Senior Guide to Mental Health During Coronavirus (COVID-19)

The aging population, ages 65 and older, is one of the most vulnerable demographic groups in the United States. The novel coronavirus (COVID-19) pandemic puts seniors and their mental health at significant risk.

Seniors are more likely to have chronic health problems, lower income levels, and isolated living situations.

This combination increases the risk of poor cognitive function, dementia, heart disease, and stroke.^{1, 2} It even brings a greater risk of contracting illnesses like the common cold, and suffering from more intense symptoms.³

Even for healthy adults, loneliness is as dangerous to health as smoking 15 cigarettes per day, according to a study published in 2015.⁴ Another report, published in 2013, found that older men and women who were lonely or isolated had a significantly higher risk of dying.⁵

Because seniors are more likely to experience serious consequences after contracting COVID-19, many must stay in their homes or retirement communities, without seeing friends, family, or even neighbors for weeks at a time.

Loneliness and fear have a huge impact on mental health, which in turn has a big impact on physical health.

Seniors can learn to manage their mental health until the COVID-19 situation stabilizes and social distancing orders can be eased.

While there is no easy solution, there are things that can be done to improve overall outlook and boost mental well-being during these challenging times.

Social Determinants of Health

The risk of mortality goes up the longer an older adult is isolated. This can be measured using the primary social determinants of health (SDOH), per the Centers for Disease Control and Prevention (CDC).⁶

The five key SDOH include:

1. Economic stability
2. Education
3. Social and community context
4. Health and health care
5. Neighborhood and built environment

Seniors are less likely to have economic stability, due to higher medical bills and lower income levels because of retirement. They are also less likely to have strong community ties and a sense of neighborhood involvement.

At the same time, seniors need consistent access to health care due to increasingly poor health.

Based on these measurements from the CDC, seniors are a very high-risk group for poor mental, physical, and emotional health.

Issues for Seniors Managing Mental Health During COVID-19

Senior citizens are already among the most socially isolated groups.

While there are typically support networks, like the Village to Village Network, activity centers, church groups, and government programs to provide more social interaction with other adults and even children, the spread of COVID-19 means these programs are largely unavailable or limited for safety reasons.

In the majority of U.S. cities, everyone must socially distance, staying a minimum of six feet away from people they don’t live with.⁷ More cities are issuing stay-at-home orders, and some mayors and governors are even locking down metropolitan areas and enforcing quarantine measures.

While all of these steps help to slow the spread of coronavirus, they each mean something a little different.

• Social distancing or physical distancing
  This involves deliberately increasing the distance between two or more people to avoid spreading illness.
  
  When maintaining a six-foot distance, particles from breathing, coughing, and sneezing are less likely to come in contact with another person. Staying more than six feet away from other people reduces the chances of spreading disease even further.
  
  Wearing a face mask, like a homemade cloth mask, reduces how far particles from the nose and mouth can travel. This reduces the likelihood of people spreading COVID-19, even if they are asymptomatic.
  
  
• Self-quarantine
  Quarantine is usually a precaution if someone was potentially exposed to COVID-19. During this time, people are separated to see if they become sick.
  
  Medical professionals recommend that anyone who believes they could have COVID-19, or who thinks they have come in contact with someone who had the virus, self-quarantine for at least 14 days.
  
  Symptoms of coronavirus typically show up about two weeks after exposure, so intentional self-quarantine allows time for those symptoms to appear.
  
  If you are self-quarantining, do not share linens, utensils, towels, or other items with anyone you live with. Do not have visitors. Stay in a separate room, isolated from everyone in your household, if possible.
  
  
• Isolation
  This is similar to self-quarantine, but it takes things a step further. Isolation is reserved for those who have COVID-19.
  
  It involves staying further away from anyone you live with or with whom you may come in contact.
  
  For those diagnosed with COVID-19, isolation is required until symptoms abate and a doctor determines the virus has cleared the body. Generally, this means they must have a negative COVID-19 test result before they can exit isolation.

For health reasons, many seniors are self-quarantining — either in assisted living homes, nursing homes, or their own living spaces. While these practices are vital for keeping the person physically safe, the individual’s mental and emotional health can suffer greatly.

Seniors are already at risk for feeling lonely and isolated. The COVID-19 situation only compounds this risk.

