Older people and COVID-19 in Mexico and Brazil. What role can Gerontology play? Webinar Report

By Thais de Carvalho Rodrigues Lopes, University of East Anglia, UK.

This Global Platform webinar ran on 24 October 2020, and was in Spanish/Portuguese. You can access the recording here: https://corona-older.com/webinars/

The webinar reunited specialists from Brazil and Mexico to discuss the role of gerontology in the prevention and care related to COVID-19. The webinar was chaired by Veronica Montes Oca, from the National Autonomous University of Mexico (UNAM). She is a national expert in gerontology and a reference in older adult’s care in Latin America, and was responsible to sowing together the experiences describes by Brazilian and Mexican speakers.

Dr Karla Giacomin, from Brazil, gave the first talk. She is the coordinator of the Frente Nacional de Fortalecimento às ILPIs, a national alliance that was established to strengthen the response of care homes to COVID-19 in Brazil. She also works at FIOCRUZ, a renowned institution of biomedical research in Brazil.

Dr Giacomin described the work of the national alliance to reduce the damage of COVID-19 among older adults in care homes. She discussed the existing gaps in public policy, the high number of deaths in Brazil and how the Frente Nacional acted in order to address this fraught system.

Brazil lacks data on the number of older adults that reside in care homes – the last data available is from 2008. Most information available is from institutions that are registered in the public system, but this does not comprehend the total of care homes that exist in Brazil. From the existing data, they infer that there is a higher concentration of care homes in Southeast region of Brazil: 58% of the national total. They also know that 94% of care homes are private institutions.

The Frente Nacional was created in 8 April, when Brazil had less than a thousand deaths due to COVID-19. It resulted from a question made by gerontologists to the National Chamber of Deputies: will Brazil see a tragedy with this disease and older adults? Their main motivation is to fight COVID-19. All members are volunteers from all regions of Brazil, from various disciplines and fields of study. Together, they have developed accessible information to raise awareness about strategies of prevention of COVID-19, taking into account the particular context of Brazilian care homes.

Despite the high mortality rate of COVID-19 in Brazil, Frente Nacional as successful. The number of deaths of older adults in care homes in Brazil (19,4%) is considerably low when compared to that of other countries. For instance, in Canada this proportion was 85%. Dr Giacomin cites a few reasons for the success of this initiative: the large offer of PPE for care homes, the training of all collaborators, and the prohibition of visits in the institutions.

The following speaker, nurse Yeda Duarte, form the University of Sao Paulo (USP) was essential to the creation of the Frente Nacional and for its success. In her presentation, she discussed the the care of older adults in Sao Paulo, the State the has the largest number of care homes in Brazil, and one of the most affected regions in the country as well.

Her presentation largely discussed the inequalities that were heightened by the pandemic. For instance, there is a gender discrepancy visible in the infection and death rates. In relation to infection, the most vulnerable group seem to be women, and in the age group of 30-50 years. However, the mortality is higher among men in the age group of 80+. Similar inequalities can be traced in regards to race. Yeda highlights that there is a large trend of infection among White people, but the death rates are higher among Black people. This gives proof of the relevancy of reflecting about a racialized access to health care. As in other countries, COVID-19 is riskier for people with comorbidities, specially diabetes and heart diseases.

To fight the spread of the disease in Sao Paulo, the regional strategy was to put up emergency units of care, distribute diagnosis kits and create a strategic committee that would build a further plan of action. They also trained relevant professionals and published accessible information for the broader population. With the reopening of the city’s activities, especially in-person schooling and entertainment avenues, USP and the Frente Nacional had the new challenge to extend tests. They found out that 26% of the adults already had COVID-19. This number was higher among Black people, reinforcing the inequality that she had previously signalled.

The next speaker was Ana Gamble, who works at the National Institute for Older Adults (INAPAM) in Mexico. Gamble started her presentation combating ageism by presenting the realities of older adults in Mexico. The country has more than 14 million people over the age of 60 and an average life expectancy of 75 years (78 for women and 73 for men). The vast majority of the elderly population (more than 80%) can participate in community life, and thus older adults are a fundamental and productive part of society.

