Coronavirus in Context: How Older Adults Can Reduce Risk and Remain Resilient

Hello. I'm Dr. John Whyte, Chief Medical Officer of WebMD. And welcome to "Coronavirus in Context." Today, we're going to talk about the impact of coronavirus on seniors. And my guest is Dr. Steven Albert. He is Professor and Chair of the Department of Behavioral and Community Health at the University of Pittsburgh Graduate School of Public Health. Dr. Albert, thanks for joining me.

Thank you, Dr. Whyte.

We've been hearing about seniors at increased risk. Why is that the case?

It's mostly older age, because older people have comorbid conditions which seem to lower resistance or response to virus. So the older people with hypertension, diabetes seems to be the ones who are dying. And we know that we have excess risk among older people. Something like 15% of the deaths due to the pandemic have involved people over age 65, and so we're concerned about that.

And we've been having all this talk about social distancing, don't go in and see people, maintain six feet. But what do you do if you're an adult with older parents. Do you need to be checking on their food supply? Do you need to make sure they're renewing their medicines? I mean, if they're independent otherwise, what advice do you give?

Well, I would partition the older population into a couple of different groups. About 80% of older people are doing fine. They do not have major multi morbidity. They do not have cognitive impairment. They are in touch with their families and their adult children like everybody else. And the answer to that is that these older adult children should practice social distancing and carefully interact with the older person. There's not a problem to have the older person come once a week for dinner. It's not a problem to go to the home and check on the person, provided you yourself are practicing reasonable social distancing.

Then there's the 20% who have a multi morbidity, and that's a group that's more challenging. There, I think some extra caution for contact probably is appropriate. And within that 20% is a smaller group that's in long-term care settings, and of course, their social distancing has to be quite extreme.

What if I have an elderly parent living at my home? Do I need to have them stay in one area of the house?

No, no, I don't think, though. We're in an infectious disease situation, so if you yourself are careful and are practicing proper social distancing, don't have symptoms, haven't had contact with someone who even remotely may have symptoms in the past two weeks, normal daily interaction in your homes is fine, I would say.

We know loneliness is a big issue in seniors, and you've talked about this. Isn't the coronavirus COVID-19 potentially making loneliness more present and worse?

Well, it's a good concern. You know, something like one third of older adults are mostly lonely. This is what they tell us. They don't have adequate social interaction. They're on their own, they live alone. And it is a concern. That group, it's important for them, potentially, just to get outside to see faces and have even normal contact with people on the street. And this is exactly what we can't do in a situation of extreme social distancing like we're in now. So it is an issue, and loneliness is related to lots of negative health outcomes, like physical deconditioning or lack of cognitive stimulation, or mental health challenges.

So it is a problem. Luckily, we have virtual contact now, and lots of check-in services from social service agencies and families and friends and networks. So I think if we didn't have the Internet -- virtual contact -- it would really be a problem.

What about technology? Is that helping here? Should we try to get elderly parents -- an elderly friend -- to use video conferencing to be more present? Social media, though, has pluses and minuses.

Right. Well, we're presuming someone has access to a computer and the internet and knows how to use it.

That's not always the case, at any one point.

That's not always the case. One of the things we've done here, is we have something called the Virtual Senior Academy. It's kind of a chat room internet class-based program for older people in their homes. And we have tech buddies -- college students and high school students who are trained to go into people's homes and set them up with the computer. We know that older people -- before the coronavirus -- were attending these classes in libraries, and even in senior centers. So that sort of model is very productive.

Older people who are a little more savvy with the internet can also plug into the same kind of online learning and classes that everybody else uses, let alone Zoom conferences with their families. So that's a great option.

How do we prevent seniors from panicking? If you listen to the news, it can sometimes be doom and gloom. We're trying to stay educated, but not scared. But sometimes it's hard when you're seeing what's on the television.

Indeed. Well, we are living in extraordinary times. I don't think anyone ever expected to have to live through a pandemic of this magnitude. We've been lucky before with Ebola and SARS and Avian Flu and MERS. Sooner or later, there was going to be an emerging infectious disease that escaped such containment, and now it's our turn. And I hope we learn from it. But in the meantime, panic is an issue. I think there is a substantial -- but unknown -- proportion of the population at all ages which has sub syndromal anxiety disorders, and something like this could push people over the edge.

What does that mean? Can you explain that?

I mean, people who have mild symptoms which are manageable in good circumstances, in structures that people have set up for themselves. But when you're in a pandemic situation where the onslaught of news and the fire hose of information is coming out, I think it's pushing some people over the edge and we do expect to see upticks in mental health use of the emergency department. We're trying to track some of this in the community in some research I'm involved with right now.

Is there something that we should be on the lookout for in elderly friends?

Well, I think here here's a case where the social isolation you just mentioned could be very important. It would be good for people to have a chance to air these concerns, make sure they're getting reasonable information, steer them to valid sources of information, and give them chat lines and 2-1-1 calls if people have problems and need some sorts of reassurance.

Now what is 2-1-1? Can you talk about what it is?

2-1-1 is a help line run by the United Way and other social service agencies throughout the country, and that's another source we monitor in some research here, just -- it's a very good sampling of social needs across the country and what sorts of problems people are seeking help for. And so, we're trying to track this in older populations to see if mental health issues are popping up more, or isolation, or things that might indicate panic of the sort you just mentioned.

Now what about on the other end, where we hear stories about seniors that maybe aren't taking this as seriously, that are talking about living their life, and you know, we see that at both ends of the spectrum. And where does tough love come in here?

That's a good question, and here we don't have the research evidence we'd like, but let me take a crack at it. You know, older people are very good at being resilient. That's one of the wonderful silver linings of age. And resilience means you can do well under challenging circumstances. It might mean accentuating the positive and downplaying the negative. It might mean compensating and optimizing with limited resources. So older people are very good at that, and unfortunately, some of them have the same sense of invincibility that everybody else has, too. And we have to -- for those folks, remind them a little more of the magnitude of this disease.

I think it's hard overall. Here we are all at home. We don't see a lot of illness, and yet, there's something looming out there and it's hard to believe that we have to be as restrictive as we are and that we're living in such a dangerous pandemic era. But that's the situation now, and I think the tough love would be to sit someone down and say, this is not a good idea. You should go to the supermarket once, early, when it's less crowded during the senior hour, and not go the way you used to which was three or four times a week for the social engagement. And I think people have to recognize those are the sorts of strategic kinds of decisions we have to make to be safe.

Well, those are good tips, and it's a great reminder about resilience. So I want to thank you, Dr. Albert, for taking the time to chat today.

My pleasure. Thanks. And I want to thank our viewers for watching "Coronavirus in Context." I'm Dr. John Whyte.