Loneliness & Long-Term Isolation

There is no current treatment for the coronavirus or COVID-19 itself. Infected persons are treated for their symptoms, such as taking steps to alleviate their fever and suppress their cough.

Supportive care such as oxygen therapy and fluid management can also be effective treatment for symptoms.

Several studies have shown that isolation increases as you get older.⁸

Seniors are more likely to have smaller social networks as friends and peers age, move into retirement communities, struggle with ailments, or pass away. In addition, their children and grandchildren may move to other locations, making in-person contact less frequent. Because of these factors, older adults are more prone to loneliness.

In the U.S., about 28 percent of older adults live alone, which is about 13.8 million people.

While a study by the U.S. Department of Health and Human Services (HHS) found that living alone was not necessarily a direct cause of loneliness, it can contribute to a sense of isolation. And some older adults report feeling alone or isolated even when surrounded by friends or family.

Feeling lonely increases the push toward isolating for unhealthy reasons. Social isolation is the objective (physical separation from others), but loneliness is the feeling of being alone (a subjective measurement of isolation).

When someone feels lonely, they may be more likely to isolate, even though this worsens the problem.

As someone isolates due to loneliness, various health risks increase.⁹ These include the following:

• High blood pressure
• Heart disease
• Obesity
• Weakened immunity
• Anxiety and depression
• Cognitive decline
• Dementia or Alzheimer’s disease

Older adults are more at risk for COVID-19 complications, so intentional isolation or self-quarantine is vital for many seniors to remain physically healthy. However, the long-term effects of this isolation could increase the risk of mortality.

Since social distancing is a way of life due to coronavirus, seniors have to manage the effects of isolation. Mitigating the associated loneliness is important, as it may reduce some of the negative health impacts.

Anxiety, Depression & Mental Health Struggles

About 20 percent of people who are at least 55 years old experience some form of mental health issue. The most common among older adults include the following:

• Cognitive impairment
• Anxiety
• Mood disorders like depression

Depression is the most prevalent reported mental health condition among older adults, and it is associated with distress and suffering. This condition can lead to impairments in physical, mental, and social functioning, including isolating oneself from social gatherings.

Medical professionals report that forced isolation during the COVID-19 pandemic will increase the risk of depression and anxiety even among those who do not normally struggle with these conditions.

Frequent mental distress (FMD) is associated with aging. This is defined as at least 14 days of poor mental health.

FMD interferes with life activities, such as eating well, maintaining a household, working, or sustaining personal relationships. It’s difficult to maintain an exercise regime and balanced diet when dealing with FMD, and physical health suffers.

In 2006, the CDC recorded that the rate of FMD among adults 50 and older was 9.2 percent. Among those 65 and older, the rate of FMD was 6.5 percent.¹⁰

With additional causes of distress like isolation and poor physical health during a pandemic, it is likely that rates of FMD will steeply rise. This indicates future chronic health issues, such as higher rates of mood disorders and physical problems.

The Mental Health Impact of Financial Hardship

The stress of financial hardship can magnify the effects of aging, which contributes to poorer health. Research suggests that adults who spend at least four years in economic hardship could be at risk of accelerated aging, compared to adults who did not live in extended periods of poverty.

First, the COVID-19 pandemic has led to a surge in unemployment claims in the U.S.¹¹ This period of financial instability and the social stress among young and middle-aged adults could contribute to shorter lifespans and higher rates of mortality among those generations as they age.

Measurements of inflammation markers in the blood, like C-reactive protein (CRP) and IL-6, are associated with chronic conditions like cancer and higher rates of infection.

One study found that people who experience economic or financial hardship earlier in life did not show higher levels of these inflammatory markers, so they may not be prone to accelerated aging.¹²

However, older adults and those in late middle age who experienced these hardships were more likely to suffer health consequences due to financial instability.

A 2015 study reported that 21 percent of the elderly reported one or more forms of material struggle, including the following:

• Dissatisfaction with one’s financial situation
• Trouble paying bills
• Cutting back on medications due to the cost
• Skipping meals because of the cost of groceries
• General food insecurity

Even among the top income quintile, 11 percent of elderly adults reported some of these issues. In the poorest quintile, 37 percent reported these hardships.¹³

While social services like Medicare, Medicaid, Social Security, and food stamps are still in place, the additional mental and emotional stress from isolation and fear may lead to greater worry about financial instability among seniors.

