Journal Identification = NRP Article Identification = 0630 Date: June 21, 2021 Time: 1:15 pm
doi:10.1684/nrp.2021.0630
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Rev Neuropsychol
2020 ; 12 (S1) : 43-5
Aging during
and after the great lockdown * Vieillir durant
et après le grand confinement
Sylvie Belleville1,2, Ana Ines Ansaldo1,2, Mylene Aubertin-Leheudre1,3, Nathalie Bier1,2,
Thien Thanh Dang-Vu1,2,4, Pierre Rainville1,2
1Centre de recherche de l’Institut universitaire de gériatrie de Montréal du CIUSSS-CSMTL
2Université de Montréal
<sylvie.belleville@umontreal.ca>
3UQAM
4Université Concordia
To cite this article: Belleville S, Ansaldo AI, Aubertin-Leheudre M, Bier N, Dang-Vu TT, Rainville P. Aging dur- ing and after the great lockdown.
Rev Neuropsychol 2020;12(S1):43-5 doi:10.1684/nrp.2021.0630
T
he Covid-19 pandemic is a global disaster that has caused distress, disappointment and death. It also highlights society’s consideration for seniors and the plight of the most vulnerable among them. Many lessons can be learned from the way seniors are treated by society, which needs to be restructured to better meet their needs.For more than 30 years, scientists and clinicians inter- ested in the biological, psychological and social dimensions of aging have been trying to convince decision-makers of the need for a major shift to build a society that takes into account an aging population. In Canada for exam- ple, the number of people over age 65 exceeds the number of children. Within 20 years, 25% of Canadians will be over age 65. This demographic revolution will impact all facets of society and calls for major transformative actions.
Seniors have heard and supported this analysis, and are well aware of the challenges they face. However, society has been slow to implement the conditions needed to create and maintain inclusive living conditions for them. These actions may be viewed as daring or even revolutionary in some respects, but they require strong will and political courage from decision-makers.
∗This article is an English language translation of the following article: Belleville S, Ansaldo AI, Aubertin-Leheudre M, Bier N, Dang- Vu TT, Rainville P. Vieillir durant et après le grand confinement.Rev Neuropsychol2020 ; 12 (2) : 161-3. doi:10.1684/nrp.2020.0559.
Correspondence:
S. Belleville
Making seniors a priority
Making seniors a central priority in society means first recognizing the great diversity in aging trajectories. Thus, health status, not age, should be the criterion for determin- ing the care and resources needed. For example, a healthy octogenarian has different needs than a septuagenarian liv- ing with advanced Alzheimer’s disease, a chronic disease or physical disabilities. Recognizing this diversity is necessary to avoid labels, prejudice, ageism and stigma.
Listening to older people’s individual and collective pri- orities and aspirations as they age should be part of the solution – and their insights may be surprising. For example, research shows that older adults are less concerned with life- threatening illnesses than health problems that could affect their autonomy, social participation and quality of life, such as memory problems, communication disorders, falls, pain, depression, poor sleep and loss of muscle strength. During the pandemic and lockdown, older people have repeatedly voiced their concerns about their quality of life, and that they wish to be part of the conversation.
Long-term care
During the recent lockdown, there have been many con- cerns about the situation in the Centres d’hébergement et de soins de longue durée (CHSLD), the Quebec equivalent of long-term care facilities or EHPADs in France– and it has been a rude awakening. Long-standing problems have been
Journal Identification = NRP Article Identification = 0630 Date: June 21, 2021 Time: 1:15 pm
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aggravated by the crisis: a crying lack of staff and resources, a lack of protection and training for staff, the transfer of infected patients from hospitals to these fragile environ- ments and, at the beginning of the crisis, a disproportionate effort focused on protecting hospitals to the detriment of CHSLDs. Yet it was known that seniors were the most vul- nerable to the disease. Many spoke of a real humanitarian disaster.
The issues related to long-term care are not new, but it is very important that concrete solutions be brought for- ward to support more humane care and living conditions in CHSLDs. Some of these solutions need to be implemented quickly: improving the working conditions of patient care attendants – who function as orderlies in Quebec – and other health professionals, who work in these environments with passion and commitment; rethinking current physical environments that are often dilapidated and poorly adapted;
creating new spaces such as the Maisons des aînés, co-living communities with outdoor spaces and personalized support that are welcoming and inviting for people to live and work there. Admittedly, the long-term care model will have to be thoroughly transformed in the future.
More must be done to go beyond the physical needs of seniors and create conditions that promote well-being, as well as cognitive and mental health in these environments while remaining connected to society. Why are people liv- ing in long-term care hidden? Why don’t we see them more often in public settings, like museums and sidewalks?
More and more people with physical disabilities are safely reclaiming public places, and this should also be possible for the very old, even for those with significant physical or cognitive disabilities. Recognition and understanding also helps destigmatize these conditions and reduce people’s fears.
