It was March 2020. Coronavirus disease 2019 (COVID-19) began spreading across the globe like a stain. At one time, that would have sounded like a dystopian rendition of one of Sophia Petrillo’s stories in an episode of The Golden Girls. But unfortunately, it was our reality, and would only get worse. Suddenly, we were all becoming too familiar with words like “pandemic,” “death toll,” and “unprecedented.” Countries shut down, businesses collapsed, unemployment soared, and fear of contracting this novel virus loomed large. At the time of this writing, there are 259,979 US deaths, and globally there are 1,412,388 deaths due to COVID-19.1
The information the public received early on was constantly changing, but one fact that has not wavered is that the elderly are most vulnerable.2 My mother is almost 80, and out of love and fear, my sisters and I imposed strict quarantine for her. Being a widow, this meant she was home alone, contacting family and friends only by phone. We wanted to minimize the danger of her contracting this disease, so she remained quarantined for quite some time. We were keeping COVID-19 away, but she was suffering from a different, dangerous condition. Social distancing, to slow the spread of the virus, was spreading something else: loneliness.3 The isolation and anxiety during this worldwide health crisis is greatly affecting the elderly.
Prior to COVID-19, my sisters and I visited my mother often. I enjoyed having everyone over for dinner and afterwards playing cards or Scrabble or Family Feud. We are a competitive bunch, but it was always fun, and we had lots of laughs. However, as the pandemic closed in on the US, we hunkered down, disconnected from others in an effort to keep ourselves and our loved ones shielded. We were all afraid and focused on the seriousness of the situation. We contacted my mother daily, at first by phone. We felt we had to make sure she stayed inside, away from everyone, including us, in order to stay alive. What we couldn’t hear in her voice, though, was how her physical and mental health changed over the next several months.
Increased risk in the elderly
According to the Centers for Disease Control and Prevention (CDC), eight out of 10 COVID-19 deaths in the United States have been in adults who are age 65 and older.2 That is staggering data, especially in my home state of Florida, where just over 20% of the total population is within that age group.4 To further complicate things for the elderly, early data showed that people with preexisting conditions have a higher chance of experiencing serious complications when infected with COVID-19.5 My mother has chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, and asthma—a trio of comorbid conditions. Cancer, heart conditions, and obesity may also put older people at a greater risk for hospitalization or death from COVID-19.6 The reports I read only supported our decision to be sure Mom stayed isolated. Anytime she mentioned trying a socially distanced visit with her friends, my sisters and I—armed with facts and data—squelched her plan to break quarantine.
That was early on, when we had no idea of the devastation this virus would unleash or how long it would impact our lives. I hadn’t seen my mother since March, and I missed her. We tried Google Duo chats, but I saw more of the top of her head and the ceiling than of her. She tried, but she just isn’t tech savvy. In May, we agreed that we needed to start bringing some normalcy back to her life. We felt we could safely visit, individually. My older sister was the first to mask up and call ahead to plan a socially distanced visit. Afterwards, she confided in me that she had concerns about Mom’s overall health and oral health. The months were ticking by, and she was getting ornery and anxious about being separated from the outside world.
My second oldest sister, a teacher, was off for the summer, and she began to visit Mom in person, following all the precautions as well. She has always tried to motivate our mother to be active, and during the pandemic she was continuing to try to keep Mom’s spirits up by urging her to take a walk or plant flowers. My sister remarked to me that at her last visit, Mom looked frail, like she’d lost quite a bit of weight. She also noticed memory issues that hadn’t seemed so pronounced just months prior. My inner health-care provider and Irish-Catholic-daughter guilt collided. It was time to intervene with an in-person wellness check. I quarantined for 14 days, then masked up, gloved up, and tucked hand sanitizer into the pocket of my yoga pants. It was time to see my mom.
Intervention
I set up lunch outside, on her back patio, making sure to space the chairs and folding tables with ample distance between. As we ate, I observed, looking for anything out of the norm. She was wheezing a bit, but she chalked it up to allergies. She was losing the words for things more frequently than I had remembered, just as my sister had reported, and that concerned me, too. She had definitely lost weight, which was no wonder since she mentioned eating mostly yogurt here, cheese and crackers there. This was neither nutritionally balanced nor sufficient to help control her blood glucose.
I also noticed that her upper denture seemed to be loose. I hadn’t used my dental hygiene skills in months, since COVID-19 had materialized and my position in a school-based sealant program evaporated. My inner dental hygienist sprang into action, and I began putting the different factors together. I knew I had to switch modes from daughter to dental professional and, in essence, treat my mother as if she were my patient. She agreed to let me do an extraoral and intraoral exam, which gave me the opportunity to ask some important questions. I learned she had not been to her dentist in over 18 months, and with the pandemic, she wasn’t sure she was ready to make an appointment. Her medications were causing xerostomia, and her breathing treatments were adding to her loss of appetite. Her upper denture was over 10 years old, and she had probably lost at least 40 pounds since then. She was also taking bisphosphonates for osteoporosis. It was obvious I needed to formulate a safe and smart plan of action that Mom would also accept.
