The Older Adult Pandemic Inventory: Preliminary Findings from an Outpatient Geriatric Psychiatry Clinic

Abstract

<h3>Introduction</h3> Older⁎Rachel Zack Ishikawa and Jennifer Gatchel are joint co-authors. adults are disproportionately affected by COVID-19. They are more likely than younger adults to be hospitalized with the illness and more likely to die from it, with 8 out of 10 deaths due to COVID-19 occurring among adults aged 65+.¹ Patients with psychiatric disorders have also been particularly impacted, with higher levels of anxiety, depression, stress, anger, insomnia and suicidal ideation, compared with those without psychiatric disorders.² Understanding specific pandemic-related concerns of older adults with psychiatric comorbidity is essential to providing appropriate treatment and to preventing illness onset or exacerbation in this vulnerable population. <h3>Methods</h3> The study involved design and administration of a brief survey, the Older Adult Pandemic Inventory (OAPI), to patients aged 60 years and above in the outpatient psychiatry clinic of a large urban general hospital. The OAPI was developed by geriatric psychiatry outpatient clinicians, and additional input was provided by the hospital's Quality Improvement (QI) committee. The OAPI consisted of 6 question domains related to pandemic-related challenges and unmet needs around mental health, physical health, psychosocial and financial well-being, as well as positive changes (e.g., growth, coping, self-efficacy). Clinicians administered the survey to patients on a rolling basis during telehealth visits in October and November 2020 and entered responses using the REDCap online survey data collection platform. <h3>Results</h3> Survey data were collected from thirty patients between October and November 2020. 67% of patients were female, and 96% identified as non-Hispanic white, with a mean age of 75 years (Range: 60-78y). Primary diagnostic classes included depressive (60%) and anxiety disorders (57%); co-morbidity/multiple diagnoses were permitted. The majority of respondents endorsed at least one pandemic-related challenge in each category. The most common mental health or emotional challenges were anxiety (93%), depression (77%), uncertainty about the trajectory of the pandemic (70%) and boredom (67%). The most common physical health challenge was difficulty maintaining physical activity (62%). Problems related to psychosocial well-being included discomfort seeing others who are unmasked (73%) and feeling unsafe in places of business (53%). 61% of participants denied financial challenges. 69% identified access to friends and family as their primary unmet need. 67% of participants reported that the pandemic has brought positive changes, including improved coping ability, increased comfort with technology, and spiritual growth. Clinicians reported that the time required to administer the survey (∼10 minutes) was a major barrier to asking the questions, given limited visit encounter times. <h3>Conclusions</h3> Older adult patients in a general outpatient psychiatric clinic reported pandemic-related challenges in mental and physical health and social well-being as well as unmet needs on the OAPI survey. The most prominent themes centered on anxiety, uncertainty, challenges maintaining physical activity and social connection, and feeling uncomfortable with mitigation behaviors of others. A majority of respondents also endorsed positive changes resulting from the pandemic. Ongoing development and revision and broader administration of the OAPI to diverse populations will clarify the specific concerns and needs of older psychiatric patients during the pandemic. Alternative approaches for administering the survey, including options for online patient self-administration, are currently being explored. <h3>Funding</h3> Not applicable