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Covid-19 – How Have Older People Been Affected?

When the New Zealand Government began to take steps to reduce the impact of Covid-19, people aged 70 and over were singled out as the group most vulnerable. From March 21, 2020 all people in this age group were required to remain at home except for brief exercise breaks. This policy affected more than half a million New Zealanders.

Since the relaxation of lock-down regulations there has been a lot of discussion about whether, in an attempt to protect older people, public health messaging and mainstream media coverage led to discrimination against people aged 70 and over, taking away their ability to decide about their own health and safety. Early headlines included –

“How do we keep older Kiwis safe during Covid-19 pandemic?”

“How to persuade elderly parents and grandparents to stay home and out of infectious harm’s way”

These excluded older people from the discussion and the solution and saw them, some thought, as a liability.

Some more recent headlines have a different tone –

“Rendering people over 70 as either passive or wilfully irresponsible is unhelpful and ill-considered.” [1]

It can be argued that chronological age is not the best basis for recent measures. When there were 1474 cases in New Zealand, only 8% were people aged 70 plus; but, admittedly, a high proportion of Covid 19 deaths were in the 70 plus age group. Sure, chronic health conditions and co-morbidity are risk factors, but many older people can manage these with some success. And older people are not all the same. This was rightly acknowledged in a Radio New Zealand article published in March that said that community organisations were ‘crying out’ for volunteers because many were older people unavailable due to lockdown.

Now a vast range of research is underway and soon to be emerging, looking at the impact of Covid 19 on older people. Here are a few of these impacts and what is being said about them.

The effects of isolation

Isolation, and the social distancing which goes with it, disrupt older people’s family and social connections. Some do not have close family, but we all know people who have children and grandchildren living overseas who could not get home or who had difficulty doing so. Older people who are caring for spouses or other dependants at home may be seriously affected when they are disconnected from support.

Routine activities are also disrupted, and this can cause anxiety. Routine activities can benefit social, physical, and cognitive wellbeing and this is especially important for people with cognitive difficulties.

These disruptions are likely to increase social isolation and loneliness, which are already major risks for older people, especially those who live alone. They can lead to anxiety and depression. Added to this has been the barrage of information about Covid 19, which has dominated the news for months and can be overwhelming. If people are told repeatedly that health and social services are under pressure they may be unwilling to ask for help, not wanting to be a burden.

Good social connections provide protection against these risks, but many older people are not skilled in digital technology, which has been crucial in keeping up social connections.

The call-out to policy-makers and service deliverers is not to make ageist assumptions: not to make age the sole determining indicator for restrictions, looking rather at health conditions; not to discount the resilience of older people. And not to let the label “vulnerable” come to mean less valuable.

The growth and potential importance of telehealth

The Ministry of Health defines telehealth as “the use of information and communication technologies to deliver health care when patients and care providers are not in the same physical location.”  Telehealth can enable people to maintain their independence and safety while remaining in their own homes by monitoring medical conditions and highlighting alerts relating to emergencies. Remote doctor-patient consultations, over the phone or through a video conference, can enable diagnoses and evaluation, manage treatments and medication.

Telehealth can also mean two-way conferencing between providers; a physician can consult a specialist; tests can be forwarded between facilities for interpretation. Telehealth can even include robotic surgery through remote access.

There are benefits for all involved.  Patients can have faster access to care and shorter waiting times, reducing travel and transfers for older patients. Doctors can develop closer working relationship with specialists, allowing for more efficient referrals and second opinions. As well as doctors, allied health workers and patients, patients’ family and whānau can be involved in telehealth video-conferences.

How is this relevant to the Covid-19 Response? It has been extremely important to continue to provide health services safely throughout the pandemic, especially for those who may be especially vulnerable. Given the need to keep physical distance as much as possible, telehealth provides a way of having an appointment with a doctor, practice nurse and other health providers without seeing them in person. With video communication you can see talk about your condition just as you would if you were in the same room as your health provider. So, the benefits, in the Covid 19 situation, include: removing the risk of catching or spreading germs; reducing time and costs involved with travelling to an appointment ; not having to leave the house when you are in lock-down or feeling unwell.

Older people have been taking up digital technology, especially during the recent lockdowns. Increasingly they are able to use telehealth to improve access to care and this may assist ageing in place, given that many older people prefer at-home support to moving to residential care. Telehealth can also reduce the burden on family members who will not have to spend as much time and money shuttling the person they care for to and from doctors’ appointments or hospital visits.

 

Protecting the contribution of older workers

As the population ages, more older people are choosing to stay longer in the workforce. Currently 22% of people over 65 are engaged in some form of paid work, and this is projected to increase to 32 % in 20 years’ time. The percentages are even higher for people aged 66 to 75. Given the economic, social, and psychological benefits of remaining in the paid workforce, this is a positive trend.

But there are concerns, expressed especially in the UK context recently,[2] that older workers will be amongst the hardest hit by the COVID-19 crisis.

“Older jobseekers face a series of barriers to finding work, with some feeling left on the scrapheap”.

The reasons for this are several – lack of confidence from older jobseekers in their own ability and employability; unsuitable training; underdeveloped digital skills; caring responsibilities or health needs, and lack of opportunities for flexible working to accommodate these needs.

The report calls for a message that older workers are just as entitled to support as younger workers. It calls for a large-scale programme of workplace-based training for older adults, which includes flexible opportunities and takes into account experience and career histories. Of particular interest to me, given my current research focus, is the call for support for older workers considering self-employment and enterprise creation, which has the potential to boost the economy and create jobs.

But underlying all this is the looming shadow of ageism. Age discrimination in employment, although unlawful in New Zealand since 1999, has not been extinguished. Much of it is covert and even unrecognised.

 

A global call

 A recent statement by António Guterres, Secretary-General of the United Nations, dated 1 May 2020, is entitled “Our response to COVID-19 must respect the right and dignity of older people”. It mentions the issues I raise and is worth quotation, in conclusion.

“Beyond its immediate health impact, the pandemic is putting older people at greater risk of poverty, discrimination and isolation. First, no person, young or old, is expendable. Older people have the same rights to life and health as everyone else. Difficult decisions around life-saving medical care must respect the human rights and dignity of all.

Second, while physical distancing is crucial, let’s not forget we are one community and we all belong to each other. We need improved social support and smarter efforts to reach older people through digital technology. That is vital to older people who may face great suffering and isolation under lockdowns and other restrictions.

Third, all social, economic, and humanitarian responses must take the needs of older people fully into account, from universal health coverage to social protection, decent work and pensions.”

 

Thank you to our wonderful volunteer, Judith Davey, for writing this article for Age Concern Wellington.

 

[1] Newsroom July 3 https://www.newsroom.co.nz/ideasroom/auckland-oped-on-old-peoplelockdown

[2] “Back on Track” Centre for Ageing Better, London, July 2020

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