Advertisement

Ways of Protecting Religious Older Adults from the Consequences of COVID-19

  • Harold G. Koenig
    Correspondence
    Send correspondence and reprint requests to Harold G. Koenig, M.D., Duke University Medical Center, Box 3400 Duke University Medical Center, Durham, NC 27710.
    Affiliations
    Duke University Medical Center, Durham, NC

    King Abdulaziz University, Jeddah, Saudi Arabia

    Ningxia Medical University, Yinchuan, P.R. China

    Shiraz University of Medical Sciences, Shiraz, Iran
    Search for articles by this author
Published:April 12, 2020DOI:https://doi.org/10.1016/j.jagp.2020.04.004
      This is an anxious time, especially for older adults who are those most vulnerable during this coronavirus disease 2019 (COVID-19) pandemic. Interestingly, this anxiety and the accompanying emotional distress are known to increase susceptibility to infection,
      • Coughlin SS
      Anxiety and depression: linkages with viral diseases.
      effects that may be especially strong as immune function decreases with aging.
      • Robinson-Whelen S.
      • Kiecolt-Glaser JK.
      • et al.
      Effect of chronic stress on immune function and health in the elderly.
      Religious beliefs and practices are known to help individuals cope with times of stress, and in many studies are associated with less anxiety and greater hope, especially in older adult populations.

      Koenig, HG.Religion and Mental Health: Research and Clinical Applications. San Diego, CA: Academic Press (Elsevier), 2018

      During the week following 9/11 terrorist attacks, 90% of Americans turned to religion to cope.
      • Schuster MA
      • Stein BD
      • Jaycox LH
      • et al.
      A national survey of stress reactions after the September 11, 2001, terrorist attacks.
      Because religious faith is an important resource for health and well-being for many older adults,
      • Koenig HG.
      • Smiley M.
      • Gonzales J.
      Religion, Health, and Aging.
      • Koenig HG.
      • King DE.
      • Carson VB.
      Handbook of Religion and Health.
      • Koenig HG.
      • Al-Zaben F.
      • VanderWeele TJ
      Religion and psychiatry: recent developments in research.
      this may be one way that clinicians can support and encourage their patients. After taking of a spiritual history to identify religious resources,
      • Peteet JR
      • Al Zaben F
      • Koenig HG
      Integrating spirituality into the care of older adults.
      here are seven simple ways that geriatric psychiatrists can help religious elders make use of their faith to relieve anxiety and help protect themselves and others during this COVID-19 pandemic.

      STAY CONNECTED WITH RELIGIOUS FAITH

      • 1.
        Spend time developing a deeper religious faith. This is an opportunity for older adults to deepen their religious faith or personal relationship with God through prayer, meditation, reading scriptures, reciting scriptures, listening to inspirational programs, or reading uplifting literature that nourishes the spirit. Most religious communities now offer live streaming of services that promote solidarity with one another and sermons that provide guidance and hope. Now that many are “sheltering in place” or quarantining at home, there is plenty of time for activities that can strengthen spiritual health. Most older adults are not aware that such activities may also serve to enhance mental health, ability to weather the anxiety of these times, and improve physical health and resistance to infection, as much research has shown.
        • Koenig HG.
        • Al-Zaben F.
        • VanderWeele TJ
        Religion and psychiatry: recent developments in research.
        ,
        • Koenig HG.
        • King DE.
        • Carson VB.
        Handbook of Religion and Health.
      • 2.
        Stay physically healthy. Religious elders are instructed within the Christian tradition (and other faith traditions as well) to care for the “temple of the Holy Spirit” as a way of honoring and worshiping God. To accomplish this, religious elders may be encouraged to:
        • (a)
          Engage in moderate intensity exercise for 30–45 minutes/day each day (after approval by their physician). This is known to improve immune function and potentially reduce risk and severity of respiratory viral infection.
          • Martin S.A.
          • Pence B.D.
          • Woods J.A
          Exercise and respiratory tract viral infections.
        • (b)
          Obtain 7–8 hours of sleep per night, since obtaining adequate sleep is associated with better immune function and protection against viral infections.
          • Ibarra-Coronado E.G.
          • Pantaleón-Martínez A.M.
          • Velazquéz-Moctezuma J.
          • et al.
          The bidirectional relationship between sleep and immunity against infections.
        • (c)
          Eat healthy and keep weight down by following the Mediterranean Diet, now rated #1 by experts throughout the world. Even among vaccinated older adults, risk of viral infection is increased among those who are overweight or obese.
          • Neidich S.D.
          • Green W.D.
          • Rebeles J.
          • et al.
          Increased risk of influenza among vaccinated adults who are obese.
        • (d)
          Take vitamin D to ensure adequate levels, given that many confined elders are low on this vitamin, which can adversely affect their immunity.
          • Prietl B.
          • Treiber G.
          • Pieber T.R.
          • et al.
          Vitamin D and immune function.
        • (e)
          Drink plenty of fluids, since older adults are at risk for becoming dehydrated due to decreased thirst, and when this occurs, risk of infection increases.
          • Cardemil C.V.
          • Parashar U.D.
          • Hall A.J.
          Norovirus infection in older adults: epidemiology, risk factors, and opportunities for prevention and control.
        • (f)
          Take medications as prescribed, keep an adequate supply of medications on hand, and maintain regular contact with a physician (by telemedicine if necessary).

