Recently, lockdowns and restrictions for our physical safety have been put into place since 2020 with no definite end in sight. However, at what cost are these changes being implemented? In these tough times where technology has become key to social integration, it is especially difficult for elderly populations around the world to keep up with the fast-paced changes of Covid-19 restrictions.
In this article, I analyse how Marge’s mental health as an elderly person has worsened during the Covid-19 pandemic, where we all seem to be connected by the common themes of stress, anxiety, and depression. Additionally, I also share some unique insight on Marge’s concerns about the increasing reliance on technology and telemedicine today. Marge is an 88-year-old widow. An outgoing individual who finds comfort in friends and family, she has found it hard to adapt to social distancing guidelines. She suffers from several chronic conditions including: arthritis in her knees and fingertips, hypertension, hearing loss and a heart murmur.
Stress & Anxiety
Mattioli et al (2020) investigated the effects of stress and anxiety during quarantine following Covid-19 regulations. They found that a more sedentary lifestyle, ‘food cravings’, and insomnia ensued after long periods of stay-at-home restrictions - all of which are symptoms that Marge has been experiencing.
Marge has recently admitted to feeling higher levels of stress, attributed to her loss of freedom and control over daily activities, alongside fear of contracting the virus as a vulnerable elderly with chronic conditions. Upon reflecting on her eating habits, Marge revealed that she had been treating herself to more treats like cakes and cookies during the third national lockdown.
These habits stray far from her usual self, where she abided strictly to a balanced diet. A possible explanation for this from the study conducted by Mattioli et al (2020) suggests that individuals respond to stress by consuming food high in sugar and carbohydrates, which encourage serotonin production and in turn promotes a positive mood.
Due to cold weather in winter, Marge had not done any form of physical exercise in at least a month, which is a stark contrast to 2020 where she made a conscious effort to go on her daily walk. The study recommended that individuals should participate in online exercise activities during the pandemic. This is difficult for Marge, who feels like there is an increasing exclusion of elderly people in society because of technology. For instance, she has brought up her immense frustration multiple times of not being able to have the same type of strong interpersonal relationship with her GP as she did with her family doctor years ago; not being comfortable or reassured with teleconference calls, and not being to access programs like exercise videos because of the technological divide.
Additionally, Marge made several visits to her GP in January 2021 and found that her blood pressure had increased. The doctor attributed this to chronic stress, likely due to Marge’s frustration about her quality of life since the first lockdown in early 2020. Spruill (2010) found higher catecholamine levels in individuals that ruminate about frustrating events, indicating higher levels of stress. This relates to Marge, who has complained multiple times about her year being ‘wasted’, and about her lack of freedom. This also made her think frequently back to the 10 years where she felt trapped, unappreciated, and isolated while caring for her home-bound husband – making her feel as though most of her life has been ‘wasted’.
Marge has always been an optimistic individual with a positive outlook on life, even after being diagnosed with multiple health conditions. However, there has been a noticeable deterioration in her attitude. Marge has mentioned feeling increasingly overwhelmed after making multiple trips to the hospital in January 2021 for dental appointments, cold sores, and neck pains, as well as finding out that her heart murmur and hypertension had worsened. She repeatedly confided that she feels she does not have much time left, especially since many of her friends have passed, and is feeling hopeless as she is not able to meet with her friends or family. These symptoms, alongside Marge’s recent onset of insomnia, are warning signs of possible depression.
Liu et al (2016) found that individuals with depressive symptoms had a higher incidence of reporting lower levels of perceived social support, loneliness, and poor perception of health status. Marge has brought up her disappointment and sadness in being unable to meet up with her friends or drive to visit her family because of Covid-19 restrictions, and admitted to feeling lonely and isolated.
Loneliness is defined as having unmet social needs, and can be classified into emotional loneliness (lack of intimate relationships) and social loneliness (lack of social network where common activities can be shared) (Liu et al, 2016). Marge fits into both categories, having a lack of social network for almost over a year. Even though she is an extrovert, she feels as though she does not have any ‘true confidants’ and this suggests that she may be experiencing a lack of intimate relationships, meeting quantitative but not qualitative relationship needs. For an outgoing individual like Marge, this might be an especially tougher time for her as she feels like a fish out of water, only able to physically interact with her next-door neighbour.
