The COVID-19 pandemic has had a profound impact on the wellbeing of older adults. In this episode of Better Edge, Anna Liggett, MD, assistant professor of Geriatric Medicine, discusses the delicate balance many geriatricians are facing between keeping seniors safe and managing social isolation in long-term care facilities. She shares recommendations and details of a new initiative her team is launching to pair medical students and seniors in underserved areas together for phone conversations to help combat social isolation.
Related: Read the study, "Reducing Social Isolation of Seniors during COVID-19 through Medical Student Telephone Contact," led by Lee Lindquist, MD, MPH, MBA and published in the Journal of the American Medical Directors Association.
The COVID-19 Paradox: Keeping Seniors Safe and Managing Social Isolation
Featured Speaker:
Anna Liggett, MD
Anna Liggett, MD, is an assistant professor of Medicine in the Division of Internal Medicine and Geriatrics. Liggett earned her MD from Ross University in 2015 and completed her residency in family medicine at United Health Services, Upstate Medical University in 2019 before joining as geriatric medicine fellow at McGaw Medical Center of Northwestern University. Her clinical work focuses on home care and using integrative medicine to treat older adults. Her academic focus is on using data to improve post-acute care outcomes and improve efficiency in long-term care facilities. Transcription:
The COVID-19 Paradox: Keeping Seniors Safe and Managing Social Isolation
Melanie Cole: We're experiencing and historical moment with an unprecedented challenge of the COVID-19 global pandemic. This outbreak of COVID-19 will have long-term and profound impact on older adults, health and wellbeing, social isolation and loneliness are likely to be one of the most effected health outcomes for this population. Welcome to Better Edge a Northwestern Medicine Podcast for physicians. I'm Melanie colon. Today, I invite you to listen in, as we discuss strategies to help reduce isolation for seniors during the COVID-19 pandemic. Joining me is Dr. Anna Liggett. She's an Assistant Professor of Geriatrics at Northwestern Medicine and a new member of the Northwestern Medicine Geriatrics Team. Dr. Liggett, it's a pleasure to have you join us today. What are you seeing in your practice as far as isolation and our seniors? What's the toll that it's taking on them. We know that seniors are of higher risk for COVID, but what are some of the risks of loneliness that you can tell us about and how can social isolation harm their health at this point?
Dr. Liggett: We are in a horrible position with senior isolation during all the restrictions that we impose to keep them safe from COVID. And as we already knew before COVID social isolation has serious negative impacts on seniors health almost as bad as smoking or being overweight. It negatively impacts the cardiovascular system and can lead to premature death. Prior to COVID long-term care facilities were excellent at combating the social isolation by having community meals and activities and musicians would come in, pet therapy, dogs would come in, but now all of that has taken a halt and our seniors in long-term facilities have really been impacted and you can see it, their morale is way down and we're seeing some cognitive changes. We can't prove that it's directly related, but we know that the social isolation is having negative physical impacts on our residents.
Host: Well, as someone who has a 96-year-old father here on the North Shore, I know exactly what you're talking about, Dr. Liggett, but speak about the COVID-19 social connectivity paradox, that theorizes that a common set of actions. I found this so interesting simultaneously protects and harms older adults during the pandemic at the same time. Tell us a little bit about the long-term care facilities and how now they're not getting some of those therapies. So it's both harming them and yet keeping them safe at the same time from COVID?
Dr. Liggett: Exactly. And we keep going in roundabout discussions of how the patients are socially isolated. Some of our residents who used to get their hair done weekly, haven't got their hair cut since March and it's really affecting them. But of course, then we think about how contagious viruses and it's just hard to justify creating that risk. So we just keep going in circles and balancing protective measures and patients' wellbeing. And it's really difficult.
Host: Well it certainly is. And now what about visitation policies? How have they been adjusted to help combat social isolation for our seniors?
