The geriatric population is at a higher risk of COVID-19 infection compared to other age groups, as most of them have pre-existing medical conditions like hypertension, lung diseases, diabetes, heart diseases and/or cancer, etc.1 WHO (World Health Organization) highlighted that fatality rate is increasing with age due to COVID-19 infection, and over 80 years of age is five times than the global average2. Governments are increasing public awareness for extreme measures to safeguard them. They recommended mandatory self-isolation for older adults from society and to stay at home1. But this can exaggerate other serious public health concerns3, including neurocognitive, autoimmune, cardiovascular, and mental health problems. It also can bring about unprecedented fear, anxiety, uncertainty, and depression in older adults4. This highlights the need to understand the self-perception of the elderly population regarding the risks related to the COVID-19 pandemic because this view affects not only their current health status but also their use of health care resources.
I have conducted a cross-sectional survey among fifty community-dwelling urban elderly individuals aged 60-88 years from Kolkata metropolitan area of West Bengal, India. Over one month (25th March to 22nd April 2020), I identified all the potential participants via a sampling frame based on all contact details of the elderly population, as obtained from an organization, namely Banchbo Healing Touch Kolkata. In-depth interviews were conducted as semi-structured research questions were elaborated to the participants in an open-ended form to analysis of their risk perception. But the questions varied with respect to older adults’ suggestions, modifying or eliminating some questions as well. The discussions lasted 40 minutes to 1 hour; and these were recorded with prior authorization of participants.
I found that people’s perception of risk of COVID-19 infection changes as they age older. Generally, the importance to stay alive deteriorate with the increasing age, and younger-old (age 60-69 years) people tend to underestimate the aged-related risks.
“I am retired now…I feel like my life is already over. I am lucky that I’m able to fulfill all my wishes. Thus I am not thinking much about the risks of COVID infection, at least for myself.”
(Male, age 81 years)
“I’m an old lady, I have already lived my whole life, and now, I have to die sooner or later. And I am ready for that.”
(Female, age 79 years)
“I don’t want to feel like old. I still take care of my responsibilities, as well as our children seriously. So, I am not thinking about any age-related risks.”
(Male, age 61 years)
Elderly people are putting their own risk on the back burner, and thinking more about their children. The present study showed that fears related to the risk of COVID-19 infection are more prevalent among older women, and spirituality plays a huge role to create positivity among them.
“My daughter is living far away from my place, and they are presently in a containment zone. The risk of infection and reason for my fear is much more for them.”
(Male, age 82 years)
“For me, the only fear is the health of my husband. And I see deterioration there. He has to visit the market and bank for our daily needs. Thus, I am worried about this situation”
(Female, age 68 years)
“I’m mentally very composed of myself. I believe a lot in my god, and praying all the time for my son and his family. They are not staying in India. God will surely take care of them.” (Female, age 65 years)
The financial status also plays a big role in the self-perception of the elderly population regarding the risk of the COVID19 pandemic. I found that perceptions and thought processes differed from the financially secure to insecure older adults, as financially secure elderly have the pleasure to take a break from work during amidst pandemic situations by keeping in mind about the risk factors while financially insecure elderly are not as delighted as their counterpart.
“We are five members in a family and my son is the only source of income. He is in a private job and we don’t have much savings as well. I am scared to think how much we will be able to sustain if it continues this way.”
(Female, age 82 years)
“I am a retired govt. bank manager and I have a fixed pension to live my life. In this difficult time, I have taken full responsibility for my caretaker’s family of our flat. I also donated rice and money to the local club, as they are very active to protect every deprived group.”
(Male, age 73 years)
“My income is highly dependent upon my hotel business, due to pandemic and locks down all the hotels are closed now. And I am not sure, even post-lockdown, people will start staying in hotels or not, might be they will afraid to do so…I am in big trouble. I am in economic risk and I have no time to think about the risks of my health.”
(Male, age 62 years)
The most significant response reported from several elderly is the risk of seeking health care or intervention for their medical complications, which ultimately jeopardize their psychical and psychological health.
“I have postponed my cataract surgery as it is not an immediate issue, but I also don’t know when I will be able to do so. This insecurity bothered me a lot”
(Male, age 82 years)
“I have several medical conditions including high blood pressure, diabetes, and osteoarthritis… So my family suggested me to postpone my monthly doctor visit. I also knew that the risk of COVID-19 infection is high for me.”
(Female, age 78 years)
The findings of this study showed that ‘aging’ is not the single marker to consider for risk assessment. Additionally, it suggests that being women, staying alone or with a spouse but without children, and/or socio-economically deprivation has a significant impact on the perspectives of risk factors during the COVID-19 pandemic, which required acknowledgment by the policymakers and gerontologists of extremely-heterogeneous sub-continent like India. In general, fear of seeking health care amidst pandemic situation is quite common among the geriatric population. Thus, it’s important to evaluate the priority areas of the elderly population for program development to prevent the potential spread of COVID-19 infection among the geriatric group.
Ph.D. Research Scholar, Biological Anthropology Unit,
Indian Statistical Institute, 203 Barrackpore Trunk Road, Kolkata– 700108, India
Email id: firstname.lastname@example.org
1 Ministry of Health and Family Welfare (MoHFW), Government of India (2020). Health Advisory for Elderly Population of India during COVID19. Retrieved from https://www.mohfw.gov.in/pdf/AdvisoryforElderlyPopulation.pdf [Accessed on 118.07.2020]
2 WHO (2020). COVID-19 Strategy Update. Retrieved from https://www.who.int/publications-detail/covid-19-strategy-update—14-april-2020 [Accessed on 118.07.2020]
3 Santini, Ziggi Ivan, et al. “Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis.” The Lancet Public Health 5.1 (2020): e62-e70.https://doi.org/10.1016/S2468-2667(19)30230-0
4 Wang, Cuiyan, et al. “Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.” International journal of environmental research and public health 17.5 (2020): 1729. https://doi.org/10.3390/ijerph17051729