Lonlieness, depression, delayed access to medical care, and the loss of loved ones are just some of the impacts of the Covid-19 pandemic on our country’s older population. Marie Mulvihill, a clinical nurse specialist in geriatric medicine at Cork University Hospital (CUH), says patients who have had their first vaccine are most looking forward to “spending time with family”. The lack of social contact has taken a huge toll on older patients. Cognitively, she says, many of them have “gone downhill... they don’t know what day of the week it is, they have lost interest, they are frail, and unsure of themselves”, Ms Mulvihill says.
“I think the fact that they have no social outlet, so no access to day centres, no meet-ups (like bingo or bridge) to look forward to, they can’t go to Mass, no social activities, no family visits, many are afraid to go out, so they have had very little social interaction,” Ms Mulvihill says. “They see their adult children coming with groceries and prescriptions, but grandchildren are not visiting and they are missing that. The loneliness for those who don’t have a family is particularly difficult.”
The ‘Irish Longitudinal Study on Ageing’ (Tilda) shows a doubling of loneliness during lockdown: 30% of older adults said they felt lonely at least some of the time and 21% of adults aged 60 and over reported potentially clinically meaningful levels of depressive symptoms. This is double the prevalence of depression before the pandemic. The study was undertaken by Trinity College Dublin researchers and the age charity ALONE and it details the effects of the pandemic, and of the associated restrictions on interaction, based on data from more than 4,000 participants aged 60 or over.
The study states that between July and November last year, 5% of adults aged 60 or over lost a family member or friend to coronavirus. Compliance with government public-health advice was high among participants, with 80% of the over-60s adhering to advice on social-distancing measures and engaging in protective behaviours, while 62% of participants reported not travelling to visit family members and 80% not visiting friends since the outbreak of the pandemic.
Dr Mike O’Connor, consultant geriatrician at Cork University Hospital (CUH), says endless months of cocooning have left older people “frail” and “presenting with conditions associated with frailty, so we are seeing a lot of people who have had a fall (some with serious consequences, like hip fractures), with brain haemorrhages, weight loss, loneliness often leading to depression, which, in turn, causes a loss of appetite and not eating, which, in turn, accelerates increased frailty”.
In normal circumstances, Dr O’Connor says, these patients would be visiting day centres, have home help, and have family members and grandchildren visiting. They would have social occasions, like birthdays, seasonal celebrations, Sunday lunch, and family and friend outings. All of these things they are now denied.
“There is the realisation that they have a limited number of years left in this lifetime. If you are 86 years old, for instance, you may have spent the last third of your life in isolation,” Dr O’Connor says.
Ordinarily, older people would be high users of primary care and have regular interaction with their GP, in proactive management of various medical conditions, but they have lost this connection in the last 12 months.
“In Covid-19 times, they tended to have reduced contact and this limited contact was by telephone or by video calls,” Dr O’Connor says. “It does not equate to normal GP interaction and has not been given the same value.”
Dr O’Connor says there are probably needs that have not been met over the last 12 months that will have to be addressed, so “things like not having their bloods done, blood pressure checked, routine checks”.
Dr O’Connor says that approximately 65% of those attending CUH live in Cork City, an urban setting, “so they are not used to isolation”. He believes those living in more remote areas, while undoubtedly at more risk of not seeing anyone, are “possibly a little more robust”.
“I think every single person has felt lonely at some point …they are transient feelings and that is OK,” Dr O’Connor says. “Persistent loneliness, however, can cause poor physical health, poor mental health, and, in addition, frailty, leading to falls etc.
“It is important older people understand the resources available to them, like panic alarm buttons and the service offered by ALONE, a charity which provides phone calls.”
Older people living in residential care and in nursing homes have been denied access to their family and friends, Dr O’Connor says, “So we are seeing loneliness on a very large scale here, leading to increased cognitive decline and depression.”
To combat this loneliness, we must change the dialogue as vaccines are being rolled out, Dr O’Connor says: “We know that things are going to improve, so it is important we give people something to look forward to. I’ve heard a lot of patients talk about how much they would love to see the sea or walk in the sand.
“Our weather is improving, the days are getting longer, so it is important we all get out for evening walks, take more exercise to help lift the ‘doom and gloom’, and make time to visit elderly relatives,” Dr O’Connor says.
Having a daily schedule, a daily routine, to focus on little things and take away “the overthinking that people do around their loneliness”, is important, Dr O’Connor says.
“It is easy, when we visit older relatives, to sit, talk, and watch TV together, but for the elderly, who have a long day to stay active, simple things, like scheduling, make a difference. Suggest doing an activity that may interest them — ie, painting, planting, needlework, art, yoga — or demonstrate low-impact workouts.”
Marie Mulvihill urges family and friends to maintain contact as much as possible — via telephone or video calls or regular visits — and if restrictions ease somewhat in April, then taking them out for a drive and a walk.
“Loneliness is a huge issue and it is going to take a while before people can relax again,” Ms Mulvihill says. “Remember, many elderly people, in particular, lost family and friends over the last 12 months and they were not able to say a proper goodbye. There were some very sad, tragic deaths of people in hospitals and in nursing homes.”
Dr O’Connor says one of the hardest things for staff at CUH has been seeing the loneliness in hospital, “seeing the sadness, the absolute palpable loneliness of patients isolated in hospital and then seeing some of them die”.
“It is so important, now, that we talk about hope, hope of a future, and to look forward to feeling some sunshine on our faces again,” Dr O’Connor says. “Many have had very bad days, but they need to focus on happier times again and on staying well and healthy and active.
“I think we are going to see great joy over the next while, as people meet their friends outdoors again …this joy cannot be overemphasised. The gates of freedom are going to open again to allow us to get out and about and be with the ones we love. We are going to see things that are going to fill us with joy, people hugging again, holding hands again, feelings of gratitude that they made it through this very difficult time.”