With the holidays quickly approaching, adults with aging parents and relatives are thinking about how to celebrate in the middle of a pandemic that’s still not under control. Many factors go into the decision of whether to celebrate virtually or in-person with older adults, who are at a much higher risk of becoming severely ill if they contract COVID-19.
Dr. Amy Paul, a Richmond, Virginia-based geriatrician who previously worked at Virginia Commonwealth University, believes the safest way is to avoid in-person contact as much as possible. This is because older adults have a “decreased capacity to weather severe illness as a result of less robust immune responses,” according to Paul. She also notes that older adults often live alone and may be unable to efficiently care for themselves independently if they are ill.
Nonetheless, millions of Americans have been avoiding close contact with their senior relatives for over seven months and feel a strong need to reconnect in person over the holidays. It’s also well-known that the holidays are a particularly lonely time for many people, and recent research notes that social isolation and loneliness can negatively affect older adults’ health outcomes.
With that in mind, Dr. Jeff Toll, an internist and medical director of Good Life Medical, a Los Angeles-based COVID-19 testing drive-through and at-home testing service, says that despite the risks, “It is possible to gather safely. All it takes to ensure your health and the health of your loved ones is a bit of planning and testing.”
Here are some factors to consider when deciding how to celebrate the holidays with older adults this year, and some expert tips for making in-person celebrations safer.
What to consider before visiting with older adults
As we know well by now, every family’s tolerance for risk when it comes to the virus is dependent on their specific health and occupational situations. Other factors to think about:
Underlying health conditions of the older family members that might place them at greater risk
Dr. Nikhil Agarwal, internist at Wellmed at Cedar Park in Cedar Park, Texas, suggests being extra mindful with older adults who have lung conditions, like COPD, or who need oxygen on a daily basis, as well as those who have heart conditions, diabetes or cancer that is actively being treated or monitored. Checking in with their doctor is always a good idea, he adds.
Paul believes people with those conditions should likely not get together at all with people who live outside their household. Her list of risky conditions is quite a bit longer and includes:
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Diabetes
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Chronic lung diseases such as COPD and moderate to severe asthma
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Cardiovascular disease
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Obesity with BMIs >35
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Chronic kidney disease on dialysis
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Liver disease
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Immunocompromised conditions such as those on cancer therapy, smokers, AIDS and those on chronic steroid therapy.
The risk is even higher for those patients who aren’t compliant with their medication regime, Paul says, and for those who live alone and don’t have a reliable caregiver to help them if they get sick. She concludes, “Should your loved one have multiple of these [conditions], visiting with them is not advised.”
Your own exposure to the virus prior to seeing elderly loved ones
When deciding whether to visit with an elderly relative, it’s important to be honest about the precautions you’ve been taking and whether you’ve been engaging in social distancing, wearing masks and avoiding large public gatherings.
This is particularly true, Agarwal says, in the two weeks before visiting older loved ones. If you or your family members have noticed any symptoms, you shouldn’t take the risk, because “even if you get tested and the test comes back negative we have to keep in mind that the false negative rates of these tests, especially the rapid tests, are high.”
The type of travel required
Can you travel to see your senior loved one in a safe, socially distant way? Paul notes, “It’s safer to travel by car rather than trains or airplanes. If quarantining is possible after travel, 14 days is recommended.”
No matter what mode of transportation you’re taking, try to avoid public restrooms as much as possible, as they have several high-touch surfaces (sinks, doorknobs, toilet handles) and are not frequently disinfected. Paul also believes it’s best not to stay in your senior family member’s home to reduce the indoor contact you have with them. Instead, rent a house or hotel room.
Lydia Elle lives in Los Angeles, but the rest of her family lives abroad. She’s planning to travel to Canada for Christmas and New Year’s. She’s already thinking about how to travel more safely. “I will be much more intentional about travel — [flying] direct instead of [via] connections — and get there early enough to follow the two-week necessary quarantine before the big day and all of the sanitization protocols,” says Elle.
While she considered not traveling at all to minimize risk, she says, “What I may be protecting in the physical, may be hurting us in the emotional and mental. Hugs and time mean so much more since they have become so scarce.”
COVID-19 positivity rate in your region
Both Paul and Agarwal concur that the positivity rate in the region where you and your elderly loved one live is an important factor. This is especially of concern if you’re traveling from a region with a high incidence of COVID-19 to see a senior family member in another region, as there may be a greater risk of transmitting it to them. Of course, if you’re traveling to an area with a high positivity rate, you also put yourself at a higher risk.