      COPING WITH STRESS AND NEGATIVE CONSEQUENCES OF SOCIAL DISTANCING

      • 3.
        Care for your neighbor. Elders should be encouraged to love and care for neighbors at this time. This is what Jesus, Moses, the Prophet Mohammad, the Buddha, Hindu sages, and other greater religious figures emphasized (and often commanded). The neighbor is anyone in need. There is an opportunity for those of all religious faiths (and those with no religious faith) to spread a message of love and hope to family members, neighbors, friends, and anyone else in need.
      • 4.
        Care for neighbor by meeting emotional needs. Many older adults live alone and are now being forced to stay in their homes. There are also thousands of nursing home patients and those in assisted-living facilities who are being confined to their rooms and not allowed to interact with other residents. This situation is increasing risk for social isolation, which itself has been shown to adversely affect immune function in both animal and human studies,
        • Scotti MA
        • Carlton ED
        • Demas GE
        • et al.
        Social isolation disrupts innate immune responses in both male and female prairie voles and enhances agonistic behavior in female prairie voles (Microtus ochrogaster).
        ,
        • Cacioppo JT
        • Cacioppo S
        • Capitanio JP
        • et al.
        The neuroendocrinology of social isolation.
        thereby increasing risk of infection and adversely affecting the body's response to it. There is no better way to relieve anxiety and reduce social isolation than by reaching out to others in need.
      Here is one practical suggestion that clinicians can suggest to older patients. First, have the person make a list of family members or individuals in their faith community who may be at risk for social isolation or have physical or emotional problems. Contact these individuals and ask if they would like to have a spiritual partner during these unsettling times. Partnering means ensuring that the person has the technology and know-how to connect to others. Next, have the elder contact that person three times/day: in the morning, afternoon, and evening at prearranged times. During this time, both partners should pray with the other, encourage the other, and remind the other of God's love for him/her. This will help to relieve the loneliness of both partners and eliminate boredom that is common when confined and alone.
      • 5.
        Care for neighbor by meeting physical needs. Many people have physical needs during this time of restriction to home, including a need for food, medicine, or medical supplies. If an older person is able, one way to put faith into action is by picking up needed supplies at a grocery store or pharmacy, driving to the person's home and leaving the supplies on their doorstep (calling at the time of delivery to ensure immediate pick up). Not everyone can do this, but for those who are physically able, have a car, and some disposable income, this can be one way to lift spirits almost immediately.
      • 6.
        Follow by social distancing guidelines. The recommendations above do not mean that elders should be reckless by exposing others (or themselves) to the coronavirus by not following Centers for Disease Control guidelines.

        CDC. U.S. Centers for Disease Control Guidelines: COVID-19 (2020). Available at:https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance-list.html?Sort=Date%3A%3Adesc. Accessed April 2, 2020

        Those with symptoms of a cold, especially fever and cough, should avoid close physical contact with others. However, this is easily addressed by reaching out remotely through technology now available (see below). Reckless also means not following the simple steps that can help to prevent the spread of the coronavirus: washing hands regularly with soap for 20 seconds every couple hours, especially after having contact with others or with objects such as Amazon boxes or mail; keeping physical distance from others, and not physically congregating with more than a couple of people at a time.
      • 7.
        Take advantage of technology. Social distancing means physically separating from one another, not socially separating. A person can be socially close and not physically close, just as one can be physically close and not socially close.
        • Morlett Paredes A.
        • Lee E.E.
        • Chik L.
        • et al.
        Qualitative study of loneliness in a senior housing community: the importance of wisdom and other coping strategies.
        Although older adults cannot give physical hugs or handshakes during these times, there are many other ways of providing social and spiritual hugs and handshakes. This can be done remotely by using the technology now available: Skype, FaceTime, Zoom, WebEx, or simply the telephone.
      Chaplain services, especially in inpatient settings, are a critical resource for clinicians. Consulting a chaplain when religious questions arise is one way to help elders work through spiritual issues that may be adversely affecting their health and well-being. Likewise, geriatric psychiatrists can also collaborate with churches and other faith-based institutions to provide education, information about safety, and tips on how elders can deal with the stress of these times (and who to contact if they feel overwhelmed). In summary, advising religious elders to stay in touch with God, focus on spiritual health, maintain good physical health, and help family, friends, and neighbors (remotely through the available technology), will help to boost immunity, develop physical and emotional resistance, and make a difference in the lives of those around them.
      Harold G. Koenig is the sole contributor to this manuscript.
      Harold G. Koenig does not have any conflicts of interest.

