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COVID-19: Helping an Older Relative Stay Connected

Most people are aware of the special risk COVID-19 presents to older adults. Since the pandemic began, roughly 80 percent of the deaths from the virus have been among people age 65 and older. And the mortality rate has been highest among people age 85 and older. Residents of nursing homes and assisted living facilities have been hit with tragic waves of loss, especially in the early weeks of the pandemic before strict measures were put in place to minimize coronavirus exposure.

But less attention has been given to the physical and mental health effects of social isolation, which can also be serious—even deadly—for older people. Isolation can lead to loneliness, depression, and the acceleration of memory loss. Social isolation is linked with higher rates of viral illness and chronic disease and with death at an earlier age. By shielding older adults in your communities from the pandemic, without countermeasures to help them stay socially connected, you run the risk of replacing one health danger with another.

Fortunately, there are steps you can take, as a caring family member or friend, to help the older people in your life stay socially connected and engaged. The goal should be to minimize both the risk of illness from COVID-19 and the risks that come from social isolation.

How Social Isolation Can Harm the Health of Older Adults

Social isolation raises stress levels and increases the risk of depression, heart disease, stroke, and dementia. It's also a risk factor for premature death—as significant as smoking, obesity, or physical inactivity.

The reasons aren't fully understood, but the associations have been demonstrated in study after study. Some of these studies have measured the negative effects of isolation on physical and mental health, and some have measured the effects of loneliness. The two are related, but not the same. Loneliness is an emotional reaction to social isolation that some people feel more strongly than others.

Many public health experts are concerned about some unintended consequences of the efforts to minimize the spread of COVID-19. Doctors make a point of stressing that "physical distancing" is the goal, and not "social distancing." You need to stay physically distant from people outside of your household, just as you need to wear masks and avoid spending time with others in poorly ventilated, indoor spaces. But you also need to stay socially connected to maintain your physical and emotional health.

The risk of negative health consequences for older adults from social isolation is especially high. Even before the pandemic, national studies showed that nearly a quarter of older Americans were socially isolated and more than 40 percent reported feeling lonely. With restrictions on visits to nursing homes and concerns about bringing COVID-19 to older relatives living in their own homes, those numbers have almost certainly gone up.

Measures to protect older people from COVID-19 may also cut them off from activities that give their lives meaning or bring them a sense of purpose—religious services and other communal gatherings, time with friends and family, or simply the opportunity to have conversations. And this new isolation comes at a time when many people—young and old—are experiencing high levels of anxiety. This time when you can't be together in person is precisely the time when you need that human connection even more.

Weighing the Risks and Benefits of In-Person Visits

Many families have wrestled with the question of whether and how to visit an aging parent or older relative.

The risk of serious illness and death to an older person from COVID-19 is clear. It is high for adults age 65 and older and even higher for adults of more advanced age. There are additional risks for older people with certain medical conditions, including cancer, lung disease, heart conditions, and diabetes. Expert guidance is also becoming clearer about how to mitigate the risk of spreading the disease to older people.

Public health experts now know the following:

• COVID-19 can be spread by people who have no symptoms. This is not only possible, it's one of the most common pathways for the virus's spread. Scientists estimate that more than 40 percent of all COVID-19 cases are spread by people who don't have symptoms. Some people develop symptoms after they've given the virus to another person, and some spread the virus without ever developing symptoms themselves. Even if you feel healthy and have no symptoms, you may have the virus in your system and could give it to an older relative.
• COVID-19 is primarily spread through respiratory droplets. Researchers have learned that the great majority of COVID-19 cases are caused by inhaling respiratory droplets—the tiny particles of moisture in the air that people exhale in normal breathing or expel in larger quantities when they talk, yell, sing, cough, or sneeze. Studies of these droplets have shown that they can hover in still air for hours and accumulate in indoor air. This has led to the recommendations to maintain physical distance from others when away from home; avoid large gatherings, especially in indoor spaces; and wear face masks. It has also raised awareness of the importance of good ventilation in indoor spaces.

Transmission on surfaces, such as door handles, grocery bags, countertops, and mobile phones, is still seen as a potential source of sickness but is not now considered the main pathway for disease spread. This is still a gray area in the research, so experts continue to recommend frequent handwashing, surface disinfecting, and avoiding touching your face.

Because inhaled exposure to the coronavirus is considered the greatest risk for catching the disease, the key risk factors are

1. The amount of the virus in the air you and your older relative are breathing
2. The amount of time you and your older relative are breathing that contaminated air
3. What kind of protection you are both wearing

The amount of the virus in the air you're breathing goes up with the number of infected people near you and down with greater air circulation and the wearing of masks. So, if you live in an area with a low incidence of disease and visit with your relative outdoors while wearing masks, the risk of exposure is relatively low. If you live in an area with a high incidence of disease and you spend time in an indoor restaurant, bar, or other space with poor ventilation before your visit, or live in a household with someone who does, your risk of exposing your relative is high if you visit. If you would need to travel by air, bus, or train to visit your relative, that might raise the risk, too.

You've already been told the risks of social isolation and the benefits of social connection for older people. If your older relative needs in-person help with the tasks of daily living, there's no question that the help must be provided. The only decisions are around how to do that as safely as possible. But the less tangible benefits of social connection can be provided in different ways—either remotely or in person.

