Older New Jerseyans have been – and continue to be – among the groups most vulnerable to the physical ravages of COVID-19. Seniors suffered some of the most severe symptoms and often faced life-threatening conditions. And, sadly, many lost their lives, especially in the terrifying early days.
That danger itself also caused mental health issues. Fear, anxiety and isolation exacted a terrible toll on many communities. Confusion about what, exactly, was going on added to the general feeling of helplessness, as did political controversies over mitigation efforts.
Fortunately, help is available. Vaccines are warding off the worst physical symptoms, and behavioral health professionals can assist with the emotional side. NJBIZ recently spoke with Dr. Carrie Ditzel, a clinical psychologist and clinical manager of the Geropsychology Program at Baker Street Behavioral Health, a care provider based in Paramus with locations across northern New Jersey.
“The one good thing that I have seen come out of this pandemic – it’s good and bad – is that I’m amazed at how many regular people – people that were coping and moving along with life and living life before the pandemic – the stress of the pandemic kind of pushed some people over the edge a little bit that otherwise would have coped just fine,” Ditzel said. “And they’re seeking help – that’s the beauty of it. The stigma is not so bad that people aren’t seeking that help.”
What follows is an abridged version of the discussion. The questions and answers have been edited for length and clarity. A video of the full interview is available at njbiz.com/njbizconversations.
NJBIZ: I’d like to start by getting your view on some of the most common issues you’ve encountered from some of the older people that, I know there was a lot of fear about the physical effects of getting COVID and then there was the problem of isolation. Were those the main things that you were seeing or were there some things that weren’t immediately obvious to those of us on the outside?
Carrie Ditzel: I think you nailed the two big ones. Just the fear that we all felt, but it was it was really elevated for older adults, because in the beginning, especially, they were more at risk for severe illness. … Additionally, the media was showing people in long term care facilities and people in hospitals and it was about older adults. So that fear then led to what we all did, but maybe even more intensely is that isolation and the shutdown and all of that which was necessary for everybody’s well-being.
But I think older adults felt it more intensely in some ways. I equated it similarly to what we saw with our kids. They had an extreme shutdown with school and social situations. The people in our families, on the other end of the spectrum, did as well. Those of us that lived in the middle, we might have still worked, we were remote, we were connecting in other ways, because we had obligations. Whereas older adults may not have had those same opportunities. … So I think the isolation was more intense. The fear was probably more intense for many individuals.
I think the other thing that did happen with some older adults, not all but some older adults, is that any physical or cognitive issues that they may have been dealing with didn’t get addressed as aggressively or they may have declined in some ways, because they weren’t going out. You were only dealing with things you absolutely had to deal with.
So I think that might be something that we’re seeing now as people come back out and are engaging with their older adults. They may notice some physical health conditions or cognitive conditions that may have progressed during that period of time.
Q: I want to get to that in a bit, but first you raise an interesting point and that is about – and this goes across disciplines – where patients, not necessarily older people, but just people in general didn’t follow through on some of the ordinary things that they would do in the course of taking care of their health. That must have been particularly acute, especially among older people, since, again anecdotally, the need to stay isolated—they felt very strongly that they could not go out anywhere and be in touch with anybody. That must have itself created some problems.
A: For sure, and when you think about it, this group of individuals, to speak generally, is more vulnerable to the impact of that. If I am middle-aged and in fairly good health, I have some issue I don’t deal with I can let it go for a few months. But for somebody that has more vulnerabilities, those few months may have been really impactful.
I think the other thing that’s really important to talk about now too is what I am seeing – and what from the mental health perspective is so important – is to differentiate depression and mental health issues from those physical and cognitive issues because they can look very similar. And so we don’t want to have a bias to just saying it’s a medical or cognitive issue or they’ve lost it a little bit, you know, when those same things that manifest in a physical way are signs of depression or anxiety in our older adults and that just like medical issues can be treated. That’s my passion, really, is seeing that difference. So I think that’s also a really important distinction and complicating the issue right now.
Q: OK. You mentioned that folks are starting to get out a little bit more – I’m curious as to whether you saw changes as the waves came and went. There was a sort of a sine wave curve to this thing where back in the spring of 2020 everybody was staying home and was frightened. Then vaccines came and things seemed to get a little bit better. Did the problems change and did that sort of coming and going and waxing and waning of danger, for lack of a better word, people must have felt like they were on a yo-yo with that?
