Digital Exclusion to Social Inclusion: Keeping Older Adults Engaged

Voice 1: Grandma can you fix my mask?

Voice 2: What’s wrong with your mask?

Voice 1: It keeps slipping off my nose.

Voice 2: Oh, it's not tight enough on your nose? Because it doesn't have to be tight on your nose to protect you, doesn't it?

Voice 1: Mhmm.

Voice 2: Let's see. So if I pull this a little bit tighter behind your ears and sew that, then will it say on your nose, I wonder? Think that might work? Does that feel tight enough now?

Voice 1: Mmhmm, thank you.

 Voice 2: You are welcome.

Janevic: The story of the pandemic vulnerable older adults is also a story of resilience. Many older adults have come through difficult times before. And in our work with older adults over the past six months, we've also been privileged to hear about all the ways in which really they're making the best of the situation. So whether it's through using a sense of humor or taking advantage of the time to do house projects or extra cooking or some of those kinds of things, or just using the perspective of their years and having already been through many difficult times, they often know and they often are in the position of reassuring some of the younger people in their lives that this too shall pass.

Narrator: We all have some sense that the pandemic has had a particularly large toll on the elderly from the disease itself, to tighter finances, isolation, and mental stress. We wanted to learn more about the ongoing risks for older adults as well as the opportunities as the pandemic continues.

Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast focusing on the ongoing coronavirus pandemic.

Mary Janevic is an associate research scientist at the University of Michigan School of Public Health. She studies how individuals with chronic pain, particularly older adults, can better manage their health. We asked her about the many ways the pandemic affects this population. 

Janevic: So to start with, during lockdown periods or simply because of a fear of contracting the virus, some older adults might forgo their regular medical appointments that they use to monitor long-standing health conditions or some might delay or skip getting prescription refills. But even going beyond these interactions with the healthcare system, we also need to think about what the pandemic is doing to the self-management routines of older people with chronic illnesses, conditions like heart disease or diabetes, or arthritis or other chronic pain.

So for example, getting regular, moderate physical activity is strongly recommended for managing all of these conditions, most chronic health conditions in fact, but the pandemic has really interrupted the exercise routines of many older adults. Of course, during these warmer months, some people have the option to exercise by walking outside, but that option is not available to everyone. Many older adults don't feel safe walking in their neighborhoods, whether it's because of uneven sidewalks that haven't been repaired or stray dogs or any number of other reasons. And then also for those older adults who relied on senior center programming for their physical activity or community recreation centers for things like fitness classes or water exercise, in many locations these services have not yet re-opened.

And then we were talking about isolation. Well, many people of all ages rely on social relationships for motivation or companionship to do things like exercise. That's knowing that your friend is also going to be at the class at the senior center, that motivates you to get there week after week. And so now that that kind of group-based exercise isn't happening, that social element or that kind of positive peer pressure is also missing for a lot of people. 

And then following recommended dietary plans is also harder now for older adults managing chronic illness, especially when we're having periods of stricter lock down. Whether it's not being able to get to the grocery store as easily due to having more limited transportation options now, or just the fact that being at home all the time makes it harder to avoid eating foods that maybe a person was trying to limit in order to better manage their condition.

As the pandemic goes on, the risks that are related to the isolation and the no-visitor-policies of many long-term care facilities will grow even more acute. So loneliness and isolation increase the risk of negative physical health outcomes, including mortality. But more immediately, of course, they have a very negative impact on mood and the quality of day-to-day life. Some facilities have been finding ways to allow visits from family or friends, especially during the warmer months when outdoor or semi-outdoor visits can be implemented. But a lot of facilities still have very strict policies.

Besides the fact that older residents are not getting their social and emotional needs met, we also know that family members have always played a large role in the care of older people in these facilities. So that's both in the sense of directly providing some of the hands-on care, but it's also providing important oversight of the care that they receive from the facility, especially given the chronic understaffing of many care facilities. And so now for months, families have not been able to provide that oversight in the same way. This is especially concerning when the older family member has significant cognitive issues or other limitations that make them unable to advocate for themselves, and really this is also hard on the facility care staff who tend to be very underpaid and were over-extended even before the pandemic.

