CCBI News – The Elderly: Social Isolation, Adverse Health Effects, Accompaniment, Care; Francis on Aging; Heat Waves and Seniors

June 24, 2022

(Today is both the Solemnity of the Sacred Heart of Jesus and the Feast of Saint John the Baptist / Fête de la Saint-Jean-Baptiste)

Dear Friends of CCBI,

Social Isolation and the Elderly: National Institute on Ageing

We know that Pope Francis frequently recommends ‘accompaniment’ on the journey, whether it be with the newly married or with the sick, and in his current catechesis on the elderly at his weekly audiences he requests the same for those at this stage. A new report from the National Institute on Ageing (NIA) based at Toronto Metropolitan University (formerly Ryerson) reveals social and medical problems experienced by Canadians in their senior years, 65 years and older: 12 percent feel socially isolated and 24 per cent report low social participation. Close to 25 per cent of older women and 20 per cent of older men report feeling lonely at least some of the time. Some groups may be particularly vulnerable to these conditions, including older adults living in rural and remote communities, immigrants, Indigenous peoples, caregivers and those with lower incomes. Feelings of isolation are more than existential and personal but also have ethical and societal implications, since the report points out that isolation and loneliness have been linked to a range of poor health outcomes among older adults, telling us that, “…adults over 50 experiencing social isolation or loneliness are 50 per cent more likely to develop dementia, 32 per cent more likely to have a stroke, and at a 45 per cent greater risk of premature death.” These are sizeable numbers giving cause for concern for not only the frail elderly, as we might expect, but also for all those over 50 – hardly senior citizens! These numbers clearly take a toll on Canada’s health-care system, since the report links social isolation to increased hospitalization, emergency department visits and use of primary-care services, as well as longer hospital stays.

To combat these problems, several strategies are suggested, for example, “Raise public and health-provider awareness about the risks of social isolation and loneliness to people of all ages, including the adverse health effects. Ensure research efforts continue to focus on understanding the impact of social isolation and loneliness in Canada, as well as evaluating the effectiveness of interventions to address it at the local, regional and national levels. Build the collective capacity of organizations to address social isolation and loneliness and improve overall service delivery.” From a Catholic perspective on preventive health care, could parish communities or accompanying groups be part of these strategies?

Pope Francis’ Catechesis on Aging and the Elderly

While the Pope encourages accompaniment of the elderly, at the same time he urges them towards greater realism about the challenges that arise during this stage of life. Instead of denying problems (‘I’m fine!’) or treating illness as a ‘battle,’ he asks the elderly to move towards a path of trust and acceptance, giving peace of mind and developing a spiritual maturity that eventually sees frailty as inevitable, as is willingly receiving help from others. Recognizing that throughout life there is a certain balance between independence and dependence on others, he reminds us to be wary of clinging through pride to being ‘in control,’ which is ultimately illusory. Everyone needs help at some stage, and we are definitely not in control!

In his audience for June the Pope recalled Jesus’ words to St. Peter, “…when you were younger, you used to dress yourself and go where you wanted; but when you grow old, you will stretch out your hands, and someone else will dress you and lead you where you do not want to go.” He added wryly, “Tell me about having to go in a wheelchair, eh!…But that’s how it is, that’s how life is: with old age you get all these diseases, and we have to accept them as they come, don’t we?” He lives what he preaches.

World Meeting of Families and Care of the Elderly

A speaker at the World Meeting of Families announced: “Elderly people are treasures and caring for them should be looked at not as a burden but an opportunity for blessing.”  He recommends keeping the elderly living with or close to us, and it would certainly be wonderful if this idea could be more universal. These days, given families scattered for reasons of career and opportunities, it is not always possible. Added to that, people are living longer so that even the children of the elderly are sometimes quite elderly themselves, not able to care for parents and their needs on a full-time basis. Referring back to the first section in today’s NEWS, we are seeing statistics that show that loneliness and social isolation are experienced by large numbers of the elderly, exacerbated but not caused by COVID-19. While I agree with the author’s recommendation about extended families living together, I am afraid it does not ‘hit the mark’ these days in many societies. It seems we own bigger houses than in previous eras but with fewer people in them, including babies and grandparents. That tells us something about current priorities!

Fortunately, he makes another proposal which could be more practicable for Catholic or other communities, although perhaps still difficult. He suggests “putting the elderly at the centre,” imagining them as the hub of a wheel around which a parish should revolve. We should not concentrate only on youth, in case by doing so we lose the experience and wisdom of the elderly. I started to think of this in another way: if the Church concentrated on listening only to younger priests, ignoring the wisdom of cardinals and bishops, it would be in a sorry state! I see families and society in the same way – the wisdom of the elderly is important.

