During the first wave of the COVID-19 pandemic in Spain, the group most affected, in terms of coronavirus infection and mortality, was the older people, especially those living in care homes. A report prepared by the Ministry of Social Rights and 2030 Agenda notes that from mid-March to 23 June 2020, registered 43,697 deaths, of which 20,268 occurred in residential homes. In particular, in those care homes located in communities with higher population density, such as Madrid, there was 52.9% excess mortality in homes in the first 12 months of the pandemic. In spite of the data, necessary measures to mitigate or reduce the impact of the virus in these homes have not yet been implemented in some Spanish nursing homes.
Regarding the high incidence in residences, decisions taken to deal with the coronavirus should be considered, such as restrictions on access to health resources. If these restrictions were age-based, this would be ageism. The World Health Organisation defines ageism as "stereotyping, prejudice and discrimination directed towards others or oneself based on age." Ageism occurs at different levels (personal, social, institutional) based on age, intersecting with other factors such as being a woman, being more vulnerable, or needing care from others, which increases the risk of discrimination and loss of well-being. Among older people, stereotypes are frequently based on being considered fragile and vulnerable or on the premise of being unable to take care of themselves and making decisions, possibly leading to a different treatment in access to care. Many experts have analyzed this factor as an enabler of mortality in older people due to coronavirus.
Discourses during confinement: from critique to reflection
In the better understanding of the relationship between ageism and coronavirus infection in older people living in residential care homes, a qualitative analysis of the discourses of key informants in the field of ageing was carried out, based on interviews conducted between 28 March 2020 and 13 February 2021 on the program Juntos Paso a Paso on Radio Nacional de España.
In this analysis, we have observed the existence of a chronological line in the discourses. At the beginning of the pandemic, the interviewed expressed a critical view of the situation, experiences, and actions taken in the homes. However, as the first wave passed, we find discourses with a more positive perspective, which understand that the pandemic has brought a reflection on the need to implement new residential models prepared for future crises and health emergencies.
During these first months, the discourses analyzed point to the intensification of actions in the residences that can be described as ageist, some of them previously latent, others newly appearing due to situational health stress. These arguments follow two lines: the discrimination that arose in the residential protocols and the difference in treatment in hospitals, and the challenge of adaptation during confinement in the face of the digital divide.
Different access to health services
The most critical discourses of the people interviewed at the beginning of the pandemic point out that the protocols designed by the communities for residential care homes overlooked the fact that not all older people can be confined in an easy and bearable way. In other words, many of them suffer from physical or psychological pathologies that prevent them from being fully independent, which implies a need for contact with nursing home staff and, therefore, greater exposure to the virus and its spread within the residential center.
In addition, limitations in the equipment that most of the residences had to deal with this type of situation, not only regarding medical equipment but also in the space available. These realities, in short, become incompatible with the containment measures proposed.
The challenge of the digital divide
As far as the use of technologies is concerned, the digital divide is a problem that specifically affected older people long before the pandemic. Among leisure and communication activities, the use of information and communication technologies is rarely followed up in residential care homes, as it is among older people in general in other residential contexts, opposed to the massive use of said technologies by younger people.
When home confinement began in March 2020, the only means of communication with family and friends was via electronic devices. As a result, both residents and staff had to adapt rapidly to this form of communication. Care homes faced the challenge of acquiring more electronic devices and supporting their residents directly to use them. The difficulties were considerable, as this was a new technology for many older people. But after a few months, there may be signs that the effort made during the confinement has helped to partially - and perhaps only temporarily - bridge this digital divide.
The situation might lead one to think that if care homes had incorporated a much more widespread use of electronic devices before the pandemic for older people's contact with friends and family, the impact of the change would have been less.
Reflections from experience: towards a new residential model
While it is true that ageist behaviors aggravated the already critical situation in residential homes, many discourses point to the fact that possibility of prevention in the future by transforming the residential model. The pandemic has brought in a wave of reflection on the current circumstances of the elderly, in particular, based on the need to develop a new residential model.
Some discourses focus on the personal and integral care of the resident, thus improving their quality of life. On the other hand, there has also been a reflection on older persons rights, being equally important as those from most social groups, and have been forgotten or relegated many times in this socio-health crisis. It implies a future vision in which care homes are genuinely considered spaces for care and support and social cohesion, therefore, adapting aid and prioritizing the real needs of the elderly, thus improving their quality of life.
Analyzing the discourses that key informants have made on aging during the pandemic has a utility beyond the mere gathering of opinions.
Its sharing allows relating the opinions of older persons representatives and experts in ageing, could indicate the way towards improving the elderly well-being while taking into account the scientific knowledge available and the needs expressed through their representatives.
By
Isabel Parra González (1), María Sánchez Román (2), C. Gadea Autric Tamayo (2), Ariane Lozano Benito (2), and Gloria Fernández-Mayoralas (3)
On behalf of the Research Group on Ageing at the Spanish National Research Council (GIE-CSIC) and the ENCAGEn-CM Research Programme
(1). Degree in Sociology. Trainee student at the GIE-CSIC. ENCAGEn-CM Research Programme
(2). Support Researcher in the ENCAGEn-CM Research Programme
(3). Main researcher and coordinator of the ENCAGEn-CM Research Programme