The COVID-19 pandemic is an unprecedented situation disproportionately impacting our older adult community. Not only are the COVID-19 medical complications and mortality risk greater for older adults, but the crisis adds another layer of behavioral health challenges.

Even in pre-pandemic “normal times,” seniors face risk factors such as social isolation, financial challenges, illness, grief and loss, all associated with greater rates of anxiety and depression. These psychiatric conditions increase the risk for poor outcomes and even higher mortality from various underlying medical conditions. To add insult to injury, older adults lack access to high-quality mental health care because of workforce shortages in health care providers specializing in geriatric psychiatry and geriatric medicine.

Because of the COVID-19 pandemic, geriatric mental health issues will likely increase. Our transition at McLean Hospital to a virtual telehealth outpatient geriatric psychiatry clinic over the past six weeks paints an evolving and variable picture of how older adults respond to these challenges in the context of the pandemic. For some older adults with pre-existing psychiatric illnesses, social distancing requirements increase their anxiety, depression, fear and, especially, social isolation and loneliness. Others, with and without known behavioral or mental health concerns, demonstrate extraordinary resilience because of the wisdom and perspective of years of life experiences. 

A particular tragedy of this pandemic is the social disconnection between older adults and their families and friends, who ordinarily support the vital connections key for successful aging. Some older adults now find themselves isolated at home, and those in assisted living facilities or nursing home communities are disconnected from visitors who provide relief, comfort and support during times of poor health and disability. It’s important to remember that many older adults need to be encouraged to ask for help, including in the use of technologies, such as video conferencing, so they can engage with friends and family.

Along with physical health, food and safety needs, it is important for older adults and their families to stay alert for early warning signs of anxiety and depression – including changes in sleep and appetite, increased symptoms of anxiety and worry, fatigue and an inability to focus on pleasurable activities. If a concern arises, ask for support from a primary care physician, who is likely available through telephone or video conferencing. Other resources include the American Association for Geriatric Psychiatry, the American Geriatrics Society and the American Hospital Association.

Although a vulnerable population, I firmly believe that the rest of society has a lot to learn from our older adult colleagues, friends and family. Their stories of resilience will inspire and teach us how to cope with the current crisis and move forward stronger and with a better sense of balance and perspective.

Brent P. Forester, M.D., MSc., is the chief of the Center of Excellence in Geriatric Psychiatry at McLean Hospital and medical director for Behavioral Health Integration, Quality and Patient Experience at Partners HealthCare.

 

How is your hospital or health system addressing the needs of seniors during the COVID-19 pandemic? Share your tips and ideas by emailing Rebecca Chickey, AHA senior director, field engagement, behavioral health services, rchickey@aha.org.

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