Nekehia Quashie focused study on hard-hit Brazil, but recommendations can be applied in any country

Sharing a home with adult children is among the most common living arrangements for older adults in developing countries like Brazil. While the arrangements are largely beneficial — providing care and support for the older adult, who in turn helps the family financially and with child care, housing maintenance, etc — there are pitfalls to living in close quarters for older adults, particularly in the age of COVID.

The social and financial benefits of such co-residence are sometimes outweighed by the health risks faced by older adults living with younger family members, according to a recently published study by Nekehia Quashie, assistant professor in the Department of Health Studies. Using data from the COVID-19 module of the Brazilian National Household Sample Survey, Quashie and her two coauthors from Brazil — Flavia Cristina Drumond Andrade at the University of Illinois, Urbana-Champaign, and Luisa Farah Schwartzman at the University of Toronto — examined the association between living arrangements and exposure to and testing for COVID-19 among more than 63,000 Brazilians aged 60 years and older, between July and November 2020.

“Overall, our findings suggest that co-residence with younger family members puts older adults’ health at risk in the context of COVID-19,” Quashie and her partners wrote. “As younger Brazilians are increasingly vulnerable to COVID-19 and experiencing severe outcomes, policy makers need to be more attentive to the health needs of households that comprise older and younger cohorts, which are also more prevalent in poor and marginalized segments of the population.”

Older adults living with their adult children in Brazil were less likely to test for COVID-19 than those living alone, and they were less likely to report symptoms associated with the disease. At the same time, older adults in multigenerational and skipped generation households were more likely than solo-dwellers to test positive for COVID-19, even though older adults were more likely than younger people to adhere to prevention measures like staying home, masking and social distancing. Preventative measures are more difficult with younger people in the home.

“When people live alone, they tend not to take anything for granted; they have to be more aware of health matters, so they’re more likely to test and pay attention to symptoms,” Quashie said. “But it’s a reality that co-residence is sometimes necessary, especially in lower-income communities. It’s really tricky to figure out how to recommend certain policies and procedures to take, especially if it’s a crowded house, which is more prevalent in a lower-income home.”

When there is a vulnerable older adult living in the home, family members should do their best to limit the spread around the house by isolating in a separate room — if possible — and wearing a mask even inside the home, especially if any family member is displaying potential symptoms. For crowded homes that don’t offer the possibility of separating, social service organizations need to step in, possibly by providing temporary housing for an older adult needing to escape possible infection.

“Of course, this is a big task, but it is not impossible,” Quashie said. “For those in really lower socioeconomic circumstances, government services should be targeted to provide an alternative so the entire household doesn’t end up in the hospital.”

Quashie and her coauthors focused specifically on Brazil, which had the second highest percentage of COVID-19 cases in the Americas, after the United States, has a rapidly aging population and faces high income and racial inequity. Furthermore, despite having recent experience dealing with highly contagious viruses such as Zika, Brazil’s government “has adopted a denialist policy toward COVID-19 and lacked a coordinated national strategy to slow the spread of the virus. This has had severe consequences: Brazil is among the countries hit hardest by COVID-19.”

While the focus of the study is on Brazil, Quashie notes all countries can learn lessons from the study and apply resources specifically to help older adults, especially those living in lower socioeconomic conditions who are among those at most risk.

“This is not only for Brazil; these are the types of strategies that can be adopted in other countries as well,” Quashie said. “It’s more about having targeted resources. Resources are limited in many countries, we know, but in the context of the pandemic, it’s really about trying to identify the most vulnerable and at risk to getting the virus. We recognize vulnerable households do have higher case counts and potentially hospitalizations, so in any country these strategies can be adopted to reduce transmission among vulnerable groups.”