Responding to seniors’ desire to age at home
The societal revolution, which we are calling for to bene- fit seniors, should not be limited to those living in long-term care facilities. We believe that it is equally vital to be proac- tive and take action before seniors are institutionalized in long-term care. It is important to remember that most Que- becers over age 65 live in their own homes, and all the data indicate that people wish to stay there for as long as possible as they age. They do not want to leave their environment and lose their bearings.
Aging at home may seem simple, but in fact the chal- lenges are significant because health conditions that limit autonomy accumulate with age. In many cases, living in a CHSLD appears to be the only solution in the absence of ser- vices that allow people to live at home. Hence, approaches must be developed to detect and respond effectively to conditions that put seniors at risk, so that those who wish to stay at home may do so for as long as possible.
The success of these approaches will be based on the establishment of a flexible home support network adapted to the status and autonomy of individuals. For this provincially-funded network to be effective, it must be deployed and managed locally at a human scale. This net- work must not be dependent on cumbersome administrative structures, which are not always adapted to the needs of older adults and the most vulnerable seniors, as we have seen in Quebec. It will be necessary to work in a con- certed manner in close collaboration with neighbourhoods and communities to better support isolated seniors and pro- vide support adapted to their needs. It will be essential to mobilize and coordinate these institutions, which currently operate in virtual isolation: municipalities, health and social services systems, community settings, businesses, etc.
Research and innovation in the service of aging
In this context, we strongly believe that research and innovation must be part of the solution. We pride ourselves on our society’s innovations, but it is time to put them to work for seniors. Obviously, innovation can only have a real impact if we also improve working conditions for those in the field. Home care in Quebec has long been neglected by investments in health care, the shortage of personnel is glaring, turnover is exceedingly high, and management is suboptimal. Patient care attendants must be valued and adequately trained and their voices must be heard, just like that of caregivers, as they spend the most time in the field.
Health research, especially in the field of aging, increas- ingly integrates seniors and caregivers to define and achieve knowledge development objectives to improve our prac- tices. Integrating the people, who are directly responsible for this care, will likely increase the impact of this research. We must collectively commit to including patient care atten- dants and managers as well as community organizations, which are playing an increasingly important role in rein- venting the way we care for seniors.
Researchers and funding agencies have been aware of these issues for decades, and structures have been put in place to link users, researchers and industry. However, these structures have been clearly insufficient. Researchers also need to be heard by decision-makers.
The impact of digital technology
As researchers in geriatrics and gerontology, we are asked about our role in this pandemic and how we could have contributed by implementing the innovations we are developing to benefit society. The objectives of the programs developed by our research teams include the identification of real-world challenges for seniors and the development of personalized interventions, which are offered when needed
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and directly in the individual’s environment. However, these programs have been slow to be deployed out of the laboratory and into real-life settings.
Yet some of these innovations could have made a difference had they already been integrated into the com- munity. For example, innovations in digital health could have helped remotely identify people who are at risk or reduce the distress of seniors in lockdown. These inno- vations could also have made possible the administration of preventive interventions that promote the maintenance of physical, psychological and cognitive health. Technol- ogy can make a difference: for example, avoiding staff travel, meeting the needs of more people, ensuring the right service is provided at the right time, providing remote rehabilitation and implementing prevention strategies. We must therefore promote access to these services. Why not equip all seniors with an Internet connection and the lat- est digital technologies, which would allow for better care, and staying active and connected to the world? Why not equip all caregivers with telehealth solutions, including health and social services at home? In this time of pan- demic, many healthcare professionals have been quick to implement telehealth initiatives. Family meetings using electronic tablets have multiplied. The pandemic has thus made it possible to disseminate innovations that were pre- viously perceived as marginal or even unsuitable on a large scale.
In summary, the inclusion and support of seniors in our society must be based on a comprehensive approach that takes into account both the opportunities and chal- lenges of aging as well as the needs voiced by seniors and the technological advancements from our laboratories.
The ultimate goal is to ensure that society includes older adults and draws from their experience, while supporting their health and well-being through an adapted environ- ment, as well as policy, social and health measures. Our dream is that this challenge will lead to a society where the development, acceleration and implementation of social, technological and digital innovations will be driven by a vision that respects and supports older adults, while also contributing to a knowledge-based and innovative econ- omy that benefits the health and well-being of society as a whole.
Acknowledgements
SB is a neuropsychologist, full professor and Canada Research Chair in Cognitive Neuroscience of Aging and Brain Plasticity. AIA is a speech-language pathologist, researcher and full professor. MAL is a kinesiologist, full professor and a Fonds de recherche du Québec – Santé scholar. NB is an occupational therapist, full professor and research fellow supported by the Fonds de recherche du Québec-Santé. TTDV is a neurologist, full professor and researcher-fellow supported by the Fonds de recherche du Québec-Santé. PR is a full professor and researcher in neu- roscience. Thanks to Laurent Mottron for his feedback on the first versions of this manuscript. Thanks to Renée-Pier Filiou and Annie Webb for translation and English revision support.
Conflict of interest None.
