75 years and over in the middle of the COVID-19 pandemic

by Dr. Satya Brink

October 5, 2020

Abstract

Historically high human longevity has resulted in a large population segment aged 75 to 100 in developed countries when the COVID-19 pandemic started in 2020.  Since this later life phenomenon is unprecedented, the characteristics of this stage, its role and its status in society are still being socially constructed.  However, the pandemic is affecting the public perception of the age group 75 and over as frail, unproductive, consuming valuable health resources and unfairly economically privileged resulting in their being undervalued and misrepresented in public discourse. Thus, the value of life is becoming age dependent and ageism more acceptable.  Whether their role and status in society will be altered or enhanced will depend on the social construction process during the months of recovery, so this paper promotes a nuanced discussion to more fairly consider impacts that were specific to them, either in character or in intensity as well as their societal contributions during the pandemic. How countries individually and collectively manage the post pandemic recovery will determine if the later life stage will be impacted negatively or if they will share equally in positive generationally sensitive recovery outcomes. 

Introduction

The year 2020 will be remembered as the year of the COVID-19 pandemic though its effects will only be fully understood through retrospective study in future years.  Only a few people, mostly centenarians, will remember a pandemic of this scale (the flu pandemic of 1918-1920 that infected one in three people – 500 million – in the world) which they experienced.  Few lessons can be learned from that pandemic experience, because the context, the state of development and life patterns now are very different. 

This unexpected pandemic intersected with a newly evolving life stage of those 75 and over, dubbed the later years. The pandemic was a life changing event for all generations, but this large segment of the population was faced with impacts that were specific to them, either in character or in intensity.  

The pandemic

The World Health Organization (WHO) defines a pandemic as “the worldwide spread of a new disease” (WHO,2010).  After six months, the pandemic still rages across the world and the spread of the infection continues unabated.  Some countries appear to have controlled the disease better than others but the total number of infected persons and deaths around the world continue to rise.  How long the pandemic will last around the globe is unknown and the best forecast is that it will probably endure as a pandemic into 2021. In the long run, the world’s population will have to learn to live with it.  

Six months of the pandemic has resulted in evolving scientific knowledge about the virus. The COVID-19 virus had a number of slowly revealed characteristics that were challenging despite the advances in medicine and health care. It was zoonotic with unique symptoms, ranging from potentially lethal or clinically severe to asymptomatic, often requiring hospitalization with no known treatments or vaccines, highly infectious, capable of fast transmissibility and community spread, differential impacts on societal groups, short term immunity and long term health impacts. (Newman, 2020).  At first, it was considered a respiratory disease, but over time, treatments had to deal with associated complications of the lung, heart and brain. Medical researchers are still working on determining the long term effects on people who were seriously infected and pharmaceutical companies are racing to find effective treatments and a preventive vaccine. 

As the disease spread due to national mobility and global travel, country after country imposed restrictions and/or lockdowns resulting in brutal impacts on economic activity and in social disruption. Nations were challenged to cope with the devastating loss of life, untenable high demand for health care and hospitalization for the infected and tremendous losses and costs for the living.  As the pandemic took hold, everyone experienced at the least, chronic uncertainty and disrupted daily life and at worst, large social upheavals, threat of unexpected death and an uncertain future.    

The virus spread from person to person and the recommended preventive strategies included social distancing, no large gatherings particularly in indoor spaces, hand hygiene, masks, avoiding touching public surfaces, not touching the face and testing if any of the symptoms of COVID were experienced.  Since medical preventive strategies were not available, authorities had to rely on lockdowns and co-operative behaviour of citizens. Education institutions, businesses and the hospitality/tourism sector were closed resulting in loss of jobs and slowing of the economy. The closure of transportation networks of cities and suburbs limited the movement of people. 

The “pandemic shock” exposed societal fault lines, heightened existing tensions and exacerbated socio-economic imbalances. Though these were known, it generated competition between groups, sectors and regions, strained the prevailing consensus and fragmented societal solidarity.  There were public pressures for difficult trade-offs and protests against the long duration of restrictions. The effects of an increasingly aging population on society were made more complex during this pandemic. This paper examines the immediate impact of the pandemic on people 75 and over as well as some prospective longer term effects on this phase of life.  

