Amid the uncertainty swirling around the coronavirus pandemic stands one incontrovertible fact: The highest rate of fatalities is among older people, particularly those with underlying medical conditions.
Of the confirmed cases in China to date, nearly 15% of patients over 80 have died. For those under 50, the death rate was well below 1%.
There is no evidence yet that older people are significantly more likely to acquire the coronavirus than younger people. But medical experts say that if people over 60 are infected, they are more likely to have severe, life-threatening disease, even if their general health is good. Older people with underlying medical conditions are at particularly high risk. Experts attribute some of the risk to a weakening of the immune system with age.
This leaves older people and their families wondering what extra precautions they should take. Several best practices have been recommended by the Centers for Disease Control and Prevention, the World Health Organization, geriatricians and infectious diseases specialists.
Familiarize yourself with guidelines and follow them
Geriatricians recommend their patients adhere to current recommendations from the CDC and WHO, a litany of advice that has become all too familiar: Wash your hands frequently with soap and warm water for 20 seconds or clean them with alcohol-based hand gel; avoid handshakes; stay away from large gatherings; clean and disinfect objects that are touched frequently; and avoid public transportation and crowds. Stock up on supplies.
Cruises are out, as is nonessential travel. Visits with grandchildren are ill-advised.
“I’ve had this conversation about a hundred times in the last week,” said Dr. Elizabeth Eckstrom, chief of geriatrics at Oregon Health & Science University in Portland. Eckstrom said most of the patients she sees in her clinic are over 80. All of them have made their worry plain.
And all of her patients, Eckstrom said, have at least one chronic condition. “Most of them have three, four, five or more,” she added.
People are wrong to assume that if an underlying condition is well managed with treatment, they’re out of danger. Even those with conditions that are stable should take extra precautions.
“These conditions can limit underlying reserve and lead to worse outcomes when older people become severely ill, which taxes all organ systems,” said Dr. Annie Luetkemeyer, an infectious diseases specialist at Zuckerberg San Francisco General Hospital.
“For example, diabetes can make it harder to fight infection, and underlying heart or lung disease may make it more difficult for those organs to keep up with demands created by a serious COVID-19 infection,” she said, referring to the syndrome caused by the new coronavirus.
Dr. Daniel Winetsky, an infectious diseases fellow at Columbia University in New York, said his advice to his own parents, who live across the country in San Francisco, has shifted dramatically. A week ago, he said, he was reassuring them about their safety, even encouraging them to go ahead with a trip they were planning to the Florida Everglades with a small tour group.
Over the weekend, his fears about the pandemic rose, and by Tuesday not only was he telling them not to go, but he also was advising them to reduce to a minimum the number of people they came into contact with. Visits with grandchildren are verboten.
Winetsky told his mother, Carol, who is 73 and has asthma, to stop meeting with her biweekly knitting group. And he instructed his father, Hank, who has had two coronary stents, not to attend either of his two book group meetings.
His mother continues to go to the grocery store, while avoiding crowded places like Costco. With her son’s permission, she still goes to physical therapy for a back injury, but she is careful to make sure the therapist washes her hands and that the equipment gets wiped down with disinfectant.
What about nonessential doctor’s appointments?
Some experts are recommending that older adults at risk cancel nonessential doctor’s appointments, including wellness visits. Telemedicine sessions, if available, are often a reasonable substitute.
Eckstrom generally agrees, but with caveats. While it might be prudent to cancel wellness and other visits that are not urgent, she said, “many older adults have issues that require regular follow up, such as dementia, Parkinson’s disease, falls, heart problems.” She worries that skipping visits might allow these conditions to spiral out of control, but agrees that telemedicine can usually bridge the gap.
Another helpful step: talking to your doctor about stockpiling two or three months of any critical prescription medicines.
Beware of social isolation
Experts warn that social distancing, the cornerstone of epidemic control, could lead to social isolation, already a problem in the older population. According to a recent Pew Research Center study of more than 130 countries and territories, 16% of people 60 and older live alone. Loneliness, researchers have found, comes with its own set of health hazards.
