“Scent of a Woman”) resonates— “I’ve been around, you know.” As a vivid example, consider the perspective of the Holocaust survivor coping with the threat of COVID-19:

“But now, I can feel freedom. I stay by the window and look out. The first thing I do in the morning is look out and see the world. I am alive. I have food, I go out, I go for walks, I do some shopping. And I remember: No one wants to kill me. So, still, I read. I cook a little bit. I shop a little bit. I learned the computer. I do puzzles.”

Coping successfully with the threats of COVID-19 was more feasible for a third reason.

Historically speaking, it is probably the best of times for older persons to be homebound. More than ever, they feel comfortable using their smartphones, ipads, and laptops, and they enjoy good broadband internet connectivity. The rapidly expanding resources of their digital worlds make sheltering-in-place more feasible. They can enjoy video communications with their family and friends, keep their minds engaged and stimulated, nourish their religious needs, secure their e-commerce material needs, and rely on a growing telehealth presence to help them monitor and respond to their health issues.

As of this writing, in both Canada and the United States, the older occupants of long-term care homes are receiving their COVID-19 vaccines. And in both countries, vaccines will soon be widely available to their community-residing seniors. We can be hopeful even with the early fits and starts of this effort.

About the author

Stephen M. Golant, Ph.D., is a leading national speaker, author, and researcher on the housing, mobility, transportation, and long-term care needs of older adult populations. He is a Fellow of the Gerontological Society of America, a Fulbright Senior Scholar award recipient, and Professor Emeritus at the University of Florida. Golant’s latest book is Aging in The Right Place, published by Health Professions Press. Contact him at [email protected]