Population aging and the evolving stage of later life

Humans have never lived this long before. “Longevity is one of humanity’s most astonishing successes” (Kirkwood, 2008) and increasing numbers of people live longer than ever before. In many countries life expectancy advances by several hours per day unhampered by aging processes.  The average life expectancy exceeds 80 years in most developed countries. More babies born since 2000 in countries with long-lived residents will celebrate their 100th birthdays and with less disability and fewer functional limitations if present yearly growth in life expectancy persists (Christensen, et al, 2009).

The numbers of people 75 to 100 years are expected to double in the next twenty years as more people will live longer (CIHI, 2020). According to the United Nations estimates, there are 573,000 centenarians worldwide in 2020 and the number is expected to rise to 3.7 million by 2050.  Furthermore, they are reasonably healthy and involved in life but over the decades they may have accumulated some physical deficits and underlying conditions. The people in this stage of later life have a great diversity of experiences, lifestyles, needs and expectations accumulated over their long lives. Since this later life phenomenon is unprecedented, the characteristics of the stage, its role and its status in society are still developing.  

The impact of the pandemic on people 75 and over 

The pandemic has been associated with a higher death rate than some other pandemics.  It is currently the sixth highest cause of death in 2020 in Canada. In 5 months, the disease killed as many as the flu, pneumonia and bronchitis do combined in an average year. There were high morbidity and mortality rates among older people in later life. In Canada about 16.6 per cent of COVID cases were among those 80 years and over (Statista, 2020). 

This has meant that countries with more people of advanced age, had greater numbers of people in later years at risk of infection and death.  Compared to Canada with 18 per cent of people 65 and over, Sweden has 20 per cent of people in this age group (World Bank, 2019). Within the later years segment, the highest number of deaths (2,333) due to the Corona virus in Sweden as of July 17, 2020 was among individuals aged 80 to 90 years – 1210 among those 70-79 years, 2333 among those 80 -89 years and 1466 among those 90 and over. In total, 5,619 Swedish people died of the virus of which 5009 people (89 per cent) were over 70 years old (Statista, 2020).   High mortality rates amongst older people started to be regarded as an ‘inevitable’ and ‘normal’ outcome of this pandemic.   In addition, the stress for older people self-isolating was pernicious, because of the high risks for this age group and the fearsome symptoms of the disease if they succumbed. 

In addition, there were prolonged complications for those that survived the infection. It is uncertain whether once infected, if their remaining life expectancy will be shortened.   Even people 75 and over who were not infected could be scarred from the experience of living through the pandemic for their remaining years.  

Social construction of the later life stage in real time

The social construction of aging entails the creation of social norms and symbols related to the aging process and the role and status of people of older ages in society.  This also forms the basis of the social contract ensuring it is fair for all generations. The pandemic not only caused deaths but had complex effects on older people and brought into sharper focus what people in later years mean to other age groups and to society as a whole.  Actions and discussions revealed the on-going process of social construction of the meaning of these later years.

The basic idea that lives of persons of any age have equal value, not intended to be measured in monetary worth, frayed under the impact of the pandemic and older persons were considered expendable rather than irreplaceable like other lives. Ageism infiltrated social and health systems. The value of a life became age-dependent. This was described by the WHO Director-General as “moral bankruptcy”.  For example, Tony Abbott, former Prime Minister of Australia suggested that some elderly Corona virus patients should be left to die “naturally” and “let nature take its course”.  Further he added that even if the lockdown in Australia had prevented the predicted 150,000 deaths, the $300 billion cost to the country worked out at $2 million per life saved – or $200,000 per year if the elderly person had only 10 years more to live (Reynolds, E., 2020). 

Mortality rates due to COVID-19 were higher among older adults compared to other groups but rather than a nuanced understanding, age was conflated with frailty though co-morbidity was likely to be a more important factor associated with mortality (Fraser, S. et al, 2020). Twenty international researchers concluded that older people’s lives were undervalued and misrepresented leading to detrimental age-related processes. The pandemic began to be seen as a problem of older people resulting in patronizing policies. Many countries imposed stricter quarantine restrictions on them depicting all older adults as ‘vulnerable’ members of society. In one Canadian city, people over 70 years of age have been encouraged to sign up for the ‘vulnerable person registry’ (Meaghan, 2020). The hashtag #BoomerRemover was an indication of the negative view that older people were vulnerable and helpless against COVID-19. They were criticized for consuming a large part of health resources and creating negative economic and social impacts on other generations (Fraser, S. et al. 2017). 

