Addressing Behavioral Health of the Diverse Older Adults in the Various Health Care Setting during COVID pandemia.

During COVID-19 pandemia being in a “golden age” group, having chronic health conditions make people more susceptible to the virus. The need to socially distance creates the sense of isolation, affects older adults routines, mass transportation, and some “non-essential” social services. Those factors in addition to the uncertainty and fear COVID-19 creates, and the potential for older adults to be more vulnerable to the virus and higher mortality rates among older adults may exacerbate depression and anxiety for which effective and safe treatment interventions are required. Virtual partial hospitalization program offers affordable and convenient opportunity to address mental health needs of older adults. There were a number of challenges with transitioning to and utilizing a telehealth platform for psychiatric evaluation in the long term care setting during the COVID 19 pandemic. First, staffing of facilities was stretched during the pandemic, making facilitation of Tele visits difficult. Without staff present through the entire visit to sort out technical difficulties, repeat questions and instructions for patients with hearing difficulties, and help patients complete questionnaires, evaluation was significantly limited. Additionally, the restrictions in place to mitigate viral transmission to residents and staff played unique roles in the psychiatric population. Isolation, lack of intellectual stimulation though group activities/dining, and halted family visits contributed to depression, anxiety, and agitation. Compounded with limited access to staff for therapy and medical management, we certainly observed a decline in motivation and functioning in our patients. In sum, while telehealth was successfully used in many settings during the COVID 19 pandemic, unique challenges in the geriatric psychiatry population residing in long term care facilities made implementation difficult. Lack of in-person visits and staffing shortages may have also contributed to escalation of psychiatric symptoms. Offering tele-psychiatry to diverse VA older adult patient population appears to be a valuable option although especially in the rural areas may present some challenges including irregularities of the internet connection, limited equipment availability as well as limited proficiency of the patient's utilization of the various telehealth platforms. However with appropriate training and equipment supplies those challenges can be resolved.