Identifying Isolation and Building Connections: How Older Adults Cope with COVID-19

Dr. Nirmala Lekhak's study on older adults coping with COVID-19 also puts a spotlight on existing problems this particular population has experienced in recent years

Dr. Nirmala Lekhak's study on older adults coping with COVID-19 also puts a spotlight on existing problems this particular population has experienced in recent years

Pictured: UNLV nursing assistant professor Dr. Nirmala Lekhak

Pictured: UNLV nursing assistant professor Dr. Nirmala Lekhak

Jul. 1, 2020

By Joseph Gaccione and Nirmala Lekhak (Ph.D., RN)

There have been many changes associated with the coronavirus pandemic, from rapid health policy adjustments to academic reshuffling, but one constant concern has been COVID-19’s impact on the older adult population. The virus puts older adults at higher risk, especially those with underlying medical conditions like heart disease and diabetes.  Recent data from the Centers of Disease Control and Prevention shows 8 out of 10 COVID-19 related deaths reported in the U.S. have been adults at least 65 years old.

But what is the extent of this impact? UNLV School of Nursing assistant professor Dr. Nirmala Lekhak is reviewing the effects.  She and her research team (Dr. Tirth Bhatta from UNLV Sociology and Dr. Tim Goler from Norfolk State University) are analyzing the data from their project, “Coping with Coronavirus Pandemic Study”. The purpose of the study is to understand how the coronavirus pandemic is affecting the older adult’s wellbeing and determine the best coping strategies moving forward.

WHAT THE STUDY FOUND

Dr. Lekhak and her team put out a national call for older people to take their survey asking how they were handling the pandemic, from psychological aspects to what they are doing to protect themselves. She says they had at least 2,270 participants in their study from across the United States. Most of them were from healthcare and academic settings equally distributed around the country.

As Dr. Lekhak’s team goes through all the data, one common finding was how participants thought of others as much as themselves. 

“We asked them how worried they are, how it will affect themselves personally. There were more [people] concerned about how it would affect humankind more so than themselves.” She said these people were more focused about their loved ones and the financial security of their family and the nation as a whole.   She said that worry over others extended to participants 50 and older. “They were fearful. They were depressed about what the pandemic is doing. They are worried about getting ill. They're worried about their family members who were living by themselves or having a chronic condition.”

Dr. Lekhak noted about half of the participants felt lonely, depressed, and fearful.  Nearly 15% had to cut back or did not have enough to make ends meet financially. Isolation among older adults is one Dr. Lekhak feels is already prevalent in Western society, but the coronavirus outbreak enhances those feelings.  “They can't really meet their family, talk with them, hug them, celebrate milestones, those kinds of things. That probably will have a psychological impact on them. Not just because of virus, because of that isolation and loneliness.”

Even being isolated isn’t enough to ward off risk of infection for older people, because it’s difficult to tell who’s a carrier, whether it’s a health care worker or a loved one. “If you're living with your grandparents, then it's very easy. They're vulnerable, because they're living with you, and if you're not following certain guidelines (especially when you do not know you may have the virus), then they can get it from you. For older adults living in a long-term care setting, if a staff member is not following the proper protocol, then they can easily transmit it to the older residents. It is especially problematic when staff members are in the early stages of infection and do not show any symptoms yet.” She added, “Older adults living in the nursing homes generally do not have much opportunity to go out and enjoy. Now because of the pandemic, their outing, including visits from family members, is prohibited. The likelihood of contracting the virus from staff members remains. Once it is in, it is very hard to control the spread of virus unless proper isolation and guidelines are followed. The higher death rates in nursing home settings indicates that the efforts to control the spread of virus inside nursing homes have not been sufficiently effective. Social isolation and the constant fear of contracting the COVID-19 infection could have significant effect on their mental health.”

Some older adults also may not have technical resources to compensate for being alone, which Dr. Lekhak cites as a limitation for her study; because it’s online, she would not be able to accurately tell who has or doesn’t have access to technology like internet, computers, or mobile phones. However, the data was not entirely dire.  It also revealed participants were taking more time with their hobbies like sewing, gardening, and music to cope with the pandemic.