Economic impacts of the pandemic on life after 75

The pandemic recession 

In addition to the devastating large numbers of lives lost, the disruption to normal life causes damage to the economy, and as the modern economy grows more complex, more recent pandemics affect the economy in insidious ways. While previous pandemics such as the 1918 Flu pandemic, relied on sanitation measures, this was the first time economically disruptive measures such as lockdowns and social distancing were applied globally. These magnified the impact on countries because of global trade patterns and integrated supply and production chains. The International Monetary Fund (IMF) predicted that the global economy will shrink by 4.9% in 2020, a figure that has been revised downwards as the pandemic continues (IMF, 2020).  In Canada, the gains in the labour market over the past decade were wiped out in one month. This recession does not affect everyone equally. One in three Canadians did not have enough savings to handle a three-month work stoppage. Moreover, the lockdown approach to pandemic control is known to exacerbate privilege while increasing inequality. The worst affected were women, low wage and hourly paid workers, young, front line and public-facing employees (Morrisette, 2020). In Canada, the uneven and slow economic recovery in the second half of the year is estimated to leave Canada’s economy 5% smaller than before the crisis.

While there is considerable uncertainty about the economic recovery, there are fewer chances of a V shaped recovery and a greater possibility of a K shaped recovery, where the well off and educated may improve their prospects while the less educated and lower income people have higher risks of being infected and fall further behind, increasing societal inequality. It is also a concern that the financial situation of those at the border line may deteriorate into poverty particularly if there is a long recession. Further, a slow recovery from the downturn will have a lasting impact on public health. Employment in some sectors were affected more than others or in different ways. For example, service workers were laid off in massive numbers, while many essential workers have had little choice but to work even if their workplaces were poorly or inconsistently adapted to a pandemic environment.  

There are three ways in which the pandemic affects life after 75: The impact on those in the cohort 75 plus during the pandemic; the impact on the cohort 65 to 74 entering late life and finally questions on intergenerational fairness.

The economic impact on those in the 75 plus cohort:

The current older generation has the reputation of being the wealthiest in history (McMahon, 2014). In Canada, the wealth of seniors quadrupled since 1984 outpacing the growth of wealth among younger generations.  In the US, the Federal Reserve’s Survey of Consumer Finances captures the shift of wealth to those 75 and over in comparison to younger families between 2013 and 2016 (Howe, 2018).  Where once the rates of elderly poverty were high, thanks to financial discipline, aggressive saving, risk averse investments particularly in housing among seniors which coincided with stock market booms, reliable economic growth, soaring real estate values and better pension coverage, todays seniors are well off compared to previous generations. However, the distribution of wealth is uneven and not all people over 75 are prosperous, or even homeowners. 

Persons over 75 live for the most part on fixed incomes, though they may have savings, they may lack liquidity. Since the main savings instrument is their primary residence which they do not want to sell, many older people find themselves, house rich but income poor.  There are a few instruments to use the home to create an income stream but many are leery of using them.

Their savings may provide poor returns requiring them to draw down their savings.  Many older people rely on savings investments to supplement their basic public pensions.  During the pandemic, those that invested in stocks may have seen a decrease in their income.  Though the stock markets did well, only certain sectors such as tech companies rose while many others such as energy, oil and gas, fell.  Those that had banked their savings found that their accounts earned hardly any interest at all. 

They had unplanned or higher expenditures.  Older people on fixed incomes found that their costs had risen, on the one hand due to a rise in prices, especially of food and on the other hand, due to costs related to the pandemic, such as costs for delivery of medicines or groceries which they could not pick up. 

