Early studies reveal the toll that lockdowns, isolation and stress have taken on those who care for older Americans.Mary Ann Boor could see her husband’s Alzheimer’s disease progressing, and her responsibilities as his caregiver intensifying.For years, David Boor had carefully taken diabetes medications. But as he grew forgetful, Ms. Boor had to start monitoring the doses and timing. She took over the driving and then the finances; she had to begin helping him bathe and dress.The Boors, retired high school teachers who moved to a lakefront retirement home in Huron, Ohio, were managing on their own. “Then, about the time I thought maybe I should look into home health aides, the pandemic struck and I was leery of people coming into the house,” Ms. Boor, 71, recalled.Her husband, 72, was a cancer survivor, she said, and “I didn’t feel I could take the chance, expose him to something that could be so serious.”Through the many surges of Covid-19, several forms of support fell away. Ms. Boor’s yoga studio, a frequent refuge, shut down. Friends and relatives who occasionally kept Mr. Boor company, giving his wife a few hours’ break, couldn’t come. Her sleep suffered.“It certainly put some additional burdens on me,” Ms. Boor said. “I was always thinking about, What if he gets sick? Or, what would happen if I became ill? That scared me even more.”Most older Americans who need help with the so-called activities of daily living — bathing, dressing, eating, using a toilet — don’t receive any kind of paid care, at home or in care facilities. They rely on unpaid family caregivers.Now, early research is showing how those caregivers struggled through 2020, as the pandemic made an already stressful job tougher.A study recently published in The Gerontologist, comparing 576 family caregivers to nearly 3,000 non-caregivers, found significantly higher rates of anxiety, depression and disturbed sleep among the caregivers (average age, 59), most of whom were caring for people over 65.The caregivers also reported less social interaction and more worries about finances and food, even after controlling for factors like income and employment.“The pandemic has exacerbated things,” said Scott Beach, a social psychologist at the University of Pittsburgh and lead author of the study. “It impacted everybody, but it impacted caregivers more.”The online survey, conducted in April and May of 2020, found disparate effects, as in many aspects of the Covid crisis. “Female caregivers, young caregivers, lower-income people and those providing more care — both personal and medical care — all were worse off,” Dr. Beach said.If they were caring for people with cognitive disabilities like dementia, or with behavioral and emotional problems, “they fared really poorly,” he added.At about the same time, Sung S. Park, a sociologist and demographer at the Harvard Center for Population and Development Studies, used a nationally representative online panel to explore caregivers’ mental and physical health. Her study distinguished between short-term caregivers, who had provided assistance for a year or less, and those who had been in the role longer.The findings, from nearly 4,800 respondents, showed that while caregivers suffered more psychological distress and fatigue than non-caregivers, the length of service made a pronounced difference. Long-term caregivers had much higher rates of physical symptoms like headaches, body aches and abdominal discomfort.The surges and shutdowns created a variety of problems for caregivers, said Grace Whiting, president and chief executive of the National Alliance for Caregiving. Some, like Ms. Boor, were afraid to bring helpers into their homes, paid or unpaid.For others, as adult day centers and senior centers closed, “the feeling of being alone, with no relief valve for the complex emotions that come with caregiving, was amplified,” Ms. Whiting said.Ms. Boor is still managing her husband’s care mostly alone. She said she copes with stress by knitting and talking to her daughter by phone.Maddie McGarvey for The New York TimesCarol Brown moved from Missouri back into her childhood home in Livermore, Calif., in November 2019 to care for her 88-year-old mother, who could no longer live alone safely.Although Ms. Brown, 58, felt glad to be able to keep her mother at home, “I cried a lot, watching my mother aging, feeling my own upheaval,” she said. What helped was a twice-monthly caregiver support group whose members, like her, were women caring for mothers with dementia.