The impact of social isolation and loneliness on resilient older adults with remitted depressive disorders during the COVID-19 pandemic: two case studies

AUTHORS: Catherine Gonzalez M.D. and Nancy Donovan M.D. INTRODUCTION: Social Isolation and loneliness (SI/L) representing objective and subjective deficits in social relationships and interactions, are important factors affecting the mental health of older adults. They are also major risk factors for cognitive decline, cardiovascular disease, and premature mortality. During the COVID-19 pandemic, instituted measures such as social distancing, stay-at-home regulations, public closures, and activity limitations, increased social isolation and loneliness for many. It is important for clinicians to recognize how SI/L contributed to worsening psychiatric symptoms during the acute pandemic, the extent to which they still persist and their potential long lasting sequelae. METHOD/CASE: These case presentations will highlight the impact of SI/L in two elderly patients receiving psychiatric care in an academic outpatient geriatric psychiatry clinic during the COVID-19 pandemic. The first case is a 75-year-old man with history of depression following the death of his wife who was euthymic and stable on a low dose of an SSRI since 2017. Between 2017-2020, he was active, well-functioning, attended religious services weekly, engaged in group grief counseling at his temple, took university extension classes, and visited regularly with family and friends. Due to the COVID-19 pandemic and social restriction measures, he lost all in person connections (counseling, classes, services), and stopped seeing others out of fear of infection and increasing depression. As restrictions eased, many of his former activities returned, albeit virtually but he has been struggling to reconnect, continuing to experience SI/L and depression. Symptoms have only partially improved with CBT and supportive therapy. The second case is a 77-year-old woman with a history of major depression since adulthood, well controlled on low dose SSRI and as needed sleep medication. In the fall of 2019, she had a brief recurrence of depressive symptoms in context of adult son's alcohol abuse and his need to live with her. Symptoms improved as she was active in her church, had many friends and had future trips plans to complete as part of her ‘bucket list’. In spring/summer 2020, depression relapsed as she felt isolated and unsupported during the pandemic and being a witness to son's ETOH and mental health problems without a clear treatment plan/next step. Throughout the last two years, she has been grieving the loss of her ‘pre-covid life’ and the realization that she might not complete her ‘bucket-list’ items. Furthermore, her physical health has been worsening, which has been difficult for her overall well-being. RESULTS: These cases highlight the ongoing challenges of the COVID-19 pandemic, in particular its negative impact on geriatric mental health via worsening of SI/L. Even after multiple pandemic surges, vaccines and new treatments, the effects of isolation and social distancing have long lasting effects. In these two cases, high functioning and resilient older adult patients were negatively impacted by isolating public health measures during the pandemic. Recovery, while slow, has been based on re-establishing the quality and quantity of social relationships, re-engagement in meaningful activities and coming to terms with the unique stresses and losses during the pandemic.