The National policy for older adults focuses on social policies and welfare. Particularly, it aims to ensure the dignity and wellbeing of older adults, prioritising those living in poverty. The Pension for the Wellbeing of Older Adults is one such enactment of this, as it offers a living wage for people over the age of 68 (and over the age of 65 in indigenous territories).

INAPAM helps to strengthen these social policies, and to promote a culture that values older adults, and active ageing and an intercultural, right-based approach with elderly people. One example of INAPAM’s action is the creation of inter-institutional regional councils that focus on older people. A technical committee is also elaborating a plan of action focused on the elderly, encompassing health, equality and justice, culture, economic and social security and education.

In face of COVID-19, INAPAM has been dialoguing with various health agents and social organisations to prevent the infection of older people and to fight the stigmatisation of the elderly in the society. Posters and flyers have aimed at strengthening intergenerational networks that could support the care and isolation of older adults. At the start of the pandemic, INAPAM sent a letter to elderly-focused institutions, alerting them against fake news and informing about the preventive measures of COVID-19. This letter is available here.

INAPAM also offered training for their staff about the right COVID-19 protocol, highlighting the risk of the virus for older people. INAPAM closed all offices in March 27, and suspended activities in care homes, cultural centres and clubs. They created a network of affiliation between older people and institutions, so that elderly could be kept well informed and have support if needed.

IANAPAM developed guidelines for care homes that host elderly for prolonged stays. There is constant communication (twice a week) with these institutions. This way, INAPAM gets constant updates about the national number of care home residents suffering from COVID-19.

The last panellist was Dr Armando Gonzalez Bedoy, who is the president of the Mexican Association for Gerontology and Geriatrics. Dr Bedoy starts by discussing the centrality of ageing in the global agenda, and how COVID-19 arises in this context. He moves forward to present the important role of gerontology in this scenario. Reinforcing what other speakers had indicated, he mentions the importance of constant research and communication to update people’s knowledge about older adult’s care, and an inter-institutional strategy that brings together national and foreign institutions, and bond with the community as a whole.

In this scope, he mentions a campaign that the Association created on Facebook with the objective to engage with a broader audience. Through this platform, they addressed several contextual problems of COVID-19: misinformation, the initial panic brought for by the emergency, the social isolation that increased the risk of abuse toward the elderly, and the overwhelmed condition of the carers during the pandemic.

Another relevant scope of their work is the promotion of a healthy ageing. This is aligned with the global trend of an aging population, and the need to prevent the stigma and the ostracism of the elderly. Dr Bedot argues that in order to achieve this goal it is necessary to educate both professionals and family members. During the pandemic, the Association addressed this through online academic sessions, symposiums, training and workshops which discussed healthy ageing in the age of COVID-19. In presenting this initiatives, he reinforced the role of gerontologists by saying that a geriatric doctor who does not engage with gerontology will not be able to achieve a comprehensive understanding of their patients.

Concluding the panel, we had a debate among all speakers and the chair. Veronica returned to the issue of inequality, which was particularly visible in Yeda’s presentation but is actually pervasive in Latin America. She wondered how inequality dialogues with the interdisciplinary perspective presented by panellists in Brazil and Mexico. Ana Gamble mentioned that part of INAPAM’s work is identifying institutions focused on elderly care is to address the poorest conditions of those that lack structure to deal with the virus (e.g.: providing support to older adults in street situation in Tijuana). Following this, Karla Giacomin argued that without a proactive position form civil society, the death rate in Brazil would have been much worse. Furthermore, she questions the mystified image of the Latin American family as a caring institution: the pandemic highlighted that women are the ones in charge of the household and they are overwhelmed. In order to offer better residential care for the elderly, we have to reckon with the reality that institutionalising the elderly is not necessarily a careless last resource. Quite otherwise, for many families it is the only viable option.

Finally, all speakers reinforced the importance of communication and interconnected action among various sectors. This is necessary not only to cope with the challenge imposed by this pandemic, but to counter the stigma of older people (other campaigns against ageism can be found in the global platform).