Managing the mental health and wellbeing of older adults during the pandemic

Looking at older adult mental health

While the COVID-19 global pandemic has undermined many of the practices and conventions of not only normal healthcare delivery, but also everyday life, arguably none are as cruel as the separation of older people from younger family members and supporters, whether this be mandated in an acute or long-term healthcare setting or within their own homes.

Older people in the first instance have been regarded as vulnerable in terms of risks to their health from COVID-19, and therefore subjected to cocooning or self-imposed isolation for what seems to be an inordinately long duration. This has severely impacted upon the mental wellbeing of older people in particular, and this piece will reflect on the triggers behind the recently accelerating stress in this section of the population, as well as suggesting practical coping strategies for the benefit of clinicians. 

In the eye of the storm

The trauma experienced by patients and family members because of unprecedented measures to restrict hospital visits has been intense and persistent, especially in worst-case scenarios where people have died in the care of a hospital or care home and where communication, support and contact has simply been unavailable or inadequate for any reason.

Those of us working in mental health will be aware that spending time with family members can create a healing bridge, which is essential to allow a person to leave acute care and to feel supported in their recovery journey. Visitors frequently advocate for their loved one’s needs and offer support in managing their physical and mental health in a variety of ways.

The lack of a family presence by the bedside has therefore been severely detrimental to the wellbeing of many older people. This suffering has also been re-circulated to care staff who themselves have been distressed by the lack of a family presence, especially at critical moments in their charges’ illness or at moments of change or deterioration.

For those of us who work in hospitals, the distress of cognitively impaired patients failing to recognise the voices of loved ones during phone calls has been all too familiar. The mental and physical de-conditioning of those we look after with dementia, who relentlessly lose orientation to their home surroundings or who see their care supports in the community progressively disintegrate, or who are sufficiently insightful to be scared to return to an isolated existence at home on their own, is palpable. These factors in the most extreme circumstances could well crystallise as greater levels of anxiety, complex grief and post-traumatic stress disorder in the months and years after the pandemic.

As clinicians, we are not immune to this trauma and intensely feel its moral residue. Devices to aid virtual communication have been highly appreciated by some and have proven to be an effective substitute for face-to-face contact, yet many clinical staff have struggled to find time to coach patients in the use of new technologies, never mind obtaining sufficient devices to deploy in a busy clinical setting. Yet technology, and its application in everyday lives, has risen to a new level for most of us during the pandemic.  

The process of recovery from mental health difficulties is about a stepwise process of readjustment and re-booting of self-confidence, and many elements of the services older people necessarily avail of are located in the community. Many older people, however, have struggled with the anxiety associated with allowing carers into their homes in the midst of multiple waves of the pandemic and may be intensely fearful of contracting the infection in the midst of simple everyday tasks, such as shopping or replenishing medication.

They may also hold back from contacting their GP or pharmacist, not wishing to disturb frontline staff with information or questions that are in fact highly pertinent and, for many, a fear of deterioration in a pre-existing condition or an anxiety about becoming acutely ill or succumbing to accident can be simply overwhelming.

People above all should be encouraged to contact treating clinicians and not see this as reckless egoism or self-indulgence. Many fear-based ruminations about symptoms and health can be managed by practical support, discussion, advice and signposting to the many services and investigative pathways that are still ‘open for business’, even during these challenging times.

We may be advised for the foreseeable future to maintain social distancing and, while this undoubtedly increases the risk of worsening isolation and loneliness, we can encourage a resilient response, being mindful that vaccination is around the corner for those most at risk of the infection. 

What can GPs do?

GPs are remarkably well placed to know the context of the person presenting with COVID-related psychological distress, yet many practitioners would also say they are least well resourced to deal with it and are remarkably burdened with other, multiple and competing priorities.

There are many practical responses that can be undertaken by primary care to mitigate negative psychological impacts associated with the pandemic, however, and this has always been the role of a GP.

GPs listen, instil hope and support the person, as well as coordinating psychosocial care measures and prescribing. Having a clinical curiosity to explore psychological symptoms presented by older adults in their depth may well lead to signposting to secondary services or the increasingly useful voluntary sector, where a whole host of needs can be effectively met.

Distinguishing mental disorder from time-limited and reversible mental distress can lead to good outcomes in terms of the quality of life for older people and we must never forget this.

Above all, prompting and supporting the re-engagement of older people with their vital community services, be they leisure, health or volunteer-based, whenever they ‘re-open for business as usual’ is likely to be the best advice a GP can give. 

This piece was written by Dr Aisling Collins, Registrar in Old Age Psychiatry, and Dr Declan Lyons, Consultant Psychiatrist, at St Patrick’s Mental Health Services, James St, Dublin 8.