Engaging with older people post Covid-19: Adapting the work of the Age Friendly programme by listening to older people

The Irish national Age Friendly Programme relies on continuous consultation and engagement with older members of the community, particularly those who are involved in Older People’s Councils. Many older people also volunteer to take part in Age Friendly walkability audits, consultation sessions, intergenerational events and a raft of other activities. Face to face meetings with all groups were suspended in March 2020 due to the global pandemic Covid-19.  In Ireland, older people aged 70 and over, and people with underlying medical conditions, were advised under Public Health Guidelines to ‘cocoon’ to reduce risks associated with transmission. Cocooning essentially meant staying at home and reducing social contact, including having visitors to the home.

These restrictions on face to face interactions have had implications for older people, in terms of loneliness and isolation, general health and wellbeing, and their ability to access services and participate in social and civic life.

Through the network of local Age Friendly Programmes, which are multi-stakeholder forums led by each local authority in Ireland, we have heard evidence of the impact of Covid-19. Stories of older people who were unable to connect digitally, who became anxious about leaving their homes, and whose physical and mental health has deteriorated because of the necessary restrictions. Testimonies about the emotional distress for parents and their adult children generated by restricted visiting to nursing homes. The Alzheimer’s Society of Ireland has spoken about the detrimental effects that closing day services and other support had on people with dementia, and the confusion that arises for people with cognitive impairment when visiting by friends and family is restricted. One of their studies found that 58% of people living with dementia reported feeling lonely or isolated during Covid-19. A study by The Irish Longitudinal Study on Ageing (TILDA)  found that the effects of the pandemic were exacerbated for older people who live alone.

Restrictions on older people’s participation also posed a particular challenge for Age Friendly Programming, which depends on the voice of the older person to inform actions. Social inclusion is at the heart of the programme. A fundamental concern for local Age Friendly Programmes in each local authority area, and the national shared service centre that is Age Friendly Ireland, was how to keep connected with older people during the pandemic and how to support their continued engagement.

Locally and nationally, the Irish Age Friendly response demonstrated great adaptability in seeking new ways to connect with older people. A report produced by Age Friendly Ireland in May 2020 showed that, within a two month period, the local authority sector and the wider community response in Ireland had developed over 300 initiatives to support older people and others through the crisis of the pandemic. The response emanating from the local authorities included actions across community, sports, libraries, transport, civil defence, housing and cultural services ultimately supporting the health and wellbeing of our ageing population.

Key among the Age Friendly actions delivered during the lockdown was a range of digital supports provided to older people. Supports included digital skills training, development of ‘how to’ guides to show people how to access online resources, and one to one support to help older people get online. Laptops and tablets were provided directly to older people through some Age Friendly Programmes, with several providing this technology to nursing homes so that residents could stay connected (including in Dublin, Meath, Louth and Cavan).  Anecdotal commentary suggests that as a result of the pandemic, older people’s adaption of digital technology has jumped eight years in a two month period.

The National Network of Older People’s Councils, which meets nationally a number of times a year, held its first video conference in June 2020. Local Age Friendly Programme Managers provided support to make sure the chairs of their local Older People’s Councils could participate. This was a very significant event, being the first time that each local Older People’s Council joined a national virtual meeting. The success of this event demonstrated to citizens and to local government how feasible it is to transition to remote platforms, once the necessary supports are in place.

The speed of the response in Ireland should be commended, in terms of both the willingness to adapt to change demonstrated by older people themselves, and the supports provided through local government and Age Friendly partner organisations to facilitate this. The pandemic has been an enabler of partnership working, as collaborative actions were rolled out by the local authorities, An Garda Síochána, the Health Service Executive, the Education and Training Boards, the community and voluntary sector, the business community and others.

We have heard that some of side effects of the pandemic have potential to hamper the development of our communities as Age Friendly. One of these relates to a re-emergence of ageist narrative and language. During Covid-19, older people are again being referred to as ‘elderly’, ‘seniors’ or ‘pensioners’ or described as frail, vulnerable and needy, rather than as active decision-makers and engaged citizens. An excellent article in The Irish Times draws attention to this phenomenon and encourages responsible media reporting. We should all remain alert to ageist language and find occasion to address it, and to focus on the abilities and contribution of older citizens.

Another change which has impacted unfavourably on older people has been the removal of public seating in shopping areas and generally in the public realm.  While it supports physical distancing, it does not support older people’s participation, or facilitate them to remain actively involved in their communities.  Solutions should be identified so that seating can safely be provided in public spaces and especially if older people are required to queue for retail or other services. Without it, the community and local services are not as accessible to many older people.

Ireland is moving through the stages of the ‘Roadmap to Reopen the Economy and Society’. We are preparing for the next stage, which will be a gradual return to face to face meetings. Virtual meetings and remote working will remain with us in some form as the new normal for the foreseeable future, but we need to navigate a way to support older people to find the balance between safety and social engagement.

We have heard from older people that they do not wish to cocoon again. Some disliked the blanket categorising of all older people as vulnerable, regardless of health, condition or fitness levels. Social contact and preventing loneliness are vital to maintaining older people’s health and well-being.

Despite the phenomenal response to Covid-19, there has sadness about the clusters of deaths in nursing homes. Most recently our political leaders and senior staff in the Health Service Executive are talking about a new approach and alternative to long-term care settings. The ‘Housing Options for our Ageing Population’ policy statement (February 2019) outlines the need to have a range of options across the continuum of care. Over the last ten years of consultation with older people, Age Friendly Ireland has constantly heard that older people want to stay in their own homes as long as possible.

Age Friendly Ireland is now giving careful consideration to how we can enable continuous engagement with older people in the community. Advice to our local Age Friendly Programmes will encourage them to continue to use remote working and virtual platforms, with an option of a free phone audio dial in for older people who do not have IT equipment. When face to face meetings with older people can resume, physical distancing will need to be maintained and other protocols such as time limitations on meetings, contact tracing, provision of microphone facilities, and a response plan in the event someone becomes unwell during a meeting. We will need to consider how regular Age Friendly programming such as walkability audits and intergenerational activities can continue in a way that respects physical distancing. An important focus will be to continue to upskill older people so they can maximise their capacity to engage online, by providing training and other opportunities such as webinars.

Our local Age Friendly Programme Managers will turn attention to supporting the safe re-engagement of older people, outlining opportunities for participation and the importance of staying connected to their communities. It is important from a health and wellbeing perspective to support older people to return to some of their regular activities. And there are many activities that can be pursued safely while heeding public health advice, such as socially distanced walking groups, book clubs, or museum visits.  We must ensure that the response to the pandemic keeps a focus on supporting older people’s engagement, independence and social connection.