By Dr. Charuni Kohombange
The world population structure has evolved due to inevitable consequences of the demographic transition and the shift to lower fertility and mortality. Many societies, especially in the more developed regions, have already attained older population age structures than have ever been seen in the past. Persons aged 60 years or older currently comprise 10% of the world population; it is much higher in the more developed regions, almost reaching 20% while in less developed regions, which are at an earlier stage of the demographic transition, it is around 8%. In the least developed countries, it is further as low as 5% of the population.
By 2050, the population over 60 years will be 30% out of the total global population, i.e. about two billion, with a significant increase of people 80 years and above.
Sri Lanka also is experiencing a large and rapid increase in the elderly population due to a combination of low fertility and high life expectancy rates. With the provision of free quality healthcare for all citizens, Sri Lanka has become the fastest ageing population in Southeast Asia. According to the last census of 2012, the population above 60 years of age is 12.4% and the population above 80 years is 5% of the total population. The share of the population aged 60 years and older is expected to double during the next three decades.
Although the Covid-19 pandemic is dispersed planet-wide, elderly populations are highly vulnerable to develop more severe symptoms. In Sri Lanka, the majority of deaths comprise the elderly population.
This article excerpts an interview with Ministry of Health Directorate of Youth, Elderly, and Disabled Persons (YED) Director Dr. Deepa Saranajeewa regarding elderly care in the current situation.
Elderly are more vulnerable
The immune system in all humans naturally wanes off with age. They need to maintain healthy behaviours such as a balanced diet, good sleep, regular physical activity, avoiding smoking and drinking, etc. to keep their immunity in balance to fight against infectious diseases. A considerable proportion of the population above 60 years of age have non-communicable diseases (NCDs). With these reasons, older adults are more likely to get very sick from Covid-19.
Getting very sick means that older adults with Covid-19 might need hospitalisation, intensive care, and/or ventilator support. According to global data, people who are 85 years and older are most likely to get very sick due to Covid-19 infection. In Sri Lanka, the age-wise distribution of deaths and the highest number of home deaths occurring among older people explains the severity of the disease among the elderly.
People with pre-existing conditions including those with cardiovascular disease (e.g. hypertension, people who have had or are at risk of a heart attack or stroke), chronic respiratory disease (e.g. chronic obstructive pulmonary disease, asthma), diabetes, and cancer are more vulnerable to develop severe disease due to Covid-19, and thus should continue their treatment and adhere to all health guidelines, making sure to stay safe at home.
Vaccination of elderly is highly essential
According to current data, older unvaccinated adults are more likely to be hospitalised and succumb to fatalities. “With the current vaccination programme, around 60% of the elderly population has been fully vaccinated at present,” said Dr. Saranajeewa.
She further explained: “Though we have given priority to older people as the vulnerable group, it is identified that some elders are reluctant to receive the vaccine, saying they are not going out from home and they may get unknown complications after vaccination. None of these reasons can be considered for not receiving the vaccine for Covid-19. They must receive the vaccine due to the obvious high prevalence and low immunity following old age as well as existing medical conditions.”
According to Dr. Saranajeewa, the majority of deaths that occurred at home were found to be of those positive for Covid-19. She said this is a matter to consider very seriously to find out how they died if they stayed at home. she added: “Most probably, they were infected from residents living with them or from any visitor. Therefore, the seniors should seriously consider this fatal infection that could be overcome only by vaccination and by adhering to health guidelines.”
Caring for elders in elderly homes
The Covid-19 pandemic raises particular challenges for care home residents, their families, and the staff that look after them. In many developed countries, the rapid spread of the virus was detected among elderly home residents and many of the debilitated individuals succumbed to Covid-19 during the pre-vaccine period. In Sri Lanka, there are numerous elderly care facilities which need to be carefully observed especially during the pandemic.
Explaining about the elderly care home system in Sri Lanka, Dr. Saranajeewa mentioned that there are long-term care homes for elderly sponsored by the government, donor agencies, and private stakeholders. These elderly homes, as a caring entity for seniors, are registered at the National Secretariat for Elders.
“However, some of the elderly care homes are registered with business registrations. Due to this reason, they are not included in the list of registered elderly homes or under provincial social services departments or the National Secretariat for Elders. Hence, these elderly homes are being missed from the vaccination programme,” said Dr. Saranajeewa, pointing out the need of a stringent monitoring system.
According to Dr. Saranajeewa, most of the elderly homes that were reported as affected with Covid-19 were unregistered and had not vaccinated their residents and staff. Also, the managers of these care homes are not knowledgeable on the importance of receiving the vaccines and they think their residents will not catch the disease as they are not going out from the care homes.
Furthermore, she emphasised that the authorities who run these unregistered institutes should be responsible for the safety of the residents and take all necessary measures to prevent infection transmission from staff members and visitors.
The Directorate of YED has introduced a guideline for elderly care home managers and caregivers on the prevention and protection measures against Covid-19. According to Dr. Saranajeewa, they have trained almost all social service officers and elderly rights promotion officers attached to the divisional secretariats to guide and supervise elderly homes using the said guideline.
“The MOH (medical officer of health) offices across the country have arranged vaccination programmes at elderly homes. If there are any unregistered elderly homes, they could have been missed. Hence, it is advisable for them to inform the area PHI (public health inspector) or MOH and arrange a vaccination programme as earliest possible, since it is the only way to minimise mortality among the elderly population,” said Dr. Saranajeewa.
Actions taken by the Directorate of YED
The Directorate of YED has developed information, education, and communication materials to elders, their caregivers, and caregivers at long-term care homes, wheelchair-bound seniors, and persons with disabilities. These materials contain practical instructions for the debilitated individuals and their caregivers. Further, the directorate has conducted awareness programmes and has disseminated the message through electronic media.
Sensitisation of people, especially the youth on elderly, and behavioural changes adopted to maintain good hygiene practices are considered as positive impacts of Covid-19. The Directorate of YED has invited seniors and youngsters to write on how they spent the lockdown with each other.
“We have received a lot of articles from both categories, elaborating how they have spent the locked down period – the caring and sharing experiences and enjoying little things that they could not be able to do,” concluded Dr. Saranajeewa. The Directorate of YED with the assistance of the World Health Organisation (WHO) has compiled these articles into two booklets: “Connecting Youth to Elderly” and “Elders’ Diary”.
When to suspect Covid-19 in elderly
- Elderly patients do not always present with typical symptoms. Caregivers who support them must be on constant alert for both typical and atypical Covid symptoms in elderly.
- During the pandemic, Covid-19 should be considered as the likely diagnosis in any elderly person who show symptoms such as:
- New continuous cough
- Temperature of 37.8°C or above
- Loss of or change in normal sense of smell or taste
- In addition, Covid-19 should be considered as a possible diagnosis in the elderly who have:
- New onset confusion and/or drowsiness (delirium)
- Decreased mobility
- Loss of appetite and/or reduced oral intake
- Diarrhoea or abdominal pain
- Elderly care home residents with suspected Covid-19 should be tested immediately and the area MOH/PHI (medical officer of health/public health inspector) should be informed. They should be isolated from other residents pending their test result and admitted to a treatment centre.