Competing crises: COVID‐19 countermeasures and social isolation among older adults in long‐term care

Abstract

While debate over the appropriate scope and goals of COVID-19 lockdowns has raged, all public health agencies have been clear on one matter: older adults have the highest rates of mortality (Comas-Herrera et al., 2020) and should be isolated (Public Health Agency of Canada, 2020). Older adults and individuals with complex health conditions are most vulnerable to the virus. Yet, social isolation contributes to the onset and intensifies depression, feelings of despair and, in older adults with dementia, further cognitive decline. Older adults living in long-term care (LTC) facilities comprise 79% of the COVID-19 death toll in Canada (Rothan & Byrareddy, 2020; Walsh & Semeniuk, 2020). While our failure to protect longterm care (LTC) facilities has been made apparent both by this high mortality and a shocking recent Canadian Armed Forces Report (Mialkowski, 2020), the singular focus on mortality has overshadowed any attention to morbidity-particularly the effects of physical distancing on health, quality of life, and autonomy. Annual mortality COVID-19 countermeasures like physical distancing involves a balance of risks for older adults living in LTC facilities. The COVID-19 epidemic has upended many assumptions about the safety, health, and well-being of older adults and revealed numerous areas for collaboration, innovation, and improvement. Within this crisis lies an opportunity for nurses to start a deeper conversation about autonomy and values and how to restore person-centred care in LTC facilities.

Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands

“…It is argued that virtual contacts cannot replace face-to-face interactions (Vernooij-Dassen, Verhey, & Lapid, 2020) and are difficult to implement for residents with cognitive problems. However, examples in our data (with residents having more than usual contacts with their family) and examples in other countries (Chu, Donato-Woodger, & Dainton, 2020) advocate for the use of teleconferencing in the post pandemic era as well. From the perspective of social health, communication is an 41106 (43) N is presented for participants who answered the question about the increase/decrease of challenging behavior.…”

“…important factor to support participation in society (Kales, Gitlin, & Lyketsos, 2015). Postal cards, written letters of strangers (Chu et al, 2020) and other increased attention from the outside world are other examples of communication strategies to combat social isolation of residents. COVID-19 measures made it impossible to provide many interventions such as group activities.…”

The Impact of COVID-19 Measures on Well-Being of Older Long-Term Care Facility Residents in the Netherlands

“…The implementation of the measures has reduced the incidence of COVID-19 infections and thus the number of deaths in LTCFs; however, a better balance between physical safety and well-being is necessary, as social isolation is a serious health threat for older residents and increases the risk of mortality. 6 , 7 During a Dutch pilot, the cautious opening of nursing homes using a Dutch guideline adapted to the local context, did not lead to new infections. 8 As social contact and meaningful daytime activities are essential for LTCF residents, 9 , 10 LTCFs should implement policies on allowing visitors and continuing daytime activities as much as possible in times of COVID-19.…”

Covid-19 and Priorities for Research in Aging

“…Older adults are experiencing increased stress and mental health challenges resulting from their increased vulnerability to the virus and the strict isolation requirements that have been imposed during the coronavirus crisis (Chu, Donato-Woodger, & Dainton, 2020;Steinman, Perry, & Perissinotto, 2020). Recreation and stimulation programs in residential living and long-term care homes have also been temporarily discontinued further increasing isolation and loneliness.…”