Navigating the Holidays With COVID-19 and Elderly Relatives with Dr. Kathleen Rogers

Podcast Transcript

Deanna Pogorelc:  Welcome to the Health Essentials Podcast, brought to you by Cleveland Clinic. I'm your host, Deanna Pogorelc. Now, we typically think of the holidays as a time for family and celebration, but for many senior adults, it can actually be a very lonely time, and that's especially true this year as the COVID-19 pandemic has required all of us to put some extra space between ourselves to slow the spread of the disease. So, what can we do to include our senior relatives in our holiday celebrations this year and stay connection with them year round? Geriatric physician Dr. Kathleen Rogers is here to help. Hi, Dr. Rogers. Thanks for joining us today.

Dr. Kathleen Rogers:  Hi. Thank you for the opportunity.

Deanna Pogorelc:  To our viewers and listeners, just a reminder that this is for informational purposes only, and is not intended to replace your own physician's advice. It's also been prerecorded, and may not reflect any changes to COVID-19 precautions or recommendations that have been made after the recording. So, Dr. Rogers, since the start of the pandemic, we've heard that seniors have been considered among the most vulnerable to COVID-19, and I just wanted to ask, why is that?

Dr. Kathleen Rogers:  As we age, our systems also age, and a lot of times they have other diseases that their body's focusing on, like diabetes, high blood pressure, if you've had a stroke and heart disease, and add to that COVID. So, you have limited resources in your body, in an already aging body, to fight the disease. So, that's why the elderly are usually at higher risk for COVID and other diseases, seasonal diseases like the flu and things like that.

Deanna Pogorelc:  So, I think we talk about seniors or the elderly really as one age group being at increased risk, but are there different levels of risk based on some of the things you mentioned, like preexisting conditions, but also living conditions or specific ages?

Dr. Kathleen Rogers:  Yes. The short answer is yes. The long answer is as you age, obviously, so do all your systems, and your ability to fight off infections and your ability to do things also age. So, your memory, for example, your ability to handle finances, maybe driving, execute functions that are complicated may also be effected. So, it is really important to make sure that you're on top of things, and talk to your doctor or provider regularly to make sure that this is well taken care, and you're at least getting ahead of the aging effects, so to speak. Living arrangements you mentioned, and yes, if you're all by yourself, you don't have help, you don't have social engagement, family members to really talk with, a lot of times that can create the isolation, and that further causes decline, because a lot of times, if you don't have things to do, you're sitting down, and that in turn causes further cognitive or memory decline and just overall health to decline. So, it really depends. It's a case-by-case scenario.

Deanna Pogorelc:  Okay. So, as we're thinking about whether it's safe to see our elderly relatives this holiday season with COVID-19 spreading pretty rapidly in our communities, what are some of the factors that we should all be considering?

Dr. Kathleen Rogers:  That's a very good question. A lot of people by now already have COVID fatigue, which means not related to the disease. They're just tired of hearing about COVID. But the truth is it's still a reality. It's still going around, and there are a lot of people now this flu season that are getting effected by it. With the elderly being more at risk, it would be ideal to try to stay away from them, even if you don't have COVID symptoms, if you're sick otherwise, like a stomach bug, or you have other upper respiratory symptoms that are mild. Sometimes that can manifest more severe in an elderly person if it's transmitted. Even if you're COVID-negative and you do want to go see your family, it's ideal to make sure that you practice safe distancing in the home, make sure you practice hand hygiene, even wear a mask when you're with your loved one. You want to do whatever you can do to protect them against this.

Deanna Pogorelc:  I mean, you kind of alluded to this, but the balance between the risk and the potential benefit of seeing someone, it can be really challenging to think about because, of course, we want to keep our elderly relatives safe, but you already mentioned have there been negative effects of this kind of need to physical distance and stay home on our seniors' health and wellbeing?

Dr. Kathleen Rogers:  Yes, there has. As human beings, we are people who are relational. We are people who like relationships, and some of us that touch in with our family members, and when we are isolated this way, even when we are in the same room, and we can't even give each other a hug or a handshake and say, "Hey, I really missed you," that's tough. That's really tough, and that can also have effects on your mental health. That can also cause some anxiety, some depression, because tough is healing in the end. But with this virus, I think it's really important to understand the perspective as well, and if you do have anxieties and depression and feeling lonely, despite having family members in the same room, and you're isolating from them, it's important to recognize that and talk with your provider, because that might be an underlying sign of something deeper that needs to be diagnosed, and you need further treatment for.

Deanna Pogorelc:  So, then does that become a unique issue for our elderly populations? Are they uniquely affected by that in a different way, or how can that kind of isolation negatively affect them?

