Since coronavirus came to my hometown two weeks ago, the virus has continued its march across the country and around the world. People are scared for themselves, with good reason, but many of my peers are also worried about their aging parents, especially those living in nursing homes.
My friend "Julia," for example, who asked not to be identified to protect her mother's privacy, lives three states apart from her 82-year-old mother, who lives in a nursing home. "I am worried because you have a group of people, many with compromised immune systems, being in very close contact with different staff members," she told me in a text exchange. While Julia said she is confident the nursing home is doing its best to limit infection, her biggest concern is that "someone may be carrying the virus and not know."
Julia's fear is not unfounded. We know that COVID-19, the respiratory illness caused by coronavirus, can be especially severe in seniors.
Data from China indicates older adults are at an increased risk, according to Nancy Messonnier, M.D., the director of the CDC's National Center for Immunization and Respiratory Diseases. She said in a teleconference that the heightened risk begins at age 60, with those 80 years and older "at the highest risk of serious illness and death." Others at high risk include those with "serious long-term health conditions," including diabetes and heart or lung disease.
While the CDC has issued some specific guidance for seniors and other at-risk groups, such as avoiding crowds, cruises and non-essential air travel, most Americans have been left on their own to puzzle through how to keep the oldest adults safe during this pandemic.
I recently reached out to Christina Chen, M.D. a geriatrician based in Minnesota and a member of HealthyWomen's Women's Health Advisory Council, and Brian Yeaman, M.D., a primary care physician in Oklahoma, for advice on translating this general guidance into practical choices to keep our parents and older loved ones safe.
Remember the Basics
The U.S. is still at least a year from developing a coronavirus vaccine, so the best weapon we have, even for high-risk groups, is prevention. Adult children can remind parents that regular hand-washing, not touching one's face, using hand sanitizer after touching surfaces outside the home and staying at least three feet away from anyone who is coughing or sneezing are all basic steps they can take to protect ourselves.
And though we're focused on the threat of coronavirus, we should remember that influenza is fatal for tens of thousands of seniors every year. During last year's flu season, for example, adults over 65 accounted for 75% of all flu fatalities — that's more than 25,000 deaths. While getting the flu shot may seem like a no-brainer for this age group, an estimated 31% of Americans over age 65 did not receive a flu shot in 2018, according to the CDC's National Center for Health Statistics.
"It's not too late to get the flu vaccine," advised Chen in an email to HealthyWomen. "The flu vaccine does not protect from the coronavirus itself, but it protects you from getting an illness that creates similar problems." Dr. Chen also advised older adults to receive routine immunizations according to the CDC guidelines, including the pneumococcal vaccine, which can help prevent pneumonia and meningitis.
While you may assume that your parents or older neighbors have, in fact, received their vaccines, it doesn't hurt to ask. It may be they intended to get the vaccine but never got around to it. A nudge in the right direction may be just what they need. Better still, offer to make the appointment and drive them.
Health Is More Than Avoiding Illness
Focusing on infection prevention is an important step, but it shouldn't cause seniors to lose focus on the many other elements that contribute to health. According to Chen, living a full and active life has a profound influence on our health.
"We should go about our days and routines normally — with extra precaution to health hygiene during this time — understanding that our behaviors and lifestyle have a substantial impact on our general wellbeing and immune system," explained Chen. "Exercising a healthy lifestyle such as maintaining a balanced diet, maintaining functional independence, proper sleep and compliance to medications all have a role in this."
When communicating with aging parents, also ask about their ability to stock-up on supplies, as the CDC has recommended, including a three-month supply of medication. Do they need help renewing or picking up prescriptions?
While you're at it, make sure you understand what medications they are taking. It's helpful to have a written list, which includes dosage information, in the event that they are hospitalized.
Given the vulnerability of the elderly, at least one state and one federal agency have already taken steps to limit nursing-home visitors. In his address to the nation on March 11, President Donald Trump said the federal government is "strongly advising" nursing homes to stop "all medically unnecessary visits." Even with these restrictions, seniors should strive to avoid isolation.