Executing the plan was not easy! Almost-80-year-old moms generally do not relinquish control without some resistance, and mine was no exception. I bought her a journal to record her nutritional intake and to write down any concerns about her health or questions she might have. It is not uncommon for older women to encounter certain barriers when communicating with their physicians.7 A patient with hearing and/or vision loss might miss important details, which could hamper the proper exchange of information. A doctor with a nonempathetic bedside manner might prevent an elderly patient from sharing key elements of changes in their health, which could alter the plan for possible treatments.7
I know the journal is a helpful reminder for Mom, but she needs more. My sisters and I have had to become supportive health advocates for our mother. She’s not always crazy about our involvement, but that day she allowed me to help. I typed up a cheat sheet, updating all of her medications, and kept it small enough to glue inside the cover of the journal. Then we called her primary physician, her cardiologist, and her pulmonologist. I made sure that either I or one of my sisters was available to accompany her to the appointments. Lastly, it was time for a new dentist, as hers had retired during the pandemic. We made a list of practices that accepted her dental insurance, and she chose one based on my recommendations and referrals from her friends. It was no magic wand, but it began to address the toll COVID-19 isolation was taking on her. With medical and dental tasks addressed, I switched the conversation.
Restoring a sense of normalcy
The loneliness and isolation she was experiencing were not separate from her other health issues. Depression and stress over the virus are very real and most likely exacerbating her health concerns. We had to help our mom formulate a more positive, yet safe, approach to living during the pandemic. It was obvious she needed her self-efficacy restored, and we hoped it would greatly benefit her physical and mental health.
Now Mom has a large collection of masks and plenty of gloves, in both her home and her car. She ventured back out into the world slowly—short trips to the market, the bank, and the post office. Eventually she had her first visit to her hairdresser, which made her feel (almost) normal. She has many doctors’ appointments, and because I am currently not working full-time, I am able to go with her. My mom has been viewing Sunday Mass virtually, but would now like to go in person. I am looking into which services are adhering to mandatory face masks, and which are the least crowded.
Mom’s elderly friends also have cautious children looking out for them. They, too, have seen the importance of our parents being able to safely socially interact. The other day, for the first time in eight months, Mom shared a pizza and a glass of wine with her best friend, outside in her backyard. Baby steps, but progress. It made her really happy, and gave me insight into how so many elderly in my community are being affected.
In 2018 I received a grant to create a dental education presentation for seniors in assisted living facilities (ALF). It was successful in helping the residents understand the importance of dental health to their overall health. With so many locals still testing positive for COVID-19, it is unlikely that I will have that opportunity again, on such a large scale, in the near future. However, I am working with my local church and a senior center to plan a smaller, safer, socially distanced event. If my own mother is struggling, I know others are too. Listening to dental hygiene instruction might be very refreshing at this time, when our concerns are many. A smile, a conversation, a laugh with a neighbor, even if it is from behind a mask, may be just what someone needs right now. I feel fortunate that my mother is well and that I have my family to help me keep her well. Going through the experience with my mom has allowed me to see the importance of helping seniors navigate through loneliness, COVID- 19, the remainder of 2020, and beyond.
References
1. COVID-19 dashboard. Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JSU). http://coronavirusstatistics.org/
2. Older Adults. Centers for Disease Control and Prevention. Updated September 11, 2020. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html. Accessed October 10, 2020.
3. Marcius CR. Isolation due to covid-19 pandemic has NYC seniors facing loneliness, depression. Daily News. October 19, 2020. https://www.nydailynews.com/new-york/ny-coronavirus-senior-social-isolation-depression-20201019-ztfylqvsozhhpehiolsyghmy4u-story.html. Accessed October 20, 2020.
4. Himes CL, Kilduff L. One quarter of older Americans live in California, Florida, and Texas. Population Reference Bureau. https://www.prb.org/which-us-states-are-the-oldest/. March 16, 2019. Accessed October 10, 2020.
5. People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#:~:text=Heart%20conditions%2C%20such%20as%20heart,%E2%89%A5%2040%20kg%2Fm2). Updated October 16, 2020. Accessed October 17, 2020.
6. Sanyaolu A, Okorie C, Marinkovic A, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. 2020;2:1069-1076. doi:10.1007/s42399-020-00363-4
7. Root MJ. Communication barriers between older women and physicians. Public Health Rep. 1987;102(4 Suppl):152–155.
Kerry Vierengel, CRDH, BASDH, has a passion for public health. Prior to the pandemic, she worked in a school-based sealant program, helping to provide oral health instruction and treatment to thousands of children each year. Currently, Vierengel is temping and volunteering in her community. She recently earned a bachelor of applied science degree in dental hygiene and hopes to one day become an educator in her local dental hygiene program.
