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Mental health and older people in a time of pandemic

From social isolation to restrictions in care homes, Covid is having a major impact

Professional Social Work magazine - 9 October, 2020

After her husband died, Joan* had no choice but to get used to living on her own.

“It was hard, especially as my children don’t live nearby,” says the 80-year-old. “But with the help of my social worker I was able to make new connections. It took some time to get out there again – after more than 50 years of marriage you rely on each other for company. But I joined an art group, a library group, weekly keep fit sessions at the local care home.

“I would see my son and daughter and the grandchildren when they came to visit and started making new friends. I had my routines that helped me carry on.”

Everything Joan had worked so hard to build, however, disappeared when the country went into lockdown in March.

“All of a sudden all my activities stopped. I couldn’t even go to the shops and had to have my food delivered. I was able to keep in touch a little with my children as they’d got me a mobile phone which I could use for video calls.

“For the first two months things were okay, you just get on with it. But then every day just became the same with no break in routine and only the television to keep you company.

“After a while you miss the physical human contact – phone and video calls are okay but they are not the same. I found myself getting quite depressed.”

Joan’s experience is one of many played out across the UK during the pandemic. Behaviour experts identify different stages of mental health during crisis. After the initial impact follows a ‘honeymoon phase’ characterised by optimism that everything will soon return to normal. When it doesn’t, the ‘disillusionment phase’ kicks in, usually after two months.

For many older people, particularly those living on their own, the pandemic has meant a prolonged period of isolation, loneliness and reduced activity contributing to a deterioration in mental health.

Currently 3.9 million people aged over 65 live alone in the UK, a 15 per cent rise in the decade to 2018. That figure is set to rise further as the population ages and lives longer.

A new report by charity Independent Age called Minds that matter: Understanding mental health in later life, says: “Loneliness and social isolation can both have a negative impact on a person’s wellbeing and are key risk factors for depression in older age.

“A consistent proportion - six to 13 per cent – of people aged 65-plus report feeling lonely often or always. This is most common among the ‘oldest old’ in our society.”

Liz, a 73-year-old who lives on her own, speaks of the added mental strain she felt during lockdown in the report.

“Some days I try to keep myself occupied but it’s hard. I feel really down. Also, not being able to see my grandchildren because of the lockdown. I just wanted to give them a hug.”

For many older people, the nature of the Covid-19 pandemic has put an end to even the most basic of social interactions.

Pam Newman, who worked for a housing association for over-55s, said: “I was speaking to a resident in her 90s recently. She used to go on a bus to the shops and buy things she didn’t really need. She would go and have a cream cake and tea in a café and the staff would have a chat with her. When she wasn’t able to do that it had a terrible impact on her.”

Figures highlighting poor mental health in older people are sobering. According to the 2014 Adult Psychiatric Morbidity Survey, 12 per cent of people aged 65 to 74 experienced a common mental disorder in the past week, including anxiety or depression.

Nearly a third (28 per cent) of women and 22 per cent of men aged over 65 are affected by depression, rising to 43 per cent and 40 per cent respectively among people 85 or older.

Independent Age’s own survey found three quarters of people aged 65-plus experienced low mood or significant anxiety at least once since turning 65 and one in ten say they feel this frequently or all the time.

The charity’s chief executive Deborah Alsina said: “Our national representative poll conducted in July 2020 told us that one in four people believe poor mental health is a normal part of getting older.

“This is a sobering and upsetting thought, showing an acceptance among too many people that feeling depressed or anxious is an inevitable part of growing older.

“In reality the evidence actually tells us that mental health problems can be treated regardless of age and that people in later life have very good recovery rates when it comes to receiving certain treatments, like talking therapy.”

The government launched the Improving Access to Psychological Therapies (IAPT) programme in 2008 to treat adults with anxiety disorders and depression in England.

It says about a million people use it a year, however only six per cent of those are aged 65 or over.

Independent Age is calling for a review of the barriers preventing this group accessing such support.

One of the biggest area of concerns during Covid has been the wellbeing of elderly people in care homes. In the early months staff were often without access to personal protective equipment, putting residents at risk. Elderly patients were also discharged from hospitals into care homes in their thousands, including those known to have Covid causing scandalous loss of life.

On top of this, strict rules prohibiting visits from family and friends to prevent spreading the virus, left many to die alone without even being able to say goodbye to loved ones.

The British Association of Social Workers has called for the dignity and human rights of residents in care homes to be upheld.

A damning report by Amnesty International says prolonged isolation from family and friends is having a “devastating” impact on the physical and mental health of care home residents.

This included loss of movement, reduced cognitive functions and appetite and loss of motivation.

One distressed daughter whose mother is in a care home in Dorset told researchers: “First they endangered older people in care homes by discharging infected patients into care homes without even providing tests and PPE and now they are only interested in preventing Covid infections and don’t look at the damage isolation is causing to residents.

“Isolation is killing people slowly and making their lives not worth living in the meantime.”

There is also concern over care homes becoming “invisible” to scrutiny with the normal checks by visiting relatives and inspection bodies suspended.

One relative told Amnesty’s researchers: “My mum is deteriorating so fast and she does not look well looked after at all.

“Whenever I try to engage with the management I get nowhere. I have contracted the CQC [the regulator in England], the local authorities, everyone, but I have received no response.

“Nobody is going in, so there are no witnesses to whatever is going on.”

Social worker Phil Mitchell, a professional officer for BASW Cymru, had similar concerns when his father-in-law had to go into a care home in Wales after his dementia became unmanageable.

“For someone with no ability to care for themselves, or make decisions for themselves, we have had to place all our trust in the care home in the hope that he is being cared for properly.

"My partner is deeply distressed at not being allowed to see him even through a window, as the care home is exercising what they call extreme caution.

“She is terrified that he will become ill and possibly pass away without her seeing him or being able to hug him.”

In this context, Phil says it’s crucial that social workers promote and uphold human rights – and use the law to do so.

“I guess the tension for social workers is knowing enough about the whole breadth of the law and being able to understand and use it in support of people like my father-in-law who have no ability to speak up for themselves or ensure they are treated well.”

With the winter likely to bring more restrictions, the role of social workers in ensuring the rights and dignity of older people are upheld will become even more important.

*Name changed to protect identity

By Shahid Naqvi

This article is published by Professional Social work magazine which provides a platform for a range of perspectives across the social work sector. It does not necessarily reflect the views of the British Association of Social Workers.