COVID-19: What people over 60 and people with chronic conditions should do

Mary Tinetti, MD, is Chief of Geriatrics at Yale and an international expert in care for the geriatric population, notably in clinical decision-making for older adults with multiple health conditions, measuring the net benefit and harms of commonly used medications, and the importance of cross-disease universal health outcomes.

Richard Marottoli, MD, MPH, is the medical director of the Dorothy Adler Geriatric Assessment Center at Yale New Haven Hospital. He also directs the Connecticut Older Adult Collaboration for Health (COACH), a partnership between healthcare organizations and public health agencies, primary care providers, geriatricians, and community-based organizations in the Greater New Haven and Bridgeport area.

In this guide, they share what is currently known about the COVID-19 outbreak and older adults, and steps that older adults and caregivers can do to stay healthy. They also suggest actions that local governments can take to assist this population.

What We Know

• The illness enters the body through the nose, eyes, or mouth, and then proceeds to the lungs. This is why we are advised to avoid touching your face or to be in crowded situations in which particles expelled through coughing and sneezing might be inhaled.
• Older age (over 60 and particularly over age 70) are at highest risk for death or severe illness with COVID-19.
• Communities that have a lot of contact between younger and older adults contacts, particularly if they are living together, may have faster transmission of the virus and worse disease severity, including death.
• Unfortunately, people over 60 staying isolated from others appears to be one of the most effective ways to reduce deaths or need for prolonged critical hospital care.
• While school closing may decrease overall spread, it also may inadvertently bring grandparents and children into closer and more frequent contact.

What Older Adults and Caregivers Need To Do

(Not All of These Will Apply to All Individuals)

• Persons over 60 should isolate yourself at home. Don't visit friends or family unless necessary.
• If you live with other people, keep a distance of at least six feet at all times.
• If you must have visitors, limit to one or two people at a time. Ask everyone who comes to wash their hands and maintain a distance of six feet. We know it is hard, but no visits with grandkids.
• To stay connected during this time, if you have the equipment and can use it, communicate with Skype or Facetime. If not, talk on the phone daily. Your friends are in the same situation and also look forward to talking with others.
• Wash your hands often for 20 seconds (sing "Happy Birthday" twice). Soap and water is better than hand sanitizer, but use hand sanitizer often if there is no access to soap and water. Use hand lotion to prevent drying and cracking of skin.
• Clean surfaces in your home using Lysol or a solution of four teaspoons bleach per quart of water. Clean door knobs, sink handles, refrigerator and oven doors, steering wheels, and other high-use surfaces daily. Change hand and kitchen towels daily. Open windows (if possible) to increase ventilation. Do not share dishes and utensils.
• Follow routines. Prepare meals, eat, exercise, bathe, nap, go to bed, and wake up just as you would on "normal" days. Try to eat healthy foods. Avoid "junk food" and keep your limit alcohol intake to one glass (or less) per day. Avoid the temptation to sleep in or sit on the couch all day. Sticking to a routine can help keep things feeling normal and keep the blues away. It may help to write out your routine and post it where you can see it.
• Walk around your house several times a day. If you live in an apartment, walk the halls with a few people at a time—keeping at least six feet apart.
• If you walk outside, do it when few people are around (for safety reasons: don't walk when no one is around) and keep at least six feet from anyone. Go to large parks if available.
• Stay out of stores if at all possible. Have stores deliver or ask someone to pick up your groceries and medications. If you must go, go very early in the morning when fewer people are there and the store is at its cleanest. Keep six feet from people.
• Do not go to any gatherings of any size. If you regularly attend worship services, see if your place of worship offers streamed services, or consider using the regular time of attendance as a time of home worship.
• If you have a primary care provider (a nurse practitioner, physician or physician's assistant), contact the office to see if they have put procedures in place for handling routine visits and visits related to any concerns you may have should you observe possible COVID-19 symptoms. It is best to avoid health care offices unless absolutely necessary. Ask them about Telehealth or telephone options which most offices are starting.

What Local Governments Need To Do

• Communicate the risk to older adults and recommendation to self-isolate, including from family members.
• Appoint a COVID czar for older adults to lead and coordinate community efforts.
• Start daily communication to all households about important reminders and updates.
• Set up a website with available resources for older adults and their families and caregivers to access.
• Identify the vulnerable residents in the community who lacks support. Match them with a volunteer.
• Encourage and coordinate local volunteers and community and faith-based organizations to reach out to isolated older adults to check their welfare, pick up and deliver groceries and medications, and provide transportation if they absolutely have to go somewhere.
• Facilitate childcare solutions that reduce contact between children and older adults who may be child caregivers (e.g. very small childcare groups if parents can't be home or adults over 60 are the primary caregivers). Perhaps places of worship, at-home teachers, or other such groups could take on this task.