“It was emotionally good to be with them,” Ms. Brown said. “They’d all been through the wringer. And they were a font of information.”She misses their support. With the pandemic, the group moved online, but Ms. Brown found Zoom sessions unsatisfying and stopped participating.Other caregivers ran into trouble accessing health care, either for themselves or their loved ones. Ora Larson, 82, was scheduled for back surgery in the spring of 2020 in St. Paul, Minn., and was looking forward to relief from the disabling pain of spinal stenosis. Then, as hospitals filled with Covid patients, her operation was postponed until October, then delayed again.As she waited, “her ability to get all kinds of therapy went away,” said her daughter, Susan Larson, 57. “She couldn’t go to exercise, or have a physical therapist or trainer come to the house, so she got weaker and weaker and her pain increased.”As Ms. Larson watched her lively mother grow depressed and lose much of her ability to walk, “I felt stressed in the way you do when you’re not sure what your next move is going to be,” she said. Her mother finally underwent surgery in March and is recovering well.Further studies will reveal more about the ongoing effects of Covid on caregivers. Perhaps they adapted as the pandemic ground on, and their stress abated. Some welcome the meaning and purpose that comes with helping family members.But the cumulative negative effects, month after month, could also mean greater hardship. And as Dr. Park pointed out, “there would be a greater probability of bereavement and grieving.”The caregivers interviewed here, and their family members, have been vaccinated and are slowly starting to resume visits and local excursions. But they also recognize that elder care tends to grow more demanding, not less. Those they care for have lost ground physically and cognitively, and may be unable to return to their prepandemic selves.Stacey Lantagne, 40, a law professor at the University of Mississippi, spent the pandemic with her family in Rhode Island, where she helped care for her grandmother while also teaching a full course load online.Her grandmother, 89, had loved attending a dementia day program three days a week, and Ms. Lantagne was relieved when it reopened and she could safely return. “But she hadn’t left the house in so long that she was really frightened,” Ms. Lantagne said. So her grandmother attends just twice weekly; the family hopes she can increase her participation soon.Several Biden administration proposals could bring some relief for family caregivers, who have saved the health care system so much money while sacrificing so much themselves.The American Jobs Plan, which sees caregiving as part of the nation’s infrastructure, would allocate $400 billion to expand access to home and community care for the elderly and disabled through Medicaid, while raising wages and benefits for home care workers. (It may not do much for seniors who don’t qualify for Medicaid, however.)The American Families Plan would establish paid family and medical leave nationally, guaranteeing up to 12 weeks of paid leave by the program’s 10th year.When Mr. Biden announced the plan in April, pointing out that it would cover the cost of care not only for children but also for seniors, “I was tearing up on my couch,” Ms. Whiting said. “It was remarkable to hear him talk about elder care as a normal part of life.”Those proposals face a fight in the Senate, however. For now, as usual, family caregivers remain largely on their own.The Boors have been able to resume some family visits, but Ms. Boor is still managing her husband’s care virtually alone. She copes with stress by knitting and talking to her daughter by phone.And she prays. “I ask God for some help, and he’s always there for me,” she said.

