“Do you fold what?”
She lives in a very nice senior community 2 miles away and had rarely been away from my father until four weeks ago. My father did everything from the dishwasher to the change of channels on television. But on February 23, he suddenly collapsed and went from the emergency room to a nursing home, two miles the other way. He has an undiagnosed disease that is most likely Parkinson’s.
In an earlier world – like two weeks ago – I would have run over and restarted your phone quickly. She just wanted to talk to my father – her 60-year-old husband. My two parents have been isolated since March 12, when the Centers for Disease Control and Prevention issued guidelines asking people to restrict visits to long-term care facilities. Since then, my mother has been navigating the TV remote control, the laptop and the iPhone mostly alone. But it needs social connections – especially with the family – like oxygen. When something goes wrong with email or your iPhone, it feels like an emergency.
“Bring your iPhone to the lobby,” I wrote, then got into the car. I think I thought the nursing home staff would let me fix my mother’s iPhone. From a safe distance. Of course, I should have called and asked an employee to fix their phone instead. But I couldn’t think of it. It was a crazy time and none of us think clearly. When I reached the facility and saw a bright red stop sign on the door, I was briefly brought up, however stupid.
For many of us, this has become a life with older parents and grandparents in this world without visitors and at a distance. In our joint efforts, it makes sense to slow the spread of the coronavirus pandemic and protect the people most affected by the disease. In China, nearly 15 percent of 80 year olds and 8 percent of 70 to 79 year olds died of Covid-19. Nobody wants this virus to affect nursing homes in the United States or elsewhere.
But at what cost? Social isolation and loneliness can also lead to health problems. It is quite possible – even likely – that the forced isolation would protect you from the coronavirus over time, which would worsen other aspects of your health.
“Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day,” wrote Vivek Murthy, a doctor and former US general surgeon recently. “Loneliness is also associated with a higher risk of cardiovascular disease, dementia, depression and anxiety.”
When it comes to the coronavirus pandemic, geriatrician and epidemiologist XinQi Dong told me that we should really focus on the “unintended consequences of social distance” as well as the disease itself.
I called Murthy to discuss the topic more. The 19th general surgeon Murthy recently focused on the health effects of isolation. (His book, Together: The healing power of human connection in a sometimes lonely world, to be released next month).
Loneliness can affect older people at three levels, Murthy said. First, it can exacerbate physical problems that you may already be dealing with by creating chronic stress that “can put a significant physical strain on your body”. Second, isolation can have practical health implications: you may not have anyone to help you get to your doctor’s appointment or remind you to take your medication. And third, it can affect them emotionally, especially when close friends have died or when they are physically restricted by arthritis, for example, and cannot easily come out to visit people.
Like all of us, older people need a variety of relationships to ward off loneliness. They need deep connections to people they know well (a spouse / partner, family member or very close friend), connections to friends on a social level (e.g. friends with whom they eat regularly) and a connection to one Community (church or groups with common interests such as knitting or handicrafts). All three types of relationships are important, and even if a person has two of these connections, but not the third, Murthy said, he or she will experience loneliness.
My parents – and other elderly people who are banned from the coronavirus pandemic – are now missing at least one of these connections, and probably more.
Until the lock on March 12, my mother visited my father in the nursing home every day. My two parents are still clear and feel the pain of separation and isolation. Fortunately, I was able to show both of them how to use FaceTime before I left. I assured my mother that I would bring the essentials and encouraged her to get in touch with the other residents. And to FaceTime us. “Just press the green button with the movie camera icon,” I said.
You would be fine, I thought. My father was due to be released from the community in less than two weeks. He had worked hard in physiotherapy at the nursing home’s rehabilitation center to regain his strength and overcome some of his Parkinson’s-like symptoms. Nevertheless, he would move home through the assisted living facility (which is affiliated to the old age community). At that point, I thought my mother could visit him there every day – without even going outside.
A few days later, the senior citizen’s residence had to forbid residents to exchange information for their own safety. They also closed the dining room. Meals would be delivered to their homes where they would eat alone.
My mother FaceTimed me. “It’s hard,” she said resignedly, “but probably for the best.”
I had to remember that too.
I also remembered that my parents are lucky. Although they cannot see me or other family members, their respective facilities are staffed with caring helpers, and my mother has lived in the community for long enough to connect with many of them.
After dropping my father off at the assisted living facility (and sobbing when I said goodbye), a friend whose husband is an emergency doctor at a Virginia hospital tried to cheer me up. She pointed out that by accepting isolation, older people and their carers are actually doing a feat. By staying healthy (hopefully), they prevent intensive care units in the hospital from being flooded. The bravest generation essentially makes one final sacrifice.
“Anyone who can stay out of the hospital makes a real contribution,” she said, “and it’s valuable.”
How long do they have to do this feat? And really, how long must one of us stay isolated and wake up to more of the same thing every day like Bill Murray’s character in the film Marmot day?
I remember an aphorism: we can go through hell if we know what day it ends. But when is this day with coronavirus?
This question is increasingly asked nowadays. David Katz – a public health doctor and founding director of the Yale-Griffin Prevention Research Center – sparked controversy last week when he was suggested Gradually relax restrictions on low-risk individuals while protecting higher-risk individuals to increase herd immunity to the virus. In an interview, he told me that he was being driven to develop his to plan Partly out of concern for his parents, who are in their 80s. He said his mother’s greatest fear was that she would die of something – coronavirus or anything – before she could hug her grandchildren again.
In the meantime, the challenge for all of us is to maintain emotional connectivity while remaining physically separate.
“It’s really about communication,” said Dong. “It depends on the basics. Older people are no different from other people who are isolated. They want to feel loved, valued and valued. Sometimes a little gesture is really a wonderful thing. Kind words can go a long way to ensure this emotional connection. Really focus on your needs and you can meet those needs. “
Phone calls are good, but they can be confusing for people with cognitive loss and almost impossible for people with hearing loss like my mother. FaceTime, Skype, and Zoom video calls are also good because they give a sense of visual connectivity, but only if the elderly are tech-savvy or need help when the technology fails.
“We don’t focus enough on how important and strong the connection is for the health and well-being of older people,” said Murthy. “If we realized how powerful it was, I think we would prioritize enabling social connections in such facilities.”
This means that seniors have isolated access to technology (smartphones, iPads, computers, internet access) as well as employees who can teach, help and troubleshoot.
Beth Baker, journalist and author of two books on aging, suggests returning to old-fashioned lines of communication – writing letters and sending pictures, which can be especially important for people with dementia. Sending home-made cookies or flowers is also good if seniors allow it in this age of coronavirus.
“An advantage of using non-digital and non-electronic communication channels is that the person can keep the letter and go back and read it over and over again,” she emphasized.
Baker is now prevented from seeing her 6-year-old granddaughter, who lives 2 miles away. That’s how the two penpals became.