COVID-19 and mental health: Impact on symptom burden in older people living with mental illness in residential aged care

Australas J Ageing. 2022 Feb 7;10.1111/ajag.13042. doi: 10.1111/ajag.13042. Online ahead of print.

Abstract

Objectives: COVID-19-related restrictions for residential aged care (RAC) have been significant. However, the mental health impacts for residents already living with mental illness remain poorly understood. In this study, we examined change in mental health symptom burden for this group and potential associations with clinical and contextual factors.

Methods: We retrospectively reviewed medical records of patients of a specialist aged mental health clinical service for RAC. Change in symptoms (measured by the Neuropsychiatric Inventory, Nursing Home version [NPI-NH]) between pre-pandemic and two pandemic timepoints were analysed using Wilcoxon signed-rank tests. Potential associations with baseline diagnosis or severity of 'lockdown' restrictions in RAC were assessed using linear regression.

Results: Data from 91 patient files were included. The median NPI-NH score slightly increased during wave one (baseline median NPI-NH score = 17.0 [interquartile range, IQR: 10.0-27.0]; wave one median = 19.0, IQR: 8.0-30.0) and fell during wave two (Median: 15.5, IQR: 7.0-28.0), but changes were not statistically significant (all p-values >0.05). Adjusting for age and gender, an association between neurocognitive disorder diagnosis and NPI-NH score during wave one was statistically but not clinically significant (p = 0.046). No other significant associations were identified.

Conclusions: Accounting for pre-pandemic symptoms, we found no clinically relevant evidence of worsening mental health during COVID-19 for a group of older people living with mental illness in RAC. This adds to evidence of relatively stable mental health in older people during the pandemic. Research and policy should consider underpinning mechanisms and emphasise patient- and carer-centred interventions.

Keywords: COVID-19; aged; mental health; residential facilities.