Railings, grab bars, shower chairs and other inexpensive devices can make it easier to continue living at home, but not enough older people acquire them.In 2019, John Hancock had become so disabled after a hospitalization that he went close to a year without being able to take a bath or a shower. Using a walker, he could, with difficulty, move around the townhouse in Baltimore where he lived with his daughter and grandson. But because he felt too unsteady to climb into the tub, one of them had to help him with sponge baths.Then a program at Johns Hopkins called CAPABLE (Community Aging in Place — Advancing Better Living for Elders) sent a nurse, an occupational therapist and a repair person to provide some inexpensive assistive devices. “It made a tremendous difference in my life,” Mr. Hancock, a retired school cook, said.Over several visits, the team asked about his needs and priorities and supplied a shower chair and a rubber bath mat. The repair person installed grab bars around the tub, attached a hand-held shower nozzle and added a railing next to the toilet. Mr. Hancock learned how to use it all.“I feel safe and I feel secure,” he said recently. “I don’t have to call somebody to help me. I feel independent, and I’ve been independent all my life.” Recovering well from a recent stroke, Mr. Hancock, now 64, can not only bathe on his own but can also cook for himself, manage stairs and go to church.How many older adults could benefit from such simple, low-cost, nonprescription devices? And how many actually acquire them?A team at the University of California, San Francisco, combed through national data and came up with an estimate, recently published in JAMA Internal Medicine: About 12 million people over 65, living in their own homes, could use equipment to help them safely bathe and use the toilet, two of the activities disabled older people most commonly struggle with. But about five million of them don’t have those items, even though they generally cost less than $50.Looking at Medicare beneficiaries in the National Health and Aging Trends Study in 2015, the researchers identified more than 2,600 people (average age: about 80) who needed such devices, based on measures like holding onto walls as they walked and being unable to rise unassisted from a chair.“They’re not as nimble as they used to be,” said Dr. Kenneth Lam, a geriatrician and lead author of the study. “They’re the parents you’re starting to worry about.”Mr. Hancock demonstrates the grab bars and shower chair CAPABLE put in his bathroom. “It was amazing,” he said. “I was overwhelmed and full of joy. I haven’t gone to the shower in a year.”Rosem Morton for The New York TimesOf those who could have benefited from a shower chair and grab bars for bathing, 26 percent did not have either and only 40 percent had both. In the group who could have used a raised toilet or toilet seat, plus a grab bar for toilet use, 44 percent had neither and 24 percent had both. Extrapolating to the national population produced the five million estimate.“It’s a technical problem which, unlike so much of aging, is actually solvable,” Dr. Lam said. Yet after four years, the researchers found, many participants in need still had not acquired the equipment, or had died without it.“In the hospital, I can order an M.R.I. and charge the system thousands of dollars,” Dr. Lam said. “But down the road, that won’t help patients not fall. What happens when they get home?”Home is where older adults want to stay. Covid-19 and its predations and restrictions have made senior living facilities increasingly unpopular; occupancy rates in the first quarter of this year reached a record low, the National Investment Center for Seniors Housing and Care has reported.Yet, “there are people all over the country whose homes don’t fit what they need,” said Sarah Szanton, a nursing researcher at Johns Hopkins University and director of the decade-old CAPABLE program in Baltimore. Thirty-three similar programs now operate in 18 states.What doctors and therapists (and families) worry about most in such cases are falls, a leading cause of hospitalization and disability for older people. Bathrooms, with their hard and slippery surfaces, pose a particular danger.CAPABLE, deploying its multi-specialty team and a modest budget of $1,300 per household for repairs, equipment and installation, offers low-income residents not only bathroom equipment but also kitchen grabbers, well-anchored banisters and other useful articles.And it pays off. “On average, people’s disability is cut in half,” Dr. Szanton said. “Their pain decreases. Their ability to bathe and dress improves. People stuck on the second floor of their houses for years can go on family trips.”CAPABLE reduced Medicaid spending and could create Medicare savings as well. Participants reported that it helped them remain at home, made their homes safer and helped them care for themselves.Elsewhere, users of assistive devices tell similar stories. “We all know someone who had an aunt or a mother who couldn’t get out of the tub or off the floor, and bad things happened,” said Wendl Kornfeld, 72, who lives in Manhattan with her 83-year-old husband.They had grab bars installed in their two showers for roughly $120 total, “not a huge investment and worth it for peace of mind,” Ms. Kornfeld said.In Mt. Kisco, N.Y., Joan Potter appreciates the apartment renovations her late husband oversaw 20 years ago. He used a wheelchair, so their bathroom had a roll-in shower with a hand-held shower head, a raised toilet and grab bars in key locations. Now that Ms. Potter, 88, has undergone two hip replacements, she said, “I’m so grateful I have all these things, because I’m not so agile myself anymore.”Why don’t more seniors take advantage of such devices?Some adaptations that help people remain at home, like outdoor ramps and stair glides, carry high price tags; basic bathroom devices, widely available in pharmacies and online, generally don’t. But cost can still present an obstacle.