As states are lifting stay at home mandates and social isolation is relaxing, older adults are still advised to remain to shelter in place. For many older adults, isolation and uncertainty have left them alone and in despair. Making it worse, some seniors fear that their lives are being seen as expendable in the rush to reopen the country.
Older adults are most likely to become critically ill and die if infected with COVID-19, so sheltering in place seems like the best option for their health and safety, but there are repercussions of extended isolation. Many desire to resume their lives as before, and not feel excluded, but remain obedient to the sheltering in place advisory for their wellbeing.
“[Older adults] are wondering if their lives are going to end shortly for reasons out of their control,” said Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, in a university magazine article, “Understanding the Three Types of Loneliness.” “They’re wondering if they’ll be able to get the care they need. And most profoundly, they’re wondering if they are going to be cast out of society. If their lives have value.”
Voices of the isolated
“It’s been really lonely,” said Kathleen Koenen, 77, who moved to Atlanta in July after selling her house in South Carolina.
She’s living in a 16th-floor apartment while waiting to move into a senior housing community, which has had cases of COVID-19. “I had thought that would be a new community for me, but everyone there is isolated,” Koenen said. “Wherever we go, we’re isolated in this situation. And the longer it goes on, the harder it becomes.” Georgia residents age 65 and older are required to shelter in place through June 12, along with other vulnerable populations.
Kathleen’s daughter, Karestan Koenen, is a professor of psychiatric epidemiology at Harvard University’s 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 “everyone was in [this crisis] together.” But now, that sense of commonality has disappeared.
“How do we keep from getting COVID-19? How am I going to get my needs met? What’s going to happen to me?”
Erin Cassidy-Eagle, a clinical associate professor of psychiatry at Stanford University, shares the concerns of her older patients. More recently, Cassidy-Eagle said, “Older 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.”
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’s director recently announced that restrictions would remain until 2021.
“This woman had a tendency to be depressed, but she was doing OK,” Cassidy-Eagle said. “Now she’s incredibly depressed and she feels trapped.”
“It’s like going back to the terror of the [concentration] camp,” Kennedy said, “an agonizing emotional flashback.”
Dr. Gary Kennedy, 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. This woman lives with her son, who got COVID-19. Then she contracted COVID-19 as well.
Older adults, who have suffered previous trauma, are especially vulnerable during this pandemic.
“She’s telling her family and her health aides ‘life’s not worth living. Please help me end it,” Sansevero said. “And she’s stopped eating and getting out of bed.”
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.
The woman’s attentive adult children are doing all they can to comfort their mother at a distance and are feeling acute anguish.
Mental health decline and failure to thrive
For most of the country, visitors are not allowed in assisted living and nursing homes and residents are mostly confined to their rooms.
“I’m seeing a lot of patients with pronounced situational depression,” said Jennifer Olszewski, an expert in gerontology at Drexel University. Olszewki works in three nursing homes in the Philadelphia area. She has found an overall “decrease in appetite and energy, a lack of motivation, and overall feelings of sadness.”
“If this goes on for months longer, I think we’ll see more people with functional decline, mental health decline, and failure to thrive,” Olszewski said.
How can we ease our loved one’s psychic pain?
Kennedy of Montefiore has several suggestions:
Validate their feelings
“Don’t try to counter the person’s perception and offer false reassurance. Instead, say, yes, this is bad, no doubt about it. It’s understandable to be angry, to be sad. Then provide a sense of companionship. Tell the person, ‘I can’t change this situation but I can be with you. I’ll call tomorrow or in a few days and check in with you again.’”
Remind them of their resilience
“Try to explore what made life worth living before the person started feeling this way,” she said. “Remind them of ways they’ve coped with adversity in the past.”
On the positive side, resilience is common in this age group. Virtually all older adults have known adversity and loss; many have a “this too shall pass” attitude. Research confirms that older adults tend to be adept at regulating their reactions to stressful life events, which proves to be a useful skill in this pandemic.
Remind them of their beliefs
If someone is religiously-inclined, encourage them to reach out to a pastor or a rabbi. “Tell them, I’d like to pray together or read this Bible passage and discuss it,” Kennedy said. “Comforting person-to-person interaction is a very effective form of support.”
Speak of the physical symptoms of depression, rather than the emotional
Do not count on older adults to own up to feeling depressed. “Some people will acknowledge that, yes, they’ve been feeling sad, but others may describe physical symptoms — fatigue, difficulty sleeping, difficulty concentrating,” said Julie Lutz, a geropsychologist and postdoctoral fellow at the University of Rochester.
Tell them that they are not a burden
“If someone has expressed frequent concerns about being a burden to other people or has become notably withdrawn, that’s a worrisome sign,” Lutz said.
“Share with them that to be human is to be a burden at times no matter your age. They made the choice to love and take care of you. Now, caring for them is something you want to do, too. You see it as a privilege — a way of saying thank you for all your parent or loved one has done for you.”
Ask for a professional psychologist or social worker referral
In nursing homes, ask for a referral to a psychologist or social worker, especially for a loved one who’s recovering from a COVID-19 hospitalization.
“Almost everybody that I’m seeing has some kind of adjustment disorder because their whole worlds have been turned upside down,” said Eleanor Feldman Barbera, an elder care psychologist in New York City. “Talking to a psychologist when they first come in can help put people on a good trajectory.”
The National Alliance on Mental Illness has compiled COVID-19 information and resource guide.
Find your local mental health resources provided by The American Psychological Association.
The Substance Abuse and Mental Health Services Administration 24-hour hotline is 1-800-662-4357.
The National Suicide Prevention hotline for those in acute distress is 1-800-273-8255.