Skip to main content
Short Review

Impact of COVID-19 on the Mental Health of Geriatric Residents in Long-Term Care Facilities

Published Online:https://doi.org/10.1024/1662-9647/a000284

Abstract. COVID-19 pandemic has raised serious concerns about the mental well-being of the older residents of long-term care facilities. The authors discuss the developing mental health crisis in this population, focusing on the major psychiatric manifestations of the COVID-19 and their underlying pathophysiology. Despite early reports of resilience among older persons against the impact of chronic lockdown, current literature suggests an overall negative impact on the mental health in this population.

References

  • Adhanom Ghebreyesus, T. (2020). Addressing mental health needs: An integral part of COVID‐19 response. World Psychiatry, 19(2), 129–130. https://doi.org/10.1002/wps.20768 First citation in articleCrossrefGoogle Scholar

  • Arnold, C. (2020). Could COVID delirium bring on dementia? Nature, 588(7836), 22–24. https://doi.org/10.1038/d41586-020-03360-8 First citation in articleCrossrefGoogle Scholar

  • Asmundson, G. J. G., Paluszek, M. M., Landry, C. A., Rachor, G. S., McKay, D., & Taylor, S. (2020). Do pre-existing anxiety-related and mood disorders differentially impact COVID-19 stress responses and coping? Journal of Anxiety Disorders, 74, 102271. https://doi.org/10.1016/j.janxdis.2020.102271 First citation in articleCrossrefGoogle Scholar

  • Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet, 395(10227), 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8 First citation in articleCrossrefGoogle Scholar

  • Brown, E., Gray, R., Lo Monaco, S., O’Donoghue, B., Nelson, B., Thompson, A., Francey, S., & McGorry, P. (2020). The potential impact of COVID-19 on psychosis: A rapid review of contemporary epidemic and pandemic research. Schizophrenia Research, 222, 79–87. https://doi.org/10.1016/j.schres.2020.05.005 First citation in articleCrossrefGoogle Scholar

  • Bu, F., Steptoe, A., & Fancourt, D. (2020). Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health, 186, 31–34. https://doi.org/10.1016/j.puhe.2020.06.036 First citation in articleCrossrefGoogle Scholar

  • Butler, M., Pollak, T. A., Rooney, A. G., Michael, B. D., & Nicholson, T. R. (2020). Neuropsychiatric complications of Covid-19. British Medical Journal, 371, Article m3871. https://doi.org/10.1136/bmj.m3871 First citation in articleGoogle Scholar

  • Cacioppo, J. T., Cacioppo, S., Capitanio, J. P., & Cole, S. W. (2015). The neuroendocrinology of social isolation. Annual Review of Psychology, 66, 733–767. https://doi.org/10.1146/annurev-psych-010814-015240 First citation in articleCrossrefGoogle Scholar

  • Centers for Disease Control, Prevention (CDC). (2020, March 28). COVID-19 cases, deaths, and trends in the US|CDC COVID data tracker. https://covid.cdc.gov/covid-data-tracker First citation in articleGoogle Scholar

  • Cipriani, G., Danti, S., Nuti, A., Carlesi, C., Lucetti, C., & Di Fiorino, M. (2020). A complication of coronavirus disease 2019: Delirium. Acta Neurologica Belgica, 120(4), 1–6. https://doi.org/10.1007/s13760-020-01401-7 First citation in articleCrossrefGoogle Scholar

  • Cucinotta, D., & Vanelli, M. (2020). WHO declares COVID-19 a pandemic. Acta Bio-Medica: Atenei Parmensis, 91(1), 157–160. https://doi.org/10.23750/abm.v91i1.9397 First citation in articleGoogle Scholar

  • Dichter, M. N., Sander, M., Seismann-Petersen, S., & Köpke, S. (2020). COVID-19: It is time to balance infection management and person-centered care to maintain mental health of people living in German nursing homes. International Psychogeriatrics, 32(10), 1157–1160. https://doi.org/10.1017/S1041610220000897 First citation in articleCrossrefGoogle Scholar

  • El Haj, M., Altintas, E., Chapelet, G., Kapogiannis, D., & Gallouj, K. (2020). High depression and anxiety in people with Alzheimer’s disease living in retirement homes during the Covid-19 crisis. Psychiatry Research, 291, Article 113294. https://doi.org/10.1016/j.psychres.2020.113294 First citation in articleCrossrefGoogle Scholar

  • Fong, T. G., Jones, R. N., Shi, P., Marcantonio, E. R., Yap, L., Rudolph, J. L., Yang, F. M., Kiely, D. K., & Inouye, S. K. (2009). Delirium accelerates cognitive decline in Alzheimer disease. Neurology, 72(18), 1570–1575. https://doi.org/10.1212/WNL.0b013e3181a4129a First citation in articleCrossrefGoogle Scholar

