Dec 11, 2020 9:00 AM

Author: University of Utah Health Communications

This information was accurate at the time of publication. Due to the changing nature of the COVID-19 pandemic, some information may have changed since the original publication date. More accurate information is now available.

Older adults are at greater risk of hospitalization or dying if diagnosed with COVID-19. As Utah continues to see high transmission rates during the holidays, it’s more important now than ever to protect those who are most vulnerable to the virus. University of Utah Health geriatric experts discussed ways older adults have been disproportionately impacted by the virus and how to provide emotional support to this population. 

Mark Supiano, MD, chief of the Division of Geriatrics at U of U Health

Kathie Supiano, PhD, LCSW, Director of Caring Connections for U of U College of Nursing

What is the current trend of COVID-19 hospitalizations and deaths?

Mark Supiano: If you look at the number of cases in Utah, the majority include people under age 65. This shows older adults are getting the message that they are at high risk of getting COVID-19. The problem is, if you are over age 65, you are at higher risk of hospitalization and dying from the virus. As of December 3, 2020, 76% of all COVID-19 deaths in Utah occurred in people 65 years and older. About two-thirds of those deaths has been a nursing resident. The population of 65 and older is about 12% in Utah. While the number of cases are fewer in those under 65, their hospitalization rate is much higher. Overall, the good news is, if you test positive for COVID-19, your risk of hospitalization is only 5%, so you’ll likely have a mild case where you can recover at home. However, if you are in the 65 to 84 age range, your risk of going to the hospital is almost 19%. If you are 85 years or older, your risk of going to the hospital is 27%. This is why we are focused so much and adamant about maintaining vigilance.

What is delirium and brain fog?

Mark Supiano: In the setting of any serious illness, an acute change in someone’s thinking or sudden loss of memory is known as delirium. Delirium can often be a signal that an older adult is seriously ill. In several studies, COVID-19 is presenting more in older adults than the usual symptoms such as fever, cough, and muscle aches. This is another important reason to prevent delirium, because older adults with COVID-19 are at very high risk of developing delirium. If a patient has delirium and COVID-19, the risk of death is doubled. It’s a real red flag that’s a very serious illness. 

We’re fortunate at U of U Health to have our delirium prevention program, the Hospital ELDER life program (HELP). The program has transitioned from an in-person volunteer, who would normally be present at the bedside of an older adult patient, to offering connection through technology such as Zoom and iPads. Volunteers use technology to help engage patients in the program to keep them oriented and socially engaged.

What is your perspective on COVID-19 and celebrating the holidays?

Mark Supiano: The risk to everyone, particularly to older adults, is as high in Utah as it has ever been. We should all be more vigilant now than we were in March and April. Despite the ongoing pandemic and the fatigue settling in, this is the time to remain vigilant. The simple precautions of masking, physical distancing, not going outside your bubble, and washing hands is all the more important.

How can families help their older adult relatives not feel isolated during the holidays?

Kathie Supiano: Now is a time to be creative and realistic. Older adults didn’t get to this age without having some resilience. They’ve dealt with heartbreak, loss, and have reconfigured their social landscape at some point in their lives. I encourage the middle-aged and young adult children to flip this around and problem solve with their older adults. They should engage and ask what would work for them: Can they video tape the opening of gifts? Can they take them on a video tour of their house? Can they mail cookies in advance? Distance is not just geography and hugs are not tactile, but there are creative ways we can do this.

What is your take on traveling during the holidays?

Mark Supiano: The risk is so exceedingly high that you shouldn’t travel over the holidays. This is not the time to be letting down your guard. Christmas in July is going to be more of a reality this year. Hopefully it is a time that we can all reunite with our families. To safely travel, it would be very complicated. You would need to quarantine two weeks before your trip, receive a negative COVID-19 test before you go, and continue to follow all the COVID-19 safety precautions. However, that still wouldn’t bring the risk down to zero.

When will older adults get the vaccine?

Mark Supiano: The advisory panel to the Centers for Disease Control and Prevention (CDC) listed nursing home residents, as well as its providers and nursing home staff (food service, custodial, etc.), as the first in line to receive the vaccine. It’s still an open question when the general population of older adults will receive the vaccine. The projections are the spring, but that’s still a work in progress.

You can learn more about COVID-19 vaccines here.

