“I was isolated before COVID,” Safieh Hekmat said, “now it’s worse.”
Hekmat has been living with her 99-year-old parents and caregiving for them for over 10 years. Her parents have very few pre-existing conditions for their age, but Hekmat said their health and happiness is very dependent on mental stimulation and social interactions.
Since COVID-19 precautions forced their neighbors inside and closed community centers, she has noticed her parents have become more tired, anxious, and lonely. “I have this nagging guilt whenever I leave the house, I call several times to make sure they don’t feel lonely,” Hekmat said.
Several years ago, Hekmat discovered Iona Senior Services and brought her parents to a Halloween party to meet and socialize with other people their age. Hekmat said even though they were the oldest people there, they had the most fun. “They were dancing, and my Mom was singing. They were the center of attention,” she said. “Even though they are old, they can be full of life.”
In-person socialization and interactive activities offer a way for seniors with Dementia, Alzheimer’s, and other mental impairments to exercise their minds and slow the speed of their condition. Since the start of the COVID-19 pandemic in March, Iona has now replaced most of their in-person events, like art-therapy, museum field trips, classes and workshops, with virtual alternatives. Because of these changes, older adults are experiencing cognitive decline at a much faster pace than before the pandemic. In addition to assisting the elderly participants, Iona’s in-person services were also crucial to the mental health of caregivers because it gave them time to focus on their own lives, families and jobs.
Sharon O’Connor is both a caregiver for her elderly father, who is living with Dementia, and the Director of the Wellness and Arts Center at Iona Senior Services in Tenleytown, Washington D.C.
She recently took a year off from leading support groups at Iona and moved to a house 3 miles away from her father so she could take care of him more easily. When she brings him his meals, pre-cooked and ready to eat, she stands six feet away with a mask on. “It’s so hard for him” she said. “He gets very lonely.” She says his Dementia has worsened because of his “social isolation.”
Social isolation is “the lack of social interaction” that can increase a person’s risk of premature death from all causes, reports the CDC. It is associated with a 50% increased risk of dementia, 29% increased risk of heart disease, and 32% increased risk of stroke among older adults. This health risk is also compared to and often exceeds that of smoking, obesity and lack of physical activity.
Recommendations for seniors who are at risk for social isolation include having some form of regular exercising, calling friends as often as possible, trying to learn a new skill, or even consider adopting a pet.
The Department of Aging and Community Living (DACL) is an D.C. government agency that provides funding and resources to older adults in the District. About a third of Iona’s overall funding comes from DACL. Right now, the agency’s website hosts a streamlined collection of information regarding COVID-19 precautions, volunteering opportunities, adult protective services, wellness centers, transportation resources, and more.
A Communications and External Affairs representative from DACL said their most pressing concern is social isolation. “The physiological impact is as dangerous as smoking 15 cigarettes a day,” she said.
In response to this concern, they have conducted several new initiatives, including Call and Talk Programs and Regular Reassurance Calls in which current participants of DACL-funded senior programs will receive regular check-ins to stay connected. DACL is also working to expand online engagement by partnering with Around Town DC, an event directory for people ages 60 and up, to deliver a variety of virtual events.
At Iona, 65 seniors who regularly participated in in-person events, lost the routine of consistently exercising their minds and caregivers, like Safieh Hekmat, lost the only time they had themselves.
“I don’t have a life,” Hekmat said. In 2017, she quit her job to be her parent’s fulltime caregiver. She said she used to have dinner with friends every weekend before COVID to give herself space, but now she said that’s not an option.
“I tried a [support] group at Sibley Hospital once,” Hekmat said, “but I don’t have the energy or time. I really do need it, but I haven’t found the right group.”
According to an assessment done by the Family Caregiver Alliance, 40% to 70% of family caregivers show significant symptoms of depression and about a quarter to half of the same caregivers meet the diagnostic criteria for major depression.
The National Institute of Mental Health defines depression as having some symptoms of sadness, irritability, low energy, sleep changes, restlessness, weight changes, pessimism and others, while “major depression” must exhibit at least five of the aforementioned symptoms.
Increasing awareness of caregiver and older adult mental health support is something that Sharon O’Connor and Iona is passionate about.
“I sometimes feel like all the decisions are now on my shoulders as to what to do. God forbid something happens to them, which it will, I have to make all the decisions,” Hekmat said, “Before COVID I wouldn’t even think about burial versus cremation. I would avoid the subject.”
The CDC recommends that caregivers should follow strict guidelines if they are caring for a loved one in a non-healthcare setting, including having a plan should someone in the home contract COVID-19. Hekmat said one of the major challenges she and her parents faced during the pandemic was back in March, when they didn’t exactly know how to best protect themselves. Before COVID-19, helpers and visitors would come in and out of the house freely, she said, it was very hard to adjust when they learned that in order to keep her parents safe, it meant doing so more independently.
Lauren Stephenson, the Manager of Development and Communications at Iona, listed four serious challenges that have affected Iona’s ability to provide their services. Due to the bulk of their programs now being online, the first challenge, she said, was the “learning curve” it took for Iona staff members to host events online. Second, was the lack of financial resources and access to technology in the homes of senior citizen which makes online programs very hard to manage without caregiver supervision.
“Some folks don’t have the cognitive ability, motor skills, or motivation to participate in a Zoom call for instance,” Stephenson said.
The third challenge she listed, was their loss of revenue at the beginning of the pandemic. Fifteen percent of the center’s revenue comes from participant health insurance, therefore when programing was at a standstill, so were their funds.
Lastly, one of Iona’s core missions is to relieve some of the stress caregivers experience by taking their family members safely off their hands for a while. Stephenson said pandemic has made this mission nearly “impossible.”
She said, “in a perfect world”, they would need increased monetary donations and technology donations to solve these problems and even then, she said, “it won’t be easy.”
“We have, though, seen an uptick in people using support groups,” Sharon O’Connor said. It is possible that because attend group Zooms virtually can be done without leaving a parent with alone or with helpers, more caregivers are utilizing this resource than before the pandemic, O’Connor said.
She also emphasized the importance of education on mental health and awareness of elder neglect in the older community. “Instead of calling someone a Dementia patient, we say ‘a person living with Dementia.’ Its better language to use person-first phrases. Its one small thing you can do to help with widespread agism.”
A survey conducted in 2018 by the American Association of Retired Persons (AARP) to evaluate agism in the workplace found that three out of five older workers have seen or experienced age discrimination in the workplace. The Equal Employment Opportunity Commission brought a total of 10 age discrimination suits in 2018.
In even older populations, The World Health Organization (WHO) said this year that one in six people over the age of 60 experience abuse in the past year, but only one out of 24 cases are reported. Their data on “psychological abuse” discovered that 15.7% of cases were reported by older adults themselves in community setting, and 64.2% was reported by staff in institutional settings.
“I think that the hardest thing for older adults to go through is isolation. As a community, we just really need to learn better ways to include older adults. They still continue to have a lot to give and a lot to offer a community. They need to feel valued,” said O’Connor.
WHO also notes that prevention methods such as screenings, school-based intergenerational programs, and caregiver support interventions are all forms of awareness that can help decrease the frequency of agist practices in communities. These educational programs and support systems are what O’Connor says are “critical” when it comes to creating a more inclusive community.
“Now we all know how it feels like to be isolated,” she said, “We’ve all had a taste of what it’s like to live that way. So many of our elders live that way on a regular basis. That is their life.”