October 1 is International Day of Older Persons, a global occasion to highlight the role of health care workers in respect to the health of the elderly. Dr Anthony Scerri from the University of Malta’s Department of Nursing chats with Newspoint on how the concept of ageing has changed with the inset of the COVID-19 pandemic.
You must be exposed to a variety of opinions on the subject of ageing. What constitutes healthy ageing, and how much of this is determined by suitable elderly patient care?
Healthy ageing has been defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age” (WHO). Healthy ageing is far more than the absence of disease or illness - it includes actions directed at optimising opportunities for physical, social and mental health. This enables older adults to remain an active part in society, remain living independently and maintain their quality of life. In this regard, caring for older adults should not be limited to meeting the basic physiological needs, but seeks to promote learning, growth, relationship building and self-actualisation.
While studying at tertiary level, how are nursing students introduced to the concept of elderly care?
All undergraduate nursing students have a compulsory study unit specifically on the care of older adults. This study unit focuses on older adults as active contributors to society. Whilst the unit teaches students about the clinical aspects of caring for the most common geriatric syndromes, students are also directed to rethink their perceptions about older persons, from being passive recipients of health and social care to active contributors to society. Thus, these study-units seek to dispel the myths associated with old age and encourage students to plan the care wherever older persons reside, based on the ethical principles of compassion, autonomy and dignity.
How important is the language used by carers at elderly homes, the health authorities and other influential people towards building a rapport with elderly patients?
In homes for the elderly, communication that is centred around the person is fundamental to ensure that the ethical principles highlighted above are adhered to. It also ensures that a rapport is built between the care triad; that is the older person, the formal and the informal caregiver. It is very common that caregivers fall into the trap of ‘elderspeak’ that demeans their personality and can be patronising and degrading. At a macro-level, law makers, health and social care authorities need to listen more to older adults and their representatives when enacting age-related policies, regulations and services.
To what extent do you think COVID-19 contributed to the widespread perception that older people are vulnerable?
It is a known fact that older adults are a higher risk of developing serious complications that may lead to death after being infected from Covid-19 when compared to younger people. In fact, 95% of deaths by Covid-19 in Europe occur in those older than 80 years. This evidence has instigated public health authorities to develop measures to prevent community spread for example by encouraging older adults to self-isolate. However, one has to remember that the cohort of older adults is NOT a homogenous group. Not all older adults have the same chance of contracting the disease; that is not all older adults have the same level of vulnerability. Moreover, is labelling a person ‘vulnerable’ based solely on their age patronizing? Whilst public health authorities have a duty to protect health of every person especially those having the highest risk, the repercussions on the general wellbeing of that person needs to be taken into consideration when drafting these measures.
Is the idea that COVID affects older people correct or are younger people also susceptible?
Younger people are equally susceptible to getting infected but the risk of morbidity and mortality increases with age. Moreover, there seems to be a difference in the presentation of infection between young and older people. For example, it is more likely that children and younger people exhibit no symptoms. On the other hand, there is some evidence indicating that older adults may exhibit atypical symptoms (not the common fever and cough) such as acute confusion and low-grade pyrexia when contracting the infection. This highlights the importance of regular testing in care homes instead of relying on symptoms to identify people with potential COVID-19 infections.
How difficult is it to sustain the current measures in homes for the elderly in the long-term?
According to a local report, during the first wave, the measures taken by the health and social care authorities have been crucial in mitigating the spread in these homes. One such measure has been the voluntary confinement of care home staff for weeks and months. There is some initial evidence that such a measure has decreased COVID-19 transmission. However, this measure is difficult to sustain over a long period of time. Other measures such as restricting and stopping access to visitors could help once again but one needs to consider the psychological repercussions on the elderly residents and their family members. In view of the second wave that is currently hitting us locally, social and health authorities are reintroducing additional measures to contain outbreaks in local nursing homes. It is imperative that social and health care authorities continue taking mitigation measures and learn from international evidence on care homes outbreak responses in order to ‘calm the perfect storm.’