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‘Patients say they'd rather die from hugging than die alone’

Lockdown accelerates aging, causes ‘deterioration that can kill’ – geriatrician

Isolation is fast eroding cognitive function, memory and physical ability, says top Jerusalem doctor, urging government to overhaul attitude to elderly

Nathan Jeffay is The Times of Israel's health and science correspondent

A man in isolation at home during the pandemic (PIKSEL via iStock by Getty Images)
A man in isolation at home during the pandemic (PIKSEL via iStock by Getty Images)

Lockdown is speeding up the aging process of Israel’s elderly, and its long-term harm to pensioners may outweigh the risks of a more lenient coronavirus policy, according to a leading geriatrician.

“Lockdown has actually been reducing the physical and cognitive functioning of many elderly people, speeding up the process of decline in an unusual and worrying way,” Dr. Yoram Maaravi told The Times of Israel. “It’s concerning because in geriatric medicine, when patients have cognitive problems, we see more deterioration and faster deterioration in their general health.”

He said that while lockdown can impact the wellbeing of all ages, it has a particularly strong impact on the elderly. For them, staying active and maintaining social interactions are key to avoiding deterioration, he said.

Maaravi commented: “I fear that, in terms of the health of Israel’s elderly, this could cause more harm than a different approach to coronavirus that uses lighter measures and makes older people less isolated. Everyone is talking about protecting people from the coronavirus but there isn’t enough talk about the harm of isolating people, especially the elderly.

“The so-called protection we see can even cause deterioration that can kill them, as the effect of isolation has such an impact on general health. It affects many systems in the body, not only the mind. We need balance. You can’t asses risks during the pandemic without getting the whole picture.”

Neighbours on their individual terraces, during a COVID-19 lockdown (rmanzanosgarcia via iStock by Getty Images)

Israel has been in a state of lockdown since mid-September, and began to relax its rules in mid-October. Last week, President Reuven Rivlin stressed that the health impact of the current crisis extends far beyond virus cases. Visiting a mental health non-profit he said, “Alongside the coronavirus pandemic, a pandemic of loneliness and isolation is developing and we must treat it.”

Maaravi, chief physician at Hadassah Medical Center’s geriatric rehabilitation department, and head of home rehabilitation in Jerusalem for the Clalit health fund, said that the most intense period of Israel’s lockdown, which ended October 18, hit elderly people the hardest.

But even now that lockdown rules have been relaxed, the government’s long-running encouragement for the elderly to limit interactions and for younger people to largely keep their distance continue to guide many. Maaravi thinks this attitude is  “patronizing” and fails to empower old people to make informed decisions about how far they want to go to protect themselves from the coronavirus. 

Maaravi said he has seen accelerated aging among the elderly since Israel’s first lockdown in the spring. However, he reported it is more marked than ever since the second lockdown began.

Dr. Yoram Maaravi, chief physician at Hadassah Medical Center’s geriatric rehabilitation department, and head of home rehabilitation in Jerusalem for the Clalit health fund (courtesy of Yoram Maaravi)

“I see it all the time now,” he said. “Elderly people who have declined quickly — cognitively, in a functional sense, and psychologically.”

He added: “It’s often people who were completely healthy and independent, who now complain of losing memory and impaired cognitive functioning. It’s people who aren’t at particularly high risk from the coronavirus but are at high risk from the impact of isolation.”

The effect is seen among people who live with partners, as well as those who live alone, he said.

The impact of isolation on the elderly has received limited attention in medical circles, but there have been some articles and studies. An editorial in the Journal of Clinical Nursing argued that there is an “urgent need to support older people to mitigate the negative impacts on their physical and mental health from social isolation.”

It claimed: “One immediate element that needs to be highlighted is the possibility of previously vigorous older people becoming increasingly frail due to reducing their activities, especially walking, and leading an (enforced) more sedentary life-style, which will likely impact on their mobility and well-being over time.”

The onset of winter, and the prospect of colder weather keeping old people indoors even more, has brought the issue increasingly to the fore among advocates for the elderly.

The Age UK charity just conducted a survey that it said pointed to fast decline. “This pandemic has hit the fast-forward button on aging for millions of older people,” the charity’s director, Caroline Abrahams, said.

Maaravi wants the government to use lockdowns more cautiously, find creative frameworks for the elderly to meet, and to change its messaging on protecting pensioners.

Dr. Yoram Maaravi with one of his patients, who is holding a photo of himself taken decades ago. (courtesy of Yoram Maaravi)

He worked with the Federation of Local Authorities to develop a format for “safe space” outdoor meetings where elderly people can go for music and physical activity. They are taking place in some locales, but he wants to see more initiatives elsewhere.

Regarding the “patronizing” national discourse he said: “The language used by the government needs to be revised. Having officials saying, ‘You should all stay home’ is wrong. They should explain what we know about the risks of the pandemic and encourage people to decide what to do.

“In reality, old people are not a single ‘at risk’ group, but rather a set of people with different risk levels, and this should be emphasized and understood. To simply tell all old people they are high-risk and tell their families not to visit grandmother because you can harm her is wrong.

“And as well as being more informed, the conversation needs to respect personal choices. I have patients who tell me, ‘If I want to die because I hugged my grandchild that’s my choice. I’d rather die from having been hugged than die alone.’”

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