Mental Health in the Elderly (Especially during COVID-19)

The uncertainty and fear of the pandemic can have increased effect on the minds of the aged, as they are aware of their vulnerability. The fear of passing remains misplaced within the existential fear of losing their loved ones and guilt of possibly being the carriers of the infection. This can lead to significant ‘what after me’ issues and self-neglect, which can in turn lead to non-compliance to the prescribed standards of precautions. Due to generation limitations and sensory and cognitive deficits, they may be unaware of the updates related to the COVID-19 situation making them easy targets of misinformation and inadequate precautionary measures are followed.

The impact of the quarantine can be immense, resulting in loneliness, physical distancing from their loved ones, grief, anxiety and chronic stress that can have long-standing psychological effects. Furthermore, increased suicidal ideations and attempts consequent to stress, on the background of the already existing suicidality risk in the elderly, is an added concern. Any form of stress is associated with decrease in immunity, which can compound the already weakened physiological defence-systems in the elderly.

Caregivers should keep an eye out for the following warning signs, which could indicate a mental health concern:

1. Changes in appearance or dress, or problems maintaining the home or yard.
2. Confusion, disorientation, problems with concentration or decision-making.
3. Decrease or increase in appetite; changes in weight.
4. Depressed mood lasting longer than two weeks.
5. Feelings of worthlessness, inappropriate guilt, helplessness; thoughts of suicide.
6. Memory loss, especially recent or short-term memory problems.
7. Physical problems that can’t otherwise be explained: aches, constipation, etc.
8. Social withdrawal; loss of interest in things that used to be enjoyable.
9. Trouble handling finances or working with numbers.
10. Unexplained fatigue, energy loss or sleep changes.

During these times of social distancing, be sure to keep a close eye on your aging loved one when you’re dropping off groceries, talking on the phone, or doing a video chat to spot signs they need help.

Families and care givers need to be holistically involved in the care of the elderly, with increased sensitivity to their mental health. Few measures that can be undertaken to ensure their psychological well-being are:

• Ensuring the adequate three-pronged precautionary measures as suggested by WHO (social distancing, hand and respiratory hygiene). They need to be explained about the needful in simple and relevant terms.
• Social connectedness with their loved ones is essential together with social integration. They need to be involved in decision-making at familial levels, during times of such crisis.
• Providing adequate emotional support is vital to those living alone. Ensuring their basic needs, safety and dignity will help them to stay free from stress and fight loneliness, more so in lockdown situations. Their doubts need to be addressed periodically to allay the pandemic-related anxiety.
• ‘Digital screen time’ is better reduced, more so for the elderly to prevent misinformation and panic. They need to be updated about the COVID-19 situation and the necessary measures in a relevant manner. Vivid data and unnecessary statistics are better avoided.
• Those in day-care or old-age homes might need special care. Preventing overcrowding, encouraging physical activity, enhancing family support and ensuring nutrition are vital for their overall well-being. Abuse can be increased in such situations and need to be prevented and identified at the earliest. Abuse identification and prevention need sensitization among the general population and physicians alike, and is unfortunately often neglected amongst other priorities during a pandemic.
• Various elder-friendly helplines exist specific to various countries both for telephonic counselling as well as food or essential deliveries at home. They need to be made aware of the same and seeking mental health care, if in need, should be actively encouraged. The elderly might have unique requirements in terms of technology- handling, communication and accessibility which need to be kept in mind while designing the digital helplines and tele-consultations
• The families and caregivers need to be sensitive to the increased needs of those with pre-existing disorders like dementia, depression and other neurological disorders. Suicide prevention using ‘gate-keeper awareness’ approach should be the top priority.
• Autonomy, respect and dignity needs to be preserved for the geriatric population, especially during the quarantined COVID-19 situation. Taking care of them is important, but what is more vital is their active involvement in decision making.

The seniors might be frail due to age, but they are definitely not weak. Their resilience can be noteworthy, if adequately cared for. It is high time that the pandemic-related policies and legislation in various countries are made more senior-friendly. Besides their physical health burden, their psycho-social needs are also vital to be protected for their well-being and healthy survival. This is just the starting phase of the crisis.

It is expected that in the post-pandemic months, there will be a surge in various mental-health issues, and a significant proportion of them might be the elderly. Preparedness to deal with this is necessary. Integrating them into this struggle against the unprecedented outbreak, can help us learn from their hope and wisdom for a better post-pandemic aftermath.

Don’t hesitate to seek help if your loved one is experiencing any of the symptoms mentioned throughout this article. Your loved one’s family doctor is always a good place to start. You can also reach out to Lifeline Durban on 031 303 1344 for more information.

Article By Yeshira Sewdayal
Mental Health Advocate & writer, psychology student.