People with disabilities, older adults and older adults with disabilities may be more likely to become infected with COVID-19, and if infected, they may be more likely to experience severe illness, which can lead to hospitalization, intensive care, ventilation, or death. The risk of severe illnesses increases with age and is also increased if there are any underlying medical conditions. In addition to these direct effects of COVID-19, these populations may also be more likely to experience more severe secondary impacts.
We describe the reasons for this in more detail below.
Direct consequences of COVID-19 on people with disabilities, older adults and older adults with disabilities
- Mortality rates: People with disabilities, older adults, and older adults with disabilities, particularly those with underlying health conditions, are at a higher risk of dying from COVID-19. One in three older people have a disability and because people with disabilities are more likely to have other pre-existing health conditions (such as diabetes, asthma, hypertension and chronic pulmonary obstructive disease), which put them in higher risk categories for developing serious COVID-19 symptoms should they become infected. These factors are displayed in the image below which shows COVID-19 mortality rates by age and according to pre-existing health conditions.
Source: Chinese Centre for Disease Control and Prevention on the BBC
- Increased exposure due to a reduced ability to practice physical distancing: People with disabilities and older individuals may be reliant on caregivers to aid with common daily tasks, so physical distancing and isolation measures may be particularly challenging or impossible to practice. Caregivers going in and out of households may also put people with disabilities, older people and their families at higher risk of exposure to the virus. However, caregivers play a vital role in allowing people with disabilities and older people to manage daily lives. In addition, data from Iraq, India, Ethiopia and Tanzania show that up to 95% of older adults live alone during COVID-19. Older adults are told to self-isolate for extended periods of time to protect over-stretched healthcare systems, but social isolation can put older adults at a greater risk of mental health problems, such anxiety and depression.
- Increased exposure due to inaccessibility of built infrastructure: People with disabilities, older adults and older adults with disabilities may be unable to avoid coming into contact with surfaces that others have touched, putting them at increased risk of being exposed to the virus. For example, people with disabilities, older adults and older adults with disabilities are more likely to have limited access to safe water, sanitation and hygiene (WASH) services and facilities. Even in households that have WASH facilities available, household members with disabilities may not be able to use them in an acceptable or hygienic manner.
- Fear, confusion and anxiety: People on the autism spectrum, or who have dementia or Alzheimer’s Disease may experience greater levels of confusion, anxiety and fear if their routines are disrupted. People with existing mental health conditions who have developed ways to live with distress or other symptoms of mental health conditions may experience additional ‘triggers’ during the crisis. For instance, people who have a history of excessive handwashing and cleaning to avoid contamination, but have successfully managed this compulsion, may experience heightened anxiety and renewed symptoms during COVID-19. In Iraq, findings from a rapid needs assessment on the impacts of COVID-19 on older adults show that 74% of older adults felt worried either ‘all the time’ or ‘most of the time’, and 22% reported being unable to cope.
- Accessing services remotely: In many settings physical distancing restrictions have resulted in an increase in digital or remote healthcare approaches instead of face-to-face consultations. These present additional barriers to accessing healthcare for people with disabilities, older populations and older adults with disabilities as new technologies are not always accessible or inclusive. This may be because services are not in accessible formats. People with disabilities and older adults may also have reduced access to technologies such as mobile phones.
Secondary impacts of COVID-19: People with disabilities and older adults face inequalities that may be exacerbated during COVID-19 pandemic. These include:
- Access to other health services: People with disabilities, older adults and older adults with disabilities face existing inequalities in accessing health care services (e.g. antenatal care services, outpatient care when needed, mammograms and assistive products) and are twice as likely to find healthcare provider’s skills and facilities inadequate. A multi-country survey found that 63% of older adults (+60 years) faced difficulties in accessing healthcare when required. People with disabilities, older adults and older adults with disabilities are also less likely to be able to afford the health care they need. People with disabilities are 50% more likely to suffer catastrophic health expenditure. Data from Cox’s Bazar in Bangladesh show how COVID-19 may worsen inequities for older adults and people with disabilities.
- Secure employment: People with disabilities are 50% less likely to be employed than people without disabilities. In low and middle income settings, people with disabilities may be five times less likely to be employed. Age discrimination is widespread in employment. If working, older adults and people with disabilities are more likely to be in the informal sector and face higher risks of inadequate social protection. Women with disabilities are less likely to be employed than men with disabilities. The economic consequences of COVID-19 are likely to result in reduced employment among people with disabilities and older adults since informal or part-time workers are more likely to be laid off and have their work hours reduced. Associated with this, people with disabilities may experience higher rates of poverty, food insecurity or live in inadequate housing.
- Violence: People with disabilities and older adults are at a greater risk of violence, and these risks may be further increased as a result of COVID-19 lockdowns. Women with disabilities may be particularly vulnerable to the increases in domestic violence.
- Education: People with disabilities are less likely to start school at the same age as their peers and are less likely to remain in education for as long as their peers. This has implications for the way information about COVID-19 is communicated to people with disabilities. School closures may also have more profound effects on children with disabilities and their families who may lack access to learning support measures which would enable home learning. This may make it harder for families to cope.
- Stigma, discrimination and social exclusion: People with disabilities, older adults, (especially people with dementia), and older adults with disabilities (e.g. people who have intellectual impairments and/or difficulties communicating) are more likely to face stigma, discrimination and social exclusion within the legal, public and private spheres which may put them at greater disadvantage during this crisis.
Want to know more about considering disability in COVID-19 hygiene programmes:
- Why should we include people with disabilities in the COVID-19 response?
- What do we know in general about disability and WASH access?
- What specific barriers might people with disabilities face in relation to handwashing with soap?
- How can we ensure people with disabilities are included in all COVID-19 hygiene promotion programmes?
Written by: Jane Wilbur
Initially Reviewed by: Hannah Kuper, Islay Mactaggart, Sian White, Chelsea Huggett
Last updated: 08.09.2020