Don't be a stranger on your street

Posted by on 5 April 2020

Auckland gerontologist Professor Ngaire Kerse is the Joyce Cook Chair in Ageing Well at the Faculty of Medical and Health Sciences. Here, she shares her thoughts on how to help our older relatives and neighbours feel less isolated during the Covid-19 crisis.

The Covid-19 shutdown – I prefer this to lockdown – is putting a global microscope on how best to look after our older citizens. The appalling footage of older people in rest-homes and hospitals in Italy, in particular, is a gut-wrenching reminder of why we need to abide by the “stay at home” message, if not to protect ourselves then to protect in particular the older, more vulnerable people in our society.

Since March 21, when the Prime Minister announced that all of those older than 70 need to go home and stay home, it’s clear that we are all grappling with the reality of what that means. I write from my desk at home and hope you all receive this in good health, safely, and with some comfort that we are here thinking about older people and the people that serve them.

Internationally, it’s clear why this is so important. The international experience reports a mortality rate of around 15 percent for those aged 80 years and older compared with less than 1 percent for those with Covid-19 aged 30 years or less. As such, prevention is by far the best approach.

But what does staying at home mean for older people, and who is in their bubble? This is a physical contact ban, not a social contact ban. How can social relationships and contacts can be kept alive from a 2-metre distance? The neighbourhood jurisdiction of the bubble is important here. If the loved one lives locally, contact through the doorway, the careful delivery of food can be possible. But please be careful who has touched what. Delivering a box of books, well-thumbed and recently pawed by other hands is NOT a good idea. Delivery of unopened food in packages is good; the freshly cooked scones can go in a clean container to be lifted out with minimal touching of the sides. I saw a lovely picture of a grandad and grandson playing noughts and crosses through a closed glass door, each taking their turn from their own side. Also stories of folk in their homes being visited through the window.

Where family live far, this responsibility falls to the neighbourhood. Does everyone know their neighbours? It may be time to do just that, to make sure there is a way to inform about needs, that shopping and small tasks can be addressed, and that the casual conversations, again with that 2-metre barrier, can be had; don’t be strangers on your street. Online and phone contact with loved ones is possible and necessary. Online contact needs to be at high volume with as large a screen as possible. Older people are resilient, have seen worse in some cases, and have life experience to share. They may have specific knowledge that is useful, so keep in touch, ask, involve.

One family I know is having “virtual drinks” via Zoom with their 85-year-old mother and grandmother – she simply loves seeing their faces and is quickly learning to adapt to new technology. But she needs to have the Zoom on “speaker view” rather than “gallery view” as she finds it confusing and disconcerting seeing so many faces all the time. It’s also important not to have people talking over each other so that your older relative can keep up with the pace of the conversation using a technology that may be unfamiliar.

And while it’s crucial to stay at home, maintaining physical activity is really important through this time. Any encouragement to those you know, or for yourselves, to maintain activity, exercise and cognitive challenge should be given. Walking, sit to stand exercises, or balance challenging exercise can continue and should. This is good for the immune system and reduces the likelihood of chronic disease deterioration. It is also good for mental health.  It is all our jobs to come out the other side of this pandemic with healthy, functioning and content older people alongside us.

Maintaining a positive outlook through the shutdown can be tricky. Managing stress while staying home is hard for all of us. Good advice about that is available online (MOH, WHO). Acknowledge it’s a tough time; have a routine; stay active; do something productive; draw on skills you have used in the past. This is where older people are ahead of the game. Experience gives resilience. Developing ways to continue contributing to society while not in your usual routine takes ingenuity. Reminiscence can be useful and cleaning out old cupboards can be illuminating and give a sense of achievement. For those with a more difficult past focussing on the present and future may be better. There is help available virtually through your GP, your usual providers, and online resources.   

For me, staying in touch with older people means ringing my Aunties at the other end of the country and the mother–in-law (in their late 80s and 90s) more regularly and finding out from them how to manage this time. One regularly takes her cup of tea to the end of the driveway to have a cuppa with her neighbour, keeping a more than 2-metre distance. Another is Facetiming her grandchildren and knitting peggy squares for when they can be collected. Writing things like this is helpful for me, to find out about how the pandemic is going elsewhere in order to give the right advice. Residential care can be a particular risk area where we don’t know how best to protect older people but rely on the skills and expertise of those working there. Maintaining contact and promoting physical and social wellbeing throughout the care home will be the challenge. Keeping the staff in place, and positive, and healthy consumes my daytime hours.

We all await a vaccine, a test to show immunity and a treatment. Until then everyone has to hang in and follow advice. Think about and keep in contact with older people - they will have good advice.