T he pandemic has brought many challenges, including how to balance your healthcare needs with trying to protect yourself from COVID-19.
“So many things have been postponed—not just things like hip replacements and cataract surgery but also regular medical appointments that seniors need to help maintain their overall well-being,” says Nancy Morrow-Howell, Ph.D., M.S.W., director of the Harvey A. Friedman Center for Aging at Washington University in St. Louis.
While we don’t know just what the next few months will bring, it’s important to plan ahead and take steps that will help keep you as healthy as possible through the fall and winter. Here, the doctors’ appointments, vaccines, and more to focus on now, and how to get what you need safely.
Catch Up on Checkups
If you’ve let routine medical appointments, such as annual physicals and eye exams, slip because of COVID-19, consider resuming them—unless you have a problem such as a compromised immune system.
“You don’t want to put it off any longer—we’re seeing older adults with chronic conditions such as heart failure or lung disease present with much more severe disease because they’ve delayed seeking care,” says Mary Tinetti, M.D., chief of geriatrics at Yale Medicine in New Haven, Conn.
Talk with your primary care doctor, however, because what’s most appropriate may also depend on local COVID-19 infection rates.
Unsure which appointments you really need? Your primary care provider can help with this as well.
“Right now, most seniors need a quarterback who can go through their medical records and determine what sort of preventive care they need and which specialists need to be followed up with,” says Kenneth Koncilja, M.D., a geriatrician at the Cleveland Clinic.
For both primary healthcare providers and specialists, you may find that there’s a wait for appointments. So ask whether a telehealth or phone consultation is appropriate for you.
For any in-person appointments, you and your providers should take safety precautions, such as wearing masks, even if COVID-19 is at very low levels in your area. What else to look for: The doctor has you wait in your car instead of a waiting room or keeps chairs in waiting areas at least 6 feet apart, has removed communal materials such as magazines from the office, checks your temperature before you enter, asks whether you or anyone you have been near has COVID-19 symptoms, disinfects exam rooms between patients, and washes their hands for at least 20 seconds before and after each patient, Tinetti says.
Some healthcare providers may take additional precautions. For instance, your eye doctor may place a plastic “breath shield” on the slit lamp machine used to look at your eyes so that you and the doctor don’t breathe on each other.
Safety steps are especially important for dental appointments, which are considered higher-risk than some other kinds of healthcare because of close patient-provider proximity and the fluids often involved. The water used in routine cleanings can form potentially infectious aerosols, says Sally Cram, D.D.S., a spokesperson for the American Dental Association and a dentist in Washington, D.C. But if your area isn’t experiencing a spike in COVID-19 cases, it’s probably safe to see the dentist, she adds.
And if you have chronic conditions, now is the time to work with your doctors on a “virtual” plan of care in the event of a large COVID-19 outbreak in your area, says Jacqueline W. Fincher, M.D., president of the American College of Physicians and a primary care specialist in Thomson, Ga. For those who have high blood pressure or type 2 diabetes, for example, certain blood pressure monitors and glucose meters now allow you to download and email your readings to your physician’s office. That lets your doctor keep tabs on your condition from afar.
Ask About Vaccines
As we await a vaccine for COVID-19, it’s crucial to make sure you’re up to date on several key existing vaccines, Tinetti says.
At the top of the list is the flu vaccine. “We anticipate a wave of COVID-19 hitting in late fall, right around the same time the flu hits,” she says.
A study presented at the Infectious Diseases Society of America’s 2019 annual meeting found that adults 65 and older who got the flu vaccine reduced their likelihood of ending up in an intensive care unit by 28 percent and their risk of needing a ventilator by 46 percent. But the flu shot may hold benefits beyond that: A study of almost 90,000 people published last year in the journal Intensive Care Medicine found that those 65 and older who are admitted to an ICU for any reason have less risk of a blood clot or brain bleed, or of dying, within a year of hospital discharge if they’ve been vaccinated against the flu.
Two versions of the vaccine are for people 65 and older: Fluzone High-Dose and Fluad, both designed to produce a more robust immune response in older adults, Tinetti says. But if these aren’t available near you by late October, get the regular flu shot. That gives your body enough time to develop immunity before flu season emerges, but it’s late enough to make sure immunity doesn’t wear off by March or April.
If you’re older than 65 and you haven’t received the pneumococcal vaccine PPSV23, make sure you do this to reduce your pneumonia risk. (Last November, the Centers for Disease Control and Prevention stopped routinely recommending that most people over 65 get a second pneumonia vaccine, PCV13.)
And if you are 50 or older and haven’t gotten Shingrix, the newer shingles vaccine, get it now (even if you previously received the older shingles shot, Zostavax).
“The last thing you want to deal with in the middle of a flu/COVID outbreak is a case of shingles,” Tinetti says. You need two doses, with the second dose two to six months after the first. Shingrix, which can cause side effects such as headache, fever, and muscle pain, was in short supply last year but is more widely available now.
Stock Your Medicine Cabinet
When the first wave of COVID-19 hit, store shelves were emptied not only of toilet paper and paper towels but also of items such as thermometers and, in some places, acetaminophen (Tylenol and others). Experts say it’s wise to keep medications such as over-the-counter pain relievers and several basic medical devices on hand. These include:
Thermometer. Oral digital thermometers are usually the cheapest, most effective option, Fincher says. Infrared thermometers are also quick and accurate but tend to be significantly more expensive.
