When the COVID-19 pandemic swept across the United States last year, it took its first and most devastating toll on older persons residing in nursing homes. The early months of the pandemic saw more than one death for every 200 nursing home residents, and deaths in long-term care facilities accounted for more than a third of all COVID-19 deaths in the United States, at one point rising as high as 43% of all COVID-19-related deaths. At least 186,000 coronavirus deaths were reported among residents and employees of nursing homes and other long-term care facilities in the U.S. Thankfully, with the introduction of vaccines and other preventive as well as more effective treatments, the number of nursing home deaths dropped precipitously.
But solely looking at the impact of COVID-19 on the nursing home population does not capture the full picture of the damage this pandemic has wrought on older people. Older adults living in the community — in their own homes — were also at increased risk of COVID-19 related illness and death, as well as other indirect effects and far too little is known about how they have been faring.
Older adults in New York City comprise 13% (1.1 million) of the population, of whom only 3% live in a nursing home. With its high-density urban population, ethnic and racial diversity, and increasing longevity, New York City must account for the needs of this population. In a survey we recently conducted, the SILVER survey, nearly 700 randomly selected New Yorkers 70 years or older residing in the community participated. They provided a clearer picture of the emotional and social consequences of the COVID-19 pandemic on their lives.
The survey showed that more than a third of participants reported negative effects of the pandemic on their lives. Specifically, two-thirds reported experiencing financial challenges and nearly one in ten did not have enough to eat. Eighteen percent reported symptoms of depression and 17% reported anxiety — double pre-pandemic levels of depression (9%). Among Hispanic older New Yorkers, the impact was even more severe with 29% reporting depression and 19% anxiety. In addition, about one in ten Hispanic and Black older New Yorkers reported a sense of isolation during the pandemic.
While many have lauded the expansion of telehealth service during the pandemic, we found through our survey that lack of internet access prevented older New Yorkers from connecting to others and accessing telehealth services, information sources, and COVID-19 vaccine appointments early on. This was even more evident among the oldest New Yorkers who participated in the survey. One in six of those aged 70-79 reported no internet in their home, as did one in three of those over 80. And the inequities in internet access were evident by race and ethnicity, with a quarter of Black and Hispanic older adults reporting no internet access compared to 16% among older white New Yorkers.
The findings from the survey point to the wider, largely silent effects of the pandemic on older New Yorkers and should be a wake-up call. Seniors — especially those in low-income environments and communities of color — have been, and continue to, struggle with a host of challenges brought on by the pandemic, even if they themselves have not been directly impacted by the disease itself. The safety net for older adults is frayed and in need of urgent attention. The precarity from unaddressed material circumstances, such as employment, food, housing, mental health services and internet access, if left unattended, aggravates the vulnerability of this population today and in the future.
As efforts are made to address the current crisis through biomedical interventions and improved public health responses, we must also act now to bolster the response to the social and mental health needs of older people living among us.
Expansion of mental health services for older New Yorkers is a critical priority. This will require expansion of internet access and consequently access to telehealth services for older New Yorkers. Securing ongoing reimbursement of these services is necessary beyond the pandemic. Expansion of in-home mental health services will also be important to reach those with mobility constraints. Importantly, ensuring financial security for older New Yorkers is necessary to allay their anxiety and to overcome food insecurity. This requires strong social support services to reach all older New Yorkers and secure the benefits they need. Finally, innovative approaches are needed to help older New Yorkers overcome their isolation, including expansion of senior citizen centers and providing them with the resources to enable reaching and engaging seniors in meaningful programs.
The COVID-19 pandemic has drawn back a curtain on an entire sector of our population that has been overlooked. Now is the time to ensure that, when the next crisis strikes, older adults will have the support they need, if we are to build a truly resilient city that protects all our citizens in times of crisis.
El-Sadr is director of ICAP at Columbia University, director of Columbia World Projects, and professor of epidemiology and medicine at Columbia Mailman School of Public Health. Greenleaf is technical specialist at ICAP and assistant professor of population and family health at Columbia University. Fried is dean of the Mailman School of Public Health at Columbia University.