Dr. Liggett: So, they've been pretty strict. Originally, there was no visitors whatsoever. Facilities definitely took advantage of the warmer weather over summer, having outdoor scheduled visits for a short amount of time and with masks, socially distance, but have the benefit of the outside ventilation was a huge, useful tool during the summer. And then now with the weather getting colder and we can't really utilize that as much.
Host: It is a little disheartening. So social isolation, Dr. Liggett doesn't have to lead to loneliness necessarily. Do you have some recommendations that you're giving your patients and their families so that other providers know how to counsel their patients and families to help combat this isolation while still staying safe?
Dr. Liggett: Yes, we are relying heavily on video telecommunication or just the telephone or old-fashioned letters. We're encouraging friends and family members to check in with their older adult loved ones regularly. Even if it's just quick, how are you? It really breaks up the monotony and the loneliness of social isolation.
Host: It is a good idea. What about the tech savvy portion of this? I know you said good old fashioned telephone. I think letters are a fantastic idea because seniors love to open a letter, but what about things like face time or even televisits with their doctors or a mental health professional, if nobody can show them how to do those things, a lot of them do have iPhones. They just don't know how to do it.
Dr. Liggett: Exactly. Very good question. Because we run into it all the time and sometimes it's hard to get through the barriers. And I had one patient who's hearing impaired and vision impaired and she was 101, believe it or not. And she was cognitively intact, but she couldn't use a phone. And then even if someone was to help her use a phone, she wouldn't get much out of the conversation. So sometimes we do just reach dead ends, but I rely on the younger family members or friends to walk through their loved ones, just to try and establish some connection they can get comfortable with using and most seniors have surprised themselves with what they can do.
Host: And I think at a lot of these assisted living and caregiving locations, there are younger healthcare workers there and maybe a family can ask them to assist as well. And a lot of them are offering this anyway. Now do you foresee a vaccine rollout and how do you, if there is one, see it going at long-term care facilities, will it be effective in stopping the spread and allowing our seniors to return to some sense of normalcy in your opinion, what do you see is going to happen?
Dr. Liggett: We are definitely all clinging to the hope that there's a safe, effective, readily available vaccine soon that could change the narrative of the situation we're currently living in. But my hunch is that actually having a test that's rapid, accurate, affordable, and plentiful to give to everyone might be able to get us to more recognizable normalcy sooner than a vaccine would. We're starting to see some safety concerns and some of the trials. And once we have an effective vaccine, we have to mass produce it and do several large-scale trials to ensure that it is a safe and effective vaccine. And a lot of companies are trying really hard. They're taking huge financial risks and mass producing the vaccine as they're trying it out. So if it is a successful one, there'll be ready to go. So I have faith in how hard everyone's working that we will get there. The question of when is, I just don't know,
Host: Can you share some of the unique approaches your team has implemented?
Dr. Liggett: Yes. So, at the beginning of the pandemic, a colleague of mine, Dr. Lindquist mobilized med students who were pulled off clinical rotations and still wanted to help and contribute in any way they could. And Dr. Lindquist and her team paired medical students with seniors who are at higher risk of being socially isolated and had them do regular phone calls and certain questions to ask the patients about who they were as people and, in their life, and how the virus was affecting them. And that had a real positive impact on both the seniors and the medical students. And I'm in the process of hoping to replicate this study again with Dr. Hauser, the program director of palliative medicine and social worker Darby from neurocognitive department. And to identify seniors in more low income areas and pairing them with medical students who are interested in this project as well, and repeating the regular phone calls and hoping to help the seniors with the current social isolation that's occurring.
Host: What a great initiative, Dr. Liggett, as we wrap up, what advice do you have for your colleagues at other institutions and really for listeners in general, that know that they have loved ones that are going through this social isolation and loneliness and how other providers can really help to bridge that gap during this time?
