I’m At–Risk for Covid-19. How Do Older Adults Get Care, and Stay Safe?

Posted June 11, 2020

While we all wish there was a solution to put an end to COVID-19, we are best served to begin adjusting our behaviors, expectations and lifestyle to acknowledge this pandemic will take time to manage and resolve. As we shift to a longer-term acceptance of our new reality, many patients in our older adult population have been asking great questions about their health, their risk of contracting COVID-19, and how to live a healthy lifestyle while social distancing. Below is a Q+A with UVM Medical Center geriatrician Amelia Gennari, MD, about how older adults can stay safe during this time.

Why are older adults at increased risk for COVID-19?

To clarify, older adults are probably not at any higher risk of contracting the virus if exposed – everyone is at high risk for contraction since this is a very contagious virus. However, if older adults contract COVID-19, they are at increased risk of getting very sick from the virus and its symptoms.

How do other health conditions, especially those common in older adults, contribute to risk?

Any history of pulmonary disease puts you at greater risk for respiratory failure from COVID-19. However, there are many other factors which will also put you at greater risk for getting sick with COVID-19. These include chronic conditions such as frailty, which includes generalized weakness, loss of muscle mass or mobility issues. Cognitive issues such as dementia can also contribute to complications because this can put you at higher risk for a confused state, which then leads to problems with recovery.

How can older adults protect themselves from the virus?

Avoiding contact with the virus is key. The older population should always wear masks out in public and avoid coming within 6 feet of anyone, especially if that person is not wearing a mask. The other key factor is to wash your hands for 20 seconds with soap and water frequently. And always avoid touching your face.

Can my family and friends visit me at home or in my assisted living facility?

Many assisted living facilities and retirement communities have appropriately restricted visitation since we know these types of communities can be the hardest hit if the virus takes hold. In the privacy of one's home, the older adult should still restrict visitation to only those individuals who are taking strict precautions and have not had any known exposures. Asking visitors to wear masks is always a good idea.

Should I avoid going to the doctor, urgent care or emergency department to protect myself from the virus?

No. Across the UVM Health Network we have seen firsthand the problems that arise when patients delay care out of fear of exposing themselves to the medical community. However, at our facilities, we have been taking very strict precautions for many weeks and we have the systems set up to provide care safely. If you have any questions, call your doctor's office to ask about available appointments.

I've heard about video visits with providers but am not very comfortable with computers, the internet or technology. What is telehealth and how does it work?

Telehealth refers to any care that is not provided in person. There are several ways to access your provider if you need care, including in-person, telephone visits and video visits that use a video camera to connect with your doctor's office. Video visits have become a very popular way to get care because you can see your doctor and your doctor can see you. These appointments can be done through a website called “Zoom” on any computer or smartphone. If you do not have this technology, sometimes a family member, friend or a staff person at your retirement community can come help connect you with the technology. Another option at some of our clinics is for you to drive to the doctor's office where a staff member can set everything up and hand you the computer for you to use in your car.

I live on my own and get lonely while isolated. What can I do to stay healthy and active?

The isolation has been very difficult for everyone, in particular older adults. There are lots of things to do while you are sheltering in place. It is very important to come up with a list of activities that are meaningful to you and create a structured schedule to your day. Part of your daily routine must include some exercise. This can be done at home or in a safe environment outside. See the list of activities and ideas list below.

How do you recommend I get my groceries and other essentials?

Friends, family, delivery and curbside pickup all work well. There are also stores that have special hours for older shoppers. If you choose to go in a retail store, call in advance and make sure that they are being very strict about requiring masks for employees and patrons and adhering to strict social distancing guidelines. You should not go into stores if there are any customers inside that are not wearing masks.

Here's my approach to things like this: we all want to have control over this frightening epidemic. It makes our minds go through all the possible options. This is a great thing: it can fuel human ingenuity. Yet, it's good also to stick to what's proven, particularly when it's pretty easy to do. Right now, I think it's reasonable enough to adhere to physical distancing measures, to wash your hands, and to stay away from folks who are sick.

What kind of safety precautions do I need to take with my pet? Can we give coronavirus to each other?

The virus that causes COVID-19 (SARS-CoV-2), came from bats, perhaps by way of a pangolin (a scaly anteater). Epidemiologists are still sleuthing in Hubei, China, to learn more. There is no sign that domestic animals can transmit COVID-19, though. Dogs and cats, etc., have surfaces that can be contaminated like any other, and so theoretically they could move the virus from a sick person to someone who is well. As a result, the CDC suggests that people who are sick (with COVID-19 or something else) have healthy people care for pets and to keep the animal away from the sick person so transmission is less likely.

Do I need to sanitize my groceries and delivered packages?

No.

When do I need to wear a mask?

Anytime you go out or are with someone who is not part of your “quarantine family”.

If I have chronic conditions that affect my breathing (asthma, emphysema, etc.), do I still need to wear a mask?

Yes – it is even more important to wear a mask if you have these conditions.

Is it safe for me to go out in my yard or should I stay inside my house at all times?

Go out in your yard! It is safe and provides some exercise which is good for your mental health. Go out and get some sunshine and fresh air.

