Tackling the impact of Covid-19 pandemic on the mental health of the elderly will benefit us all
Sloka Iyengar, The American Museum of Natural History, New York, United States.
The state of mental health in the elderly pre-Covid-19
It is no secret that efforts focused on mental health in the elderly were sparse at best and dismal at worst. With the proportion of the elderly steadily rising worldwide, international bodies have focused their efforts on mobilizing and instituting treatment and care strategies to address specific mental health needs in the elderly population. Still, elder abuse, neglect, loss of dignity, the sense of being invisible, and loss of autonomy seem to be the norm for the elderly in many places. Added to these are physical problems such as frailty, limited mobility, chronic diseases such as cancer, cardiovascular diseases that have a substantial impact on elder mental health. From the widows of Vrindavan in India who are abandoned by their families after their husbands die and are forced to beg on the streets, to winter deaths in older women in the UK due to fuel-poverty, society seems to have forgotten its oldest inhabitants. Even elderly people that are fortunate enough to have the means to get into long-term care nursing facilities (NFs), skilled nursing and rehabilitation settings (SNFs), and assisted living residences (ALRs) are not immune to this mistreatment. Even in the developed world, long-term facilities are often burdened with under-investment, under-staffing, and the engagement of low-wage, non-sustainable employment and staff.
The COVID-19 pandemic has exposed many gaps in mental health, including for the elderly
It is not uncommon for the elderly to be left behind literally and metaphorically in humanitarian crises. For example, after hurricane Maria in Puerto Rico, long-term care facilities were found to be ravaged and devastated years after the actual crisis. The situation was even more pronounced for elderly that were poor. While a pandemic of the scale of Covid-19 left many systems overwhelmed, care for the elderly was certainly one of them. In the EU, many older people were forced to sign Do Not Resuscitate (DNR) forms giving the unambiguous impression that their lives weren’t worthy of saving. Given the susceptibility of the older population to the virus, and age increasing risk of hospitalization, many elderly care homes, and nursing homes found themselves completely ill-equipped to take care of their residents. People in nursing homes passed away without having their loved ones close by. Individuals that had evidently “recovered” from Covid-19 were sent back to nursing homes, infecting even more people. The pandemic and ensuing lockdown brought along additional challenges in the mental health of many age groups, and specifically for the elderly.
For many older people, volunteering, places of worship, old-age centres, and community centers were crucial ways to socialize. The lockdown meant that these opportunities were lost. What is worse is that we don’t know the complete impact of the pandemic and the lockdown on elderly mental health exactly. Without knowing the exact burden of isolation and loneliness, how are we to come up with solutions? Nursing homes residents typically live in close quarters proving it challenging to socially distance. On the one hand, there were shortages of protective equipment; and on the other, scared and frail elderly people, cut off from their families were rendered even more frightened as the staff were less familiar when they wore these protective devices.
The pandemic also brought along issues related to food delivery for elderly shut-ins, legal recourse for elder abuse, and responding to housing concerns such as evictions and foreclosing. The pandemic has also meant that we are more reliant than ever on technology. However, there is a digital divide which is even more pronounced elderly people living in low-and-middle-income countries, where the lack of technology is even grimmer. The lack of physical activity, exercise, sunlight, outdoor time, and how that has had additional effects on the elderly, especially for people that are frail and immunocompromised. These issues are compounded in living with health or neurological conditions such as those older people with cognitive impairment. The restrictions on who could visit and give company to these individuals had certain ramifications for the mental health of individuals with dementia or Alzheimer’s Disease.
So what can we do?
While it is undeniable that the elderly have massive reserves of resilience and capability to adapt, I wonder if we use this as an excuse to relegate the elderly to those that do not need support. The fact that they can adapt especially well means that our efforts are more likely to succeed! These systems of support range from a holistic structure around healthy aging, to spaces that are accessible for frail and elderly people, to closing the digital divide. The arts have proved to be a great way of engaging the elderly, with artwork and music therapy providing benefits overall.
But these acute, stopgap measures need to be supported with changes with a national and international aging policy that tackles elder abuse. More importantly, we need to make a societal and perceptional shift in the way we see and treat the elderly. By supporting community-based mental health and psychosocial interventions in the elderly to funding companies dedicated to building elderly-friendly digital technology, giving attention to the oldest members of society will have definite benefits for all of us.
To find out more about the Global Mental Health Action Network, click here.