By Dr. Mark Paz
Senior patients who are moved to self-isolate secondary to the COVID-19 pandemic are experiencing significant social and emotional issues that are worsening due to the impact of the virus. However, the isolation and increased sedentary lifestyle is also exacerbating physical health conditions like diabetes, obesity, and additional decreased physical activity issues among seniors. Currently, it is estimated that 8 out of 10 seniors are not seeking treatment despite needing routine medical surveillance of their underlying medical conditions. The number of seniors affected is steadily climbing as seniors avoid routine checkups and doctor appointments out of fear of exposure to COVID-19.
The concern is shared by those caring for an elderly family member, either a parent or grandparent, who are responsible for having the patient attend to their chronic medical conditions and potential worsening the condition(s). Those caring for these individuals may be concerned regarding the risk of having the patient attend appointments at clinics during the pandemic for conditions which may not be life-threatening, but may be impacting, physically and/or mentally, the short and long-term lifestyle of the elderly patient.
The decision-making to resume routine healthcare monitoring and maintenance in the primary care clinic has, and continues to evolve over the last year. However, during the last three months the demographics of the COVID-19 virus have been trending in a positive direction. The CDC tracking of COVID-19 infections, hospitalizations, and most importantly mortality associated with the virus since November 2020 reflect that the incidence of these events peaked in January 2021, followed by a precipitous rate of occurrence through March 2021.
In the diabetic population, with poorly managed or unmanaged blood sugars, there exists an established risk to vision and kidney function which may be irreparable. The elderly patient with symptomatic osteoarthritis of the back and knees, who has been limited to a sedentary lifestyle for the last year, may have increased overall Body Mass Index (BMI), which may now meet the criteria for obesity or increasing the severity of pre-existing obesity. The progressively untreated osteoarthritic knee may place the senior at increased risk of fall. The increased risk of fall places the patient at increased risk of hip fracture, a serious injury with associated mortality implications in the elderly population.
Fundamentally, we continue to live in a world with quantifiable and non-quantifiable risk. We make conscious and unconscious decisions to manage risk. Given all the upheaval which has occurred, and we have endured as a result of the pandemic over the last year, it is easy to forget that we lived our lives pre-pandemic despite the risks present all around us day in and day out. When we overestimate the risk in one area, it can lead to anxiety which may interfere with carrying out our normal daily routine.
In the context of the pandemic, some individuals consciously make a risk assessment such as traveling by car to work or to doctor’s appointments against the risk of getting COVID-19 infection. In general, the risk of dying in a motor vehicle accident is substantially higher when compared with the risk of dying from COVID-19. Prior to the pandemic, an unconscious risk assessment was made, and we still drove where we needed to.
It can be difficult for us to remember, that everything that has a beginning as an end, and the pandemic will be no different. Once the COVID-19 pandemic is declared to have ended, we will continue to live in a world in which we make decisions which are associated with risk.
The state and local COVID-19 safety protocols implemented at medical clinics have responded to the risk of becoming infected with COVID-19. Currently, the vaccination of a larger and larger percentage of the population is anticipated to reduce the risk of infection to the general population and ultimately contribute to herd immunity. Postponement of medical monitoring and management may have a greater risk than the risk of COVID-19 infection.
In conclusion, where we find ourselves, there is every reason to look optimistically and a reduction in risk of COVID-19 infection now and in the days and weeks to come. Approaching today and tomorrow with optimism is a healthy mental approach to anticipating that we will return to a pre-pandemic lifestyle. That lifestyle included scheduling and completing an evaluation with the primary care provider, as needed. The final recommendation I would leave you with is to begin consciously transitioning to a mentally positive and optimistic anticipation of returning to your pre-pandemic lifestyle without being overwhelmed by risk assessment. Consider the risks associated with completing routine healthcare maintenance of chronic medical conditions versus the predictable consequences of not having the conditions evaluated and managed.
An accomplished, award-winning physician with a comprehensive background in Occupational and Internal Medicine, Dr. Paz provides professional services in Occupational and Internal Medicine, including primary care medical treatment and management of injured workers in the greater Denver area. Dr. Paz delivers outstanding patient outcomes, success and satisfaction, highlighted by patient management abilities. Dr. Paz establishes, cultivates, and manages productive relationships and prepares medical opinions based on the findings of an Independent Medical Evaluation (IME) which in some cases is followed by expert medical/witness testimony. In all phases of professional practice, central is the application of Internal Medicine principles and greater than 25 years of the practicing medicine.
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