Nelson Mandela once said: “A society that does not value its older people denies its roots and endangers its future.” As an ageing population, we Irish would do well to heed his words.
In 2019, one in seven people on the island of Ireland was aged 65 or over. By 2051, this is due to increase to one in four. The acceleration will be most stark in the 85-plus age group. In 2019, there were 73,000 people aged 85 and above; by 2051, there will be more than 301,000 in this category.
This is the second part of Nicole Glennon's series in which she asks older people how they have fared during the pandemic. Click Ageing in the pandemic to read the first part.
Over the last 100 years, the average life expectancy at birth in Ireland has risen by several decades and healthy Irish men and women can now expect to live well into their 80s.
Professor Rose Anne Kenny, the founding principal investigator of Ireland’s largest adult population study on the experience of ageing in Ireland — The Irish Longitudinal Study on Ageing (Tilda) — says the team know from their studies that loneliness increased threefold during the pandemic.
This is of great concern because social engagement, “the flipside of loneliness”, is a major player in many aspects of ageing, “from the biology of ageing, literally how our cells age, right through to mood — in other words, happiness or depression or quality of life”, she says.
“Even with physical health, there is very substantial evidence showing that the quality of your social engagement, in other words, your friendships and the frequency with which you engage with people, is as strong a factor in influencing physical ageing as whether you smoke or have moderate to active physical activity or have low cholesterol.
“So it’s a very strong predictor of good health, physical and mental, when people are getting older.”
Prof Kenny, president of the Irish Gerontological Society and a professor of medical gerontology — the scientific study of the biological, psychological, and sociological phenomena associated with ageing — believes that, as a society, we will look back on some of the restrictions introduced during the pandemic as “draconian”, particularly those introduced in nursing homes.
Prof Kenny believes the policy of cocooning was akin to locking people away from society and family — in some cases for the last months of their lives.
While some will argue this was done with good intentions, which Prof Kenny acknowledges, she says the key issue is that older people were not given a choice.
“When somebody dies, and their family hasn’t seen them, they haven’t seen their family... that’s huge,” she says. “That family will probably never get over that guilt and that pain.
Prof Kenny says some older people felt “very aggrieved” at the types of policy interventions that were used to help contain the spread of the disease.
“It was almost being labelled as inappropriate to go out as an older person,” she says,” adding that the cocooning advice for those over the age of 70 was “an arbitrary number” that was used to determine what made people vulnerable.
“I think it was easy to introduce these policies because, generally speaking, society is quite ageist,” she explains.
"Obese people are hugely at risk from Covid: Imagine they had said anyone over a certain weight can’t leave the house? As a society, we had no problem picking an age and we didn’t ask enough questions about the different policies with respect to age.”
As a clinician, Prof Kenny says she is concerned about the levels of frailty she is seeing in older people as the pandemic continues.
“Some people have become much frailer, and they will never get back to where they were. It’s just overwhelmed them — both physically and mentally. It’s the frailty that I’ve really noticed; the cognitive frailty and the lack of confidence that people have after it all.
Prof Kenny says she believes the “ageist approach” to the pandemic has contributed to a loss of confidence in older patients.
Imelda Browne, who is in her late 60s, counts herself and her husband, who is in his mid-70s, as being among the lucky ones.
“We weren’t living on our own; we also have a reasonably decent-sized house and a garden,” she says.
The hardest aspect was being unable to visit her mother, who sadly passed away in a nursing home during the pandemic at the age of 93.
“For months on end, we weren’t allowed to see her. A woman that would have had visitors every single day.
“We were lucky in the sense that we had gotten back in for an open visit the week she died.” While Imelda and her two siblings tried to stay in contact with their mother during the various lockdowns, she says things such as Zoom just did not work.
Then, the nursing home allowed its residents to receive visitors through the window.
“The funny thing about that was her three children are well into their 60s. So we’d be at this open window and it was lashing raining most of the time and Mammy would say ‘let them go, you’ll catch your death!’ Mammy ended up worrying about us outside in the cold.”
For Imelda, the experience of living through the pandemic as someone in her late 60s was frightening because it projected her forward into what her future might look like. “It was very scary,” she admits.
Living in Naas, she has always felt that Dublin was on her doorstep, but the pandemic made her realise how much her life depends on her mobility.
