{"id":6181,"date":"2020-08-06T06:41:40","date_gmt":"2020-08-06T10:41:40","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=6181"},"modified":"2020-08-08T06:52:18","modified_gmt":"2020-08-08T10:52:18","slug":"covid-19-sets-off-a-pandemic-of-despair-for-older-people","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2020\/08\/covid-19-sets-off-a-pandemic-of-despair-for-older-people\/","title":{"rendered":"COVID-19 Sets Off a Pandemic of Despair for Older People"},"content":{"rendered":"

As communities cautiously open up after the lockdown, older adults are being urged to not leave home yet because they\u2019re more vulnerable than those who are younger. Journalist Judith Graham explores some of the consequences in this article that was posted on the KHN website on May 28, 2020.<\/span><\/i> Funding from the Silver Century Foundation helps KHN develop articles (like this one) on longevity and related health and social issues. Graham\u2019s story also ran on <\/span><\/i>CNN<\/span><\/i><\/a>. <\/span><\/i> <\/span><\/p>\n

As states relax coronavirus restrictions, older adults are advised, in most cases, to keep sheltering in place. But for some, the burden of isolation and uncertainty is becoming hard to bear.<\/span><\/p>\n

This \u201cstay at home awhile longer\u201d advice recognizes that older adults are more likely to become critically ill and die if infected with the virus. At highest risk are seniors with underlying medical conditions such as heart, lung or autoimmune diseases.<\/span><\/p>\n

Yet after two months at home, many want to go out into the world again. It is discouraging for them to see people of other ages resume activities. They feel excluded. Still, they want to be safe.<\/span><\/p>\n

\u201cIt\u2019s been really lonely,\u201d said Kathleen Koenen, 77, who moved to Atlanta in July after selling her house in South Carolina. She\u2019s living in a 16<\/span>th<\/span>-floor apartment while waiting to move into a senior housing community, which has had cases of COVID-19.<\/span><\/p>\n

\u201cI had thought that would be a new community for me, but everyone there is isolated,\u201d Koenen said. \u201cWherever we go, we\u2019re isolated in this situation. And the longer it goes on, the harder it becomes.\u201d<\/span><\/p>\n

(Georgia residents age 65 and older [were] <\/span>required to shelter<\/a> in place<\/span> through June 12, along with other vulnerable populations.)<\/span><\/p>\n

Her daughter, Karestan Koenen, is a professor of psychiatric epidemiology at Harvard University\u2019s T.H. Chan School of Public Health. During a Facebook Live event this month, she said her mother had felt in March and April that \u201ceveryone was in [this crisis] together.\u201d But now, that sense of communality has disappeared.<\/span><\/p>\n

Making it worse, some seniors fear that their lives may be seen as expendable in the rush to reopen the country.<\/span><\/p>\n

\u201c[Older adults] are wondering if their lives are going to end shortly for reasons out of their control,\u201d said Linda Fried, MD, dean of the Mailman School of Public Health at Columbia University, in a <\/span>university publication<\/a>.<\/span> \u201cThey\u2019re wondering if they\u2019ll be able to get the care they need. And most profoundly, they\u2019re wondering if they are going to be cast out of society. If their lives have value.\u201d<\/span><\/p>\n

If anything, I\u2019ve seen a very strong will to live and acceptance of whatever one\u2019s fate might be.<\/b><\/p>\n

\u2014 Marc Agronin, MD <\/b><\/p><\/blockquote>\n

On the positive side, resilience is common in this age group. Virtually all older adults have known adversity and loss; many have a \u201cthis too shall pass\u201d attitude. And research confirms that they tend to be <\/span>adept at regulating their reactions<\/span><\/a> to stressful life events\u2014a useful skill in this pandemic.<\/span><\/p>\n

\u201cIf anything, I\u2019ve seen a very strong will to live and acceptance of whatever one\u2019s fate might be,\u201d said Marc Agronin, MD, a geriatric psychiatrist and vice president of behavioral health at Miami Jewish Health, a 20-acre campus with independent living, assisted living, nursing home care and other services.<\/span><\/p>\n

Several times a week, psychologists, nurses and social workers are calling residents on the campus, doing brief, mental health checks and referring anyone who needs help for follow-up attention. There\u2019s \u201ca lot of loneliness,\u201d Agronin said, but many seniors are \u201calready habituated to being alone or are doing OK with contact [only] from staff.\u201d<\/span><\/p>\n

Still, \u201cif this goes on much longer,\u201d he said, \u201cI think we\u2019ll start to see less engagement, more withdrawal, more isolation\u2014a greater toll of disconnection.\u201d<\/span><\/p>\n

Erin Cassidy-Eagle, PhD, a clinical associate professor of psychiatry at Stanford University, shares that concern.<\/span><\/p>\n

From mid-March to mid-April, all her conversations with older patients revolved around several questions: \u201cHow do we keep from getting COVID-19? How am I going to get my needs met? What\u2019s going to happen to me?\u201d<\/span><\/p>\n

But more recently, Cassidy-Eagle said, \u201colder adults have realized the course of being isolated is going to be much longer for them than for everyone else. And sadness, loneliness and some hopelessness have set in.\u201d<\/span><\/p>\n

