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SPECIAL REPORT: GERIATRIC PSYCHIATRY
The population of older adults (65 years or older) in the United States is increasing rapidly. It is estimated that their population will nearly double from 15% in 2014 to 24% (98 million) of the total population by 2060.1 Currently, 1 in 5 older adults in the United States has a diagnosable mental health disorder, with personality disorders, anxiety disorders, mood disorders, and substance use disorders being the most common.2 It is also estimated that the total number of individuals with Alzheimer disease in the United States will rise from 5 million in 2013 to approximately 14 million by 2050.1
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During the initial stages of the COVID-19 pandemic, older adults were more likely to be infected with the virus and have worse outcomes than their younger counterparts (Figure).3 Similarly, morbidity and mortality rates were highest among older adults who had cooccurring conditions such as hypertension, cardiovascular disease, diabetes, chronic respiratory disease, and chronic kidney disease.4
Figure. Older Adults and COVID-19 Outcomes3
Older adults were also susceptible to loneliness and social exclusion.5 The risk factors that were associated with worsening of physical, psychological, and social well-being among these individuals included age, ageism, isolation, loneliness, lack of security, frailty dependency, sexism, stigma, abuse, and cognitive and sensory impairments. The pandemic also had a significant effect on the mental health of older adults.6
COVID-19 infection presented as altered mental status in the absence of respiratory symptoms or fever. Worsening of confusion, agitation, disorientation, refusing care, and apathy were also presenting symptoms among this population. Older adults also reported greater rates of loneliness, depression, risk for substance use disorders, and suicide.7-9 In addition, worsening of psychiatric symptoms was noted among older adults who were admitted to hospitals during the lockdown periods.10
To care for older adults with mental health disorders during the pandemic and to minimize the effects of sustained social isolation, many alternative methods to providing care were developed.11,12 Electronic devices or platforms to conduct virtual interactions for social, profession, or clinical interactions became important tools. Telephone evaluations were conducted for older adults who were not able to use technology. In addition, community connection websites were established to provide a searchable directory of organizations that provided essential daily services for older adults. Older adults were also encouraged to participate in social, spiritual, or religious interactions using electronic means/platforms.
Despite the difficulties they endured during the pandemic, older adults with mental health disorders in the United States have done fairly well, compared to younger adults.13 Families, friends, clinicians, social support systems, health care agencies, health care systems, and governmental and nongovernmental agencies have rallied together during this period of uncertainty to ensure that the provision of care to these vulnerable individuals did not suffer significantly.
It would behoove us to use the lessons learned during the pandemic to continue to improve the psychiatric care of older adults going forward. By doing so, we can enhance the quality of life of these individuals and minimize the negative effects any such future global events may have on their lives.
Dr Tampi is chairman of the Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, Ohio; chief, Section for Geriatric Psychiatry, Cleveland Clinic, Ohio; and professor of medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.
References
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2. Tampi RR. Learning from the past and creating the future: American Association for Geriatric Psychiatry (AAGP) and geriatric mental healthcare in the United States. Am J Geriatr Psychiatry. 2019;27(12):1421-1427.
3. CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346.
4. Shahid Z, Kalayanamitra R, McClafferty B, et al. COVID-19 and older adults: what we know. J Am Geriatr Soc. 2020;68(5):926-929.
5. D’cruz M, Banerjee D. ‘An invisible human rights crisis’: the marginalization of older adults during the COVID-19 pandemic - an advocacy review. Psychiatry Res. 2020;292:113369.
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9. Wand APF, Zhong BL, Chiu HFK, et al. COVID-19: the implications for suicide in older adults. Int Psychogeriatr. 2020;32(10):1225-1230.
10. Serafini G, Bondi E, Locatelli C, Amore M. Aged patients with mental disorders in the COVID-19 era: the experience of northern Italy. Am J Geriatr Psychiatry. 2020;28(7):794-795.
11. Roy J, Jain R, Golamari R, et al. COVID-19 in the geriatric population. Int J Geriatr Psychiatry. 2020;35(12):1437-1441.
12. Parker CB, Forbes MP, Vahia IV, et al. Facing the change together: reflections of coping and resilience from American geriatric psychiatrists during COVID-19. Int Psychogeriatr. 2020; 32(10):1107-1111.
13. Czeisler MÉ, Lane RI, Wiley JF, et al. Follow-up survey of US adult reports of mental health, substance use, and suicidal ideation during the COVID-19 pandemic, September 2020. JAMA Netw Open. 2021;4(2):e2037665. ❒
