Depression rates for seniors soaring amid COVID-19
‘I miss everything. I miss everybody’
When she retired from her job as a hospital technician in 2011, Johnnie Lilly soon found she felt lonely. She told herself: I’m going to get out and do something.
That’s how the 79-year-old Texas resident came to work with preschool kids as part of a reading program run by The Senior Source, an older-adult advocacy agency serving greater Dallas.
Then came the COVID-19 pandemic. With many schools and organizations suspending in-person operations as part of a national shutdown, the activity she had loved was gone.
“It was so enjoyable and enlightening,” Lilly said. “The kids just gave me so much pleasure. I miss them so much. I miss all my babies.”
Even before the pandemic, advocates and health experts had warned of loneliness and social isolation among the nation’s population of older adults. Now, nearly two years in, they say government mandates and precautionary measures meant to control the virus by limiting social interaction have taken an emotional, mental and physical toll.
Geriatric workers say rates of depression and anxiety have risen among their clients, and in more severe cases, those conditions have led to cognitive and physical deterioration, or worse.
“People experienced cognitive decline from having no stimulation, and that has persisted,” said Stacey Malcolmson, Senior Source president and CEO. “For those with underlying mental health conditions like dementia or Alzheimer’s, we’ve been finding that that cognitive decline is irreversible.”
Carla Perissinotto, a geriatrician and palliative physician who works with mostly homebound patients in San Francisco, has seen similar patterns with her clients.
“There are people who used to be able to walk, and suddenly, because of weeks in their room, they lost the ability to do so,” she said. “That’s huge.”
Perissinotto served on a National Academies of Sciences, Engineering, and Medicine committee that issued a report in February 2020 that found one-fourth of Americans 65 and over said they were socially isolated, and 40% described themselves as lonely.
While loneliness – the subjective feeling of being alone – is a growing global concern for all groups, social isolation, defined as an objective lack of social contact with others, is a particular risk for older adults.
The reasons can be summed up in one word: loss. As years pass, seniors face loss of life partners and social networks, loss of sight and hearing, loss of travel opportunities, loss of a sense of value to society.
“They’re losing friends as they age,” said Kathleen Cameron, senior director of the National Council on Aging’s Center for Healthy Aging. “They’re no longer in the workplace. They’re experiencing an increase in disabilities like vision impairment, or they may have a chronic illness that reduces their ability to be as mobile.”
The National Academies report linked loneliness and social isolation to poor physical and mental health outcomes, from depression and cognitive decline – including a 50% higher risk of dementia – to higher mortality rates. Among heart failure patients, loneliness was associated with a nearly fourfold increased risk of death.
With the pandemic, things only got worse.
A fear of going outside
Like Lilly, many who benefited from the social interaction of a part-time job or volunteer work saw those opportunities disappear. Even as COVID-19 vaccines have led to eased restrictions and reopening of public places, many older adults – who are at higher risk of becoming seriously ill or dying from virus complications – remain hesitant to reenter society.
“You had fully independent people with thriving social lives who found themselves fearful of going outside,” said Meredith Levine, senior director of Jewish Association Serving the Aging, which serves 40,000 clients in New York City. “The initial anxiety has subsided, but this changing world has fostered different anxieties. This isn’t how they thought they would be spending their golden years.”
Advocacy & Services for LGBT Elders, a New Yorkbased organization known as SAGE, found that calls to its national LGBTQ elder hotline increased tenfold during the pandemic, from 20 to 30 calls a month before the pandemic to more than 200 monthly calls now.
“Anxiety is the No. 1 concern,” said Sherrill Wayland, the agency’s director of national education initiatives. “People are dealing with a lot of stress.”
Lilly, the retired hospital worker, knows the feeling. “When it all started, it was awful,” she said. “We were having to stay in, and that was the worst part: listening to the news about how many people were dying. In New York, they had all those trailers full of people. That blew my mind. I went through a phase where I was crying and praying for the families. It was very hard.”
Lilly still dreads going to the grocery store and wears a mask and gloves just to put gas in the car.
“It’s just so scary. It really is,” she said. “Now they’re saying there’s another variant coming. I’m better with it, even if it’s still dangerous. But I miss being able to hug somebody when I go into church. I miss everything. I miss everybody.”
Resilient yet vulnerable
As with any age group, older adults are a varied population, and some have displayed remarkable resilience amid the isolation. A JAMA Network article in November 2020 based on international data collected in the pandemic’s early stages reported that seniors, on the whole, were coping better than younger groups were.
The authors attributed the population’s initial success to a tolerance for stress developed over a lifetime of experience dealing with crises, from wars, market crashes and natural disasters to lost jobs and family struggles.
“They’re highly resilient,” said Dilip Jeste, director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego. “They have been there. They have done that. They have been through crisis and survived.”
Ipsit Vahia, associate chief of the geriatric psychiatry division at Boston’s Mclean Hospital and the report’s lead author, noted that older adults generally experienced less pandemic-related disruption of their daily lives, with fewer concerns about things like managing children’s child care or schooling or keeping a job to maintain health coverage or pay rent.
“Older adults withstood the early phase of the pandemic quite well,” Vahia said. “But as there have been waves of new variants, we’re seeing rates of depression go up across the population.”
Advocates say those who have better coped tend to have strong social networks, deep faith or more introverted personalities accustomed to a solo existence.
“We do have clients who have lived alone for a long time, and their difficulties are not as great,” said Leibensberger of Jewish Family Service of Greater Dallas. “But they’re not the majority.”
As some seniors eagerly return to public activities with proper precautions, others remain hesitant.
“We have a large number of older adults who are immunocompromised,” said Levine of New York’s JASA, which offers webinars to help people make educated decisions about returning to public life amid the pandemic. “‘Am I going to see my grandchildren? Am I going to see my friend for lunch?’ Every decision is a risk analysis.”
The power of technology
Advocates urge lonely and isolated older adults to maintain the social connections they do have, to be as physically active as they can, and to keep their minds stimulated.
Kathleen Rogers, service chair for geriatric medicine at Cleveland Clinic Akron General Hospital in Ohio, said it’s important in retirement to replace the routine a job once brought.
“One thing we strongly recommend is physical activity, which gets their blood pumping,” she said. “Cognitively, it might be learning a language or doing puzzles or crocheting.”
The National Institute on Aging, a division of the U.S. Department of Health & Human Services, has compiled a social isolation and loneliness outreach toolkit for older adults, caregivers and health care providers.
One bright spot, advocates say, has been the ability of many older adults to adapt to communication technologies they had never used before – and those who did have been better equipped to handle the pandemic.
Many agencies have added tech training and support to their services, empowering people to connect with loved ones via video calls or to order groceries online.
For Lilly, learning that skill was transformative. “The Senior Source got us into Zoom communication, playing bingo and doing exercises together,” she said. “That got our minds off of whatever was going on.”
That has helped with her depression. She has started snacking on fruit instead of potato chips. She turns off the TV when pandemic news is too dismal.
“If I start feeling down, I do a puzzle or a word search or call one of my Senior Source sisters,” Lilly said.
All she can do is pray – she accepts that now. And she thanks God she no longer feels so alone.