Coming out of COVID: Mental Health

The challenges associated with our gradual return to some kind of normal are sure to vary throughout our populations. Will our older neighbors be hesitant to leave homes for a while? How has the isolation affected them? What about our children and teens, who lost the last three months of school? How has this disruption of routine and regular interaction with peers affected them? In this low-fidelity edition of The UConn Health Pulse podcast, Carolyn and Chris remotely ask two mental health experts about this: Dr. Kristina Zdanys, geriatric psychiatrist in the UConn Center on Aging, and Julian Ford, UConn Health clinical psychologist with expertise in PTSD and adolescent psychiatry.

(Drs. Julian Ford and Kristina Zdanys, Carolyn Pennington, Chris DeFrancesco, June 2020)


Chris: Reopening for business or emerging from lockdown, however we want to describe this next phase of the COVID-19 pandemic, what seems to be a “new normal” can take some adjusting for many of us.

This is the UConn Health Pulse, a podcast to help you get to know UConn Health and its people a little better, and hopefully leave you with some health information you’ll find useful too. With Carolyn Pennington. I’m Chris DeFrancesco. Now, history is likely to show that 2020 affected many of us in many different ways.

Carolyn: Oh, that’s for sure. And that goes for how we react to not only to the period of no gatherings or meetings, but also how we came out of that transition period. And that’s why today we have two experts in psychiatry to guide us through that transition. Dr. Julian Ford is a UConn Health clinical psychologist with expertise in post-traumatic stress disorder and adolescent psychiatry, and Dr. Kristina Zdanys. She is a geriatric psychiatrist in the UConn Center on Aging. Welcome to you both. And I apologize ahead of time in case my cat comes walking through. He loves to join these conversations. I think, you know, my friends and family have all handled this fine, but my cat is a mess. I don’t know if you guys do a little pet therapy on the side, let me know because I need some advice from my poor kitty cat.

So Dr. Zdanys, let’s start with you. We know this pandemic has been especially trying for older adults, a lot of them in nursing homes who are not being able to see any visitors, family members. How are they making this adjustment, and how are they going to handle this gradual move toward getting back to normal?

Dr. Zdanys: I know, as you’re alluding to, the COVID situation among older adults has been awful. About 80% of COVID deaths have been in adults over the age of 65 but that risk of death has actually increased by decades. So somebody in their 60s, they have like a 3.5% chance, risk of death, somebody in their 70s about an 8%, and then in their 80s and beyond, 14%. So it’s our oldest, older adult cohort that’s really being disproportionately affected.

At baseline, older adults are at risk for anxiety and depression related to social isolation, and financial stress and medical illness and loss. All of these are really magnified by this COVID pandemic. And the COVID situation in skilled nursing facilities is particularly tragic. In Connecticut, nearly 60% of COVID deaths have been fatalities related to getting COVID in the nursing home. That equates to over 2,000 deaths. This is likely because older adults, they have a variety of medical comorbidities, especially those who end up living in nursing homes for various reasons. Nursing homes are also very close, close quarters. There wasn’t the ability to do broad testing and nursing facilities early on. So we see older adults in the community and in nursing facilities disproportionately affected by this pandemic.

The impact from a psychological perspective, and the psychiatric perspective has been grave. Isolation is hard. The older adults who were living in skilled nursing facilities or assisted living facilities, they’re essentially in lockdown right now. These are people who don’t do think we have a ton of social interaction, but now they really can’t see their family and their friends, and they don’t always have access to technology that they can do over Skype or FaceTime with family members. I think that has been associated with this unfortunate amount of anxiety, depression and concern for sure.

Chris: I’ve got some more questions on how we get them back reacclimated with life. But before we do that, Dr. Ford, what about for the adolescents? We’ve got children and teens missing school, not seeing their friends regularly. I suspect a lot of them are kind of getting used to not having to be at school in the morning and maybe getting used to not having to get up early and get ready for school, and maybe they’re thinking, “I know I can handle this, I’m in no hurry to get back when school finally does start.” What kinds of things should we be concerned about as far as how the adolescent is approaching this?

Dr. Ford: Chris, what I’ve heard from adolescents and young adults and from their parents as well, since they’re all in this together to a large extent, is that the extent that they’ve been able to keep some of the routines that are familiar and create some new ones too, because the opportunities to do things where you can see people virtually, sometimes that actually brings, has brought kids together, as well as families together in ways that work as possible, or we just didn’t think about in the past. So what I’ve heard is that for the teenagers, the important thing is to be able to stay in contact with their friends, to be able to continue to have some of the activities that they would have had otherwise.

You know, a lot of teenagers and young adults are at the point of graduation. And for many of them, that means that they’re not going to have a traditional graduation. However, they’ve found, and their teachers and other adults in their lives have found, some very creative ways to help them to still celebrate their accomplishments, continue on with the activities that are important to them. Where they’ve been involved in sports, often that’s had to take a back seat, and yet they’ve found other ways to be competitive. They found ways to be active and stay in shape. So I think it’s largely, the challenge has been not to go too far out of one’s lane and get too far out of the routine, but to create some new routines that actually fit with the current situation. And so many kids and so many families have been doing that. And of course it’s been very hard for parents as well because they’ve often had to juggle keeping kids at home, doing schooling with kids, doing their jobs, trying to deal with situations where sometimes jobs have been stopped and they’ve had to deal with some financial stresses.