The impact on the cohort 55 to 74 entering late life:

This cohort may have lower retirement income because of earning and saving difficulties due to the pandemic. Experience from past recessions indicate that workers in this age group have limited options in a recession: either working longer, saving more or living on less (Munnell and Rutledge, 2013).  Particularly low income but even middle income seniors may have to work longer into their later years but may face lower job security, job loss and poorer chances of re-employment. Such displacement among “late-career workers” can lead to lower retirement income and reduced savings (Butrica et al., 2012). Ipsos Mori found in their research that the pandemic could leave the next generation of retirees significantly poorer resulting in a “lost generation” of retirees facing financial insecurity in retirement (Centre for Aging Better, 2020)

Unlike previous recessions where men in industrial and manufacturing lost their jobs, during this pandemic more women lost their jobs than men. The economic impact on women has been severe, so much so that the recession has been called “She-session”. In Canada, in the first two months 1.5 million women lost their jobs.  In this time span, the pandemic reduced women’s participation in the labour force down from a historic high to its lowest level in over 30 years.  By April, women’s participation dipped to 55 per cent for the first time since the mid-eighties. (RBC Economics, 2020). It is uncertain if women’s employment will rebound to pre-COVID levels quickly. 

During this pandemic downturn, the majority of jobs lost were in female-dominated industries, including accommodation and food services, retail trade, educational services and health care and social assistance.In 2015, 56% of Canadian women were employed in jobs in the “five Cs” – Caring, Clerical, Catering, Cashiering and Cleaning- according to the Canadian Women’s Foundation (Payne,2020). Women still represent three quarters of all part-time workers. In addition to these jobs placing women at increased risk during the pandemic, they were also in precarious employment. Initially more women experienced job losses than men and they were slower to return to work, while some never did. 

In addition, women shouldered a disproportionate amount of unpaid caregiving responsibilities, with children out of school and day care.  Those taking care of older people or their elderly spouses, took over from women home care workers who could no longer work for similar reasons. Over three quarters of family caregivers are women, mostly older than 45 years. (Payne, 2020). It is uncertain if women’s employment in the caregiving sector will recover well and even if they do, they are likely to suffer wage penalties. Furthermore, the jobs in women dominant sectors may have a rocky recovery so their jobs may be insecure.

Even those women who were able to work were badly stressed.  About 80 per cent of workers in health care and social services were women and so they were largely responsible for combatting the pandemic in hospitals and long term care homes. This meant that they may have been forced to live in isolation, away from their families to avoid infecting them.  Even women in other professions as second household earners [on average earning 42% of family income before the pandemic (RBC, 2020)] may drop out of the labour force, as they combine trying to work at home, do child-care and home schooling for older children. The impact on single mothers is severe.  Most women entrepreneurs and business owners tended to continue child care but their men counterparts did not. When schools reopen, some children will be learning remotely at home or be in hybrid on-line programs, which might require a parent to be home on certain week days.

Due to these pandemic created labour market conditions, if men and women in a pre-retirement stage had prolonged unemployment, retired early or had interruptions, both their savings and their pensions could be negatively affected. This could affect their economic security in the years after 75. Since the economic impacts were worse for women and because they tend to live longer, their retirement income can be insufficient. 

Intergenerational fairness: 

Because those in later life had pensions, savings or assets, they did not experience severe income disruptions faced by cohorts in the labour force. They also tended to have less personal debt. They had some financial security because they had equity in their homes while younger cohorts did not because they had difficulty purchasing their first homes.   About 83% of 75+ households had equity in their primary residence in the US—but only 74% of late-wave Boomers (55 to 75 years), 63% of Gen Xers (35 to 54 years), and 33% of Millennials (20 to 34 years) (Howe, 2018). Those in the labour force who had just purchased their homes, but lost their incomes due to the shutdown, had reduced working hours or job loss, had difficulty making their mortgage payments. 

There is uncertainty about the length and severity of the pandemic generated recession. Countries borrowed heavily to provide financial aid to a large proportion of the population affected by the lockdown/recession and incurred “pandemic debt” (over 30 billion dollars so far, in Canada) which by all accounts will take several decades to pay off.  Over a long recovery period the later life generation would contribute less to the repayment of national debt compared to the working age cohorts who likely will outlive them.  This has raised questions about fairness between generations, over and beyond the argument, that in time all cohorts will grow old and gain age related benefits. Wealth tax, capital gains tax on sale of primary residence and inheritance tax are discussed as potential ways to redistributed the burden between generations.   