“I remember, my mother used to say in her 80s, and we didn’t really understand at the time, ‘your world gets very small’. It all came back to me. It made me realise just how lonely life could get in old age.”
Imelda said she has noticed among her friends, particularly those in their mid-70s, that there is a “low-level anxiety” now, even with the vaccine.
“Some of them haven’t left their home or garden in over a year. The things that they can do now, they’re not really comfortable doing them, they’re still afraid,” she says.
Imelda, who is involved in the Irish Senior Citizens’ Parliament, points to a meeting the group was hoping to hold in person. “When people were contacted, the amount of them that were afraid of travelling on public transport, even with the vaccines. I think people don’t trust the vaccines [to keep them safe] any more,” she says.
For Imelda, it is time to start living life again, despite high case numbers.
“I know a lot of people are getting it, but I don’t know a lot of people who were very sick,” she says.
Alongside the impact on older people’s physical and mental health and wellbeing, digital exclusion has been identified as one of the “key issues” coming out of the pandemic, says Age Action's head of advocacy, Celine Clarke.
Recent research by the Central Statistics Office (CSO) suggests that almost half of Irish residents aged 75 or older have never been on the internet, while one in five aged 60-74 have never been on the internet.
Age Action’s own research shows the proportion of people aged 60-74 going online has more than doubled since 2018, but the percentage of them who have sufficient digital skills is declining, with 43% of that age cohort deemed to have digital skills “below basic levels”.
“They don’t have the necessary digital skills to be able to surf the internet properly and to do their business online,” Ms Clarke explains.
The total number of “digitally excluded” older people is “conservatively” estimated at more than 466,000, or 65% of all older people. As such, the move to a digital-first approach by many businesses and key public services during Covid-19 was particularly challenging for older people, many of whom did not have the digital skills or the devices necessary to carry out processes that were now almost exclusively online.
“It was an area of stress for people,” Ms Clarke says.
Digital exclusion had “a large impact” on older people’s ability to access services and information, to stay connected, and prevent loneliness and isolation, and to stay independent during the pandemic.
In an increasingly online world, older people are at risk of being “left behind,” Ms Clarke says, “unless active steps are taken to ensure their inclusion, including through non-digital forms of communication.”
As we move forward post-pandemic, “a digital-first approach should not mean a digital-only approach,” she says.
Ms Clarke adds that publicly funded services should not make the assumption that all older people have adult children who can assist them.
She says older people should not be required to divulge their private information to others in order to access publicly funded services.
Like Prof Kenny, Ms Shaw, and many of the others theinterviewed for this series, Ms Clarke believes there was an element of ageism in how the Government, and society as a whole, viewed and treated older people throughout the Covid pandemic.
“That has impacted on individual people’s own attitudes to themselves as older, and all our attitudes to how we think, feel, and act about growing old and ageing ourselves,” Ms Clarke says.
Older people felt “negatively stereotyped” throughout the past 22 months and many have self-reported to Age Action that they feel more ageism in how policies are formed and people’s attitudes as a result of their experience during Covid-19, she says.
Most of us want to be treated with dignity and respect, and to have a good quality of life in our older years.
Ms Clarke says it is time we all “reframe the narrative around ageing”.
“One of the key things that we can do is check our language and check the type of imagery that we use. Are we perpetuating negative stereotypes or are we making a more positive contribution?
“There’s a hashtag, ‘no more wrinkly hands’, on social media, which is basically about getting rid of these wrinkly hand images that we see in newspapers and advertising when talking about older people. There is always a wrinkly hand on a walking stick, or a wrinkly hand with a younger hand over it.
“If we really look hard at the ageist representation of older people in our media, in our education systems, [and] in our healthcare systems, we begin to look at it at the way we might have addressed gender bias. We see that we perpetuate negative stereotypes in our language and in our imagery, and that counters self-ageism too.
“People think that as they grow older they will grow frailer, but that doesn’t necessarily have to be the case,” she says.
Retired priest Fr Joe McCarthy has one question on his mind as he begins to meet friends and family as Covid restrictions ease — are you okay?
“The pandemic isn’t impinging on us so much now we’ve learned how to live with it,” he says, but it has left a lot of collateral damage.
