By Judith Graham MAY 21, 2021
Donald Lundquist, 87, has
been active all his life. So, he wasn’t prepared for what happened when he
stopped going out during the coronavirus pandemic and spent most of his time,
inactive, at home.
“I found it hard to get
up and get out of bed,” said Lundquist, who lives with his wife of 67 years in
Palm Springs, California. “I just wanted to lay around. I lost my desire to do
things.”
Physically, Lundquist
noticed that getting up out of a chair was difficult, as was getting into and
out of his car. “I was praying ‘Lord, give me some strength.’ I kind of felt,
I’m on my way out — I’m not going to make it,” he admitted.
One little-discussed,
long-term toll of the pandemic: Large numbers of older adults have become
physically and cognitively debilitated and less able to care for themselves
during 15 months of sheltering in place.
No large-scale studies
have documented the extent of this phenomenon. But physicians, physical
therapists and health plan leaders said the prospect of increased impairment
and frailty in the older population is a growing concern.
“Anyone who cares for
older adults has seen a significant decline in functioning as people have been
less active,” said Dr. Jonathan Bean, an expert in geriatric rehabilitation and
director of the New England Geriatric Research, Education and Clinical Center
at the Veterans Affairs Boston Healthcare System.
Bean’s 90-year-old
mother, who lives in an assisted living facility, is a case in point. Before
the pandemic, she could walk with a walker, engage in conversation and manage
going to the bathroom. Now, she depends on a wheelchair and “her dementia has
rapidly accelerated — she can’t really care for herself,” the doctor said.
Bean said his mother is
no longer able to benefit from rehabilitative therapies. But many older adults
might be able to realize improvements if given proper attention.
“Immobility and debility
are outcomes to this horrific pandemic that people aren’t even talking about
yet,” said Linda Teodosio, a physical therapist and division rehabilitation
manager in Bayada Home Health Care’s Towson, Maryland, office. “What I’d love
to see is a national effort, maybe by the CDC [U.S. Centers for Disease Control
and Prevention], focused on helping older people overcome these kinds of
impairments.”
The extent of the need is
substantial, by many accounts. Teodosio said she and her staff have seen a
“tremendous increase” in falls and in the exacerbation of chronic illnesses
such as diabetes, congestive heart failure and chronic obstructive pulmonary
disease.
“Older adults got off schedule
during the pandemic,” she explained, and “they didn’t eat well, they didn’t
hydrate properly, they didn’t move, they got weaker.”
Dr. Lauren Jan Gleason, a
geriatrician and assistant professor of medicine at the University of Chicago,
said many older patients have lost muscle mass and strength this past year and
are having difficulties with mobility and balance they didn’t have previously.
“I’m seeing weight gain
and weight loss, and a lot more depression,” she noted.
Mary Louise Amilicia, 67,
of East Meadow, New York, put on more than 100 pounds while staying at home
round-the-clock and taking care of her husband Frank, 69, who was hospitalized
with a severe case of covid-19 in early December. While Amilicia also tested
positive for the virus, she had a mild case.
“We were in the house
every day 24/7, except when we had to go to the doctor, and when he got sick I
had to do all the stuff he used to do,” Amilicia told me. “It was a lot of
stress. I just began eating everything in sight and not taking care of myself.”
The extra weight made it
hard to move around, and Amilicia fell several times after Christmas,
fortunately without sustaining serious injuries.
After coming home from
the hospital, Frank couldn’t get out of a chair, walk 10 feet to the bathroom
or climb the stairs in his house. Instead, he spent most of the day in a
recliner, relying on his wife for help.
Now, the couple is
getting physical therapy from Northwell Health, New York state’s largest health
care system. Just before the pandemic, Northwell launched a “rehabilitation at
home” program for patients who otherwise would have seen therapists in
outpatient facilities. (Medicare Part B pays for the treatments.)
The program is serving
more than 100 patients on Long Island, in Westchester County and in parts of
New York City. “The demand is very strong and we’re in the process of hiring
another 20 therapists,” said Nina DePaola, Northwell’s vice president of
post-acute services.
Sabaa Mundia, a physical
therapist working with the Amilicias, said Mary Louise can walk up to 400 feet
without a walker, after doing strengthening exercises twice a week over the
course of three weeks. Frank had been using a wheelchair and is now regularly
walking 150 feet with a walker after more than a month of therapy.
“Older adults can lose
about 20% of their muscle mass if they don’t walk for up to five days,” Mundia
said. “And their endurance decreases, their stamina decreases, and their range
of motion decreases.”
Recognizing that risk,
some health plans have been reaching out to older members to assess how they’re
faring. In Massachusetts, Commonwealth Care Alliance serves more than 10,000
older adults who are poor and eligible for both Medicare and Medicaid, the
federal-state program for people with low incomes. On average, they tend to
have more medical needs than similarly aged seniors.
Between March and
September last year, the plan’s staffers conducted “wellness outreach
assessments” by phone every two weeks, asking about ongoing medical care, new
physical and emotional challenges, and the adequacy of available help, among
other concerns. Today, calls are made monthly and staffers have resumed seeing
members in person.
An increase in physical
deconditioning is one of the big issues that have emerged. “We’ve had physical
therapists digitally engage with members to coach them through strength and
balance training,” said Dr. Robert MacArthur, a geriatrician and Commonwealth
Care’s chief medical officer. “And when that didn’t work, we sent therapists
into people’s homes.”
In California, SCAN
Health Plan serves a similarly vulnerable population of nearly 15,000 older
adults dually eligible for Medicare and Medicaid through its Medicare Advantage
plans. Care navigators are calling these members frequently and telling them
“now that you’re vaccinated, it’s safe to go see your doctor in person,” said
Eve Gelb, SCAN’s senior vice president of health care services. Doctors can
then evaluate unmet health needs and make referrals to physical and
occupational therapists, if necessary.
Another SCAN program,
Member2Member, pairs older adult “peer health advocates” with members who have
noted physical or emotional difficulties on health risk assessments. That’s how
Lundquist in Palm Springs connected with Jerry Payne, 79, a peer advocate who
calls him regularly and helped him come up with a plan to emerge from his
pandemic-induced funk.
“First, he said, ‘Ron,
you should try getting up every hour and taking a few steps’ — that was the
start of it,” Lundquist told me. “Then, he’d suggest walking another block when
I would take my dog out. It was painful. Walking was not pleasant. But he was
very encouraging.”
A month ago, Payne had a
Fitbit sent to Lundquist. At first, Lundquist walked about 1,500 steps a day;
now, he’s up to more than 5,000 steps a day and has a goal of reaching 10,000
steps. “I’m sleeping better and I feel so much better all around,” Lundquist
said. “My whole attitude and physicality has changed. I tell you, this has been
an answer to my prayers.”
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