REVIEW
Home
containment and COVID-19: a perspective about the mental health of the
geriatric population
Nicolle dos Santos
Moraes Nunes1, Jacqueline Stephanie Fernandes do Nascimento1,
Maria Eduarda Abreu Rangel1, Esther Victória Lima de Mello1,
Janie Kelly Fernandes do Nascimento1,
Marco Antônio Alves Azizi2, Adalgiza Mafra Moreno3, Marco
Antônio Orsini Neves4
1Graduate student at the
Iguaçu University Medical School,
Universidade Iguaçu UNIG-RJ, Nova Iguaçu/RJ, Brazil, 2MD,
Full Professor at the
Iguaçu University, Iguaçu University
UNIG-RJ, Nova Iguaçu/RJ, Brazil, 3Full
Professor at the Iguaçu University, Iguaçu University
UNIG-RJ, Nova Iguaçu/RJ, Brazil, 4MD, Post
Doctor at the Federal University of Rio de Janeiro, Full Professor at
the Iguaçu University,
Iguaçu University UNIG-RJ, Nova Iguaçu/RJ, Brazil
Received
on July 15th, 2020; accepted on August 15th, 2020.
Corresponding author: Janie
Kelly Fernandes do Nascimento, Av. Dr. Mário Guimarães 863/1603 Centro 26255230
Nova Iguaçu RJ
Nicolle dos Santos
Moraes Nunes: nicolle.nunes_@hotmail.com.br
Jacqueline Stephanie
Fernandes do Nascimento: jac.fn@hotmail.com
Maria Eduarda Abreu
Rangel: dudaabreur16@hotmail.com
Esther Victória Lima de
Mello: melloesthervictoria@gmail.com
Janie Kelly Fernandes do
Nascimento: janiekelly@hotmail.com
Marco Antônio Alves Azizi: marcoazizimed@gmail.com
Adalgiza Mafra Moreno:
adalgizamoreno@hotmail.com
Marco Antônio Orsini Neves: orsinimarco@hotmail.com
Abstract
Introduction: The COVID-19 pandemic is a major Public Health problem today. Social
isolation is the main measure established so far to delay the spread of this
pathology. However, the loneliness resulting from confinement can be
particularly problematic in senescence. This article aimed to produce and
update reflections about the impact of social isolation on the mental health of
the elderly during the COVID-19 pandemic. Methodology: A search was
carried out in the main data sources: Lilacs, Bireme and Pubmed,
in Portuguese and English. Articles that address inclusion requirements were
selected and exclude those that do not. It was also decided to perform a
reverse search, in order to expand and diversify the results. Results:
By crossing the keywords in the database, a total of 475 publications were
found. Joining selected articles in the database and in the reverse search, the
sample was composed of 21 articles in all. Conclusion: Social isolation
negatively affects the mental health of the elderly. Thus, health professionals
must be prepared to face an epidemic of emotional disorders arising from the
confinement of this population.
Keywords: elderly, mental health, pandemic, COVID-19, social isolation.
Resumo
Confinamento domiciliar
e covid-19: uma perspectiva acerca da saúde mental da população geriátrica
Introdução: A pandemia de
COVID-19 é um grande problema de saúde pública atualmente. O isolamento social
é a principal medida estabelecida até o momento para retardar a disseminação
dessa patologia. No entanto, a solidão resultante do confinamento pode ser
particularmente problemática na senescência. Este artigo tem como objetivo
produzir e atualizar reflexões acerca do impacto do isolamento social sobre a
saúde mental de idosos durante a pandemia de COVID-19. Metodologia: Foi
realizada uma busca nas principais fontes de dados: Lilacs,
Bireme e Pubmed, em português e inglês. Foram
selecionados artigos que abordassem os critérios de inclusão, e excluídos os
que não abordassem. Optou-se também por realizar uma busca reversa, no intuito
de ampliar e diversificar os resultados. Resultados: Através do
cruzamento dos descritores na base de dados foi encontrado um total de 475
publicações. Unindo artigos selecionados na base de dados e na busca reversa, a
amostra foi composta por 21 artigos ao todo. Conclusão: O isolamento
social gera impactos negativos acerca da saúde mental da população geriátrica
devido à exacerbação de sentimentos negativos provocados por ele. Assim, os
profissionais de saúde devem estar preparados para enfrentar uma epidemia de
distúrbios emocionais decorrentes do confinamento dessa população.
Palavras-chave: idosos, saúde mental,
pandemia, COVID-19, isolamento social.
