The eight days of Passover begin next Wednesday evening. Depending on family traditions, the Seder can take hours and hours or be quite brief. But in all cases, it is essential to recount the Exodus of the Israelites from Egypt as if we were experiencing it ourselves. As the story goes, it took ten plagues before Pharaoh finally considered granting freedom to the Israelites. Brought to him by courtiers of the palace, Pharaoh asks Moses and Aaron, “Who will go?”, implying that only some will be granted permission to leave.
“We will go with our young and with our old…”, replied Moses. The entire community would go. They would leave no one behind. As members from our community of Health and Aging Policy Fellows work tirelessly to address the needs of older adults during the coronavirus pandemic, Moses’ words keep coming back to me. With particular concerns about the health and safety of the octogenarians of my family, I want to highlight work that our Fellows are doing to protect the elders of our society in the throes of our current plague. Their thoughtful efforts can help all of us maintain our mental health and wellbeing as we make our way through these challenging times.
1. To Stay Put or Not To Stay Put. Many of us have loved ones residing in assisted-living and long-term care communities. Coronavirus poses a particular threat in these settings due to the vulnerabilities of residents in general and the comings and goings of necessary healthcare aides. Many of us are left to wonder if our loved one should stay put or move in with us. In their piece in Next Avenue, Health and Aging Policy Fellows Lori Frank, Sharon Inouye, Gary Epstein-Lubow, and Lewis Lipsitz, along with Robyn Stone, combined their expertise to articulate essential considerations, principles and guidelines to help us manage our anxiety and make clear headed decisions. Read their piece entitled, Should You Consider Taking a Loved One Out of a Long-Term-Care Facility Now?
2. Advance Planning and Palliative Care. Health and Aging Policy Fellow Dr. Joanne Lynn is focused on ensuring that the wishes of older adults are known and respected as care decisions need to be made. Right now, she is particularly focused on helping older adults articulate how much and what kind of care they want in the context of COVID-19. As a geriatrician and hospice physician, she has seen the benefits of thoughtful advance planning and knows that things can go terribly wrong in its absence. As I wrote in a previous Five on Friday, these can be difficult conversations, but ones that most older adults want to have with someone they trust. In her contribution to Health Affairs, Dr. Lynn encourages every one at high risk because of age or illness to set goals about the care they would want if they were to contract this novel coronavirus well ahead of having to actually make such decisions. In the best of times, advance planning reduces stress and anxiety for older adults and family members. At times like this, it really is essential.
3. Older Adults, Emergency Departments and COVID-19. Health and Aging Policy Fellow Kathleen Unroe co-authored a piece in The Journal of Geriatric Emergency Medicine entitled “COVID-19 in Older Adults: Key Points for Emergency Department Providers.” Recognizing that COVID-19 impacts geriatric emergency departments disproportionately, Dr. Unroe, who is on faculty at Indiana University School of Medicine, and her co-authors provide clear principles specific to older adults around criteria for testing, decision making, and pursuing emergency department care for COVID-19. This kind of essential guidance informs emergency department protocols needed by healthcare workers on the frontlines of the current pandemic.
4. Physical Distancing and Older Adults. We know that older adults are at risk for social isolation and loneliness, which leads to significant negative health problems, including mental health. But when it comes to COVID-19, we also know that keeping our distance is the cornerstone of our public health strategy to reduce the transmission of this highly contagious virus. Health and Aging Policy Fellow Sharon Inouye was the moderator of a National Academy of Medicine- American Public Health Association webinar series on “The Science of Social Distancing.” The webinar explores efforts to mitigate the downside of social distancing for older adults and other vulnerable populations. As Director of the Aging Brain Center and Milton and Shirley F. Levy Family Chair Professor of Medicine at Harvard Medical School, Dr. Inouye emphasizes that creative solutions to promote social connection despite physical distancing is especially important for our mental health and well being during this stressful time.
5. Ethical Dilemmas. All the wisdom in the world does not protect us from the ethical dilemmas heading our way. The looming shortage of equipment for coronavirus patients in many parts of the world, including New York City, means that doctors in various circumstances and locales are likely to face “catastrophe” triage decisions about allocation of care. This was the case in Italy, and it will likely be the case elsewhere. Health and Aging Policy Fellow Dr. Tia Powell holds the Shoshanah Trachtenberg Frackman Chair in Biomedical Ethics and directs the Center for Bioethics at Montefiore Health Systems and Albert Einstein College of Medicine. She has been called on to discuss these issues and provide guidance in many contexts, including on CBS Sunday Morning with Ted Koppel. Her thought leadership on the ethical dilemmas posed by COVID-19 is principled, clear and wise.