The Punjab Health Department has issued advisory for the special care of Elderlies/Senior citizens during the COVID-19 pandemic. In a letter issued by the Health and Family Welfare Department, Punjab the elderly citizens aged 60 or above are advised to follow certain preventive guidelines (and their caretakers), so as to prevent the spread of the COVID-19.
The elderly citizens aged 60 or above are particularly susceptible to COVID-19 due to their low immunity & body reserves and co-existing illnesses. The course of COVID-19 disease in elderlies tends to be severe resulting in increased fatalities than younger population. All such individuals who are 60 years or above and have one or more chronic conditions such as Chronic (long-term) respiratory disease such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, post tuberculous sequelae, interstitial lung disease, Chronic heart disease such as heart failure, Chronic kidney disease, Chronic liver disease, such as alcoholic and viral hepatitis, Chronic neurologic conditions such as Parkinson’s disease, stroke, Diabetes Mellitus, Hypertension/ Increased Blood pressure and Cancer should follow the advisories strictly to be safe from Corona virus.
All senior citizens are advised to stay inside the house at all the times, avoid having any visitors at home, if a meeting is essential, the sitting arrangement should be such that a minimum distance of 1 metre amongst the participants is maintained, Handshakes/hugs to greet each other should be avoided. If an elderly citizen is living alone, he/she can consider depending on their healthy neighbours for acquiring essentials for home. Always maintain hygiene by washing hands regularly and especially before having meals and after using the washroom. Wash the hands with soap for at least 40 seconds by applying the soap gently on the palm and back of the hand including web spaces between the fingers and space as well as between the finger and the thumb and the wrist wherever and whenever the opportunity to wash the hands is available. However, a two-hourly handwash is recommended. Alcohol-based sanitizer (minimum 70% ethyl alcohol v/v) can also be used. The sanitizers are to be refilled/replaced frequently. Use a minimum of 3ml of the sanitizer (approximately 2 pushes of sanitizer dispenser) on DRY HANDS for at least 30 seconds for good hygienic hand disinfection. Sanitize the hands even if the hands appear to be apparently clean. The frequently touched objects such as spectacles, dentures, medicine boxes, utensils etc should be properly cleaned before and after use.
In case of a cough/sneeze, the elderly/caretaker should use the handkerchief to cover the face which shall then be kept in his/her own pocket/purse in a manner that the surface of the handkerchief exposed to the cough/sneeze shall not touch the other parts of the belongings directly. In case the person is not carrying the handkerchief he/she should cough/sneeze into the flexed/bent elbow. In either case, the person should immediately hand wash with soap in the manner prescribed his hands/other exposed surfaces to cough/sneeze. The elderly should refrain from touching face, mouth, nose and eyes with his hands at all times. The elderly should not spit except when absolutely essential and only in the washbasin of the toilet.
Specific Advisory for the elderlies
Avoid all small and large gatherings- social, religious etc at all cost. Remain actively mobile within the house, can consider doing light exercise and yoga at home, ensure proper nutrition through home cooked fresh hot meals, frequent hydration to prevent dehydration (caution for those suffering from Kidney/Liver disease) and also take fresh juices to boost their immunity. The senior citizens are advised to take their prescribed medicines as advised by their Doctor, keep an adequate stock of all such prescribed medicines readily available at all times, self-monitor their health. If they develop fever, cough and/or breathing difficulty or any other health issue, they should contact the nearest health care facility and the medical advice should be meticulously followed. Avoid any self-prescribed/prescribed by family, friends etc. medication/remedy and should always consult the nearest health care facility. Refrain from visiting any medical office/hospital for a routine check-up. As far as possible, opt for tele-consultation with their physician for all the enquiries. The tele-counselling helpline no of Government of Punjab is 1800-180-4104. They may consider postponing their elective surgeries (if any) like cataract surgery or total knee replacement. Take help from family members, if needed, via video conferencing or other electronic media.
Advisory for senior citizens on mental well-being
The senior citizens should constantly communicate with relatives at home, communicate with neighbours, provided social distancing is followed, and gathering of people is avoided, should be provided with a peaceful environment, rediscover old hobbies like painting, listening to music, reading etc, make sure to access and believe only the most reliable sources of information, avoid tobacco, alcohol and other drugs to avoid loneliness or boredom. Contact the nearest medical facility in case of change in mental status, such as excessively drowsy during the day, not responding, speaking inappropriately and new onset of inability to recognise relative which he/she could do before.