Pulse oximeter. You can place this device on your fingertip to measure the amount of oxygen saturation in your blood. This might be helpful if you develop symptoms of COVID-19 and your doctor wants to monitor your oxygen levels, says Veronica Rivera, M.D., assistant professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York City.
Though home pulse oximeters are fairly accurate, if you experience shortness of breath but have a normal reading, call your physician. Do the same if you need help interpreting the results. And skip oxygen-level phone apps: A review by the University of Oxford in England, published this past May, showed that many are unreliable.
Acetaminophen. This can help relieve fever, and muscle and body aches, associated with viruses such as COVID-19 and the flu, Koncilja says. It’s also safer for people over age 65 than over-the-counter nonsteroidal anti-inflammatories such as ibuprofen (Advil, Motrin, and others), which can cause side effects like gastrointestinal bleeding or can increase blood pressure if used regularly.
Guaifenesin. Many OTC cough and cold medicines aren’t recommended for older adults because they contain either phenylephrine or pseudoephedrine, which drive up blood pressure, or the antihistamine diphenhydramine, which has been linked to side effects such as dizziness, sleepiness, and even cognitive impairment in seniors. But guaifenesin (found in products such as Mucinex) simply thins mucus in your lungs so that you can cough it up more easily, Koncilja says.
Scale. A scale is critical for helping those with problems such as chronic kidney disease and congestive heart failure check for weight gain from fluid buildup. Also, obesity hikes the risk for COVID-19-related complications, and a scale may help those who are obese keep an eye on their weight.
Blood pressure monitor. About 78 percent of people older than 60 have high blood pressure, according to the American Heart Association. Members can see CR’s blood pressure monitor ratings online.
In addition to the above, Koncilja recommends having broth and drinks that contain electrolytes, such as Pedialyte, on hand to help with hydration if someone is ill.
Do a Medication Review
This is a good time of year to check in with your primary care doctor or physician for what’s known as a brown-bag review—a look at all your current medications and their dosages, Fincher says. That means getting all your meds together and taking them to your doctor or pharmacist. (Do this virtually if need be.)
In some cases, the medication list in your electronic health record may be incorrect, so a review can help. “There are always times where a medicine may get changed via a phone call over the weekend and it doesn’t end up in a patient’s medical record,” Fincher says. “But it’s critical that the label on the medicine bottle match the medicine list that both your primary care physician and pharmacist have.”
A medication review can also reveal whether you’re taking more meds than you need. More than one-third of older adults take at least five prescription medications, but some may be inappropriate or unnecessary. One 2017 study published in the Journal of Managed Care & Specialty Pharmacy found that a pharmacist-led review program for older adults was associated with a significant reduction in the use of high-risk medications, such as muscle relaxants and meds that worsened preexisting health conditions.
In addition to updating your medicine list, make a plan for getting prescriptions delivered (or having a friend pick them up), Tinetti says.
Shop for Must-Have Home Supplies
These include:
Face masks. If you use reusable face coverings, it’s smart to have at least two so that you don’t get stuck if one is in the wash, says Koncilja.
Hand sanitizer. Scrubbing your hands for at least 20 seconds with soap and water is best, but if that’s not possible, use hand sanitizer that’s at least 60 percent alcohol. If you want to stash a container of sanitizer in your car for convenience when you’re on the go, you can, experts say.
Disposable rubber gloves. The Centers for Disease Control and Prevention recommends donning a pair of disposable rubber gloves if you’re interacting with a family member who has COVID-19. Be sure to change gloves after every interaction.
Disinfectants. Not all household cleaning products can kill the coronavirus. The Environmental Protection Agency has a full list of products that do: Go to epa.gov and search for “List N.” You’ll see some familiar names, such as Clorox and Lysol, on the list, as well as advice about how to use disinfectants most effectively. You can also search for products by name online. If you’re unable to find disinfecting products, you can make your own by mixing 1/3 cup of bleach with a gallon of room-temperature water.
Keep Your Medical Info Handy
Being able to quickly put your hands on information such as medical test results and medication doses is important. What to do:
Have it all in one place. Print out office visit summaries and lab test results from your doctors’ patient portals. Store these, and the names of all your healthcare providers and their contact information, in a binder. You can take this to doctors’ appointments or check it easily during a virtual healthcare appointment. (If you prefer, keep the data in a file on your computer.)
Use visual aids for meds. Include a list of meds you take, information about them, and a photo of each. (In a pinch, tape a pill to the page.)
“A lot of pills are similar in shape, size, and color, and people get confused,” says Jan Busby-Whitehead, M.D., professor and chief in the division of geriatric medicine at the University of North Carolina School of Medicine in Chapel Hill. “This way, a pharmacist, physician, nurse, or even a family member can help sort it out.”
Get up to date on essential documents. If you haven’t put an advanced healthcare directive—which spells out the level of care you want if you become incapacitated—in place, consider doing so. This is particularly important in the era of COVID-19 because some older adults might not want to be put on a ventilator if they become sick enough to require one, says Nancy Morrow-Howell, Ph.D., M.S.W., director of the Harvey A. Friedman Center for Aging at Washington University in St. Louis.
Some people also give another (trusted) person their power of attorney for healthcare. This allows that person to make healthcare decisions on your behalf if you can’t. Discuss your wishes with your primary care doctor, too. If you don’t have a formal written agreement, writing down your desires for loved ones and medical providers is better than nothing, Morrow-Howell says.
Editor’s Note: This article also appeared in the September 2020 issue of Consumer Reports On Health.
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