'You just can't isolate the elderly completely'

'Families look after the elderly. And these families are facing a lot of problems now.'

How vulnerable are the elderly to coronavirus?

In Europe and the United States, the elderly have dominated the coronavirus fatalities.

How can we take care of the elderly at this troubled time?

"Those who are struggling a lot are patients with health issues, who need support for their day-to-day lives. They are the ones who are fragile and who need help," Dr Sridhar Vaitheswaran, below, tells Rediff.com's Shobha Warrier.

It is the elderly, especially those with co-morbidities like cardiovascular diseases, diabetes, etc, who are more vulnerable to coronavirus.
As a doctor who is involved with the care of the elderly, how do you look at this situation?

To protect the elderly as they are the most vulnerable, we shut the OP for the elderly. We asked them not to come to hospital. But we found that even that increases the risk for the elderly because if family members get infected, they take it back home to the elderly.

If the pandemic spreads more, you just can't isolate the elderly completely. We need to take care of them and take adequate precautions. We need a common sense approach to this.

The UK initially decided to quarantine only the elderly and let the rest of society continue with their lives. How do you look at something like that?

I would say it is not practical at all. How can you just quarantine the elderly or completely isolate them from society?

In India, the situation is slightly different from that in the UK. We do not have many old age care homes.

Even in the care homes that we have, I have heard stories of them getting affected and homes getting closed due to the lockdown as there is a scarcity of care givers. In fact, some of these homes are asking the guardians to take the elderly back home as they do not have people to take care of them.

This kind of a situation is unprecedented.

The most common situation in India is families look after the elderly. And these families are facing a lot of problems now.

One of the major problems these families face because of the lockdown and the restricted movement of people is, non-availability of caregivers.

We have had several phone calls asking for caregivers as there are many households that are badly in need of caregivers to take care of the elderly to bathe them, feed them, etc.

The caregivers are not able to go to these places as there is no public transport. They are also scared to come out for the fear of getting infected.

You mean in India, more than the virus infection, it is the care of the elderly that is affected...

Exactly. Many families are asking the caregivers to stay with the family. Some others are trying to pick the caregivers from their homes. With the police not allowing vehicular movements and stopping people and questioning them, picking caregivers is also becoming difficult.

There are so many such problems which need attention, clarity in thinking and implementation.

Also, there are many elderly people who live alone and need assistance to cook and take care of the household. Not just the elderly, people with disability also need help.

With so many people calling us, I contacted the services who provide support to the elderly and those with disability. I found that their situation also is no different with their staff finding it difficult to visit these people.

Is it due to fear of the virus or are they finding it difficult to move?

Movement is the big problem.

Of course, there is also the fear of the virus. Most of these caregivers are young women and their families are not letting them out. Even if they are not worried, their families are worried.

Studies show that all over the world, the elderly feel isolated and in the grip of fear...

Unfortunately, it is very true. The elderly who are alone find it hard to watch stories of the coronavirus whenever they switch on the TV.

One thing their families can do is connect with them regularly through video calls if they are technically sound, or at least over the telephone. It is essential to be in touch with your elderly relatives and assure them of your support.

Neighbours also can play a big role in offering them support. This is where a civil society has to come together.

Even families who have been taking care of the elderly are struggling. A patient of mine who likes to go out for daily walks is getting very agitated being cooped up at home 24x7. He lives in an apartment where his movements are quite restricted, and this had a huge impact on his mental state.

A change in routine can be very distressing for everyone, more so for the elderly.

This particular patient of mine was feeling so restless and agitated that I wrote a letter to the authorities requesting for permission for his family to take him to his native village where they have a house with compound, garden, etc. The availability of space to move around will reduce his level of agitation.

Do you feel the lockdown came without any warning and without any time to prepare ourselves, and that was why the elderly, the migrant workers, etc are suffering a lot?

I would say, yes. Especially in the case of elderly patients.

If we had the time to make some kind of an arrangement, some kind of planning to look after the elderly in the care homes or their own homes, we could have done something like arranging passes for the caregivers.

Similarly, if there was a warning, the families could have arranged for the caregivers to live in their homes, or get passes to pick them up every day. Many families are willing to do so but they are not able to do because of the travel restrictions.

Also, if we had prior warning, those families who had ancestral homes in villages, would have taken the elderly there where there was space to move around.

This is something I have learnt now. Maybe in the future, I will have a 'care plan' for all my patients in emergency situations like these.

How fragile is the mental condition of the elderly who are staying alone and in care homes?

They are more isolated now. They are already living by themselves and now, they are more alone.

If they are able to connect with their families on a daily basis by any means of communication, they may feel better.

But you cannot say that every isolated elderly person is in a fragile state of mind. It depends on their personality too.

Those who are struggling a lot are the patients with health issues, who need support for their day-to-day lives. They are the ones who are fragile and who need help.

If we can come up with a plan to support them emotionally and otherwise, it would be of great help.

I read about a policeman visiting all the elderly in his area of work, and helping them with their supplies of medicines and other things. What he is doing is at the individual level.

What we need is an organised system where we can protect the needy in situations like these.

Other than the government, civil society also has to step in. For example, the resident welfare associations can make a list of the vulnerable in their locality, and help them.

From your experience, do you feel more than the fear of the virus, it is the fear of things running out and fear of isolation that is affecting the elderly now?

Definitely. The real worry for them is, when they see their supplies coming down and medicines running out. Their constant fear is, what will I do when I exhaust my medicines and food I have?

We are not a geriatric society yet, but do you feel we have not given importance in creating a system for the elderly?

Yes, there are many things we need to do more and better. And this is one of them.

What happened is totally unprecedented, and we are all learning from this experience.

Having said that, there is only so much that any government can do. It is up to society to pick up from there.

This is just one of the disasters that we have faced and in future, we may face more. This is a good learning opportunity for all of us.

We need to have a proper plan for the elderly and the other vulnerable sections of society if there is a disaster like this in the future.

Do you feel care for the elderly is a neglected area in India?

Yes, definitely. We are not thinking much about the elderly because it is not affecting the vast majority of people right now. Only those who have the elderly living with them or the elderly themselves, think about this.

Though the proportion of the elderly is only 10 or 11% of the total population of 1.36 billion now, if we look at the absolute numbers we have a huge number of elderly population; we are second or third in the world. This number will grow in the next few years.

By 2050, 15% to 20% of our population will be elderly and the number will be huge. So we need to have a robust plan to meet the needs of the elderly.

The mark of a developed and an evolved society is, when you are able to take care of the most vulnerable.

Dr Sridhar Vaitheswaran's photograph: Sreeram Selvaraj.