COVID-19

Does Everyone Over 60 Need To Take The Same Coronavirus Precautions?

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She knew it wasn鈥檛 a good idea and her daughter would disapprove. Nonetheless, Barbara Figge Fox, 79, recently went to four stores in Princeton, New Jersey, to shop for canned goods, paper towels, fresh fruit, yogurt, and other items.

鈥淚 was in panic mode,鈥 said Fox, who admitted she鈥檚 been feeling both agonizing fear and irrational impulsivity because of the coronavirus pandemic.

Susannah Fox, Barbara鈥檚 daughter, had been warning her exceptionally healthy mother for weeks of the need to stay inside as much as possible and limit contact with other people. Everyone age 65 and older is at high risk of complications from COVID-19 and should adopt these measures, the .

鈥淎t one point, when I was pushing her to limit her activities, my mother said defiantly, 鈥榃ell, I鈥檓 going to die of something,鈥欌 said Susannah, an adviser to health care and technology companies. 鈥淎nd I said, 鈥榃ell, that鈥檚 true, but let鈥檚 not rush it.鈥欌

Are precautions of the sort the CDC has endorsed really necessary, even in areas where the new coronavirus doesn鈥檛 yet appear to be circulating widely? What about disease-free adults in their 60s and 70s? Do they need to worry about going to a restaurant or a friend鈥檚 house for dinner? Are all outside activities ill-advised?

I asked several geriatricians for their advice. All cautioned that what they told me could be upended by unforeseen developments. Indeed, over the past week, the governors of about a dozen states 鈥 including California, Delaware, Illinois, Indiana, Louisiana, Michigan, New Jersey, New York, Ohio, Oregon and Washington 鈥 have told residents, and not just older adults, to stay inside, in an to stem the spread of the coronavirus.

Here鈥檚 what geriatricians think is reasonable, and why, at the moment:

Know the odds. Current warnings were originally based on data from China, which has reported that 80% of deaths from COVID-19 occurred among people age 60 and older.

The from the U.S. was published by the CDC last week. Of 4,226 known COVID-19 cases at the time, people 65 and older were responsible for 80% of deaths, 53% of intensive care unit admissions and 45% of hospital admissions. Those 85 and older suffered the worst outcomes.

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Data from China, the U.S. and other countries also indicates that people with illnesses such as heart disease, diabetes, kidney disease and lung disease, and those with compromised immune systems, are more likely to become critically ill and die if they become infected. The that these patients stay inside and practice strict precautions.

What鈥檚 not yet known: lots of details about the underlying health status of older adults in China and other countries who鈥檝e died from COVID-19. 鈥淲e just don鈥檛 have this kind of information yet,鈥 said Dr. Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California-San Francisco.

As a result, considerable uncertainty about the true nature of risk remains. What鈥檚 clear, however, is that older adults have less robust immune systems and are less able to mount a protective response against the coronavirus.

Exercise more caution. Uncertainty also surrounds the degree to which the coronavirus is circulating in communities across the country because testing has been so limited.

Some people don鈥檛 develop symptoms. Others won鈥檛 realize they鈥檝e contracted the coronavirus until becoming symptomatic. Both groups may unwittingly transmit the virus, which can live on hard surfaces such as door handles or store shelves for .

Given how little is known about the extent of the virus鈥檚 community spread, most physicians suggest erring on the side of caution.

Dr. Michael Wasserman鈥檚 82-year-old mother, Fern, called him several times recently with questions. Could she go out to dinner with his brother? No, Wasserman said he told her, 鈥渞estaurants are one of the most dangerous places right now for old people.鈥 Could she go pick up a prescription at the pharmacy? No, he said, 鈥渢he last place you want to go is a pharmacy or a doctor鈥檚 office where there are sick people next to you.鈥 What about the grocery store? No, get deliveries, he urged.

But Wasserman, who鈥檚 60 and a triathlete, isn鈥檛 as strict with himself. 鈥淲ould I go for a walk? Yeah. The way I see it, I鈥檓 in a gray zone. I can go out, but I have to be careful.鈥

Consider your health. Wasserman isn鈥檛 alone in making a distinction of this kind. 鈥淲hat a number of physicians are saying is, you should consider whether you鈥檙e frail鈥 in assessing your personal risk, said Dr. John Morley, a professor of geriatrics at St. Louis University School of Medicine.

He ticked off the questions that entails. 鈥淔: Are you consistently fatigued? R, for resilience: Can you climb a flight of stairs? A, for aerobic: Can you walk a block? I, for illnesses: If you鈥檝e got five or more, that鈥檚 bad. L, for loss of weight: That鈥檚 not good.鈥

If you answer yes to three or more of those questions, you should be 鈥渞eally careful and self-isolate,鈥 Morley said.

Even if you score 1, 鈥測ou should be taking some care,鈥 he continued. 鈥淚f you want to have a couple over for dinner, make sure they don鈥檛 have the sniffles or a fever or a new cough and they haven鈥檛 been traveling.鈥

鈥淚鈥檝e been telling people, this is about how healthy you are, not how old you are,鈥 said Dr. William Dale, director of the Center for Cancer and Aging Research at City of Hope, a cancer center in Duarte, California.

But even healthy people are becoming sick and, 鈥渉onestly, I think we鈥檙e all trying to figure out how worried to be,鈥 Dale said.

Assess risks. Of course, older adults should follow guidance from state and local health departments, as well as the federal government. But the advice varies widely, adding to people鈥檚 uncertainty.

鈥淚 don鈥檛 think it鈥檚 as simple as 鈥楧on鈥檛 go out鈥 for all older adults. Social contact is still really important,鈥 Perissinotto said. 鈥淚f you鈥檙e healthy and over 60, with prudence, hand hygiene and being aware of your surroundings, you should still be able to go about some activities,鈥 such as taking a walk or visiting with a neighbor while maintaining a safe distance.

Leslie Kernisan, a San Francisco geriatrician and the founder of the geriatrics advice website BetterHealthWhileAging.net, offered several concrete suggestions. If you鈥檙e going to the store, consider wearing cloth gloves, because viruses don鈥檛 survive as well on soft surfaces.

Try not to handle your smartphone when you鈥檙e out of the house. 鈥淎 phone is a hard plastic surface that can easily get contaminated,鈥 she said.

If you鈥檙e worried that older parents aren鈥檛 following rigorous enough precautions, don鈥檛 lecture them, Kernisan advises. Instead, ask how they鈥檙e feeling about the coronavirus. What do they know about it? What plans have they made?

Foster well-being. Asked what was safe for older adults, Dr. Paul Tatum, an associate professor of medicine at the University of Texas-Austin鈥檚 Dell Medical School, focused on factors that contribute to well-being.

鈥淚t is safe to exercise, and, in fact, it鈥檚 very important to keep exercising,鈥 but not at the gym or in large groups, he said. 鈥淚t鈥檚 safe to get plenty of sleep鈥 鈥 but avoid sleeping pills, if possible.

鈥淚t鈥檚 safe to prevent worry and take a break from social media and too much news,鈥 Tatum said.

鈥淚t鈥檚 safe to take care of your spiritual needs in this time, but doing it at a distance is wise. Don鈥檛 hesitate to reach out to your church or synagogue community and say, 鈥業鈥檓 not able to come in. Can I schedule a few minutes on the phone with someone?鈥 It鈥檚 safe to call your neighbor and say, 鈥業 need some help.鈥欌

[Update: This story was updated at 3 p.m. ET on March 27 to reflect the Centers for Disease Control and Prevention's new guidance that adults 65 and older are at higher risk for severe COVID-19 illness.]

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AgingCovidNavigating Aging

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