Social Isolation Makes Homebound Elderly
Even More Lonely
Looking back at all of the Chinese New Years he had, his house would be filled with relatives and friends. They would gather on New Years' Eve for the reunion dinner, which is believed to be the most important meal of the year. The whole apartment will be filled with laughter and joy as they do some catching up with each other.
But this year with the pandemic ongoing, he has no choice but to tell them not to come over. He did not want any of his family and friends to take the risk of getting infected with the virus. In the end, only his daughter and sons came to visit him. Only five of them, including his domestic helper, celebrated the Chinese New Year together.
Since the elderly are identified as a “high risk” group, 95-year-old Chan Kei was told to stay at home. Staring at the four walls, Mr Chan felt as if it has been ages since the last time he stepped foot outside of the building. He felt like he was trapped for months.
Celestine Chow Ching-yi, the Programme Secretary at Chai Wan Neighborhood Elderly Centre in Chinese YMCA of Hong Kong, mentioned that the elderly already faced many emotional, physical, and financial difficulties before the pandemic.
However, as the pandemic hit Hong Kong in January 2020, the Hong Kong government started to initiate social distancing measures. Many social welfare services were suspended or only opened on a limited scale including the elderly day-care centres and community centres. Given the amplification of the existing problems, it has also created new challenges to the senior citizens.
Doing regular physical exercise is crucial, especially for the elderly who suffer from movement difficulties, in order to prevent their muscles from dystrophy.
Mr Chan also suffered from metabolic arthritis, so he also needed to do exercise regularly. But he is one of the lucky ones. Since he lived in a twin tower block, a traditional style public housing in which apartments surround the building in the form of a well-liked shape, he could take a walk in the corridor twice a day.
Mr Ken Tsoi, the Acting Centre Manager of Aberdeen Kai-fong Welfare Association Social Service Jockey Club Wong Chi Keung District Elderly Community Centre (AKA JCWCK), said for those who are stuck in a confined space at home, they would gradually lose their motivation and neglect their physical exercises.
However, the lack of physical exercise causes their bodies to deteriorate faster. Studies in the past show that a reduction in physical activity and inadequate nutrition plays a vital role in the reduction of muscle mass with normal ageing.
Alongside the coronavirus itself, conspiracy theories and false information have spread rapidly across the world, as people are increasingly desperate for more information about the crisis.
False information related to the virus, including statements of health authorities, therapy, preventative measures, the prognosis of the disease, and vaccination, are shared across all social media platforms.
According to research conducted by the American Journal of Tropical Medicine and Hygiene in 2020, about 800 people died, while 5,876 were hospitalized and 60 developed complete blindness after drinking methanol, believing that it was a cure of the virus.
The United Nations has issued a joint statement alongside other international governmental organisations in September 2020 to warn the public about the surge of misinformation during the pandemic.
While people of all ages fall victim to fake news, the elderly are the most vulnerable to misinformation.
According to research published by the American Association for the Advancement of Science in 2019, it was found that people above the age of 65 are seven times more likely to share fake news related articles compared to the younger adults.
Studies explained that older adults have high engagement rates with false information on social media due to decline in their cognitive thinking, shift in social goals and limited media information literacy.
Virginia Wong, the Head of Nurse at Community CareAge Foundation (CCAF), said unlike adults, they do not have much knowledge on how to protect themselves from the deadly disease. Coupled with the lack of digital literacy, many elderly would believe in the misinformation circulating online.
“During the beginning of the pandemic, when everyone was panic-shopping for masks and everywhere ran out of supplies, some of them tried to wash and steam their masks, it really happened!” said Ms Wong, “This is because they didn’t know how to distinguish genuine information from falsehood.”
Even though community centres were only allowed to provide services on a limited basis, many organisations and centres have tried to reach out to the elderly-in-need while maintaining social distancing rules.
Elderly service organisations, including AKA, YMCA, Chicken Soup Foundation and CCAF, have given out healthcare supplies, especially during the beginning of the pandemic when resources were scarce.
As Zoom and WhatsApp have both become the must-have social networking platforms to keep in touch with the outside world, organisations have also initiated tutorial classes for the elderly. According to Mr Tsoi, many are eager to take the classes, especially those in their 60s, for the purposes of keeping in touch with their family and participate in the activities provided by the centre.
When Ms Chow was teaching the elderly, she once questioned herself as to whether teaching them using iPads is suitable. She was worried that they would have a feeling of defeat since it is difficult to operate the screen with their shaky hands.
“One day, I suddenly received a WhatsApp call from an elderly, who was so frustrated at first for not being able to operate WhatsApp, at that moment, I was so relieved and happy for her,” she exclaimed.
Ahead of time, AKA JCWCK has actually already taught the elderly how to use Facebook, WhatsApp and YouTube. They would upload tutorial videos of physical exercises on these social media platforms as demonstrations.
To motivate some of the elderly, AKA JCWCK would also visit them and teach them physical training skills. Instead of going inside their homes, they would stand outside of the corridor. The safety of both parties can be ensured while they are able to motivate the elderly to do exercise at the same time.
To assist the elderly under the current restrictions, many organisations would check on them through phone calls. YMCA has around 1000 elderly members, and has got in touch with all of them. Ms Chui said by checking on them, social workers are able to ascertain whether their cognitive abilities have worsened through their responsiveness.
“Hidden elderly are the most prone group amongst all the elderly,” said Mr Tsoi. “Prior to the pandemic, they rarely approach any organizations. Amidst the pandemic, they will be even more resistant in leaving their apartments.”