Impact of the pandemic on health and health care services for life after 75

Canadians aged 80 and over accounted for 72 per cent of the deaths but only 18 per cent of the cases were in this age group (Shiab and Pelletier, 2020).  Therefore, the stated risk factors for the COVID virus were old age first, then underlying conditions such as heart disease, diabetes and low immunity. Most of the persons in late life that were infected, hospitalized and died were living in nursing homes. Not all nursing homes were affected but it was difficult to contain the infection once it was in one.  Among the developed countries half of all the deaths occurred in care and nursing homes, even though less than 1 per cent of seniors live in them (The Economist, 2020). In Canada, roughly 5 per cent of seniors live in long term care homes but according to the Canadian Institute for Health information, by May 25, 81 percent of all reported COVID deaths in Canada were long term care residents (Szklarski, 2020), one of the highest rates among countries. 

But advanced age was not always the defining factor. Later, when the outbreaks in nursing homes were brought under control, the number of deaths among the younger generations rose considerably as they returned to education, work and social life.  By September, according to the Public Health Agency of Canada, there were 20,829 (16.1%) cases of Canadians aged 20-29 compared to 18,842 cases of those 80 and over (14.6%).  (Public Health Agency of Canada, 2020). In both cases, high risk settings included closed spaces, crowded places and close contact situations.

This overstated relationship between age and COVID made the public consider older Canadians as fragile and heavy users of health care and hospitals.  Earlier in the year, when the virus was rampant and the health care system was unprepared and overwhelmed, the process of triage affected older people negatively, especially when there was a shortage of ventilators. In the US, several states had Ventilator Allocation Guidelines where ‘age may be considered as a tie-breaking criterion in limited circumstances’ (Piscitello et.al. 2020) .

Researchers at Tel Aviv university found that the number of care-home beds explained 28 per cent of the variation in death rates among European countries, controlling for population density, the percentage of older adults in the population and the number of hospital beds per capita. Countries with fewer care homes had fewer deaths all else being equal.  Findings supported the claim that long-term care living arrangements of older people including structural features of care and nursing homes, such as a communal living areas, multiple residents in a room and care provided by multiple caregivers to multiple care recipients probably led to a greater number of deaths (Gandal, N., et al., 2020)

It became clear later that such high concentrations of deaths also occurred in other closed environments that had high density and similar arrangements such as nunneries, religious communities and cruise ships. 

While these points were distressing, age was rarely discussed in context.  Since key factors such as predisposing conditions, age, and living conditions were simultaneously present, older seniors were more susceptible to infection. But the recovery rates were high if older people were in relatively good health.  In Wuhan China, 70 per cent of those aged 80 and over recovered. Around the world, many centenarians recovered from COVID-19 (Aliyev, 2020).

It is true that most residents concentrated in nursing or care homes are in their eighties and have more limiting health conditions, such as Dementia, compared to those in the community. Nonetheless, the vast majority of seniors live in the community and their infection rates were far lower. It is recognized that they may be in better health than those in nursing homes but many of them were of similar age and had predisposing conditions. 

Those people 75 years and over who lived in the community had other health impacts that affected their health and wellbeing.  Many had their medical or dental appointments delayed or cancelled where untreated conditions could negatively affect their health irreparably. Their mental health had also worsened. Many reported heavier smoking and alcohol consumption (Centre for Aging Better, 2020). A further major physical and mental impact on this cohort was due to cancelled surgeries.  Many of the surgeries such as joint replacements, cancer, cardiac and cataract operations that were cancelled affected health outcomes and decreased independence. 

An unacknowledged but heartening fact was, that as demand for professional nursing care in hospitals and nursing homes rose, many hundreds of retired nurses returned to work. In the province of Quebec, Canada over 10,000 nurses responded to the call for help (Beauchemin and Jones, 2020).  One returning nurse that made the news was 85 years old (Ibrahim, 2020). 

If age was overemphasized, the worse impact on women and people of colour especially those with low income were only recognized months later.  More research is being conducted where data is available.  In Canada, unlike other countries, more women (64,806 -55%) than men (52,608 -45%) died from COVID-19.  As of June 2020, among the reported deaths, the male to female ratio of deaths among confirmed cases was 0.85, generally attributed to factors such as more women with underlying conditions in the older age groups due to their longevity, higher female nursing home population and high number of women among the front line workforce of care givers (Lien et al., 2020). 

