Depression and Anxiety in Residents of a Retirement Community during the Covid-19 Pandemic

Research Article

J Fam Med. 2021; 8(9): 1281.

Depression and Anxiety in Residents of a Retirement Community during the Covid-19 Pandemic

Aguilar EA¹*, Barry S¹, Chavez M¹, Chapple AG², Ducote R¹, Johnson A¹, Ali L¹, Pattabhi R¹, Poudel P¹ and Reske T¹

1Department of Internal Medicine, LSU Health Science Center School of Medicine, New Orleans, Louisiana, USA

2Department of Biostatistics, LSU Health Science Center School of Public Health, New Orleans, Louisiana, USA

*Corresponding author: Aguilar EA, Department of Internal Medicine, LSU Health Science Center School of Medicine, 1542 Tulane Avenue, New Orleans, LA 70112, USA

Received: November 03, 2021; Accepted: December 01, 2021; Published: December 08, 2021

Abstract

Background: During the COVID-19 pandemic, the State of Louisiana implemented a quarantine leading to a decrease in social interaction, a risk factor for anxiety and depression among the elderly population. The objective was to determine if quarantine would negatively affect the mental health of the elderly in a residential community.

Methods: This limited longitudinal assessment and analysis, uitilizing the Geriatric Depression Scale (GDS) and Geriatric Anxiety Inventory (GAI) to assess depression and anxiety during quarantine. Data was collected three times over 12 weeks during the quarantine from 46 of 57 residents stratified as nursing home, assisted living, and independent living of a Continuing Care Retirement Community (CCRC) in the New Orleans area. 37 (80%) of 46 patients were females, mean age 86.1 (SD 9.1) years old; 25 (54.3%) were nursing home residents, 13 (28.3%) were in assisted living, and 8 (17.4 %) were in an independent living community.

Results: 16 (34.8%) patients were diagnosed with depression before being surveyed. Five (10.9%) had previous diagnoses of anxiety. Anxiety scores decreased significantly from baseline (average 4.35 vs. 3.28, p-value = 0.045) at 6 weeks, but did not change from 0 to 12 weeks or 6 -12 weeks. Depression, scores did not change significantly between time periods. Our data indicate a trend toward an increase in depression and anxiety during periods of pandemic quarantine isolation.

Conclusion: Assessing these indicators may help mitigate economic burden and cognitive decline resulting from the complications of depression and anxiety in elderly populations.

Keywords: Depression; Anxiety; COVID-19; Elderly

Introduction

During the COVID-19 global pandemic, people worldwide were subjected to an unprecedented quarantine and ensuing social isolation to decrease the risks of infection and spread. Research indicates that social isolation and loneliness increase the risk of mental disorders, although we know less about the contributions of different aspects of isolation. In the general population of older adults, their social networks’ structure and function are strongly intertwined with anxiety and depression symptoms [1]. To determine whether being quarantined while living in a residential community would negatively affect the mental health of the elderly, we assessed levels of anxiety and depression in a group of residents at a Continuing Care Retirement Community (CCRC) in the New Orleans metropolitan area at three times during the quarantine: baseline, 6 weeks, and 12 weeks.

Being quarantined during the COVID-19 pandemic led to increased levels of stress, depression, irritability, insomnia, fear, confusion, anger, frustration, and boredom in people of all ages [2]. Elderly individuals in continuing care facilities were identified early in the pandemic as most vulnerable to COVID-19 and may have experienced increased fear of exposure to sources of infection, including family members, friends, and facility staff. At the same time, the physical distancing measures, limitation of group activities, disruption of routine, and cessation of family visits imposed by most facilities increased the residents’ social isolation and may have led to higher levels of depression, anxiety, psychosomatic preoccupations, insomnia, and increased vulnerability to preexisting physical or psychological conditions [3].

The feeling of loneliness is a significant public health concern among elders and can likely increase the risk of mental health disorders, including anxiety and depression [4], which are the most common mental disorders among the elderly but often go undiagnosed [5]. Disconnection from social networks itself places older adults at greater risk of depression and anxiety [6]. Furthermore, anxiety and depression have been linked to an increase in mortality among elderly populations [7], not explained by poor physical health [8].

To mitigate infection rates, social quarantine became the norm during the COVID-19 pandemic, placing older adults at increased risk for anxiety and depression. A better understanding of the mental health effects of this unprecedented social quarantine may improve diagnosis and treatment of anxiety and depression in the elderly population.

Methods

To measure anxiety and depression during the period of social quarantine, we developed a protocol to assess residents of a CCRC at baseline, 6 weeks, and 12 weeks during the quarantine period [9]. We selected a single CCRC site with three separate living arrangements and levels of care-nursing home, assisted living, and independent living-and excluded patients with a diagnosis of dementia. The sample consisted of 57 cognitively intact adults aged 65 and older. Care levels were stratified as follows; nursing home (n = 28), assisted living (n = 20), and independent living (n = 9).

To assess levels of anxiety, we used the Geriatric Anxiety Inventory (GAI) (The GAI was used with licensing from UniQuest eShop (#1528), University of Queensland, Australia) because of its validated accuracy and sensitivity as a screening tool with the geriatric population [10]. Previous studies showed that the GAI has good psychometric properties [11]. To assess the quarantine’s effects on depression, we selected the 15-item Geriatric Depression Scale-Short Form [12] because of its validity in the geriatric population [13].

Following mandatory safety regulations per the State of Louisiana and acting as the intermediary between the research team and the subjects, the CCRC facility staff administered the questionnaires to avoid contact between the research team and the subjects. To comply with quarantine protocols and minimize COVID-19 exposure, completed questionnaires, which were anonymous and de-identified, were scanned by the CCRC staff and returned to the research team. We report the number and percentage who answered �yes� to each answer. Dependent one-sample t-tests were used to determine whether overall anxiety and depression scores changed significantly from 0-6 weeks, 6-12 weeks, or 0-12 weeks. These tests were used because the same set of patients who answered surveys at week 0 also answered these surveys at other time periods, which violates traditional assumptions of independence in ANOVA, twosample t-tests, and similar measures. We do not report p-values for individual item comparisons.

Results

Following the COVID-19 quarantine restrictions of the CCRC, 46 of the 57 patients in the original sample completed surveys at all three time points: baseline, 6, and 12 weeks. Reasons for incompletion included being discharged from the CCRC during the survey period (1), being away from the facility at the time of testing (3), refusal to take the testing (3), inability to complete the tests (1), and death (2). Thirty-seven (80%) of the 46 patients were females, with a mean age of 86.1 (SD 9.1) years old; 25 (54.3%) were nursing home residents, 13 (28.3%) were in assisted living, and 8 (17.4 %) were in an independent living community. Sixteen (34.8%) patients were diagnosed with depression before taking the survey, and five (10.9%) had previously diagnosed anxiety. Table 1 (depression) and Table 2 (anxiety) display the number and percentage of people who answered yes to each survey item over time.