Dr. Mireille Norris, an internist and geriatrician with Sunnybrook Health Sciences Centre, on Jan 26, 2021.Fred Lum/The Globe and Mail
One man, who was living on canned food ordered from the online retailer Amazon because he couldn’t get out to a grocery store, arrived at the hospital weak and emaciated. A woman whose support workers didn’t show up for days to help her out of bed eventually called 911 and was brought in covered in feces. And yet another woman came to the emergency department with abdominal pains and a desperate need simply to speak with someone because her son had died and she was all alone.
These are among a growing number of older patients Sarah Connelly has been seeing lately who are socially isolated and struggling to get by on their own. Ms. Connelly, a geriatric emergency management nurse at Toronto’s Mount Sinai Hospital, said the pandemic has made loneliness and isolation worse for those living alone, leading to a decline in their health and well-being.
“The social part of medicine is quite big and it has a huge impact on people,” she said. “We’re seeing more often patients that are just not functioning well.”
Some health care professionals at other hospitals are seeing a similar trend. With fewer social contacts during the pandemic, individuals suffering from loneliness and isolation are not accessing timely medical care, not eating well, not regularly taking their medication, and are winding up in hospital as a result.
Data from the Edmonton area, which includes 14 hospitals, suggest the proportion of patients visiting emergency departments whose conditions are complicated by social isolation has risen significantly since November, according to Matthew Douma, an emergency nurse and adjunct professor of critical care medicine at the University of Alberta. A busy urban emergency department now typically sees three to four such patients a day, up from one per day previously, he said.
Of these patients, Mr. Douma said most are brought in by ambulance or family members after someone has discovered them, and they arrive weak with wasting and severe dehydration, often with decreased levels of consciousness.
“They’re largely incapacitated. Many of them have been in their urine and feces for a prolonged period of time, haven’t changed their clothes or bathed,” he said.
Mr. Douma said these include older adults and adults with disabilities whose neighbours and friends used to check in on them, but now, because of the pandemic, are not able to do so. Alternatively, he said, they come from congregate settings, such as group homes or long-term care homes, where extreme staffing shortages have meant fewer people are able to care for them.
At Toronto’s Sunnybrook Health Sciences Centre, internist geriatrician Mireille Norris is seeing grave and numerous consequences of loneliness and isolation among her older patients. Those living alone are experiencing more anxiety, some are consuming more alcohol, cannabis and other substances, and many are not getting out to walk as much, causing their mobility to decline.
Dr. Norris said isolated patients, especially those who are afraid of getting infected by the coronavirus, are also delaying seeking care for serious health issues, including symptoms of heart attack and stroke. (Health care professionals emphasize people should not hesitate to visit hospital emergency departments.)
She is seeing patients who are losing weight, losing their appetite and eating less because they are lonely. Older people tend to be at a higher risk of dehydration because age-related changes in the brain’s regulation of thirst make them feel less thirsty, she said. And those with mobility issues may drink less to avoid having to get up to pour a glass of water or to go to the washroom. Dehydration leads to confusion and falls, Dr. Norris said. It also makes one’s mouth dry and contributes to constipation, which in turn, can lead to decreased appetite.
While people of all ages are experiencing loneliness and isolation during the pandemic, it can be particularly difficult for older individuals living alone, especially for those no longer working, who have outlived their friends and who don’t have family nearby, said Don Melady, co-chair of the geriatric emergency medicine committee at the Canadian Association of Emergency Physicians.
Although many live happy, vibrant lives nonetheless, the in-person social connection they would normally have through participating in church or community groups and engaging in learning activities has largely disappeared, he said. And those whose social connections were, at best, tenuous before the pandemic, are now at home alone 24 hours a day, seven days a week.
“People can go days without saying a word out loud, which is very bad for a person,” said Dr. Melady, who is also an emergency physician at Mount Sinai Hospital. “It leads to health problems and inattention to health needs.”
The good news is there are many resources available to help, Ms. Connelly said. Part of her job is to connect patients with programs and services that will help them function at home, including grocery delivery services, and volunteers who regularly check in by phone. “There’s lots of stuff available. It’s just a matter of finding it,” she said.
Dr. Norris said the plight of lonely, frail older adults underscores the need to prioritize COVID-19 vaccinations for this group, and to develop a national seniors strategy for protecting and caring for them.
In the meantime, the rest of the population can do its part to help mitigate their loneliness and isolation, Dr. Melady said.
“I urge people to just pick up the phone and call,” he said. “You might be saving a life by picking up the phone.”
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