      Appendix. SUPPLEMENTARY MATERIALS

      References

        • Coughlin SS
        Anxiety and depression: linkages with viral diseases.
        Public Health Rev. 2012; 34: 7
        • Robinson-Whelen S.
        • Kiecolt-Glaser JK.
        • et al.
        Effect of chronic stress on immune function and health in the elderly.
        in: Manuck SB Jennings R Rabin B Baum AS Behavior, Health, and Aging. Psychology Press, NY, NY2014: 81-94
      1. Koenig, HG.Religion and Mental Health: Research and Clinical Applications. San Diego, CA: Academic Press (Elsevier), 2018

        • Schuster MA
        • Stein BD
        • Jaycox LH
        • et al.
        A national survey of stress reactions after the September 11, 2001, terrorist attacks.
        NEJM. 2001; 345: 1507-1512
        • Koenig HG.
        • Smiley M.
        • Gonzales J.
        Religion, Health, and Aging.
        Greenwood Press, Westport, CT1988
        • Koenig HG.
        • King DE.
        • Carson VB.
        Handbook of Religion and Health.
        2nd Ed. Oxford University Press, New York, NY2012
        • Koenig HG.
        • Al-Zaben F.
        • VanderWeele TJ
        Religion and psychiatry: recent developments in research.
        BJPsych Adv. 2020; https://doi.org/10.1192/bja.2019.81
        • Peteet JR
        • Al Zaben F
        • Koenig HG
        Integrating spirituality into the care of older adults.
        Int'l Psychogeriatrics. 2019; 31: 31-38
        • Koenig HG.
        • King DE.
        • Carson VB.
        Handbook of Religion and Health.
        2nd Ed. Oxford University Press, New York, NY2012
        • Martin S.A.
        • Pence B.D.
        • Woods J.A
        Exercise and respiratory tract viral infections.
        Exerc Sport Sci Rev. 2009; 37: 157-164
        • Ibarra-Coronado E.G.
        • Pantaleón-Martínez A.M.
        • Velazquéz-Moctezuma J.
        • et al.
        The bidirectional relationship between sleep and immunity against infections.
        J Immunol Res. 2015; 678164https://doi.org/10.1155/2015/678164
        • U.S. News & World Report
        Best Diets Overall.
        2020 (Available at:) (for methodology, see https://health.usnews.com/best-diet/experts). Accessed January 5, 2020
        • Neidich S.D.
        • Green W.D.
        • Rebeles J.
        • et al.
        Increased risk of influenza among vaccinated adults who are obese.
        Int'l J Obesity. 2017; 41: 1324-1330
        • Prietl B.
        • Treiber G.
        • Pieber T.R.
        • et al.
        Vitamin D and immune function.
        Nutrients. 2013; 5: 2502-2521
        • Cardemil C.V.
        • Parashar U.D.
        • Hall A.J.
        Norovirus infection in older adults: epidemiology, risk factors, and opportunities for prevention and control.
        Infect Dis Clin. 2017; 31: 839-870
        • Scotti MA
        • Carlton ED
        • Demas GE
        • et al.
        Social isolation disrupts innate immune responses in both male and female prairie voles and enhances agonistic behavior in female prairie voles (Microtus ochrogaster).
        Horm Behav. 2015; 70: 7-13
        • Cacioppo JT
        • Cacioppo S
        • Capitanio JP
        • et al.
        The neuroendocrinology of social isolation.
        Ann Rev Psychol. 2015; 66: 733-767
      2. CDC. U.S. Centers for Disease Control Guidelines: COVID-19 (2020). Available at:https://www.cdc.gov/coronavirus/2019-ncov/communication/guidance-list.html?Sort=Date%3A%3Adesc. Accessed April 2, 2020

        • Morlett Paredes A.
        • Lee E.E.
        • Chik L.
        • et al.
        Qualitative study of loneliness in a senior housing community: the importance of wisdom and other coping strategies.
        Aging Ment Health. 2020; : 1-8https://doi.org/10.1080/13607863.2019.1699022