Elderly in South Africa under extreme pressure

In the time of the Covid-19 pandemic, the elderly in our families and communities are under significant threat, as is evident from the ages of those who have died in our own country.

Medical researchers guiding societal responses to Covid-19 have identified the elderly as at greater risk from the disease.

In South Africa, the latest figures show that 60% of the country’s Covid-19 deaths have been of people older than 60 years.

It doesn’t mean that being old on its own will lead to death, but that the elderly, and those with chronic comorbidities, are both susceptible to infection and are limited in their ability to fight the more serious effects of infection.

The societal challenges for the elderly under normal conditions are immense, with neither social infrastructure nor services being supportive of the needs of elderly people.

Director of UCT’s Walter and Albertina Sisulu Institute for Ageing in Africa, Dr Sebastiana Kalula, says the Covid-19 pandemic had affected older people “quite severely”, exacerbating their situations.

Apart from the real clinical challenge of the disease, and the overwhelming need to protect themselves against infection, there are the stress and anxiety caused by the suggestion of impending death, the disruptions in relations with loved ones, the breakdown in supportive social networks caused by social distancing, voluntary or enforced isolation and the halting of regular routines.

In many poor communities — especially in rural provinces like the Eastern Cape — elderly women are the primary caregivers of their grandchildren, either because the child is orphaned or the child’s parents are forced to migrate elsewhere for employment opportunities.

“The concern for older people is that if at all they get infected, the prognosis is not as good as for the young people.

"‘Will I survive this pandemic?’ must be a question older people ask themselves — that restricts their lives even more by trying to avoid contact at all, which is difficult if they are living with their grandchildren,” says Kalula.

“When schools start, that will be a concern.

"‘How do I avoid being at risk and having my grandchildren going out there — to school or work. What is my risk, will I be able to continue looking after them?’”

The social distancing measures and the lockdown in particular have restructured the social network of elderly people.

“This is a time of anxiety and depression and we all need a network to interact with people to help us get over the thoughts we are having and help us seek the answers.

“The elderly also need a network of people who talk to, help and visit each other. That has been restricted.

“They do not have the kind of electronic networks others have such as WhatsApp, which can allow someone to share a joke with them. That can lead one to having negative thoughts all the time.

“Routines are important. They give a purpose to each day.

“It is easy to say ‘I am on my own. Why should I get up, dress? I am at risk of infection. I’m not going to go out’.”

And depending on where one lives, says Kalula, it may not be safe to to do the usual things which bring one into contact with others.

“It can be a challenge to restructure one’s life and say this is what I used to do and this is how I will change my life.

“It all depends if one is living alone or not.

“If one is living with other people, someone can organise alternative means of activity.”

She says vast numbers of grandmothers are the primary caregivers for their grandchildren.

Under normal circumstances they had to take care of the children, “never mind” their own needs.

“That is difficult enough in a normal situation.

“It depends on the age of the children they are caring for [but] all this time during lockdown they have had children at home.

“How many of the grannies can do home schooling, let alone having the ability to provide for the children’s daily needs?

“Now they must worry about how they provide for the family the whole day, provide three meals a day, seven days a week, entertain the children and make sure that the welfare of the children is good.

“There is no cushion for them to deal with those issues, which create anxiety and depression.

“If you say to anyone, ‘if you do this you are going to die’, it will create anxiety and depression.

“It’s important not to make them feel so vulnerable. Give them a more positive role to play in being advocates for more preventive measures, focus on encouraging their grandchildren to focus on hygiene, to maintain routines, rather than saying ‘you are going to die’.”

She says self-isolation is not practical for most people and especially for the elderly.

However, if other preventive measures, such as basic hygiene, are practised “everywhere — when young people go out and work and when they come home — we can protect older people”.

By looking after their grandchildren so that parents can migrate to work opportunities elsewhere, older people contribute a lot to the economy but their contributions “remain invisible”.

“The grandparents enable the young population to remain economically active.

“If they did not give that help, the younger people would not be able to do what they do.

“Most of what the elderly do is not remunerated, so their economic contribution is not regarded as such. It’s not visible.”

She says elderly people also do a lot of volunteering in informal care of other older people, which releases government from the burden of care.

Yet, Kalula says government’s only intervention on behalf of the elderly since the Covid-19 outbreak in the country is to give them “a different day to collect their SASSA grants”.

She says many old age homes have to depend on private fundraising initiatives to stay afloat.

“Although the department of social welfare does give money, it is not enough.”

In many other countries, old age homes have become hubs of Covid-19 infection.

“It is very easy to get an outbreak in such an environment.

“Old age homes cannot afford to protect the older people or the people they employ through providing PPE.

“We talk about hospitals but none of that has been picked up for communities out there.”

Kalula says once the Covid-19 pandemic has been dealt with, the degree of chronic illness,  especially among the elderly, will have worsened because of forced neglect, impacting on their physical and mental functions.

Even in normal circumstances, the majority of older people do not have easy “age-friendly” transport access to public health facilities, which are congested, with limited resources.

The result is that while older people — often with a multitude of conditions which must be managed together — wait long hours in primary health clinic queues, they spend “less than five minutes with a health professional”.

“They will go to clinics when they are desperate, otherwise they will postpone their visit; they would rather stay away until it is absolutely necessary for them to go.

“Or else, they sit for a whole day, get to the end of the queue only to be told their chronic medication is not available and they must come again.

“They wonder ‘do I have money to go again or must I buy food?’”

She hoped, as has been suggested in others areas of life, that Covid-19 might result in a positive reset of the conditions under which the elderly are regarded in society.

“Covid-19 has made all of us look at what our deficiencies are.

“Hopefully, there will be some positive outcomes.”