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Before the COVID-19 pandemic, Sandra Banner was an active octogenarian. She enjoyed going to movies, traveling from her Palm Desert, Calif., home to Los Angeles for Dodgers baseball games and having friends over for happy hours.
Early on, she avoided isolation by teaching outdoor tai chi classes and staying engaged online, but once she was fully vaccinated, Banner, 85, was ready to get back out into the world.
Unfortunately, she noticed that not everyone felt the same -- even some of her friends.
"Some were absolutely ready to get out," Banner said, though she also saw the opposite extreme. "I had friends who had been isolated so long that even though they were fully vaccinated, they were uncomfortable with the idea of being with other people."
With older adults at high risk of serious illness and death from COVID-19, lingering fears of infection and continuing isolation have both taken a toll.
"I think also being isolated at home for so long created a fear in some people that they could not be socially active at this time -- they just were not ready for it," said Banner, who has tried not to push anyone beyond their comfort level.
"The only thing I ever said to anyone -- because I didn't judge anyone's fears -- was take it a step at a time, take a baby step, talk about what you can do. That is a baby step. Then you will take another step," she said. "And so far, that's what my friends have done."
'Just this real fear'
Dr. Sonja Rosen, chief of geriatric medicine at Cedars-Sinai Medical Center in Los Angeles, is Banner's doctor. Rosen agrees that it's time for many fully vaccinated seniors to begin interacting with other folks in person again.
"I have been hearing it from a lot of patients, just this real fear of getting out there and getting back to normal life, even though patients have been vaccinated, with or without masks depending on what environment they're in, just being afraid to leave their homes, really," Rosen said. "Even though they've been connecting often on Zoom or other venues for telecommunication, it's not the same."
Earlier in the pandemic, Rosen told her patients to stay at home to stay safe, and then to get vaccinated. Now she's encouraging many of them to resume a normal life and engage with their communities. (There are exceptions, though, including folks on immunosuppressing drugs, because they may not get good protection from the vaccines.)
For many seniors, though, a return to in-person interaction is just what the doctor ordered.
Venturing back out into the world for some means simply visiting their doctor's office in person, which is important for preventive health care.
For others, it's visiting the grocery store and chatting with a clerk -- a more significant social interaction than most people realize, Rosen said.
And for others still, it could be bigger steps, such as taking a trip or seeing grandkids again.
"For some of my patients, I've been encouraging them to go on a vacation and others just more basic daily activities that still bring a lot of meaning and joy," Rosen said.
Social isolation and loneliness are risk factors for poor health outcomes, she said.
One reason: People are less likely to engage in healthy habits like exercise if they're isolated. And Rosen noted that many folks have been less active during the past year because their go-to places for exercise, such as senior centers, were closed.
Though online programs can be antidote against the effects of isolation for some, Rosen said they don't work for everyone.
"There are a lot of people who need to physically interact in person and to go out to be motivated to exercise, et cetera," she said. "That's who we want to get back out."
And, yes, Rosen said, if folks are more comfortable wearing a mask as they resume their regular lives, that's OK. In fact, face coverings are still required in some settings.
Decisions based on individual risks
Dr. Sharon Brangman, head of geriatrics at SUNY Upstate Medical University in Syracuse, N.Y., said one's willingness to get back out there often hinges on local vaccination rates. The decision should also weigh individual risks, and folks with certain medical issues should proceed with caution, she said.
"They should be happy that they're vaccinated because that reduces the chance of them getting very sick, but vaccines are not 100%," Brangman said. "There are still some people who are fully vaccinated who are testing positive."
Folks between the ages of 65 and 95 have very different needs, Brangman said. Questions remain about how their risks are affected by new variants of COVID-19.
"We still have a problem with younger people not feeling that this is an issue for them to get vaccinated and they're keeping the virus circulating," Brangman said. "I think you have to figure out your risk profile and what the event is."
Some of her patients, who are in assisted living facilities or nursing homes, may now be hopeful they can have visitors or go out with family. Concerns for homebound patients include whether their visiting health aides have been vaccinated, Brangman said.
Still other seniors may be spending time with older grandchildren who have also been vaccinated or yearning to visit those who are too young for the shots.
"What I tell my patients and their families and their adult children who are trying to navigate risks is that outdoor activities are better than indoor activities, and small groups with confidence that everyone is vaccinated are better than large groups," Brangman said.
When kids under age 12 who are too young for the vaccine are present, everyone should consider wearing masks, she added.
Since getting her vaccine, Banner has gone to the movies several times, been in the stands for Dodger baseball games and dined outdoors with friends. She's also traveled to spend time with her grandchildren.
When it puts her at ease, Banner still wears a mask.
"My philosophy of life is, I wake up every morning and say, 'thank you God for another day, for allowing me to feel well and be able to enjoy all that nature and the world has to offer,' " Banner said.
SOURCES: Sandra Banner, Palm Desert, Calif.; Sonja Rosen, MD, chief, geriatric medicine, Cedars-Sinai Medical Center, Los Angeles; Sharon Brangman, MD, past president, American Geriatrics Society and chair, geriatrics, SUNY Upstate Medical University, Syracuse, N.Y.; Cedars-Sinai Medical Center, news release, July 6, 2021
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