On April 2, 2022, Shanghai was sealed due to the epidemic, and the staff delivered the meal to Mr. Wang, an elderly man living alone. (Xinhua News Agency reporter Jin Liwang/photo)
The impact of COVID-19 on mental health cannot be ignored. In March 2022, the World Health Organization released a scientific bulletin showing that in the first year of the COVID-19 pandemic, the number of cases of major depressive disorder (MDD) increased by 27.6% globally and the number of cases of anxiety disorder (AD) increased by 25.6%.
Compared with other age groups, the elderly have weaker self-immunity, and most of them suffer from different degrees of underlying diseases, which are high-risk groups that are prone to severe illness and death after infection with the new crown virus, and also bear multiple psychological pressures.
But the psychological problems of the elderly are easily overlooked. The Lancet's World Psychiatric Association Depression Major Report, published in February 2022, notes that depression problems in older adults are often underestimated or overlooked and classified as normal aging, functional impairment or physical illness.
Age discrimination makes the situation even more difficult for older groups. According to the World Health Organization's 2021 Global Report on Age Discrimination, a survey of 83,034 people in 57 countries found that one in two people held moderate or high age discrimination. For example, during an epidemic, age discrimination may manifest itself in the belief that older people are frail and "would have left no matter what", resulting in reckless and irresponsible viral transmission.
The United Nations has declared 2021-2030 a Decade of Healthy Ageing, and governments and civil society agencies are committed to joining forces to create an environment conducive to older persons, combat ageism, develop long-term integrated aged care, and help older people gain access to their rights and appropriate health care services, such as vaccinate the elderly during the pandemic.
Debanjan Banerjee is an Indian geriatric psychiatrist and currently a consultant to the National Institute of Mental Health and Neuroscience in India, and has long focused on geriatric psychiatry research, focusing on a series of issues such as the marginalization of the elderly and the protection of their rights.
As early as the beginning of the epidemic in 2020, Debanjan Banerjee noticed the mental health problems of the elderly group and published an article in Nature India calling for attention. In the article, he pointed out that the fear of infection, the sense of shame and self-blame brought about by the disease, the panic caused by various problems such as rushing to buy and the survival crisis, and the increase in loneliness during the isolation period make the elderly vulnerable to depression, anxiety and other psychological problems while being threatened by their health.
"We should always remember that social isolation means maintaining physical rather than psychological distance, and in special periods, we should maintain communication and contact with the elderly in order to help the elderly resolve possible psychological problems and psychological concerns in a timely manner." Debanjan Banerjee told Southern Weekend.
How to find and help the elderly cope with psychological problems? Here's a conversation with Southern Weekend and Debanjan Banerjee.
Southern Weekend: What psychological problems may the elderly face during the epidemic?
Debanjan Banerjee: Ignored. This can be a key problem for the elderly, including physical, financial, psychological, and emotional neglect. Sometimes this neglect is invisible, for example, we tell parents and grandparents not to go out, but for the elderly, it may be their only entertainment activity throughout the day, when they have the opportunity to be with their peers, and now the right to go out is also deprived.
There is also a lack of autonomy. Sometimes, some decisions are said to be for the good of the elderly, but the elderly themselves are not able to participate in the decision-making, or even have the right to know.
Elderly people with mental illness and cognitive impairment who have long been dependent on drugs, but in the closed state, they cannot go to the outpatient clinic, there is no other medical service, and they may face the problem of drug discontinuation. It is important to note that ageism and sexism are interplaying, so older women may face a number of other problems.
Isolation can also lead to exacerbation of psychiatric disorders. There are many studies, including our clinical practice, that many patients with mild and moderate cognitive impairment may not be able to go out because of closure, lack of social stimulation and interaction, and eventually develop severe patients. Even after the situation is relatively stable, the impact of isolation will continue to plague many elderly people with long-term mental sequelae.
On April 27, 2022, the happiness house of Sandishui Community in Guojiapu Street, Dingcheng, Hunan, the elderly played chess together. (Xinhua News Agency reporter Chen Sihan/photo)
Southern Weekend: During the epidemic, what factors are likely to cause psychological problems in the elderly?
