As the country buckles down to survive the first global pandemic since 1918, the new coronavirus disease, or COVID-19, it’s paramount to recognize the most vulnerable demographic among the citizenry: the elderly.

Inquirer Lifestyle posed some questions to Dr. Maria Teresa “Metch” C. Ramirez, a doctor of geriatric medicine with St. Luke’s Medical Center Quezon City and Dr. Jesus Delgado Memorial Hospital. She is the past president of the Philippine Society of Geriatrics and Gerontology, and sits on the board of directors of the Philippine College of Geriatric Medicine.

Why are older people particularly vulnerable to contamination with COVID-19?
As the individual ages, the different systems of the body which are used to fight diseases wear down, and because of this, older persons are more likely to be afflicted with chronic diseases. One elderly person may have hypertension, diabetes, stroke, pulmonary disease and cancer, all at one time.
More importantly, the immune function declines, which makes the elderly very vulnerable to infections like COVID-19. The immune function is not as robust as when they were younger. Most of those elderly who have died in this crisis have other comorbidities or preexisting conditions like ischemic heart disease, chronic obstructive pulmonary disease, and others.

Is it true that their chances of recovery are also much lower?
Recovery depends on the status of the immune system. If the older person still has a strong and robust immune system and is in good health, there’s a strong chance of survival. The fewer the preexisting diseases, the better.

What should we do with their living/sleeping areas to keep them safer? How isolated should they be?
Their room should be well-ventilated and kept clean, with no clutter. The room should not be too hot nor too cold. They can open the windows to let in fresh air, but this may depend on where they live, as long as there is no pollution, so they can get some sunlight.

The elderly should just stay home and be isolated from people who are sick, but there should always be somebody at home who can attend to their needs, like a caregiver or relative, the spouse, children or house help. It is very important for the older person to feel needed and important, so we still need to spend time with them, provided we have no symptoms of COVID-19.

The older person still wants to have a sense of meaning and purpose, and this is good for their overall health and well-being. They need to be connected, so they can talk to friends on the phone. Most important of all, they need to be properly informed about COVID-19.

How about nutrition? What are the best things they can eat to stay healthy?
They need a well-balanced diet consisting of plenty of fruits and vegetables, fish and some meat. They can also be given vitamin supplements, especially vitamin C with zinc, especially if they are unable to eat well due to existing medical conditions affecting their appetite, or even because of poor dentition. They should also be well hydrated and drink eight glasses (1.5 to 2 liters) of water per day, as well as fruit juices. Please tell seniors who still do it to avoid smoking and drinking alcohol.

Many older people are still strong enough to leave their homes, and some actually insist on it! Would you encourage them to stay put completely, even when they say, “Malakas pa naman ako”?
Yes, stay at home. But in the event that they really have to go out for very important reasons, like to see a doctor, they should wear surgical masks and are advised not to stay out too long. They should be accompanied at all times, especially patients already showing signs of forgetfulness or dementia.

How about other family members and caregivers who are living with them—what are best practices?
Make sure that no one has symptoms related to COVID-19, like cough, fever, shortness of breath or diarrhea. They should refrain from kissing or hugging the elderly for now. Coming from outside, make sure they wash their hands or even better, take a bath before coming into contact with the older person. They should wear masks if they have a cold or are coughing, but better not to stay in the same room with the older person at all.

Finally, for their peace of mind—how can we reassure them and keep their spirits up at a time like this?
Let them keep in touch with family and friends as often as possible, by phone or online. Let older people feel important by asking how they are feeling every now and then. They can spend time doing things they enjoy; this might include reading, cooking, other indoor hobbies, listening to the radio and watching their favorite telenovelas. Reassure them that for as long as they don’t get exposed to somebody who is infected and they are in good health, they will be perfectly okay. Remind them to keep on praying, and that they are loved unconditionally. INQ