Impact of COVID-19 on mental health of the elderly

Sir,

The COVID-19 pandemic has had an unprecedented effect on the lives of people, irrespective of social demographics. The elderly, however, face special challenges, and it is imperative that healthcare professionals identify and highlight their special needs so that they can be adequately protected and supported through these trying times. Unless care is taken, the elderly as a group may face significant fallout with regard to their mental and psychological wellbeing.¹

There are several reasons why the elderly constitutes an especially vulnerable group.

Firstly, advanced age itself is a pre-disposing factor to physical and mental health issues. With rapid strides in medical care and increasing average lifespans, the elderly also comprises a significantly large proportion of the population. The presence of comorbid conditions makes them more susceptible to new infections and the accompanying psychological distress.²

Secondly, the elderly are prone to social isolation even under normal circumstances, and this problem has been further amplified in the current climate.³ Older people generally have only a close circle of friends and family with whom they routinely interact. However, social interactions form a large part of their life in retirement, and this has seen drastic disruption with the apt advisory on social distancing. It is sadly a sign of the times that not visiting older relatives, with the intention of not inadvertently exposing them to infection, has now become a symbol of love. Needless to say, the lack of outlets for social interaction can precipitate or worsen mood and anxiety issues in the elderly.

Thirdly, there is the issue of access to medications and health facilities, as the elderly may have physical problems that make this difficult. With most countries enforcing strict lockdowns to control spread of the pandemic, this issue has taken on even more significance for older people. If such persons are unable to obtain a regular and sustained supply of medication, they are bound to suffer relapses or deterioration in their mental state.

Fourthly, the near-constant stream of information pertaining to the pandemic may become a source of anxiety and stress, especially for the elderly.⁴ Most media outlets highlight the increased mortality rates of COVID-19 in older people, and regular exposure to news reports on rising numbers of deaths can trigger episodes of anxiety, low mood and sleep disturbances. This, in turn, can have an overall detrimental effect on quality of life.

There has been some recognition of these problems leading to headway being gained in implementing measures to remedy them. Supermarkets and grocery stores in certain localities have started opening their doors an hour early, setting aside the first hour exclusively for older shoppers, with social distancing norms in place as well. This can reduce their exposure to infection. Young, healthy individuals are also encouraged to help out their neighbors by picking up groceries for them as well during their trips to the supermarket. Local governing bodies have organized volunteers to deliver essential household items and medication to the doorsteps of the elderly, which cuts down on their need to move out of their homes. Helplines have been started to provide brief psychological interventions to those in need, in turn providing a comforting ear to older people who may be feeling socially isolated.⁵ Volunteers perform phone check-ins on elderly persons in their communities to enquire if they need assistance and to provide it if necessary. These interventions have been successful to some extent in alleviating the difficulties faced by the elderly in these times, but there is certainly scope to go one step further.

Measures to alleviate stress and anxiety need to be taught to vulnerable groups like the elderly, perhaps through outlets like print and visual media. Information overload regarding the epidemic needs to be managed by encouraging people to limit their sources of information to a few trusted ones, to be viewed only one or two times a day for a fixed duration. In the longer term, financial assistance may be extended to retired personnel and pensioners, perhaps by means of subsidies, favorable interest rates and incentives on pension schemes to provide peace of mind and a sense of financial security.

In summary, the impact of the current epidemic on mental health of the elderly is profound but may be as easily missed. We hope to direct attention to the needs of this vulnerable group, and highlight remedial measures taken to ensure that society is able to fulfill those needs adequately, as well as gaps that need to be filled.

REFERENCES

1. 1. World Health organization. Mental Health Of Older Adults. 2017. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults. Accessed on 11 April 2020.
2. 2. Andreas S, Schulz H, Volkert J, Dehoust M, Sehner S, Suling A, et al. Prevalence of mental disorders in elderly people: The European MentDis_ICF65 study. Br J Psychiatry. 2017;210(2):125-31.
3. 3. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5):e256.
4. 4. Depoux A, Martin S, Karafillakis E, Preet R, Wilder-Smith A, Larson H. The pandemic of social media panic travels faster than the COVID-19 outbreak. J Travel Med. 2020;27(3):pii:taaa031.
5. 5. Zhang J, Wu W, Zhao X, Zhang W. Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital. Precision Clin Med. 2020;3(1):3-8.