Fr Joe, who is now in his late 70s and lives in Bantry, Co Cork, has made a promise to himself to ask people that question in the coming weeks and months.
“You don’t see the harm being done, but it’s there. And when you’re asked that question, it unblocks the dam and there’s a rush that comes out. Because you can’t be okay, especially if you’ve had a bereavement or someone was sick belonging to you.
“I just met a very good friend, and she buried her husband in the middle of it all. He was in the hospital, she couldn’t go in to see him, and that’s what I asked her and it all poured out.
He says “horrendous” things have happened to all of us during the past 23 months, and we’ve just had to swallow it: “We’ve an awful lot of processing to do and there’s no easy way of doing it.
“We’ve been through hell. People have died and we couldn’t throw our arms around [their family and friends] and say, ‘Jesus, I am sorry’, and all that.
“We do the funeral business so well here. It is very, very comforting and you get the strength to go through it because your neighbours are there with you, they’re at the wake, they’re at the Mass, and they’re in [your home] talking to you. We’re branded by it.”
While communities tried to come together in their own way during the pandemic, standing outside churches, having guards of honour outside homes, “it’s not the same at all”.
While the worst of the pandemic may be behind us, “we’re not back to next or near normal yet”, he says.
Kay Murphy, who is in her mid 70s, said she got tired of “being put in a box” for over-70s.
“I am not old, but I am older now than I ever was, because you were made feel old,” the Co Clare woman says.
Kay, who is an active member of her local Active Retirement group and previously served as president of the organisation, said many older people had very busy lives before the pandemic struck.
“Our group had four activities every week. We went to the pool for aqua aerobics every Monday, we went to the leisure centre every Tuesday for bowls, on a Wednesday we had a cup of coffee together or whatever we wanted to do. On the Thursday we had a structured walk which could involve going off on a bus to another city and having a tour guide take us all over the city and coming back having lunch out and what not. That all stopped overnight.”
When the group reconvened in person for the first time last September, there was a sense of excitement, of hope, but Kay said with a new wave of cases and new restrictions, they’ve once again been forced to pare back. The pandemic has had a massive impact on the social side of older people’s lives, she said.
“The majority of us older people are not up there with IT at all, I wasn’t myself, but I’ve had to learn, because I had to have board meetings on Zoom and contact with my family, and I’m more used to it, but there are thousands that don’t know how, and there are thousands that don’t even have a smartphone, that don’t have broadband speeds to make a Zoom call.
"Even those who are able to use it, it is strange in itself to be alone inside your room on your own and talking to people. That’s something you have to adjust to.
“There isn’t any human contact there. You hear the voice and you can see the people all right but it’s not the same, it’s not the same at all.” Kay said she did “a little happy dance” when she got her first jab, and has since got her second and third doses, along with most of her peers.
Kay said getting the vaccine did give her a sense of freedom, but despite being fully inoculated against Covid-19, she is still very cautious: “I certainly wouldn’t be going to Croke Park or going into major crowds, I shop, but I time it and go when I know it’s going to be quiet.
“It’s up to yourself now really what you do. I think at this stage in my life I’ll probably always wear a mask.”
But while Kay has remained cautious, she isn’t hiding away, and in recent months she has travelled to the United States and Denmark to visit family.
“Each time, I kept my head down, I wore my N95 mask, and I didn’t talk to anyone,” she laughs. “My family picked me up, and I stayed in their house. I wasn’t out and about.”
Waiting for her test to come back negative before she got on a flight to America was nerve-wracking, she says, because it was so important to her.
“I hadn’t seen my son in two and a half years. I would have swum the Atlantic to see him.
Bill Roe, who is in his late 70s, first became aware of how much Covid-19 might impact his life while on holiday with his girlfriend Ita in Tenerife.
“We had a lovely meal on a Saturday night in the restaurant, and the next morning we were told we couldn’t leave our room.”
Thankfully, Bill and Ita managed to get home thanks to a helpful Cassidy Travel agent and Aer Lingus.
“When I got off [the flight] in Dublin, I wanted to kiss the ground like the Pope. I was just so relieved.”
Bill lost his wife and soulmate Helen in 2008. In the years since, he had kept himself busy with dance classes, golf, and attending rugby games. It was all about having “structure” in his life.