“Medicare covers ‘durable medical equipment’ — hospital beds, wheelchairs, walkers,” said Tricia Neuman, who leads the Kaiser Family Foundation’s program on Medicare. “It doesn’t cover hand rails or grab bars, things used around the house.”With the help of new railings, Mr. Hancock can manage stairs again.Rosem Morton for The New York TimesMedicare Advantage plans have more flexibility, but a Kaiser study found that of Advantage enrollees, only six percent were in plans that covered bathroom safety equipment.A recently announced federal program from the Department of Housing and Urban Development will provide $30 million for a home modification program for low-income homeowners aged 62 and older, a helpful but small step.Moreover, price isn’t the only barrier to assistive equipment. “You need whole systems to deliver it,” Dr. Lam said. Sometimes, faced with the challenges of selecting the appropriate devices, ordering and installing them, “even for people who want them, it just doesn’t happen.”And a lot of seniors don’t want them. “These are symbols to people that they’re losing control,” said Marcie Gleason, a social psychologist at the University of Texas at Austin who studies such issues. “It feels like dependency to need these devices — even though they probably help them remain independent.”Karen Purze spent a decade caring for her late parents, who hoped to age in place in their Chicago home. She worried every time her father, undergoing cancer treatment in his late 70s, climbed in and out of an old-fashioned claw-foot bathtub without supports.She suggested modifications, but “he wouldn’t listen.” He’d say, “‘I don’t need that. I’m fine,’” Ms. Purze recalled. “He was clinging tightly to every bit of independence.”Trying to overcome that resistance, and simplifying the process of acquiring and using safety equipment, will require a multipronged effort, with more attention from primary care doctors, more programs like CAPABLE and shifts in Medicare policies.But it may require changes in outlook, too. Ms. Purze, 50, and her husband are most likely years away from needing raised toilets and shower chairs — but are already talking about them.In their next house? “Grab bars, for sure,” she said. “I’ve seen how important it is, in maintaining your independence, that your house helps you and doesn’t hinder you.”

Meal programs for older adults have long been underfunded. The new economic recovery plan will help.Long before the coronavirus hit, nutrition programs that served the nation’s older adults struggled to keep up with a growing demand. Often, they could not.In Charlotte, N.C., and nine surrounding counties, for example, the waiting list for Meals on Wheels averaged about 1,200 people. But Linda Miller, director of the Centralina Area Agency on Aging, which coordinates the program, always assumed the actual need was higher.She knew some clients skipped meals because they couldn’t travel to a senior center for a hot lunch every weekday; some divided a single home-delivered meal to serve as both lunch and dinner.Some never applied for help. “Just like with food stamps, which are underused,” Ms. Miller said, “people are embarrassed: ‘I worked hard all my life; I don’t want charity.’”In Northern Arizona, state budget cuts coupled with only modest increases in federal dollars through the Older Americans Act also produced waiting lists.“We get flat funding and say: ‘Thank you! We didn’t get cut!’” said Mary Beals-Luedtka, director of the Area Agency on Aging that serves four largely rural counties there. “But flat funding is like a decrease. It’s not adequate.”Covid-19 made the task immeasurably harder. Across the country, it shut down the senior centers and church halls that served meals to healthier, more mobile seniors. Then those closures, plus shelter-in-place policies and fears of exposure, drastically boosted the number of older people who needed meals delivered.Many volunteers, also at risk because of age, stayed away. Sometimes, so did family members who had pitched in with shopping and cooking, now worried about infecting their elders.The Arizona team scrambled to distribute 150 percent more meals at home last year than the year before. “My staff was reeling,” Ms. Beals-Luedtka said. “It was crazy.” She still has about 70 people on a waiting list.Help has come, however. To the relief of administrators and advocates, the first three federal Covid recovery packages included substantial increases in funding for the Older Americans Act, which supports both congregant, or group, meals (which serve the majority of participants) and Meals on Wheels.Nicole Carey, left, and Tameika Drye, center, prepared meals for delivery to seniors and others at Cabarrus Meals on Wheels in Concord, N.C.Travis Dove for The New York TimesThe fourth infusion and the largest by far, $750 million, will come from the American Rescue Plan that President Biden signed last month. It brings the total increase for senior nutrition services to $1.6 billion. In fiscal 2019, they received $907 million.