Senior citizens deserve better than to be left in isolation

Senior citizens deserve better than to be left in isolation
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On March 4, 2020, California Gov. Gavin NewsomGavin NewsomBusinesses plead for states to enforce mask mandates A nationwide response from an unusual place: City halls California, Florida, Texas report new single day high coronavirus death tolls MORE (D), and later the Los Angeles County Health Department, declared a state of emergency, which included mandatory lockdowns of all senior living centers and nursing homes. 

This was prompted by events at a nursing home in Washington State, where many died of COVID-19 and precautions were inadequate.

Similar orders were soon promulgated all over the country, by most states and counties. Though the rest of society is now opening up, there is still little interest in lifting or modifying these senior care facility lockdown orders. Government seems determined to prevent any senior in a residential community from dying of COVID-19. That is a noble goal, but has unintended adverse consequences.  

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Nearly every resident of any retirement center or skilled nursing home in the U.S. is locked down. Residents are told to stay in their rooms. All visitors including family are denied access. The dining rooms where residents shared meals and socialized closed. Social and diversional activities halted. Group exercise programs ended. Outings to parks and outside entertainment stopped. Within the parameters of these orders the facilities did what they could to help their residents, but their hands were tied by government decrees with stiff fines and punishments if violated.  

Residents now find themselves alone in solitary confinement. Many have become inactive, immobile, delirious, disoriented, depressed and terrified

This is happening to many of the millions of seniors in nursing homes and senior care centers all over America. As a geriatrician, I have personally seen it happen to my own patients, some of whom had to be hospitalized near death as a result. 

Some patients have extra resources, but most do not. If there is a concerned family that can afford one-on-one care — 24 hours per day, seven days per week — at the retirement home, then some social interaction can be provided. Patients might fare better under those circumstances, but it is costly. Most cannot afford such extra services, and many of these patients will suffer and die — not necessarily from COVID-19, but from what I call C-SIS (COVID - Senior Isolation Syndrome).

Deaths of despair, depression and anxiety are on the rise. It has been predicted that because of our mitigation efforts we could have 75,000 additional suicides, mostly by young people.

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And that could be only the tip of the iceberg. We may lose many more seniors to isolation, depression and lack of medical care and malnutrition than to the virus.  

Seniors in their own homes are free to connect with family and friends, and most do. The risk of getting the virus is similar, but when institutionalized seniors are forced to stay alone in their rooms with no visitors for months, they may feel no reason to live. This is not being factored into the equation by most modelers.  

It is true we have lost 100,000 souls to COVID-19 in only about two months. This is a horrible toll. It is also true that most of our COVID-19 deaths have been in the elderly with comorbidities living in nursing homes and retirement centers. We must try to protect them. However, there is no evidence that total lockdowns will accomplish that goal. Lesser precautions probably would work without isolating seniors from all contact. Isolation is dangerous too, as we on the frontlines have rediscovered. 

Thousands of U.S. seniors die in nursing homes every two months in the best of times. We mourn the loss of each and every one of them. Let’s not accelerate the loss unnecessarily by locking them all up alone.  

We need to return our senior care living centers to some semblance of normalcy, to save lives. Most, well over 90 percent, would actually survive COVID-19. Of those who get ill, 80 percent have mild illness anyway.  Moreover, at least 25-80 percent who get the virus do not get ill at all, and would not even know they had it, so many are asymptomatic.    

I am not at all sure they will survive “C-SIS.” 

There are resources that can help prevent seniors from social isolation in both institutionalized and independent senior care facilities. 

Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a board certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance, California. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital.