Here are the excerpts from an exclusive interview conducted with Dr. Lasantha Ganewatta during which she shares expert opinions from her apt academic and clinical know-how about COVID-19 and elders.
Q. It is elders over the age of 60 who are at higher risk and dying from COVID-19. In addition to basic health guidelines, what else can they do to protect themselves?
Dr. Lasantha Ganewatta works as a Consultant Physician attached to the New District General Hospital, Matara looking after the Corona-infected patients.
She obtained the required qualifications in Geriatric (Elderly Care) Medicine from Royal College of Physicians, London and obtained comprehensive on-the-job training attached to the Geriatric Medical ward in Queens University Hospital, London, UK. She has ‘Diabetes and Endocrinology’ qualification from Royal College of Physicians, London.
A. COVID-19 affects elders disproportionately causing high morbidity and mortality among them. As many elders are suffering from other chronic illnesses such as diabetes mellitus, heart diseases and other organ impairments, they are more vulnerable to develop severe Covid pneumonia. We all know ageing is a distinct state where people gradually lose their inbuilt biological and physiological reserves leading to less resilience against illnesses. This process is called frailty in elders. Therefore, age is an independent risk factor to have fatal outcomes in Covid-19 illness. According to my experience, 80 percent to 90 percent of morbidity and mortality of Covid-19 is distributed among people over 60 years. Hence, the most important aspect is to prevent the infection of the disease among this vulnerable group.
There are some important things everyone can do to reduce their risk of catching COVID-19. Regularly and thoroughly wash your hands with soap and water. You should wash your hands for at least 20 seconds, including the palms and back of your hands, between your fingers, fingertips and nails.
While washing your hands with soap and water is preferable, if you are out, or do not have access to soap and water, use an alcohol-based hand rub to clean your hands. This must also be done for at least 20 seconds with enough rub for your hands to stay wet for the whole 20 seconds.
Avoid touching your eyes, nose and mouth, particularly if you have not washed your hands.
Make sure you cough or sneeze into a tissue. Throw the tissue away to a safe place immediately. If you do not have a tissue, cough or sneeze into your elbow. Then, immediately wash your hands thoroughly.
You need to maintain social distancing of at least two metres (six feet) away from anyone who is coughing or sneezing to prevent direct transmission.
You need to wear an appropriate face mask like a surgical mask or KN 95 when you go out. Please remember to cover both nose and mouth and it should be tightly fitted. Do not touch the mask unnecessarily till you return home and make sure you change the face mask frequently. Even as doctors when we examine patients we wear masks properly and never remove them in the public even for five seconds as Delta variant of Covid is very infectious.
Consider avoiding large groups or gatherings of people, for example, social events, community meetings and cultural activities. As elderly people do feel loneliness frequently, we observed they entertain outsiders even during the quarantine curfew period without weighing the risk. This practice should be avoided as the disease exists everywhere. An 85-year-old woman who was under our care acquired the disease as she provided overnight accommodation for her son-in-law who returned from Colombo. She developed severe Covid pneumonia and stayed 42 days under our supervision and went home. Though she recovered it was not the baseline of her health when she returned home. She was easily exhausted and needed some assistance to cope with basic activities – like getting on from bed to chair, eating, dressing and toileting. This was a very common and simple example of merely an ignorance of both parties. I encounter so many patients of this nature every day and they face many adverse health outcomes including death due to severe pneumonia.
As we look after quite a sizable amount of Covid infected patients in our hospital, I could confidently say the most common modes of getting the infection are gatherings and living with a family member who has Covid symptoms without adequate isolation.
You should avoid shaking hands or hugging other people, even your own children or loving grandchildren as unknowingly they might be asymptomatic carriers of Covid-19.
Most importantly our elders should receive the Covid vaccine without any fear or delay. We observed it is uncommon that fully vaccinated elderly people are going into severe disease. Even if they acquire the infection, it causes mild to moderate symptoms which are treatable and ultimately, they go home without a demonstrable disability. Some elders and their family members are under a wrong impression as they do not go out, it is not necessary to have the vaccine. But it is a myth. Even if your older family member is homebound, it is very important to vaccinate them as young family members are carriers of the disease. Especially the caregivers for bedbound elders should be very careful as unknowingly they can act as carriers of Covid. Many such elders lost their lives, locally and internationally, due to this reason. We should make sure your caregiver is fully vaccinated.