“It’s a victory and a validation of the value of this program,” said Bob Blancato, executive director of the National Association of Nutrition and Aging Services Programs. “Older adult malnutrition is an ongoing problem.”Separately, a 15 percent increase for everyone who qualifies for food stamps, more formally the Supplemental Nutrition Assistance Program, will benefit an estimated 5.4 million older recipients.For years, advocates for older adults have lobbied Congress for more significant federal help. Although the Older Americans Act has enjoyed bipartisan support, small annual upticks in appropriations left 5,000 local organizations constantly lagging in their ability to feed seniors.From 2001 to 2019, funding for the Older Americans Act rose an average of 1.1 percent annually — a 22 percent increase over almost two decades, according to an analysis by the AARP Public Policy Institute. But adjusted for inflation, the funding for nutrition services actually fell 8 percent. State and local matching funds, foundation grants and private donations helped keep kitchens open and drivers delivering, but many programs still could not bridge their budget gaps.At the same time, the number of Americans over 60 — the age of eligibility for O.A.A. nutrition and other services — grew by 63 percent. About one-quarter of low-income seniors were “food insecure,” meaning they had limited or uncertain access to adequate food.And that shortfall was before the pandemic. Once programs hastily closed congregant settings last spring, a Meals on Wheels America survey found that nearly 80 percent of the programs reported that new requests for home-delivered meals had at least doubled; waiting lists grew by 26 percent.Along with money, the Covid relief legislation gave these local programs needed flexibility. Normally, to qualify for Meals on Wheels, homebound clients must require assistance with activities of daily living. The emergency appropriations allowed administrators to serve less frail seniors who were following stay-at-home orders, and to transfer money freely from congregant centers to home delivery.Even so, the increased caseloads, with people who had never applied before seeking meals, left some administrators facing dire decisions.In Northern Arizona, about 800 clients were receiving home-delivered meals in February 2020. By June, that number had ballooned to 1,265, including new applicants as well as those who had previously eaten at the program’s 18 now-shuttered senior centers. Clients were receiving 14 meals each week.By summer, despite federal relief funds, “I was out of money,” Ms. Beals-Luedtka said. She faced the grim task of telling 342 seniors, who had been added to the rolls for three emergency months, that she had to remove them. “People were crying on the phone,” she recalled. “I literally had a man say he was going to commit suicide.” (She reinstated him.) Even those who remained started receiving five meals a week instead of 14.Now, Ms. Beals-Luedtka awaits an estimated $1.34 million from the rescue plan, which will largely eliminate the waiting list, increase the number of meals for each recipient and help local providers acquire and repair kitchen equipment as senior centers reopen.Amanda Buck, right, a volunteer with Cabarrus Meals on Wheels, delivered a meal to Gloria Grooms, a former caregiver in Kannapolis, N.C.Travis Dove for The New York TimesIn North Carolina last month, the Centralina agency, working with a food bank, started delivering grocery boxes — containing produce, canned food and other staples — to low-income seniors, using federal money from last year’s CARES Act. “They’re a huge hit,” Ms. Miller said. “I could never do that before.”It may seem unnecessary for senior nutrition programs to accomplish anything beyond feeding hungry older people, but research has demonstrated their broader impact.“Addressing nutritional needs isn’t good only for people’s quality of life,” said Kali Thomas, a researcher at Brown University whose studies have demonstrated multiple benefits to Meals on Wheels. “It improves their health.” These programs diminish loneliness and help keep seniors out of expensive nursing homes. They also may help reduce falls, although those findings were based on a small sample and did not achieve statistical significance.Interestingly, Dr. Thomas’s research found daily meal deliveries had greater effects than weekly or twice-monthly drop-offs of frozen meals, a practice many local organizations have adopted to save money.Frail or forgetful clients may have trouble storing, preparing and remembering to eat frozen meals. But the primary reason daily deliveries pay off, her study shows, is the regular chats with drivers.“They build relationships with their clients,” Dr. Thomas said. “They might come back later to fix a rickety handrail. If they’re worried about a client’s health, they let the program know. The drivers are often the only people they see all day, so these relationships are very important.”Congregant meals contribute to participants’ well-being, too, staving off food insecurity and providing socialization and healthier diets, a prepandemic evaluation found.So while program administrators relish a rare opportunity to expand their reach, they worry that if Congress doesn’t sustain this higher level of appropriations, the relief money will be spent and waiting lists will reappear.“There’s going to be a cliff,” Ms. Beals-Luedtka said. “What’s going to happen next time? I don’t want to have to call people and say, ‘We’re done with you now.’ These are our grandparents.”