  • Gerritsen, D. L., & Oude Voshaar, R. C. (n.d.). The effects of the COVID-19 virus on mental healthcare for older people in The Netherlands. International Psychogeriatrics, 32, 1–4. https://doi.org/10.1017/S1041610220001040 First citation in articleGoogle Scholar

  • Goldberg, T. E., Chen, C., Wang, Y., Jung, E., Swanson, A., Ing, C., Garcia, P. S., Whittington, R. A., & Moitra, V. (2020). Association of delirium with long-term cognitive decline: A meta-analysis. JAMA Neurology, 77(11), 1373–1381. https://doi.org/10.1001/jamaneurol.2020.2273 First citation in articleCrossrefGoogle Scholar

  • Gupta, D., & Morley, J. E. (2014). Hypothalamic-pituitary-adrenal (HPA) axis and aging. Comprehensive Physiology, 4(4), 1495–1510. https://doi.org/10.1002/cphy.c130049 First citation in articleCrossrefGoogle Scholar

  • Habiger, T. F., Achterberg, W. P., Flo, E., & Husebo, B. S. (2019). Psychosis symptoms in nursing home residents with and without dementia: Cross-sectional analyses from the COSMOS Study. International Journal of Geriatric Psychiatry, 34(5), 683–691. https://doi.org/10.1002/gps.5067 First citation in articleCrossrefGoogle Scholar

  • Hawkley, L. C., Cole, S. W., Capitanio, J. P., Norman, G. J., & Cacioppo, J. T. (2012). Effects of social isolation on glucocorticoid regulation in social mammals. Hormones and Behavior, 62(3), 314–323. https://doi.org/10.1016/j.yhbeh.2012.05.011 First citation in articleCrossrefGoogle Scholar

  • Holmes, E. A., O’Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Silver, R. C., Everall, I., & Ford, T. (2020). Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science. The Lancet Psychiatry, 7(6), 547–560. https://doi.org/10.1016/S2215-0366(20)30168-1 First citation in articleCrossrefGoogle Scholar

  • Hu, W., Su, L., Qiao, J., Zhu, J., & Zhou, Y. (2020). COVID-19 outbreak increased risk of schizophrenia in aged adults. PsyChinaXiv, 1, 2–4. First citation in articleGoogle Scholar

  • Iadecola, C., Anrather, J., & Kamel, H. (2020). Effects of COVID-19 on the Nervous System. Cell, 183(1), 16–27.e1. https://doi.org/10.1016/j.cell.2020.08.028 First citation in articleCrossrefGoogle Scholar

  • Iob, E., Kirschbaum, C., & Steptoe, A. (2020). Persistent depressive symptoms, HPA-axis hyperactivity, and inflammation: The role of cognitive-affective and somatic symptoms. Molecular Psychiatry, 25(5), 1130–1140. https://doi.org/10.1038/s41380-019-0501-6 First citation in articleCrossrefGoogle Scholar

  • Kaelen, S., van den Boogaard, W., Pellecchia, U., Spiers, S., Cramer, C. D., Demaegd, G., Fouqueray, E., van den Bergh, R., Goublomme, S., Decroo, T., Quinet, M., Hoof, E. V., & Draguez, B. (2021). How to bring residents’ psychosocial well-being to the heart of the fight against Covid-19 in Belgian nursing homes: A qualitative study. PLoS One, 16(3), Article e0249098. https://doi.org/10.1371/journal.pone.0249098 First citation in articleCrossrefGoogle Scholar

  • Kennedy, M., Enander, R. A., Tadiri, S. P., Wolfe, R. E., Shapiro, N. I., & Marcantonio, E. R. (2014). Delirium risk prediction, healthcare use and mortality of elderly adults in the emergency department. Journal of the American Geriatrics Society, 62(3), 462–469. https://doi.org/10.1111/jgs.12692 First citation in articleCrossrefGoogle Scholar

  • Kępińska, A. P., Iyegbe, C. O., Vernon, A. C., Yolken, R., Murray, R. M., & Pollak, T. A. (2020). Schizophrenia and influenza at the centenary of the 1918–1919 Spanish influenza pandemic: Mechanisms of psychosis risk. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00072 First citation in articleCrossrefGoogle Scholar

  • Khademi, F., Moayedi, S., Golitaleb, M., & Karbalaie, N. (2020). The COVID‐19 pandemic and death anxiety in the elderly. International Journal of Mental Health Nursing, 12, 403. https://doi.org/10.1111/inm.12824 First citation in articleGoogle Scholar

  • Kuo, C.-L., Pilling, L. C., Atkins, J. L., Masoli, J. A., Delgado, J., Kuchel, G. A., & Melzer, D. (2020). APOE E4 genotype predicts severe Covid-19 in the UK biobank community cohort. MedRxiv, 5(7), 20094409. https://doi.org/10.1101/2020.05.07.20094409 First citation in articleGoogle Scholar