Q. What can their family members do to protect them?
A. If there is a family member who is suspected or confirmed of Covid-19, he or she should be isolated in a separate room, should wear an appropriate mask, use a separate washroom, maintaining basic hygienic practices and avoid encountering elderly family members are important points. If you think that you do not have adequate facilities at your place to face this kind of situation you may change their accommodation to another familiar place as a precaution. Otherwise you need to come to the hospital to have institutional isolation.
Monitor food and other medical supplies needed and create a plan in the event that such resources become depleted. For families, know what medications your loved one is taking and see if you can help them have extra in hand.
It is important to facilitate them to receive the Covid vaccine if they have not received it yet.
Staying connected to others is another key part of maintaining the health and well-being of elders. Giving regular phone calls to their older parents can make a huge difference in their mental satisfaction. They are always so happy to hear the voices of their children. It will reduce the level of loneliness.
Family members should educate and train their older family members about simple hygienic practices and the nature of the disease and virus. We experience when doing the comprehensive geriatric assessment, many elders are having little knowledge about the disease, ignorance of hygienic practices and inability to practice said steps due to existing disabilities.
Q. In addition to taking precautions, what else can elders do to protect themselves from COVID-19?
A. The older people and people with weakened immune systems due to underlying health conditions are at greater risk for serious infection or even death from Covid-19. It is because as we age, we experience a gradual deterioration of our immune system, making it harder for our body to fight off diseases and infection. To improve the inbuilt immune reserve there are many things that we could do. Consuming a balanced diet with an adequate amount of protein (one-third to one-fourth of a meal) and with reasonable amounts of fruits and vegetables to provide trace nutritional elements is the first step. Prevention of dehydration by consuming at least 1.5 to 2 litres of liquids is very protective. This amount is varied according to some illnesses like heart and kidney diseases and needs a physician’s directions. Doing regular exercises of strength and balance training as well as aerobics are important to maintain general wellbeing as well as adequate ventilation. It is recommended to do exercises for 30 minutes per day for at least five days per week. We advise elders to have enough sleep at night for six to eight hours which boosts their immunity. Relieve your psychological stresses and staying mentally and physically active by doing indoor activities are important. Finally, they should strictly adhere to medical advice that they received regarding chronic illnesses to prevent acute worsening.
Q. What about the elders who are already suffering from other NCDs?
A. Older people and those with other health conditions, particularly Non-Communicable Diseases (NCD) such as hypertension, diabetes and heart disease, are more likely to become more seriously ill with Covid-19. It is important that you take care of your health, including any specific conditions you already have. It is important that even if you are unwell, you continue to take any other medication you have been given by a doctor for other illnesses or health issues. People with diabetes are at increased risk. If you have diabetes, continue to take medication, monitor your blood sugar closely and seek medical help if you have fever, cough or shortness of breath. People with asthma should continue to use their inhalers as usual. If you think your condition is getting worse or you have fever, cough or shortness of breath, seek medical help.
Make sure you have enough medicines, and if you are unwell, ask a friend, family member or caregiver to collect medicines for you.
Q. What an elderly person should do if he/she feels that he/she suffers from a disease or have some health issues not related to Covid-19?
A. If you feel this new health issue is something unusual, you need to seek medical advice without any delay. It might be your usual doctor or you may come to the outpatient department of the hospital. It may be important to have a simple blood check, taking an ECG or checking your blood pressure to have a basic assessment of the ongoing problem. We encounter unattended heart attacks, strokes and severe infections among elders in the community who did not seek medical advice promptly. The morbidity and mortality of these problems are higher compared to that of Covid-19. Hospitals are fairly safe as they are functioning according to the guideline provided by the Health Ministry. Therefore, my advice to you is to meet a qualified doctor either virtually or in person to have an assessment of your illness.
