Changing Mask Mandates

Older adults navigate pandemic restrictions, balancing safety with socialization

When Illinois officials lifted pandemic mask mandates in February, Linda Balla, who is fully vaccinated, gave considerable thought as to whether to wear a mask. At 72, she is in a high-risk age group for complications from Covid-19.

Ever since Covid-19 restrictions loosened — and now with a judge voiding federal mask mandates for public transportation and airlines — many older adults remain in limbo, especially as Covid-19 numbers have gradually started to tick up again.

Many older adults wonder if they can safely ditch their mask when they travel or when they visit with their young grandchildren who may not be vaccinated, among other scenarios.

Now with masks no longer obligatory, individuals must decide for themselves whether or not to go mask-free. But many older adults are torn, wanting to enjoy life without restrictions but also wanting to preserve their health.

Balla considers a few factors when thinking about whether to mask. She and her husband live in an Evanston condo building that also houses a large number of university students, many of whom traveled recently for spring break. So Balla says she wears a mask in the building’s common areas and especially in the confines of the elevator.

Covid-19 statistics illustrate why older adults are right to be prudent. Covid-19 was the number one cause of death for people ages 45 to 84 in January 2022, followed by heart disease and cancer, according to The Peterson Center on Healthcare and KFF. Almost 75 percent of Americans who died from the coronavirus from January 2020 to April 2022 were aged 65 or older, according to CDC data.

Age itself can make older adults more vulnerable. With the passing years, the immune system grows weaker and less capable of fending off infectious diseases. Additionally, as people age, they’re more likely to have underlying health conditions that increase their risk of complications.

To mask or not to mask

Vaccination offers the first line of protection against Covid-19 for older adults. Julie Blankemeier, MD, a family health specialist at Oak Street Health, says she and her 83-year-old mother are both vaccinated to protect each other. “People should decide to get vaccinated not only because of the statistics but also to decrease the risk for those you love — your grandkids and older adults.”

The pandemic has been an especially difficult and confusing time for seniors, says Erika Hutz, DO, a specialist in geriatric and internal medicine at Swedish Medical Group. “They have been vigilant and isolated themselves for two years,” she says. “And some of them have been overly cautious about the lockdown because their adult children were so afraid their mother and father might catch the infectious disease.”

People can ask their primary care physician about the risks and benefits of wearing a mask, Hutz says. “He or she is the person who knows the patient best and knows about their chronic conditions,” Hutz says. While age is a risk factor for Covid-19, there is a difference between a healthy 65-year-old and an 85-year-old who has lung disease, so different guidelines may apply.

The safest place to go mask-less is outdoors, if the older adult can maintain a distance of six feet from others, Hutz says. If they are going to an outdoor festival with many people in a small space, it would be safest to wear a mask. If they are indoors with a lot people, it also would be safest to continue masking, she says.

Balla says when she is walking alone outdoors or with a vaccinated friend, she doesn’t wear a mask. But she works as a library assistant in the Department of Early Learning and Literacy at the Evanston Public Library, where she is in close contact with children who are too young to be vaccinated.

“I wear a mask to protect them from my germs and me from their germs,” she says. For the same reason, she also wears a mask when she volunteers with a quilting group, even though members are vaccinated. And instead of going to her fitness class in person, she opts to participate virtually, the way she did earlier in the pandemic.

Before older adults get together with family and friends, Hutz recommends asking anyone with symptoms to stay home. If family members and friends are vaccinated and symptom-free, with no recent exposures to Covid, it may be safe to go mask-free indoors with a small group. For grandchildren who are unable to be vaccinated, it is most important to ask about symptoms because even mild sniffles in children could indicate a Covid infection.

Re-engaging with others

But while the pandemic’s lockdown and social distancing may have protected seniors from the virus, the restrictions have also caused significant harm.

“Being alone has had a very serious effect on older adults who have experienced depression, anxiety, and a decrease in memory,” Hutz says. “So that is a reason for them to get out of the house now, see family and friends, and be social again.”

Blankemeier underscores the advice. “With telemedicine, I get to spend a lot of time with patients, and I am one of their few social contacts. I know people are suffering even more now, so I encourage them to return to as much normalcy as they want to,” she says.

The lack of normalcy during the height of the pandemic contributed to another adverse side effect for older adults: an increase in falls.

“That has to do in part because of their mental health, but also because they have not been out and haven’t been exercising regularly,” Hutz says. “They’ve been fearful of going to physical therapy or even seeing a home healthcare worker because they are fearful of the contact, so a lot of them are deconditioned.”

To stay on top of medical and mental health issues, Blankemeier recommends older adults:

  • Limit social media consumption to avoid taking in too much negative information.
  • Reach out to behavioral health specialists and social workers to talk through the challenges of this particular time.
  • Make appointments for preventive health screenings, such as mammograms and colonoscopies, while Covid cases and hospitalization rates are low.

While older adults should seek professional help for their health issues, it’s also important to find ways to improve their quality of life. Blankemeier says her patients who are doing the best “have somehow found ways to be active, to laugh, and still connect with others.”

She offers these suggestions for older adults to stay active:

  • Avoid crowds, but stay connected by doing things outdoors with family or friends.
  • Exercise at home or outdoors to your ability level, such as dancing, exercise biking, and practicing chair yoga.
  • Listen to music, do art activities and puzzles, and read books.
  • Find ways to laugh with friends and watch humorous TV shows.
  • Enjoy virtual concerts and other joyful virtual programs.

With Covid-19 cases and hospitalizations still at relatively low levels, now is the time for older adults to finally enjoy being with loved ones again and to get a breath of invigorating fresh air.