A: I don’t think it’s any different for any one of us. It’s confusing. It’s a lot of what they call “decision fatigue”— do I or don’t I? Do we get together or don’t we get together? We take the risk or don’t take the risk. I think that’s true of everybody, so I don’t think older adults were different, in that sense. If anything, anecdotally, I’ll say some of the older adults in my life showed, I think the grit and resiliency that maybe came with experiences they’ve had in their life, where they said listen we’re doing the best we can, we have a vaccine, I’m living my life. That’s not everybody’s attitude, but I saw that myself personally, with some of the people in my life.
And I think there was something to be said for that you know, like “hey we’re doing the best we can we’re not going to lose time anymore – my time is precious, I’m going to go out and live now.” So I personally learned that from that experience.
Q: All right, well I guess if you lived through the Depression and a world war and the cold war, what’s a what’s a germ here or there?
A: Right, right. Well, I mean, when you think about it, too, I think some older adults said, “enough is enough. I’ve lost enough time. I’m going forward and I’m going to take my chances.” That’s an anecdote but I think there’s something to be said for that generation learning from that.
Q: I wonder, though, if that itself raises a concern about people needing to sort of show that kind of resilience. If the expectation is, well, just suck it up. You’ve been through a lot in your life, don’t worry so much.
A: I think this pandemic was taxing to all of us in ways that we’ve never been taxed before. So I think we need to be conscious of that. … Maybe we were coping fine. We dealt with stress before the pandemic in certain ways. We had our systems in place, our sports, our hobbies, the things we like that that got us through. The chronic stress of the pandemic, the ups and the downs like you were talking about really has made some individuals – older adults and young adults, children, teens, everybody – just so much more stressed that now we’re seeing some pathology. We’re seeing depression, anxiety—things that might be more diagnosable, whereas if that chronic stress didn’t happen, maybe it wouldn’t have but it’s OK, let’s acknowledge what happened.
We can move forward. We can treat it and we can recover from it. And that’s I think the important message, is honoring however you feel. If you really struggled, fine. Now get help if you’re not able to engage back in life effectively. That’s a sign – if you’re moving along and sucking it up and doing just fine – great. But not everybody’s going to be like that and that’s OK.
Q: Well, that brings us to I think one of the most important parts of this discussion and that is what should family and friends do – what are the things they should be looking for? How should they distinguish, as you say, between the sort of ordinary cognitive shortfalls that an older person may have, and something that’s really dangerous in terms of a behavioral health issue? What should they be looking for and then what should they do if they suspect or come to believe that someone they love or care about is in trouble?
A: This is such an important thing to talk about. And the key is talking. That’s the thing to do first, is to talk, talk, talk with your loved ones, about how they’re feeling. Don’t be afraid to have that discussion. Don’t neglect to have that discussion with the older adults in your life and ask them. Share your own feelings and experiences to kind of open the door to them sharing what they’re feeling and what their stress level is. And then listen and look for signs of major change, so things like cognition or physical health that don’t seem right or seem to be a large change, something to check out that might mean going to the medical doctors first and that’s fine. Signs of depression can mimic and look like what some people typically think of as old age. That includes sleep disturbance, appetite changes, low motivation, a lack of will, fatigue, negative thinking, negative talking. Feeling kind of hopeless. Not really wanting to do much. Those things can align with not feeling well, align with real medical issues, align with just not wanting to do much.
But there’s a degree, where it can become clinically significant if it inhibits you from engaging in daily life—from taking your medicine, from going to your doctors, from eating enough, from sleeping enough. Not moving your body around. These are the kinds of things you want to look for.
So I would not take anything for granted. If you have any question in your mind if an older adult in your life is doing well, encourage them, talk to them. Encourage them to go talk to, if it’s their medical doctor first – that’s who they know and trust – to go there first. Those are usually the first individuals to screen and see behavioral health issues.
We here at Baker Street are really proud to have started this geriatric line of service – of our older adult caregivers. We accept Medicare, so there’s access to that service, for psychotherapy. And it is available via telehealth [or] in office. And it is as effective for older adults. Psychotherapy is as effective for older adults, studies show, as it is for any other cohort of individuals.
Sometimes people have a bias that they just aren’t who they are. They’re old and grumpy or they’re just kind of losing it and it is what it is, that’s who they are. Well, no, nobody should feel lousy all the time. That’s not good. So older adults can really respond to treatment and that’s what we’re here for and what I’m passionate about. And Baker Street is passionate about now being able to provide for the community.