Support During COVID-19

Knowing that you have forms of support during self-quarantine, isolation, or a stay-at-home order can improve your mental stability and reduce fear.

Here are some practical tips for seniors and their loved ones to manage mental health and worries about money or illness during the coronavirus pandemic:

1. Try telemedicine.

In the past several years, more telemedicine options have become available to the general public. Video calls, emails, and chatting over the internet have allowed medical providers, like doctors and nurses, to reach more patients.

These advances allow these professionals to connect with people who may have chronic illnesses preventing them from coming into clinics; rural and remote patients; and those who may have a contagious disease that would otherwise spread to those sitting in waiting rooms or doctors’ offices.

Specific facets of telemedicine have been around for decades.¹⁴

For example, teleradiology has existed since the 1960s, and the evolution of this service has created a basic set of guidelines for transmitting and storing sensitive health data. Teleradiology allowed patients in rural areas to avoid being transported far distances for treatment, which could make concussions or traumatic brain injuries worse.

Telepharmacology and telepathology have existed for decades, allowing doctors to diagnose certain conditions and provide prescription treatments for them. In the past few years, teletherapy practices are also allowing greater access to therapists and social workers, which improves mental health for patients.

Many hospitals, doctors’ offices, and insurance providers offer some level of telehealth services already.

But with COVID-19 forcing most of the population to remain isolated from close contact with any other person, including many doctors, more of these services are being heavily used to discuss concerning symptoms or other health worries with physicians and nurses.¹⁵

To get access to telemedicine services, you will need the following:

• An internet connection
• A video platform like a computer with a webcam or a smartphone with a camera
• A software platform, often a third-party app

Seniors with Medicare can use telehealth services to talk to doctors and nurses within minutes of having a question.¹⁶ Medicare Part B covers certain telehealth services.

The federal government has instituted more telemedicine options for medical professionals as of March 6, 2020. In most cases, you will not have to pay out of pocket for COVID-19 tests if your doctor determines you need one using telemedicine, and you will not have to pay out of pocket for your telemedicine visit.

2. Use computers and smartphones to stay connected.

Although having people over to physically socialize is risky and not recommended, technology allows an unprecedented amount of communication with the outside world.¹⁷

There are several programs that allow seniors to talk to friends and family through a computer, tablet, or phone. Here are some of the most popular:

• Facetime
  This is primarily a program for iPhones, although you can set up a version on your Mac desktop or laptop computer if you prefer.
  
  On your iPhone, go to Settings > Facetime, and turn on the program. Enter your phone number, Apple ID, or email address to use the service. Then, you can open the program on your phone and use your contacts list to decide who to call. You can only Facetime with other Apple subscribers.¹⁸
  
  
• Zoom
  You can download Zoom and set up an account so you can host video chats, or you can join someone else’s Zoom meeting as a participant without an account. The basic program is free, but there are additional benefits to signing up for a paid account.
  
  If you download the Zoom program yourself, you can easily start a meeting or chat through options on the homepage.¹⁹
  
  
• Google Hangouts
  Many people have a Gmail address, but if you do not, it is easy to set one up. Once you have a Gmail account, you can access all kinds of features, including Google Drive, Photos, and Hangouts.²⁰
  
  To start a video conversation in Hangouts, go to hangouts.google.com.
  • Make sure Google has access to the camera and microphone on your computer or smartphone.
  • Click New Conversation.
  • Enter and select a name or email address to contact.
  • Click Start Video Call, which has a video camera icon next to it.
  • A separate window will pop up so you can see the person you are speaking to.
  • When you are done, click the red receiver icon to hang up.
    
    
• Marco Polo
  This is a mobile phone app for both iPhone and Android devices.
  
  Unlike other forms of contact, Marco Polo allows you to take turns recording short videos. Once you download the app from the app store, you can add contacts you know already use the service or invite friends to join.
  
  Click on the icon of the person you want to talk to, and then hold down the Start button to begin recording your message to them. Hit Stop when you are done. The person will respond in turn, and you can reply to their message when you are ready.²¹
  
  There are several other features available in this program, but Marco Polo primarily allows you to see and hear loved ones without the pressure of live contact.
  