Minorities of colour and indigenous people are known to experience health inequities with the result that they are particularly vulnerable to infectious diseases, because they often live in poverty, in multigenerational families living in crowded housing and work in front line low paying essential service jobs with no paid sick leave. Black and South Asian people were nearly two times more likely to suffer a COVID related death than white people and the most socio-economically deprived were 1.8 times more likely to die than those that were well off (Kirkey, S. 2020). Research does not yet report on the age factor for these groups. 

Impacts of the pandemic on activities of daily living on life after 75

Even those people in the over 75 age group that were not infected were impacted by the pandemic, because it affected their access to services and to social networks.  Much depends on the types of homes in which older people reside. Over half of persons 85 and over still lived in their single-family homes. In 2009, 53% of people aged 85 and over lived in a single-family home, compared with 71% of people aged 75 to 84, 70% of people aged 65 to 74 and 75% of people aged 55 to 64 (Turcotte, 2012). Services may be accessed unevenly because of insufficient demand in rural areas or because of affordability.    

Both essential and optional services were not accessible during the pandemic.  For instance, it was not possible to use a barber or hairdresser, a podiatrist or a massage therapist.  Many older people in late life relied on physiotherapy or exercise programs (Aqua fit, chair yoga) for retaining their strength and flexibility which were closed during the pandemic. It was noted that interest in hygiene and personal appearance waned as people were isolated in their homes. 

Since chronic conditions increase with age, many of them rely on drugs which sometimes were in short supply. Many pharmacies required clients to order their drugs on-line which was an unfamiliar process for many in this age group.  Pharmacies would dispense only a one-month supply which meant more frequent shopping. Though many pharmacies delivered drugs, this was often an additional cost. 

Grocery shopping was also a challenge. Groceries offered home delivery or pick up but this method required seniors to order on-line. Contactless delivery was useful but required pickup by car.  Some grocery stores offered a special hour for seniors usually early in the day right after the store was disinfected but which was not always convenient. 

Very few older people walk or bicycle great distances.  Though Public transit is usually available in large metropolitan areas, it is not a preferred solution for older people.  About 40 per cent of persons 75 years and over used public transport in the past (Turcotte, 2012) But because of the pandemic many were scared to use public transport or were bothered by poor or unpredictable service.  They had to rely on others to either drive them or shop for them, particularly if they lived in residential neighbourhoods in the suburbs. 

These transportation difficulties that have persisted for a long time may have an impact on future driving habits of seniors. In 2009, 3.25 million people aged 65 and over had a driver’s license—three-quarters of all seniors in Canada. Of that number, about 200,000 were aged 85 and over (Turcotte, 2012). Since people in their 80s and over are, and will continue to be, a fast-growing segment of the senior population, the number of elderly drivers will also continue to increase at a rapid pace.

As an immediate response, there were informal efforts to form groups in order to help each other. Over half of persons 85 years and over said that they were passengers in a car driven by another person (Turcotte, 2012). Perhaps in the longer term, there will be more and cheaper delivery services available, particularly in areas where there are concentrations of older people.

Social and emotional impacts of the pandemic on life after 75

Lockdowns and social isolation as COVID prevention strategies can cause problems from social deprivation which affects social and emotional wellbeing of all citizens. Comparison before the pandemic and five weeks later show that levels of very high anxiety quadrupled from 5 per cent to 20 per cent and the levels of high depression doubled from 4 per cent to 10 per cent (Mental health research, Canada, 2020). The pandemic impact on people over 75 can be problematic because of the inter-related negative effects and their helplessness to address them.  

The social and emotional impacts of this pandemic can be examined from the perspective of the cohort and of individuals based on their unpaid roles as providers and users of the “care economy”.  Of 7.8 million care givers, many are spouses caring for their partners and others are adult children in their sixties and seventies caring for parents aged 85 and over (Keefe, 2020) 

Over half of women and 27 per cent of men aged 85 and over live alone in the community and rely on support of friends and relatives (Keefe, 2020). Social distancing meant distant socializing. People over 75 and over living independently were advised to self-isolate and their contacts were counselled to stay from them for their personal protection. The hypervigilance expected of this cohort in itself was draining. This added to their grieving for the loss of normalcy as their health supports from family and home services were lost or much reduced.  

