Caring for Older Adults with Mental Health Disorders in the United States: Lessons Learnt from the Covid-19 Pandemic

Rajesh R. Tampi & Deena J. Tampi

Abstract

The recent COVID-19 global pandemic has affected millions of individuals. The true devastation and the extent of suffering caused by this pandemic is slowly being realized. The older adult population has been particularly affected in terms of catching the illness and suffering its consequences, including greater morbidity and mortality rates. Older adults with mental health disorders are an extremely vulnerable group of individuals whose care has suffered immensely during this pandemic. In this commentary, we discuss issues faced by older individuals with mental health disorders in the US during the COVID-19 pandemic. In addition, we will describe the lessons learnt from the pandemic that will help us provide better care for these individuals.

Introduction

It is estimated that the population of older adults (≥65 years) in the United States (US) will nearly double from 52 million or 16% of the population in 2018 to 95 million or 23% of the total population by 2060.¹ Mental health disorders are not uncommon among older adults in the US with an estimated prevalence of approximately 20%.² Common mental health disorders include personality disorders, anxiety disorders, mood disorders, and substance use disorders. In addition, the number of older adults with Alzheimer's disease is predicted to rise from 4.7 million in 2010 to 13.8 million by 2050.

COVID-19 and the older adult population

The Centers for Disease Control and Prevention (CDC) reported that older adults are more likely to get COVID‐19 infection and have worse outcomes when compared to the general population.³ Older adults made up 31% of COVID‐19 infections, 45% of hospitalizations, 53% of intensive care unit admissions, and 80% of deaths caused by this infection. Available evidence indicates that morbidity and mortality rates are highest among older adults with comorbidities such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease.⁴

COVID-19, older adults, and mental health disorders

It has been noted that older adults have been vulnerable to loneliness and social exclusion during the pandemic.⁵ Additionally, both age and ageism appear to be significant risk factors for worsening of physical, psychological, and social well-being of the older adults. Furthermore, the lack of security, loneliness, isolation, sexism, dependency, stigma, abuse, frailty, cognitive and sensory impairments along with limitations in access to healthcare have been identified as risk factors that affect the well-being of older adults during the pandemic.

Emerging evidence indicates that the pandemic has had a significant impact on the mental health of older adults.⁶ COVID-19 may have an atypical presentation among older adults with altered mental status being an initial presenting symptom in the absence of respiratory symptoms or fever. In addition, presenting symptoms of the infection may include worsening confusion, agitation, disorientation, refusing care, and apathy. Older adults have also reported higher depression and greater loneliness following the onset of the pandemic with loneliness positively predicting depression.⁷ Furthermore, there have been concerns raised by health professionals regarding the increased risk for substance use disorders and suicides among older adults during the pandemic.^8,9 Older adults admitted to hospitals may experience a worsening of their psychiatric symptoms during lockdown periods due to the pandemic.¹⁰

Lessons learnt from the pandemic

To maintain adequate care for older adults with mental health disorders and minimize the fallout from prolonged social isolation, various facilities have implemented alternative methods for communication by virtual visits using capable electronic devices.¹¹ Many organizations like the National Association of Area Agencies on Aging (N4A) have launched community connections websites to provide a searchable directory of mutual aid organizations that provide key daily services for the older population. The World Health Organization has encouraged the support of older adults through networks of family, friends and health professionals. Many locations are encouraging older adults to maintain any type of spiritual/religious affiliation using free online classes, live streaming of prayer services, and community gatherings using Zoom. The clinical care has also shifted from in-person visits to virtual visits using online platforms and/or using smartphones.¹² For those older individuals who don’t have access to technology or are unable to use available technology, telephone evaluations are being conducted.

Geriatric mental health leaders have urged greater attention to four goals to improve the care of older adults during the pandemic.¹³ These include making clinical research more inclusive of all ages for both experimental therapies and diagnostic tools; engaging healthcare professionals in institutional decisions regarding care; informing policy and funding with cognizance of the needs of vulnerable population; and emphasizing the importance of personalized approaches to care of older adults that enacts respect for autonomy, justice, and beneficence.

ABOUT THE AUTHORS

Rajesh R. Tampi, MD, MS, DFAPA, DFAAGP

Dr. Tampi is the Co-President of the American Association for Geriatric Psychiatry (AAGP). He was the President for 2019-2020. Dr. Tampi is a Professor of Medicine, Cleveland Clinic Learner College of Medicine of Case Western Reserve University and Chairman, Department of Psychiatry & Behavioral Sciences at Cleveland Clinic Akron General.

Deena J. Tampi, MSN, MBA-HCA, RN

Ms. Tampi is a member of the Board of Directors of the American Association For Geriatric Psychiatry (AAGP). In addition, she the Chairperson of the Membership Committee of the AAGP. Ms. Tampi is the Co-Founder and Managing Principal of the Behavioral Health Advisory Group in Strongsville, Ohio.

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