Nobody would deny that 2020 resulted in less-than-perfect health.
The effects on the senior population arguably have been the most significant. Isolation, fear and loss have had undeniable effects not only on older adults’ mental health, but also on their physical health. The sudden change to a sedentary lifestyle and a lack of preventive / maintenance care or attention to underlying medical conditions — such as diabetes, hypertension and obesity — created a rapid deconditioned state that worsened their current comorbidities and created new ones.
Naturally, as fear of hospitals and other medical facilities grew, avoidance of treatment followed, and a deterioration of organic disease states rapidly grew. Now that the immediate threat is subsiding due to vaccinations, the focus for older adult healthcare can be redirected to the management of chronic diseases and the removal of barriers that prevent a return to their previous, active lives.
It is well-known that inflammation is a driver of pain and that untreated or undertreated disease processes increase inflammation. Uncontrolled disease processes such as diabetes, hypertension and obesity cause a systemic inflammatory response in the body, which in turn increases overall pain. In a population that already has functional limitations, chronic and worsening pain only increases the resistance to mobility, further decreasing motivation, inspiration and independence, and amplifying what already can be a tenuous mental state for older adults.
On the flip side, adequately treating pain by focusing on the prevention of underlying inflammation creates a natural pathway to complete health and, ultimately, disease control. The ultimate goal of pain control is not just to make someone feel comfortable; instead, it is to improve quality of life by improving mobility.
When someone is pain-free, he or she is more open to exercise and overall movement, thereby resulting in weight loss, better glycemic control and an improvement in mental health and cognitive function. As the individual reaches immunity, however, he or she will become more interested in medical treatment for past and present disease, but especially pain, which will cause an influx of desire for care without enough medical availability to serve the need.
The rise of telehealth
Changes to the platform of medical care have increased access to care across all demographics. The technology limitations specific to the older adult population have created some unforeseen challenges, but for the most part, the change has been welcomed.
Telehealth visits have moved from a small fraction of the patient visits to greater than half in some senior living communities and other long-term care facilities. Although some have resisted this change, others have embraced it with overwhelming acceptance, especially in places where mobility and transportation are issues.
Although virtual care has its limitations, it does provide an option of care for those who are still fearful of seeking medical treatment. From the perspective of the healthcare professional, its use also has encouraged a return to the collection of a thorough history from the individual, to help identify conditions by symptoms and not just signs and diagnostics, and allowing the patient to feel “heard.”
Although telehealth supports the medical management of people’s conditions, it never can replace the face-to-face visit. One does not negate the other; instead, they work in synergy to provide an effective “medical home” for all older adults.
Expand our approach
For physicians and other healthcare providers, it is important not to become myopic in caring for older adults as the pandemic wanes. Instead, we must broaden our lens of practice.
The goal in any treatment program is to reduce symptoms, maximize function and optimize quality of life. The approach to the older adult who has been deconditioned by the pandemic is to recognize the disease processes, identify modifiable behaviors and elements of change, and develop targeted treatment plans, making sure not to overlook the role of inflammation and pain in overall function.
It is important to take the time to help the individual optimize his or her quality of life by identifying what quality of life means to that individual, so as to promote not just buy-in, but motivation for change. As we move forward, let’s no forget to reflect on the lessons learned, the knowledge gained and the progress made in the midst of adversity, questioning not what brought us here but instead looking ahead to where we will go.
Frederick Mark Paz, M.D., is an an accomplished, award-winning physician with a comprehensive background in occupational and internal medicine. He provides professional services in occupational and internal medicine, including primary care medical treatment and management of injured workers, in the greater Denver area.
The opinions expressed in each McKnight’s Senior Living guest column are those of the author and are not necessarily those of McKnight’s Senior Living.