The number of older adults who use cannabis is on the rise, and some health experts are concerned.For years, Harry B. Lebowitz spent the cocktail hour at his home in Delray Beach, Fla., sitting in his backyard overlooking a lake and smoking a joint while his partner relaxed with her vodka and club soda.Mr. Lebowitz, 69, a mostly retired businessman, qualified for a state medical marijuana card because he suffered from anxiety, sleep apnea and back pain. He credits cannabis with helping to wean him off several prescription drugs.Then came Covid-19, heightening both his anxiety and his boredom. “It was like the world stopped,” Mr. Lebowitz said. “We’re all suffering from some form of PTSD, all of us.”He found himself smoking several times a day instead of once, and downing three to five shots of añejo tequila daily, too.Even before the pandemic, researchers were reporting on the growing popularity of cannabis among older adults, although the proportion using it (or at least acknowledging its use) remained small.Last spring, an analysis based on the National Survey of Drug Use and Health found that marijuana use in the prior year among people over 65 had jumped 75 percent from 2015 to 2018, from 2.4 percent of that group to 4.2 percent. By 2019, use had reached 5 percent.“I would expect it to continue to increase sharply,” said Dr. Benjamin H. Han, the lead author of the analysis. The data showed use rising particularly among women and among people with higher education and income.A team using a different national data set documented a similar trend last fall. From 2016 to 2018, the proportion of men ages 65 to 69 who reported using marijuana or hashish within the past month had climbed to 8.2 percent from 4.3 percent. Among women, it grew to 3.8 percent from 2.1 percent.“It’s rare to see that much change in a three-year period,” said William Jesdale, an epidemiologist at the University of Massachusetts. “It shocked us.”Maybe it shouldn’t be so surprising, though. During that period, “you had the backlash against opioids,” said Donna M. Fick, a researcher who directs the Center of Geriatric Nursing Excellence at Penn State. With addiction and overdoses so prevalent, “clinicians are wary of prescribing them to older adults anymore, so people are looking for a solution.”The inexorable increase in legalization plays a part, too. In November, voters in four states (Arizona, Montana, New Jersey and South Dakota) approved recreational use; the Virginia Legislature did the same last month, with the governor expected to sign the bill.That would bring the total to 16 states, plus the District of Columbia, that permit “adult use” marijuana. Mississippi and South Dakota legalized medical cannabis in November, too, joining 34 other states.“It’s easier to get and it’s also less stigmatized,” Dr. Jesdale said. With less punitive policies and just-say-no rhetoric, “people who used in their youth and may have stepped away might have come back, now that it’s not Demon Weed anymore,” he added.There are no data yet on how the pandemic, with its stress and isolation, affected use among older people. But legal cannabis sales grew by 20 percent last year, according to the National Cannabis Industry Association. Leaf411, a nonprofit, nurse-staffed information hotline, received 50 percent more calls, most from older adults.Researchers therefore expect the numbers will show greater geriatric use. Mental health surveys of older people last year showed rising anxiety and depression, conditions frequently cited as reasons to try cannabis.“I’ve definitely seen my patients who were stable returning for tuneups,” said Eloise Theisen, president of the American Cannabis Nurses Association and a geriatric nurse-practitioner in Walnut Creek, Calif. “Their anxiety was worse. Their insomnia was worse.”The effects of the pandemic varied, of course. Ileane Kent, 80, a retired fund-raiser in Lantana, Fla., has vaped nightly for years, “just to chill out,” she said.She became a legal user for the first time in June, because she no longer wanted to risk entering her supplier’s house. With a medical marijuana card, and as a longtime breast cancer survivor — “Honestly, they don’t turn anyone away,” Ms. Kent said — she now patronizes a dispensary whose Covid protocols she finds more reassuring.Barbara Blaser, 75, a nurse who worked at a dispensary in Oakland, Calif., had