She tells of a woman in her 70s who moved into independent living in a continuing care community because she wanted to build a strong social network. Since March, activities and group dining have been canceled. The community\u2019s director recently announced that restrictions would remain until 2021.<\/span><\/p>\n

\u201cThis woman had a tendency to be depressed, but she was doing OK,\u201d Cassidy-Eagle said. \u201cNow she\u2019s incredibly depressed and she feels trapped.\u201d<\/span><\/p>\n

A 93-year-old plunged into despair after her assisted living facility went on lockdown in mid-March. Medications have not helped.<\/b><\/p><\/blockquote>\n

Especially vulnerable during this pandemic are older adults who have suffered previous trauma. Gary Kennedy, MD, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, has seen this happen to several patients, including a Holocaust survivor in her 90s.<\/span><\/p>\n

This woman lives with her son, who got COVID-19. Then she did as well. \u201cIt\u2019s like going back to the terror of the [concentration] camp,\u201d Kennedy said, \u201can agonizing emotional flashback.\u201d<\/span><\/p>\n

Jennifer Olszewski, EdD, an expert in gerontology at Drexel University, works in three nursing homes in the Philadelphia area. As is true across most of the country, no visitors are allowed, and residents are mostly confined to their rooms.<\/span><\/p>\n

\u201cI\u2019m seeing a lot of patients with pronounced situational depression,\u201d she said, \u201cdecreased appetite, decreased energy, a lack of motivation and overall feelings of sadness.\u201d<\/span><\/p>\n

\u201cIf this goes on for months longer, I think we\u2019ll see more people with functional decline, mental health decline and failure to thrive,\u201d Olszewski said.<\/span><\/p>\n

Some are simply giving up. Anne Sansevero, a geriatric care manager in New York City, has a 93-year-old client who plunged into despair after her assisted living facility went on lockdown in mid-March. Antidepressant and anti-anxiety medications have not helped.<\/span><\/p>\n

\u201cShe\u2019s telling her family and her health aides \u2018life\u2019s not worth living. Please help me end it,\u2019\u201d Sansevero said. \u201cAnd she\u2019s stopped eating and getting out of bed.\u201d<\/span><\/p>\n

The woman\u2019s attentive adult children are doing all they can to comfort their mother at a distance and are feeling acute anguish.<\/span><\/p>\n

What can be done to ease this sort of psychic pain? Kennedy of Montefiore has several suggestions.<\/span><\/p>\n

Older adults may not own up to feeling depressed, but some will describe physical symptoms, such as difficulty sleeping or concentrating.<\/b><\/p><\/blockquote>\n

\u201cDon\u2019t try to counter the person\u2019s perception and offer false reassurance. Instead, say, yes, this is bad, no doubt about it. It\u2019s understandable to be angry, to be sad. Then provide a sense of companionship. Tell the person, \u2018I can\u2019t change this situation but I can be with you. I\u2019ll call tomorrow or in a few days and check in with you again.\u2019\u201d<\/span><\/p>\n

\u201cTry to explore what made life worth living before the person started feeling this way,\u201d he said. \u201cRemind them of ways they\u2019ve coped with adversity in the past.\u201d<\/span><\/p>\n

If someone is religiously inclined, encourage them to reach out to a pastor or a rabbi. \u201cTell them, I\u2019d like to pray together or read this Bible passage and discuss it,\u201d Kennedy said. \u201cComforting person-to-person interaction is a very effective form of support.\u201d<\/span><\/p>\n

Do not count on older adults to own up to feeling depressed. \u201cSome people will acknowledge that, yes, they\u2019ve been feeling sad, but others may describe physical symptoms\u2014fatigue, difficulty sleeping, difficulty concentrating,\u201d said Julie Lutz, PhD, a postdoctoral fellow at the University of Rochester.<\/span><\/p>\n

If someone has expressed frequent concerns about being a burden to other people or has become notably withdrawn, that\u2019s a worrisome sign, Lutz said.<\/span><\/p>\n

In nursing homes, ask for a referral to a psychologist or social worker, especially for a loved one who\u2019s recovering from a COVID hospitalization.<\/span><\/p>\n

\u201cAlmost everybody that I\u2019m seeing has some kind of adjustment disorder because their whole worlds have been turned upside down,\u201d said Eleanor Feldman Barbera, PhD, an elder care psychologist in New York City. \u201cTalking to a psychologist when they first come in can help put people on a good trajectory.\u201d<\/span><\/p>\n

The National Alliance on Mental Illness has compiled a <\/span>COVID-19 information and resource guide<\/span><\/a>, available at https:\/\/www.nami.org\/covid-19-guide. The American Psychological Association has created a <\/span>webpage devoted to this topic<\/span><\/a> and recently wrote about <\/span>finding local mental health resources<\/a>.<\/span> The Substance Abuse and Mental Health Services Administration has a 24-hour hotline, 1-800-662-4357. And the national suicide prevention hotline for those in acute distress is 1-800-273-8255.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

As states relax coronavirus restrictions, older adults are advised, in most cases, to keep sheltering in place. But for some, the burden of isolation and uncertainty is becoming hard to bear.<\/span><\/p>\n

Read more COVID-19 Sets Off a Pandemic of Despair for Older People<\/span> ›<\/span><\/a><\/div>\n

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