"Precaution should not mean complete avoidance of staying connected with those around you. We can help [seniors] find ways to stay safe without becoming confined or homebound," said Chen. "It is important for older adults to stay connected with their environment. It helps them maintain function, stay independent and adds to their day to day quality of life."
Yeaman, the primary-care physician, suggested that seniors avoid close contact with children — who may unknowingly be infected — and replace personal visits from the grandkids with video chats.
Take Advantage of Telemedicine
Last year the Centers for Medicare & Medicaid Services (CMS) loosened restrictions for telemedicine for Medicare patients, and this past week Congress passed an emergency aid package that went further, waiving some medicare restrictions on payment and making telemedicine more widely available.
It's a good idea to learn about your telemedicine options now, before your parents or other elderly loved ones need medical care. You may also want to set your parents up with an iPad or other device that will allow them to communicate with medical professionals remotely.
Don't Assume a Caregiver or Health-Care Provider Isn't Sick
We know that COVID-19 is a highly contagious disease — and it doesn't distinguish between doctors and patients. In fact, medical personnel are most at risk of becoming infected, and they don't always have the necessary resources to protect themselves.
And consider this troubling statistic: On average, 61% of healthcare workers are not adhering to best handwashing practices, according to a 2016 World Health Organization study.
"We know as physicians and nurses that we can spread disease," said Yeaman. "During your medical encounters, whether you're in a nursing home or at your doctor's office, assume that even when you see your provider they're like anyone else in the community. You need to continue all your precautions during your medical visits, and afterwards. Wash your hands before and after an encounter with the health care provider," Yeaman advised.
Have That Tough End-of-Life Conversation
No one wants to have conversations about end-of-life decisions, but they are necessary and can spare families a great deal of confusion, conflict and pain. We should all be having these important conversations with our elderly parents and siblings about these issues, and the coronavirus outbreak is a good catalyst to get started.
First, ask if your elderly parent or relative has chosen a health-care "proxy", who can make decisions for them if they are incapacitated. You may be surprised to find that you have been named as a health-care proxy but no one told you! Find out where this document is located, and, for example, if a second proxy has been named in case the first is not readily available.
Second, find out if your parent has created a written advance directive or living will, in which they specify what types of medical treatment they would want (or not want). For example, many people choose to have a Do Not Resuscitate (DNR) order, meaning they would not want aggressive treatment if their heart stopped beating, or a Do Not Intubate (DNI) order, meaning they do not want to be intubated and placed on a ventilator, a form of life support, if they develop respiratory failure.
"Whether its an accident, trauma, chronic condition or acute event like coronavirus, being prepared is really key in terms of making sure your wishes and desires are known about how you want your medical care delivered, should you become critically ill," said Yeaman, who also serves as the director of clinical informatics and workflows for the company ADVault. Through ADVault's MyDirectives, people can create an advance directive and name a health-care proxy, free of charge.
Yeaman added that one common misconception about advance-care planning is that it is a statement that the patient no longer wants care. "That is absolutely not what this is," explained Yeaman. "It's letting your family know what your wishes and desires are and it's an important part of caring."
Once you have located or helped create your parents' advance directive or DNR/DNI orders, it's critically important to share them with other family members, close friends or your healthcare proxy. If a loved one is rushed to the hospital in an ambulance, paperwork filed in a kitchen drawer may easily be forgotten or overlooked. If your parent is in a nursing home, double-check that the nursing home is aware of their end-of-life wishes. And of course, now's as good a time as any to make sure you have these documents for yourself.
This is a scary time, especially for seniors. Stay informed (from reputable sources of information) and advocate for your parent or loved-one. Be sure to check in on them frequently and ensure that they are taking all the necessary precautions.
My friend Julia has gone from calling the nursing home once a week to contacting the staff daily and asking them to monitor her mother more closely.
"I have to trust that the staff have things under control but I really wish I could be there myself," Julia said. "It's hard being so far away from her."
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