Dr. Liggett: I would say to other providers to continue to take the best care of themselves as they can, because when they show up for the patients, they're one of the main physical contacts that these patients have. So coming to them with your full attention and an upbeat demeanor really picks up their spirit in a big way. And I know we've been working hard during this difficult time, so it's easy to get run down, but keep doing what you can to get your own self feeling well. And so you can be there for others. And I think we should remind everyone what a great job they're doing. This is a difficult time. We've been doing it for eight months and we're still getting up and rising to the challenge
Host: Well, you certainly are. And thank you for that. And thank you for taking such good care of our senior loved ones. To refer your patient, or for more information on COVID-19, you can visit our website at nm.org/geriatrics to get connected with one of our geriatric specialists. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians, please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.
The COVID-19 Paradox: Keeping Seniors Safe and Managing Social Isolation
Melanie Cole: We're experiencing and historical moment with an unprecedented challenge of the COVID-19 global pandemic. This outbreak of COVID-19 will have long-term and profound impact on older adults, health and wellbeing, social isolation and loneliness are likely to be one of the most effected health outcomes for this population. Welcome to Better Edge a Northwestern Medicine Podcast for physicians. I'm Melanie colon. Today, I invite you to listen in, as we discuss strategies to help reduce isolation for seniors during the COVID-19 pandemic. Joining me is Dr. Anna Liggett. She's an Assistant Professor of Geriatrics at Northwestern Medicine and a new member of the Northwestern Medicine Geriatrics Team. Dr. Liggett, it's a pleasure to have you join us today. What are you seeing in your practice as far as isolation and our seniors? What's the toll that it's taking on them. We know that seniors are of higher risk for COVID, but what are some of the risks of loneliness that you can tell us about and how can social isolation harm their health at this point?
Dr. Liggett: We are in a horrible position with senior isolation during all the restrictions that we impose to keep them safe from COVID. And as we already knew before COVID social isolation has serious negative impacts on seniors health almost as bad as smoking or being overweight. It negatively impacts the cardiovascular system and can lead to premature death. Prior to COVID long-term care facilities were excellent at combating the social isolation by having community meals and activities and musicians would come in, pet therapy, dogs would come in, but now all of that has taken a halt and our seniors in long-term facilities have really been impacted and you can see it, their morale is way down and we're seeing some cognitive changes. We can't prove that it's directly related, but we know that the social isolation is having negative physical impacts on our residents.
Host: Well, as someone who has a 96-year-old father here on the North Shore, I know exactly what you're talking about, Dr. Liggett, but speak about the COVID-19 social connectivity paradox, that theorizes that a common set of actions. I found this so interesting simultaneously protects and harms older adults during the pandemic at the same time. Tell us a little bit about the long-term care facilities and how now they're not getting some of those therapies. So it's both harming them and yet keeping them safe at the same time from COVID?
Dr. Liggett: Exactly. And we keep going in roundabout discussions of how the patients are socially isolated. Some of our residents who used to get their hair done weekly, haven't got their hair cut since March and it's really affecting them. But of course, then we think about how contagious viruses and it's just hard to justify creating that risk. So we just keep going in circles and balancing protective measures and patients' wellbeing. And it's really difficult.
Host: Well it certainly is. And now what about visitation policies? How have they been adjusted to help combat social isolation for our seniors?
Dr. Liggett: So, they've been pretty strict. Originally, there was no visitors whatsoever. Facilities definitely took advantage of the warmer weather over summer, having outdoor scheduled visits for a short amount of time and with masks, socially distance, but have the benefit of the outside ventilation was a huge, useful tool during the summer. And then now with the weather getting colder and we can't really utilize that as much.
Host: It is a little disheartening. So social isolation, Dr. Liggett doesn't have to lead to loneliness necessarily. Do you have some recommendations that you're giving your patients and their families so that other providers know how to counsel their patients and families to help combat this isolation while still staying safe?
