The pandemic has affected people physically, emotionally and financially. Our older population has also been affected by feelings of isolation. My mother is 91 and up until this year was enjoying a twice-a-week community social group. It really was the best medicine to her mental wellbeing. With most of our older population not engaging in social activities and social distancing visits from family members, there comes some new concerns.
I connected with Bronwyn Keefe at the Boston University School of Social Work to discover ways we can help the older people in our lives. Bronwyn is a research assistant professor and director of the School's Center for Aging and Disability Education and Research.
(This interview has been edited for length and clarity)
Jeanette Pavini: How has the pandemic affected older people? How do you see it will continue to affect them? What are the best ways to address each of these?
Bronwyn Keefe: In recent years, there has been greater awareness of how social determinants affect our health. Studies have documented the beneficial effect of social support on various health outcomes. Researchers are learning more about those who are lacking support and experiencing social isolation:
- A recent study found that 1 in 3 adults say they lack regular companionship, and 1 in 4 say they feel isolated from other people at least some of the time.
- Individuals who report high levels of perceived social isolation have a greater risk of hospitalization and emergency room visits.
- Individuals who are more socially connected have a 50% reduced risk of early death relative to those who are less socially connected.
- Research shows that prolonged social isolation can lead to an increased risk of heart disease, depression and anxiety, and other negative health outcomes.
For many, the Covid-19 crisis has upended lives and social connections. Physical and social distancing have left many people, including older adults, feeling isolated and lonely with their normal routines disrupted as senior centers, places of worship and local businesses are no longer available. And while physical distancing is important to maintaining health during the crisis, as time at home has lengthened, loneliness has set in for many older adults.
These are risk factors for isolation and will likely continue beyond our current pandemic:
- Lack of transportation
- Poor health and well-being
- Life transitions
- Societal barriers
- Lack of access and inequality
When you recognize symptoms of social isolation and loneliness, you can recommend physical and social activity. When it’s safe, suggestion getting out of the house, going for a walk, taking an exercise class or participating in programs at the local community center can promote fitness, socialization, and overall wellbeing. An important suggestion would be talk to the social worker who will be able to connect you with local resources such as the Council on Aging or the Area Agency on Aging. Faith communities can also provide support and build important connections.
Here are some questions you can ask:
- Do you have relatives or friends you see or hear from at least once a month?
- Do you have relatives or friends you can ask for help?
- Do you have relatives or friends you can talk to about private matters?
- Are there people you can rely on when you have problems?
- Are there many people you can trust completely?
It’s more important than ever to stay in touch with older adults. Technology has been a key tool in keeping people connected through video call platforms such as Skype, FaceTime, and Google Hangouts. Although, we know there is a great digital divide and many older adults may not have access to technology, it’s important to make connections without technology by picking up the phone and calling on a regular basis or write a note or sending a card.
How can adult children help older people they care for?
There are many national organizations that are providing great resources during this time and in general, such as the Administration for Community Living, National Association of Area Agencies on Aging (n4a), and the National Council on Aging (NCOA).
- To find your local Area Agency on Aging, contact the Eldercare Locator, a national center that supports older Americans in connecting to local resource.
- To find your local senior center, go to NCOA’s website for information.
- Daily Caring provides a list of low-cost internet options
- Senior Planet is hosting free online classes for older adults on topics including introduction to social media, how to use zoom, and virtual social gatherings
- Take a virtual exercise class at the YMCA or through your local senior center or Area Agency on Aging
As always, it’s important to continue to cultivate mental wellness for yourself and those you care for. Here is a list of suggestions from AARP around mental wellness and staying connected:
- Develop a plan to connect with family, friends or loved ones: This is especially important for people living alone.
- Limit news consumption: Hearing about the pandemic repeatedly can be upsetting.
- Care for living things: Caring for pets or plants provides a sense of purpose and improved health.
- Listen to music, find activities that bring joy
- Keep your mind active: Completing puzzles, reading, and engaging in art projects helps to keep the mind occupied and can improve cognitive functioning.
- Use calming techniques: Such as deep breathing, stretching, meditation prayer, taking a warm bath or shower, or sitting with a pet.
- Find ways to laugh: Watch a TV show, or chat with a friend or family member who brings joy.
- Create short personal videos that can be shared between family and loved ones.
How do you prepare the workforce that is serving older adults?
My goal through The Center for Aging and Disability Education and Research (CADER), which I lead at Boston University School of Social Work, is to create comprehensive, skill-based online training programs to ensure workers have the knowledge and skills needed to meet the long-term services and supports needs of older adults, people with disabilities, and families.
One of the greatest barriers to the provision of mental health services is the lack of a trained workforce. In 2012, Congress formed an expert national committee to look at the needs of the older adult population and the workforce that serves it. This national committee created the report “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?”, which found that health and mental health professions often fail to receive basic curricula in aging in general, and geriatric mental health, and substance use in particular.
We developed a program that incorporated mental health training into age-friendly initiatives. We created and implemented a three-tiered program that focused on:
- An outreach and educational campaign focused on reducing the stigma of mental illness,
- Increasing awareness of the effects of social isolation and mental wellbeing in the community, and
- Providing training to key stakeholders, including aging service providers, clergy, first responders, and resident coordinators focusing on the need to effectively identify and respond to older adults with mental health concerns. Results showed significant changes in attitudes around stigma and increases in competency scores around training content were statistically significant.
Additionally, we have developed a targeted online training program for senior centers and area agencies on aging, the first line of defense for many older adults, families, and caregivers needing social and support services.
The online certificate program is built around key competencies in behavioral health treatment that help workers identify and respond to older adults with mental health and substance use concerns, increase resilience, and further suicide prevention.
Preliminary results show that 94% of participants report they will be more effective in serving older adults with behavioral health concerns due to the training – showing progress towards the goal to promote the emotional well-being of older adults, decrease stigma related to topics such as suicide and substance use, and increase referrals to treatment.
Another important audience are paramedics, who are frontline healthcare providers responding to everyday emergencies from heart attacks and strokes, to public health crises like Covid-19 and the opioid epidemic. While these workers are skilled in life-saving resuscitation and stabilization, a study I recently completed found that they are far less prepared in their training to deal with behavioral health issues.
In order for older adults to be fully engaged in community life, mental health concerns need to be addressed with a focus on social isolation, depression, and substance use. Without a community-wide capacity-building effort, these issues among older adults often fade into the background. A trained workforce can work to identify sustainable community-based initiatives to address the emotional well-being and decrease isolation among older adults.