Resumen
Contención
en la casa y covid-19: una perspectiva sobre la salud de la poblacion
geriátrica
Introducción: La pandemia de
COVID-19 es un importante problema de salud pública en la actualidad. aislamiento social es la
principal medida utilizada hasta ahora para retrasar la propagación de esta patología. Entonces la soledad resultante del confinamiento puede ser particularmente problemática en
la vejez. Este artículo tiene como objetivo producir y actualizar reflexiones sobre el
impacto del aislamiento
social en la salud mental de las personas
durante la pandemia de COVID-19. Metodología:
Se realizaron búsquedas de las principales fuentes de datos: Lilacs, Bireme y Pubmed, en portugués y inglés. Se seleccionaron los artículos que abordaban los criterios de inclusión y se excluyeron los que no. Fue decidido realizar
una búsqueda inversa para expandir y diversificar los resultados. Resultados: Al cruzar los descriptores en la base de datos,
se encontraron un total de
475 publicaciones. Uniéndose
a los artículos seleccionados
en la base de datos y en la
búsqueda inversa, la muestra estaba compuesta por 21 artículos en
total. Conclusión: El aislamiento
social afecta negativamente la
salud mental de los ancianos al exacerbar los sentimientos negativos. Por lo
tanto, los profesionales de
la salud deben estar preparados para enfrentar una epidemia de trastornos emocionales
resultantes del confinamiento
de esta población.
Palabras-clave: ancianos, salud mental, pandemia, COVID-19,
aislamiento social
The COVID-19 pandemic is the biggest Public Health problem of the
century. The number of new cases increases gradually in several countries. This
fact becomes important since the feeling of danger and threat of illness
generate damage to mental health [1]. Social isolation is the main measure
established so far, in Brazil, to delay the spread of the disease. Although
necessary, isolation is related to the exacerbation of pre-existing psychiatric
disorders and the development of new conditions [2]. Disorders such as anxiety,
depression and insomnia have been the most related to the pandemic [2].
Classified by the World Health Organization (WHO) as the group of
greatest vulnerability to SARS-Cov-2 infection, the elderly, in addition to
previous comorbidities, naturally have the characteristic of immunosenescence [3]. Immunosenescence
is a physiological process of metabolic reduction that directly influences the
immune response of these individuals, increasing the chances of unfavorable
prognosis for COVID-19 [4]. By ensuring the guidelines of the Ministry of
Health [5], regarding the prevention of the elderly to such infection, the
aggravating factor consists in the exacerbation of feelings and emotions
promoted by total isolation when changing the routine of these individuals.
Studies show that loneliness is an independent risk factor for depression in
old age [6].
Aging is characterized as a biopsychosocial process of changes that
occur over the life of an individual [7]. It is a multidimensional process
centered on the correlation between biological, psychological and social
factors. It is estimated that by 2050 there will be more than 2 billion elderly
people living in developing countries [8]. The growth of the elderly population
reinforces the need for a more detailed look at their needs and
vulnerabilities. Thus, it is essential to assess the negative impacts of the
pandemic on the mental health of the geriatric population, and the alternatives
that demonstrate better results to mitigate them.
The outburst of mental health problems during a pandemic is common, as
reported in previous episodes [9-11]. Excessive exposure to drastic news,
abrupt interruption of routine, and social distance are factors that can
contribute to unfavorable outcomes in mental health of elderly [12]. The
objective of the present study is, through a brief literature review, to
characterize the negative impacts of home confinement on the mental health of
the geriatric population during the COVID-19 pandemic.
The purpose of this article is, based on current literature, to produce
and update reflections about the current pandemic context. For this, a
literature review had been carried out through articles that address the theme
of home confinement necessary due to the COVID-19 pandemic, and its impacts on
the mental health of the elderly.
The databases used were PubMed, Lilacs, Bireme, which are considered
important scientific bases of international scope. In this study, it was
decided not to limit the year of publication of the articles, expanding the
results for study. In addition, it was also opted to perform a reverse search,
an article search technique based on the investigation of the references of the
articles selected for the sample, in order to expand and diversify the results.
The inclusion criteria for the sample were: articles that addressed
psychological damage related to the COVID-19 pandemic, the theme of loneliness,
depressive symptoms and insomnia in the geriatric population. The exclusion
criteria were articles that did not address the afore mentioned themes. The
descriptors indexed in the DeCS "social
isolation", "COVID-19", "mental health",
"insomnia", "health of the elderly" and their respective
descriptors in Portuguese were used.
The process of eligibility of articles for the sample of this review
followed three steps: reading the title to suit the theme of the impacts of the
pandemic on the mental health of the elderly; reading the summary to
investigate your ability to answer the guiding question; and reading the full
articles in order to extract the data for later summarization of the outcomes.
By crossing the descriptors in the database, a total of 475 publications
were found. Joining selected articles in the database and in the reverse
search, the sample was composed of 21 articles in all.
The mental health of the geriatric population is often neglected [12].