Q. What is the best way of measuring temperature, blood sugar, pressure, oxygen level etc.?
A. To measure the body temperature on their own, it is not suitable to use the usual mercury thermometer that we used for ages as elders can’t easily read the value due to vision impairments, if any. In fact, the best one is the digital thermometer. To measure the blood pressure values and pulse rate, again, the good one is the digital blood pressure monitor. In order to check the oxygen level, you can purchase a pulse oxymeter which is less than Rs, 3,000 in the local market right now. You can just attach the oximeter to your thumb or to any other finger then so that it will show the value. A digital glucometer is good enough to measure blood glucose levels. It is necessary to select a recommended brand as there are much fake equipment.
Q. What can elders do to improve their mental health these days?
A. As Covid-19 began to spread in the world in early 2020, elders experienced disproportionately greater adverse effects from the pandemic including more severe complications, higher mortality, concerns about disruptions to their daily routines and access to care. They are facing difficulties in adapting to technologies like social media, internet, and concerns are there that isolation would exacerbate existing mental health conditions. Elders tend to have lower stress reactivity, and in general, better emotional regulation and well-being than younger adults. The concern pertained to elders both at home and in residential care facilities, where contact with friends, family, and caregivers became limited.
In Sri Lanka, most of the elders were engaging in various social and religious societies and retired peoples’ associations and they met frequently. For the last two years, all those gatherings have been inactive. Therefore, reading books and magazines, watching TV, engaging in social media, meditation and filling puzzles are some of the indoor activities that they can do to stay mentally active. Not only that they could communicate with family members and with friends via phones. It is a well-known fact that the best way of keeping your memory cells active is by learning new things, especially languages and new technologies. Not only that, eating 2 to 3 portions of fruits and vegetables, drinking an adequate amount of liquids, doing exercises and having a healthy sleep also contribute to the sound mental health among elders in this pandemic situation.
Q. Having and not having someone for support is a problem for elders these days when it comes to Covid-19. What is the best way to take care of themselves?
A. Yes. both situations carry a risk for life. As explained in previous answers, family members and caregivers should be safe for the older person. They should follow all the health measures and need to be fully vaccinated. Even though Covid is infected, disease transmission is less in vaccinated people.
If you do not have someone to get support, please inform it to the local authorities like Grama Niladari. The Medical officer of Health (MOH) of the area will support you if you develop symptoms of Covid 19. Call 1990 and ask for the ambulance service to be transferred to the hospital.
Q. What should they do if they feel unwell?
A. We should know the full range of symptoms of Covid-19. The most common symptoms of Covid-19 are fever, dry cough, and tiredness. Other symptoms that are less common and may affect some patients include loss of taste or smell, aches and pains, headache, sore throat, nasal congestion, red eyes, diarrhoea, or skin rash.
Stay home and self-isolate even if you have minor symptoms such as cough, headache, mild fever, until you recover. Call your healthcare provider or hotline for advice. Have someone to bring your supplies. If you need to leave your house or have someone near you, wear a medical mask to avoid spreading. If you have fever, cough and difficulty in breathing, seek medical attention immediately. Call over the telephone first, if you can and follow the directions of your local health authority.
Get updated on the latest information from trusted sources, such as your local and national health authorities. Local and national authorities and public health units are the best places to advise on what people in your area should be doing to protect themselves.
Q. Any special message for elders?
A. Please remember, Covid-19 is a serious illness as there is no medicine is available to cure, all the treatment modalities we practice in the hospital are supportive measures to speed up the recovery but there are things we all can do to protect ourselves and others. Taking sensible precautions including vaccination is important. Covid is a complex disease which cannot be fully explained, especially about some complications and after effects. One of them is post-Covid syndrome in which some people develop multi-system symptoms even after clearing the virus from the body like headache, numbness of the body, shortness of breath, muscle pain, joint pain, lack of sleep, palpitation, heart burning, loss of appetite, undue fear of life etc. If you are suffering from these symptoms, it is necessary to meet your physician or contact Covid support service hotline.