Older adults have been disproportionately impacted by the COVID-19 pandemic, both in terms of mortality and disruptions to care. In 2020, there were at least 41,394 more deaths among dementia patients than expected, according to the Alzheimer’s Association.

“The psychological consequences of social isolation and all the disruptions to daily life have impacted older adults in both community and longer-term settings,” said Brent Forester, M.D., M.Sc., co-president of the American Association for Geriatric Psychiatry (AAGP) and chief of the Division of Geriatric Psychiatry at McLean Hospital in Belmont, Mass.

During a session at APA’s Annual Meeting, Forester and his AAGP colleagues will focus on the challenges facing geriatric psychiatry in the age of COVID-19. They will also touch on some of the changes the organization has made in light of the pandemic, including adjusting AAGP’s leadership structure and transitioning two caucuses—Public Policy and Inclusion, Diversity, Equity in Action (IDEA)—into standing committees with board positions.

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There has been an urgent need to improve access to geriatric psychiatric services for some time, but the pandemic has made the already limited resources available to older adults even sparser, Forester explained.

“The older generation is less technologically savvy, so it’s taken extra effort to engage them in treatment beyond phone calls,” he said. At the McLean geriatric psychiatric outpatient clinic, some research assistants were able to help older adults learn how to use teleconferencing programs. “We went from 10% of our patients using video to 70% using video over the course of a few months,” he said. “But without funding to support such technology-enabling efforts, this model is not widely replicable.”

Geriatric psychiatry is at a crossroads, he said. Increasingly fewer psychiatrists participate in geriatric psychiatry fellowships, with less than half of the available spots getting filled every year. During the symposium, Forester will highlight the benefits of working within this specialty. “Not only are geriatric psychiatrists in great demand, but it’s a privilege to be able to work with these patients,” he said.

This winter, Forester has noticed an increasing demand for psychiatric services among the geriatric population. “Some of it is recurrent symptoms for patients with longstanding histories of psychiatric illness, but we’re also seeing new onset in the setting of the pandemic, and it’s hitting a tipping point,” he said.

Increasingly, older adults are requiring inpatient care and waiting in emergency departments because they’re experiencing suicidality or behavioral symptoms of dementia that are increasingly prevalent with the aging of the population and challenging to manage in both long term care and home care settings. He hypothesized that the governmental upheaval, particularly evidenced by the January 6 violence at the U.S. Capitol, may be especially distressing to older adults.

But there are also silver linings. Forester pointed to the August 2020 report from the Centers for Disease Control and Prevention that found that adults 65 years and older were not experiencing as much anxiety and depression as their younger counterparts (see Psychiatric News). He also noted that researchers have found that older adults may have resiliency that is helping them through the pandemic (see Psychiatric News).

“Older adults have tremendous wisdom and resilience,” Forester said. “Sometimes, we downplay some of their incredible strengths.” ■