It is believed that this is related to a belief that the decline in mental
health in this group is a normal part of the aging process, in addition to the
lack of awareness about the symptoms of mental illness in the elderly [13].
Studies show that living alone, or in a nursing home, and the presence of other
comorbidities are also related to prevalence of depression in this group [14].
A cross-sectional study conducted in China revealed that more than half
of the participants demonstrated feelings of psychological distress secondary
to the outbreak of COVID-19 [15]. Isolation during the SARS-CoV-2 pandemic
tends to affect mainly the elderly who have social contact exclusively outside
the home, those who live in long-term homes or without a family nucleus, those
who have no spouse, as well as those who depend on voluntary services and
social assistance [16,17].
Isolation among the elderly can be associated with secondary morbidity
and mortality, neurocognitive complications, and mental health problems
[18,19]. In a study conducted in France, markers of vulnerability were
identified among psychiatric patients during the COVID-19 pandemic, among which
stood out: advanced age, difficulty in fulfilling confinement and hygiene
measures due to cognitive and behavioral disorders [20]. Therefore, it is valid
to emphasize the geriatric vulnerability and the high risk of exacerbation of
psychiatric, cognitive disorders and loss of autonomy within of the pandemic
outlook.
Studies carried out in Hong Kong, during the epidemic of Severe Acute
Respiratory Syndrome (SARS), demonstrated an increase in suicidal events,
especially in women over 65 years of age [21,22]. Likewise, the confinement
resulting from the COVID-19 pandemic, and its financial stressors, are related
to the exacerbation of psychiatric disorders that increase the risk of suicide,
such as: depression, anxiety and post-traumatic stress. In addition to these,
domestic violence, mistreatment and alcohol abuse are also precipitating
suicide that can be adversely increased by isolation [2].
Insomnia is the most common sleep disorder among the elderly [23]. It is
believed that its highest prevalence in this age group is related to the
combination of physical and mental health comorbidities associated with aging
[24]. The anxiety caused by confinement tends to aggravate this situation,
leading to very negative impacts on the quality of life of the elderly, such
as: increased risk of falls, psychological and physical illnesses, in addition
to economic and social costs [24].
A study showed that the COVID-19 pandemic reduced the number of elderly
people doing physical activity [26]. When interviewed, these elderly people
demonstrated to perceive the negative impacts of this reduction on their
well-being [25]. While isolation protects them from infection, it also makes it
difficult to perform daily activities, such as physical exercise, generating a
greater risk of functional decline [25,26].
In Australia, after the implementation of the social distancing
protocols to reduce the spread of COVID-19, the government instituted advances
in telehealth due to the concern with patients with chronic diseases who need
regular consultations with their general practitioners, promoting a reduction
in the rate of grievances [27]. Another study, carried out in a nursing home in
Taiwan, showed a significant reduction in the feeling of loneliness among
residents after videoconferences on virtual platforms [28]. Within this
context, the use of Digital Information and Communication Technologies (ICT)
appears as a possible tool to mitigate negative impacts on both mental and
physical health [29]. Even so, the elderly have
limited access to technological tools when compared to younger patients, which
can be a factor that hinders accessibility to them.
Although little is known about the extent of the negative impacts of the
pandemic among the geriatric population, it is a fact that mental health
professionals must be prepared to face an epidemic of emotional disorders
caused by the confinement of the population [16,20]. Within this context, it is
essential that patients are well informed about the various negative feelings
that will arise during the pandemic. However, if these symptoms become too
frequent and intense, they should be advised to seek specialized professionals
in mental health. Currently, it is suggested to recommend quality of sleep and
regular daily routine, physical exercise, social interaction through virtual
social networks, reduction of exposure time to drastic false information
disseminated on social networks, in addition to encouraging the mobilization of
the elderly patient's family so that they have the necessary support and
dignity [20,30].
The COVID-19 pandemic, social distance and other maneuvers for its
control generate significant negative impacts on the mental health of the
elderly. Although the mental health of this group is often neglected, the
gradual growth in the population's life expectancy makes clear the importance
and need for health policies aimed at the elderly. Psychiatric disorders such
as depression and anxiety were the most described in the current literature,
especially when associated with isolation. In addition, sleep disorders and
increased suicide predictors also appear to have been adversely increased. The
use of digital information and communication technologies seems promising in
terms of reducing the feeling of loneliness during confinement, requiring
further research related to measures that increase the accessibility and
adherence of the geriatric population to them. Stimulating physical activity,
reducing exposure to drastic news, cleaning sleep and mobilizing family members
and caregivers also suggest benefits. There are still no concrete
epidemiological data to corroborate the current negative psychological impacts
of COVID-19, however, given the reports of previous outbreaks, mental health
professionals must be prepared to face an epidemic of emotional disorders
arising from the confinement of the population.