for years dealt with pain and anxiety after extensive surgery. She had come to rely on five milligrams of edible cannabis, in the form of one chocolate-covered blueberry, each morning and each evening. But after being laid off last year, she no longer faced a stressful commute or spent hours on her feet, so her use has diminished.Still, the $17.5 billion legal cannabis industry keeps seniors squarely in its marketing sights. Major retailers offer dispensary discounts of 10 to 20 percent on “Silver Sundays” or “Senior Appreciation Days.” Some offer older customers free delivery.Older customers at Bud and Bloom, a cannabis dispensary in Santa Ana, Calif., in 2019.Jae C. Hong/Associated PressThe pandemic suspended promotions like the free bus that ferried customers from a retirement development in Orange County, Calif., to a dispensary in nearby Santa Ana called Bud and Bloom, which offered them a catered lunch, new product information and a senior discount. But Glen Turiano, a general manager at the dispensary, hopes to revive the service this summer.Trulieve, another retailer, similarly plans to resume its monthly Silver Tour, which sent a cannabis advocate to assisted living facilities across Florida, where he told residents how to qualify for and use medical cannabis. Green Thumb has reached potential older users at a senior recreational center in Waukegan, Ill.; at a Lunch & Learn event at Century Village in Deerfield Beach, Fla.; and at senior health expos in Pennsylvania.All of which makes health care professionals who treat seniors uneasy. “Older people need to know that the data is very unclear about the safety of these medications,” Ms. Fick said. “Whether or not they actually help is also unclear.”A recent review in JAMA Network Open, for instance, looked at clinical trials of cannabinoids containing THC, the psychoactive ingredient in marijuana, and found associations with dizziness and lightheadedness, and with thinking and perception disorders in users over 50. But the authors called the associations “tentative” because the studies were limited and included few participants over 65.A major 2017 report from the National Academy of Science, Engineering and Medicine found evidence that cannabis could alleviate nausea and vomiting from chemotherapy, muscle spasms from multiple sclerosis and certain kinds of sleep disorders and chronic pain, although researchers deemed its effect “modest.” But evidence for a long list of other conditions, including neuropathic pain, remains limited or insufficient.“It’s hard to weigh the benefits and the risks,” Dr. Han said. As a geriatrician and addiction medicine specialist at the University of California, San Diego, he fears for older patients already susceptible to fall injuries, to interactions from taking multiple drugs and to cognitive impairment.“I worry about any psychoactive substance for older adults,” he said. Moreover, his study showed that cannabis use is increasing among seniors who drink alcohol, a combination that is potentially riskier than using either substance alone.Like other health care professionals whose patients try cannabis, he advocates a “start low, go slow” approach, asking them to monitor the results and report side effects. He also warns patients who haven’t used much weed since the 1960s and 70s that THC concentrations are often stronger now than in their youth.“Older adults generally need less, because their metabolism has slowed,” Ms. Theisen said. That also means that “they can have a delayed onset, so it’s easier to over-consume, especially with products that taste good,” she continued. She urges older adults to consult health care professionals knowledgeable about cannabis — who, she acknowledges, are in short supply.More research into the pros and cons of cannabis use would help answer these questions. But since marijuana remains a federally outlawed Schedule I drug, mounting studies can prove difficult. So its growing use among older people constitutes an uncontrolled experiment, with caution advised.Mr. Lebowitz said he is regaining his equilibrium. Recognizing that he was drinking too heavily, and disliking the resulting hangovers, he has backed off the booze. “It’s really not my drug of choice,” he said.But he is still smoking somewhat more marijuana — preferring strains called Dorothy, White Fire and Purple Roze — than before the world stopped.

