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The impact following Covid-19 rules has had on older people

Original article entitled 'I can't imagine not leaving your home for four months': The impact on older people of following the Covid-19 rules', was published in the Journal online and is available to view here

As we face into longer-term restrictions, ensuring proper supports for older people who’ve had to cocoon has been described as vital.

THE “unintentional consequences” of cocooning have resulted in older people becoming more isolated and facing further problems that require “urgent” intervention from the government. And the rising number of cases – particularly among younger people – is a source of concern for more at-risk populations as the country has re-opened, according to Trinity College professor Rose Anne Kenny.

Professor Kenny is the principal investigator of TILDA – the Irish Longitudinal Study on Ageing – which is a large-scale and long-term investigation into the experiences of people getting older in Ireland.

New research from Tilda and older persons charity Alone this week painted a stark picture of the situation facing older members of the population as we come out of lockdown.This includes an increased sense of loneliness and of isolation, with those over 70 and those advised to cocoon among the majority of people who reached out for help since March.

There is also concern that as they continue to follow the public health guidelines – which remains stricter on people over 70 than others – those who don’t follow the advice could put them at greater risk again.

At the same time, an academic at UCD specialising in behavioural science has emphasised the importance of maintaining and improving the messaging to younger people as we continue to live with Covid-19 as some may be feeling “fatigue” over the restrictions after so many months.

Isolation and anxiety

With Tilda, a specially-selected nationally representative group of people aged 50 and over is asked to give feedback on their experiences over a long period of time. Prior to the pandemic, its research found that over 70% of these people reported that they never or rarely felt lonely. Of those living alone, 31% said they were rarely lonely while 37% said they were often lonely.

Professor Kenny said, “At that time [before Covid-19], they were an independent, very active, very engaged group of people. But then that changed.”

At the onset of the Covid-19 pandemic, then-Taoiseach Leo Varadkar indicated what it would mean for those over the age of 70 and those most at risk of getting seriously ill with Covid-19.“At a certain point… we will advise the elderly and people who have a long-term illness to stay at home for several weeks,” he said.

“We are putting in place the systems to ensure that if you are one of them, you will have food, supplies and are checked on. We call this ‘cocooning’ and it will save many lives… particularly the most vulnerable… the most precious in our society.”

Professor Kenny said that when this measure was subsequently introduced in March, it suddenly meant a whole group of people had to withdraw from all their voluntary activities and daily social engagements.

“It would appear that from the same time, Alone had a significant increase in calls to their hotline from this age cohort,” she said.

Set up at the beginning of the pandemic, 55% of callers to the Alone line were over the age of 70 while 75% of callers were living alone. In all, from 9 March to 5 July, the helpline received 26,174 calls.

Over time, there’s been an increase in callers who are putting off medical treatment or examination – such as after falls – due to fears around Covid-19. The charity has also seen a rise in callers reporting negative emotions, such as suicidal ideation, during the pandemic.

The Trinity professor said that the consequences of the Covid-19 restrictions have had a negative effect on such a large cohort of people in Ireland. According to the 2016 Census, there were just over 637,000 people aged 65 or over in Ireland.

“[When it comes to the loneliness and isolation people are facing now], you can see how this wasn’t the case beforehand,” Professor Kenny said, highlighting the figure of 37% of people who said they were often lonely before the pandemic. It may be the case that this figure could be much higher now.

“This is the unintentional consequences of the enforced cocooning,” she said. “People are still afraid, particularly when they hear the virus may have increased in prevalence among other persons, among younger people. They’ve been so careful with the restrictions. Perhaps younger cohorts of people aren’t that careful now and that’s a worry.

Complying with the rules

Alison Stapleton is a PhD student in UCD specialising in behavioural science. She told The that the public health messaging was so strong at first because they came with“credibility and from authority.”

“We were told this advice was coming from the World Health Organisation, the public health experts,” she said. “And we were told that these were rules that should be followed. They were plausible and made sense.”

To use the most extreme example, health advice coming from the likes of Simon Harris and Leo Varadkar back in April that we’ve to social distance and wash our hands made sense because they explained the science behind it.

Varadkar even checked his notes on the Late Late Show to be sure he was giving the right information because it wasn’t coming from him, it’s coming from the experts. On the other end of the spectrum, there was the US President appearing to suggest the injecting of bleach. Stapleton said such statements can be dismissed and public health advice more easily ignored if it’s clear the suggestion doesn’t make sense.

She said another factor that contributed to the public health advice having such a strong effect on the public was that we were told that if we follow these rules, we would be helping to prevent loved ones getting sick.

“A rule is less likely to be followed if it’s not linked to what that person cares about,” she said. “They were reminded that breaking the lockdown rules could mean they put family members at risk.”

However, given that we’ve been living with restrictions for many months now and the likes of social distancing will persist into the future, it’s to a degree understandable that people may not be adhering to them as closely as they were.”

A person who may not have personally affected by the pandemic may be less likely to adhere to the rules going forward, even if it’s coming with the same messaging from the authorities that was effective before. And the rules have become more complex rather than the simple stay-at-home and social distance guidelines that were in effect in April.

Stapleton said:

“It ties in with fatigue. Initially there were things that might have been really effective – over time, that feeling of risk might decrease. With the number of cases each day, people might rationalise it and say it looks fine and maybe not pay attention to the warnings that go with them.”

The researcher said it was important that the messaging doesn’t veer into using threatening language, like the public being told there’ll be a second lockdown if they don’t adhere to the rules.It follows on from comments made by acting chief medical officer Dr Ronan Glynn who has said, on more than one occasion, that it’s “not about blame” when it comes to those who flout the restrictions.

Images of people out drinking in large numbers that were shared on social media had drawn ire but Dr Glynn emphasised that it was important for people to think twice before engaging in such behaviour given how it could aid the spread of the disease.Dr Tony Holohan previously ruled out a second lockdown even if there’s a resurgence of the virus, and Stapleton said stark warnings that we could face having to stay inside again if there’s a second wave may be counterproductive.

“I don’t think that would work,” she said. “It’s important about putting into the context of what ‘we need to do’ rather than ‘you must do this’.” She cited the example of wearing a face mask in public transport being mandatory and the importance of stressing that we all must do this to protect each other.

She added: “Over time, the threat may not seem as imminent, so it’s important that messaging continues to stress the right things and to link them to what matters to people – like the desire to go back to normal.”

Supports for older people

The problems present now for older people have arisen because of their strict following of the guidelines. Adhering to the rules around cocooning have brought about a host of issues of their own.Now, the advice for over 70s is as follows: stay home as much as you can, maintain social distancing with visitors, use times allotted for shopping, and use face coverings when attending shops or busy public areas.

Professor Kenny said the work done by Tilda will now seek to get more data on how its participants have been affected by isolation and loneliness during Covid-19.

“The indicators are from what we’ve seen [in the Alone data] that it’s a serious problem,” she said. The research team have received responses and expect to be in a position to publish data in around six weeks’ time.

She said:

“I spoke recently to a woman in her 80s. She hadn’t left the house since March, and had everything delivered. I can’t imagine what it’s like not to leave your home for four months.People need social engagement. They need exercise. They need to get out. People are still vulnerable and worried. I would hope we can engage immediately with policy makers. We need to offer solutions. We urgently need to find ways that will improve their quality of life.”

A link to report ‘Loneliness and social isolation among the over 70s: Data from The Irish Longitudinal Study on Ageing (TILDA) and ALONE’ can be found >HERE