Older Adults Have Been Primed for Pandemic-Related Mental Illness

Source: Nickolas Nikolic | Unsplash

The last two years have been the longest yet, eerily in many ways, the fastest of our lives. Since 2019, the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) outbreak has led to over 231,550,000 infections of the coronavirus disease (COVID-19) worldwide, with a mortality rate among the infected exceeding 2 percent. But what of mental health sequelae? Particularly among older adults who can get lost in the story of national recovery.

The triple threat of fear, bereavement, and restriction

Older adults are individuals who, for a remarkably extended period of time, have experienced intense fears of contagion because of heightened awareness of their individual fragility. Individuals who have heard over the airways, read online, seen in print, and been cautioned by their loved ones a reinforced message of their considerable vulnerability to death from the coronavirus. Individuals who, accordingly, were most likely to be bereaved. Individuals who, of all age groups, were most likely to live alone.

Older adults are the same individuals who were subjected to the most intrusive (albeit necessary) pandemic containment measures intended to limit pathogen transmission and reduce prognostic severity. These containment measures adjourned daily routines, such that social, medical, and economic activity was put on pause (or even in rewind). Meanwhile, these systemic interruptions to the outside world, in part, accounted for a horrifying upsurge in domestic discord.

Stress: a major manipulator of behavior and mental health

Needless to say, the proliferation of pandemic-related stress has resulted in a dislocation of people’s lives, which has had very broad effects indeed. One cannot deny that epidemiological mitigation efforts have come at the unfortunate expense of psychological well-being. More so, given the unpredictable and uncontrollable nature of these stressors. However, these effects may prove worse in older adults due to the inevitable biological effects of inflammaging—a hallmark of advancing age, linked to numerous health conditions. Elevated levels of inflammation have been shown to prime older individuals toward mental ill-health in the face of pandemic-related challenges.

By the same token, a host of psychological responses have been documented across the globe, from emotional distress, depression, irritability, insomnia, and severe psychopathology, to fear, anxiety, despair, guilt, and anger. We know, also, that harmful behaviors such as high-risk alcohol consumption, dysfunctional eating, and medical care avoidance have been on the rise. Together these sound an alarm about the psychological vulnerability of older adults during and post-pandemic.

Disproportionate patterns of vulnerability

Further, given pre-pandemic inequalities in community mental health, disproportionate patterns of vulnerability from this highly virulent infectious disease came as no surprise. Research quickly exposed disparities in the distribution of distress, the severity of mental illness, and a variation in the magnitude of change from pre-pandemic status. Aside from age, some characteristics contributing to these disparities include social strata, gender, ethnicity, disability, and pre-existing conditions.

Solutions to a global pandemic should be global.

In spite of flagrant zero-COVID strategies being employed in some countries, most of the world recognizes the necessity for long-term national strategies that operate in unison across the globe. While vaccines and advancing clinical treatments have offered a potential route out of the pandemic, the bad news is that global disparities in medicine, health, and disease mean that we are not likely to escape this pandemic any time soon.

Sunshine of hope versus strategy

However, when that glorious time does come, and the world emerges from the darkness that is COVID-19, minds cannot be expected to just snap back into pre-pandemic shape. As if awakening from a nightmare: heart racing, perspiring, breathless, in early-morning disarray, only to self-soothe in an attempt to convince oneself that the last two years were make-believe. Nor can we merely rely on the “sunshine of hope” to repel the darkness of COVID-19. Concerted, structured efforts to mitigate the long-term damages of the pandemic on mental health are crucial for national recovery.

Mitigating pandemic-related damages

Mitigation efforts can have a number of faces. Community program referrals for sleep hygiene, with their conferred benefits on stress levels that were discussed in an earlier article, healthy food promotion, and stress management techniques, particularly aid in the identification of and coping strategies for fluctuations in personal distress. Other social prescriptions include scheduled physical activity, gardening, cleaning (yes, this too can be therapeutic!), reading, writing, teaching, babysitting, dogsitting, scheduling, organizing, researching—all crucial contributions, perhaps too many to name here, to the individual and, in many instances, to society more broadly.

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For others, mitigation efforts will need to be more pragmatic, focused on the fundamentals. For instance, helping to manage prescription medicines (specifically in case of polypharmacy), transportation to routine appointments, and meaningful social calls. The ultimate goal is a soothing of the mind, with a manageable re-integration into society that is in equal parts safe, feasible, and enjoyable. The time to plan is now.

This is, in part, an adaptation of Hamilton and colleagues’ 2021 peer-reviewed “Systemic inflammation and emotional responses during the COVID-19 pandemic,” published in Nature, Translational Psychiatry.