Dr. Kathleen Rogers:  Well, that's a great question. The elderly, at least this group of the population, they are a retired group if they held a job for a long period of time. So, when you're working, you have guaranteed time, and you have a good routine and schedules that you go off of, but once you retire, the routine kind of goes out the window. You like to do whatever you want. You sleep longer or sleep later. You don't really have routines for yourself and your family. So, a lot of times, that's when you start noticing some of the issues like anxiety or memory issues. Then add to that the isolation from the pandemic. So, that relationship that we talked about before, you don't have that social engagement, like to go out with your friends for a weekly dinner, or play golf, for example.

So, that relationship affects your mental health, so not only your physical activities where you're staying active, but also your mental health, and they both play off of each other. So, for example, if we have someone who loves to go out and do yoga once a week, and that's where the person sees his or her friends, now with the pandemic you're not going to be able to do that, so it's going to affect your mental function, and that can cause anxiety, it can cause depression, and believe it or not, these two, anxiety and depression, can worsen isolation and worsen underlying memory issues, or even cause memory issues. Memory issues in itself can worsen anxiety and depression, so it's almost like a vicious cycle. So, the isolation and loneliness can cause a lack of brain stimulation, and therefore completely worsen your overall health.

Deanna Pogorelc:  Okay. So, I've seen some people saying, "Well, this could be our last holiday together with our elderly relative, so we absolutely should be physically together." What's your take on that line of thinking?

Dr. Kathleen Rogers:  Well, obviously, it's a case-by-case basis. With the number of COVID cases going up, we always want to err on the side of caution, and if it truly is... If your loved one, this is their last holiday, you may never see them again, then you may want to rethink seeing them. Obviously, you want to go see them, but you also want to take cautionary steps when you see them. You want to practice things like we talked we, mask up, hand hygiene. Just make sure you exercise those cautions. Some places will offer COVID testing, so when you go see your terminal loved ones, that if you're negative, that would at least help with that.

Deanna Pogorelc:  So, if a family decides that it's not safe to see my parents or grandparents this holiday season, that can be a heartbreaking decision to make, and then to have to say to that relative, "We're not going to be spending the holidays with you," is there any way to make that less painful.

Dr. Kathleen Rogers:  Well, yes. It is going to be painful as it is, but I think in this event, that's where technology and assistive devices that way through technology would help. If your loved one is not technology-savvy, you may want to use the telephone, and you may want to call often. Some of the patients that I see, they actually do activities together online. So, for example, they'll join a book club where they and their loved ones will actually choose a chapter. At the end of the week they come together online. They could see each other, and they could have a book party where they talk about the chapters that they read, and maybe sip on wine and have dinner online, or other activities such as learning a new hobby together, or you can dance on video as well in your living room. So, there are a lot of things you can try.

Deanna Pogorelc:  Yeah. Kind of on that note, so much of our connectedness is based around technology, like you mentioned, but for seniors who find that to be really challenging or maybe don't have help in setting things up, are there any low-tech ideas for staying connected or being involved in the holidays this year?

Dr. Kathleen Rogers:  Yes. I cannot emphasize using the telephone enough. You can call your loved one two, three times a day if they're willing and you're willing, obviously. There are many services out there that will also help seniors set up a basic connection in their home, whatever their provider might be, internet provider. I'm sure a lot of loved ones will be more than willing to help with that as well. There are many video-assistive devices too that offer seniors help to help set them up at home. So, I would ask them to look into these services with their family members or friends, and even their just local providers, internet providers or telephone providers. There are many phone services that also offer video-assisted technology just for seniors specifically. So, just looking into that I think would be helpful.

Deanna Pogorelc:  Are there options for seniors who are either visual or hearing-impaired as well?

Dr. Kathleen Rogers:  Yes, there are, but again, that would be basically what their provider would... I know for hearing-assisted technology, there are a lot of options now. There's amplification where you can actually put devices in your ear and use your phone or a tablet to kind of change the volume on there to help with specific... If you want to just listen to the phone call and minimize background noise, there are amplification devices that can do that. For vision, I would advise to look at your local vision department. There might be a blind society that offers technology specifically for people who can't see, who want to talk to their loved ones or friends and family.

Deanna Pogorelc:  Are there community groups or organizations, I think you mentioned a few, that are doing things to help seniors stay connected, and is there anything that those of us, even if we maybe don't have elderly relatives, to do to kind of reach out to this group?

Dr. Kathleen Rogers:  Well, yes, there is, and it really depends on what type of... Medically, if you do have a diagnosis of memory issues, or if you have Alzheimer's disease, for example, there is a local Alzheimer's disease chapter that you can reach out to, and they have a lot of resources. In fact, I know some of the local chapters also offer caregiver groups. So, if you have caregiver burden, you can get into that. A lot of counties also at this time do a lot of activities online, and even with the telephone, they do telephone conference calls, and they also offer free food, and maybe some activities where you can get a free book. Some counties also have grants where they will also provide tablets for the seniors through the grant.

