Restoring life to our shattered world

Reflections on COVID-19

Despite all our medical, scientific and technological advancements, the mortality rate for humans has remained constant – one per person.

It was in March 2020, the World Health Organisation made the assessment that COVID-19 could be characterised as a pandemic. This type of crisis at a global level has never been seen in our lifetimes and the stress that is generating is permeating through populations. Unutterable trauma and unspeakable pain echo through local communities and the global village. The invisible threat of COVID-19 has changed the way we live. It has crippled healthcare systems and exposed the imperfections of aged care systems. This pandemic has highlighted many consequences of social isolation and emphasised the fragility of mental health and wellbeing in ageing populations.

The implications of COVID-19 for ageing populations is an important issue. According to The Medical Journal of Australia, people identified at greatest risk of hospitalisation, severe disease and death from COVID-19 are the elderly. The risk increases cumulatively from 60 years of age and becomes worryingly high for individuals over 70 years old. One model-based analysis shows hospitalisation estimates for COVID-19 increased with age from 1.04% for individuals aged 20-29 years and increasing to 18.4% for individuals aged 80 years and older.

Australia has seemed relatively unscathed in comparison to other countries including America and Spain but still highlights the vulnerability of the older population to COVID-19. Newmarch House situated in Sydney's west has had 19 deaths with the facility under lockdown from mid-April when a healthcare worker tested positive. The total number of cases linked to the home was 71, with 37 residents and 34 staff testing positive. Family members of residents who were infected were informed that they would be cared for through a Hospital in the Home program. They would receive the same treatment as that provided for a patient in hospital. Isolation of residents was a key factor in stopping further community transmission but would be an issue for the mental wellbeing of residents.

Older adults, particularly those in isolation and who have any level of cognitive decline or dementia, can become more agitated, stressed, angry, anxious and withdrawn during an outbreak such as this one. It is important to provide emotional support through informal networks including family and friends, and healthcare professionals. Sharing simple facts on key issues can be reassuring. This requires communication channels that are effective and offer clear, concise and jargon-free information. It is particularly critical to provide support for mental and psychosocial wellbeing during this outbreak. This pandemic has and will continue to impact people in many countries and diverse locations. COVID-19 does not discriminate, therefore it is important not to associate the disease with any specific nationality, ethnicity or cohort. People who have been impacted by COVID-19 deserve our compassion, kindness and support.

COVID-19 has thrust our mortality into the limelight and indeed the urgency of protecting the wellbeing and health of our ageing and more vulnerable older populations has become paramount. Under normal circumstances, ageing is not a particularly comfortable conversation to have, however it is not a conversation we can afford not to have right now. Being in self isolation during the pandemic has perhaps allowed many of us the time to reflect more deeply and honestly on our values and thought processes. A critical reflection on our attitudes, actions and reactions can perhaps reveal some of what is generally obscured by the pressures of daily life. Values, belief systems and discourses are the foundations of our personal narratives, but these narratives are often concealed behind the many masks we wear in society to fit in and avoid the scrutiny of society's judgmental eye. And that without wearing an N95 respirator.

American cognitive psychologist Jerome Bruner once said that, "Self is a perpetually rewritten story." I believe that commencing in late adolescence and perhaps young adulthood, we construct coherent narratives of ourselves that selectively recall the past and optimistically anticipate the future to provide our lives with some semblance of purpose and meaning. Personal identity is the internalised and evolving life story that each of us tinkers with throughout our lives. There is no complete life. There are only fragments which are linked chronologically.

The inevitability of death has been dancing at the forefront of my mind for many years since my early encounters with elderly patients and residents. No matter where older adults reside, whether in the community, retirement villages or in aged care facilities, that moment would always arrive whether they were prepared or not. I remember one particular lady saying she wanted a swift and peaceful death during her sleep, a comfortable end to life that would preserve her dignity and be painless. The conversation about death is another one that tends to be taboo in modern society. It is uncomfortable and can cast a sudden shadow of loss which may cloud an individual's vision of the future and perhaps strike fear into the heart of those unprepared or lacking acceptance. During the end stage of life, many of us may have regrets. In the book Top Five Regrets of the Dying, an Australian palliative care nurse interviewed many patients in the last 12 weeks of their lives. It was found that the top five regrets included wishing they had the courage to live a life true to themselves, not the life others expected of them; wishing they had not worked so hard; wishing they had the courage to express their feelings; wishing they had stayed in touch with their friends; and wishing that they had let themselves be happier. Perhaps a list to reflect on before it’s too late.

COVID-19 has reminded me that regardless of ethnicity, wealth or intelligence the days, hours and minutes for us all will someday shrivel to nothing. Time will continue on uninterrupted as we mourn the loss of loved ones. When a part of our world is no longer there, and we are numbed by despair, we are also faced with the need to reassemble our lives and mourning is only the first step in the process. This is a time to remember that the stars continue in their orbits, and the seasons come and go as before.

With new challenges come distinct opportunities. This pandemic has highlighted the need to better protect the future of our ageing populations. It requires a response not only in terms of the robustness of our healthcare system, but also an intergenerational appreciation of the fundamental differences in our attitudes and the willingness to communicate. Reframing attitudes toward ageing in the community is invaluable for supporting mental health, personal identity and wellbeing. There needs to be a paradigm shift in our relationship with ageing as a concept, and older people specifically, so that we can work to support the autonomy and dignity of our older populations. We will all age whether we like it or not. Remember, our mortality remains at one per person, the time is late, and action is needed.

[Source: Leslie Chung, Director and co-founder of AgeYZ Allied Health, M.Ageing, B.Phty.]