Senior Health Day

A Look Into the Impact of Covid-19 on the Senior Community's Mental Health

As the world attempts to step into a “new normal” following the past 3 years of unprecedented challenges due to the COVID-19 pandemic, society must begin looking at the effect this world-changing event has had on the individuals and groups most impacted. While there is no doubt that the pandemic has caused a ripple effect across all groups, our senior community remains at the forefront of those impacted on all accounts -- physically, mentally, socially, and emotionally.

Depression in the senior population is not a new phenomenon resulting from the pandemic but rather a long-standing concern that has been further impacted by concerns over the past 3 years ^[1]. Studies have shown high rates of depression because of isolation and increases in physical health conditions. Suicidality in the elderly community has remained a concern based on these factors, which has only been further magnified by the COVID-19 pandemic and its ongoing danger to the senior population.

The lasting effects of COVID-19 can be witnessed in side-by-side reviews of mental health statistics in the senior community prior to the pandemic and directly following it. While mental health in seniors has been studied for many years, tracking common mental health struggles experienced by individuals 55 and over, recent studies show an overall increase in the prevalence of depression, isolation, and suicidality ^[2].

According to the National Center for Biotechnology Information (NCBI) ^[1], “Loneliness is not only associated with anxiety, anger, and emotional instability, but it also activates the sympathetic nervous system, leading to hypertension, inflammation, and elevated stress hormone levels. Social isolation is associated with increased mortality, decreased quality of life, and increased risks of premature death, stroke, and dementia in the older adult population.”

The state of our elder community prior to the pandemic

Mental health on our aging population has been a long-standing area of focus due to high rates of anxiety, depression, and suicidality. According to the Centers for Disease Control and Prevention ^[3], the national average rate for depression among the population is roughly 1-5%, whereas depression among the senior population sits at 11% for seniors who live independently and 13.5% for those who require home health care ^[4]. This significant increase suggests that seniors who live with a co-occurring disorder are at a higher risk for depression.

While it is known that seniors are at a higher risk for depression, seniors themselves sometimes struggle with identifying the signs and symptoms of depression, especially in cases where the individual lives alone and may not connect physical symptoms, such as difficulty sleeping, gaining weight, fidgeting, or withdrawing from social activities, as direct signs of depression, but rather as signs of aging ^[3]. When paired with co-occurring health conditions, unaddressed depression can negatively affect compliance with treatment causing complications in an individual’s physical health.

Isolation in seniors who live independently exacerbates cases of unaddressed depression due to a lack of eyes on the individual on a day-to-day basis. A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) found that one in four adults over the age of 65 experiences loneliness and is socially isolated ^[5]. Studies throughout this research find that depression and loneliness correlate directly, which in turn results in faster cognitive decline, increases in cases of dementia, and premature death ^[5].

Unaddressed depression, as well as other mood disorders and anxiety, has been associated with suicidality ^[6]. Not surprisingly, suicidality has also shown to be prevalent in individuals over the age of 85, with data supporting this age group having the second highest occurrence of successful suicide attempts in the United States after adults ages 45-65 ^[3]. According to the National Council on Aging (NCOA), seniors who are contemplating suicide plan their means more carefully, typically use more lethal means, and are more successful in completion than individuals outside of the senior population ^[6]. As a result, successful suicide attempts in older adults are not typically preceded by prior unsuccessful suicide attempts, making the number one indicator of suicidality in this group a prevalence of depressive symptoms ^[1].

COVID-19 exacerbates symptoms of anxiety and depression

As the world grappled with a constantly evolving climate of information and COVID-19 precautions, one reality remained consistent, i.e., the pandemic was especially dangerous for individuals over 55. Specifically, research shows that 80% of all COVID-19 deaths occurred in individuals over the age of 65 ^[5]. From the onset of the pandemic, seniors were urged to limit in-person social interactions, and eventually to avoid them altogether to stave off the ever-increasing threat of serious illness. While these precautions were the best defense against the virus, they also created ample opportunities for social isolation and loneliness^[3].

In addition to the increase in real danger to the senior community’s physical health, the group also reported feeling dispensable and undervalued as the world worked to reopen and encouraged at-risk groups to remain inside^[1]. Studies on senior mental health throughout the pandemic showed a clear, concerning, but not surprising increase in cases of anxiety and depression over the past 3 years. Between March 2020 and August 2020, the senior population showed a marked increase in cases of anxiety and depression, jumping to 24% from 11% prior to the pandemic^[1].

A look at opportunities for mitigation

Although anxiety and mood disorders are common for individuals over the age of 55, many cases go underrecognized, underreported, and undertreated. Additionally, the past 3 years have brought increased depression through isolation in the senior community. While these statistics are concerning, they have shined a light on an issue that needs attention. How can we better care for our senior community in a way that best addresses the core issue of isolation?

Opportunities for improvements in this area have been explored in a study by the NCBI that encompasses several external factors and natural supports, as well as internal factors within the individual. At a minimum, seniors should be made aware of resources available to them in the event of transportation barriers. In many areas, seniors can access food delivery, telehealth, and home health care support. Taking advantage of these supports when access to the outer community is restricted is beneficial to keeping seniors connected and receiving the support they need. There is little research on the impact of screen time on this population, however, it is suggested that seniors reduce the amount of time they spend watching the news each day in order to reduce negative feelings^[1].

Health care providers need to spend more time assessing signs of depression and accurately diagnosing and treating seniors. The access to telehealth has expanded and is showing efficacy in removing transportation as a barrier and increasing access to quality health care for both mental and physical health services.

The increase in comfortability in using technology has opened doors for seniors to stay connected to friends and family when in-person visiting is not possible. Family caregivers, grandchildren, and friends can stay connected to their senior loved ones through video calls, creating more opportunities for meaningful social interactions for seniors. This increased facetime can help friends and family remain abreast of the mental and physical health of their loved one on a more consistent basis, allowing for earlier intervention if concerns for depression arise.

Takeaways

The past few years have been difficult for everyone. However, the senior community faced significant challenges throughout the pandemic with lockdowns, social distancing, and disproportionate COVID-19 deaths in their community. Mitigation measures during these unprecedented times caused seniors to experience higher levels of social isolation than ever before, which in this population created a real risk for depression and early death^[7].

While the pandemic incited a deeper concern for isolation in the senior community, it also shined a light on a problem that existed long before COVID-19. Additionally, it forced our world to get more digital, creating opportunities and comfortability for seniors to use technology to connect them to friends, family, doctors, and more frequent care^[1].

The senior community remains one of the most vulnerable populations in the country, and attention must be paid to their social-emotional and mental health as well as their physical health. Current care for the elderly leaves opportunities for growth, and new technology is opening the door to deeper and more accessible care.