Considerations for how to mitigate the psychological impacts of COVID-19 in older adults

There have been numerous outbreaks of infectious diseases in the world. On January 30, 2020, theWorld Health Organization (WHO) declared the outbreak of novel coronavirus disease (COVID-19)a Public Health Emergency.1 The pandemic has caused not only the risk of death, but also too muchpsychological pressure on people all over the world.Older adults are more susceptible to severe infections, cascade of complications, disability, anddeath.2, 3 The elderly might also be more vulnerable to mental health problems because of theirhigher risk of infection.4 They may experience adverse feelings such as fear of death because ofthe potential lethality of the illness. Some of them claim that dying from coronavirus is a horriblenuisance for them because none of their family members would be able to attend their funeral.They are also afraid of being hospitalized in medical facilities that lack sufficient equipment.They fear that if they contract the virus, no one will be able to visit or help them. The otherfear the elderly experience is the infection of their spouses, children, and siblings. Dismal anddisappointing news spreading via social media could also increase their fear and anxiety. Socialdistancing; reduced contact with others, especially loved ones; inability to take part in routineday-to-day activities (e.g. shopping for necessities); and cancellation of community events leadto boredom, frustration, and a sense of loneliness and isolation, which is distressing to olderadults. This problem is particularly prominent in older adults who have limited access to theInternet-based services and smartphones.5, 6The statement “coronavirus is mostly deadly to the elderly” increases a sense of fear andworthlessness in them. Some older adults have become extremely dependent on their childrenbecause they fear in-store shopping of essential items in large supermarkets, while they are notskilled in shopping online; this problem adds to their sense of worthlessness.Furthermore, restrictions on public transport and the fear of referring to treatment centersbecause of the contagion have become major barriers to receiving maintenance treatments forthis age-group. Limited access to Internet-based services and smartphones increases the problemsof this age-group.Therefore, stakeholders and health policymakers should take measures to prevent the potentialmental health problems that might arise in older adults who are quarantined during the COVID-19 outbreak. Here are some suggestions to help mitigate the consequences of quarantine amongolder adults:- Give older adults as much information as possibleOlder adults often have catastrophic appraisals of any physical symptoms they experience,which may further increase feelings of fear and anxiety. This fear might be exacerbated byinadequate information. There is long-standing evidence to suggest that news has a direct impacton mental health. Feelings of uncertainty and doubt have long been associated with anxiety.6Therefore, it is necessary to ensure that older adults shape a good understanding of the diseaseand the reasons for quarantine.- Provide information to older adults mainly via broadcast mediaFast transmission of COVID-19 restricts face-to-face educational interventions. Moreover,Internet-based services, smartphones, social media (e.g. WhatsApp), and electronic books are notwidely available to older adults. Therefore, governments and community-based health servicesshould provide enough information about the disease via mass media, such as radio and television,which are most accessible to the elderly.- Provide community-based health services to address health issues of older adultsCommunity-based health services, including primary care, community nursing, and pharmacyservices should provide telephone-based consultation services addressing health status, treatment,and medication management. Health services must also communicate adequate information toolder adults in quarantine about what to do in the case of developing illness symptoms. It wouldhelp reassure the elderly that they would be taken care of if they fell ill.- Provide mental health services to guide older people on how to manage their negativeemotions and feelings of isolationMental health services should consider strategies to guide older people on how to managestress, anger, and other negative emotions, and how to have effective communication with lovedones who do not live with them, so that the feelings of loneliness, stress, and anger are reduced.Such psychoeducational programs should be broadcast on mass media, which are most accessibleto the elderly. Moreover, the elderly should receive practical advice on the ways which help themto reduce boredom and about the importance of having constant communication with their lovedones to overcome feelings of isolation.- Provide adequate suppliesPublic health authorities should provide the older adults with basic supplies, such as food,masks, and disinfectants during quarantine. Some studies have shown that insufficient basicsupplies during quarantine are associated with the feelings of frustration, anxiety, and anger.6Considering the conditions in near future and the possibility of lengthy quarantines, respectiveorganizations should practice effective strategies to enhance mental health in the society, especiallyamong older adults. Some strategies that stakeholders and health policy-makers should implementto provide effective services to older adults who are quarantined at home during the COVID-19pandemic are suggested in the present article.