Ronald Lundquist, 87, has been active all his life. So, he wasn鈥檛 prepared for what happened when he stopped going out during the coronavirus pandemic and spent most of his time, inactive, at home.
鈥淚 found it hard to get up and get out of bed,鈥 said Lundquist, who lives with his wife of 67 years in Palm Springs, California. 鈥淚 just wanted to lay around. I lost my desire to do things.鈥
Physically, Lundquist noticed that getting up out of a chair was difficult, as was getting into and out of his car. 鈥淚 was praying 鈥楲ord, give me some strength.鈥 I kind of felt, I鈥檓 on my way out 鈥 I鈥檓 not going to make it,鈥 he admitted.
One little-discussed, long-term toll of the pandemic: Large numbers of older adults have become physically and cognitively debilitated and less able to care for themselves during 15 months of sheltering in place.
No large-scale studies have documented the extent of this phenomenon. But physicians, physical therapists and health plan leaders said the prospect of increased impairment and frailty in the older population is a growing concern.
鈥淎nyone who cares for older adults has seen a significant decline in functioning as people have been less active,鈥 said Dr. Jonathan Bean, an expert in geriatric rehabilitation and director of the New England Geriatric Research, Education and Clinical Center at the Veterans Affairs Boston Healthcare System.
Bean鈥檚 90-year-old mother, who lives in an assisted living facility, is a case in point. Before the pandemic, she could walk with a walker, engage in conversation and manage going to the bathroom. Now, she depends on a wheelchair and 鈥渉er dementia has rapidly accelerated 鈥 she can鈥檛 really care for herself,鈥 the doctor said.
Bean said his mother is no longer able to benefit from rehabilitative therapies. But many older adults might be able to realize improvements if given proper attention.
鈥淚mmobility and debility are outcomes to this horrific pandemic that people aren鈥檛 even talking about yet,鈥 said Linda Teodosio, a physical therapist and division rehabilitation manager in Bayada Home Health Care鈥檚 Towson, Maryland, office. 鈥淲hat I鈥檇 love to see is a national effort, maybe by the CDC [U.S. Centers for Disease Control and Prevention], focused on helping older people overcome these kinds of impairments.鈥
The extent of the need is substantial, by many accounts. Teodosio said she and her staff have seen a 鈥渢remendous increase鈥 in falls and in the exacerbation of chronic illnesses such as diabetes, congestive heart failure and chronic obstructive pulmonary disease.
鈥淥lder adults got off schedule during the pandemic,鈥 she explained, and 鈥渢hey didn鈥檛 eat well, they didn鈥檛 hydrate properly, they didn鈥檛 move, they got weaker.鈥
Dr. Lauren Jan Gleason, a geriatrician and assistant professor of medicine at the University of Chicago, said many older patients have lost muscle mass and strength this past year and are having difficulties with mobility and balance they didn鈥檛 have previously.
鈥淚鈥檓 seeing weight gain and weight loss, and a lot more depression,鈥 she noted.
Mary Louise Amilicia, 67, of East Meadow, New York, put on more than 100 pounds while staying at home round-the-clock and taking care of her husband Frank, 69, who was hospitalized with a severe case of covid-19 in early December. While Amilicia also tested positive for the virus, she had a mild case.
鈥淲e were in the house every day 24/7, except when we had to go to the doctor, and when he got sick I had to do all the stuff he used to do,鈥 Amilicia told me. 鈥淚t was a lot of stress. I just began eating everything in sight and not taking care of myself.鈥
The extra weight made it hard to move around, and Amilicia fell several times after Christmas, fortunately without sustaining serious injuries.
After coming home from the hospital, Frank couldn鈥檛 get out of a chair, walk 10 feet to the bathroom or climb the stairs in his house. Instead, he spent most of the day in a recliner, relying on his wife for help.
Now, the couple is getting physical therapy from Northwell Health, New York state鈥檚 largest health care system. Just before the pandemic, Northwell launched a 鈥渞ehabilitation at home鈥 program for patients who otherwise would have seen therapists in outpatient facilities. (Medicare Part B pays for the treatments.)
The program is serving more than 100 patients on Long Island, in Westchester County and in parts of New York City. 鈥淭he demand is very strong and we鈥檙e in the process of hiring another 20 therapists,鈥 said Nina DePaola, Northwell鈥檚 vice president of post-acute services.
Sabaa Mundia, a physical therapist working with the Amilicias, said Mary Louise can walk up to 400 feet without a walker, after doing strengthening exercises twice a week over the course of three weeks. Frank had been using a wheelchair and is now regularly walking 150 feet with a walker after more than a month of therapy.
鈥淥lder adults can lose about 20% of their muscle mass if they don鈥檛 walk for up to five days,鈥 Mundia said. 鈥淎nd their endurance decreases, their stamina decreases, and their range of motion decreases.鈥
Recognizing that risk, some health plans have been reaching out to older members to assess how they鈥檙e faring. In Massachusetts, Commonwealth Care Alliance serves more than 10,000 older adults who are poor and eligible for both Medicare and Medicaid, the federal-state program for people with low incomes. On average, they tend to have more medical needs than similarly aged seniors.
Between March and September last year, the plan鈥檚 staffers conducted 鈥渨ellness outreach assessments鈥 by phone every two weeks, asking about ongoing medical care, new physical and emotional challenges, and the adequacy of available help, among other concerns. Today, calls are made monthly and staffers have resumed seeing members in person.
An increase in physical deconditioning is one of the big issues that have emerged. 鈥淲e鈥檝e had physical therapists digitally engage with members to coach them through strength and balance training,鈥 said Dr. Robert MacArthur, a geriatrician and Commonwealth Care鈥檚 chief medical officer. 鈥淎nd when that didn鈥檛 work, we sent therapists into people鈥檚 homes.鈥
In California, SCAN Health Plan serves a similarly vulnerable population of nearly 15,000 older adults dually eligible for Medicare and Medicaid through its Medicare Advantage plans. Care navigators are calling these members frequently and telling them 鈥渘ow that you鈥檙e vaccinated, it鈥檚 safe to go see your doctor in person,鈥 said Eve Gelb, SCAN鈥檚 senior vice president of health care services. Doctors can then evaluate unmet health needs and make referrals to physical and occupational therapists, if necessary.
Another SCAN program, Member2Member, pairs older adult 鈥減eer health advocates鈥 with members who have noted physical or emotional difficulties on health risk assessments. That鈥檚 how Lundquist in Palm Springs connected with Jerry Payne, 79, a peer advocate who calls him regularly and helped him come up with a plan to emerge from his pandemic-induced funk.
鈥淔irst, he said, 鈥楻on, you should try getting up every hour and taking a few steps鈥 鈥 that was the start of it,鈥 Lundquist told me. 鈥淭hen, he鈥檇 suggest walking another block when I would take my dog out. It was painful. Walking was not pleasant. But he was very encouraging.鈥
A month ago, Payne had a Fitbit sent to Lundquist. At first, Lundquist walked about 1,500 steps a day; now, he鈥檚 up to more than 5,000 steps a day and has a goal of reaching 10,000 steps. 鈥淚鈥檓 sleeping better and I feel so much better all around,鈥 Lundquist said. 鈥淢y whole attitude and physicality has changed. I tell you, this has been an answer to my prayers.鈥
Coming Monday: Tips for Older Adults to Regain Their Game
We鈥檙e eager to hear from readers about questions you鈥檇 like answered, problems you鈥檝e been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.
Correction: This story was updated at 10:25 a.m. ET May 24 to correct the spelling of Ronald Lundquist’s name.
