Mental Health During COVID-19: The Invisible Threat to Seniors

Operators must find ways to keep residents social or risk their well-being.

By Joanna Frank, Founding President and CEO, The Center for Active Design

A less visible, yet very significant health impact of COVID-19 is the psychosocial implications for our senior populations. Seniors are not only particularly vulnerable to the medical risks of COVID-19, but also the effects of social isolation.

Seniors housing operators are taking critical steps to reduce the risk of viral spread, such as suspending visitations and limiting face-to-face interactions. Although necessary, we must remember that these measures may also reduce stimulation, diminish physical activity opportunities, and aggravate cognitive and behavioral symptoms of dementia.

While physical distancing is essential to reducing virus transmission, we must also take steps to simultaneously mitigate the negative mental health consequences of social disconnection, since social relationships are essential to our health and well-being.

COVID-19 exacerbates social isolation

Social isolation among older adults has been a known, serious public health concern even prior to the implementation of COVID-19’s social distancing requirements. A meta-analysis found the increased likelihood of premature mortality was 26 percent for reported loneliness, 29 percent for social isolation and 32 percent for living alone. The prevalence of loneliness in American adults aged 70 years and older is estimated to be between 25 and 29 percent.

Based on what we know about the impacts of past pandemics and the rise in mental health concerns during quarantine and isolation, researchers have predicted significant increases in anxiety and stress in response to COVID-19. For example, the SARS epidemic of 2003 was associated with a 30 percent increase in suicide among those 65 years and older, and left long-lasting reverberations of anxiety, depression and stress disorders.

Research shows that the physical and mental health risks of isolation and loneliness are twice that of obesity, and on par with risk factors such as smoking or having an alcohol use disorder. Depression, anxiety and stress negatively impact our neurobiology and weaken our immune systems. Thus, the negative mental health impacts on our senior population represent an unintended consequence of social distancing protective measures.

Practical guidance for operators

The good news is we know there are a multitude of evidence-based design and operational practices that seniors housing operators can implement to mitigate unintended negative mental health consequences. The following strategies can support operators who are striving to balance social distancing practices with social connectedness to support well-being for residents.

  • Emergency preparedness plans. While most facilities have emergency preparedness plans that address continuity of care, those plans may not include contingencies for support services and social activities. Plans should detail procedures for maintaining or rapidly resuming essential services, which include health, social and community services. These programs are vital to supporting the health and well-being of seniors, particularly of those with underlying chronic health conditions or cognitive impairments. Research suggests that structured recreation can significantly improve mental well-being, particularly for those with dementia.
  • Digital resources. Offering access to digital resources on site, providing training and technical literacy to older adults, can facilitate the transition to digital behavioral health services during isolation. When social distancing strategies are put into place, internet, phone and digital technologies can help bridge the gap. While digital services may not be as impactful as face-to-face interactions, they can offer an alternative delivery model for the health benefits of socialization, recreational activities and intergenerational interactions.
  • Health promotion programming.Programs can be used to provide health information and support services. When residents are isolated and in-person gatherings aren’t feasible, ensuring residents still have access to information about vital resources and current policies via virtual programs can help them to feel connected and empowered.
  • Staff support. Research indicates that staff does often not recognize depression in residents of senior living facilities. Therefore, training staff to identify depressive symptoms and hone behavioral health communication skills is imperative. Research also indicates that the well-being of personal care staff may impact resident outcomes. Invest in the health and well-being of staff by addressing organizational factors — such as resources and workload. Provide support services and health programming that may improve job satisfaction and quality of resident care.
  • Partnerships. Networks between facility administration, public health departments, caregivers and suppliers are essential in terms of sharing information, tracing outbreaks and coordinating public health responses. Having established partnerships and collaboration across key stakeholders will prove to be vital in future emergency preparedness.
  • Access to nature. Views of nature have therapeutic benefits. A recent study from the Harvard T.H. Chan School of Public Health shows indoor natural elements were also associated with faster recovery and reduced anxiety. Emerging evidence indicates virtual reality stimuli of nature scenes and sounds may also be impactful in alleviating stress, which can be useful when residents are unable to access outdoor spaces or views of nature.
  • Operable windows.Improve air quality, increase exposure to natural light and improve feelings of well-being, especially during times of increased stress, by having windows that open. Some seniors housing facilities have seen success in providing garden concerts for residents to listen through their windows.

As COVID-19 continues to unfold, prioritizing design and operations strategies that support mental health of residents will be vital. By applying these evidence-based strategies, seniors housing operators have the opportunity to improve community resilience and strengthen trust among their residents and staff — during this pandemic and over the long term.


Joanna Frank is the founding president and CEO of the Center for Active Design (CfAD), the sole licensed operator of the Fitwel Certification System, which was designed by the U.S. Centers for Disease Control and Prevention and U.S. General Services Administration to enhance the health and productivity of tenants and residents in commercial buildings.