Dr. Liggett: Yes, we are relying heavily on video telecommunication or just the telephone or old-fashioned letters. We're encouraging friends and family members to check in with their older adult loved ones regularly. Even if it's just quick, how are you? It really breaks up the monotony and the loneliness of social isolation.
Host: It is a good idea. What about the tech savvy portion of this? I know you said good old fashioned telephone. I think letters are a fantastic idea because seniors love to open a letter, but what about things like face time or even televisits with their doctors or a mental health professional, if nobody can show them how to do those things, a lot of them do have iPhones. They just don't know how to do it.
Dr. Liggett: Exactly. Very good question. Because we run into it all the time and sometimes it's hard to get through the barriers. And I had one patient who's hearing impaired and vision impaired and she was 101, believe it or not. And she was cognitively intact, but she couldn't use a phone. And then even if someone was to help her use a phone, she wouldn't get much out of the conversation. So sometimes we do just reach dead ends, but I rely on the younger family members or friends to walk through their loved ones, just to try and establish some connection they can get comfortable with using and most seniors have surprised themselves with what they can do.
Host: And I think at a lot of these assisted living and caregiving locations, there are younger healthcare workers there and maybe a family can ask them to assist as well. And a lot of them are offering this anyway. Now do you foresee a vaccine rollout and how do you, if there is one, see it going at long-term care facilities, will it be effective in stopping the spread and allowing our seniors to return to some sense of normalcy in your opinion, what do you see is going to happen?
Dr. Liggett: We are definitely all clinging to the hope that there's a safe, effective, readily available vaccine soon that could change the narrative of the situation we're currently living in. But my hunch is that actually having a test that's rapid, accurate, affordable, and plentiful to give to everyone might be able to get us to more recognizable normalcy sooner than a vaccine would. We're starting to see some safety concerns and some of the trials. And once we have an effective vaccine, we have to mass produce it and do several large-scale trials to ensure that it is a safe and effective vaccine. And a lot of companies are trying really hard. They're taking huge financial risks and mass producing the vaccine as they're trying it out. So if it is a successful one, there'll be ready to go. So I have faith in how hard everyone's working that we will get there. The question of when is, I just don't know,
Host: Can you share some of the unique approaches your team has implemented?
Dr. Liggett: Yes. So, at the beginning of the pandemic, a colleague of mine, Dr. Lindquist mobilized med students who were pulled off clinical rotations and still wanted to help and contribute in any way they could. And Dr. Lindquist and her team paired medical students with seniors who are at higher risk of being socially isolated and had them do regular phone calls and certain questions to ask the patients about who they were as people and, in their life, and how the virus was affecting them. And that had a real positive impact on both the seniors and the medical students. And I'm in the process of hoping to replicate this study again with Dr. Hauser, the program director of palliative medicine and social worker Darby from neurocognitive department. And to identify seniors in more low income areas and pairing them with medical students who are interested in this project as well, and repeating the regular phone calls and hoping to help the seniors with the current social isolation that's occurring.
Host: What a great initiative, Dr. Liggett, as we wrap up, what advice do you have for your colleagues at other institutions and really for listeners in general, that know that they have loved ones that are going through this social isolation and loneliness and how other providers can really help to bridge that gap during this time?
Dr. Liggett: I would say to other providers to continue to take the best care of themselves as they can, because when they show up for the patients, they're one of the main physical contacts that these patients have. So coming to them with your full attention and an upbeat demeanor really picks up their spirit in a big way. And I know we've been working hard during this difficult time, so it's easy to get run down, but keep doing what you can to get your own self feeling well. And so you can be there for others. And I think we should remind everyone what a great job they're doing. This is a difficult time. We've been doing it for eight months and we're still getting up and rising to the challenge
Host: Well, you certainly are. And thank you for that. And thank you for taking such good care of our senior loved ones. To refer your patient, or for more information on COVID-19, you can visit our website at nm.org/geriatrics to get connected with one of our geriatric specialists. That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians, please remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.