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Advice About COVID and People Over 60 and With Chronic Conditions

February 09, 2021
by Mary Tinetti, Richard Marottoli and James M. Lai

Mary Tinetti, MD, is Chief of Geriatrics at Yale and an international expert in care for the geriatric population, notably in clinical decision-making for older adults with multiple health conditions, measuring the net benefit and harms of commonly used medications, and the importance of cross-disease universal health outcomes.

Richard Marottoli, MD, MPH, is the medical director of the Dorothy Adler Geriatric Assessment Center at Yale New Haven Hospital. He also directs the Connecticut Older Adult Collaboration for Health (COACH), a partnership between healthcare organizations and public health agencies, primary care providers, geriatricians, and community-based organizations in the Greater New Haven and Bridgeport area.

James Lai, MD is the Associate Chief of Clinical Affairs for the Section of Geriatrics at the Yale School of Medicine where he directs all the geriatric clinical activities which include inpatient, skilled nursing, outpatient and home-based primary care.

In this guide, they share what is currently known about the COVID-19 outbreak and older adults, and steps that older adults and caregivers can do to stay healthy.

What We Know

· The illness enters the body through the nose, eyes, or mouth, and then proceeds to the lungs. Avoid touching your face or being in crowded situations in which particles expelled through coughing and sneezing might be inhaled.

· The COVID-19 Vaccine appears to be safe and reduces the likelihood of developing a symptomatic Sars-Cov-2 infection; however, the length of this benefit for older adults is unknown. The vaccine appears to reduce risk of serious infection with the new variants, but that is still being evaluated. It is strongly recommended that all eligible individuals be vaccinated.

· Nursing homes residents and staff have been a priority for COVID-19 vaccinations. As a result, cases of COVID-19 have been decreasing at these facilities and making them safer.

· Wearing masks, eye protection, and social distancing continue to be effective ways of reducing the spread of the virus, even after getting the vaccine.

· Older adults (over 60 and particularly over age 70) are at highest risk for death or severe illness with COVID-19.

Communities that have a lot of contact between younger and older adults, particularly if they are living together, may have faster transmission of the virus and worse disease severity, including death.

What Older Adults and Caregivers Need To Do

(Not All of These Will Apply to All Individuals)

· Once persons over 60 are vaccinated,

o Limit visits to 2 or 3 people at a time. Follow CDC guidelines to know when there are enough people with immunity that it is safe to meet in larger groups.

o Minimize contact with crowds, even after vaccination. Have stores deliver or ask someone to pick up your groceries and medications. If you must go yourself, arrive early in the morning when fewer people are there and the store is at its cleanest.

o For those who regularly attend worship services or other gatherings, see if your group offers streamed services. If you go, do it at a time when there a few other people. Keep 10 feet from people if it is indoors. Avoid singing, which has a high likelihood of spreading COVID-19.

· If persons over 60 haven’t been vaccinated yet,

o Sign up to be vaccinated for COVID-19 once you are eligible; People 65 and older can sign up now. Talk to your doctor about whether the vaccine is appropriate for you if you have had severe allergies to medications, previous serious reactions to vaccines, or recently had COVID.

o You can identify who’s eligible and where to get vaccinated by visiting the Connecticut Department of Health (DPH) website:

https://portal.ct.gov/Coronavirus/covid-19%20vaccinations

o If you don’t have access to, or familiarity with, computers, you can schedule your vaccine by phone. If you need help with this, you can call (877)-918-2224 or (833) ASK-YNHH (833-275-9644).

o Caregivers of older adults should be vaccinated as soon as eligible. Make this a priority and consider deferring to other care providers until you are vaccinated.

· For everyone,

o Go for walks outside with other people, unless it is very cold or slippery. Stay at least six feet from others unless you need support to walk safely. Moving in the fresh air helps your physical and mental health and decreases the risk of getting COVID-19 from being with people.

· Develop safe ways to communicate with your family and friends through phone calls, the internet or social distancing to prevent isolation, reduce the risk of depression, and maintain healthy contact with your community.

· To stay connected during this time, if you have the equipment and can use it, communicate with Skype or FaceTime. If not, talk on the phone daily. Your friends are in the same situation and look forward to talking with others.

· Wash your hands often for 20 seconds (sing “Happy Birthday” twice). Soap and water is better than hand sanitizer but use hand sanitizer if there is no access to soap and water. Use hand lotion to prevent your skin from drying and cracking.

· Follow routines. Prepare meals, eat, exercise, bathe, nap, go to bed, and wake up just as you would on “normal” days. Try to eat healthy foods. Avoid “junk food” and limit your alcohol intake to one glass (or less) per day. Avoid the temptation to sleep in or sit on the couch all day. Sticking to a routine can help things feel normal and keep the blues away. It may help to write out your routine and post it where you can see it.

· Contact all your clinicians’ offices to see if they have procedures in place for safe office visits, and visits related to any concerns you may have should you observe possible COVID-19 symptoms. Ask them about Telehealth or telephone options, which most offices are starting. If your clinicians think you should come to the office and they have COVID-19 precautions in place (most do), then it is important for your overall health that you maintain your health care visits.

· If you have been in the hospital and need more help than usual, then you should consider short-term rehabilitation as an option. Many staff and residents in these facilities have been vaccinated for COVID-19; they may be safer places to receive the help you need if home caregivers are not yet vaccinated. Ask potential caregivers (at rehabilitation facilities or at your home) if they have been vaccinated. Wherever you get your care, the caregivers and you should wear masks and keep at least a six-feet distance except when necessary.

Submitted by Jane E. Dee on February 09, 2021