Advisory for the care givers of the dependent senior citizens
The care-givers should have a sense of connect and empathy with the senior citizens even if the senior citizen is in a bad mood/ restive mood. The caregivers should wash their hands in the manner prescribed before helping the older individual. The caregivers should cover nose and mouth adequately using a cloth mask while attending on the senior citizen. The masks shall be worn in a manner that it snuggly covers the nose as well as the mouth. The cloth mask should be washed with soap and water daily after use. The caregivers should clean the surfaces which are frequently used. These include a walking cane, walker, wheel-chair, bedpan etc. The caregivers should assist the older individual and help her/him in washing hands. The caregivers should ensure proper food and water intake by senior citizens. The caregivers should monitor the elderly’s health. The caregivers should not go near senior citizen if suffering from fever /cough/difficulty in breathing. The caregivers should not keep the older individual completely on bed rest. They should encourage movement or walking within the house of the individual. The caregiver should contact the nearest medical facility if the older adult has the symptoms of Fever, with or without body ache, New-onset, continuous cough, shortness of breath, unusually poor appetite, inability to feed.
Other Advisories for the Old Age Homes (in addition to Advisories for Care-givers)
Ensure a minimum distance of 1 meter amongst the inhabitants and Staff at all times, including meals/tea times. No outsiders and outside food shall be allowed. Ensure an adequate stock of medicines of all the inhabitants is available as well as the essential stock for the home. Ensure that the Doctor regularly visits the senior citizens and all the inhabitants are duly examined at the time of such visit. Demarcate a separate area as an isolation ward in case of any exigency.
Disinfection of the Old Age Homes
Indoor Areas: Indoor areas including office spaces and common rooms should be cleaned every evening or early in the morning. If the contact surface is visibly dirty, it should be cleaned with soap and water prior to disinfection. Prior to cleaning, the cleaner should wear disposable rubber boots, gloves (heavy duty), and a cloth mask.
Start cleaning from cleaner areas and proceed towards dirtier areas. All indoor areas such as entrance lobbies, corridors and stair cases, elevators, security guard booths, office rooms, common rooms, cafeteria should be mopped with a disinfectant with 1% sodium hypochlorite or equivalent disinfectants commercially available in the market.
High contact surfaces such as tables, chairs, elevator buttons, handrails / handles and call buttons, equipment like telephone, printers/scanners, and other office machines should be cleaned twice daily by mopping with a linen/absorbable cloth soaked in 1% sodium hypochlorite. Frequently touched areas like table tops, chair handles, pens, diary files, keyboards, mouse, mouse pad, tea/coffee dispensing machines etc. should specially be cleaned. For metallic surfaces like door handles, security locks, keys etc. 70% alcohol can be used to wipe down surfaces where the use of bleach is not suitable.
In a common room, if someone is coughing, without following respiratory etiquettes or mask, the areas around his/her seat should be vacated and cleaned with 1% sodium hypochlorite. Carefully clean the equipment used in cleaning at the end of the cleaning process. Protective gear used during sanitation process should be discarded as per the requirements.
Outdoor areas: Outdoor Areas have less risk then indoor areas due to air currents and exposure to sunlight. Cleaning and disinfection efforts should be targeted to frequently touched/contaminated surfaces as already detailed above.
Toilets: Sanitary workers must use separate set of cleaning equipment for toilets (mops, nylon scrubber) and separate set for sink and commode. They should always wear disposable protective gloves while cleaning a toilet. All the areas of the toilet such as the sinks, commode, taps etc. should be thoroughly cleaned/scrubbed using soap and water and then wiped with 1% sodium hypochlorite solution or equivalent commercial disinfectants available in the market.
Pantry should also be cleaned as the other inside office spaces. Special care needs to be taken while cleaning the slabs and the sinks, if any with soap/detergent and water.
The utensils should be properly cleaned with dish wash bars /liquids and water. The utensils should not be shared amongst the inhabitants/staff. Consumption of raw fruits/vegetables should be discouraged and the same shall be washed with lukewarm water before consumption. Similarly, the milk packets shall be washed with soap and water before opening the same for usage.
In case an older adult/caretaker is diagnosed as COVID-19 with whom one had a contact, there is no need to panic. One should report to the Helpline No. 104/State Control Room No. 01722920074/08872090029, detailing the exact nature of exposure so as to assist the medical facility to undertake further necessary actions.
All are encouraged to take proper diet, assimilate correct information and keep themselves aware and updated with the information at all times, and indulge in useful and productive activities during the available free time.
The elderlies are encouraged to download “COVA APP” developed by the Government of Punjab for the correct, timely and authentic information on COVID- 19. The elderlies are also advised to preferably keep the set of Helpline numbers of the Government/ relatives handy for immediate use in case of any emergency.