The medical community and society at large are still absorbing lessons from the COVID-19 pandemic, but for UCI Health geriatrician Dr. Lisa Gibbs, it highlighted the longstanding bias against older people.
“We’ve known for many years that ageism is part of the healthcare system — the assumption that older people aren’t resilient is implicitly ageist,” says Gibbs, chief of geriatric medicine and gerontology and the Ronald Reagan Endowed Chair of Geriatrics at the UCI School of Medicine.
The thoughts that perhaps older patients can’t recover from a major illness, that pain is just a part of getting older or that we shouldn’t look further and do more simply based on a person’s age have been problematic for years, says Gibbs.
But during the pandemic, Gibbs says this bias became more overt, with some hospitals making plans for rationing medical care — such as prioritizing the treatment of younger adults before older adults. Embedded in these plans was the value judgment that young peoples’ lives are worth more because they presumably have more years left to live.
“As geriatricians, we are advocates for older adults and we fight ageism every day,” she says. “We reject the idea that loneliness, depression, pain and frailty are just part of growing older.”
Mental health declined
The pandemic took a heavy toll on older adults, and not just in lives claimed.
Living in a society that was shut down for over two years had a profound emotional and mental effect on seniors, especially those in assisted living communities and nursing homes, says Gibbs.
They suffered in many ways, not just from the virus, itself, including:
- Isolation and loneliness
“You can be isolated without being lonely and you can be lonely surrounded by a group of people,” says Gibbs. “Unfortunately, during the pandemic, our seniors suffered from both. People in nursing homes, especially, were alone in their rooms for weeks at a time with food shoved through a barely open door and without visitors.”
- Depression and anxiety
“Depression in older adults is not considered a normal part of aging, but we did see increasing loneliness that contributed to increased depression during the pandemic,” says Gibbs.
Major depressive disorders generally occur in 1% to 5% of people over age 65. It worsens as people require more home healthcare and is highest among nursing home patients. Gibbs says those numbers increased significantly during the pandemic.
An August 2020 Kaiser Foundation study found that 24% of adults aged 65 and older reported anxiety or depression. This rate stayed steady throughout the pandemic and was more than double the 11% reported by Medicare in 2018.
- Higher suicide rates
Unfortunately, Gibbs says, this increased depression and anxiety among older adults led to higher suicide rates. She urges friends, neighbors and family members to be alert to the following suicide risk factors in older adults:
• Older men have almost double the rate of suicide than women, especially after age 65.
• Older adults are most likely to die in suicide attempts.
• Firearm availability doubles the risk for suicide and death.
• Disruption of social ties increases the risk.
• The risk of suicide is higher in the first year after the loss of a spouse.
• Profound physical illness also increases the risk of suicide.
• Older adults who are functionally impaired are a greater risk for suicide.
• Substance use or abuse can also be a contributing risk factor.
More than 1.1 million Americans have died from COVID-19. The U.S. Centers for Disease Control and Prevention (CDC) reports that 75% of those deaths were in people over 65. Because they suffered more deaths than any other age group, the pandemic leaves behind many bereaved loved ones. “Our patients are still trying to navigate their grief and heal,” says Gibbs.
Connections foster resilience
“Engagement in community has been shown to help seniors bounce back,” Gibbs says.
According to studies cited in the recently published Orange County Strategic Plan for Aging, a sense of purpose and social connectedness are key factors to recovering and maintaining mental health, she adds.
“One study showed that older adults who belong to a community felt lonely only 26% of the time compared to those who were not engaged at 39%.”
The California Health Interview Survey (CHIS, 2015-16) showed that people who had volunteered in the previous year were substantially less lonely (28%) than those who had not (40%).
“We can prescribe medicines and therapy, which are sometimes helpful, but just being active in your community and having a purpose is absolutely huge,” she says.
From fitness to frailty
Like most of the population, the pandemic also brought a decline in the physical health of older adults. Four areas for special concern are:
- Diminished care and quality of life
Seniors experienced a lack of caregiving. Sometimes caregivers were ill themselves or needed to stay home with children and other loved ones. Some people were afraid to admit caregivers into their homes out of fear of exposure to COVID-19. Whatever the reason, this led to a diminished quality of life.
- Worsening medical conditions
Many people were too frightened to seek healthcare or could not get an appointment with their healthcare providers. This delayed routine screenings, tests and preventive care, often for serious conditions such as heart disease or diabetes, which contributed to worsening health in this age group.
- Weight gain
When told to stay home and practice social distancing, many seniors stopped walking and generally became less physically active, which led to weight gain.
“The ‘COVID 15’ phenomenon did not skip seniors,” says Gibbs. “We have many patients coming into the office who gained 15 or more extra pounds because of the lockdown.”
This extra weight may exacerbate health conditions such as heart disease, stroke, high blood pressure, type 2 diabetes, osteoporosis and arthritis. It can also lead to sleep apnea and respiratory difficulty.
- Decreased physical activity
The lack of exercise and physical activity took an enormous toll on older adults, who lost muscle mass and overall fitness. Muscle mass peaks around 25 to 30 years of age. After that, adults lose up to 8% of their muscle mass per decade.
“When people lose enough muscle mass, we call it sarcopenia," Gibbs says. “Unfortunately, 20% of community-dwelling adults under age 70 and more than 50% of people over 70 experience this skeletal muscle disorder. Sadly, it’s associated with increased adverse outcomes, including falls, functional decline, frailty and mortality.”
After three years of pandemic life, a lot more people went from being fit to becoming frail — a condition when people lose so much muscle mass and strength that they’re no longer able to function well in their daily lives.
“This has wide concern for geriatricians because it leads other geriatric syndromes and to more frequent falls, fractures, delirium, cognitive impairment and even incontinence,” she says. “Frail patients who have surgery are also at increased risk for death, disability and for longer hospital stays and frequent readmissions.”
Regaining physical fitness
There is some good news: frailty is reversible, but you must be consistent.
“One study showed gains in physical strength, mobility and function and a 15% decrease in frailty at 12 months,” Gibbs says. “They didn't see this effect at three months, but instead at 12 months — which shows that fitness really needs to become a lifestyle.”
Gibbs strongly advocates for age-friendly exercises, which means starting out slow and gradually building strength to avoid injury. For those that have joint pain or specific areas of concern, ask your doctor for physical therapy. She also recommends support groups for weight loss and fitness trackers to stay motivated.
“We need to remember that we've all been under extreme stress and strain these last three years, especially older adults who have suffered the most,” she says. “We also need to understand that learning how to be resilient will require physical, emotional, spiritual and community work.”