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'I worry about the effects of social isolation on elderly patients'

“Despite the phone and video calls, he seems more muddled than usual”

While contracting COVID-19 could spell disaster, we mustn’t forget about the impact of social isolation on the mental wellbeing of shielded elderly patients, says Nadira Callachand

“He’s definitely getting worse,” my husband remarks as he comes off the phone to his 80-year-old father. My dear father-in-law, who is living with Parkinson’s disease, had a rocky start to the year after being admitted to hospital with pneumonia in January.

The decline in his cognition during this hospital stay and over the following six weeks took the whole family by surprise. His deterioration was frightening, but after two months of slow recovery he was almost back to where he had been at the end of 2019. Then COVID-19 struck.

So far, thank goodness, he hasn’t contracted the virus – he is shielding and following the recommended advice. A sensible man, not one to take any risks or disregard public health advice, we are lucky he’s doing what he’s been told by staying indoors.

But social isolation brings its own worries. His previous daily routine wasn’t complete without an outing to mass at church and a visit to Tesco. Along with visits from family, this kept an extremely sociable man busy with plenty of people to see daily, despite living alone.

How much I underestimated the value of those chats over cups of tea and how important they were for his mental health. Despite the phone calls, online mass and video calls, he seems to be more muddled and forgetful than normal.

Before the COVID-19 outbreak, we may have overlooked the value of simple things like sitting with loved ones, a hug on arrival and a kiss goodbye on the cheek – but we sure as hell don’t now. Evidence has shown that isolation and loneliness are associated with cognitive decline. I worry about this on top of managing Parkinson’s disease. As the illness progresses, cognitive decline and dementia loom ahead – but is the COVID-19 prison accelerating this process?

Dropping off food and groceries brings some chat to the door, but as my father-in-law shuffles back a few steps I can tell he thinks I’m breathing germs into the hallway. I stand back well over two metres, but he doesn’t seem convinced.

Should I tell him to take a walk once a day up the street? It’s a quiet cul-de-sac. In the 14 years I’ve been visiting the house, I’ve never actually seen anyone walking around – so what harm could it do? He could stretch his legs, get some exercise and fresh air. A sneaky walk would do his mental health the world of good. But, knowing my luck, that would be the day he runs into a neighbour – and a coughing one at that.

There was panic last week when I dropped off some dinners. He gingerly opened the door to reveal a cut to his forehead. He’d fallen in the garage and banged his head.

I had to go in and take a closer look, but I was suddenly hyper-conscious of my breathing. Usually it’s the most natural thing in the world, but now I was trying my best to hold each breath as long as possible.

Although I was pretty sure I wasn’t infectious, I was still terrified of breathing deathly aerosol droplets on him. His wound needed to be cleaned and dressed, so manic handwashing ensued.

He was obviously a bit shaken, so I was reluctant to leave him, but we were both on edge about the virus. I made sure he was seated and comfortable, and felt I had no choice but to head off.

What was this invisible enemy that had made me feel so suspicious and act in a way that left me feeling inadequate and uncomfortable? I made regular phone calls for the rest of the day to check he was feeling ok and didn’t suffer any ill effects of the fall. Still, I felt so crumby leaving him. But at the forefront of my mind was the worry that I could have given him COVID-19. Surely that would have been worse?

Like everyone, I’m hoping and praying that this period of prolonged social shielding for vulnerable patients doesn’t last much longer. There are so many challenges to be faced by most of this group already, never mind with COVID-19 on top of them.

For my father-in-law we are trying all we can to keep him safe and well at home to carry out his daily tasks for as long as possible before Parkinson’s snatches these luxuries away from him. The longer he’s isolated in this surreal new world, the more I fear that he may succumb to Parkinson’s sooner than we had hoped.

Nadira Callachand is a pharmacist and career leadership coach based in Dublin

1 Comments

Lucky Ex-Locum, Superintendent Pharmacist

This is one of the best articles I've read on here ever.

The hideous thought is that Covid isn't going to go away for a long long time, even if the vaccine proves effective (whenever that becomes available) so there is pain to come for families torn apart for months to come.  I feel so sorry for all of you Nadira, and I sincerely hope you all come through this unscathed. At least you are in Ireland where it doesn't seem quite as bad as over here.

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