The COVID-19 disease, in itself, has hit older adults harder than other age groups.

Older adults are more likely to already have underlying conditions such as cardiovascular disease, diabetes, or respiratory illness — comorbidities that we now know raise the risk of severe COVID-19 and COVID-19-related death. In addition, a likely weaker immune system makes it harder for older adults to fight off infection.

As a result, the impact on older adults is notable. According to World Health Organization (WHO) data from April 2020, more than 95% of COVID-19 deaths were among people over 60 years of age, and more than half of all deaths occurred in people of 80 years-plus.

In Sweden, for example, 90% of the deaths from COVID-19 were among people more than 70 years of age.

The Chinese Centers for Disease Control and Prevention offered data in March showing an average COVID-19 case fatality rate of 3.6% for adults in their 60s, 8% for those in their 70s, and 14.8% for people 80 years and above.

“Older adults are at a significantly increased risk of severe disease following infection from COVID-19,” said Dr. Hans Henri P. Kluge, WHO Regional Director for Europe in a WHO press briefing, who added:

“Supporting and protecting older people living alone in the community is everyone’s business.”

COVID-19 deaths in care homes

While the wider community should indeed be preoccupied with the health and well-being of older adults, there are epicenters to the current crisis, and nursing homes, alongside hospitals, are one such place.

The United States Centers for Disease Control and Prevention (CDC) warn that “nursing home populations are at the highest risk of being affected by COVID-19,” compounding not only the risk for older people but also placing care workers at risk.

The New York Times (NYT) gathered recent data showing that in the U.S., at least 28,100 residents and workers have died from a SARS-CoV-2 infection in a nursing home or in another long-term care facility for older people.

Overall, more than a third — that is, 35% — of all COVID-19 deaths in the U.S. occur in long-term care facilities, comprising residents and workers.

Living with dementia during COVID-19

According to the CDC, at least half of the older adults living in these care facilities have Alzheimer’s disease or other forms of dementia, which makes it more difficult to contain possible infections with the new coronavirus.

One of the specific challenges for people living with dementia and similar forms of cognitive impairment is that they may have difficulty understanding the dangers of infection. Also, they may forget to follow safety precautions, such as washing their hands or practicing physical distancing.

Those who care for people with dementia and have contracted the virus may also avoid seeking treatment or being hospitalized because they cannot afford to leave their elders alone.

On the other hand, people with dementia themselves who have COVID-19 and need hospitalization may avoid it because they fear that, due to hospital triaging protocols, they may fall at the bottom of the ladder when it comes to receiving medical resources and attention.

Pandemic exposes ageism, gaps in care

Some have suggested that ageism — that is, a discriminatory attitude towards people of more advanced age — may have significantly contributed to the detrimental effects on the health and longevity of older adults with COVID-19.

For instance, Joan Costa-Font, an associate professor at LSE’s department of health policy, suggests that countries that tend to view their elders with more respect have implemented physical distancing measures more promptly, even if such measures primarily impacted the social lives of younger people.

“Differences in social perceptions underpin the social environment in European countries where we have observed delays in policy interventions, such as lockdown, (which are detrimental to the social lives of younger cohorts), and why countries like China implemented more stringent measures.”

– Joan Costa-Font

However, it is worth noting that other countries, for example, Japan, where there is a tradition of respecting the elders, did not choose to have a lockdown.

According to the same author, “a delayed introduction of a lockdown is not the only way we reveal the low social value of older individuals.”

The COVID-19 pandemic has also shown how poorly funded, and disorganized long-term care facilities are in several European countries. In the U.K., for example, a government study that used genome tracking to investigate the spread of outbreaks has only recently discovered that temporary staff had unwittingly spread SARS-CoV-2 between care homes as the pandemic grew.

As a result of this revelation, some politicians have said the pandemic “brutally exposed how insecure, undervalued, and underpaid care work is,” with “the prevalence of zero-hours contracts, high vacancy rates, and high staff turnover” having all contributed to the pandemic.

Mental health and elder abuse

Loneliness is a known factor that negatively affects a person’s mental health and well-being, and some older adults were already at a higher risk of experiencing it. Deteriorating health or the death of partners and friends may get in the way of maintaining a healthy social circle.

However, the pandemic and the quarantine heighten this risk of loneliness.

“Loneliness is a complex, subjective emotion, experienced as a feeling of anxiety and dissatisfaction associated with a lack of connectedness or communality with others,” explain Joanne Brooke and Debra Jackson in a paper appearing in the Journal of Clinical Nursing.

The authors go on to highlight the importance of loneliness and social isolation for mental and physical health.

“The acknowledgment of social isolation and loneliness of older people is essential and paramount due to the detrimental impact on their physical and mental health, which has been recognized for over two decades. Social isolation and loneliness increases older people’s risk of anxiety, depression, cognitive dysfunction, heart disease, and mortality.”

— Joanne Brooke and Debra Jackson

What is more, emerging reports have shown that lockdowns raise the risk of abuse among older people.

During the pandemic, older adults have become even more dependent on their caregivers, and, in a pattern similar to the one that has raised the rates of domestic violence, some caregivers have used the pandemic to exercise their control and abuse further.

Elder abuse tends to occur more frequently in communities that lack mental health or social care resources. The perpetrators of the abuse also tend to have mental health problems, as well as reporting feelings of resentment with their informal caregiving duties.

According to a recent paper appearing in the journal Aggression and Violent Behavior, people who experience “elder abuse” are more likely to develop mental health problems such as depression, high stress, and self-neglect — conditions that can only be made worse by lockdowns.

Overall, lockdowns mean that more elders are trapped with their abusers, that some perpetrators of abuse reluctantly find themselves in a caregiving role, and that, as a result, there is a higher need for mental health and community support services.

Medical reference: Medical News Today