Do I need antibody testing, if available in my area?

We do not recommend antibody testing at this time. We do not yet know whether or not the tests are reliable and accurate and – even if they are - what the test results actually mean. In other words, if the testing show you have the antibody, we don't know that a person is actually protected from catching the virus.¯

I'm tired of all of this and want to get back to my normal life. What can I do?

As best we can, everyone is trying to transition to learning to live with the virus instead of just waiting for it to go away. This requires being very creative to both stay safe, but also enjoy your life and keep both physically and mentally healthy. See below for a list of ideas and activities.

No Internet? No Problem. Activities to Keep You Entertained During Quarantine

Arts and Crafts

• Crossword puzzles
• Sudoku
• Adult coloring books
• Knitting
• Sewing
• Cross Stitch
• Needlepoint
• Jewelry-making
• Macrame
• Quilting
• Painting - watercolors, finger paints, paint-by-numbers, etc.
• Puzzles - for adults living with dementia, consider large pieces and puzzles with fewer pieces
• Scrapbooking - reminiscent pages of their life or favorite things
• Photo albums - sort, organize and store photos

Exercise/Movement

• Walking indoors or out
• Yoga, Tai Chi, simple weight bearing exercises
• Dance in your kitchen or room

Home Maintenance

• Home chores - daily routine of cleaning, tidying, making meals and cleaning up
• Spring cleaning - chores such as window washing, airing rugs, changing batteries in smoke detectors, turning mattresses, cleaning out closets, garage, basements
• Lawn cleaning/prepping for gardening
• Seed starting, garden bed work, compost turning
• Tend to your houseplants

Nature

• Bird Watching
• Daily nature walks, no matter what the weather brings

Social Connections

• Phone - outreach to a friend who haven't heard from in a while, he or she is probably home! Make a new connection daily or several times a week
• Write a letter
• Call your pasture or priest - many are welcoming outreach calls to active & non-active followers

Cooking

• Try a new recipe or an old favorite you haven't tried in a while
• Look through out recipe cards and cookbooks you've collected and organize them
• Enjoy tea or dessert with a friend - set up a time with a friend over the phone

Reading

• Trade books with neighbors or friends, leave in each other's mailbox
• Re-read old favorites

TV/Movies

• Enjoy a new or old movie with popcorn

Journal

• Keep a daily record of this time, record daily gratitude's, weather, feelings, who you make contact with, etc.

TV/Movies

• Enjoy a new or old movie with popcorn

Get Online and Get Creative!

There are a lot of online resources to help you with self-isolation. From online church services, to education, to online zoo tours, the Internet has opened up our ability to stay connected while apart.

Online Church Services

• https://www.vermontcatholic.org/covid-19/
• https://www.mynbc5.com/article/how-to-stream-online-church-services-from-our-region/31826600

Education

• https://www.coursera.org/courses?query=free

Mindfulness

• Free mindfulness apps: No need to make in-app purchases.
  • https://apps.apple.com/us/app/smiling-mind/id560442518
  • https://insighttimer.com/meditation-app
  • https://www.headspace.com/covid-19
  • https://www.tenpercent.com/coronavirussanityguide
• YouTube mindfulness (5 minutes)
  • https://www.youtube.com/watch?v=inpok4MKVLMv

Yoga

• https://blog.paleohacks.com/yin-yoga-to-calm-anxiety/?fbclid=IwAR35jVqlzwC1a1HR69Po01NsN_tk4Fy-qbiQPL_C3JcLk1V-UDGUSJgGt3s#

Free Audio Books

• https://librivox.org/

Cooking

• https://www.bonappetit.com/gallery/simple-recipes-five-ingredients

Free Museum, Zoo, Theme Park Tours

• Online Museums: Many museums now have online content. This link will take you to many museums, libraries, parks and historic landmarks in NY: https://ny.curbed.com/2020/3/17/21183837/virtual-museum-tours-home-new-york-moma-met
• Smithsonian National Museum of Natural History: https://naturalhistory2.si.edu/vt3/NMNH/z_tour-022.html
• https://www.goodhousekeeping.com/life/travel/a31784720/best-virtual-tours/
• https://www.sevendaysvt.com/vermont/enterprising-vermonters-go-virtual-with-online-classes-tours-and-cute-animals/Content?oid=29992802

Solitaire and Games

• https://apps.apple.com/us/app/solitaire/id359917414
• https://games.aarp.org/?intcmp=FTR-LINKS-FUN-GAMES-EWHERE

Tai Chi – Free

• https://www.youtube.com/watch?v=hIOHGrYCEJ4
• https://taichiforhealthinstitute.org/free-tai-chi-lessons-from-dr-paul-lam/

This link includes options for individual moves as well as sitting in a chair:

• https://www.108taichimoves.com/tai-chi-online.html#.Xo9u6ORYY2w

Virtual Concerts

• https://www.npr.org/2020/03/17/816504058/a-list-of-live-virtual-concerts-to-watch-during-the-coronavirus-shutdown

Amelia Gennari, MD, is a geriatrician at the UVM Medical Center and an associate professor of Geriatric Medicine for UVM's Larner College of Medicine.