Precautions to take if you decide to visit in person
If you decide to do in-person holiday gatherings with older adults, there are a number of actions you can take before and during the visit to mitigate everyone’s risk of contracting COVID, according to experts.
If your get-together involves travel, taking certain precautionary measures can decrease the possibility of being exposed to the virus before traveling, says Paul. She recommends taking the following steps at least two weeks before your visit:
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All attendees should limit their activities outside their home with consistent mask-wearing over the nose and mouth.
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Work from home if you can.
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Have school-aged children attend school virtually.
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Update your vaccine profile with your flu shot and ensure that the same is true for your senior loved one. They should also have their pneumonia shot if it is due.
Also, a few days before you travel, schedule a PCR test, advises Toll, which will determine whether you have an active COVID-19 infection. “Be sure to make an appointment at a clinic that can guarantee rapid 24-48 hour turnaround time on their PCR test,” he urges. “Rapid tests are widely advertised but are very inaccurate and much more likely to have a false negative.”
A PCR test might be especially important if you’re flying, Toll also notes that many airlines require a negative PCR test result a few days before the flight.
Obviously, a positive test would mean canceling your travel plans, but even with a negative PCR test, you should remain cautious and maintain all protocols, says Paul.
Allison Salerno, from Athens, Georgia, is already thinking about these precautions, as her 89-year-old mother was widowed early this year and moved in with Salerno’s family after her retirement community was infected with COVID-19. Her adult sons, who live in Massachusetts and Washington, D.C., will be traveling to Georgia for Thanksgiving. “They will be taking COVID tests before they come,” Salerno says, as “we have had no one in our home since [my mom] arrived who has not had a recent negative COVID test.” In terms of travel precautions, she adds, “The Massachusetts son will stay with the D.C. son on his drive down, so no one will have been in hotels or restaurants before coming.”
Precautions to take during your visit
Gather outside. We all know outdoor gatherings are much safer than indoor ones, because of the greater ability to socially distance and the natural ventilation. If that’s not possible, perhaps because of weather conditions, “keep doors and windows open to improve ventilation,” suggests Paul.
Physically distance. If you’re indoors, arrange furniture to maintain at least six feet of distance between people in different households, says Paul.
Keep it briefer than usual. If you’re going to be inside, you could also consider making a shorter visit to reduce potential exposure time.
Remember all the usual and customary precautions. Mask-wearing is absolutely crucial for indoor gatherings, as well as frequent hand-washing. Agarwal suggests, “Avoid physical hugging and kissing, especially [with] kids, as they can transmit the disease without exhibiting symptoms themselves.”
BYO. While it may seem a bit awkward, Paul says everyone who attends should be advised to bring their own supplies and food. The host should also clean and disinfect hard surfaces and high-touch places like doorknobs and light switches frequently during the gathering.
The best alternatives to in-person gatherings
If your senior loved ones have conditions which make getting together unsafe, there are alternatives to in-person gatherings. Zoom is always an option, though many people find it impersonal and difficult or chaotic for large social gatherings.
Paul suggests getting creative and doing activities together virtually, such as watching a movie together, sharing meals, crafts or reading books together. (Just bear in mind that your loved one may need some instruction to assist them to maneuver the technological aspect, she notes.)
Lizzie Goodman, from Chicago, is getting creative to celebrate Thanksgiving with her parents, her sisters and their families, who all live within five minutes of each other. “We are going to have a moveable feast of sorts, with each family cooking a dish and then, delivering it to the others,” she explains. “We’ll share our potluck together by Zoom. Then, when dinner is complete, we’ll bundle up and head to my sister’s yard where we can stretch out on the deck with outdoor heaters, a bonfire and hot toddies.”
They’ll be wearing masks when not eating or drinking. Even though rain or snow may be in the forecast, all have agreed not to go indoors at all, even if it means switching the in-person portion of Thanksgiving to another day.
The bottom line on spending holidays with older adults this year
“By taking the proper precautions and getting adequately tested, you can get back to enjoying the gathering without wondering whether you’re putting your loved ones at risk,” says Toll.
Nonetheless, exercise caution, especially because, as Agarwal notes, it’s not only COVID-19 we’ll be dealing with during the holidays but flu season. “The above measures in isolation are not as effective as all of them combined, so I highly encourage following all the precautions. When in doubt, consult your physician or call off the gathering completely.”
