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How to Support Older Relatives During the Covid-19 Outbreak

Cathleen Colón-Emeric, MD, chief of the Division of Geriatrics at the Duke School of Medicine
Cathleen Colón-Emeric, MD, chief of the Division of Geriatrics at the Duke School of Medicine

Like many of us, Dr.  Cathleen Colón-Emeric, chief of the Division of Geriatrics at the Duke School of Medicine, has older parents who live nearby. Here are some of her suggestions for navigating the new and urgent conversations and decisions facing many families, including her own.


Q: What conversations should we be having with our older relatives?
Colón-Emeric: This is challenging because it requires talking about difficult topics like mortality. The message we’re giving to older adults is that after age 70 your risk of dying from this infection goes up exponentially, from less than 1 percent for younger people to as high as 13 percent for adults in their 70s and 80s. If your father says, “I’m healthy and strong,” change your appeal to “You could bring the virus home to mom and she’s more frail.” 
For older adults with cognitive impairment, we suggest putting up signs on the refrigerator or the door as an extra reminder they need to stay put. Frequent reminders and daily check-in calls can be really helpful. Think proactively of how you can facilitate their social distancing by making sure their pantries are stocked and arranging for home delivery of medications. 


Q: My parents and I are arguing about what’s safe for them to do. What’s the most important point I need to make?
Colón-Emeric: The activities you want to discourage are where they are going to be in close proximity with a lot of folks. If there is something that your older loved one is insisting on doing, try to understand their motivation. Is there a compromise to make that activity safer? With going to grocery store, it may be they are worried about imposing on you. Set up a grocery delivery option, or curbside pickup.


Q: How can I keep my extroverted dad from getting socially isolated?
Colón-Emeric: There’s plenty of literature to suggest that if we completely cut off older adults from social engagement, that’s not healthy. It’s a matter of judging risk versus benefit for those social contacts. If your dad has a friend that he goes out to lunch with, have them convert that to a walk where they can maintain more social distance. Or they could develop an online chat group. 
Be creative and look for opportunities to engage virtually. Set up a video chat time every night. Try games and apps where you can interact virtually, like Words with Friends. Do online crossword puzzles “together.” Many of the symphony orchestras are converting to virtual concert halls, including the Berlin Philharmonic. My family is going to watch a concert virtually in our own homes and we’ll be able to talk about it afterward. We’re celebrating my husband’s birthday by going to a park with my parents, just the four of us.

Q: Should my older relatives go to routine medical appointments?
Colón-Emeric: For routine check-ups, or routine visits to the dermatologist or a specialist for a chronic medical condition that’s stable, we’re suggesting those get converted to telemedicine appointments. If they need to be seen face to face, that’s fine, but for most folks it’s to their benefit to stay put and touch base via telemedicine.


Q: How can I encourage my parents to stay physically active while self-isolating?
Colón-Emeric: Sitting on the couch all day is not healthy either, so encourage them to get out and take a walk. Most local parks are staying open, and there are lots of lovely trails they can explore. The National Institute on Aging has an online program called “Go 4 Life” with great at-home exercise videos, a downloadable book, online chat groups, and the option to make and track exercise goals.  


Q: Should my parents move in with me?
Colón-Emeric: If you are working in healthcare and potentially bringing home the virus, that would be something you want to avoid. If your parents need a lot of care or if social isolation is getting to them and your whole family is going to be hunkered down, it could be a reasonable solution for some families.


Q: My parents receive visits from professional caretakers. Should we cancel this service?
Colón-Emeric: Again, that’s going to be an individual family risk-benefit decision. All home care agencies have protocols in place to screen workers each day and they are making sure they are doing hygiene between visits, but it’s still a risk. Some families are temporarily suspending those services; others are saying the family isn’t able to provide those services, so the risk is worth it. There is no one-size-fits-all. 


Q: What if my older relative develops symptoms of COVID-19?
Colón-Emeric: The most appropriate thing to do is call their primary care provider. All primary care providers have protocols in place for how they are going to assess people over the phone. Let the primary care provider make the call about whether they meet testing guidelines. If they do, the provider will have to decide whether to send the public health nurse to their home, or have them come to a drive-through testing site, or go to the emergency room. 
If a loved one doesn’t have a primary care provider, then the local public health department has these services available. If they are going via 911, let the dispatcher know that they are displaying symptoms so EMS workers can take specific precautions.