So this has been a really challenging time for families and the extent to which families have been able to continue to actually enjoy being together, while still having times where it’s annoying, just like having a cat walked through, the precious time that we have — I think we’re all going to look back on this, even teenagers are going to look back on this and say, “This is a really unique time, because I actually got more time with my family sometimes even with my friends than I would have before.”

Carolyn: And don’t you feel like the younger people are more resilient and like you said, they’ll look back on this and think, “Yeah, I spent more time with my family.” I’m much more worried about the older adults, who are living alone, solitary, whether they’re in a nursing home or whether they’re at home by themselves, and now the risks of dementia, of suicide because they felt so isolated. I mean, have you been hearing stories about older people who have really suffered mental breakdowns because of this?

Dr. Zdanys: I think of loneliness as a social epidemic that has been going on for years and years, even before COVID has come to us. We know that loneliness is a risk factor for mortality. It can shorten life span by 15 years. It’s the equivalent of smoking 15 cigarettes a day when somebody is lonely.

Carolyn: Wow.

Dr. Zdanys: There’s negative effects on physical health, there’s increased risk of cardiovascular disease and stroke. There’s mental health implications in terms of anxiety and depression. As you said, it impacts the risk of cognitive decline. So loneliness has been with us as a society for a very long time, and now it’s just magnified by the COVID pandemic.

What I try to tell patients and their families is, first validate that isolation is really hard, but I also want to distinguish between social isolation, social distancing, and physical distancing because those are two different things. And I try to help families and my patients think creatively about, even though they can’t be physically necessarily right with their loved one who’s an older adult, are there ways of maintaining that social interaction that can meet an older adult where they are, in terms of their technological ability and their physical health and their in their cognitive health. For example, I have people who don’t necessarily have access to a computer, but whose family will come and sit on the front porch and talk to them and share a meal with them through the front door without actually breathing on each other. So thinking outside the box I think is really important and addressing the impact of the social isolation.

Dr. Ford: And I’ll add that. I, I’ve heard very similar things, and I just want to tell you, I heard an example. This is something that can happen in a very positive way for older adults who are in skilled nursing facilities and therefore even more isolated in most cases than those who are able to live at home. A psychiatric nurse practitioner colleague told me that as he was leaving work from a skilled nursing facility one day, a couple of weeks ago, he was very moved because he saw an older gentlemen sitting outside on a bench having dinner, and he looked at him and said, “What is this, what’s going on here?” And he realized that that gentleman was having dinner with his wife, who was in the facility. He was sitting on the bench right outside her window and they were sharing dinner together. So that kind of connection is so crucial because that is exactly what does help to counteract the sense of loneliness that is so dangerous.

Carolyn: So moving forward, I think it’s going to be very difficult, the transition. I know, going to the grocery store, it seems like the collision between people who are on board with masking and then those who aren’t maybe, I just notice more interaction, more attention than I ever did before. So I’m really wondering as we reopen, move forward, what is that going to look like? What tips do you have for us as far as all getting along, continuing to get along and really handling the reopening?

Dr. Zdanys: I think going forward it’s important to remember that as things open up across the state, it’s not a light switch, that all of a sudden it’s going to be safe for our older adults to go out because they’re going to continue to be one of our most vulnerable populations. And I think we have a societal responsibility to be helping older adults in our community. Remember not all older adults are able to go online and order groceries to be delivered to their home because they don’t have internet access or they don’t have a computer. Some older adults can’t drive themselves to the grocery store. Thinking about older adults in our community, whether they’re relatives, friends, neighbors, people from your church or religious community, remember that they’re going to continue to need some extra help going forward. So be there for them, offer them support, offer them resources they might not necessarily have. But at the same time, respect their autonomy and respect their comfort levels. And I think together we can help them navigate this complicated new world.

Dr. Ford: And I think it’s a perfect complement for younger adults and for teenagers and for their parents and teachers and other adults in their lives. We all can support our elders by making sure that we balance freedom on the one hand — which is a wonderful thing to have a greater degree of, and the opportunity to actually be out more, be around people more — but always safely. And I think one of the things that really makes a difference to teenagers is realizing that some of the adults in their lives, that they can make a contribution, that this is not just about being a kid, that this is really about being a member of the community. And if they see their parents taking very seriously all the ways in which is important to continue to stay safe, but at the same time to begin to resume some of the activities that are a part of normal life, to let down one’s guard just a little bit, but never, never letting go of the careful precautions that are so important, when they see parents and adults doing that, I think teens will follow. And if they see us as adults being responsible and taking care of those who depend upon us, whether they’re older adults or other members of our family, I think that youth will also follow along, and this could be a really wonderful, remarkable lesson in how to be a citizen and how to be a member of a community and a family.

Chris: I think that’s a terrific message to go out on, and we appreciate that from Dr. Julian Ford from the UConn Department of Psychiatry, also Dr. Kristina Zdanys from the UConn Center on Aging. That is our time for today, so thank you both for joining us.

For Dr. Kristina Zdanys, Dr. Julian Ford and Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.