Persons 75 and over living as couples or alone in the community had reductions in informal supports that threatened their health and independence, causing stress. Informal supports such as cleaning ladies could no longer enter their homes. A survey conducted among the three largest home and community care services found that in the weeks after the lockdown, “non-essential” services were cut. Thus, home nursing care fell by 22 per cent; personal support workers’ services by 32 per cent and home-based treatments such as physiotherapy and occupational therapy by 65 per cent (Carlone, 2020). Among those who relied on mental health supports before the outbreak, 33 per cent felt they had less frequent access to mental health support since the outbreak (Mental health research, Canada, 2020).  Some of them faced unexpected breaks or abrupt cessation of services from faithful care providers who, undervalued and overworked during the pandemic, experienced breakdowns, or Post Traumatic Stress Disorder (PSTD) due to the pressures of their work. 

The mental and physical health of people 75 and over in nursing homes deteriorated rapidly as there was a shortage of front line workers. Many front line workers were infected due to lack of protective equipment. In several nursing homes, residents were found malnourished, dehydrated and neglected. Many residents died alone without a family member beside them.  When outbreaks of COVID caused high rates of death, family members were not allowed to visit their loved ones and some only had access through “window visits” which confused and distressed many of the residents. It is now recognized that family care givers performed similar tasks that they provided in the home, such as feeding, grooming, medication adherence, ambulation and exercise, co-ordination of care and transportation, in addition to emotional support and companionship.  Overstretched nursing staff were hard pressed without their contributions and such auxiliary care reduced resident anxiety and increased better safety and wellbeing (Drury, 2020). 

Humans are social creatures, wired to connect with others through adaptive evolution, in order to form groups and communities, support each other and to collaborate to do things individuals cannot do on their own.  While the social and emotional impact on all individuals are similar, the impacts due to the pandemic are magnified for those 75 and over.  

Social networks grow and change over life but the pandemic altered the way in which these networks endured or operated. In the later stage of life, social networks are shrinking for those that have outlived siblings and friends and that have experienced dispersal of children and close friends.  Yet their independence is very dependent on their remaining and functional social contacts and their personal competence is maintained by the care and support they provide to others. The prospect that those that are your social support can unintentionally kill you by infecting you is contrary to expectations and raises anxiety and isolation among those in this life stage. Grandparenting is a key role and being quarantined from children and grandchildren had major impacts on older people. To overcome these obstructions, several “shaped” or focused” networks were set up as a specific support service. 

Recommendations to stay home and avoid visitors led to a sense of confinement and boredom for those living in their own homes, especially if they lived alone. An Ipsos poll found that 40% of people older than 55 felt lonely and isolated (Collie, 2020). There are limits to social contact mediated through technology and non-tactile but visual relationships. Eye contact through Skype or Facetime is qualitatively different from face to face contact.  This has hastened feelings of social isolation – a state of having few relationships or infrequent social contacts with others due to the pandemic.

Impacts on the individual were no less serious. Loneliness can trigger the release of stress hormones associated with higher blood pressure, decreased resistance to infection and increased risk of cardiovascular disease and cancer, increasing the risk of death by 45 per cent.   Loneliness has been estimated to shorten a person’s life by 15 years, equivalent in impact to being obese or smoking fifteen cigarettes a day (Pomeroy, 2019, Lake, 2020). 

Touch is an imperative for human beings, essential for communication, bonding and overall health. Babies who are not held, hugged and cared for over prolonged periods of time could die (Szalavitz, 2020). Touch soothes and calms in times of worry and cardiovascular stress by signaling safety and trust. It elicits a physical response, activating the vagus nerve, lowering the level of cortisol and triggering the release of oxytocin.  It is normal and comforting for people to touch their faces, a movement that was considered risky during the pandemic. A simple handshake, a hug from a friend, or a kiss from a grandchild were forbidden due to high risk of infection. With COVID restrictions, months could pass without touching another person. Some people have experienced “skin hunger”- a term which describes mental health consequences such as higher stress levels, disturbed sleep and even a weakened immune system (Miller, 2020).

