Perhaps the pandemic hasn’t been as hard — from a mental health perspective — on older adults has we first feared it might? In fact, we have reason to believe older adults have coped as well as any other age group, or perhaps more so. Dr. David Steffens, UConn Health chair of psychiatry and geriatric psychiatrist, and second-year UConn medical student Tia Kozar have been studying this, and what they’re seeing may surprise you.
(Dr. David Steffens, Tia Kozar, Carolyn Pennington, Chris DeFrancesco, September 2021)
Chris: We’re still trying to come out of COVID. How have we been coping? Today on the Pulse, we talk about one particular age group, and the observations may surprise you.
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.
With Carolyn Pennington, I’m Chris DeFrancesco. While the isolation has been easing, we’re not back to normal just yet.
Carolyn: And how has that isolation, coupled with concerns over vulnerability to complications, been affecting older adults? Today. We have the chair of psychiatry at UConn Health, Dr. David Steffens here to tell us about it, plus Tia Kozar, a second-year medical student who’s been working with Dr. Steffens to study some aspects of this. Thank you both for joining us.
So let’s start off with you, Dr. Steffens. Overall, how have older adults been handling the COVID pandemic?
Dr. Steffens: Carolyn, they’ve been handling them surprisingly well, actually. We were really worried about how the isolation would affect older adults. We know that there’s lots of beneficial effects to older adults of being out there, enjoying their usual activities, and were frankly really worried about how they would handle this level of isolation. We know that, for example, the beneficial effects of social activity include more physical activity, because they’re out and about, that improves muscle mass and overall strength, improves people’s balance so they’re less risk for falls. In my line of work, in mental health, it also has a lot of beneficial effects in terms of improved self-esteem, improved mood, less depression, less anxiety. So we were really worried, but a lot of the studies coming out show that older people are really handling this much better than thought, and that the we’re not seeing these increased rates of depression, anxiety and, frankly, suicidal thinking that we were really worried about when this pandemic hit.
Carolyn: So it sounds like they’re doing better than the average population than the younger folks.
Dr. Steffens: They are. And in fact, a lot of the studies that have looked at the effects of the pandemic on different age groups, really point to vulnerability in the adults below age 25. In the 18-to-24-year-olds, they have, in one report, half reported a significant depression symptoms, half reported significant anxiety symptoms, and about a quarter thought about suicide from time to time. That, compared to the adults over 65, those numbers are well less than 5% or 6%. And so really focusing on the younger adult population is important.
I will say though, that another important population that seems to be at risk are caregivers, and those can be caregivers across the age span, but the stress of caregiving to particularly older adults seems to be wearing, the pandemic seems to be wearing a lot on that age group as well.
Carolyn: So I find that so interesting. Why do you think older adults are handling it better than the younger people?
Dr. Steffens: I think it comes down to the notion of resilience. In studies, we kind of define resilience as the capacity to navigate adversity in a manner that protects health, wellbeing, and life satisfaction. So being able to withstand the stress of COVID really maps back to sort of a lifetime of learning, how to deal with all sorts of stress. This is a group that has lived through, some through the great depression, certainly several recessions, wars, all sorts of other really bad events in their life. And for many adults who have survived into older age, they bring with them this toolkit of how they were able to cope with and get past some of these challenges. So this notion of resilience has really taken on, I think, a new importance in terms of the research going on in how older adults are generally grappling with the current pandemic.
Chris: That’s a fascinating aspect of this, because I remember more than a year ago, actually having a conversation with Julian Ford, similar to this, like you’re talking about a group of people who have gone through what you just described have gone through is like, we have this world of crisis. Now today, what we’re being asked to do our part, we’re not going off to fight a war or dealing with an, with an economic depression, but we’re being asked to stay home, sit on the couch and order takeout. I think we can weather this. But it makes me wonder, if we were having this conversation 50 years from now, how would my generation be doing, or probably the generation following me, how would they be doing? I wonder how resilient they would be.
Carolyn: But I remember, and I was surprised because I always felt like the younger people would be able to handle things better. I was much, at the start of the COVID, I was much more worried about my older relatives and family members and friends, because I just thought they’re going to be in their home all by themselves and not as active. And so I was much more worried about, about them than my younger friends and family, and so here you go. Who knew?
Dr. Steffens: Right. But when you think about it, though, so much of being a young person is being out there and looking for that special someone or going out with friends and really being out there, and having that restricted has much greater effects, I think, on the younger folks. And, like you said, Chris, with the older people, OK, we’re being asked to sit on the couch. We also, I think underestimate older adults’ ability to be connected. And so a lot of them have that ability through, their churches have gone online, and other support groups or their friends are online, and they’ve figured out Zoom meetings and other things like that, that we sometimes don’t think that older adults can do. But in fact, I think they’ve risen to the occasion because they’ve kind of had to.
Chris: Dr. David Steffens, the chair of psychiatry, UConn Health, and Tia Kozar, a second year medical student who is helping Dr. Steffens with some of his research, let’s talk a little bit about how you’re finding out this information. I mean, sure. Some of it’s observational from what you do, but as a specialist in geriatric psychiatry, you’ve got your finger on the pulse on these types of matters. How are you collecting this?
Dr. Steffens: Right. I’m fortunate to have a longitudinal study where we’re studying a group of older adults that come in depressed, and hopefully through the study become undepressed, but also a group of never-depressed older adults. And so we’ve been following them longitudinally and with the onset of the pandemic we knew it would be important to try to get some measures of how the pandemic was affecting both the what we call the depressed group and the control group. And fortunately we were able to gather some data from 2020, and then, also fortunately, Tia was able to join our group this year and do some followup on those measures of resilience and depression and anxiety.
