Loneliness and social isolation are perennial concerns for the elderly population, as they start to lose family members and spouses and their physical ability to get out of the house and participate in social activities becomes diminished over time.
The threat of COVID-19 has amplified this concern, as nursing home visiting rules and self-imposed isolation designed to protect older adults have cut them off from family and friends.
Adults over the age of 70 make up 12.2 percent of confirmed COVID-19 cases in Michigan, but account for 71.8 percent of confirmed deaths, according to COVID-19 statistics from the state of Michigan.
To protect this population, state and county health departments have prohibited visitors from congregant living facilities.
Many seniors who live independently, like Holland resident Darlene Kolean, have also chosen to isolate themselves for their own safety.
Kolean's children delivered groceries to her apartment for a while during the initial shutdown in the spring. Since then, the 79-year-old has started venturing out to do her own errands, but she still only keeps in touch with friends and family over the phone.
"I don't have anyone coming here to visit me and I don't go anywhere either," Kolean said.
Experts are concerned about the long-term mental and physical health effects that will follow from older adults being separated from family and friends during the pandemic.
According to the U.S. Centers for Disease Control and Prevention, social isolation is associated with a 50 percent increased risk of developing dementia and an increased risk of heart disease, stroke and premature death.
"The isolation is robbing them of whatever good days they have left — it accelerates the aging process," Joshua Uy, associate professor at the University of Pennsylvania Perelman School of Medicine, told NBC News in October.
"You see increased falls, decrease in strength and ability to ambulate. You see an acceleration of dementia, because there is no rhythm to your day. There isn't a single part of a person's life that isn't affected."
Why Does It Happen?
Sara Van Tongeren, a clinical social worker in Holland who specializes in helping people through traumatic and unexpected life events, explained that the human body reacts to stressors like fear of the virus and fear of isolation in physical ways, such as not being able to eat or sleep well.
"When we are isolated, we experience a stress reaction that occurs on a neurobiological level, so increased excretion in our brain of various stress hormones that can actually trigger a physiological experience like fevers or pain or exhaustion or insomnia," Van Tongeren said.
"Those are all very natural human responses that are common. For people that are elderly that are faced with social isolation — because it is a stress, it is a threat — their bodies could very well be reacting to that threat. And the result of that is often depression and more stress."
The COVID-19 pandemic is triggering deeply-rooted existential fears for people of all ages, Van Tongeren said.
She and husband Daryl Van Tongeren, a psychology professor at Hope College, published a book together in March called "The Courage to Suffer," which outlines four existential fears everyone faces, according to the authors: loss of control, loss of identity, death and fear of isolation.
Part of the process of aging is coming to terms with the inevitability of death, a loss of control over one's own body and a loss of identity as people retire from the jobs and activities that may have defined their sense of purpose, Van Tongeren said. This leaves isolation as a particularly powerful threat.
"Part of what happens as we age is we often define our meaning with the relationships that we've built over our lifetime," Van Tongeren said.
Having those relationships cut off due to visitor restrictions and self-imposed quarantines, then, is like cutting off that source of life's meaning.
"Especially for the elderly, it's really important to try to find ways to mitigate that," she said. "If we can understand (relationships) as a true, real, human desire and need, then we can learn to meet that need and be as creative as possible with it."
Caregivers Also Affected
Susan Evans, program coordinator for the Alzheimer's Association's Michigan chapter, said stress and anxiety is also growing problem for those who care for the elderly, often a spouse or a child, in the pandemic.
"The caregiver is constantly worried about not exposing the person with dementia to COVID-19, so they're doing less as a person," Evans said. "We always encourage caregivers to stay social yourself and take time for yourself and go out and do fun things, and they can't do that now, so they're very isolated, too."
Home health care agencies and adult daycare programs that, under normal circumstances, would give live-in caregivers a break have become riskier options, and at times have been completely unavailable due to programs suspending their services.
"So many seniors were previously served by adult day programs, and losing that routine has been just devastating for so many people with Alzheimer's and dementia, as well as their caregivers," Evans said.
"The typical dementia caregiver routine would have included some sort of a break for the caregiver and there's not much of an opportunity for that. And where there is an opportunity there's the added stress of paying for it and deciding whether its the right thing to do."
If a loved one is living in a long-term care facility, family members face the worry of a virus outbreak occurring there. They may also feel helpless to care for their loved one due to the visitor restrictions.
How Can We Cope Better?
Caregivers who are under stress are not in the best position to help others.
As Van Tongeren explained, the human response to stress is often going into "survival mode," where it becomes increasingly difficult to problem-solve and look beyond making it through each day.
"It's like when they give you the safety warning on the plane when the oxygen mask comes down, you need to take a breath first so you can help someone else. You need to take care of yourself first," Evans said.
Evans recommends that caregivers, and other family members feeling stress about a loved one, set aside time to take care of yourself, with practices like exercising, meditating and doing something that makes you laugh.
For those specifically caring for someone with Alzheimer's disease, the Alzheimer's Association holds online classes and support groups for caregivers to learn more about the disease and to talk about their experiences with others.
The Alzheimer's Association also operates an around-the-clock helpline with experts available who can direct caregivers to resources in the Holland area.
To connect with loved ones who you can't see in person due to COVID-19, the important thing is maintaining a connection, whether it's through phone calls, video calls or letters and postcards.
If there's no way to get a video call connection, record a video or audio message and send it to them. Staff at long-term care facilities can sometimes help set up video calls or play video messages for a family member who isn't adept with technology.
Evans said there are lots of creative ways to remind a family member that they are loved and cared for even if you can't be there for them in person or if it's difficult to communicate with them virtually for one reason or another. Send them photos, drop off a favorite meal or treat, or send them a candle with their favorite scent when they aren't expecting it.
For older adults, Van Tongeren said a weighted blanket can also be a soothing stress reliever, as it replicates the sense of touch.
"A strategy I do with some of my clients is giving yourself a hug," Van Tongeren said.
She said understanding one's own stress response, why it's happening and what the effects are is often the first step toward reducing stress.
"If we understand it, we don't have to be afraid of it and then we can learn how to cope with it," Van Tongeren said.
To stave off feelings of loneliness, Kolean meditates, exercises and draws companionship from her Christian faith which teaches that God is always with her.
Sitting on her balcony when it's warm enough to do so and enjoying nature, the trees and the sky, and singing her favorite hymns are some things that bring her comfort, she said.
Kolean has found joy in small things, like going all out to decorate her apartment for Christmas even though she won't be hosting any family this year for the holidays.
"I hadn't put all of those Christmas decorations up for a couple of years, and now I have everything up. I've been having so much fun putting my decorations up," Kolean said. "Of course, nobody is going to come here, but it just is fun to do that."
Finding a Silver Lining
Lisa Evans, executive director of Community Action of Allegan County, a nonprofit that delivers meals to the elderly and homebound, said she hopes something that comes of the pandemic is a better understanding and empathy for those who have no choice but to be isolated, pandemic or no pandemic.
"All of us now, in ways that we maybe had not appreciated prior to the pandemic, can relate, as we've all needed to be at particular times in our own self-imposed quarantines and isolation from our friends and our family, and know what it's like to go without human touch for weeks at a time," Evans said.
"It absolutely has been, for so many of us, an opportunity to put ourselves in other people's shoes, to have empathy in ways that we might not have before, for some of the challenges ongoing for so many people who live in our community."