by: Kahli Zietlow, Serena P Wong, and Mitchell Heflin
In a recent telehealth visit, a patient presented alongside her husband, who was concerned that she had become a “shell of herself.” She previously enjoyed reading, spending time with family, and attending a water aerobics class at her local YMCA. Since the pandemic began, she has suffered from isolation; her aerobic classes were suspended, and their children had stopped visiting in an effort to protect them from contracting COVID19. She hadn’t left the house in months, stopped reading books, and seemed disengaged when her family called. He observed that she spends her days watching television and sleeping, and he was concerned that her memory had dramatically worsened in the past four months.
Social engagement and intellectual stimulation are critical to one’s wellbeing, memory, and mood. Numerous observational studies demonstrate that social engagement and cognitive stimulation can delay or prevent onset of dementia. Even before the pandemic, social isolation was a threat to the well-being of older adults. Social isolation and loneliness were identified as “serious public health risks” by the National Academy of Medicine in 2020 . Older adults are at particularly high risk of social isolation for a number of reasons, including sensory impairment that may limit mobility or ability to drive, cognitive impairment, geographic separation from friends and family, and the risk of widowhood and loss of loved ones that increases with age. The pandemic has amplified these barriers, and caused a staggering increase in reported loneliness and social isolation, particularly among older adults. Clinicians in practice may represent the only point of contact for some older adults and, therefore, should be prepared to recognize signs of social isolation and respond with suggestions for activities and resources with which they might engage. We have compiled a list of free or low-cost resources for older adults that provides for social engagement and intellectual stimulation during this period of physical isolation and social distancing.
Overcoming Technological Barriers
A recent study by Lam et al found that approximately 30% of the US population over the age of 65 had barriers to engaging with virtual technology due to lack of internet access, lack of internet-accessible device, and/or inexperience utilizing technology . Overcoming these barriers are vital to allow older adults to engage with their communities. Although some older adults are reticent to learn new technology, the Coalition to End Social Isolation and Loneliness emphasizes the importance of virtual connections during the pandemic era .
For older adults on a fixed income who don’t have access to the internet, there are a number of very low cost ($5-10/month) options available. Daily Caring compiled a list here. There are also a number of resources available to teach older adults how to utilize various virtual platforms:
- AARP Tek Academy offers free technology learning events and seminars for members.
- AARP offers a Zoom tutorial(free to the general public).
- Goodwill Industries offers a variety of free online classes of varying complexity, from the “Basics of Email” to utilizing the Microsoft Office Suite.
- Area Agencies on Aging (AAA)can also provide information local resources and volunteer organizations to help get older adults connected and comfortable using new technology. Visit the National Association of Area Agency on Aging and enter your zip code to find your local AAA.
Once adults have established a reliable internet connection and are comfortable with the basics of browsing the internet and using interactive video chat platforms, there are a number of online resources they can access.
Senior Centers are community-based organizations that promote the health and wellness of older adults. They receive federal, state, and sometimes local funding, as designated through the Older Americans Act. Senior Centers have varying minimum age requirements (typically between 50-60), and offer a wide variety of services, including adult education courses, fitness courses, volunteer opportunities, social groups, and more. Many services are free or available at low cost; if services have fees, they often exist on a sliding scale based on the participant’s income. During the COVID pandemic, many senior centers have converted their enrichment courses to an online format, making it even easier for adults in the community to engage. AAAs are an excellent resource to help older adults connect with local senior centers and explore their offerings.
Adult Education and Learning Opportunities
- Libraries: In addition to offering books, audiobooks, and other media at no cost, libraries are an excellent source of community engagement. Many libraries are offering a mix of in-person and virtual events, such as hosting local musicians, art courses, book clubs, and continuing adult education. Offerings will vary significantly based on location.
- Osher Lifelong Learning Institute (OLLI): OLLI is an adult learning program where adults can participate in lectures, special events, and workshops, on a broad range of topics. Members join study groups and enjoy rich discussion in the courses they select. Sponsored by Northwestern University, classes are usually held in Chicago, but programs have been moved online during the pandemic. There are registration fees, which vary according to membership type. Adults can also reach out to local institutions of higher learning to find out more about adult education and community outreach programs they may offer.
- MasterClass:This online program has a compilation of over 85 classes, taught by professionals and celebrities on their topic of expertise. The classes are available in short (approximately 10 minute) segments, so they are very digestible for adult learners. Classes are available for a small monthly fee.
- Senior Planet: This is a unique community of older adults with an emphasis on interactive, lifelong learning. They offer unique seminars and workshops on a variety of topics. Recent offerings include: digital skills (from computer basics to website design), holistic wellness, chair yoga, and drumming. Adults can become members by making an annual donation of any amount.
Faith and spirituality are important to many older adults, who may be struggling to engage with their religious communities while maintaining social distancing. Many places of worship have embraced virtual technology to record and broadcast sermons or offer community engagement activities. Older adults should reach out to their local place of worship to see what options are available.