Here are some ways to reduce the risk to your relative from an in-person visit:

• Reduce the risk of your own infection. If you plan to spend time with an older relative, practice extra vigilance to avoid exposing yourself to the virus. For at least two weeks before your visit, spend no time indoors with anyone beyond your household. Wear a mask and practice physical distancing even when outdoors. Hold others in your household to the same standard.
• Prepare your children to behave safely, or leave them behind. Be sure your children understand what the rules will be for the visit and how you expect them to act. If you aren't confident they'll behave safely, don't bring them.
• Wear a mask. You, your older relative, and anyone else visiting, should wear a face mask. You might wear gloves, too, if you'll be handling food or touching indoor surfaces.
• Consider staying outdoors. Unless your relative needs help with something inside, make it an outdoor visit. That will greatly reduce the risk of aerosol transmission. Sit with your relative on the porch, in the yard, or in a nearby park. You might take a walk together. Keep at a six-foot distance and wear masks. If you need to go inside to help your relative take care of something, open windows for ventilation and keep at a distance from each other.
• Don't share food. Eating a meal together is a traditional and comforting way to connect with another person, but it may not be safe with an older relative during the pandemic. Instead, you might bring a prepared meal (cleaning the outside of the containers with disinfecting wipes) and leave it for your relative to eat later. You might each bring a sandwich and eat outside together at a safe distance. But it's probably too risky right now to share a meal the way you used to do.
• Watch the time. The longer the visit, the greater the risk of virus transmission. An outdoor visit, with masks and at a safe distance, carries little risk. But if you need to be indoors together or in close proximity, keep it quick.

Ways You Can Help an Older Relative Be More Socially Connected from a Distance

If you choose to delay in-person visits for now, or keep them to a minimum, you can still help your older relative become more socially connected. Technology can help with this, but it's not the only solution. Phone calls are social connections, and so are old-fashioned, mailed letters and packages.

Here are some ways to help your older relative stay connected socially and engaged with activities they find meaningful and enjoyable:

• Focus on the quality of social interactions. Whether connecting remotely or in person, use the time together to talk and to listen. Ask questions to find out how your older relative is doing and what their biggest worries or frustrations are. Validate and sympathize with your relative's emotional reactions to this unusual time while offering practical help in solving problems. Show your relative that you love them and value the time you spend together.
• Establish a regular contact schedule. If in-person visits are too risky, you may need to step up the frequency of other forms of contact. Establish a regular schedule for these contacts so they become something your relative can count on. Knowing when to expect a call from you, or that you'll have a regular video conversation, can give your relative a small anchor of certainty in an otherwise uncertain world. It can also provide an element of structure to your relative's day.
• Talk on the telephone. Telephone calls are easy and don't require special technology. A regular phone call from you and other family members might give your relative just the emotional boost they need right now. You can even supplement your own phone calls by signing your relative up for regular calls from volunteers. One of these programs is the AARP's Friendly Voice program (Link opens in a new windowhttps://aarpcommunityconnections.org/friendly-voices).
• Set up video chats. Supplementing a regular schedule of phone calls with some video chats may help your relative feel even more connected. You might need to do some training if your relative isn't familiar with the video program you use, but your patience should pay off. Once your relative masters the new tool, they may want to use it for video connections with friends and other relatives.
• Help your relative become more tech savvy. Training on video chats is one step in the mastery of new technology, but there are many more opportunities. Depending on your relative's interests, you might help them watch movies, access lectures, listen to concerts, take virtual tours of museums, play games, or take their photography or knitting up a notch with online tutorials.
• Start a virtual book club. Sharing reading experiences is a fun way to connect. Ask if your relative would like to be part of a family book club. Choose books you'll all enjoy, then get together to discuss them in a video chat.
• Send letters, cards, and packages. Sometimes, old technology is the most effective. Write letters and cards to your relative. Encourage other family members to write, especially the younger ones. Send packages with homemade cookies, jigsaw puzzles, books, or whatever else might bring your relative a smile. Take care in preparing packages to keep the virus out of the gift. Wash your hands thoroughly before you begin, and clean plastic bags and nonporous containers with sanitizing wipes.

Additional Resources

Information on the Health Effects of Social Isolation
"Social Isolation and Health" (Link opens in a new windowhttps://www.healthaffairs.org/do/10.1377/hpb20200622.253235/full), by Julianne Holt-Lunstad (Health Affairs, June 22, 2020). This resource includes links to key research studies and review articles on the health effects of social isolation.

Ways to Help an Older Relative Stay Connected at a Distance
Senior Planet's Coronavirus Resource Guide (Link opens in a new windowhttps://seniorplanet.org/coronavirus-2)—This guide includes articles and video tutorials for older people on using technology to make social connections and access entertainment, health, and learning resources.

The AARP Foundation's Connect2Affect initiative (Link opens in a new windowhttps://connect2affect.org)—The AARP Foundation has focused on reducing social isolation among seniors as one of its core missions. The Connect2Affect website offers helpful resources for older adults and their families, including the "How Connected Are You?" self-assessment, a search tool to look for local resources, and an app to help an older person build new connections.