Introduction The COVID-19 pandemic has presented significant public health challenges worldwide, resulting in over a million deaths worldwide and major changes in social processes. Older adults are disproportionately represented among those experiencing severe illness and death. Older adults, particularly those with pre-existing psychiatric conditions, may also be more vulnerable to the psychiatric impacts of the pandemic and its resulting social sequelae. During peak months of the pandemic, our inpatient geriatric psychiatry service has cared for patients who presented with severe psychiatric states related to the pandemic. In this study, we examine four cases to illustrate differing mechanisms by which the pandemic causes acute psychiatric distress in older adults and describe targeted interventions to address each mechanism. Methods Cases seen in the Geriatric Psychiatry/Neuropsychiatry inpatient service at Johns Hopkins Hospital late in the first wave of the pandemic (June 2020) are analyzed to identify the psychological and social mechanisms for acute psychiatric distress, using a timeline representation approach. Results The timeline analysis of the cases indicated four mechanisms for acute psychiatric distress during the pandemic: incitement of fear, social isolation, loss of routine and purpose, and disruption of medical services. These factors have been shown in other work to have adverse effects on the psychological well-being of older adults. Conclusions While the older adult population as a whole may be heterogeneous in their psychological reactions to the COVID-19 pandemic, those with fewer social resources, lower resilience, or pre-existing mental illness are likely to experience disproportionate distress in the face of these changes. Interventions should be tailored to promote flourishing in individuals; including assistance in navigating changes in the healthcare system, developing technological skills, and leveraging connections and resources in the individual's social circle and community. Funding None
The Acute Psychiatric Impacts of the COVID-19 Pandemic on Older Adults