The impacts of the pandemic on Technology adoption and use in the later stage of life

The “no touch” economy and “digital by default” society had major consequences for older people because of the ubiquitous use of hyper digital technology for data, communication and commerce.  Doctors’ visits were by telephone, for instance.  Though many were unused to using video chats with family or friends, there were few other options. Among those that used video chats and email, 40 per cent stated that they had a positive effect (Mental Health Research Canada, 2020). 

People 75 and over have had positive and negative experiences shopping on-line and they are particularly nervous about paying on-line.    Many people over 75 were unaccustomed to ordering their medications at the pharmacy on-line but they were able to avoid risking infection at pharmacies.  They had to arrange for some means to pick up their prescriptions once they were filled which sometimes involved expenses or demands on other people. 

Many people in this later stage of life did not rely on technology for their work during their careers.  In any case, the speed of change made their technological knowledge and skills obsolete. So a large number of them did not consider up to date technology an essential tool for this stage of life and many of them were able to use old digital devices for simple tasks such as email. They rarely updated their telephones every three years and were not early adopters of new technology.  They do not often have strong and reliable wifi connections.  When Ontario, Canada designed a free tracing and alert system, many older people had out of date devices which could not be used with the new software. 

Social media was used for information, alerts and communication, but many older people were not reached through these methods.  They still relied on radio and television and even visitors.  At nursing homes where visitors were forbidden, nurses set up Facetime or similar video chat visits for residents. 

The impacts of the pandemic on learning in the later stage of life 

Education and learning can on the one hand be a source of risk and on the other a font of valuable information to avoid risks. 

The education sector was one of the most affected during the pandemic because of the lockdown, keeping more than a billion children around the world from school. School and higher education institutions are re-opening six months later in Canada.  Despite precautions at these institutions and regular testing, young people exposed to a large group of people could bring the infection home to their parents and grandparents. 

Given all the impacts described above, information about COVID and its prevention can be valuable to people 75 and over. It is not clear where self-isolating seniors get their information on the virus. No particular self-help courses were on offer on managing during the pandemic. 

Furthermore, for those sequestered in their homes, learning in areas of particular interest to them could be a fruitful expenditure of time but restrictions affected what is learned and when it could be learned.   The health risks for older adults arising from the virus were so high that prevention and protection were the priorities and the opportunity was not seized. Facilitating learning was not on the list of priorities in most countries and where there were adult education concerns, they were directed to reskilling workers who had lost their employment. So, adults and in particular older adults have not been the focus of most education policies and strategies. Though they may have gained free time during social isolation, their existing learning resources were limited to distance and remote learning. Libraries, for instance, were closed, and even when they reopened offered limited services. 

However, informal contributions by people over 75 to learning were welcomed.  Older people, particularly grandparents volunteered to take over home schooling of children, so their parents could work either in their workplace or at home. They also helped children and young people with their homework and assignments and worked to mentor them, to ease the burden on parents. 

Schools and colleges offered remote and hybrid instruction for students and there was a shortage of teachers.  There were two responses.  Several teachers and professors close to retirement chose to leave because of the risks of infecting themselves or their families.  On the other hand, a call went out to retired teachers and professors to deal with the shortage and many seniors returned to work. 

Conclusion  

Despite other pandemics, no single event since the second world war has left so many people in so many places shocked by unexpected intersectoral impacts all at once resulting in “collective trauma”. Disruptions, opportunities and innovations accumulate as the world functions as a laboratory for dealing with COVID-19.  Considerable uncertainty about the duration of the pandemic and the potential protection provided by vaccines bedevil future planning. Many economic, social, environmental and technological scenarios are possible.  How countries individually and collectively manage the post pandemic recovery will determine if the later life stage will be impacted negatively or if they will share equally in positive generationally sensitive recovery outcomes. The role people 75 and over play and whether their status in society will be altered or enhanced will depend on the social construction process during the months of recovery. It will reflect societal choices made to benefit or to detract from the gift of longevity in the 21st century.  

Dr. Satya Brink retired as Research Director of the Learning Policy Directorate in Human Resources and Social Development Canada and now works as a policy research consultant inaging, human development and social policy.  

Key words

Later life 75-100 years; COVID-19 pandemic; Impacts on 75 years and over

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