“When the pandemic came, everything fell away,” he said. In the early days of cocooning, Bill said he used to disguise himself and sneak out of the house.
“My neighbours were very helpful, I got several texts from them offering to do my shopping. That was great for the bit of bread and stuff, but I used to do a big weekly shop.
"So what I did was, I used to put on a pair of trousers, slick back the hair, and hope I looked like a 62-year-old!” he laughed.
Looking back over the past 22 months, he admits he “brooded” at times.
“You think of what might have been your golden years,” he said. “As you get older, you value every year. I feel I lost two years, and it’s very difficult to make up for those years.”
There are many older people, especially those in their late 70s or 80s, who haven’t returned to their normal lives, and probably never will, he says. But, for him, with two vaccines and a booster under his belt, it’s all about making the most of his time left on this planet.
“I use the Luas regularly,” he says. “I’d go to a show tonight if I could.”
Irish Senior Citizens' Parliament (ISCP) chief executive Sue Shaw also believes there was an ageist approach taken to the pandemic. Indeed, she believes Covid-19 exposed a kind of “institutionalised ageism”.
“I think the message that permeated through Covid was that older people are vulnerable and needed to be protected,” she says.
Ms Shaw says there is a difference between providing protection and care for a section of the population who may be more vulnerable and making decisions on their behalf. We must learn to talk with, rather than talk at, older people, she says:
The ISCP is a non-partisan political organisation working to promote the views of older people in policy development and decision-making. Ms Shaw believes mental health will be “an emerging issue” for older people post-Covid.
Research carried out by Tilda in 2011 and 2021 gives an insight into the state of older people’s mental wellbeing pre- and post-Covid.
Pre-Covid, 10% of over 50s surveyed by the research group reported clinically significant depressive symptoms. This has doubled in the intervening years, with 21% of over 60s reporting clinically significant levels of depressive symptoms in 2021.
Amongst the over 70s, who were cocooning at the time of the survey, 40% reported that their mental health was worse or much worse since they were asked to cocoon. In addition, 70% reported low mood at least some of the time whilst cocooning, while 12% reported low mood very often.
Three in five participants reported loneliness, and this was twice as prevalent in those living alone than those living with spouses or other family members.
In a 2020 report, the State’s mental health watchdog warned that the pandemic had presented a “perfect storm” for ill mental health among older people, and noted the alarming scarcity of services available. The report found that Ireland has just 1.2 acute mental health beds for older persons per 100,000 population. This compares to six beds per 1000,000 population in England, and 9.7 in the North.
There are 43 mental health teams for older people in Ireland, but the report found that each team is under-resourced. Overall, the teams are only staffed to approximately 54% of what is recommended.
On top of the challenges in terms of resources is the fact that people in their older years “are not of a generation who learned to talk about or recognise, mental health issues,” Ms Shaw says.
“Many wouldn’t feel it’s all right to say ‘I am struggling to come back from the pandemic’.”
Resources will be needed at a community level to address mental health issues in our elderly population, she says: “There’s going to be a need for district nurses or local volunteers to recognise that, two years later, this person still hasn’t left home.
The ISCP also has “huge concerns” surrounding growing hospital waiting lists.
The latest data published by the National Treatment Purchase Fund shows close to 9m people are on waiting lists.
Around 114 people were added to hospital waiting lists every single day throughout 2021, with over 100% increases in outpatient and inpatient waiting lists at some public hospitals.
While this is an issue affecting all age groups, it’s something that disproportionately affects older people. A survey conducted by Age Action last September showed more than half of older people have had non-Covid medical appointments cancelled or postponed. As Omicron surged across the country, it’s unlikely this figure will have changed much.
“There isn’t any plan to address the backlog that we went into the pandemic with,” Ms Shaw says. “And now all of the weaknesses there are in the infrastructure have just been compounded.
“There are people who don’t have access to private care, who have extended a waiting list for two years. At our age, that’s really not doable.”
Help and support contacts include the following.
- Alone — supporting older people to age at home, call 0818 222 024;
- Seniorline — operated by older people for older people. Freephone 1800 804591 10am to 10pm every day;
- Active Retirement Ireland — Call 01 8733836;
- Men’s Sheds — Call 01 8916150.