We’re starting a new year, and the pandemic still rages on. Its complete demise never was guaranteed, but there was a quieted optimism that the virus would be largely improved by now. On the contrary, cases are on the rise and experts warn that we’ll likely see a resurgence in these winter months.
The possibility of a second wave is anxiety-provoking for the general population, yet it also elicits many questions for long-term care executives and staff members. How many more cases and deaths might we expect? What could this mean for at-risk populations who already have been disproportionately affected by the virus?
The coronavirus has been hundreds of times more deadly for people over 60 than any other age group. Physically, this makes sense. Older adults have weakened immune systems that are more vulnerable to new microorganisms they’ve never experienced before. Physician and immunobiologist Janko Nikolich-Zugich, M.D., Ph.D., calls this “the twilight of the immunity.”
But what we don’t talk enough about is an issue that has long since been present among seniors and has only been exacerbated by the virus: loneliness and social isolation.
The idea that mental health is directly tied to our physical well-being isn’t new, but the severe effects of loneliness on senior health are becoming more profoundly understood. One study found that its health effects are comparable with that of smoking 15 cigarettes per day, and another found that loneliness can be more life-threatening than obesity. It leads to higher levels of anxiety and depression, is linked to dementia, and results in higher mortality rates.
Even before COVID-19, residents in senior living communities and skilled nursing facilities struggled with feelings of isolation and loneliness. But once the pandemic hit, these settings — their homes — quickly became coronavirus hot spots, accounting for more than 40% of COVID-related deaths in the United States, leading providers to mandate social distancing protocols, ban outside visitations and postpone group activities for residents — as you are all too familiar.
Seemingly overnight, long-term care residents lost their avenues for social contact, and it’s been months since then. I will never forget a story I read in the New York Times about a daughter whose 95-year-old mother-in-law was cut off from the outside world in compliance with social distancing protocols. As she told the New York Times: “I’m concerned that the loneliness and helplessness will kill her quicker than the virus.”
Being barred from seeing relatives, friends and even other residents may be a necessary safety precaution, but at what cost? COVID-19 has shown us how fundamental our social connections are, both for our mental and physical well-being. Just as the economy will feel the effects of a recession for years to come, the same can be said for people placed under social restrictions for too long. The solution to this isn’t waiting for normalcy; it’s about creatively addressing the loneliness epidemic in any safe way we can.
An emphasis on person-centered care
In clinical settings, it’s easy to get wrapped up in the cycle of consult-treat-leave. Healthcare professionals want to treat the ailment, but they don’t always remember to treat the person.
The pandemic has shined a spotlight on why we need a more holistic approach to care. Nurses need to check in with residents more frequently about how they’re feeling. The UCLA Loneliness Scale is a great tool that gauges when someone should be assessed for depression and other cognitive impairments based on their feelings of isolation. This outlook requires supporting staff to be more proactive and less reactionary.
Technology also can play a huge supporting role in enhancing care. Telehealth and video visitations, for example, help to ensure residents get access to safe and convenient care while also maintaining a strong sense of connection with friends and family. But the effects of tech on health outcomes go much deeper than that.
You likely have seen films depicting what society will look like once we live alongside robots. Movies such as “Robot and Frank” illustrate how technology can help us live more independently, even in old age. Although we’re not quite at this level of science fiction yet, it does raise a good point about how robots and artificial intelligence can benefit senior living and care through digital companionship.
Mobile robotic telepresence, or MRT, systems are perhaps the most familiar invention to us. They’re essentially video screens on wheels set at human-height. Residents can “visit” with their relatives and other specialists through these devices; although virtual, MRT systems mimic face-to-face interactions better than platforms such as FaceTime and Skype, which can only be done through a smartphone or computer.
Developers also have begun working on even more life-like companions. Robotic pets, which were created as an alternative to traditional pet therapy, are doing wonders for dementia care. These AI “pets” have been shown to reduce anxiety and stress and even have decreased the amount of pain and psychoactive medications required by people with dementia.
And then there’s the future of senior caretaking. Although MRT systems are great for virtual visits and robotic pets can enhance feelings of companionship and happiness, other robots, such as the Care-O-bot and Pepper prototypes answer more pressing needs in the healthcare industry. These AI robotics fill the gaps in short-staffed centers while at the same time combating senior isolation. With all baby boomers expected to reach retirement age by 2031, these robots are a necessary solution to providing the complex care these individuals will require as they age while also halting senior loneliness in its tracks.
This kind of care leads to better health outcomes, and it makes good economic sense, too. The AARP found that social isolation alone is responsible for approximately 6.7 billion in annual Medicare spending. We need to care for residents’ social needs as we would their physical needs to truly offer them comprehensive care — and save on excess healthcare spending in the process.
Social connection is the key to human health and survival. Although social distancing measures may be critical for the safety of the older adults in our care amid the coronavirus, the only way to really ensure their health and happiness through a global pandemic is to accommodate for the loneliness epidemic as well.
Avi Philipson is the head of operations at Axis Health, a consulting company entrusted by long-term care facilities across Maryland and New Hampshire.
Editor’s note: See the articles below for additional information on this topic.