Liu et al (2016) stated that loneliness not only affects mental health but also cognitive functioning. Marge is a highly self-aware individual and admitted that talking to us has been one of the few chances to practice her speech in a long conversation. She was worried about cognitive decline and noticed her increased difficulty in stringing sentences together, and even asked if we had difficulty understanding her. This provides more evidence to believe she might be experiencing depression.
To feel more connected to her family, Marge has recently installed ‘WhatsApp’ onto her mobile phone and is extremely pleased with being able to video call her children. She described this as being ‘lovely’ as opposed to talking to them on a voice call. Tanaka (2018) pushes the importance of family relationships and social support in playing a role for strength and resilience in adults showing depressive symptoms, which is something Marge has come to realise on her own. If Marge agrees to it, perhaps we could guide her through the Hospital Anxiety Depression Scale checklist to gain a better impression of whether she is depressed and should seek more medical help.
Exclusivity of the Elderly in the Modern Healthcare System
Marge has had many complaints about the ‘modern’ healthcare system compared to the healthcare system back in her days. I was concerned when I learnt that many elderly like Marge and her friends find that they have been neglected by the NHS, due to the increased reliance on technology such as teleconferences and online booking of appointments, which is hard for them to navigate. This allowed me to understand the importance of improving inclusivity and accessibility in healthcare – for instance, providing accessible education for the elderly on technology or customising technology for easier use like using bigger buttons, simpler functions, and clearer and more concise instructions.
Additionally, the fast pace of society and growing population results in an increased patient to doctor ratio, reducing the time per consult. With no ‘fixed’ GP, Marge feels frustrated and feels that ‘the interpersonal aspect of going to the doctors’ has gone!’ This has made me more aware that the elderly have different expectations and needs when it comes to medical care. In the future, I would take additional effort to get to know patients on a deeper level, and show them that I care not only about their health but about them as an individual as well.
I was dismayed to find out that Marge’s wellbeing could deteriorate in such a short period of time, from being an optimistic individual to thinking that ‘her time was over soon’. I realised that a large part of mental health well-being in the elderly is often underestimated and overlooked – it is increasingly important to educate them on how to prevent this by participating in social support groups or partaking in more activities. As doctors, we also have a crucial role in providing assurance and supporting the patient by listening carefully between the lines for additional needs.
*Marge – not her real name.
Mattioli, Anna et al (2020). Quarantine during COVID-19 outbreak: Changes in diet and physical activity increase the risk of cardiovascular disease. Nutrition, Metabolism & Cardiovascular Diseases [online]. 30, 1409-1417. [20 Feb 2021]. Available from: https://www-sciencedirect-com.sheffield.idm.oclc.org/science/article/pii/S0939475320302131.
Spruill, Tanya M. (2010). Chronic Psychosocial Stress and Hypertension. Current Hypertension Reports [online]. 12, 10–16. [20 Feb 2021]. Available from: https://link-springer-com.sheffield.idm.oclc.org/article/10.1007/s11906-009-0084-8. Doi: https://doi-org.sheffield.idm.oclc.org/10.1007/s11906-009-0084-8
Custers, Mariette H.G., Van Den Berg, Agnes E. (2011). Gardening Promotes Neuroendocrine and Affective Restoration from Stress. Journal of Health Psychology [online]. 16 (1), 3-11. [20 Feb 2021]. Available from: https://journals-sagepub-com.sheffield.idm.oclc.org/doi/abs/10.1177/1359105310365577. Doi: https://doi-org.sheffield.idm.oclc.org/10.1177/1359105310365577
Liu, Lijun et al (2016). Social support mediates loneliness and depression in elderly people. Journal of Health Psychology [online]. 21 (5), 750-758. [20 Feb 2021]. Available from: https://journals-sagepub-com.sheffield.idm.oclc.org/doi/full/10.1177/1359105314536941. Doi: 10.1177/1359105314536941 hpq.sagepub.com
Franck, Linel et al (2016). Systematic review of interventions addressing social isolation and depression in aged care clients. Quality of Life Research
25 (6), 1396-1407. Available from: https://www-jstor-org.sheffield.idm.oclc.org/stable/44852887?seq=1#metadata_info_tab_contents. Doi: 10.1007/s11136-015-1197-y
Tanaja, Koji (2018). Strengths promoting the recovery process in older adults with depression. Journal of Clinical Nursing. 27 (15-16), 3032-3043. Available from: https://onlinelibrary-wiley-com.sheffield.idm.oclc.org/doi/full/10.1111/jocn.14359. Doi: