Health in Transition – 2019 vs. 2021
Professor Luiza Spiru
“Carol Davila” University of Medicine and Pharmacology,
Head of Discipline 13: Geriatrics, Psychogeriatrics and Gerontology,
“Ana Aslan” International Foundation
The current global pandemic is having a negative impact, both directly and indirectly, on the health of the elderly:
The direct effect:
Older adults carry a higher risk of developing severe complications, with mortality rates growing by up to 8% in patients between 70-79 years of age, and by up to 14.8% in those aged over 80 (Sanchez et al., 2020).
Limited access to medical assistance. Isolation and quarantine measures have reduced the availability of primary medical assistance and have led to the postponement or cancellation of scheduled interventions. The risk of decompensating patients suffering from chronic ailments therefore grows, concurrently accelerating their degree of fragility (independently of any potential COVID-19 infection).
Higher risk among the elderly
66% of people aged over 70 suffer from at least one underlying condition. This places them in the category of individuals with a high risk of severe consequences secondary to the COVID-19 crisis.
Elderly persons can also face age-related discrimination with regard to the decisions they take pertaining to their medical care, triage or life-saving therapies. Global inequality has meant that, even before the advent of COVID-19, half of the elderly populations of some developing countries lacked access to essential health services.
Non-COVID-19 curative treatments suffer
53% of countries around the world have either partially or entirely interrupted their mandated services to treat hypertension; 49% have ceased offering support to treat diabetes and related complications; 42% have stopped cancer treatments and 31% are no longer responding to cardiovascular emergencies.
Rehabilitation services have been closed in almost two-thirds (63%) of the world’s countries, despite rehabilitation being essential to a healthy recovery. Disadvantaged and marginalized persons have to contend with healthcare system inequality, worsened as a consequence of the difficult choices forced upon hospitals as a reaction to the pandemic.
The indirect effect:
- Exacerbating loneliness and social isolation.
- Loneliness and/or social isolation within the elderly carries multiple negative effects on their physical and mental well-being (for example, a decrease in their quality of life, cognitive decline, stress and depression, lower quality of sleep etc.)
- The pandemic has also caused a parallel “ageism” epidemic, by way of media coverage that more and more often describes those above 70 years of age as helpless, fragile and incapable of contributing to society.
Even before the ongoing COVID-19 pandemic, loneliness and social isolation had already been identified as a global epidemic affecting the elderly (Murthy, 2017).
Isolation of the elderly is “a serious problem for public health”, as it increases the risk of cardiovascular, auto-immune, neurocognitive and mental health afflictions.
The long-term (more than 4-year) effects of loneliness and social isolation can be devastating, and may include: heightened arterial pressure, depression, weight gain, increased consumption of alcohol, tobacco or other drugs, diminished physical activity, cognitive ailments, heart disease, perturbed sleep patterns, stroke and coronary diseases (Berg-Weger & Morley, 2020).
The “ageism” pandemic
This is problematic for a number of reasons. Older adults are an extremely heterogenous group (Fingerman & Trevino, 2020), while “ageism” leads to stereotypy. Age-related stereotypes influence the elderly perception of their own aging, having a negative impact on their health as a result (Levy, 2009). Experimental (longitudinal and intercultural) research shows how negative beliefs related to age adversely affect the health as well as emotional stress responses of the elderly themselves (e.g., Chasteen, Pichora-Fuller, Dupuis, Smith & Singh, 2015; Levy, Slade, Kunkel & Kasl, 2002; Levy et al., 2016; Siebert, Braun & Wahl, 2020). With regard to the costs associated with healthcare provision, continued population aging imposes significant economic costs upon society, costs that will accentuate the economic constraints brought about by the pandemic (Levy, Slade, Chang, Kannoth & Wang, 2020). The impact on the elderly will vary throughout the world, while the most influential factors will be different for those in low to medium income countries as compared with those in highly-developed states (Lloyd-Sherlock, Ebrahim & Geffen 2020).
Since the recent global crisis is rapidly evolving, at present, very little is known about its broader impact on physical and mental health.
On a positive note:
The COVID-19 pandemic will offer us the possibility to evaluate our current approach, to quantify the lessons learned over this period and to develop new strategies and approaches to combat loneliness and social isolation among the elderly population.How?
- By training medical assistants, social workers and the elderly themselves in the use of new technologies – non-traditional interaction with others can become an integral part of social work.
- By taking into consideration the new needs of the post-pandemic era with regard to our patients and their families that can suffer from heightened depression, anxiety and financial challenges and by finding new and innovative ways to address these challenges, ones that can also underpin the elaboration of new policies in the field.
- By iterating instruments better equipped to evaluate loneliness and social isolation – since it is essential that we have instruments that can be quickly and easily administered in order to determine whether the elderly is lonely or socially isolated.
- By implementing new technologies predicated on “self-quantified” resources accessible online, which may aid in optimizing the health of the elderly. Such technologies should focus on disease prevention, supporting the elderly in order to overcome stressful or acute developments without needing to physically attend a clinic.