The strain of isolation is taking its toll, with the population most at-risk for COVID-19 also being the most likely to suffer depression and anxiety. According to the Centers for Disease Control and Prevention, older adults, especially those in long-term care, are more likely to succumb to COVID-19. In Tennessee, 60 percent of deaths have been over age 70.
James Powers, MD
"The isolation has been devastating, not only to those living alone but in long-term facilities with families who can't visit," said James Powers, MD, program director for the Vanderbilt Geriatric Fellowship Program. Powers, who also serves as the associate clinical director for the VA Tennessee Valley Geriatric Research Education and Clinical Center, has witnessed firsthand the impact of the virus among the elderly, as seven of his patients have died from COVID-19.
The emotional effects related to the pandemic are inevitable for seniors, so loved ones and providers must remain diligent in the early detection of loneliness, anxiety, depression, stress or other mental illness.
Social vs. Physical Distancing
Luigi Cardella, MD
"We're all at risk of the mental health and psychiatric consequences that can go along with isolation and the atmosphere of our world right now, but it's important to realize that those who are a little older may be at higher risk," said Luigi Cardella, MD, psychiatrist at Centennial Psychiatric Associates and TriStar Centennial Parthenon Pavilion.
Cardella said one important thing family and friends can do is attempt to normalize some of their own emotions and thoughts to let seniors know it's okay to feel sadness, worry and anger. Families should be alert when negative emotions become predominant or overwhelming, or if those emotions begin to impact day-to-day function, especially among those with a history of mental illness.
A good strategy to start a conversation is for family members to voice their own feelings and how they're dealing with them. "Let them know you're under stress, too, so they can feel comfortable talking about how they're feeling," said Cardella.
He also encourages families to re-examine their definition of social distancing. "The whole idea of social distancing is slightly detrimental in a sense," he said. "What we really need is physical distancing, which is more important than social distancing, especially if we can use other strategies to accomplish socializing."
If it's reasonable to visit a loved one, Cardella said to make sure they're comfortable wearing a mask and try to maintain a physical distance. "We need to be a little bit flexible by shifting the focus on the COVID-19 high-risk toward a mental health high-risk," he added.
Loneliness or Isolation?
Cardella also stressed the difference between feeling isolated and feeling lonely. "We're all a little isolated because we have to be, but lonely is a different beast," he said. "Feeling that you're alone brings with it anxiety, depression and lots of negativity."
From drive-by parades to virtual birthday parties, families should get creative in reaching out when they're not comfortable visiting or if long-term care rules prohibit onsite visits. Items sent from home and hand-written letters also resonate well with the older generation. "Think of something from the heart that has a lot of meaning to it that you took the time to write and send," Cardella said. "That carries negligible risk and helps make sure the feeling of loneliness isn't profound."
Don't Delay Care
Providers are urging seniors to continue their routine check-ups to help catch diseases in their earliest stage. Powers still sees two-thirds of his elderly patients via telehealth, and he urges providers to continue offering the service to older adults, particularly for return visits.
"CMS is covering 600 CPT codes through telehealth, so if you already know the patient, telehealth visits can be very meaningful," he said. And while routine labs can often be delayed, Powers said Americans need to learn from patients in Italy, who delayed care out of fear of hospitals and experienced a high volume of at-home deaths from heart attacks. "We need to stress to patients that if it's an emergency, you need to come in because it's worth the risk," he said.
Advice to GPs
Because general practitioners provide the most psychiatric care in the country, Cardella advised them to be extra alert to signs of depression and anxiety. Asking about sleep and weight changes, day-to-day rituals and if patients are engaging in activities that keep up their interests could help uncover subtle red flags. "Make sure that, although their normal day-to-day functioning is different from six months ago, they're still functioning appropriately," he said.
Cardella also stressed the importance of prioritizing the mental health of caregivers - an often-overlooked population. "When a caregiver is struggling with depression and anxiety, it impacts the care being delivered," he said. "You can end up in spiral loop where the caregiver is affecting the person being cared for and back to the caregiver."
And if help is needed, don't hesitate to find it. "This is a really trying time, but the good news is that the depression and anxiety disorders we're seeing aren't new," Cardella said. "We have effective treatments for them and can help get this under control." Powers agreed, "We're all in this together ... and together we'll get through it."