Considerations for how to mitigate the psychological impacts of COVID-19 in older adults

Document Type: Letter to the editor


1 Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Gerontology, University of Social Welfare & Rehabilitation Sciences, Tehran, Iran


There have been numerous outbreaks of infectious diseases in the world. On January 30, 2020, the
World Health Organization (WHO) declared the outbreak of novel coronavirus disease (COVID-19)
a Public Health Emergency.1 The pandemic has caused not only the risk of death, but also too much
psychological pressure on people all over the world.
Older adults are more susceptible to severe infections, cascade of complications, disability, and
death.2, 3 The elderly might also be more vulnerable to mental health problems because of their
higher risk of infection.4 They may experience adverse feelings such as fear of death because of
the potential lethality of the illness. Some of them claim that dying from coronavirus is a horrible
nuisance for them because none of their family members would be able to attend their funeral.
They are also afraid of being hospitalized in medical facilities that lack sufficient equipment.
They fear that if they contract the virus, no one will be able to visit or help them. The other
fear the elderly experience is the infection of their spouses, children, and siblings. Dismal and
disappointing news spreading via social media could also increase their fear and anxiety. Social
distancing; reduced contact with others, especially loved ones; inability to take part in routine
day-to-day activities (e.g. shopping for necessities); and cancellation of community events lead
to boredom, frustration, and a sense of loneliness and isolation, which is distressing to older
adults. This problem is particularly prominent in older adults who have limited access to the
Internet-based services and smartphones.5, 6
The statement “coronavirus is mostly deadly to the elderly” increases a sense of fear and
worthlessness in them. Some older adults have become extremely dependent on their children
because they fear in-store shopping of essential items in large supermarkets, while they are not
skilled in shopping online; this problem adds to their sense of worthlessness.
Furthermore, restrictions on public transport and the fear of referring to treatment centers
because of the contagion have become major barriers to receiving maintenance treatments for
this age-group. Limited access to Internet-based services and smartphones increases the problems
of this age-group.
Therefore, stakeholders and health policymakers should take measures to prevent the potential
mental health problems that might arise in older adults who are quarantined during the COVID-
19 outbreak. Here are some suggestions to help mitigate the consequences of quarantine among
older adults:
- Give older adults as much information as possible
Older adults often have catastrophic appraisals of any physical symptoms they experience,
which may further increase feelings of fear and anxiety. This fear might be exacerbated by
inadequate information. There is long-standing evidence to suggest that news has a direct impact
on mental health. Feelings of uncertainty and doubt have long been associated with anxiety.6
Therefore, it is necessary to ensure that older adults shape a good understanding of the disease
and the reasons for quarantine.
- Provide information to older adults mainly via broadcast media
Fast transmission of COVID-19 restricts face-to-face educational interventions. Moreover,
Internet-based services, smartphones, social media (e.g. WhatsApp), and electronic books are not
widely available to older adults. Therefore, governments and community-based health services
should provide enough information about the disease via mass media, such as radio and television,
which are most accessible to the elderly.
- Provide community-based health services to address health issues of older adults
Community-based health services, including primary care, community nursing, and pharmacy
services should provide telephone-based consultation services addressing health status, treatment,
and medication management. Health services must also communicate adequate information to
older adults in quarantine about what to do in the case of developing illness symptoms. It would
help reassure the elderly that they would be taken care of if they fell ill.
- Provide mental health services to guide older people on how to manage their negative
emotions and feelings of isolation
Mental health services should consider strategies to guide older people on how to manage
stress, anger, and other negative emotions, and how to have effective communication with loved
ones who do not live with them, so that the feelings of loneliness, stress, and anger are reduced.
Such psychoeducational programs should be broadcast on mass media, which are most accessible
to the elderly. Moreover, the elderly should receive practical advice on the ways which help them
to reduce boredom and about the importance of having constant communication with their loved
ones to overcome feelings of isolation.
- Provide adequate supplies
Public health authorities should provide the older adults with basic supplies, such as food,
masks, and disinfectants during quarantine. Some studies have shown that insufficient basic
supplies during quarantine are associated with the feelings of frustration, anxiety, and anger.6
Considering the conditions in near future and the possibility of lengthy quarantines, respective
organizations should practice effective strategies to enhance mental health in the society, especially
among older adults. Some strategies that stakeholders and health policy-makers should implement
to provide effective services to older adults who are quarantined at home during the COVID-19
pandemic are suggested in the present article.


  1. World Health Organization. Novel Coronavirus (2019-nCoV) situation reports. WHO; 2020. [Cited 24 April 2020]. Available from:
  2. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Internal Medicine. 2020. [a head of print]
  3. Garnier-Crussard A, Forestier E, Gilbert T, Krolak-Salmon P. Novel Coronavirus (COVID-19) Epidemic: What Are the Risks for Older Patients?. Journal of the American Geriatrics Society. 2020. [a head of print]
  4. Yang Y, Li W, Zhang Q, et al. Mental health services for older adults in China during the COVID-19 outbreak. The Lancet Psychiatry. 2020;7:e19.
  5. Jeong H, Yim HW, Song YJ, et al. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and Health. 2016;38:e2016048.
  6. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet. 2020;395:912-20.