  
• Phone calls, text messaging, email, and social media
  These are all common methods for loved ones to stay in contact with each other. If these approaches to talking and seeing your friends and family work well for you, consider using them more often.
  
  Regular communication with loved ones is important to overall health. Since seniors are advised to maintain the highest levels of social distancing due to COVID-19, make sure you are visiting with friends and family regularly via other means of communication.
  
  You’ll likely notice a boost in overall mood after chatting with loved ones.

3. Make lifestyle improvements to manage physical and mental health.

Healthy aging requires certain lifestyle improvements.²²

• Physical activity
  This can include daily walks, stretching, and low-impact strengthening exercises. Activity improves physical health, including heart and lung problems, digestive issues, immune system problems, and mental health.
  
  Leaving the house may seem frightening during this pandemic, and your doctor may not recommend it. Most guidelines allow for walks around the neighborhood, provided you maintain at least six feet of distance between you and others.
  
  You can also use your front yard or backyard to stretch and strengthen your body while getting some sunlight.
  
  Exercise routines are available online, and you can practice these indoors. Many membership-based services are offering free short-term memberships during the COVID-19 pandemic.
  
  
• Nutrition
  It’s important to focus on maintaining a healthy weight with a balanced diet. Holding too much body fat in certain areas increases the chances for and risks of heart disease and diabetes.
  
  Getting groceries may be difficult for many seniors right now, but friends and family can help. An online delivery service like Instacart can safely deliver groceries to your door.
  
  In addition, some charity programs offer delivery services for groceries or takeout meals. Many stores are offering dedicated senior shopping hours.
  
  
• Hobbies and activities
  Gardening, art and crafts, worship services, and hobbies can be vital to maintaining mental and emotional health.
  
  While social activities must be limited right now, many religious organizations and social groups are moving to online participation models, which can help you maintain a sense of community support.

4. Understand your financial picture.

One report found that 23 million older American adults are economically insecure.²³ They live either at or below the federal poverty line, putting them at risk for short-term and long-term problems because they cannot fulfill basic needs.

More elderly adults are in debt because they cannot afford to pay for necessities like groceries or rent.

There are various scams targeting senior citizens, often fronting as the Internal Revenue Service or Social Security Administration. Some scams capitalize on health care worries to frighten seniors into giving away personal information.

If you receive government benefits for older adults, like Social Security income (SSI) or Medicare, you should know that these programs will not contact you by phone or email. They will send you a letter in the mail.

Government programs do not call participants and ask for verification of personal information, like credit card information, bank account details, or Social Security numbers. Anyone who asks for this information is a scammer.

Budgeting is important, but access to programs like Medicare can ease financial worries around health care. These programs can answer COVID-19 questions, provide access for accurate diagnoses, and offer therapy to manage mental strain and illness.

You can use telemedicine through Medicare to get referrals for online therapy, if needed. Other programs can help you keep track of prescriptions, symptoms, and overall physical health.

Finding Balance During COVID-19

Worries about physical health, increased isolation from social distancing and stay-at-home orders, and financial struggles all impact mental health during this trying time.

When these factors are considered together, it makes sense that older adults may feel increasingly anxious or depressed.

Seniors may experience more intense symptoms of both mental and physical illnesses. They may have a harder time remembering to eat, take their medications, or sleep.

The impact of coronavirus on the world adds stress on a macro and micro level. This toll on mental health quickly trickles down to physical health if it is not managed.

Fortunately, there are many ways to get support during the COVID-19 pandemic. Taking care of your mental health is as important as caring for your physical health.

Check in with yourself regularly, making sure that all your physical, mental, and emotional needs are met. Engage in activities that bring you joy, and try to get some form of physical activity every day.

Stay in close contact with family and friends via phone, email, video conferencing, or other means. These forms of social interaction are crucial during this time of physical distancing. Most importantly, don’t be afraid to reach out for help when you need it.

References

¹ Evidence-Based Nursing. Older Adults Reporting Social Isolation or Loneliness Show Poorer Cognitive Function Four Years Later. (2014). Retrieved from https://ebn.bmj.com/content/17/2/59.

