The other day, I watched a family on the news celebrate the 100th birthday of their matriarch. Since her retirement home was on lockdown because of the COVID-19 pandemic, they did it by waving to her through the window. That got me thinking. The elderly are being urged to isolate because they are at higher risk for serious complications from the virus, but the isolation creates its own risks of loneliness, depression, anxiety and mood dysregulation. What can we, as family and friends of older loved ones, do to help them cope and remain strong during quarantine when we are physically prevented from being with them?
My own mother is 86 years old, living in the suburbs of Seattle, in Kirkland, just down the road from the Life Care Center nursing home, where 35 people died from COVID-19 infections in late February and early March. She is safely hunkered down, not leaving her home, but you can imagine our concerns in the first days and weeks.
As a physician, I understand the stress and anxiety of COVID-19 social distancing will tend to exacerbate the feelings of isolation, loneliness, and mood dysregulation that some people already experienced prior to the quarantine. As an addiction specialist, I’m especially concerned that our older loved ones may lack the necessary coping skills for this stressful situation. Unfortunately, people who were already using mood-altering substances – alcohol and even prescription medications – may use more right now, and others without previous issues may develop unhealthy habits to self-medicate.
Either way, it’s important to stay connected to help support the older adults in our lives during this difficult time. Here are strategies to help keep your loved one grounded and assess how they are coping. These are strategies that can benefit everyone.
Connect with older relatives more frequently
Those locked down in retirement communities and nursing home facilities face a specific set of challenges. Visitors are now prohibited and all the usual social activities – one of the big benefits of living in a retirement community – have been cancelled for the foreseeable future. Many older adults living on their own also have extremely limited social engagement right now. With their normal outlets and activities no longer available, family and friends will need to provide more social connection essential to mental and emotional well-being.
Of course, please do it on their terms. Ask your loved ones how they would like to stay in touch. Maybe they don’t want to talk every day, but twice a week is enough. Is there a time of the day that is better? Would they prefer keeping in touch by phone? What would they like to talk about?
Connecting more frequently has two amazing benefits. First, it energizes everyone, providing mental stimulation and helping to sooth anxiety over the drastic circumstances. Second, and perhaps more importantly, it provides you a baseline for how your loved one is doing in this time of stress. If there is a problem, and you are not in regular communication, it may be weeks before it is noticed. You also may not recognize whether a behavior is problematic if you’re not talking frequently.
Establish a new routine
During this uncertain time, it’s important for older adults to establish regular schedules and patterns. For some, elements of their usual routine have been disrupted. The dining hall and the gym are likely closed, and any classes or group activities cancelled. This disruption in routine can make them confused and disoriented, raising their anxiety.
It can be helpful to even work with them on a written routine that encompasses everything including waking-up, breakfast, bathing, entertainment/activities at home, communicating with loved ones, bedtime and medications. Establishing a schedule can make a major difference in their feeling of control, peace and well-being.
Get the grandkids involved
With the kids at home while schools are closed, enlist them in talking regularly to older family members. Put it on that schedule, with the time and who's calling, so the older adults can see that their grandson is supposed to call tonight at 7 p.m. You could start a regular story hour, where the grandparents read a story. For older kids, ask them to interview their grandparents about their lives growing up and some of the old family history. Record the interview, or have the kids write down the stories.
Or, get the grandparents to help with remote homeschooling. Maybe grandpa’s got math skills and can help with algebra. Perhaps your great aunt was an elementary school art teacher and has ideas for projects. Feeling needed and helpful can boost their morale and be helpful for you as well.
Teach technology to maintain social connections
Technology can help build connections, to both friends, family, and the world at large. The grandchildren and other younger members of the family could be tasked with helping set things up on the older adult’s computer or television. My daughter helped my mother learn to use Apple Facetime.
The use of Facetime, Zoom and other on-line videoconferencing tools is exploding. People are holding regular Zoom meetings with friends and family over lunch and dinner, so no one must eat alone. Zoom could also be useful for attending virtual 12-step meetings. Phone calls are nice but being in a group of people you can see is especially heart-warming.
There are other opportunities for learning or entertainment. Every day, the Metropolitan Opera in New York is streaming an opera from their decades of performances, and dozens if not hundreds of other cultural institutions and theaters are putting up free programming. No one's going to the theater or shows, but the groups still want to remain engaged with their audience members, so they're making it available for free.
Get your own house in order
I would urge everybody to make sure you have a backup in case you fall ill yourself. All of us are at risk in this pandemic. If you are responsible for providing stability and support to older loved ones, you will need someone else to take over if you’re unwell.
Now is the time to be vigilant
Unfortunately, many older adults may turn to alcohol and other drugs to manage stress and difficult emotions during this time. It’s important to take note and ask for help from a behavioral healthcare provider if you notice any of the following. They could be indicators of stress or signs of danger.
Red flags to watch for
Family members should remain alert to these potential mental health or substance abuse problems:
- Changes in routine. If mom and dad always called every Wednesday night to talk to the grandkids, and suddenly they stop, that is worth investigating. During this pandemic, it could be due to the disruption in routine, but it could indicate they are disoriented due to the use of substances.
- Memory and cognition problems. Perhaps they are suddenly showing signs of confusion, or suffering memory lapses, when that was never a problem before. This can be a sign of substance use.
- Going through prescriptions more quickly. If you are delivering their prescriptions to them and they are being filled with greater frequency or at a higher dosage – that could be a sign of abuse.
- Isolation and lack of interest in socializing. If they seem more isolated, or they stop answering the phone or don't want to participate in social activities, that could be a sign of depression.
- Losing track of dates and times. When people are confined indoors for a long time, they may get confused about the date or time, or whether it is night or day. It is not unusual for someone stuck indoors, who is unable to move around and interact with people, to suffer a cognitive decline.
- Anything out of the ordinary. If something seems to have changed in their behavior, it is worth investigating. That’s why it is important to remain in frequent contact, so you have a baseline for their “new normal.”
We may not be able to control many elements of life right now, but the good news is there’s a lot we can control. Staying connected to the older adults in our lives and supporting them can make a significant difference for everyone. If you’re a friend or family member and you see differences in behavior or attitudes in the older adult in your life that concern you, I encourage you to ask for help. Even in these difficult times, there are safe and effective ways to access mental health and substance use disorder treatment, such as an older adult inpatient program.
By Carol Waldman
By Ming Wang, MD, FASAM