Experts Offer Guidance on Helping Seniors Handle COVID-19 Stresses
Abstract
Reaching out to family and friends by phone and/or videoconference and exercising regularly are among the ways that may help seniors combat the feelings of loneliness that can come from social isolation.
Yeates Conwell, M.D., says seniors have important strengths that can be leveraged to help them cope with social changes due to the pandemic.
Navigating the critical need for social distancing and the enduring human need for social contact is a challenge for nearly everyone living through the worldwide COVID-19 pandemic. For seniors—at heightened risk of serious complications from COVID-19, yet also susceptible to the adverse effects of loneliness and social isolation—it may be especially trying. Psychiatrists and mental health professionals can assist seniors during this time by drawing on their strengths of experience and resilience as well as resources available in the community.
“This is a perfect storm,” Yeates Conwell, M.D., director of the University of Rochester Medical Center Office for Aging Research and Health Services, said of the delicate balance between the need for social distancing and the psychiatric risks of loneliness in older adults. For instance, data from Hong Kong following the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic showed that there was nearly a 30% increase in suicide among people aged 65 or older, with women at higher risk than men. Moreover, research looking at coroners’ reports suggested that what was driving the phenomenon, in addition to the fear of becoming ill, was loneliness and loss of social support, according to Conwell.
“We have also known for a long time that social connectedness is protective [against suicide],” he said.
But seniors have important strengths that can be leveraged, Conwell said. By virtue of age and experience, older people can often accept dramatic changes, such as are being necessitated by the pandemic, with greater equanimity than can younger people. Moreover, seniors have learned to value close relationships with a handful of really important people in their lives who can be a source of support and strength when sheltering at home.
Conwell offered the following recommendations for mental health professionals working with older patients:
No One-Size-Fits-All for Reducing Loneliness
Kimberly Van Orden, Ph.D., principal investigator at the Hope Laboratory at the University of Rochester Medical Center, has focused her research on specific ways to facilitate connectedness among seniors.
She and colleagues have developed a model of cognitive-behavioral therapy that she believes can help reduce loneliness and increase connectedness among seniors during the pandemic. The model focuses on three domains:
Cognition. Psychiatrists and mental health professionals should encourage patients to consider alternative perspectives: How can they view the situation from a different perspective? Can they imagine someone optimistic whose opinion they highly value? How would this person perceive the situation?
Van Orden said it is also important to remind patients that thoughts are thoughts, not necessarily facts. So, patients should be encouraged to examine the evidence for their thoughts (such as, “No one cares about me”) and list the evidence in support of that thought and the evidence that contradicts it, she said.
She recommended resources that patients can use to help develop mindfulness and feel more connected, including Head Space and Insight Timer. These can be downloaded on a smartphone from the user’s app store.
Behavior. While social distancing limits physical contact with others, psychiatrists and mental health professionals should encourage patients to consider how phone or video calls can offer new opportunities for connection. Other behaviors that increase a sense of connectedness might include exercise in fresh air, creating art of any kind, listening to music, and enjoying nature.
Van Orden recommended several websites useful to seniors. For instance, AARP’s website (aarp.org) includes multiple online resources for older adults looking for connection with others. The website GeroCentral also offers a clearinghouse of resources for clinicians and older adults and families. “Care Not Covid” is an interactive website with stories of hope for nursing home and assisted-living residents and staff.
Body physiology. Here the task for a patient—and the psychiatrist treating the patient—is to change how the patient physically feels. Practices that help a patient relax, such as prayer or meditation, can lead to physical improvements, as can music, use of incense or spices to create relaxing smells in one’s home, and the care and grooming of pets, says Van Orden.
“In contrast to cognitive-behavioral interventions for depression—where any kind of ‘behavioral activation’ is likely to improve mood—one size does not fit all in the effort to increase connectedness,” Van Orden told Psychiatric News. “Rather, a specific recommended intervention for connecting socially and overcoming loneliness needs to be tailored to the unique needs and circumstances of the individual.”
Advise patients and family members to be creative about using telephone, Skype, Zoom, or other technologies to maintain regular contact with the most important people in patients’ lives. Social distancing can be mitigated by staying in contact—through whatever means are available—with the people who matter most.
Empower patients by reminding them that they can be helpful to others by initiating contact with grandchildren and other family and friends. Loneliness tends to be embarrassing to talk about and stigmatizing, Conwell said, but seniors can be the ones who offer solace and companionship to those suffering from social distancing.
Encourage patients to get regular exercise. Even taking walks outside while maintaining an appropriate distance from other individuals is mentally and physically beneficial. Moreover, maintaining a regular schedule with daily times set aside for walking or other exercise can help maintain a sense of normalcy.
Psychiatrists can work with community social service agencies that will help older adults with social connectedness. In Rochester, Conwell partners with the nonprofit Lifespan, a community aging services agency helping people stay connected by delivering meals and providing in-home and telephone-based supports.
“There is only so much that health care professionals can do in the current crisis,” Conwell said. “This is a problem that requires a public health approach that includes drawing on resources in the community that are there to help in times of crisis and can be enormously beneficial to older people and their physicians.”
Conwell added that the rapid movement in psychiatry from in-person visits to tele-mental health visits has been well received by seniors.
“Even under ordinary circumstances, telehealth visits are a favored option for many people, especially older adults for whom travel to the office or clinic or hospital may be challenging for a variety of reasons,” he told Psychiatric News.
In the midst of a pandemic requiring people to shelter at home, it can be especially therapeutic and valuable for older people to know that a doctor or therapist is reaching out, helping to maintain a sense of normalcy, he said.
“We are learning a lot,” he said, “including lessons that I expect will carry on well after this crisis is over about how to best help our older adult patients use these technologies.” ■
“Elderly Suicide and the 2003 SARS Outbreak in Hong Kong” is posted here.
