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| Keeping Older People Safe During the Coronavirus Crisis | Keeping Older People Safe During the Coronavirus Crisis |
| (3 months later) | |
| In the United States today, there are approximately four million older adults who are not in nursing facilities but who need help with personal care (bathing, dressing or eating) and another 3.5 million older adults who need assistance in areas such as finances and cooking to live independently. These older adults depend on caregivers, either paid home health aides or unpaid family members, for their day-to-day existence. Both family caregivers and those they care for need to rapidly adapt if they are to remain safe during the coronavirus epidemic. | In the United States today, there are approximately four million older adults who are not in nursing facilities but who need help with personal care (bathing, dressing or eating) and another 3.5 million older adults who need assistance in areas such as finances and cooking to live independently. These older adults depend on caregivers, either paid home health aides or unpaid family members, for their day-to-day existence. Both family caregivers and those they care for need to rapidly adapt if they are to remain safe during the coronavirus epidemic. |
| The best strategy for older adults with caregiving needs is to shelter in place, the same approach that is being used for the entire population in some of the hardest hit communities in the country. They need to stay away from sites where people congregate, including, whenever possible, health care institutions. | The best strategy for older adults with caregiving needs is to shelter in place, the same approach that is being used for the entire population in some of the hardest hit communities in the country. They need to stay away from sites where people congregate, including, whenever possible, health care institutions. |
| Older people may well develop acute symptoms that have nothing to do with Covid-19 and will benefit from caregiver intervention to avoid having to visit health care providers to manage those problems. | Older people may well develop acute symptoms that have nothing to do with Covid-19 and will benefit from caregiver intervention to avoid having to visit health care providers to manage those problems. |
| Family caregivers are advised to redouble their efforts at “social distancing,” both for their own safety and to help protect those they care for. To be sure, many people have already taken such steps. But as the reach of the virus spreads, for those who are not already using technology to interact with pharmacies, banks, grocery stores and health care providers, this is the time to start. | Family caregivers are advised to redouble their efforts at “social distancing,” both for their own safety and to help protect those they care for. To be sure, many people have already taken such steps. But as the reach of the virus spreads, for those who are not already using technology to interact with pharmacies, banks, grocery stores and health care providers, this is the time to start. |
| A first step should be arranging for mail order delivery of medications for the older adult, preferably a three-month supply of all chronic medicines. Most Medicare Part D drug plans offer this option. It also means arranging for home delivery of groceries and over-the-counter drugstore supplies, making sure to include any necessary disposable undergarments or nutritional supplements. | A first step should be arranging for mail order delivery of medications for the older adult, preferably a three-month supply of all chronic medicines. Most Medicare Part D drug plans offer this option. It also means arranging for home delivery of groceries and over-the-counter drugstore supplies, making sure to include any necessary disposable undergarments or nutritional supplements. |
| In many areas grocery delivery slots are very hard to come by right now, so you may have to plan ahead and try multiple stores’ options. Setting up automatic bill paying of credit card charges as well as for gas, electric, and telephone services can lighten the load on the caregivers’ shoulders if they handle the finances of the older adult. | In many areas grocery delivery slots are very hard to come by right now, so you may have to plan ahead and try multiple stores’ options. Setting up automatic bill paying of credit card charges as well as for gas, electric, and telephone services can lighten the load on the caregivers’ shoulders if they handle the finances of the older adult. |
| To minimize the need for visits to the physician’s office or hospital emergency room, caregivers should consider utilizing simple medical technology such as a home blood pressure cuff, a pulse oximeter (to measure the amount of oxygen in the blood), a digital thermometer, and a digital step-on scale. | To minimize the need for visits to the physician’s office or hospital emergency room, caregivers should consider utilizing simple medical technology such as a home blood pressure cuff, a pulse oximeter (to measure the amount of oxygen in the blood), a digital thermometer, and a digital step-on scale. |
| By learning to use these devices, caregivers will be able to collect valuable data that they can provide to primary care physicians, nurse practitioners or physician assistants who, in turn, will be better equipped to offer medical advice or prescribe treatment over the telephone or the internet. This information can enhance telemedicine visits, when those are available, and substitute for them among the many older Americans who do not have access to video technology. | By learning to use these devices, caregivers will be able to collect valuable data that they can provide to primary care physicians, nurse practitioners or physician assistants who, in turn, will be better equipped to offer medical advice or prescribe treatment over the telephone or the internet. This information can enhance telemedicine visits, when those are available, and substitute for them among the many older Americans who do not have access to video technology. |
| As an example, if an older adult experiences dizziness and has a low blood pressure reading, the clinician might propose as a first step increasing the fluid intake or cutting out a diuretic pill. If the individual reports shortness of breath and proves to have gained weight and to have swollen ankles, along with a history of heart failure, the clinician might advise increasing the diuretic dose — all without the patient and caregiver having to risk exposure to the virus by venturing to a medical appointment in person. | As an example, if an older adult experiences dizziness and has a low blood pressure reading, the clinician might propose as a first step increasing the fluid intake or cutting out a diuretic pill. If the individual reports shortness of breath and proves to have gained weight and to have swollen ankles, along with a history of heart failure, the clinician might advise increasing the diuretic dose — all without the patient and caregiver having to risk exposure to the virus by venturing to a medical appointment in person. |
| If the patient shows symptoms that suggest Covid-19, checking oxygen levels with a pulse oximeter can help the health care providers decide whether the next step in the evaluation should be the physician’s office or the hospital emergency department. | If the patient shows symptoms that suggest Covid-19, checking oxygen levels with a pulse oximeter can help the health care providers decide whether the next step in the evaluation should be the physician’s office or the hospital emergency department. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | |
| In a time of crisis, using technology and partnering with the health care team to address acute symptoms can benefit both older adults and their caregivers. These strategies may even prove useful in more auspicious days. | In a time of crisis, using technology and partnering with the health care team to address acute symptoms can benefit both older adults and their caregivers. These strategies may even prove useful in more auspicious days. |
| Muriel Gillick is a professor at Harvard Medical School and the author of “The Caregiver’s Encyclopedia: A Compassionate Guide to Caring for Older Adults.” | Muriel Gillick is a professor at Harvard Medical School and the author of “The Caregiver’s Encyclopedia: A Compassionate Guide to Caring for Older Adults.” |