As COVID-19 Hits Older Persons, Asia’s ‘Grey Divide’ Deepens

The older persons who have helped build Asia’s societies need extra support during the pandemic. Photo: ADB
The older persons who have helped build Asia’s societies need extra support during the pandemic. Photo: ADB

By Aiko Kikkawa, Lilibeth Poot, Donghyun Park

While the pandemic has affected the entire population, it has had a disproportionate impact on the older generation that built this region’s prosperity. We owe it to older persons to pursue policies that help them to make it through the crisis healthy and happy.

COVID-19 has claimed the lives of tens of thousands of people in Asia and the Pacific, and continues to threaten our health, livelihoods, and wellbeing.  While the pandemic has affected the entire population, it has had a disproportionate impact on older persons. Individuals age 60 years old and above account for 53% of total deaths in India and 44% in Indonesia.  In rapidly aging People’s Republic of China the share is as high as 81%.  Weaker immune systems coupled with high incidence of comorbidity among older persons are major contributing factors.

Measures that limit mobility have proven effective in containing the panic and protecting vulnerable population groups, including seniors. However, prolonged stay-at-home orders and other social restrictions can compromise the ability to access basic needs such as food and health service, as well as the overall health of older persons. There is growing evidence that restrictions affect both physical and mental health.

Extended stay-at-home periods are taking a toll on the physical health and ability of older persons. The pandemic has significantly decreased all types of physical activity, from casual walking to more rigorous physical exercise.  In Japan, older persons reported that they cut physical activity by 30% since the advent of COVID-19.  Postponement of regular visits to doctors and check-ups due to fear of infection can also harm their physical health.

The impact of pandemic-induced social isolation to the mental health of older people is well documented. A study in the People’s Republic of China showed that about 37% of older persons experienced depression and anxiety during the pandemic.  Meanwhile, longitudinal data shows that the lack of social interaction such as meeting friends and relatives outside the home is linked with higher risks of depression and premature death.  

The same study, along with others, also points out that physical distancing can reinforce the decline in cognitive functions – such as memory, processing speed, thinking, and language – due to old age.  Seniors with impaired cognitive abilities often have difficulty understanding and observing precautionary measures against infection. Dementia patients might suffer from behavioral problems and wandering tendencies that compromise health and safety protocols.

Physical distancing has proven effective in reducing COVID-19 infections. However, older people are more likely to be in social isolation and more prone to loneliness, grief, anxiety, and depression when social capital or the less tangible assets of personal and community networks are undermined. The impact of physical inactivity extends beyond physical wellness. Therefore, it is advisable for authorities to allow some social participation for seniors rather than restrict their movement altogether even as they maintain physical distancing to contain the pandemic.

A wide range of practical solutions can allay fear among older persons and help them adapt better to the COVID-19 environment. For example, health information campaigns relating to COVID-19 prevention can be delivered in the way that is easier for older persons to understand. Public messaging should stress the importance of maintaining physical activities and social connections while complying with mobility restriction protocols. This can mitigate social isolation and its harmful consequences. At the same time, care service providers and mental healthcare facilities should be ramped up to prepare for a possible surge in caseloads since COVID-19 takes a heavy toll on the physical and mental health of older persons.

Multiple generations living together is common in the region and there is a greater burden for family members, especially women who tend to provide informal care. The prolonged fight against the pandemic necessitates extending support to these informal caregivers. The support can initially be mainly virtual before gradually shifting to direct methods such as day-care and on-site visits. Many developing countries in Asia are preparing to establish a system of long-term care and these efforts can be strengthened into an important pillar for supporting older persons in the stressful COVID-19 environment.

Support to older persons, especially the poor and low-income seniors, is important during shocks, whether health or economic in nature. Studies show that socioeconomic status factors such as income, education, or employment are significantly linked to health status.  Efforts should particularly be devoted to putting in place measures that will facilitate access of older persons to health care and other support services.

Older persons built the societies in Asia and the Pacific that are enjoyed by the broader population today.

One group of older persons who deserve special attention are older persons living alone. The proportion of people living alone increases especially after the age of 50, with the highest observed among those aged 80 and above, particularly among widowed women. Some 21% of women in the age group in Mongolia live by themselves, followed by Indonesia (18%), Viet Nam (17%), and the People’s Republic of China (16%).

They often remain unnoticed despite facing the highest risk of health deterioration. Regular visits from community members, volunteers, and service providers, such as those practiced by Thailand’s Village Health Volunteers, can provide important social connections, increase resilience and prevent negative health conditions.

Innovative solutions such as expansion of telehealth services can contribute to uninterrupted access of senior citizens to healthcare. Many are hesitant to visit clinics and hospitals for fear of getting infected with COVID-19. Telehealth services can also be a tool to maintain regular consultation with other older persons. Digital media such as social networking and video chat apps can help older people maintain communication with family and friends.

Older persons in developing countries in Asia suffer from the double burden of a digital and grey divide. Greater efforts to enhance digital literacy among older persons are needed; and families and friends can play a big role in closing the divide. Age-friendly technological advancement can also be promoted through public and venture capital investments that fund initiatives to change the way seniors engage with technology.

Older persons built the societies in Asia and the Pacific that are enjoyed by the broader population today. We owe it to this important segment of society to recognize the unique challenges they face during the pandemic and to help them to make it through healthy and happy.