Chris: All right. So Tia, tell us a little about your role in this.
Tia Kozar: Yes, so this summer I started picking up where Dr. Steffens left off. What we thought would have been our COVID endpoint here in 2021 ended up being a continuation, via in-person interviews and phone interviews, determining different factors related to the pandemic with the tool “EPII-G,” so “epidemic pandemic impacts inventory,” looking at social support, economics, as well as some other factors to see how that played into older adults, resilience and depression.
Chris: And how did you get involved in that?
Tia Kozar: Well, I have a passion for geriatrics, specifically, geriatric psychiatry, so when I heard about the work Dr. Steffens was doing, I had to get involved. At the beginning of the pandemic, I ran a dementia unit in a nursing home. So that was kind of the eye of the storm, March, 2020. Seeing everything that happened there, I definitely wanted to see what I could do to see how that affected older people.
Chris: And geriatric psychiatry, is that the path that you see yourself on?
Tia Kozar: Oh, absolutely, without a doubt in my mind.
Carolyn: So for this survey, where you actually talking to, you’d call them?
Tia Kozar: Yes, I was interviewing older people, asking about them, the people who lived at home with them, whether it be their caregivers, their partners. So it was really great to be able to hear these stories straight from the older people themselves.
Carolyn: Oh, I’m sure some were very emotional and it must have been difficult at times.
Tia Kozar: It definitely was. A lot of times they’d be so eager to be able to share what they went through, sometimes, not having had other people to be telling this to. So it was nice to be able to be an ear for them to lean on.
Chris: Now I would think as someone not involved at the level you’re involved in, the factors that would have the most impact on someone’s state of mind, as an older person especially, would be loneliness or depression, or maybe possible economic concerns, or just the threat that, “I’m at an age where I’m in a more vulnerable position to get really, really sick from this.” Are those kind of what might’ve been the biggest factors in how people were reacting to this, or were there other factors that someone like me wouldn’t know about?
Dr. Steffens: So it is true that depression played a role, and in Tia’s work we found that the depression did edge up a bit, actually in both groups,and that there was a relationship between I think some financial stress and just sort of the sum of that isolation and things affecting other members of the family that were at home. But interestingly, and consistent with what we talked about at the beginning of this, is that in both groups, a sense of resilience actually increased over over the year and through the pandemic. So I think that they were able to show, “Yes, I can get through this. It’s really difficult.” We think that part of this is the wisdom that they have gained over their lifetime so that maybe they think, “Well, this is bad, but really my lifestyle hasn’t changed that much,” or, “There are changes, but I’m adjusting well, particularly I’ve learned how to use new technology,” or, “I’m doing OK, but I’m unhappy about some of these lifestyle changes,” or, “I’m not so thrilled with not being able to have those in-person interactions.” But by and large, they’ve been able to strike that balance of, “There are some lemons out there, I’ve been able to make some lemonade. I’ve been able to sort of get past this, in a similar way that I was able to during past stress.”
Tia Kozar: Yeah, specifically going off of that, we saw that there was a lot of positive change in self that these older folks were seeing, where they saw the silver lining, as Dr. Steffens was saying, whether it was more quality time with their loved ones, even if it be virtual, learning a new hobby or skill. So I think that really played into that resilience, where they were able to have that positive outlook.
Chris: What do we know today that we didn’t know in March of 2020 that might help our care and understanding of mental health in older adults?
Dr. Steffens: I think a focus on resilience in both depression and never-depressed people is really important. I think that sometimes we have viewed people who’ve had depression as people who’ve been defeated by life. And in fact, depression is too complex for that. There are certain biological conditions that can set you up for depression — recent loss of somebody, all that. But in fact, people do carry with them through life this toolkit of how they’ve been able to overcome from the past. And I think part of what I certainly have learned as a clinician is to trust that there is a resilience there, even if somebody presents with a lot of depression symptoms, and that, while we worry about our older adults, really it’s the younger folks that we really do need to focus on and worry about in terms of the effects of the isolation related to the pandemic on their mental health.
Chris: And Tia, what have you taken from the last year and a half, or however long you’ve been involved in this?
Tia Kozar: I think specifically, as a student and as a young person, there are a lot of misconceptions about what aging looks like and what aging can be. Going into this project I had a lot of the same concerns, where I was expecting certain results. I was expecting that increased depression and that there’s so much more we need to be doing for our older people. And I think that is true, but rather we should be supporting them and that there is a lot that we can learn from them as well, and a lot we should be able to take to take away moving forward after this pandemic.
Chris: And what’s next for you? As we speak today, recording this, you’re a second-year medical student, which means you just started your number two. So how long are you involved in this project and kind of what’s ahead for you.
Tia Kozar: I love to see, since this was supposed to be our endpoint, moving forward once we are kind of out of the weeds with the pandemic, to see if this resilience continues once we are past the pandemic, and if this depression also stabilizes as well. I think there’s a lot to see how lasting these results are.
Chris: Alright. Tia Kozar, thank you so much, second-year medical student, UConn School of Medicine, and Dr. David Steffens, chair of psychiatry at UConn Health. And that is our time for today. Thank you to Dr. Steffens and future Dr. Kozar, and Carolyn Pennington.
I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Now be sure to subscribe so you can catch us next time, and please share with a friend.