key: cord-0732960-1bg1g3x8
authors: Serafini, Gianluca; Bondi, Emi; Locatelli, Clara; Amore, Mario
title: Aged patients with mental disorders in the COVID-19 era: the experience of Northern Italy
date: 2020-04-22
journal: Am J Geriatr Psychiatry
DOI: 10.1016/j.jagp.2020.04.015
sha: e1106887ba6ad217bd44af62c51fa0f9db5d9f84
doc_id: 732960
cord_uid: 1bg1g3x8

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Additionally, individuals aged 65 or above may be cognitively impaired and more susceptible to the effects of stress and major depression than younger individuals 4 . The rapid transmission of COVID-19 infection as well as the higher case-fatality might exacerbate existing psychiatric disorders, and enhance the risk of new episodes. In addition, elderly subjects usually suffer from lower social support and require long-term care due to existing disabilities; this may significantly enhance loneliness, despair and hopelessness which are independent predictors of suicide. Furthermore, older patients may be not adequately treated particularly in territories where the activities of mental health services are drastically restricted due to quarantine, and only a limited access to Internet services and smart phones is allowed 5 . Last but not least, prejudices and discrimination towards marginalized individuals such as aged subjects with mental disorders may be generally reinforced in situations of social crisis, fear, frustration and uncertainty. Stigma is a relevant predictor of negative outcome and represents an important barrier to care, particularly when it coexists with social isolation.

According to our experience of the Hospital Papa Giovanni XXIII in the city of Bergamo, medical departments, after appropriate training of all healthcare workers, were rapidly converted into specific units aimed at treating patients with COVID-19 infection. In order to manage infected patients with acute psychiatric conditions, the regional authorities established that all psychiatric hospitals dedicated specific beds or, alternatively, guaranteed the continuous support of psychiatric staff in medical settings.

Specifically, we directly observed a rapidly growing request of psychiatric interventions in aged patients with COVID-19 infection due to the emergence of severe delirium (mainly hyperkinetic) which was observed in approximately 30-50% of cases increasing with age, psychomotor agitation, anxiety and depressive symptoms. When compared with younger subjects, we found that subjects aged 65 or above with prolonged hospitalization in our hospital are more vulnerable to: i) environmental factors (e.g., social isolation and distance from family members, stay in intensive/subintensive units, communication difficulties due to therapeutic devices); ii) individual factors (COVID-19 possible neurotropic properties, impairments in insight and cognitive dysfunctions comorbid medical conditions, and use of multiple medications).

In order to attenuate the psychological impact and traumatic consequences of COVID-19 outbreak and facilitate coping abilities towards emotional distress, group interventions have been regularly promoted for all healthcare workers. Our special thank needs to be dedicated to everyone who assisted with competence and supports with devotion patients and their relatives in the COVID-19 era. We firmly believe that the management of older adults with psychiatric disorders really represents a major challenge in this difficult period. Unfortunately, inadequate attention has been provided for this vulnerable population while targeted interventions aimed to remove barriers to care need to be carefully planned.

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Gianluca Serafini, Emi Bondi, Clara Locatelli, Mario Amore have all contributed to the letter equally.

In the last three years, Dr Serafini received lecture honoraria from Neuraxpharm, Janssen-Cilag, Angelini, Lundbeck. For the remaining authors none were declared. The author(s) received no financial support for the research and/or publication of the present article.