Debanjan Banerjee: Older adults are at higher risk of contracting the coronavirus, developing critical illness or dying after infection, and these health threats exacerbate the psychological stress of the elderly.
Second, home isolation also exacerbates the marginalization of the elderly. Imagine that the elderly are staying at home, many are alone, the domestic helpers cannot come to the door, and when they plan to go out, they are blocked and persuaded to return, how can their daily and spiritual needs be met in this situation? Moreover, many older people are less likely to use electronic devices, especially in South Asian countries and low- and middle-income countries, and the path to maintain contact with the outside world through electronic devices has been cut off, further increasing their loneliness.
In addition, the fear of infection, the sense of shame and self-blame brought about by the disease, the panic caused by various problems such as rushing to buy and the crisis of survival, and the sadness caused by the death of many people, especially young people, in the epidemic have led to the psychological problems of the elderly to varying degrees.
Southern Weekend: Which elderly people are more likely to have psychological problems?
Debanjan Banerjee: As we age, noncommunicable diseases become closely related to psychology, such as diabetes, hypertension, dyslipidemia, stroke, heart problems, all of which are associated with depression, anxiety, cognitive impairment, etc., so the elderly with underlying diseases are also prone to psychological problems.
In addition, the elderly who are infected with COVID-19, who are not vaccinated, and who live alone, are stranded or isolated, are also vulnerable to psychological problems.
Southern Weekend: For families, how to detect possible mental health problems in the elderly in a timely manner?
Debanjan Banerjee: There are two situations, one is that there are mental problems such as depression, anxiety, and dementia before the outbreak, which are further aggravated during the epidemic, and the other is that the elderly who originally have no mental health problems have gradually developed from sad emotions to depression, anxiety or memory problems after the new crown pneumonia epidemic.
To spot these signs, the most important thing is to stay awake and sensitive enough. For families, basic behavioral science knowledge can be learned. If the elderly begin to have memory or cognitive problems, including the inability to remember names and dates, and the inability to handle daily affairs normally, this is most likely a sign that the elderly suffer from mild cognitive impairment, but are often considered to be a normal part of aging, delaying diagnosis.
Family members should be aware that depression in later life is different from that in young people, such as physical problems such as constipation, pain, headaches, etc., and the elderly may choose to digest themselves without revealing it to others, especially psychological problems. Therefore, when the active, socially active elderly become extremely anxious and nervous, they should be especially concerned. In addition, when the elderly encounter major changes, such as the death of someone around them, the sadness lasts for more than a year, or the symptoms such as sleep disorders, poor appetite, and weight loss do not ease for a long time, the family should consider seeking professional help.
For professional psychiatrists, simple screening tools, talking to family members or people, etc. can be used. The diagnosis is based on a detailed record and observation of the medical history. In addition, it is best for doctors to see patients frequently and keep track of them, and to disclose some information to them appropriately, mental health problems sometimes do not require medication, and patients may be able to effectively control their own situation.
Southern Weekend: After discovering that the elderly have mental health problems, how to help them cope?
Debanjan Banerjee: If the elderly understand electronics, family members can keep in touch with them, even if it is online, spiritual contact. In the process of contact, it is also very important to pass on accurate information about the epidemic situation. But data on deaths and the number of infections can lead to panic among the elderly, who may not be able to understand what is happening due to perception problems, memory problems, hearing or vision deficits, and will naturally generate fear when they hear that the elderly are dying and more people are being infected.
This is where you need to maintain a certain amount of "digital distancing," just like social distancing. For the elderly who have a certain degree of digital literacy and can independently access media information, their families should help them establish an awareness of information screening and ensure that the epidemic data contacted by the elderly comes from authoritative platforms such as the World Health Organization and the CDC. At the same time, the elderly should be advised that if they have doubts about something, they should discuss it with their families or call the official hotline for consultation, and the lack of authoritative social media information is not trustworthy.
Southern Weekend: How to help the elderly overcome "vaccine hesitation" and increase the vaccination rate of the elderly?
