Experts Point to COVID-19 Danger for Older People in Low-Income Countries

Older age is a central risk factor for becoming critically ill from the novel coronavirus (COVID-19).

An editorial in BMJ published on March 13^th, argues that guidance has not sufficiently incorporated the needs of this at risk population. The editorial suggests that a global expert group should be formed around response to the virus in settings including nursing homes and long-term care facilities.

The editorial was written by faculty from the London School of Hygiene & Tropical Medicine, the University of East Anglia, and the Samson Institute for Ageing Research.

The risk of dying from COVID-19 increases with age, and most of the deaths observed are in people older than 60 years, especially those with underlying health conditions.

“Yet, to date, guidance largely ignores this issue, not only in high income countries, but in low- and middle-income countries (LMICs), which contain 69% of the global population aged ≥60 and where health systems are weaker and covid-19 could potentially have the greatest impact,” the authors wrote.

The study authors identify 4 key concerns for older people in low- and middle-income countries. The first of these is changing family dynamics.

Because labor has become more mobile, in many countries parents may live and work distantly from their children. In these circumstances, children may be raised by their grandparents. This caregiving role provides an added risk of exposure and under current circumstances makes it impossible for them to truly self-quarantine.

There are substantial implications for their extended families because those working abroad are likely to be unable to return home at short notice due to the pandemic.

The second challenge the editorial identifies for older people in LMICs is that many older people in these countries are now cared for in nursing homes or long-term care facilities.

“These homes are often unregulated and provide care that is of very poor quality. Institutions in which people live in close proximity, such as prisons and mines, can act as incubators of infection,” the authors explain.

Even in the United States, many of the initial deaths from COVID-19 were reported in a nursing home setting. Residents in these facilities are highly dependent on health care workers, who could become infected outside the facility even if strict measures are practiced internally.

The third problem facing older populations in LMICs is that health care systems may become burdened to capacity by surges in demand. Under typical circumstances, many health systems in these countries are already under strain. It is already difficult for older individuals to access adequate care in many contexts.

“Health systems in LMICs face severe constraints on capacity at normal times and are unlikely to be able to offer the care needed, especially if the precarious staffing levels—already depleted by migration, low salaries, and poor working conditions—and limited gerontological expertise are reduced further by illness,” the authors indicated.

The fourth problem, and one of the most difficult to solve, will be the conditions of social distancing themselves. Older people around the world often live in precarious circumstances, either living alone or dependent on others for support.

As quarantine conditions become more widespread, people in this population may face challenges acquiring food or other essential supplies. In LMICs, many older individuals are illiterate and will have limited access to public health information.

In concluding, the authors of the editorial suggest that international response coordination include a group primarily focused on the needs of older adults. There is no simple solution to these problems, the authors acknowledge, and many are deeply rooted. The first step, however, is admitting that they exist.

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