Impact and Implications of Rapid Transition to Virtual Mental Health Care during COVID-19 in older adults

INTRODUCTION: Since being declared a pandemic, COVID-19 has infected over 96 million individuals in the United States alone. Consequently, healthcare systems quickly transitioned from in-person clinic visits to phone or video visits (telemedicine). Various reports have highlighted the detrimental impact of COVID-19 on the mental health and well-being of vulnerable patient populations. Although telepsychiatry services have been largely deemed comparable to in-person visits in terms of patient satisfaction and care outcome, the impact of this transition amongst the elderly during the pandemic is unclear. In this retrospective study, we sought to evaluate how the transition to telemedicine during the pandemic affected psychotherapy visits for older adults. METHODS: Data was collected from three Mental Health Research Network (MHRN)-affiliated health systems from January 2019 through December 2020. All participating healthcare systems provide both comprehensive healthcare and insurance coverage to defined member/patient populations. Data on demographics, including age, race, gender, income, and education level; encounters, diagnoses, and procedures were coded using the same standard across the health systems. The period during the pandemic was defined as visits from March 14, 2020, to December 31, 2020; and the period “before the pandemic” was defined as visits between May 1, 2019, and March 13, 2020. The primary outcome was a disruption in psychotherapy, defined as the absence of psychotherapy visits for more than 45 days after the previous psychotherapy visit. Data were analyzed using logistic mixed-effect models on the dichotomous outcome of interruption in psychotherapy. These models included fixed effects of sociodemographic factors and types of mental health diagnoses. Repeated measurements by patients were included in the models as a random effect. The interaction effect between mental health diagnoses and time (pre- versus during the pandemic) was also examined in the analyses. RESULTS: A total of 19,973 patients aged 65 or older who had any mental health diagnoses during 2019-2020 were included in this study. Of these, 64% had a depressive disorder, 58% had an anxiety disorder, 4% had a psychotic disorder and 16% had dementia. During the pandemic, a large proportion of this population had transitioned virtually, with virtual visits increasing to 39% from 0.3% before the pandemic. Across all socio-demographic groups, psychotherapy visits during the pandemic were found to have less disruption compared to pre-pandemic periods. This finding was statistically significant for patients with any type of underlying mental health diagnosis. Of note, patients with dementia were more likely to have disruptions in psychotherapy, both pre-and during COVID, than patients with other psychiatric conditions. Additionally, as regards improvement in the magnitude of disruptions in care during the pandemic, we found that patients who had autism, personality disorder, or schizophrenia had less improvement in care disruptions during the COVID pandemic compared to patients without these diagnoses. CONCLUSIONS: Overall, during the pandemic, psychotherapy visits were found to be associated with less disruption in psychotherapy compared to the pre-pandemic period. It is not clear what specific factors resulted in this. Further studies examining factors contributing to the varying magnitudes of disruption among different diagnoses in the care of older adults are warranted, especially, considering the post-pandemic potential for expanded telepsychiatry use in this population. THIS RESEARCH WAS FUNDED BY: Mental Health Research Network Grant from NIMH: NIMH: Grant # U19MH092201.