Winetsky is aware of the danger, and has suggested to his parents that they switch to virtual meetings with friends and relatives, with the benefits of social engagement in mind. “I’ve tried to frame it as, ‘Don’t cancel these things, but change to Zoom or Skype or FaceTime,’” he said.
April Vollmer, 68, an artist who lives in New York, flew to California in November for an extended stay with her 91-year-old father, who lives in Santa Cruz. She has yet to leave.
Just when she was planning last month to fly back to New York, she said, where she has a husband, friends and a rich cultural life, the coronavirus hit. Now she oversees her father’s home health aides and takes long walks along the bluffs above the Pacific, a “virus-free” activity.
Recently, Vollmer got an email from a friend of her father’s who last year decided to move to assisted living. “The home has canceled group events, and residents are eating alone in their rooms,” Vollmer said. “Seems like a bigger change there than for someone living at home.”
Have a talk with home health aides
The National Association for Home Care & Hospice estimates that 12 million “vulnerable persons of all ages” in the U.S. receive care in their homes, delivered by a home care work force of approximately 2.2 million people. For many older adults, that means a steady parade of home health aides trooping through the door, some more mindful of hygiene than others.
People should have conversations with their caregivers about hygiene, suggested Dr. David Nace, president-elect of the Society for Post-Acute and Long-Term Care Medicine, a professional group that represents practitioners working in long-term care facilities.
Double-check that aides are washing their hands or using hand gel. Any equipment they bring in should be wiped down with disinfectant. And make sure they are feeling healthy.
“If you’re by yourself, you may be in a very vulnerable position because you’re dependent upon that person,” Nace said. “It can feel intimidating. But hopefully there’s a good enough relationship that you can open the conversation."
Adam Henick, an investor who lives on the Upper East Side in Manhattan, said his father, 92, and mother, 88, live in an apartment a block away, and aides come through every day. Only one wears a mask, he said.
“In a perfect world, no one would enter the apartment without putting a mask on,” Henick said. “But it’s better than being in a nursing home.”
The nursing home conundrum
Some 1.7 million people, mostly older, are in nursing homes in the U.S., a fraction of the 50 million Americans over age 65.
Given the rash of deaths at a nursing home in Kirkland, Washington, hit hard by the virus, nursing homes are on high alert. Many have gone into full lockdown mode.
The federal government is telling nursing homes to bar all visitors, making exceptions only “for compassionate care, such as end of life situations.”
Curtis Wong, 66, a retired Microsoft researcher who lives in the Seattle area, used to visit his parents often. They are in their 90s and live in an assisted living facility in Sierra Madre, California.
On Thursday, the facility prohibited all nonmedical visits and said it was changing its building entrance codes. In an email announcing the measure, the facility’s management offered to put residents in touch with family members via FaceTime.
Three days ago, Wong said, during a video chat with his father, “I worried I might not see him again. Things got very emotional.”
Cathy Johnson, who lives outside of Boston, is trying to take matters into her own hands. Johnson is the primary caregiver for her 96-year-old father, who lives nearby in an independent living facility with 2,200 residents. Two cases of coronavirus have been reported in the area and Johnson, worried that the facility might shut its doors to visitors, has been planning to extract her father and bring him to live at her house.
“I actually think that’s not unreasonable, if it’s in your community and you have the ability to care safely for that person in your house,” Nace said.
But so far, Johnson’s father, wedded to place and routine, is refusing to leave the facility.
Stay active, even in a pandemic
Geriatricians fear that social distancing may affect routines in ways that can compromise the vitality of older adults. They emphasize the importance of maintaining good habits, including sufficient sleep, healthful eating and exercise.
Exercise may be beneficial in fighting the effects of coronavirus. It can help boost the body’s immune functions, decrease inflammation and have mental and emotional benefits. A patient who relies on daily exercise at the gym but is trying to avoid risky situations might simply go for a walk.
On Wednesday afternoon, Hank Winetsky, 80, had just returned from a round of golf with a small group. His foursome ranged in age from 70 to 81. “Golf is pretty safe when it comes to human contact,” he said.
But even golf proved not to be a contact-free sport. “There was a bottle of water on the cart, and everybody thought it was their own bottle,” he said. “All four of us drank out of it. Now we’re all freaked out.”