In a pandemic situation, in addition to being more vulnerable to medical problems, older adults also face the emotional and social backlash of social isolation, loneliness, feeling of susceptibility, heightened dependence and restricted autonomy and freedom. Add to that are challenges in using technology, grief, loss and financial constraints and you have a recipe for increased psychological problems. Many elders also worry about the uncertainty of being hospitalised alone or, worse still, dying alone in the absence of loved ones. One would have, therefore, expected higher rates of psychiatric problems, especially among older women. However, limited available data, at least from the West, shows that the older adults actually cope better and have lower rates of mental health problems. The possible reasons are higher mental resilience, positivity, and the inherent wisdom acquired with age and experience.
However, data on stress among elders from most low-and-middle income countries (LMIC) during COVID-19 are unavailable. The voices of elders are also absent in policies as they are usually not represented in any decision or policymaking body. A simple policy such as protected hours during shopping in grocery stores used in the West, could not be found in any city in India.
Women elders in India have always found their own ways of social connections and engagement. Meeting their grandchildren, children and peer groups provide them with a sense of identity, security and support. The pandemic and its consequent precautions have restricted these day-to-day sources of joy. Moreover, limiting the movements and activities of our aged parents and grandparents with the best intentions of protecting them, has been often done without providing alternatives. The norms that dictated and restricted them all their lives as women got a renewed impetus during COVID-19. Those in care-homes have also faced an increased risk of loneliness, known to be an independent predictor of depression in the elderly.
Cultural influences on older women are also of paramount importance. In the Indian socio-cultural milieu, wives who are often younger than their spouses serve as their main caregivers in the older age. The pandemic has grossly restricted domestic help and paid caregivers due to safety concerns, which made the elder women the sole carers of their elderly husbands. Their own safety and psychological concerns might not have been catered to. For some, it all just became a habit over time, with indifference forming the mainstay of coping. In the words of an elder woman, “My children are abroad, my husband is ill, my house help can’t enter the home, I cannot go out and I am not as `smart’ as my smartphone. So practically I am physically, socially and emotionally distanced in all ways!”. Another pointed out the permanence of social isolation and confinement, “Even earlier, with the traffic, pollution and my husband’s health, social distancing was already the norm. So COVID-19 didn’t make much of a difference except I did not have help at home!”
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The World Health Organisation defines elder abuse as a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. While there has been an overall increase in domestic violence, the extent of elder abuse, particularly towards older women is largely invisible.
Though the pandemic has digitalised lives and living, it is not prudent to expect many of our senior citizens to handle virtual meets and online platforms for staying connected, without any training. Also, a video call cannot be a substitute for a hug, a handshake, a pat or a kiss, each of which convey the affectionate touch that is so important for older adults. The digital divide in ownership of gadgets, poor access to technology in rural areas and gender inequality of digital literacy have further isolated older women from social connections. This might be another possible reason, why in spite of the boom in tele-healthcare, it has been utilised by senior citizens only to a limited extent.
Contrary to many popular taglines, the pandemic has not been a “great equaliser”. Age and gender have been a major factor. Age brings in frailty, issues with memory, vision, hearing and thinking process, all of which together with skill-deficits may interfere with online participation in studies and surveys contributing to their voices remaining “unheard”. It will be a collective responsibility to counter both ageism and sexism to prevent isolation in any such future situation. The media and the administration both have a leading role to play. This is not to say that the elderly women are weak, but they do have unique vulnerabilities. With adequate support and understanding, they can not only withstand stress but also gift us with important life lessons to learn.
Their psychological wellbeing, social support, education, autonomy and independence need inclusive attitudes from all of us. These strategies need to be an integral part of public health measures and disaster preparedness during any future outbreak. Valuing their contributions, improving digital literacy, early identification of mental health problems, and avoiding negative risk-biased communication can further bolster their resilience. Prevention of elder abuse, encouraging prompt detection and reporting, integrating helplines for older adults and finally home-delivery of essential commodities, including daily amenities (like grocery, medicines, etc.) are the need of the hour. Research-driven policies need to be tailored based on their voices as well.
This article first appeared in the print edition on March 19, 2021 under the title ‘Covid and an invisible crisis’. Chandra is professor, department of psychiatry, NIMHANS; Banerjee is senior resident, department of psychiatry, NIMHANS.
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