  • LaHue, S. C., Douglas, V. C., & Miller, B. L. (2020). The one-two punch of delirium and dementia during the COVID-19 pandemic and beyond. Frontiers in Neurology, 11, Article 1409. https://doi.org/10.3389/fneur.2020.596218 First citation in articleCrossrefGoogle Scholar

  • Langa, K. M., Larson, E. B., Crimmins, E. M., Faul, J. D., Levine, D. A., Kabeto, M. U., & Weir, D. R. (2017). A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51–58. https://doi.org/10.1001/jamainternmed.2016.6807 First citation in articleCrossrefGoogle Scholar

  • Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020). The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public: A systematic review and meta-analysis. Psychiatry Research, 291, Article 113190. https://doi.org/10.1016/j.psychres.2020.113190 First citation in articleGoogle Scholar

  • MacLullich, A. M., Ferguson, K. J., Miller, T., de Rooij, S. E., & Cunningham, C. (2008). Unravelling the pathophysiology of delirium: A focus on the role of aberrant stress responses. Journal of Psychosomatic Research, 65(3), 229–238. https://doi.org/10.1016/j.jpsychores.2008.05.019 First citation in articleCrossrefGoogle Scholar

  • Magaziner, J., German, P., Zimmerman, S. I., Hebel, J. R., Burton, L., Gruber-Baldini, A. L., May, C., & Kittner, S. (2000). The prevalence of dementia in a statewide sample of new nursing home admissions aged 65 and older: Diagnosis by expert panel. The Gerontologist, 40(6), 663–672. https://doi.org/10.1093/geront/40.6.663 First citation in articleCrossrefGoogle Scholar

  • Mazza, M. G., De Lorenzo, R., Conte, C., Poletti, S., Vai, B., Bollettini, I., Melloni, E. M. T., Furlan, R., Ciceri, F., Rovere-Querini, P., & Benedetti, F. (2020). Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, Behavior, and Immunity, 89, 594–600. https://doi.org/10.1016/j.bbi.2020.07.037 First citation in articleCrossrefGoogle Scholar

  • McArthur, C., Saari, M., Heckman, G. A., Wellens, N., Weir, J., Hebert, P., Turcotte, L., Jbilou, J., & Hirdes, J. P. (2021). Evaluating the effect of COVID-19 pandemic lockdown on long-term care residents’ mental health: A data-driven approach in New Brunswick. Journal of the American Medical Directors Association, 22(1), 187–192. https://doi.org/10.1016/j.jamda.2020.10.028 First citation in articleCrossrefGoogle Scholar

  • Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: From evolutionary imperative to modern treatment target. Nature Reviews Immunology, 16(1), 22–34. https://doi.org/10.1038/nri.2015.5 First citation in articleCrossrefGoogle Scholar

  • Muneer, A. (2016). Bipolar disorder: Role of inflammation and the development of disease biomarkers. Psychiatry Investigation, 13(1), 18–33. https://doi.org/10.4306/pi.2016.13.1.18 First citation in articleCrossrefGoogle Scholar

  • Noone, R., Cabassa, J. A., Gardner, L., Schwartz, B., Alpert, J. E., & Gabbay, V. (2020). Letter to the Editor: New onset psychosis and mania following COVID-19 infection. Journal of Psychiatric Research, 130, 177–179. https://doi.org/10.1016/j.jpsychires.2020.07.042 First citation in articleCrossrefGoogle Scholar

  • O’Hanlon, S., & Inouye, S. K. (2020). Delirium: A missing piece in the COVID-19 pandemic puzzle. Age and Ageing, https://doi.org/10.1093/ageing/afaa094 First citation in articleCrossrefGoogle Scholar

  • Okusaga, O., Yolken, R. H., Langenberg, P., Lapidus, M., Arling, T. A., Dickerson, F. B., Scrandis, D. A., Severance, E., Cabassa, J. A., Balis, T., & Postolache, T. T. (2011). Association of seropositivity for influenza and coronaviruses with history of mood disorders and suicide attempts. Journal of Affective Disorders, 130(1), 220–225. https://doi.org/10.1016/j.jad.2010.09.029 First citation in articleCrossrefGoogle Scholar

  • Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 88, 901–907. https://doi.org/10.1016/j.bbi.2020.05.026 First citation in articleCrossrefGoogle Scholar

  • Paulin, E. (n.d.). Is isolation killing America’s nursing home residents. AARP. http://www.aarp.org/caregiving/health/info-2020/Covid-isolation-killing-nursing-home-residents.html First citation in articleGoogle Scholar

  • Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., & Abel, K. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. https://doi.org/10.1016/S2215-0366(20)30308-4 First citation in articleCrossrefGoogle Scholar