There are also a number of virtual resources for various religious communities. A small sampling is included below:
- The Online Faith Collective: This website houses a collection of online worship services, organized by faith. A number of Christian denominations, nondenominational services, and Jewish services are available.
- Virtual Mosque: A website housing articles and sermons on Islamic faith, with media available in English, Arabic, Spanish, and Malay.
- Catholic Digest is maintaining an updated list of resources for those of Catholic faith during the pandemic, including liturgies, discussion questions, inspirational music, and more.
Museum and Zoo Tours
Many national landmarks and tourist spots have begun offering online experiences. These “virtual visits” can be more engaging if performed with a companion. Loved ones sheltering apart can participate in these experiences simultaneously while communicating with each other by phone or interactive video platform, allowing them to make observations, discuss what they see, and learn together.
A small sampling of free experiences:
- The San Diego Zoo (San Diego, CA) offers “Live Cams” – a chance to view several of their exhibits in real time.
- Shedd Aquarium (Chicago, IL) offers an At-Home with Shedd interactive tour, including interactive learning activities. This is a great option to do with grandchildren, or for anyone that enjoys aquatic animals.
- The Smithsonian Museum of Natural History (Washington, DC) offers virtual tours. Visitors have the option of self-guided tours or narrated tours of select exhibits.
- The MET (New York, NY) offers MET 360°, an immersive video tour of 6 galleries within this historic space.
There are a number of fitness course offered virtually. Older adults should always discuss the safety of initiating a new exercise program with their primary care providers and consider a physical therapy evaluation if they have significant impairments in balance or mobility. If safe to participate in an exercise program, a number of older-adult specific programs exist:
- The National Institute on Aging houses a collection of resources on safe exercising for older adults; this is a great resource for adults who may be new to exercise.
- Silver Sneakers has a variety of exercise classes tailored for older adults across a wide spectrum of functional and fitness levels. There are both supervised classes (through Zoom and/or Facebook Live) and on-demand video content. Silver Sneakers membership is supported by many, but not all, Medicare-Advantage plans. Older adults can check eligibility and learn more here.
- The YMCA offers a variety of on-demand video courses geared for older adults, from chair aerobics to tai chi.
Mental Health and Counseling
There are a number of resources to address mental health needs during the COVID crisis:
- The Institute on Aging Friendship Line (415-750–4111) is a 24-hour crisis line for “lonely, depressed, isolated, frail and/or suicidal older adults.” The Friendship line provides both supportive counseling during an emotional crisis and resources to address isolation.
- Traditional psychology and psychiatry offices have expanded their telehealth infrastructure. Patients can be referred to mental health providers through their primary care physician. Psychology Today also offers a directory of psychology providers that accept Medicare; this database can be searched by zip code.
- The Alzheimer’s Association offers a robust community for older adults suffering with dementia, as well as their caregivers. They also offer a free, 24-hour support line (800-272-3900), with augmented staffing during the COVID crisis.
Creative Activities at Home
Active participation in creative, structured, goal-oriented activities can provide variety and cognitive stimulation.
- Cooking: Older adults can stimulate multiple cognitive domains by cooking a meal. Following a recipe requires sustained attention; measuring ingredients involves calculations, and keeping times and multi-tasking utilizes executive function. Whether preparing a favorite meal from a cherished family cookbook, or looking for new recipes on cooking shows or YouTube, cooking is a great way for older adults to be adventurous while remaining socially distanced. For people with cognitive impairment, supervision and careful recipe selection should be considered.
- Learning a new skill: There are a seemingly infinite number of tutorials on Youtube – from crafting to learning an instrument, it’s easy to learn new skills at home. Also consider the free website and/or phone application DuoLingo for a free, fun, interactive way to learn a new language
- Watching TV or reading a book: These activities can be enjoyable, but are passive experiences. For more interaction, older adults can read a book or watch a show alongside a friend, family member, or spouse, and set aside time to discuss the experience. Many books or television shows have reviews or even published “discussion questions” online, to help guide an interactive discussion that relies on recall, processing, and critical thinking.
Loneliness has affected people worldwide during the COVID pandemic, and older adults are one of the hardest-hit demographics. We have mentioned only a handful of high level options for older adults to stay positive, engaged, and healthy during the pandemic. While many of these are national programs, more specific and accessible options may exist at the local community level. Contact local AAA’s or Councils on Aging for more information. Regardless, we urge everyone to reach out and check in with the older adults in their lives, think outside the box, and be creative to find solutions to address this critical issue.
- National Academies of Sciences, E. and Medicine, Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. 2020.
- Lam, K., et al., Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. JAMA internal medicine.
- How to stay connected while intentionally isolated. 2020 [cited 2020 August 17]; Available from: https://www.endsocialisolation.org/covid19.