So this is really a very tough issue. It really even touches issues related to the autonomy of older adults to make their own decisions about balancing risk with their quality of life, and it's yet another situation where inequity comes into play. So older adults who are in long-term care facilities who are not able to use technology to communicate with family members are really doubly isolated. The reason for not using technology might be that they are too frail or have cognitive impairments or because they lack access or some simply because previously, they never have to learn how to use it. So the situation in long-term care is really very complicated because of course, we know that long-term care facilities are at the top of the list in terms of being highly susceptible to COVID outbreaks, but as the pandemic goes forward without a clear end in sight, having the kind of universal and flexible strict isolation policies that we've seen so much of doesn't seem sustainable or even humane.

Narrator: In March, we weren't sure how long the pandemic would last. It's clear now, we need long-term strategies for managing our health and reducing the emotional toll of a situation that's making already difficult tasks all the more difficult for many older Americans.

Janevic: Of course, we all hold out hope that we will be able to resume normal life as quickly as possible, but the reality is that we don't know and that's going to be. So it's going to be essential for organizations and institutions serving older adults to adapt to the changed circumstances. We've already seen this happening in some places, and I just wanted to take a minute to highlight the important role of senior centers in particular in the lives of many older adults. 

Senior centers are really a lifeline for many older adults. They provide socialization. They provide opportunities for exercise. Sometimes they do health screenings or health checks. They provide volunteer opportunities, enrichment classes, nutritious meals, just lots and lots of things. And so when senior centers are closed, as has been necessary to do during this pandemic, it really could have a very detrimental impact on the lives and on the health of older adults. Just to take one example of a center that's implemented some creative modifications since the pandemic, St. Patrick’s Senior Center in Midtown Detroit with whom we've collaborated on some of our research projects, has been a great example of how senior centers can adapt to continue to offer activities and resources to older adults.

So St. Pat’s has been offering virtual classes and helping their members with some of the technology aspects, also doing wellness check-ins over the telephone, and in the summer they've also been offering some classes in their outdoor space outside of the center. And they also continue to provide meals several days a week for people to pick up. And then I've also been starting to hear about initiatives in other agencies serving older adults, both to extend technology access and equipment and to train older adults in using technology. These kinds of initiatives, and in general just making some of these adaptations that I think senior centers and community centers are going to need to do, are going to require resources. And this is especially true in underserved areas, where it might mean providing not just training and how to use technology, but also sometimes the technology itself. But as we head into the fall and winter months, it's really critical that we have plans in place for ensuring that older adults and especially those who are most at risk because of isolation or their economic situation, or their health situation or really all of the above, are not left on their own during this exceedingly difficult and uncertain time.

It's also possible to provide support during this time for those older adults who don't have internet access or even smartphones, and I can tell you about an example of one local program that does this. So along with colleagues in Social Work and the School of Information here at U of M, we evaluated a pilot program known as the Silver Center. So the Silver Center was telephone-based health and enrichment classes for older adults in the Detroit tri-county area.

The class topics are varied. They include things like book clubs or Detroit history or a virtual tour of the Detroit Institute of Arts, to classes about anxiety reduction, mindfulness meditation, or other health topics. The classes are run like conference calls, and so basically all participants have to do is dial in to a phone number. So it's very simple from a technological perspective, and then the classes are led by either volunteers or staff of local organizations or societies like the Detroit Historical Society or the Detroit Institute of Arts. So it's also a great opportunity for local organizations to do outreach and to reach older adults who they normally could not reach with their programming. So this idea of just conference call-based classes is really kind of a simple concept, but it has the potential to meet a huge need among the older population for social connectedness when there aren't options through the internet involving screens. In our evaluation, we found that the participants in the Silver Center got significant benefits from the program. They told us that the Silver Center helped them feel more connected to others, more connected to the wider world, that they learned new things and they enjoyed learning new things, and really, that it gave them something to look forward to, something to help them structure their days.

Narrator: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph.