Abstract:
When older adults came together in focus groups to share their experiences during the first 18 months of the COVID-19 pandemic, they told of loneliness, anxiety, and depression; physical and cognitive decline; and heartbreak over losing family members and friends with no chance to say goodbye. This article focuses on ways they coped and their recommendations and hopes for the future. The 17 participants represented a mix of races, geographic locations, living situations, and health issues. In addition to their own experiences, several worked with low-income and homeless individuals and shared insights into how those socioeconomic groups fared.
Key Words:
older adults, pandemic, COVID-19, isolation, mental health, public health, cognitive decline, grief
Across the past two years, we have heard a lot about the personal pandemic experiences of Americans, ranging from school age through the working years, but much less is known about how older adults fared. In July 2021, two focus groups of Medicare Advantage members in Washington State came together to discuss their experiences during the first 18 months of the pandemic.
The 17 participants ranged in age from 62 to 101 and represented rural and urban locations across the state. Their mix of races included Black (24%), Hispanic (12%), Asian (6%), and White (58%), and they lived in houses, condominiums, and continuing care residences. Some lived alone, while others lived in single generation or multigenerational households. They all had food, shelter, and some communication tools during the pandemic, but several worked with individuals who were not as lucky, and they shared those perspectives.
Focus group members told of suffering loneliness and varying degrees of anxiety and depression while isolated during the pandemic. Some experienced physical and cognitive declines. Many lost family members or friends during that time, and their grief was palpable during our discussions.
Here are highlights of our group members’ pandemic experiences.
Pandemic Intensified Isolation and Losses
Ms. E.O., age 101, lives alone in a large house, and for her, isolation was the hardest part of the pandemic. “Everyone was wonderful about asking if I was okay and if I needed anything. But the only person I let into my house for over a year was my son, and I missed having company.”
“I have kids living in the area, but I couldn’t see them or touch them for five or six months,” said Ms. B.B., age 67. “My daughter and I were planning her wedding and had to cancel everything, which caused mental health issues for both of us. We lost four relatives and some friends during that time, and we didn’t get a chance to say goodbye. That was really hard.”
Focus group participants told of the heartbreak of having parents hospitalized or in skilled nursing facilities, not being able to visit them, and having some of them die. “My mom was hospitalized and then moved to a rehab facility, and my father was hospitalized after a fall and passed away,” said Ms. K.M., age 62. “Making care and end-of-life decisions during COVID was agonizing.”
Mr. J.C., age 66, shared the trauma of having his 34-year-old son die suddenly in China. He wasn’t able to go to China to retrieve his son’s body. Cremation had to wait several months, and the memorial service had to be held virtually. “When you can’t get together, difficult times are that much more difficult,” he said.
One participant’s wife was diagnosed with cognitive decline in early 2019, and the isolation created by the pandemic contributed to her worsening condition, he believes. “Before the pandemic we were doing volunteer work and getting together with friends,” said Mr. T.B., age 85. After months of isolation, they were struggling to return to some form of normalcy, and his wife had become hesitant even to go to the store with him.
‘We all lost time and knowledge during the pandemic.’
Residents of retirement communities were confined to their apartments for weeks at a time and experienced physical, social, and mental health declines. “We couldn’t go out to exercise or socialize, and that took its toll,” said Ms. S.S., age 81. Some of her neighbors now need more care and have moved from independent living to assisted living situations.
Several participants told of how the pandemic had put their long-anticipated retirement dreams on hold. “Travel was on my bucket list, and putting that off was really disappointing,” says Mr. T.M., age 69.
“I wanted to teach gluten-free cooking and attend sewing classes when I retired, but it takes people to do those things,” said Ms. St.C., age 67. “We all lost time and knowledge during the pandemic.”
Pandemic Spotlights Plight of Shut-ins and the Unhoused
Ms. C.T., age 70, is the executive director of a senior center, and she worked full-time during the pandemic. “The social isolation has been very damaging to our 50+, disabled, low-income, and homeless populations,” she said. “The senior center provided lunches every day for pick up and, while the food was important, the chance to see somebody, even 6 feet away and masked, was vitally important.” Volunteers also delivered meals to people’s homes and spent a little time with each individual. They let us know if people needed medical attention or anything else, and they literally saved some lives.”
The pandemic gave Ms. C.T. a new awareness of the large number of homeless older adults in her community—many of them women. “Some of them wouldn’t go to a shelter because of COVID, so they rode the bus all night,” she said. “When homeless people came to the senior center to get a sack lunch, we had a chance to connect them with places to stay, and with the food bank. We also handed out tablets and hot spots so people without computers could connect with family, friends, or whomever.”
