Vulnerable Elders, Social Determinants and COVID-19: A perfect storm

The COVID-19 pandemic has brought to an even more glaring spotlight the impact of social determinants of health on the medical and psychiatric morbidity and mortality outcomes from the infection in individuals both in the US and globally. Social determinants of health (SDOH) impact health outcomes for both medical and psychiatric disorders (Compton and Shim 2015). . In this session, we will begin with a vignette presented by Dr. Ahmed that illustrates this phenomenon. Dr. Trinh will then facilitate group discussions of the case. We will transition to an overview of SDOH led by Emily Tan, in which she will discuss how social determinants implicated in poor medical and mental health outcomes include being part of a disadvantaged minority or immigrant group or other marginalized population, experiencing systemic and structural racism, poverty, living environment (including crowding, pollution, and climate change), and having limited access to healthcare. Dr. Trinh will then present on the ways SDOH can increase the likelihood of numerous mental health concerns, including dementia, depression, suicide, anxiety disorders, and substance use disorder– all of which themselves have been identified as risk factors in contracting and experiencing poorer outcomes from COVID-19 infection. Dr. Nix will discuss how the intersectionality of older age, SDOH, and COVID-19 has led to a perfect storm of widespread devastation from the COVID-19 pandemic, impacting medical comorbidity and mortality. Three groups in particular have disproportionately suffered this health burden: (1) ethnic/racial minorities; (2) the socio-economically disadvantaged; and (3) the elderly, especially those living in residential care homes and nursing homes (Ali, Asaria, and Stranges, 2020). We will wrap up the session with a presentation from Dr. Ahmed on lessons learned from the pandemic and future directions, with a focus on how we can support elders and those affected by SDOH.