On any given week, my mother, who is 80, plays bridge, goes to church, attends public lectures, takes part in a book club, and meets friends for lunch.
“You should stop doing these things,” I told her recently. She lives in a retirement home, and according to the Centers for Disease Control, because of her age, she’s “higher risk” for serious illness from Covid-19.
“I know,” she said, sadly. “I will just stay in the apartment.”
Telling my mother to recede from the world feels antithetical to everything I know about how to respond to a crisis. Like most people who have made it to 80, my mom has faced a lot of losses—a son and a husband in recent years, not to mention many friends. Being connected to others is part of what has saved her from the anger and despair that are natural companions to deep grief and suffering. Now, to minimize her chances of contracting coronavirus, I am asking her to stop doing the thing we have been encouraging her to do for years: get out, explore, embrace the world.
Millions of people, alongside worrying about an unfamiliar and fast-moving pandemic, are also wondering how to care for and connect with parents, grandparents, and neighbors who are are being told to isolate—a condition most of us, usually, desperately try to avoid.
In a 2018 BBC survey of 55,000 Brits, 29% of 65-to-74-year-olds and 27% of respondents aged 75 and over reported they were “often or always” lonely. Recent research shows the pernicious effects of this loneliness. In 2010, Julianne Holt-Lunstad, a professor of psychology at Brigham Young University, showed the cost of weak social ties. Being disconnected, she demonstrated, posed comparable danger to smoking 15 cigarettes a day, and was more predictive of early death than the effects of air pollution or physical inactivity.
But now, staying connected is running headlong into a wall of needing to stay alone, with many of the newly isolated not fluent in technology which might mitigate those effects.
The children of elderly parents are introducing their mothers and fathers to food-delivery apps and online classes, and discouraging social gatherings. “I encouraged my Mom last night to shift to play online bridge instead of going to her bridge tournaments,” said Amy Wilkinson, author of The Creator’s Code and a lecturer at Stanford Business School. Others are telling parents who attend religious services to opt for streamed ones, have their prescriptions delivered by mail instead of picking them up from pharmacies, and logging on for online classes to pass the time (a few options: here and here).
These changes can be unnerving, though, especially when it means upending important relationships.
Into the heart of the helping economy
Patti Palmer, 61, has been volunteering in a mentorship program in Norwalk, Connecticut, since January. Every Wednesday she meets a third-grade boy who has been identified by social services for being at risk, and they chat about school and life. Often they play cards. Palmer showed him how to properly hold a hand, and taught him to shuffle. ”You are there to be their friend, and you want it to last over the years,” Palmer says.
But last week, she decided she had to stop. She had been to visit her mom in Colorado and her husband had been to California. “It’s not right to be going into the school, and as someone with asthma and over 60, I didn’t want to put myself at risk,” she says. It was a hard call because she believes in the core mission of the project: to stick with the kids through thick and thin. “I hate letting this child down,” she says.
She told the school, which was very understanding, and they discussed how best to tell the student. But she never had to. The next day, the superintendent canceled the program. “We were just informed that the superintendent has directed schools not to allow mentors into schools due to proactively mitigating the COVID-19 spread in Norwalk and Fairfield County,” a note from the program’s leader said.
The bigger picture
Daniel Dickens spent six years running social interventions in the UK related to aging, chronic health conditions, and employment. Community-based efforts like his, which rely on relationships and building people’s capabilities, have been gaining widespread acceptance. When the National Health Service released its 10-year plan in January, it called for investing in “link workers,” to help people managing complex medical conditions, and “social prescribing,” in which doctors prescribe community activities.
“This represents a new relationship between people, professionals and the health and care system. It provides a positive shift in power and decision-making that enables people to feel informed, have a voice, be heard and be connected to each other and their communities,” the NHS plan reads.
Much of that work now feels under threat.
“It has taken a long time to build the evidence base that human connection and behavioral interventions are as effective as a pill,” says Dickens, who is now managing director at the Helix Centre, a healthcare innovation lab at Imperial College London. “And in the moment when there is a critical mass of support amongst policymakers and healthcare providers, some of these models are now a public health concern.”
Dickens is particularly worried about both vulnerable patients and health workers whose jobs take them into people’s homes every day. “In addition to overstretched hospitals, continuity of care could be affected” for the beneficiaries of social-care workers, community health workers, and volunteers, he says.
Helix is running clinical trials on new technologies and services that help stroke survivors recover, and provide support in dementia care and palliative care. The research involves in-person visits, all of which have been called off to prevent any risk of Covid-19 spreading.
Dickens is excited by the possibilities that new technologies bring in terms of widening access and using data to deliver more effective care, but “the relationships you build in person are the ones that change lives,” he says. “Those are being disrupted by coronavirus.”
What to do
Since 2015, Jenny Hartnoll, services lead for Frome Medical Practice in Somerset, UK, has been strengthening social connection in her community. She runs a team of 1,000 “community connectors” who know what is available in the area—stroke support groups, choirs, exercise groups for people with mental health challenges, macular degeneration support groups—and point people to it. Those groups are all calling her now and asking: What do we do?
“Community connectors are all about connecting the community and potentially we have to have the opposite with social distancing,” Hartnoll said. For now they are following Public Health England guidelines, but with the expectation that things will change fairly quickly as cases ramp up across the country.
She is worried about those who are alone, and who may not have many ways to connect. “If we are isolated at home, the only want to connect is through the telephone or social media, and I imagine some older people might not have access to the internet.”
The connectors have started activating their networks, making sure people have phone numbers for those who might be isolated. Already people in the community are doing what they can. Jo Fordham, a health connector at Frome, separately runs a weekly private exercise class for roughly 15 local residents, most of whom are over 70. The goal is to keep fit so they can be active in their daily life, as well as to offer a place to connect around healthy living.
This week Fordham felt the need to remind the exercise group that if any one of them felt unwell, or had a cough, they should not come to class. But she added something else: If they did get ill, with coronavirus or anything else, she would be willing to drop off supplies at their house and check in with them via text or phone.