'Seniors' curfew aided Turkey's fight against pandemic'

Barçın Yinanç - ISTANBUL

Turkey has its elders to thank for abiding orders to stay home and thus making the COVID-19 pandemic manageable, the head of a seniors’ advocacy group told Hürriyet Daily News.

But there is need for more cooperation and coordination among government, local administrations and civil society to make their lives easier, according to Gülüstü Salur.

There was a general conviction that Turkey’s elderly typically sit around at home. We were surprised, therefore, to see that we have a very mobile elderly group. Would you concur with that observation?

Yes, in part, as the 65+ group is not a homogeneous group.

Being active depends on one’s physical and mental health and personality, rather than age. A significant segment of older adults lead self-sufficient lives, which requires going out when needed.

More than 9 percent of the population is above 65, and of those, more than 1.3 million elderly people live alone.

Therefore, when you impose a curfew and tell a specific group of people to stay home, you need to introduce support systems to provide for their various needs. Determining and providing for these needs at a comprehensive and sustainable level requires coordination, cooperation and collaboration among government, local administrations and civil society.

Were you surprised that it was hard at the beginning to keep some of the elderly at home?

I don’t think it was that hard. I believe the rationale behind the curfew for older adults had a few levels. First, keeping older adults at home would be a sure way to flatten the curve through social distancing and decrease demand for intensive care beds as this group was at the highest risk for severe disease.

Second, most older adults were already retired and more able to stay at home without a major disruption to their lives, at least financially. The question was not about being inside or outside; it was essential to abide by the rules of social distancing even when at home.

Were you for or against the curfew for the elderly?

As a physician, I was in favor of a general lockdown at a very early stage. A partial curfew keeping the younger and older [those below 20 and above 65] at home was a beneficial but insufficient approach to control the spread of COVID-19.

The curfew for older adults helped ensure Turkey’s health system was not overburdened by severe cases and registered a relatively low level of mortality – particularly when we hear very sad news from nursing homes all over the world each day. Nursing homes in Turkey have been under strict quarantine provisions since the beginning of the pandemic, and so far, incidental reports of positive COVID-19 cases have not resulted in mortality.

Lately, you have been asking to ease the curfew.

As I mentioned before, the aim is physical distancing, not keeping people indoors. And one size does not fit all.

If people have the right information and awareness on how to protect themselves and others through measures of distancing, there may not be the need for strict curfew measures. There is a continuing need for fewer people sharing common spaces whether there is curfew or not.

So, we know that there is a need for normalization. Let us learn to wear masks and wash our hands as often and as thoroughly as needed, and we can control the spread of the disease. Just starting to go out for a breath of fresh air will not mean things are back to normal unless we apply what we now know in our routines.

To answer your question, we have indeed called for some flexibility underlining the fact that this is a heterogeneous group with varying needs. For instance, those with dementia need a different approach, people with walking difficulties need someone to accompany them.

Just saying you can walk in the neighborhood for a while may not sufficiently address everyone’s physical, social and psychological needs.

Being well entails an integrated approach. We cannot pretend to have kept people healthy by just protecting them from the virus. The discussion has been around physical isolation, but the deprivation at the social and psychological level goes deeper than that.

Can you elaborate?

It will be difficult to continue with this level of social isolation for older adults, even for those who are younger. We know there are asymptomatic people who have the virus but not the disease. So there is a potential to catch the virus every time we interact with others in the absence of self-protection. Rules of self-protection need to be stricter for older people, for people with chronic diseases and healthcare professionals. So keeping this information in mind not individually but as a community that is protected with limited interaction inside or outside will eventually be the norm.

There is a relative easing of the curfew. Older adults will be able to walk in their neighborhoods or nearby parks for up to four hours, but they will not be able to ride in a car or other vehicles, essentially so that this is kept under control.

But some live in houses on hills and say they cannot go anywhere without a car. Some have hip or knee problems and require vehicles for any degree of mobility.

So there needs to be room for more flexibility. This will be a good start. But I am afraid there will be some difficulties in applying these four hours’ worth of “freedom.”

The feeling is of a very limited freedom based on the need for continued restrictions for disease control.

What are your current demands?

First of all, there is a need for flexibility in varying needs depending on people and places. Not all have the same needs. Someone living in a nine-story apartment building with no balconies and sunlight will not have the same needs as someone living in a rural ranch house who already enjoys being outside.

We keep forgetting that poverty may be an issue for the elderly. We have worked with those in the 65+ category who make a living picking up trash. One set of rules and regulations may not offer all the provisions needed by these people. So the varying needs of older adults should be recognized and met.

Second, it is essential to empower the elderly with information on the disease and protection. And for those who are unable to protect themselves or continue their lives with the limits imposed by the pandemic, we need widespread support mechanisms. We have witnessed some delays in terms of their access to masks or their monthly pensions. So when we impose a sanction, we need to plan and provide for unmet needs. Professionals and civil society organizations working with and for older adults in the community need to be heard to ensure the comprehensive management of seniors’ issues during the pandemic.

How do you think the particularities of the elderly group are affecting the country’s performance so far in the fight against the pandemic?

Older people contributed to the fight against the spread of disease by staying at home. Their patience and resilience played a huge role in making the pandemic manageable. It is always a good idea to turn to wise elders in times of dire stress.

*Who is Gülüstü Salur?

Gülüstü Salur is the chair and co-founder of the 65+ Elder Rights Association Turkey. After graduating from Istanbul University Medical School, Salur specialized in neurology, as well as behavioral neurology and movement disorders. Salur undertook further studies under Professor Marsel Mesulam at Northwestern University in Chicago between 1998 and 2002.

Since 2003, she has operated her own private practice where she specializes in cognitive neurology, dementia and movement disorders.

Salur is also a part-time instructor at Boğazici University’s Department of Psychology and among the founders of the Alzheimer’s Association of Turkey.

As a member of the study group on the standardization of neuropsychological tests in Turkish, she is also working on the digitalization of screening tests and assessment tools.