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutNew Variants TrackerAdvertisementContinue reading the main storySupported byContinue reading the main storythe new old ageCan Long-Term Care Employers Require Staff Members to Be Vaccinated?As legal experts and ethicists debate, some companies aren’t waiting.Joe Pendergast, a resident of Juniper Village, a nursing home in Bensalem, Pa., with Kevin Birtwell, a wellness nurse manager there. All staff members at Juniper are required to be vaccinated.Credit…Kriston Jae Bethel for The New York TimesMarch 5, 2021, 5:00 a.m. ETFor much of the winter, Meryl Gordon worried about the people caring for her 95-year-old mother, who was rehabbing in a Manhattan nursing home after surgery for a broken hip.“Every week they sent out a note to families about how many staff members had positive Covid tests,” said Ms. Gordon, a biographer and professor at New York University. “It was a source of tremendous anxiety.”Ms. Gordon feels reassured now that her mother is fully vaccinated and has returned to her assisted living facility. But what about the two home care aides who help her 98-year-old father, David, in his Upper West Side apartment?Neither has agreed to be vaccinated. David Gordon’s doctor has advised him to delay Covid vaccination himself because of his past allergic reactions.Ms. Gordon has not insisted that the caregivers receive vaccinations. “You’re reluctant to do something that could cause you to lose the people you rely on,” she said. But she remains uneasy.It’s a question that many long-term care employers, from individual families to big national companies, are confronting as vaccines become more available, although not available enough: In a pandemic, can they require vaccination for those who care for very vulnerable older adults? Should they?Some employers aren’t waiting. Atria Senior Living, one of the nation’s largest assisted living chains, has announced that by May 1 all staff members must be fully vaccinated.Silverado, a small chain of dementia care homes, most on the West Coast, mandated vaccination by March 1. Juniper Communities, which operates 22 facilities in four states, has also adopted a mandate.“We felt it was the best way to protect people, not just our residents but our team members and their families,” said Lynne Katzmann, Juniper’s chief executive. Of the company’s nearly 1,300 employees, “about 30 individuals have self-terminated” because of the vaccination requirement, she reported.Juniper’s experience supports what public health experts have said for years: Vaccine mandates, like those that many health care organizations have established for the flu vaccine, remain controversial — but they do increase vaccination rates. As of Feb. 25, 97.7 percent of Juniper residents had received two vaccine doses, and so had 96 percent of its staff members.Tamara Moreland, executive director at Juniper Village in Bensalem. The company operates 22 facilities in four states and reports about 30 “self-terminations” of its nearly 1,300 employees.Credit…Kriston Jae Bethel for The New York TimesThat stands in stark contrast to staff vaccinations in many facilities. The Centers for Disease Control and Prevention has reported that during the first month of vaccine clinics in nursing homes, only 37.5 percent of staff members received the first shot, along with 77.8 percent of residents.The results of opinion surveys vary, depending on who is asked and when. In January, a Kaiser Family Foundation analysis found that 29 percent of health care workers expressed doubts about vaccination.A national recruiting platform for health care companies, myCNAjobs.com, last month polled 250 companions, aides and nursing assistants in facilities and in home care; it interviews thousands more daily. It estimates that 35 percent plan to be vaccinated, 20 percent do not and more than 40 percent remain unsure.The Coronavirus Outbreak