COVID-19 has most of the nation practicing “social distancing,” which for those of us not on the front lines of hospitals, grocery stores, or the shipping of goods means spending most of our time inside our homes. In the midst of our physical isolation, those of us able to work from home are learning how to connect virtually with colleagues so we can continue to get work done. I’ve joined in my city’s planning meetings, broadcast by Zoom. We’re also visiting with family and friends—even reconnecting with some with whom we’d lost touch due to busy lives and, ironically, physical distance. These connections have been bright spots in a scary and uncertain time, and I know I’m not alone in hoping that these instincts to reach out to one another will remain even after our period of isolating at home is over. But I also hope it gives us new ideas about reaching out to people for whom isolation was the norm before this pandemic began, particularly older people who are homebound or are otherwise isolated.
As of 2018, nearly 13.5 million people age 65 and over lived alone, including 4.4 million in their 80s and over. As I noted in a recent blog, the number and share of US households in their 80s and 90s is set to grow rapidly over the next two decades—10 million of whom are likely to live solo. At older ages, people spend most of their time at home, and many find it difficult to get out. They may have given up or reduced driving, and their communities lack other forms of transportation. They may fear getting jostled in a public space. Those with mobility challenges or who rely on mobility devices may find the terrain in their neighborhoods or other destinations pose barriers. A subset of these older people are homebound; one 2016 article estimated that almost 2 million people age 65 or over were completely or mostly confined to their homes. For these older adults, isolation was already a concern before COVID-19.
Isolation can imply physical separation from others but also a lack of meaningful relationships. Not only do many older adults live alone, but they are also likely to experience “social isolation” as their networks thin or disperse or if their health prevents them from engaging outside their homes. That is, while those of us practicing social distancing during the pandemic are able to connect with friends and family online or by phone, these older adults may have fewer opportunities for connection. A host of research suggests that social isolation and loneliness (the subjective experience of being isolated) is associated with poor health outcomes, including heart disease, depression and anxiety, cognitive decline, and weaker immune responses. Sadly, as many have pointed out, the public health imperative that we isolate ourselves is at odds with typical health advice. And the guidance to self-quarantine might last longer for frailer older adults and others more vulnerable to COVID-19 until vaccine or treatments are made available.
We’ve learned a lot about the ill effects of isolation—as well as how to weather periods of it—from research on older adults. We’re all benefitting from that now, in the advice that we make sure to socially connect even as we physically distance. Yet when the time comes for most of us to resume “normal” life, many older adults will still be isolated and lonely. I’d like to think that we might have more empathy for their situations, and perhaps we’ll also have new insights into solutions.
Indeed, there are bright spots. While many older adults are well-versed in social media and platforms like Skype or FaceTime, many more are learning and becoming comfortable with these now. Existing research points to positive outcomes for older people using technology for social connection, including improved health and reduced loneliness. Book clubs, exercise classes, religious services, and other more formal gatherings have gone virtual too, offering more opportunities for engagement. However, more research is needed to understand the effects of social technology use, the extent to which it can augment wellbeing (or diminish, particularly should it replace in-person relationships), and the effects of various types of virtual connection (e.g. one-on-one conversations versus use of sites like Facebook). In addition, while it is often assumed that it might be difficult to convince older people to adopt new technology, barriers may in fact be physical, related to sensory or mobility challenges. In a recent interview, Geoffrey Hoffman, a professor of nursing at the University of Michigan, noted that arthritis prevented his own relative from operating an iPad. Yet surely there are interventions that would address these challenges, such as voice recognition.
Another positive that might emerge from the pandemic relates to the delivery of food, medications, and health. As grocery delivery systems have popped up or expanded, perhaps there will be more avenues for home delivery and/or seniors’ hours can in some way continue for those who can or prefer to go to the physical store. Telehealth has taken a giant leap forward in recent weeks, and the recent $200 million appropriation for telehealth services that is part of the CARES Act will propel it further. Teletherapy is expanding as well, and is itself an intervention that can help people cope with isolation. Yet we will need to continue to address inequalities that prevent even virtual connection (such as a lack of access to high-speed internet or hardware).
On the non-technology side, there are new efforts to check in on and support older people isolated at home during the pandemic. In the UK, over 750,000 people signed up to deliver food and medicine to older residents and other vulnerable people. All over the world, people are offering similar help to neighbors, friends, and older relatives, or just making an extra phone call to check in.
More formally, intentional communities may help address isolation, including service-enriched housing tailored to older adults as well as various forms of shared housing developed with a community ethos. In addition to providing certain conveniences and supports, service-enriched housing tends to offer a range of opportunities for engagement, onsite and off, with fellow residents and others. While people living in these communities may not be able to socialize in person during this pandemic, the support systems embedded within them are making it easier for older residents to get groceries, medications, and other services—as described in the COVID-19 response of 2Life Communities, a non-profit operating in the Boston area.
Finally, there are many homebound older adults who might—in normal times—be able to become less socially isolated were it not for physical barriers presented by their own homes. Low-tech interventions like those offered by the CAPABLE program of Johns Hopkins School of Nursing can help. CAPABLE employs a nurse, handyperson, and occupational therapist to modify and repair accessibility barriers in the homes of low-income older adults, including those related to entry and exit, and helps older adults gain greater strength and balance (see “Mrs. B.’s Experience” with CAPABLE).
With the creativity we’re using to solve our own challenges of societal isolation during the COVID-19 pandemic—and to support the older people in our lives—we can take great strides in improving the lives of older adults who are and will be vulnerable to social isolation in the future. Many promising paths already exist, but will need our ongoing energy and commitment.