In spite of being at high risk, Dr. A.I., age 65, a retired physician, and her husband wanted to help out during the crisis. She became a medical reserve volunteer, going to nursing home outbreak sites and assisting with investigating COVID cases. She and her husband both delivered meals for the local food bank.
Differences of Opinion Caused Lingering Rifts
The diversity of opinions about COVID-19, politics, and racism caused clashes between family and friends during the pandemic.
“It magnified differences in our family that we didn’t know were there and aggravated rifts that had been under the surface,” said Ms. C.V., age 64. “There are still tender spots in some relationships that we’ll be tending to for quite a while.”
Dr. A.I. had to practice patience and tolerance when talking to her family members who didn’t trust vaccines. “Discussing that without slamming down the phone or shutting off Zoom was a challenge,” she admits.
“I came through the civil rights movement, and those issues were exploding again during the pandemic, which made everything even harder,” said Ms. J.Q., age 73. “We need to respect each other, even if we have different opinions, different religions, different educations.”
Finding Ways to Minimize Anxiety and Stress
Tuning out “the noise” is one approach several of the focus group participants found helpful in managing their mental health during the first 18 months of the pandemic. “The politicization of the pandemic affected me mentally as much as anything,” said Mr. C.B., age 80. “I decided to focus on the person who seemed to have the real word: Dr. Fauci. That helped me navigate the waves of misinformation.”
Ms. S.S. became depressed during the early months of the pandemic and reconnected with a therapist she’d seen in the past. She reported that their Zoom sessions have provided some of the most meaningful and helpful psychotherapy she’s ever experienced.
‘The politicization of the pandemic affected me mentally as much as anything.’
Another participant found that sticking to his previous routines made it easier to deal with the demands of avoiding COVID. “Continuing to do charity work was also good for my soul and good for my mental health,” he said.
Several focus group participants told of the power of getting outside to walk, hike, explore new places, and observe nature. “I’ve become much more focused on what’s around me, looking at how insects and birds and squirrels are behaving,” said Ms. Su.C., age 86. “I needed to be outdoors where I could find a little peace,” said Dr A.I. “My husband and I did a lot of gardening, and I took yoga and a painting class via Zoom,” said Ms. K.R., 71.
Recommendations and Hopes for the Future
Many of the focus group participants said the pandemic reminded them not to wait too long to do things or put things off until tomorrow. “I lost my brother to COVID, and we’d barely spoken in 20 years. I learned not to take anyone for granted, and not to hold a grudge,” said Ms. St.C.
While group participants were glad to see masking and isolation requirements relaxing in July 2021, they weren’t ready to consider the pandemic over—which turned out to be prophetic when the Delta variant surged just a few weeks later and Omicron months after that. One participant expressed the viewpoint of many: “I’m fully vaccinated, but I wear a mask out in public and continue to be careful. Considering my age, I’m not sure I’d make it if I did catch COVID-19.”
Improvements to masks could make pandemic living more manageable for older adults who have hearing loss, suggested several participants. “Let’s get masks that don’t cause hearing aids to fall out,” said one participant. “Masks where mouths are visible would be so helpful for people who read lips,” said another.
Group members suggested following the example of countries that use masking on a regular basis to help control contagion. They recommended teaching school-age children about the severe medical and psychological impacts of the pandemic, so they’re better informed for the future. They’d like to see the United States start funding and paying more attention to public health before the next emergency—and to develop a much more cohesive plan for handling future crises. They recommended collaboration from every level of our society to address misinformation, racism, and an inequitable healthcare system, as well as environmental issues and climate change.
Looking toward the legacy they hope to leave for their children and grandchildren, several focus group participants gave the future a positive spin. “I like to think that enough people will do enough smart and compassionate things to get us through this and other crises so we can leave something good for our children,” said Mr. C.C.
“No one would voluntarily go through a pandemic, but it forced us to do things in different ways,” said Mr. J.M., age 82. “I hope we can take the good parts of that learning forward and continue to expand our capabilities.”
“Since we can’t undo yesterday, last month or last year, we can vow to live today to the fullest, to reach out to someone else and connect with them,” said Ms. St.C. “The lost, hopeless, afraid, and alone could be you or me some day.”
Christine Himes Fordyce, MD, is a retired geriatrician. She extends a big thanks to all the focus group participants. Ginny Smith is a freelance writer specializing in healthcare topics.