² Heart. Loneliness and Isolation are Risk Factors for Coronary Heart Disease and Stroke: Systemic Review and Meta-Analysis of Longitudinal Observation Studies. (2016). Retrieved from https://heart.bmj.com/content/102/13/1009.  

³ Health Psychology. Loneliness Predicts Self-Reported Cold Symptoms After a Viral Challenge. (2017). Retrieved from https://psycnet.apa.org/record/2017-14291-001.

⁴ Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytical Review. (March 2015). SAGE Journals, Perspectives on Psychological Science. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1745691614568352.

⁵ Proceedings of the National Academy of Sciences of the United States of America (PNAS). Social Isolation, Loneliness, and All-Cause Mortality in Older Men and Women. (April 2013). Retrieved from https://www.pnas.org/content/110/15/5797.full.

⁶ Centers for Disease Control and Prevention (CDC). Frequently Asked Questions, Social Determinants of Health: Know What Affects Health. (December 2019). Retrieved from https://www.cdc.gov/socialdeterminants/faqs/index.htm#faq1. 

⁷ Johns Hopkins Medicine. Coronavirus, Social and Physical Distancing and Self-Quarantine. (April 2020). Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-social-distancing-and-self-quarantine.

⁸ Iranian Journal of Public Health. Social Isolation in the Elderly: The Neglected Issue. (February 2019). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556198/.

⁹ National Institute on Aging (NIA), National Institutes of Health (NIH). Social Isolation, Loneliness in Older People Pose Health Risks. (April 2019). Retrieved from https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks.

¹⁰ National Association of Chronic Disease Directors (NACDD), Centers for Disease Control and Prevention (CDC). The State of Mental Health and Aging in America. Retrieved from https://www.cdc.gov/aging/pdf/mental_health.pdf.

¹¹ USA Today. Unemployment: These Are Every State’s Claims Since the Coronavirus Shut the Economy Down. (April 2020). Retrieved from https://www.usatoday.com/story/money/2020/04/14/coronavirus-unemployment-claims-caused-covid-19-crisis-state/5130034002/.

¹² Medical News Today. Financial Hardship May Accelerate Aging. (September 2019). Retrieved from https://www.medicalnewstoday.com/articles/326408#The-studys-significance-and-limitations.

¹³ The Russell Sage Foundation Journal of the Social Sciences. Income, Poverty, and Material Hardship Among Older Americans. (November 2015). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5110250/.

¹⁴ National Academies Press. The Evolution of Telehealth: Where Have We Been and Where Are We Going? (November 2012). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK207141/.

¹⁵ American Academy of Allergy, Asthma, & Immunology (AAAAI). Technology Requirements in Telemedicine. Retrieved from https://www.aaaai.org/practice-resources/running-your-practice/practice-management-resources/Telemedicine/technology.

¹⁶ Medicare. Telehealth. Retrieved from https://www.medicare.gov/coverage/telehealth.

¹⁷ Insider. The Difference Between Social Distancing, Self-Isolating, and Quarantining During the Coronavirus Outbreak. (March 2020). Retrieved from https://www.insider.com/coronavirus-what-is-social-distancing-self-isolation-quarantine-2020-3.

¹⁸ Apple. Set Up Facetime on iPhone. Retrieved from https://support.apple.com/guide/iphone/set-up-facetime-iphc4774d8d8/ios.

¹⁹ Zoom. Frequently Asked Questions. Retrieved from https://support.zoom.us/hc/en-us/articles/206175806-Top-Questions?_ga=2.203706131.286745567.1586986748-1559542388.1586986748.

²⁰ Google. Start a Video Call. Retrieved from https://support.google.com/hangouts/answer/3110347?co=GENIE.Platform%3DDesktop&hl=en.

²¹ Marco Polo. How Do I Use Marco Polo? Retrieved from https://support.marcopolo.me/article/73-how-to-use-marco-polo.

²² National Institute on Aging (NIA), National Institutes of Health (NIH). What Do We Know About Healthy Aging? (June 2018). Retrieved from https://www.nia.nih.gov/health/what-do-we-know-about-healthy-aging.

²³ National Council on Aging (NCOA). Money Management: Tips for Seniors to Manage Money and Avoid Scams. Retrieved from https://www.ncoa.org/economic-security/money-management/.