key: cord-0752264-kggfqqg1 authors: Vahia, Ipsit V. title: COVID-19, Aging and Mental Health: Lessons from the First Six Months date: 2020-06-05 journal: Am J Geriatr Psychiatry DOI: 10.1016/j.jagp.2020.05.029 sha: d43aad6d0c402689b3c54361e912c391d1e001d6 doc_id: 752264 cord_uid: kggfqqg1 nan The earliest epidemiological findings from the COVID-19 pandemic have made clear that the disease had a disproportionately high impact on mortality and morbidity in older adults (1) . Over the subsequent six months leading up to the time of writing, a significantly more complex picture is emerging that points to a much broader impact on the mental health of older adults (2) . While the initial focus has been on understanding the impact of the virus itself on infected older adults, clinicians and researchers around the world have recognized that there are also major challenges arising from the resulting lockdown and quarantine measures. These include the disruption of regular clinical services, challenges around transitioning services to telecare and most notably, the disproportionate impact on older adults in nursing homes (3) . In response to a clear need for evidence to guide clinicians, researchers, administrators and policymakers, the American Journal of Geriatric Psychiatry issued a global call for submissions focused on COVID-19 on March 20, 2020. This call for papers was met with an overwhelming response from the international community. In the month of April 2020 alone, the Journal received nearly four times more submissions than it did in April 2019, and almost as many submissions as the prior three months combined. In order to expedite dissemination of this information, all accepted papers are published online with complimentary Open Access immediately after acceptance (at https://www.ajgponline.org/covid19). Readers should note the dates when these papers were published electronically, given how quickly guidelines and care protocols are evolving. Many of the early papers published in March and April, several of which are correspondences, serve the essential function of capturing a specific moment in time during this crisis. These papers serve as a chronicle of an evolving response shaped by quickly changing realities, and may inform future responses to other healthcare crises from similar or different causes. At the time of writing, we remain in the midst of a situation that continues to evolve rapidly, and the field of geriatric psychiatry will bear the onus of responding accordingly in the interest of the well-being of older adults with mental health needs. In fact, we may still be in the very early stages of recognizing how vast and deep the impact of the pandemic will be on the field. However, some key themes are beginning to emerge from the published literature thus far, and are represented in this special issue. Early reports indicate that similar to other medical illnesses, COVID-19 may present atypically in older adults. Two studies by Ward and colleagues (4) and Isaia and colleagues (5) indicate that altered mental status can be an be initial presenting symptom even in the absence of respiratory symptoms or fever. Presenting features may include worsening confusion (especially among those with dementia), agitation, disorientation, refusing care and apathy. These are initial findings with significant clinical implications and bear replication, but suggest that among older adults a new-onset change in mental status be treated as a potential initial sign of COVID-19 and managed accordingly. In an effort to enforce social distancing policies, there have been lockdowns of varying stringency in most parts of the world. Because of their being at a higher risk of negative outcomes from COVID-19, older adults may self-restrict their activities and interactions even beyond the general population (16) . This, in turn, appears to trigger a range of impact including increasing isolation and loneliness, disrupting daily routines and activities, changed access to essential services such as doctor's visits. The impact can also include some positive changes such as adopting newer technologies, renewed focus on enhancing relationships and identifying resilience. We are also learning that there may be predictors of how older adults react to social distancing and isolation, and we anticipate that future research will shed light on these factors. The efficacy of cognitive and behavioral interventions in reducing the burden of isolation has been well established. Two recent reports demonstrate how these approaches can be translated to virtual care and how clinicians may implement strategies to mitigate isolation worsened in the context of social distancing measures (16, 17) . It is likely that this specific issue will receive greater attention as we better understand its longer-term consequences. Koenig (18) discusses how of religion and spirituality can play a role as a risk or protective factor. On the one hand, religious older adults may experience additional strain from not being able to participate in services. Simultaneously, for these adults, their faith may also serve as a major coping mechanism. In addition to impact on patients, we are learning how COVID-19 can impact staff who care for them as well. DeCaporale-Ryan and colleagues (19) discuss the importance of addressing staff well-being at skilled nursing facilities and present a telemedicine-based approach to support care professionals working under isolation measures. As the pandemic has spread across the world, lessons learned from the countries affected earlier have played an important role in informing the actions of nations impacted later in the crisis. While six months is a relatively short window and the worldwide spread of the pandemic has been dramatic, experiences from a geriatric psychiatry inpatient unit in China (20) and Italy (21) provide early evidence that older adults in hospital based settings may experience worsening of psychiatric symptoms under lockdown measures. Over the coming months, these initial experiences may help providers elsewhere anticipate and plan care more effectively. It is also noteworthy that there is relative consistency in reported observations and findings across the world (22, 23) In conclusion, we recognize that much remains to be learned, and the response of geriatric psychiatry, and indeed all of healthcare to COVID-19 and its broader impact will change considerably over the next few months and indeed years. However, the early lessons learned so far and initial reported observations and findings will serve as a foundation for the field to broaden and deepen its fund of knowledge. Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19 COVID-19, Mental Health and Aging: A Need for New Knowledge to Bridge Science and Service Achieving Safe, Effective, and Compassionate Quarantine or Isolation of Older Adults With Dementia in Nursing Homes Altered Mental Status as a Novel Initial Clinical Presentation for COVID-19 Infection in the Elderly Atypical Presentation of Covid-19 in an Older Adult With Severe Alzheimer Disease Anticipating and Mitigating the Impact of the COVID-19 Pandemic on Alzheimer's Disease and Related Dementias Online ahead of print Access to Care for Dementia Patients Suffering From COVID-19 Addressing Problems With Alcohol and Other Substances Among Older Adults During the COVID-19 Pandemic Electroconvulsive therapy for geriatric depression in the COVID-19 era: reflection on the ethics Electroconvulsive Therapy During COVID-19-Times: Our Patients Cannot Wait Remote Monitoring of Intranasal Ketamine Self-Administration as Maintenance Therapy in Treatment-Resistant Depression (TRD): A Novel Strategy for Vulnerable and At-Risk Populations to COVID-19? Intensive Medicine and Nursing Home Care in Times of SARS CoV-2: A Norwegian Perspective Steffens DC Ethical and Logistical Considerations of Caring for Older Adults on Inpatient Psychiatry During the COVID-19 Pandemic An Emerging Paradigm for Psychiatric Practice in Integrated Care Amidst a Crisis Promoting Technology and Virtual Visits to Improve Older Adult Mental Health in the Face of COVID-19 Strategies to Promote Social Connections Among Older Adults During 'Social Distancing' Restrictions Improving Social Connectedness for Homebound Older Adults: Randomized Controlled Trial of Tele-Delivered Behavioral Activation Versus Tele-Delivered Friendly Visits Koenig HG Ways of Protecting Religious Older Adults from the Consequences of COVID-19 Addressing Skilled Nursing Facilities' COVID-19 Psychosocial Needs Via Staff Training and a Process Group Intervention Preventing and Controlling Measures of 2019 Coronavirus Disease (COVID-19): Practice in Psychogeriatric Ward Online ahead of print Aged Patients With Mental Disorders in the COVID-19 Era: The Experience of Northern Italy The impact of COVID-19 on Mental Health in the Hispanic Caribbean Region. Int Psychogeriatr. 2020. Online ahead of print Providing quality end-of-life care to older people in the era of COVID-19: perspectives from five countries. Int Psychogeriatr. 2020 Online ahead of print