Chiropractor Chandler AZ

Social Isolation: A Second Pandemic Hastening Functional Decline in Older Adults

There is no question that older adults, particularly those with chronic medical conditions, are more vulnerable to the Covid-19 virus than younger individuals. Because of this, many seniors are sheltering in place. Unfortunately, self-isolation carries its own risks, including depression and functional decline due to decreased intellectual stimulation and physical inactivity.

Researchers have dubbed this phenomenon the COVID-19 Social Connectivity Paradox (Smith et al., 2020). Many older adults who previously took care of grandkids, volunteered in the community and continued working in their careers have been forced to give this up in order to protect themselves from infection. If you have older adult patients, now is the time to take measures to protect them against various forms of functional decline that may be irreversible in the post-pandemic world.

Being aware of this “second pandemic,” there are a variety of assessment tools to help you identify persons who may be at risk. The UCLA Loneliness Scale includes two short forms, that condense the original 20-question tool into either three or ten questions. The Duke Social Support Index is an alternative clinically-validated tool. If you suspect a person is experiencing rapid functional decline, using one of these two assessments can help you to identify the need for behavioral intervention.

The National Council on Aging (NCOA) Resources for Professionals includes toolkits, webinars and factsheets to help providers deliver their services virtually. PEARLS (Program to Encourage Active, Rewarding Lives) is a program developed by the University of Washington School of Public Health to combat late-life depression due to social isolation. The program trains front-line social service providers to teach older persons how to achieve a ‘new normal’ as they age: a very relevant topic in the wake of the pandemic (Smith et al., 2020).

Although loneliness and depression are the obvious consequences of social isolation, physical decline is equally significant. Your patients who previously met with friends to walk, bicycle or perhaps engage in a friendly game of pickleball are now staying at home, losing strength and agility in the process.

If you have an older client that you haven’t seen in awhile, reach out to that individual by phone to enquire about their activities. Although social distancing is paramount, it may be possible to engage a family member who your patient trusts to be vigilant, to check in personally and report back (Steinman et al., 2020).

Older adults who are self-isolating may not be eating well either, since they are afraid to go to the grocery store. If this is the case, your local area Agency on Aging may be able to help with food delivery services (Steinman et al., 2020).

Persons at increased risk are seeing their primary care physicians and specialists less often than normal, which means that serious medical problems are going undiagnosed and untreated. Telemedicine is helpful, but not necessarily a perfect solution for individuals who have sight impairment or hearing loss. Make sure that your patients are wearing their hearing aids and using their telephonic adaptive devices. Again, a friend or family member can be invaluable in this situation, to visit your patient in person and assist him or her with any technical difficulties that arise from hearing, vision or cognitive impairment (Steinman et al., 2020)

Finally, there is evidence that delirium is a frequent consequence of COVID-19, particularly for those with severe infections. Unfortunately, neither delirium nor mental health are routinely assessed in patients hospitalized for COVID-19.

According to O’Hanlon and colleagues, delirium is considered the ‘barometer’ for severe illness in older adults (O’Hanlon & Inouye, 2020). Furthermore, antipsychotic medications typically used to treat delirium come with their own set of problems. Therefore geriatric physicians recommend behavioral interventions first: reorienting communication, mobilization and relaxation exercises (O’Hanlon & Inouye, 2020).

Granted, some of this may be outside your scope of practice. But it is important to be aware of the downstream consequences of the pandemic, so that you can advise and refer your patients appropriately. Keep your older patients in a communications loop, and don’t assume that no news is good news. They will appreciate your concern more than you imagine.

References

O’Hanlon S. & Inouye, S. (2020). Delirium: a missing piece in the COVID-19 pandemic puzzle. Age and Ageing, 1-2. https://doi.org/10.1093/ageing/afaa094

Smith, M., Steinman, L. & Casey, E. (2020). Combatting Social Isolation Among Older Adults in a Time of Physical Distancing: The COVID-19 Social Connectivity Paradox. Frontiers in Public Health, 8(403) 109. https://doi.org/10.3389/fpubh.2020.00403

Steinman, M., Perry, L. & Perissinotto, C. (2020). Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic. JAMA Internal Medicine, 180(6) 819-820. https://jamanetwork.com