Unlike other socially active elderly, the hidden elderly are those who disengaged themselves from the community due to lack of family support and ill health. They do not know how to seek help and support from the existing services.
According to research conducted by the Asia-Pacific Institute of Ageing Studies at Lingnan University in 2009, there are about 70,000 to 90,000 hidden elderly in Hong Kong.
“Since living alone is a choice, an attitude for some, we respect their choice and will not intervene. Unless living alone would cause danger to their lives or extreme bad hygiene,” said Mr Tsoi, “we would help them slowly reintegrate into society.”
During the pandemic, AKA has expanded their outreach team to check on all of their hidden elderly clients via phone calls and home visits.
“While some of the elderly live alone by choice, many of them are ‘forced’ to be hidden elderly,” said Calvin Cheng Pak-wing, a Clinical Assistant Professor at the University of Hong Kong, Department of Psychiatry and Honorary Associate Consultant at Queen Mary Hospital. “It’s not that they don’t want to be connected with society, for some it is because they really lack a social support network, or have serious mobility problems.”
Since there are only a limited number of social workers in the outreach teams, without any help from volunteers, it is difficult for them to reach out to all of the hidden elderly. “Their situation has definitely worsened since they rely a lot on home visits by social workers,” he said. “Without these home visits, ‘lonely death’ could possibly happen.”
Ms Chow also said since many of the hidden elderly are more reclusive and stubborn, they would refuse to follow some of the coronavirus restrictions, for example, they would insist on not wearing masks or not wanting to scan the “Leave Home Safe” application.
When being asked whether he is feeling okay under the pandemic, Mr Chan whispered, worried that his daughter would overheard him, “not really because I can’t leave the building whenever I want to, but I couldn’t let my children know, I’m worried that they will worry about me.
Calvin Cheng Pak-wing, a Clinical Assistant Professor at the University of Hong Kong, Department of Psychiatry suggests the government to provide more support to elderly with behavioural problems.
Dr Cheng said that the elderly rarely express their negative emotions directly because they do not know how to express their feelings and are worried that it will bring extra burden to their children.
“Instead many will visit the doctors constantly, saying that they have a bad appetite and are not feeling well,” he said. “But having headaches, bad appetite, digestive problems or insomnia are some of the symptoms of having mental illnesses.”
To help the elderly deal with their anxiety during the pandemic and build up their resistance to stress, AKA JCWCK has taught the elderly about positive psychology. Through practising positive psychology, the elderly could change their perspective of negative situations.
“For instance, if what you see in front of you is simply a wall, you can draw a window on it and climb over the window,” said Mr Tsoi, “it all depends on how you look at the situation.”
Dr Cheng said depression diagnosed after the age of 60 could increase the risk of dementia. Their responsiveness towards medicine would also decrease, meaning that they would need higher doses of medication to reach the same level of treatment compared to those who were diagnosed before the age of 60.
There are no exact statistics showing whether there is an increase in the number of elderly diagnosed with late-life depression at this moment. But Dr Cheng predicts that there is an increase in elderly with late-life depression since loneliness is one of the major contributing factors.
The elderly who were diagnosed with late-life depression are much more likely to have suicidal thoughts during the pandemic compared to other elderly, according to a recent research paper published by the University of Hong Kong in March.
It shows that loneliness is associated with the level of suicidal thoughts and traumatic stress related to the pandemic.
The research paper from Hong Kong University also emphasised that early detection of suicidal risks in the elderly with late-life depression is vital during the pandemic and that it requires timely mental health support.
YMCA and AKA JCWCK are two of the many elderly social service organisations that provide free check-up to elderly who are suspected of having late-life depression.
AKA JCWCK hopes to reconnect with the elderly who were diagnosed with moderate depression by organising more face-to-face and online activities. Referring to the Activity Theory of Aging, Mr Tsoi said that the elderly’s negative emotions will be relieved once they regain sufficient social interactions.
“Through educational talks, we will teach the elderly to normalise their negative thoughts,” said Mr Tsoi, “it is important to halt stereotypes associated with depression, in order to help the elderly to stop thinking that it is their fault for having negative emotions.”
The Hong Kong Jockey Club Charities Trust in partnership with The University of Hong Kong Department of Social Work and Social Administration started the Jockey Club JoyAge Holistic Support Project for Elderly Mental Wellness in 2016. It aims to support the collaboration between elderly service organisations in Hong Kong to provide better services for the elderly with depression.
Mr Chan’s daughter, Teresa, visits him twice a month and will bring him out for afternoon tea.
The project provides peer support service to the elderly. “Since these peer supporters had been through the same experiences as these elderly, the supporters could understand their needs better and provide them with emotional support,” said Bowen Cheung, research assistant at the University of Hong Kong and is responsible for Public Awareness and peer supporters training.
“Even though family members might not be able to visit them in person, giving them a phone call means a lot to them, so they know that they are concerned,” Dr Cheng said. “The call doesn’t have to be very long, you just have to listen to them express their feelings.”
He emphasized that it is important to make them feel they are not lonely, even though they might be living alone or with their domestic helper.
“The government has provided more financial support for the non-government organisations to help the elderly in the past few years,” he said, “but none of the supporting programmes are connected, many of their services overlapped.”
He urges the government to coordinate services and provide a clear guideline for users to know where and how to seek assistance.
(From left) Dara Leung and Bowen Cheung from Jockey Club JoyAge Holistic Support Project for Elderly Mental Wellness Programme.