Debanjan Banerjee: Family members should help the elderly understand that the new crown epidemic is only an epidemic, although it brings certain risks, but it does not mean that all elderly people will be infected or die due to infection, vaccination will bring a great degree of protection, usually pay attention to physical distance, respiratory hygiene can be. Life needs to go on, to keep the virus in your head, to manipulate it even if it is not infected.
Vaccine hesitation is a common problem, when explaining to the elderly, first of all, it is necessary to express it clearly; second, it must be adapted to the cultural context in which the elderly are located; second, it should be communicated with the language that the elderly can understand; finally, it is necessary to repeatedly confirm whether the elderly really understand.
In addition, family members can also maintain contact with community hospitals, nursing homes and other institutions to ensure a professional response in the event of an emergency.
On April 9, 2022, in Beijing, the elderly were vaccinated against COVID-19 in a mobile vaccination truck. (Xinhua News Agency reporter Chen Zhonghao/photo)
Southern Weekend: How do nursing homes and other institutions need to pay attention to the psychological problems of the elderly?
Debanjan Banerjee: It should be emphasized that elderly people who are housed in nursing homes or elderly care institutions are also prone to psychological problems. This part of the elderly is relatively fragile both physically and psychologically, so the professionalism of nursing home staff is particularly important. Nursing homes can carry out appropriate communication training for their staff, in my opinion, communication should pay attention to the CARE principle, C stands for Care (care), A stands for Autonomy (autonomy), R stands for Respect (respect), E stands for Equality (equality), that is, nursing home staff should fully respect the human rights and dignity of the elderly when communicating with the elderly.
In addition, nursing homes can hold collective activities such as activity days for the elderly, so that the elderly can have the opportunity to communicate with their peers; at the same time, they should maintain communication and referral relationships with other medical institutions; and they can also try to establish a scientific and systematic comprehensive assessment method for the elderly (CGA) in the hospital, regularly assess the physical health, functional status and mental health of the elderly, and formulate corresponding treatment plans.
Southern Weekend: At the social level, how to help the elderly cope with psychological problems?
Debanjan Banerjee: Social support networks should first ensure that welfare safeguards are in place to reduce the burden of medication and economic pressure on the elderly. When formulating relevant policies, policy makers should maintain appropriate communication and cooperation with professionals in the field of elderly care, and it is difficult to formulate effective policies without contact, communication and understanding of the actual situation.
At present, the health security and priority services of the elderly are often insufficient, and everyone will get old, so even for their own sake, they should actively create an "age-friendly" world.
Southern Weekend: Please give an example, what is the embodiment of the "age-friendly" world?
Debanjan Banerjee: The establishment of specialized geriatric clinics and the dissemination of knowledge on primary health care for the elderly are important initiatives. In addition, psychological assistance hotlines and assistance web pages can also be targeted to meet the needs of the elderly, and India's national assistance webpage (https://www.helpageindia.org/) is supported by the National Institute of Mental Health and Neuroscience and the Indian Association for Geriatric Dementia-related Diseases, and such assistance models can promote the formation of a social support network.
Southern Weekend: How to better take care of the elderly in daily life?
Debanjan Banerjee: Anyone should understand that aging is a process that doesn't start suddenly on a sunny day or suddenly has a watershed from birth to 50 or 60. Therefore, it is necessary to establish good intergenerational relations, let young people understand the needs of the elderly, protect the autonomy of the elderly, and respect the elderly, in order to prevent age discrimination to a certain extent.
The kindness of the individual begins in the family, and each family member should be sensitive to the needs of the elderly, which means understanding the needs of the elderly. For example, targeted efforts to help the elderly adjust their lifestyles to adapt to changing times, encourage them to participate in meaningful social interactions, and assist them in obtaining appropriate social benefits.
We have long ignored the marginalization of older people, and the COVID-19 pandemic has shown how big the gap in health inequalities among older people is. The theme of World Mental Health Day in 2021 is "Mental Health in an Unequal World", and 1 October of the same year is also the United Nations International Day for Older Persons, with the theme "Digital Equity for All Ages", all of which are efforts to promote attention to the elderly population.
Older adults suffer from a lot of health inequalities, psychologically or physically, and it's time to remove this barrier.
(Southern Weekend intern Chase also contributed)
Southern Weekend contributing writer Zhong Caifen
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