Why it’s important to tend to the mental health of the elderly during Covid-19

Ever since Covid-19 came to the scene, across the world, people who are 60 and older have been encouraged to self-isolate to protect themselves from getting infected. It seems likely that these guidelines will be around for an indefinite amount of time, increasing the risk for social isolation, a recognised public health concern in the elderly.

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Social isolation is connected to the development of issues related to mental health, such as depression and anxiety. Though physical distancing is crucial to limit the spread of the coronavirus, the effects of social isolation need to be monitored and tended to, to prevent mental illness in the elderly.

Health effects on the elderly

Although many may be in good health, older adults are at a risk of developing mental health issues even during the normal course. While this risk is not specific to retirement years, stressors experienced by senior citizens may be unique, such as ongoing loss in functional abilities, reduced mobility and health problems that require long-term care. Covid-19 brings additional challenges, especially with regard to the mental health of the elderly.

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It is not just the chances of getting infected with COVID-19 that present a risk to mental health, altered mental status can also be an initial presenting symptom of Covid-19 in the elderly, even in the absence of respiratory symptoms or fever.

As many have noted, concerns about the elderly getting infected are not hyperbole. Their immune system is less robust, putting them at greater risk. They are more prone to developing pneumonia. There is a higher likelihood of more of the lung being affected, i.e., of infection spreading to multiple lobes of the lungs, in elderly patients compared to young and middle-aged patients. Pre-existing illnesses they may have, further increase the risk (either of contracting the virus, or making the outcome worse).

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The most severe outcome in Covid-19 is acute respiratory distress syndrome, or ARDS. It is the leading cause of death in patients with Covid-19. Advanced age is related to increased incidence of ARDS, and higher mortality. When ARDS does not kill, it leaves people with a high chance of secondary complications after recovery, including cognitive decline. Simply put, this is a reduction in the ability of the brain to function.

Learning from evidence to help the elderly

Within the short but intense six-month time frame of the Covid-19 outbreak, early evidence from geriatric psychiatry in China and Italy is already indicating that older adults in hospital-based settings may experience a worsening of psychiatric symptoms under lockdown measures. There is a need to examine such corresponding trends in India as well.

The importance of documenting the myriad of ways that Covid-19 will affect Indians, of varying age groups and economic status, cannot be overstated. Feelings of loneliness and of being socially isolated rank high on the list of risk factors for poor mental and physical health. Isolation can cause health effects such as increased incidence of depression, anxiety symptoms and cognitive decline, which can outlast the duration of isolation itself. Thus, it seems important at this time to address social isolation in the elderly by finding ways to offer support and emotional connection.

At present, most of the studies examining effects of isolation in the elderly are conducted abroad. We urgently need studies within India to estimate the impact of the COVID-19 outbreak on India’s senior citizens and other vulnerable groups. More information through such studies will allow us to develop evidence-based interventions and policies to address mental health concerns in the elderly.

(Avantika Bhatia is an Assistant Professor of Psychology at Ashoka University. Reeteka Sud is a neuroscientist, working at NIMHANS, Bengaluru. Both are members of Indian Scientists Response to COVID19 (ISRC))

Disclaimer: The views expressed above are the author’s own. They do not necessarily reflect the views of DH.