FINDING THE CONNECTIONS AND PUSHING FOR CHANGE

Dr. Lekhak specializes in gerontology, which contributed to her wanting to understand the factors surrounding COVID-19 and older patients. But her expertise originated from her personal experiences, from childhood through nursing.  “I've always been interested. I think I connect more with older adults. When I was working first as Certified Nursing Assistant and then as a nurse in a long-term care setting, I found they were very alone.  Aside from few residents, most of them did not have family visitors, which I believe is one of the factors that amplified their health decline after their admission to nursing home.” She says this helped motivate her to go back to school for older adult care.

Dr. Lekhak’s research puts older adult wellbeing under the microscope, as there are broader issues at play beyond COVID-19. “People are living longer now, but they're living with more chronic conditions”, she says. “About 90% of them have at least one condition, and about 70 or more have at least two conditions. Our health care system has not been successful in understanding how multiple chronic conditions as a whole affect older adults. They are given different medications for different conditions. I think we should really put effort now to understand how that is affecting their health. That is one of the reasons why I am interested in non-pharmacological interventions to manage health.”

She says with the rise in dementia, a lot of times the family wants to take care of their older loved ones but are hampered by resources and the availability to do so.  Assisted living facilities and nursing homes become the next best option, but Dr. Lekhak cites the stigma associated with these long-term care centers, particularly nursing homes.

“Most of the time, there is this feeling with older adults that if they go to a nursing home, they're there to die.  Not so much with assisted living, where you still have independency, but with nursing home, most people feel like they don't have that autonomy anymore. I think the psychological factor play a bigger role than the physical factor. They pretty much, I think, give up after a while.” She clarified while she is not currently working in clinical settings now, she remembers these experiences first-hand when she was. “When I was working, I felt that hope leaving them slowly.”

She said the nursing home system requires change, particularly with staffing. “They don't have enough people. One person has to take care of the whole hall. It's not just like in a hospital, you're taking care of seven to eight patients or in an ICU, one or two. In nursing homes, you have a whole hall or whole building on your own. That doesn't help. So, people who are really sick get some kind of attention, but people who are not, then they don't get as much attention.” She added in terms of big picture, the nursing system culture needs to be revamped, and that can be difficult. “It needs to come from within. People need to be okay with the change. A lot of times, people are not so accepting of change.  However, the change is needed.”

READY TO HELP

Looking ahead, Dr. Lekhak is optimistic to further her current research.  40% of participants say they would take part in a future study. 

She says older adults still need to be cautious because of their vulnerability, and she hopes other people respect that susceptibility when going outside. There are people who are living alone.  They still have to go out and get supplies.  People have to be mindful of that.  If they see older adults, at least keep their distance, wear masks.  If they need help, provide them help, but wear PPE.” She also says you can offer resources to older adults like Helping Hands of Nevada and Meals on Wheels to minimize their potential exposure. But Dr. Lekhak is also concerned about the older population’s mental health going forward during the pandemic. “I feel like they won’t be able to socialize. Limited ability to meet family members, to celebrate milestones or to simply talk with other human being could impact their psychological wellbeing. There are virtual ways like social media or zoom which could help them socialize and take part in different activities, but the value of human touch is not replicable by those activities. Something that could help during this stressful time is to marshal internal resources by meditating or engaging in other spiritual activities to reduce anxiety and depressive symptoms.”

When it comes to improving overall conditions among older adults in the U.S., Dr. Lekhak recommends more education on nursing care, especially with younger people and encouraging older adults to stay active and promote those activities. She also argues more education can fight off common stigmas and ageism. “We can't lump all older adults in one group, [like] we can’t lump all younger adults in one group. Different people have different hopes and talents, and they're contributing to the society as much as other population groups. I think they're contributing more because they have gained so much knowledge and experience overtime.”