Older Adults More Resilient to COVID's Mental Health Impact - Medscape

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As a group, older adults, appear to be withstanding the mental health strains of the COVID-19 pandemic better than all other age groups.

Roughly 8 months into the pandemic and contrary to expectations, multiple studies indicate that older adults' mental health is not as negatively affected as other age groups.

"Older adults seem to have handled the strain of the pandemic better than others and we believe that resilience is part of the reason why," Ipsit Vahia, MD, medical director of geriatric psychiatry outpatient programs and medical director at the Institute for Technology and Psychiatry at McLean Hospital, Belmont, Massachusetts, told Medscape Medical News.

Vahia and coauthors Dilip Jeste, MD, University of California San Diego and Charles Reynolds, III, MD, University of Pittsburgh, Pennsylvania, summarize the evidence on the mental health effects of COVID-19 in older adults in a Viewpoint published November 20 in JAMA.

Resilient, Wise

Physically, older adults are particularly vulnerable to the effects of the COVID-19 pandemic, with higher risks of severe illness, complications, and death.

There is also a concern that isolation during the pandemic could be more difficult for older individuals, which could exacerbate existing mental health conditions. Yet, data gathered over the past several months suggests a much more nuanced picture, Vahia and colleagues found.

For example, a survey of more than 5400 US adults living independently conducted by the US Centers for Disease Control and Prevention in June found that those aged 65 years and older reported significantly lower rates of anxiety, depressive disorders, and trauma- or stress-related disorder than younger age groups. 

Older adults also reported lower rates of new or increased substance use and suicidal ideation in the prior month.

These observations are similar to what has been reported from other high-income countries including Canada, Spain, and the Netherlands. "There are also studies from China, Hong Kong, and Taiwan that echoed these findings," Vahia told Medscape Medical News.

Greater resilience to the mental health effects of COVID-19 at least in a proportion of community-dwelling older adults may be one factor driving the differences.

Resilience may reflect an interaction among internal factors — such as an individual's stress response, cognitive ability, personality traits, and physical health — and external resources like social connections and financial stability.

Wisdom is likely an additional protective factor for older adults, the researchers note. 

Wisdom is a complex personality trait that includes empathy and compassion, emotional regulation, the ability to self-reflect, and decisiveness while accepting uncertainty.

Studies have shown higher levels of wisdom, especially compassion, in older than in younger adults, Vahia and colleagues say.

'The Story Is Still Being Written'

They caution that the currently available data do not provide perspectives on key subgroups of older adults like those with dementia, those caring for persons with dementia, or those residing in assisted living facilities or nursing homes. The effect of comorbid chronic medical or psychiatric conditions also remains unclear thus far.

Vahia said it's also important to note that the studies published to date represent the initial phase of the pandemic. The longer-term effects of COVID-19 on older adults' mental health, especially in the United States and other hard-hit countries, are unclear.

"We haven't seen more recent data," he said.

"Over the next few months, we expect to see more longitudinal studies that may be able to shed light on how this initial resilience has trended as the pandemic has dragged on, especially in the United States. Whether older adults are still feeling okay about it. Really, the story is still being written," he added.

This research had no specific funding. Vahia and Reynolds have reported receiving honorarium, respectively, as editor and editor-in-chief of the American Journal of Geriatric Psychiatry. Jeste has reported receiving a stipend as editor-in-chief of International Psychogeriatrics.

JAMA. Published online November 20, 2020. Full text

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