  • Psychiatric Times. (2020, December 10). The impact of COVID-19 on mental health in long-term care settings. https://www.psychiatrictimes.com/view/the-impact-of-Covid-19-on-mental-health-in-long-term-care-settings First citation in articleGoogle Scholar

  • Rahman, M. A., Islam, K., Rahman, S., & Alamin, M. (2020). Neurobiochemical cross-talk between COVID-19 and Alzheimer’s disease. Molecular Neurobiology, 58(3), 1017–1023. https://doi.org/10.1007/s12035-020-02177-w First citation in articleCrossrefGoogle Scholar

  • Rajkumar, R. P. (2020). Bipolar disorder, COVID-19, and the risk of relapse. Bipolar Disorders, 22(6), 640. https://doi.org/10.1111/bdi.12947 First citation in articleCrossrefGoogle Scholar

  • Robb, C. E., de Jager, C. A., Ahmadi-Abhari, S., Giannakopoulou, P., Udeh-Momoh, C., McKeand, J., Price, G., Car, J., Majeed, A., Ward, H., & Middleton, L. (2020). Associations of social isolation with anxiety and depression during the early COVID-19 pandemic: A survey of older adults in London, UK. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.591120 First citation in articleCrossrefGoogle Scholar

  • Santini, Z. I., Jose, P. E., York Cornwell, E., Koyanagi, A., Nielsen, L., Hinrichsen, C., Meilstrup, C., Madsen, K. R., & Koushede, V. (2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): A longitudinal mediation analysis. The Lancet Public Health, 5(1), e62–e70. https://doi.org/10.1016/S2468-2667(19)30230-0 First citation in articleCrossrefGoogle Scholar

  • Seitz, D., Purandare, N., & Conn, D. (2010). Prevalence of psychiatric disorders among older adults in long-term care homes: a systematic review. International Psychogeriatrics, 22(7), 1025–1039. First citation in articleCrossrefGoogle Scholar

  • Smith, K. J., Gavey, S., RIddell, N. E., Kontari, P., & Victor, C. (2020). The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 112, 519–541. https://doi.org/10.1016/j.neubiorev.2020.02.002 First citation in articleCrossrefGoogle Scholar

  • Steardo, L., Steardo, L., & Verkhratsky, A. (2020). Psychiatric face of COVID-19. Translational Psychiatry, 10(1), 1–12. https://doi.org/10.1038/s41398-020-00949-5 First citation in articleCrossrefGoogle Scholar

  • Taquet, M., Luciano, S., Geddes, J. R., & Harrison, P. J. (2020). Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62,354 COVID-19 cases in the USA. The Lancet Psychiatry, 8(2), 130–140. https://doi.org/10.1016/S2215-0366(20)30462-4 First citation in articleCrossrefGoogle Scholar

  • Vahia, I. V., Jeste, D. V., & Reynolds, C. F. (2020). Older adults and the mental health effects of COVID-19. JAMA, 324(22), 2253–2254. https://doi.org/10.1001/jama.2020.21753 First citation in articleCrossrefGoogle Scholar

  • Varatharaj, A., Thomas, N., Ellul, M. A., Davies, N. W., Pollak, T. A., Tenorio, E. L., Sultan, M., Easton, A., Breen, G., Zandi, M., & Coles, J. P. (2020). Neurological and neuropsychiatric complications of COVID-19 in 153 patients: A UK-wide surveillance study. The Lancet Psychiatry, 7(10), 875–882. https://doi.org/10.1016/S2215-0366(20)30287-X First citation in articleCrossrefGoogle Scholar

  • Victor, C. R. (2012). Loneliness in care homes: A neglected area of research? Aging Health, 8(6), 637–646. https://doi.org/10.2217/ahe.12.65 First citation in articleCrossrefGoogle Scholar

  • Wang, H., Li, T., Barbarino, P., Gauthier, S., Brodaty, H., Molinuevo, J. L., Xie, H., Sun, Y., Yu, E., Tang, Y., Weidner, W., & Yu, X. (2020). Dementia care during COVID-19. The Lancet, 395(10231), 1190–1191. https://doi.org/10.1016/S0140-6736(20)30755-8 First citation in articleCrossrefGoogle Scholar

  • Wang, Q., Xu, R., & Volkow, N. D. (n.d.). Increased risk of COVID-19 infection and mortality in people with mental disorders: Analysis from electronic health records in the United States. World Psychiatry, n/a(n/a). https://doi.org/10.1002/wps.20806 First citation in articleGoogle Scholar

  • Zimmerman, S., Sloane, P. D., & Reed, D. (2014). Dementia prevalence and care in assisted living. Health Affairs, 33(4), 658–666. https://doi.org/10.1377/hlthaff.2013.1255 First citation in articleCrossrefGoogle Scholar