Heed mental health during the pandemic

The danger of COVID-19 for seniors has been well-documented, with Floridians older than 65 dying in greater numbers than any other age.

But experts say the pandemic has also had a profound impact on older adults’ mental health, with many hesitant to seek care and finding that insurance coverage is lacking when they do.

“I think older adults are overlooked when it comes to mental health, because they are often less comfortable [talking about it],” said Marni Stahlman, president and CEO of Mental Health Association of Central Florida. “They come from a generation where

you don’t talk outside of the home or you don’t talk outside of your network of close friends.”

And for those who recognize they need help, finding it may not be easy.

Although traditional Medicare covers visits to psychologists, social workers and psychiatrists— but not mental health counselors — the elderly “may not knowhowto use it or even be comfortable using it because of that stigma and shame. So we have a lot of work to do,” Stahlman said.

Meanwhile, experts worry that the pandemic is going to further exacerbate the existing shortage of mental health providers and psychiatrists, particularly those who specialize in geriatrics.

Not all mental health providers accept Medicare, because the reimbursements are low. And many of the existing ones are not taking new patients. There’s also a threat of further cuts toMedicare reimbursements, which could result in more providers leaving the Medicare system.

“We know that service delivery for mental health services with seniors is very lacking,” said Dr. Jim Messina, a lecturer at Troy University in Tampa Bay and a longtime advocate of getting mental health counselors covered by Medicare. “Baby boomers are flooding the market and the number of seniors has increased, so substantially that we don’t have enough helpers.”

Addressing mental health is important because it affects longevity and quality of life. And the pandemic could jeopardize both formany seniors.

By now, several months into the pandemic, researchers have shown that the necessary measures to contain the virus, such as social distancing and closing or limiting visitations to nursing homes, have led to social isolation for many elderly, leading to feelings of loneliness, depression and anxiety. The information overload, amid a contentious election year, has been a source of stress, which can affect memory.

“The circuitry of memory and depression and anxiety are all in the same regions of the brain,” saidDr. Catherine Price, a clinical psychologist and associate professor at University of Florida.

So when a person is increasingly stressed or depressed, this area of the brain can get bombarded with hormones and neurotransmitters that can disrupt the memory circuits andwear downthe system.

“And when people have some percolating memory issues or something going on early, they have this thrown into the stressors, it can really push them along to having more difficulties,” Price said.

Another concern: isolation has led to less physical activity among seniors. Those who were going to physical therapy might have stopped or reduced the number of their visits.

“So they’re getting frailer, meaning muscle loss, which is also less activation of their central nervous and peripheral nervous system and those are direct correlates to their brain vulnerability,” Price said. “So frailty itself is a huge predictor of poor outcome and increased mortality.”

In a survey by the Kaiser Family Foundation in midJuly, nearly half of the elderly said the pandemic has had a negative impact on their mental health, up from about 30% reported inMarch. Older adults are especially at risk of depression, which is often misdiagnosed and untreated, according to the Foundation.

For older adultswho are caring for family members or spouses, the pandemic has not only isolated them, but also reduced the amount of help they can get in caring for their loved ones, leading to increased risk of stress, depression and anxiety.

The impact could be even greater for individuals with lower social resources, lower economic resources, or those who have lost their jobs, said Price.

And while young adults today are more open about mental health, seniors are still hesitant to talk about it or seek care.

Many times it’s the family members who notice that their loved one has become more quiet, less interactive or has had memory changes, said Dr. Mariam Mufti, a geriatrician and assistant professor atUniversityof Florida.

“They [familymembers] bring these things up and it depends on the clinicians to identify it in the grand scheme of things because it’s masked,” Mufti said.

Signs and symptoms of depression or anxiety such asweight loss or sleeplessness may be chalked up to aging by individuals and providers and existing cognitive and functional limitations can hide the conditions. Andpeople are living longer.

“We have to wake people up to the pressing emotional needs of seniors,” Messina said.

Messina, 75, takes awalk every day around his neighborhood. He advised seniors to do the same.

“Get up off your rear ends. Be active. Watch your diet. And get a good night’s sleep,” he said. “And more importantly, you have to social distance, and you have to wear a mask. Wash yourhands. Appreciate [these practices]. Don’t put it down. Look at it as a life extension program by doing three little simple tasks.”

And if you’re not feeling like your usual self, don’t ignore your symptoms.

“Seek a medical care provider, even if it’s your primary care and talk about what’s happening and what’s been changing,” said Stahlman.

Signs and symptoms of depression

■ Persistent sad, anxious, or “empty” mood.

■ Feelings of hopelessness, guilt, worthlessness, or helplessness.

■ Irritability, restlessness, or having trouble sitting still.

■ Loss of interest in once pleasurable activities, including sex.

■ Decreased energy or fatigue.

■ Moving or talking more slowly.

■ Difficulty concentrating, remembering, making decisions.

■ Difficulty sleeping, early-morning awakening, or oversleeping.

■ Eating more or less than usual, usually with unplanned weight gain or loss.

■ Thoughts of death or suicide, or suicide attempts.

■ Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease with treatment. ■ Frequent crying.