As of March 26, the Department of Health (DOH) has recorded a total number of 45 fatalities in the country due to COVID-19. Twenty-nine of these deaths are senior citizens or those 60 years old and above.
Unfortunately, COVID-19 infection tends to get worse among elderly patients due to physiological reasons, says geriatrician and clinical epidemiologist Dr. Shelley Dela Vega. The natural age advancement leads to the gradual deterioration of an old person’s immune system—this is called immunosenescence. “The immune cells in the body are weaker in recognizing and killing the virus and slower in producing antibodies that make the person immune,” she explains.
This age group is considered vulnerable because they are prone to chronic degenerative conditions such as diabetes, heart disease, chronic lung disease, kidney disease, and asthma, Dr. Dela Vega points out. “Their lung function is less efficient and their cough reflex and swallowing can be weaker. They are more predisposed to adverse drug effects and polypharmacy [simultaneous use of multiple medications]. Some may have dementia, making them unable to comply with early recognition and reporting of symptoms. Disability and poor function prior to the disease adds a layer of frailty.”
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How do we reduce their risk of getting infected? We must give extra attention to those who have an increased risk for serious COVID-19 illness, especially those with severe chronic medical conditions like heart, lung, or kidney disease, or diabetes, says Dr. Jay Butler, Deputy Director for Infectious Diseases at the Center for Diseases Control and Prevention (CDC). Below are experts’ advice:
Make sure they take every precaution to avoid exposure to the virus
By now, we already know the drill: “Wash your hands with soap and water for at least 20 seconds. Use an alcohol-based sanitizer with at least 60% alcohol if soap and water are not available. Cover your cough and sneezes with a tissue. Or cough or sneeze into your elbow, not your hands. Avoid contact with people who are sick. Clean and disinfect surfaces in your home such as counters, tabletops, and doorknobs to remove germs. Use household cleaning sprays or wipes according to the instruction,” Dr. Butler enumerates.
Our crucial role now is to make sure that our elders and all the people in our home practice these. Take note that persons with dementia need closer supervision and frequent reminders on hand washing and importance of staying home.
Be ready with contingency measures
Make a plan if the old person in your family, you, or the caregiver gets sick. “Talk to your healthcare provider about getting extra necessary medications to have on hand, for the old person. Get enough supplies, too. Include enough household and groceries so you can stay for a few weeks, if you have to,” says Dr. Butler.
Similarly, Dr. Dela Vega advises the elderly to quit smoking, take their maintenance medicines, and avail of vaccination against seasonal flu and pneumonia.
Pay attention to what’s happening locally
“If COVID-19 is spreading in your community, stay home as much as possible and avoid crowds,” Butler stresses. If the old person gets sick with fever, cough, or shortness of breath, call your healthcare provider or the DOH COVID-19 emergency hotlines 02-894-COVID (02-894- 26843) and 1555. If patient develops warning signs, such as difficulty in breathing, persistent pain or pressure in your chest, confusion, or blueness of the lips or face, these may be signs of a serious illness, call for help.
Protect their mental and emotional health
“Older persons themselves can form a network or online support group of friends and relatives,” advises Dr. Dela Vega. “Allow them to keep in touch with your older relatives, friends, neighbors through phone calls and other social media tools.”
Facilitate activities for them like gardening, cleaning the house, cooking their favorite recipes, organizing their closet. They can watch online shows, avail of audio and free online books to relieve their stress, says Dr. Dela Vega.
We don’t want them to be clueless about the current situation, so we should also provide them with useful updates on COVID-19 and other ways to cope. “Get them involved in home and barangay decisions and plans. They may hold the answer and give the best advice,” Dela Vega adds.
She also reminds family members to “watch for signs of depression and anxiety such as poor sleep, mood changes, reduced appetite.” She also advises to observe if there is a need to refer the old person for professional counselling and help.
Now what to do if they get infected
How do we nurse an old person back to health if he or she is on home isolation with possible or confirmed COVID-19 infection? The Center for Disease Prevention and Control (CDC) and the Department of Health (DOH)provided general guidelines on taking care of persons under monitoring (PUM). The CDC stresses though that older adults and people of any age with certain serious underlying medical conditions like lung disease, heart disease, or diabetes are at higher risk for developing more serious complications from COVID-19 illness and should seek care as soon as symptoms start.
Prof. Lydia Manahan, PhD of the UP College of Nursing and Gerontology Nurses Association of the Philippines, Inc. stresses on the importance of “compassionate care” for older persons during this precarious time. She says that while it is important to follow the CDC guidelines in caring for older persons affected with COVID-19, “Caring, loving presence, and honest communication” will go a long way. She shares these tips:
Reassure the old person
Informing old adults about the safety precautions that should be practiced is crucial to keeping everyone safe at home. “Orient them on the changes in care like distancing and isolation while they are sick. Inform them of the need to wear the face mask,” says Prof. Manahan.
Older adults tend to feel insecure due to their aging condition. You wouldn’t want lolo and lola to feel rejected, so it is important that the situation is clearly explained to them. “Inform them that much as you want to stay with them, it could be dangerous for you because you might also get the infection. Explain that the family will have to limit the number of people who will care for them.” Social distancing, especially with their young apos need to be practiced, as they are also vulnerable to the disease and can also be a source of infection for them.
“Agree on the terms that you will peep frequently but not go near,” he advises. “Make a poster in big readable letters, saying, ‘Hi, I love you, I am here’, every time you will peep.”
Be cognizant of the older person’s deficit
Create a way of communicating, suggests Prof. Manahan. For instance, if the elderly patient has a weak voice, give a bell or kutsara (spoon) to create noise, if they need you. If the old person can still write, provide a writing pad. If he or she is hearing impaired, talk a little louder—but do not shout. You may write messages in big letters if the patient has poor vision.
Provide ample nutrition
“Encourage hydration (have a glass of water ready at their bedside) unless contraindicated. Provide nutritious food. Food should be soft, cut in small chewable pieces to decrease consumption of energy cutting the food,” notes Prof. Manahan.
Balance of rest and mobility
“Encourage napping for short periods so as not to disturb circadian rhythm. Encourage mobility in the area inside the room if there is not enough space outside. You may exercise with them but observe social distancing. They may also do bed or chair exercises,” advises Prof. Manahan.
Maintain good personal hygiene
This is important for the patient’s physical comfort and to prevent other infections. “Bathing need not be done daily, but it is a must that oral hygiene, cleaning the armpits as well as perineal care (vaginal and rectal area) be done. Remember that doing the perineal care starts from vagina towards the rectum and not the other way around, to prevent urinary tract infection,” say Prof. Manahan.
Create a healthy environment
The patient’s room must be kept clean, well-lighted (not glaring), and with good ventilation, she notes. Be sure to put a waste basket (plastic is best) within the patient’s reach. Waste materials should be properly disposed.
Allow them to engage in spiritual activities
“Put their religious articles like prayer books at the bedside. Remind them of their spiritual activity, if they tend to be forgetful. For the Catholics, if praying the rosary is a routine, do not skip it.” But she cautions, “Maintain the six-feet social distance” from the rest of the household.