The author comes up with an approach echoed by the practice of synodality, where people can tell their stories and have a voice. Young and old could be brought together in semi-synodal fashion to see what might develop for the future from such a meeting. There is an ethical and bioethical component to this, a duty to the elderly to help and care for them and their bodily needs as well as, hopefully, an innate willingness to do so.

Both younger people and mid-life generations need to realize that existential, spiritual and moral challenges play an important role in the emotional and mental health of the elderly, with consequences for physical health, shown in the NIA report. Relevant education could be undertaken in a parish community, the author suggests, where the elderly could be more actively engaged as the ‘hub.’ The NIA urges this type of involvement and Pope Francis practically begs society to value and respect the elderly rather than to ‘discard’ them. In many ways they have the same goal, while Pope Francis reminds Catholics time after time that, as members of the Body of Christ we are called to help and respect all the other members, including the elderly. 

PR+-+Social+Isolation+-+FINAL.pdf (squarespace.com) 

Heat Waves and Seniors
Dr Rory Fisher

The report “Extreme Heat and Human Mortality: A Review of Heat- Related Deaths in BC in Summer 2021” highlights the excess mortality of seniors during that heat wave. Excess deaths amongst seniors were a major issue in the heat waves in Europe in 2003 and in Chicago in 1995. With climate change, these events will become more frequent. Already this year, the southern US and Europe are experiencing very high temperatures so a greater awareness of the dangers to seniors is particularly important. Heat waves present a clear and present danger to the elderly, and there needs to be an increased public awareness of the problem.

The World Meteorological Organization defines a heat wave as one in which there is a temperature of 5 degrees Celsius over the normal maximum for several consecutive days. In Toronto, a heat warning is issued if there is a forecast of two or more days with a daytime maximum of 31 degrees C or more with a nighttime temperature of 20 degrees C or warmer. The Urban Heat Island Effect in major cities shows localized increased temperature variations due to asphalt and concrete replacing trees and green spaces, which is very helpful in identifying areas of greatest heat intensity and risk. Maps of such areas are available in Montreal and other major cities.

The body’s temperature is kept at 38 degrees C by a fine balance between heat production by the body’s metabolism, physical exercise, the ambient temperature, and heat loss due to evaporation, conduction and convection. Evaporation is not successful in very humid conditions. Heat loss in hot weather is increased by sweating, dilatation of blood vessels near the skin, and increased output by the heart, with a redirection of blood from the internal organs to the skin. Within several days people adapt better to the conditions.

Seniors are at more risk because these methods of heat loss may not be as effective as in younger adults due to decreased sweating, less effective blood flow to the skin and a smaller increase in heart output. Secondly, seniors with chronic respiratory diseases, heart disease, asthma, epilepsy, and cognitive impairment are at greater risk. The risks for all the elderly are increased when the air quality deteriorates and causes smog, which is often the case in large cities during heat waves. Medications such as antidepressants, other psychiatric medications, anti-Parkinson medication and diuretics add to the risks. Living circumstances may contribute if they are living in old non-air-conditioned apartments in older downtown areas where an Urban Island Heat Effect is a factor.

When heat production exceeds heat loss, the body’s temperature rises and can lead, first, to heat cramps, with painful spasms of the legs or the stomach muscles. Secondly, more serious heat exhaustion may cause loss of appetite, nausea, vomiting, weakness. Headaches, lightheadedness and fainting may be present. Finally in more advanced cases, heat stroke can occur with an absence of sweating, confusion, agitation, hallucinations, and seizures. Treatment consists of emergency rapid cooling of the patient with replacing fluids and electrolytes.

As preventive measures, seniors should avoid exercise, and heavy meals. They should wear light clothes and decrease the intake of alcohol and caffeine. Cool showers and cool sponging are also of value. Seniors should avoid going out in the maximum heat of the day if possible. Advantage should be taken of an air-conditioned environment when possible. Air conditioning is highly advised for seniors’ homes and should be essential in long term facilities. If not available in the seniors’ homes, use can be made of public libraries, community centers, shopping malls and cinemas though there may be concerns of using these areas because of the pandemic. Homes should be kept cool with fans and drawn curtains on the sunny side of the building are important measures. Reduced use of stoves or ovens is advisable. Windows may be opened wide at night, in non-air-conditioned homes if this may be done safely.

In summary seniors, their families, informal and formal caregivers need to be alert to the very serious threat posed by the increasing number of heat waves due to climate change. This is a public health issue of increasing importance. Building codes need to be adapted to ensure better temperature control. Heat warnings needed to be taken very seriously. Preventive measures and an early response to symptoms by taking measures to keep cool and replacing fluids are essential in preventing unnecessary deaths.

Pope Francis’ Intentions for June

We pray for Christian families around the world; may they embody and experience unconditional love and advance in holiness in their daily lives.

Moira, Rory and Bambi