GALESBURG - Older adults are more vulnerable to hospitalization and death from COVID-19, and those in long-term care settings were among the first groups to experience restrictions on face-to-face contact.
So for a year-and-a-half, older individuals had the double burden of age-related diminishing social circles and the implementation of COVID-19 safety measures that required physical distancing and enforced isolation. Dr. Denise Dechow (pronounced DECK-oh), DO, a psychiatrist at OSF HealthCare in Galesburg, Illinois, says the so called ‘double whammy,’ as some clinicians have called it, presented a significant mental health risk for older people in long-term care.
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Dr. Dechow specializes in geriatric psychiatry and regularly treats nursing home residents by visiting their facilities. When COVID-19 mitigations closed long-term care sites to visitors, Dechow found herself and her patients struggling with virtual visits.
Patients who had trouble hearing and seeing really struggled with the technology. Dr. Dechow says in-person visits with masking and face shields also made those visits challenging for older patients, particularly those who have already experienced some cognitive decline during isolation.
“It was difficult for patients. They did not recognize who you were. It was often very frightening to them and they could not hear you through all the layers of PPE. So, although these were better than the virtual visits, there were still many limitations.”
Some nursing homes with COVID-19 outbreaks required patients to remain in their rooms, so residents experienced even more isolation than usual. That, in turn, affected their physical and mental health, Dr. Dechow says.
“Feelings of loneliness can lead to increased risk of depression, anxiety, substance use disorder, aggression, impulsivity and suicidal thoughts.”
Decades of research on prolonged isolation and loneliness shows it can be worse for a person’s health than obesity, and it is as damaging to health as smoking 15 cigarettes a day. Newer research from the AARP Foundation in 2020 showed the consequences of isolation and loneliness on nursing home residents’ quality of life are alarming: 50% increased risk of developing dementia, a 32% increased risk of stroke and a nearly fourfold increased risk of death among heart failure patients.
Additionally, the Kaiser Health Foundation estimates with COVID-19 now among the leading causes of death in the U.S., roughly five million people are in mourning. The pandemic prevented many families from gathering and holding funerals, even after deaths caused by conditions other than COVID-19.
Dr. Dechow says grieving is more challenging without access to the rituals that might make it more bearable. There is a condition called Prolonged Grief Disorder (PGD). In complicated grief, painful emotions are so long lasting and severe, individuals have trouble recovering from the loss.
“And this has to do with prolonging symptoms of anxiety, depression, sadness and sleep disturbance. What we notice is that we can’t not participate in these rituals. These are important and must take place, even if it’s a year after someone has passed.”
The risk of PGD is higher in older adults and those with a psychiatric history. Dr. Dechow says health care providers are going to have to recognize symptoms of this relatively newly defined disorder and make proper referrals.
Some Solutions
A Public Policy and Aging report produced in 2017, well before the pandemic, pointed out the impact of implementing technologies to reduce social isolation and loneliness has been limited. In the report, researchers say this area is ripe for innovation. Researchers also recommend it would be helpful for long-term care facilities to use older adult peer support specialists with the lived experience of aging with a mental health and a physical health condition.
Dechow says those specialists could be trained and accredited to provide Medicaid and/or Medicare reimbursable telehealth support.
“Encouraging them to use technology for some of the support that they have been lacking because some of the older adults are very hesitant to use any of the technology because they don’t understand it and it scares them.”
In June, Illinois Governor J.B. Pritzker signed legislation that will require nursing homes to connect residents virtually with family members, loved ones, and to religious or recreational activities when in-person visits are prohibited or restricted due to federal or state rule or guidance.
Technology and assistive equipment may be funded through federal Civil Monetary Penalty (CMP) Funds and/or other state and federal resources.
If you or a loved one are suffering from the impact of loneliness and isolation, OSF HealthCare offers free behavioral health navigation services to help understand all resources available in your area.
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