The Pandemic is Stress Testing Aging in Place

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Power of Ideas

The Pandemic is Stress Testing Aging in Place

Author(s)
Christopher Herbert
Christopher Herbert
(Managing Director, Joint Center for Housing Studies, Harvard University)
Jennifer Molinsky
Jennifer Molinsky
(Senior Research Associate, Joint Center for Housing Studies, Harvard University)

As we write this article, the COVID-19 pandemic has forced large swaths of the globe to remain at home and practice physical distancing to limit the spread of this new and dangerous virus. For most people, this is a highly unusual and uncomfortable experience that greatly restricts how we socialize, work, and access needed goods and services. However, for many older adults, isolation at home is an all-too routine experience, as those with an inability to drive or access public transportation, as well as those with mobility or cognitive impairments, have limited opportunities to move about their communities and connect with others in person.

While the course of the pandemic remains uncertain, it will hopefully be a relatively short-term disruption (while obviously quite significant). In this respect, the response to the pandemic may be likened to a stress test of our societal and community supports for aging in place: revealing cracks in our support networks and surfacing potential interventions to address isolation over the long term. Taking these steps is urgent, as the number of older and more vulnerable households is growing. Indeed, the number of households age 80 and over will more than double from 8.1 million in 2018 to 17.5 million by 2038. Research suggests that social isolation and loneliness (the subjective experience of being isolated) put older people at risk of poor health outcomes, including heart disease, depression and anxiety, cognitive decline, and weaker immune responses.

The COVID-19 pandemic has been catastrophic in so many ways, not least for older people. But we may yet benefit in the long run from this experience if we heed the lessons of this stress test to take steps to minimize the isolation of our oldest citizens.

A potential silver lining to our current experience with social distancing is the increased use of virtual means of communication, particularly among older relatives most vulnerable to COVID-19. Encouragingly, research points to positive outcomes for older people using technology for social connection, including improved health and reduced loneliness. There are barriers to the widespread adoption of these technologies—but also promising solutions. For those with physical or cognitive difficulties, a program in Barcelona has made tablets with a very simple to use app to connect those with physical or cognitive difficulties with a network of friends and service providers. Enhanced public efforts are needed to expand such initiatives to reach the needed scale. Another barrier is access to the broadband networks needed for these technologies to be effective. An analysis by the Pew Research Center shows that those over age 65 are less likely than others to have access to broadband, as are racial minorities and those living in rural areas. Investments in expanding broadband access are needed to assure that this resource is available to the vast majority of older adults.

Technology can also help connect isolated older adults with health-care providers. The pandemic has led to the rapid adoption of telemedicine (including teletherapy) to enable health-care providers to maintain physical distance while treating patients. As with the use of technology to maintain social connections, the pandemic may provide greater experience and comfort with these approaches that will be helpful for their more widescale adoption in coming years. Still, expanded technological infrastructure, training for providers in virtual care, and education of patients will all be needed. Rules and regulations governing when, by whom, and at what reimbursement level telemedicine can be used will also need revision; many existing restrictions have been waived during the pandemic, which may provide valuable lessons for regulatory changes going forward. Of course, inequality in broadband access is an issue here as well.

Finally, there are also lessons about the importance of the built environment in supporting opportunities for physical activity. With athletic facilities closed, people of all ages are heading outdoors to walk, run, and bike while maintaining physical distance. But for older adults (particularly those living in low-density areas without safe sidewalks and road intersections), even walking outdoors comes with risks. The age-friendly communities movement aims to involve state and local leaders in efforts to adapt the physical environment to ensure that older adults can age actively and participate fully in society.

The COVID-19 pandemic has been catastrophic in so many ways, not least for older people. But we may yet benefit in the long run from this experience if we heed the lessons of this stress test to take steps to minimize the isolation of our oldest citizens.

Published April 14, 2020