The two current vaccines were only tested on people 80 years and younger. Are there concerns for vaccinating people older than that?

Mark Supiano: An article in the New England Journal of Medicine reports that people 70 and older who received the vaccine in the trial saw their antibody levels increase on the same trajectory as younger people. Their antibodies also lasted as long as for the younger age group. I would be comfortable at this point recommending people who are most at risk (80- to 90-year-olds) to be vaccinated.

Can the vaccine harm older adults?

Mark Supiano: The latest data shows the adverse event rate from the two vaccines that are under consideration by the FDA have been low and mild. That holds true to the information that’s been published for the 70 and older population (not including the 96 and older). Based on what we’ve seen so far, the adverse event rates are probably lower than influenza vaccination, although I still would recommend older adults to get a flu vaccine.

Will restrictions loosen for those in assistant living who get the vaccine?

Mark Supiano: It will take some time before we can start to loosen restrictions. We will need to see how these policies are rolled out at assisted living facilities and nursing homes, where strict visitation policies have been in place. The hope would be to relax visitation policies if enough residents and staff got vaccinated. But just because a person has been vaccinated doesn’t mean they’re able to let their guard down. They’ll still be required to wear a mask and physical distance to mitigate risk.

Could you address the concerns of people letting down their guard because a vaccine is coming?

Kathie Supiano: That’s like saying we know at some point they are going to put seatbelts in cars, so in the meantime, be reckless. Or it’s like a marathon runner. You got to get over heartbreak hill. It’s miserable, but you have to get over it to get to the finish line.

Mark Supiano: Once airbags were added in your car as standard, you didn’t stop using your seat belt. You need both. Right now, a mask is the most effective vaccine you have. It won’t be until 60-80% of the population is vaccinated that we can begin to think about letting our guard down.

Kathie Supiano: There’s still a lot of work to be done after vaccination. The vaccine is one big part of the solution. It’s not the solution. People have to say, “I am willing to sacrifice Christmas, Hanukkah, and New Year’s so I can see the daffodils bloom in the spring.” I invite people to consider how they would feel if they were the one who brought down members of their own family. People need to accept that with a level of responsibility. We all have to assume we are a carrier—or everyone around us is a carrier—and keep that distance.

What can we do for older adults who are feeling socially isolated?

Kathie Supiano: One of the huge blessings in the state of Utah is we have one of the best area agencies on aging—Aging and Adult Services. If you are far away from a family member and they need a resource, they can deploy resources. There is also Meals on Wheels and other services/connections out there.

Some other ideas:

  • Mobilize your faith community
  • Increase the frequency and variety of communication
  • Use Zoom to connect
    • Watch a movie together
    • Cook together
    • Organize an activity
    • Read books to grandchildren
  • Organize drive-by food deliveries

This is an invitation to be creative and to be fun. I would take you back to World War II, where neighborhoods supported each other because everyone had a son overseas. People were doing things in different ways, and we can do that too. This is an invitation to transform society in very fundamental ways and to create passionate communities.

How can we convince older adults to stay home when they’re willing to risk being with family?

Kathie Supiano: It’s the difference between short-term sacrifice and long-term gain. This is where you need to view life over the horizon instead of life in front of you. We have to do life differently. We have to realize that transmission goes two ways. We don’t want to bring risk to those who are most vulnerable.

What type of support does U of U offer?

Kathie Supiano: Money from the CARES Act was directed to University of Utah through the Utah Division of Substance Abuse and Mental Health (DSAMH) to provide two kinds of programs through Caring Connections. The University was well positioned to offer COVID grief support groups to the public. These groups are for people who lost someone to COVID but also for those who lost someone during the time of COVID. This could include people who couldn’t go to the nursing home, be present during the time of death, couldn’t have a funeral, or couldn’t travel due to the pandemic. We are also offering COVID-19 recovery groups. These are commonly called the long-haulers. Many people have had very debilitating “aftershocks” of COVID such as fatigue, the inability to return to work, physical problems, and mental health changes. These virtual support groups are facilitated by trained clinicians who are frontline mental health people in the COVID care community. All these groups are free.

coronavirus COVID-19 vaccine older adults delirium brain fog Hospital ELDER life program holidays social isolation travel mental health caring connections covid-19 support groups

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