So, I would suggest talking to your county department to see what activities that they have. Where senior centers now are closed, I think a lot of them have gone virtual, and a lot of them have actually gone on the phone, and they're getting pretty creative with activities. So, don't hesitate to reach out. They also offer where these activities could include loved ones, like your family, your spouses, your children, which makes it just a wholesome activity.

Deanna Pogorelc:  Yeah, great. So, if we are decided to see elderly relatives this holiday season, either virtually or in-person, how can we know that they are handling this whole pandemic experience well, and are there certain warning signs we should be looking for in our relatives?

Dr. Kathleen Rogers:  That's a very good question, especially now with the pandemic and the isolation. Without seeing our loved ones in-person, it is hard to see over the phone because they might sound great over the phone. Some of the red flags, if you do see them in-person, are they have lost weight. Maybe they're not cooking as much because they're bored. It might be a sign of depression or anxiety. Their house is not really kept up, when they used to keep it clean, all of the dishes are done, there's food in the fridge, and it's not as bright as it used to be. They've lost interest in keeping that. They've lost interest in hobbies, just basic hobbies that they like to do at home, maybe crafting or knitting, things like that. They're forgetting to pay bills. That's a big red flag for memory, especially memory disorders that need early attention, and if you notice some bruises, maybe they're falling, and especially if there's dents on the car, and maybe they have had issues with remembering how to drive, if they've gotten lost.

There are a lot of things like that that you could kind of see in just conversation and just observation. Another thing I would recommend is if your loved one seems to ask the same questions over and over again, take note of that, and then feel free to ask them some more questions. "Hey, Mom, Dad, or Grandma, Grandpa, how are you doing? Are you okay? Do you feel anxious in any way? Are you feeling bored or lonely or isolated?" Because sometimes this might be just a red herring where if you get it early and you have them bring it to their attention, maybe they might just realize, "Hey, yes, I haven't been feeling great for a while," and a lot of times with the pandemic, we don't go into the providers' offices like we used to, and everything's virtual there as well. This might beg the question to see their primary care provider in-person, and that might show a difference in how they are in their upkeep, and just in general, their health.

Deanna Pogorelc:  So, would the best step if we do notice any of those behaviors, to suggest that they do see their provider?

Dr. Kathleen Rogers:  Yes, and also, engage other family members who may have also noticed things like that. Oftentimes, when I see patients, it usually starts with one sibling or a friend who would call the other and say, "Hey, I've kind of noticed this about Mom, about Dad," and they'll be saying the same thing, "Yes. You know what? I've noticed this too, but I really never gave it much thought," and that kind of also forms a support system because everybody's on the same page, especially is there is a diagnosis that could be occurring soon. This will give you an idea, at least to the family, as to, "Okay, this is happening. How can we prepare? What are the resources that we need? How can we plan forward?" These are all important questions.

Deanna Pogorelc:  Okay. Then are there things we can be doing to make sure that our elderly relatives are not just staying healthy and well, but also safe if we're not going to be there to check on them as often as usual?

Dr. Kathleen Rogers:  Yes. So, this is a question I get a lot with my patients, especially with family members that live across state lines. One of the most popular, I would say, choices that families tend to use are the video doorbells, especially when you have scammers or people coming to the front door, having a loved one on the phone bill so they can sort of make sure that they're not being scammed by people who just call and say, "Hey, your grandson is in jail. You've got to pay us thousands of dollars." These are real cases that happen.

Another thing is just checking on them regularly throughout the day to make sure they're okay. Some families choose to put a little video monitor in their home where they can just call in, and it kind of opens a window to the patient's or loved one's home, and they can sort of see the surroundings, see is everything okay, especially if there's motion in front of the camera, for example, like a baby monitor they can use. Also, there are many apps that you can use on the phone that will help connect you via video, and you can sort of looking into their surroundings that way as well.

Deanna Pogorelc:  Great. Those are great tips. Is there anything else we haven't covered yet that you would like to leave our viewers and our listeners with?

Dr. Kathleen Rogers:  It's just important not to be fearful during the season. I know it's taken a lot. This has been one of the hardest years in a long time, and it can take a toll on so many people, young and old. But my advice would be try to enjoy whatever you can enjoy, especially during the holidays, safely. Try to use your observational skills for your loved one, and always be an open communication channel, because that really helps your elderly loved on feel connected, even if it's virtually and on the phone, and just enjoy the holidays together as much as you can. Don't live out of fear. Just take it one step at a time.

Deanna Pogorelc:  Great. Well, thank you so much for your time and for taking all of those questions. For the latest updates on the coronavirus pandemic, please visit clevelandclinic.org/coronavirus. You can also hear more interviews with our Cleveland Clinic experts by subscribing wherever you get your podcasts, or visiting clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter, and Instagram @ClevelandClinic, for more health tips, news, and information. Thanks for joining us.