Mental Health Meets the Pandemic

#47 How are you doing?

Mental health and COVID collided head-on at my house. Before March 16th, 2020, my husband, Daniel, had dementia, but lived at home. Family members stopped by. We did things he enjoyed, such as playing miniature golf and pool, taking walks by the ocean, or going out to dinner. I took him shopping with me, so he was not alone. It wasn’t easy, but we managed.

Then the pandemic arrived, and the plan fell apart. We had to stay home, and no one was allowed to come by. Daniel never understood why we had to wear masks or why we were not going places. He had nothing to look forward to and became belligerent, argumentative, and abusive.

After five months of decline, he went to a memory care facility. We could not visit the facility prior to his admission nor could we visit him regularly. While he was there, he contracted COVID, was hospitalized, and died. I was not with him in the hospital or when he passed away. We could not have a memorial service for several months.

The pandemic is now two years old – I suspect that it has affected people of every age and in many areas of their life – particularly the elderly. It seems unfathomable that as of February. 4th, 2022, over 600,000 older adults have died from COVID (ages 65- 84), according to Statista.com.

The Kaiser Family Foundation website said

The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new barriers for people already suffering from mental illness and substance use disorders. During the pandemic, four in ten adults in the U.S. reported symptoms of anxiety or depression. From January to June 2019, one in ten adults reported the symptoms.

A KFF Health Tracking Poll from July, 2020 found that many adults were reporting specific negative impacts on their mental health and well-being. Those impacts included difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus.

According to Psychology Today - there is hope. Research over the past year showed that older adults have been psychologically resilient during the pandemic.

In August 2020, the CDC published a survey of more than 5,000 adults. Older adults surveyed reported significantly lower percentages of anxiety disorder (6.2 percent), depressive disorder (5.8 percent), and trauma-or stress-related disorder (TSRD) (9.2 percent) than participants in younger age groups. The conclusion was that older adults tend to be good at coping.

I wonder what the research would show today.

Challenges

Challenges affecting an older person’s mental health during the pandemic are numerous. They include fear of getting the virus or being more susceptible to it because of pre-existing conditions, worry about finances and the economy, depression about the situation, and loneliness because of isolation.

Even though I am a psychologist and have more skills than most people going through this time, my mental health was deeply affected - to the point where I wondered if I wanted to live.

I was constantly worried and anxious about daily situations, future decisions, and moving forward. I was lonely because of the enforced isolation and Daniel’s refusal to let anyone else in the house. I was discouraged, sad, and grieving as I watched his decline, bore the responsibility of being his primary caregiver, and encountered all the losses.

I did a lot of reading while trying to survive my situation.

General suggestions that seemed helpful were to

1. Limit the news: It fuels stress, anxiety, and depression.

2. Keep moving: Exercise is essential for relieving stress and maintaining physical, mental, and emotional health.

3. Follow a routine: Creating and following a daily schedule gives structure and a sense of normalcy that can help offset stress.

4. Connect with technology: Somehow find ways to talk with family and friends.

5. Stay healthy: Food affects mental and physical health. A good night’s sleep is also vital for one’s mental health.

6. Seek help: If diagnosed with a mental health disorder, stick with a treatment program.

We didn’t watch the news because Daniel thought what was happening on television was happening in the neighborhood. We took lots of walks, made puzzles daily, and he helped with basic household chores. Having a set routine was a must, given his dementia. We used Skype to connect with family and friends. Our meals were healthy, but sleep was difficult because he wandered and got lost in the apartment.

I coped by taking a daily walk, but used a pet camera to keep an eye on him, stayed in my office as much as possible, but checked on him constantly to make sure he was okay. I worked on my hobbies and did things for myself, like having flowers in the house and writing in a journal. In retrospect, much more was necessary.

The Mayo Clinic suggests the following ways to reduce stress.

Other suggestions that weren’t as helpful were to  

• Focus on the positive things in your life instead of dwelling on how bad you feel. Consider starting each day by listing things you are thankful for. Maintain a sense of hope, accept changes as they occur, and try to keep problems in perspective.
  The situation overwhelmed the positive thoughts I started out with each morning. There was no hope.

• Set priorities. Set reasonable goals each day and outline steps you can take to reach them. Give yourself credit for every step in the right direction, no matter how small. And recognize that some days will be better than others.
  We got to the point where the only goals were making sure he was safe and getting through the day.

