In early 2020, Sarah Crouch started a tally on her cell phone: a list of names of family members and friends who died since the pandemic began. As of July 2022, there were 51 names. About half died due to COVID-19.
“Some weeks there were two deaths of close friends in one week,” said Crouch, 72. “One person would die, and I barely had time to grieve before the next one hit.”
On top of all that, her father-in-law almost died in November 2020. He spent two weeks in the hospital alone, because visitors weren’t allowed. Around the same time, her husband contracted COVID. Thankfully, both recovered, but with all the stress, Crouch’s own health started to suffer. Her thoughts raced. She couldn’t sleep.
“I had sudden hearing loss,” she said. “I spent six weeks in bed with vertigo. My body just quit on me. Because of all of that, one of my doctors said, ‘You know what? I think you should probably talk to a counselor.’”
Crouch was reluctant. She worried therapy was too costly. She’d tried it in the past; it didn’t help. But she took her doctor’s advice and contacted a psychologist.
Isolation and Loneliness
Crouch wasn’t alone. In the United States at the beginning of 2021, an estimated one in five older adults, ages 50 to 80 were experiencing mental health symptoms, such as depression, anxiety, insomnia or substance abuse, according to the University of Michigan National Poll on Healthy Aging. When asked about the last two weeks before they were surveyed, 28 percent said they had felt depressed or hopeless, 34 percent had been nervous or anxious, and 44 percent had recently felt stressed. Almost two-thirds reported trouble falling asleep or staying asleep, twice the percentage who reported sleep problems in a similar poll in 2017.
Nora Gravois, a licensed social worker and counselor at the nonprofit Wellness Center for Older Adults in Plano, TX, witnessed these effects of the pandemic firsthand.
“We got calls from neighbors, church members or family, asking us to check on an older adult who hadn’t opened their curtains for ages, or whose mail was piling up,” she said. “Older adults were isolated, and some didn’t have the emotional resilience to call us for help themselves.”
Even before the pandemic, older people were at higher risk of social isolation and loneliness than younger age groups. Studies show that loneliness can trigger anxiety, anger and emotional instability or contribute to physical problems like hypertension. For some, the restrictions imposed by the pandemic led to even deeper isolation.
“What we saw in our grief support group was almost like a trauma response,” Gravois said. “Our clients were not able to physically touch or say goodbye to their loved ones at the time of death. Grief and loss became a traumatic experience for them.”
An Outpouring of Sadness and Worry
Susan Rebillet, a geriatric psychologist in Dallas, saw a dramatic uptick in physician referrals beginning in the summer of 2020.
“So much had happened,” she said. “On top of the pandemic, there was political turmoil and the Black Lives Matter movement. It was a chaotic time.”
Some patients needed help from a child or grandchild to connect online with Rebillet, but once they did, there was an outpouring of feelings of grief, loss, sadness and worry.
“Many people had a real fear of dying themselves or losing someone to the virus,” she said. “There was a lot of information out there that wasn’t helpful or accurate. I told many patients, ‘Do not watch the news 24 hours a day.’”
Everyone was affected by the disruptions and restrictions of the COVID pandemic, but some older adults were hit especially hard, according to Lisa Murray, a social worker with OhioHealth’s John J. Gerlach Center for Senior Health in Columbus, OH.
“If you’re an older adult who’s living alone, or who cannot drive because of mobility or cognitive issues, then COVID meant you no longer had access to services that provided transportation,” said Murray. “We saw people falling out of their normal routines that helped sustain their mental health, whether it was going to church or being involved with family dinners.”
For older people, the psychological work of this life stage is stymied without social connections.
“While depression is not a normal part of aging, there were so many changes during the pandemic that increased the risk of depression,” said Lakshmi Rangaswamy, DO, a geriatrician at OhioHealth Riverside Methodist Hospital in Columbus, OH.
She added that depression and anxiety in older adults can manifest in unexpected ways. She saw patients during the pandemic with pseudodementia, in which anxiety or depression triggered symptoms that mimicked dementia.
“In those cases, when we treated the anxiety or depression, the cognitive impairment improved,” she said.
While the media highlighted concerns about the effects of the lockdown on children and youth during their formative years, Gravois says, “The pandemic was a disruption for older people too, because every stage of life has its own challenges.”
Gravois cites Erik Erikson’s stages of psychological development, which span the entire lifespan from birth to death. Just as young people must grow and mature in childhood and adolescence, older adults face their own psychological challenges in later life. Retirement, for example, demands that older adults find new ways to contribute and stay engaged, once a career is over. Older people often reflect on their lives and look to find peace with the past, rather than feeling stuck in despair or regret. But without social connections, the work of this life stage gets stymied.
Janet Pyne, 66, saw that in the spring of 2020, when she retired from her job as an assistant principal in Austin, TX. As they had planned for years, she and her husband, Rick, moved shortly after her retirement to be near grandchildren in the Dallas area.
Because school was virtual due to COVID, “I never got to tell my co-workers and students goodbye in person,” she said. “It was a sad and depressing way to leave a job I loved.”
Another complicating factor affected older adults’ mental health during the pandemic: reluctance to seek mental health care. Past research showed that many older adults who need that don’t get it. One 2012 study, for example, showed that 70 percent of older adults with mood and anxiety disorders did not use mental health services.
But more recent research suggests that the pandemic may have moved the needle. A voluntary survey of nearly 4,000 Medicare recipients, published by eHealth, found that more people were willing to seek mental health care two years into the pandemic. Nearly half (48 percent) were willing to consider talk therapy or another form of mental health care, up from 35 percent pre-pandemic.
