We can support our patients’ well-being by encouraging safe social interactions and addressing psychiatric illness.
A couple of times a month, I meet with colleagues in primary care clinics to talk about their patients with dementia. We discuss the depression, anxiety, insomnia, aggression, paranoia, and hallucinations that can accompany dementia. We also talk about the pandemic and how restrictions have been affecting patients, families, and caregivers.
Here’s one story: An older woman with dementia living in a nursing home has been more irritable and aggressive since the pandemic started. Her husband is allowed to visit her briefly only once a week, a plexiglass barrier separating them. Whenever he leaves, she starts screaming, pounding on the glass, and sobbing uncontrollably. We’ve reduced the risk that she and other residents in her nursing home will contract COVID-19 and die. But at what psychological cost?
We’re social creatures. Isolation and loneliness take a severe toll on emotional health. As we head into the first winter of the pandemic, we can support the emotional health of our patients in the following ways:
1. Encourage safe social interactions.
We can lower the risk of in-person visits through adequate PPE, physical distancing, good ventilation, and designating one or two family members who can remain direct contacts. We should support older adults’ use of technology to allow for online interactions—tech skills learned now will serve them well in the coming months and after the pandemic. (And while we’re at it, we should advocate that all staff have access to PPE, good wages, and benefits.)
2. Promote healthy habits.
The pandemic has disrupted routines. We must encourage our patients to eat well (the closer to a Mediterranean diet, the better), avoid alcohol and drugs, and get adequate sleep. Ideally, older adults should exercise for at least 150 minutes per week—but any exercise is better than no exercise. Oh, and turn off the news.
3. Address mental health.
We have to identify and treat depression and anxiety ideation in older adults. Older adults are at especially high risk of suicide, and evidence from the SARS pandemic suggests that the risk is even higher during a pandemic. Telehealth may make it easier for older adults to get mental health services, see a therapist, or participate in support groups. and may be especially important for underserved populations such as ethnic minority elders, who are disproportionately suffering from COVID-19
I recently co-led a workshop on the effects of the pandemic on older adults’ access to healthcare and social services. The participants were mostly social services workers from Wisconsin. They shared how they helped support older adults in their communities by hosting virtual memory cafes to help those with dementia and their loved ones socialize and get support. They also held drive-in games and a car horn indicated, “BINGO!”
We must be creative in helping older adults survive the pandemic, not just physically but emotionally. And we need to start right now.