Worry and Anxiety

I had to watch him 24/7 – we were housebound for days - my one break was a daily walk. He wanted to drive the car, so we took the keys. There were enormous fights. We tried in-home care, but he refused to allow anyone else in the house. He needed to go to a doctor but he refused. We finally had a video appointment; he thought he was talking to a friend. His thinking was crazy and dangerous at times.

I was not so worried about getting sick, but I did take precautions. It didn’t occur that Daniel was not safe in the memory care facility. They appeared to be taking the necessary precautions. Visitations were monitored and typically held outdoors but, it took only one person with COVID to spread the disease throughout the community, causing the death of several residents. 

Now, the worry remains, but the focus is on what I should be doing or what the right thing to do is for a single older woman.

Loneliness

Even before COVID, about one-quarter of Americans over age 65 were socially isolated, and more than 40 percent of people over age 60 reported feeling lonely. The pandemic’s arrival left older adults who lived alone even more isolated than before and cut off those living in nursing homes and assisted living facilities from family and friends, as facilities closed their doors to visitors in an attempt to protect residents.

While older people are especially vulnerable to loneliness and social isolation, there are ways to overcome it, even if you live alone and find it hard to get out. Several websites offer ideas. Maybe some of them will work for you.

• https://www.psychologytoday.com/us/blog/click-here-happiness/201902/feeling-lonely-discover-18-ways-overcome-loneliness.·   

•  https://www.carepatrol.com/blog/Solutions-for-Isolation-and-Loneliness-in-Older-Adults-During-COVID-19_AE275.html.

• https://www.verywellmind.com/how-to-cope-with-loneliness-3144939.

• https://www.forbes.com/sites/womensmedia/2020/10/27/how-to-reduce-the-stress-of-loneliness--9-tips/?sh=76db58b051b6.

Coupled with the loneliness is grief. Many people have experienced the deep grief caused by the sudden death of friends and family. However, grief is a reaction to any loss, which means the COVID-19 pandemic may also cause grief over the loss of a job, health, or lifestyle.

The pandemic amplified my grief as I watched Daniel’s constant decline. My lifestyle and my life role changed– from wife and partner to caregiver and parent. Today, I grieve, not so much, but there are times when it takes over.

Valentina Petrova wrote the article What to do about grief In the Life Intelligence newsletter. I liked her ideas. Here are a few of them.

• Cry when you feel like it. Sit with the anger. Be honest with yourself. Contemplate the importance of what you've had and lost. Give yourself a break.

• Journal about your thoughts and feelings.

• Find time for fun. It may be the last thing on your mind, but keep your hobbies, your hikes, your outings with friends, your trip plans, etc. It helps you stay connected with life in the present and gives your mind a break from the heaviness. Consider it a form of self-care.

• Keep your routines - they stabilize life. Keep going to the gym, walking the dog, making your morning coffee, or cleaning the house, for example.

• Take care of your health. As your body feels better, your mind will too.

• Rituals mark time. They close one chapter in life and open another. If your loss doesn’t come with a closure ritual like a funeral, create your own. Say goodbye in a meaningful way.

Depression

According to Boston University researchers,

Depression rates tripled the first year of the pandemic. Before the pandemic, about 8% of U.S. adults experienced depression. But in a survey of 1,161 people taken between March and April of 2020, that statistic jumped to 28%. When researchers surveyed the same people a year later, they saw a jump to 32%.

There’s no easy solution for depression. Finding the energy and motivation to take the first step can be a challenge. You have more control over your mood than you may realize, but, depression can make things seem even worse than they really are. When you’re depressed, everything is seen through a lens of negativity. Many tips discussed previously can be applied if you are depressed and professional help is available both online and in person.

I don’t see myself as depressed, but there is an underlying sadness. I write in a journal, talk with a coach and friends and read a lot. Some days are better than others.

Acknowledging your feelings goes a long way toward diminishing their overall impact on your mental health. Sometimes, you can boost your resilience by telling yourself that anxiety, lonliness, and sadness are normal and that this too will pass.

For now, my plan is to accept that there are times when I am filled with worry, loneliness, and sadness, that I need to forgive, and that I must move on even though. Still and all, there are no easy answers.

How are you taking yourself doing these times?