Similarly, the 2021 University of Michigan poll indicated that older adults were now more open to seeking mental health, with 71 percent saying they wouldn’t hesitate to see a mental health professional in the future and 13 percent saying they had talked with their primary care provider about a new mental health concern since the pandemic began. More than 85 percent reported feeling “very comfortable” or “somewhat comfortable,” talking about their mental health.
“Most older adults do feel comfortable discussing their mental health and understand that it’s an important component of overall health,” said Lauren Gerlach, DO, a geriatric psychiatrist at Michigan Medicine who worked with the University of Michigan poll team.
Among those who were unsure or who had reservations about seeking help, the most common reasons cited were the belief that therapy or other interventions would not help, feeling embarrassed and the cost. (According to the eHealth survey, many older adults don’t know that Medicare provides mental health care benefits.)
Gerlach sometimes sees a perception among older patients “that they should just be able to pull themselves up by their bootstraps and get better on their own.” When she encounters hesitancy, she tries to normalize patients’ experiences of anxiety, depression or other symptoms.
“I tell them that many people are experiencing significant mental health symptoms, and explain that, just like diabetes or hypertension, mental health conditions are real illnesses, with treatments that can really help,” she said.
I try to explain that anxiety and depression, for example, can be due to a chemical imbalance in the brain, and not a sign of weakness.
Rangaswamy observes that some of her older patients seem more willing to take medication for mental health conditions than to engage in counseling or psychotherapy.
“I think there’s a stigma attached to needing help,” she said. “Patients will say they don’t want to talk to a ‘head shrink.’”
She added that older patients who experience symptoms, such as frequent crying, decreased appetite, inability to sleep, racing thoughts or a case of the “nerves,” may not frame them as mental health conditions.
“I try to explain that anxiety and depression, for example, can be due to a chemical imbalance in the brain and not a sign of weakness,” Rangaswamy said. “I’ve even told patients that I’ve sought counseling at times myself and that it was beneficial to me. Normalizing things is very important.”
Rangaswamy believes that reluctance may be a generational issue too. Many older adults who lived through the Great Depression or World War II prize self-reliance. Working through feelings isn’t part of their coping toolkits.
Ellen Edwards, 63, sees that with her own parents, ages 90 and 92. Edwards (not her real name) didn’t hesitate to seek counseling herself when she began feeling overwhelmed by the challenges of caring for them during the pandemic. But her parents won’t consider counseling, even though they’ve struggled with isolation and a series of health problems.
“They have a very strong, independent spirit,” she said. “My mom’s father died when she was four. My dad was placed in an orphanage during the Great Depression. Their feeling is, if you’re having trouble, you’ve got to take care of it yourself.”
COVID-19 caused mental health problems but also helped to destigmatize them.
Even older patients who do overcome their hesitations and see a counselor may struggle with the process itself.
“Some people can’t engage because they don’t know how,” Rebillet said. “They don’t want to complain. They say things like, ‘I know it’s going to work out’ or ‘It just takes time.’ This is a coping strategy they saw their parents use, and it’s their way of getting through challenges. They never got the message that it’s OK to talk about your feelings.”
Despite those challenges, research suggests that older adults still experienced significantly less depression, anxiety and stress-related conditions than younger adults did during the pandemic. In a survey conducted early in the pandemic by the Centers for Disease Control and Prevention, nearly 50 percent of adults ages 18 to 24 reported anxiety, depression and/or stress-related disorders. Researchers believe many adults 65 and older, having lived through crises or difficult times in the past, possessed resilience and wisdom that enabled them to withstand the stresses of COVID-19.
Many mental health experts also believe that the pandemic increased awareness of mental health in general. News reports about the virus often included information about the effects of isolation and stress.
“COVID-19 did more than increase the prevalence of mental health issues; it also accelerated positive momentum to raise awareness about these issues … and accelerated long-term efforts to destigmatize mental health issues and normalize the search for help for these kinds of problems,” writes psychologist Michele Nealon.
That awareness also spurred more older adults to practice self-care during the pandemic, Gerlach added. In the University of Michigan poll, one in three people reported making lifestyle changes—such as exercise, diet or meditation—to improve their mental health since the start of the pandemic.
“As a culture, we are talking so much more about mental health as part of our overall well-being,” said Murray. “If we can really normalize this and acknowledge that we’ve all gone through difficult times, that opens the door to conversation.”
Sarah Crouch overcame her initial hesitancy about counseling, and she’s glad she did.
Weekly sessions with Rebillet—Crouch was surprised to discover they were covered by Medicare—proved incredibly helpful. She continues to see Rebillet, although less often. If she were to give her mental health a grade, Crouch says, it’s up from a D in the midst of the pandemic to a B+ or an A- these days.
While she was never suicidal, Crouch believes she wouldn’t have made it without help.
“I think I would have ended up more isolated, more unhappy and sicker if I hadn’t done counseling,” she said. “I still have moments of fragility, but I’m a whole lot further along than I was. Counseling was really a lifeline.”
Freelance writer Mary Jacobs lives in Plano, TX, and covers health and fitness, spirituality, and issues relating to older adults. She writes for the Dallas Morning News, the Senior Voice, Religion News Service and other publications; her work has been honored by the Religion Communicators Council, the Associated Church Press and the American Association of Orthopaedic Surgeons. Visit www.MaryJacobs.com for more.