Edward "Ed" Coleman spent a lifetime taking on challenges as he climbed through government jobs from the local to federal level, but he didn't have a plan for how isolation would affect his mental health during the coronavirus pandemic.
Coleman, 81, watched television to pass the time, but that grew boring. He read the Bible. He talked to his wife. He talked to his best friend from childhood.
Then the friend died, leaving Coleman even more lonely.
"I was trying to figure out how to stay busy because, you know, you can only paint the wall once or twice," Coleman said. "I tried to go back and think about my past life and if there is something I need to do in case the big day comes."
His thoughts wandered.
"I can't really tell you, it changed the way I was thinking," Coleman said. "I never thought about the isolation part. I thought I could do it well."
Depression set in.
"I was thinking unreasonable thoughts," he said. "I was beginning to blame folks for not treating it earlier than they could. I got into the conspiracy part of it."
It took conversations with his minister and family to come out of the confusing state of mind. It also took getting back to a new routine at Patrick Henry Hays Senior Center in North Little Rock.
Coleman isn't alone. Early data shows that every adult age group has seen mental health effects from the pandemic.
A Centers for Disease Control and Prevention study from August shows that out of 933 participants 65 or older, 6% reported an anxiety disorder brought on during covid-19 and 5% experienced depression. Among 731 study participants between 18 and 24, by comparison, 49% reported experiencing significantly more anxiety and 52% cited a depressive disorder.
While early data suggests the nation's aging population might be coping with the pandemic better than other age groups, researchers caution there isn't enough data to know the true impact on older people.
Research before the pandemic has shown that isolation can be detrimental, said Marcia G. Ory, a Texas A&M professor and director of the university's Center for Population Health and Aging.
"It impacts almost everything you can think of," Ory said. "It impacts going out and being physically active and engaging in healthy lifestyles."
A National Academies of Sciences report published in 2020 says social isolation and loneliness were more likely among older adults before covid-19. It also says more research is needed for the population because isolation is a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking and obesity.
"I think about my mother who lived to 93 years old," Ory said. "She would say, 'I'm so sad. All of my lifelong friends have died.'"
Those at the highest risk are people whose family and friends have dwindled.
"Younger relatives who aren't that young may have died," Ory said. "It is also those people living alone. It is people with lower incomes."
FINDING COMMUNITY
Coleman said he has been active in sports his entire life. Before covid-19, he found a social community at the senior center, where he also is a member of the commission.
The senior center reopened during the summer and slowly has rolled out more services. Restrictions were put in place such as wearing a mask, social distancing and temperature checks.
"I found that given my age and people I've known throughout my life, this is a place where you can come and talk to people who know what you are talking about," Coleman said.
It was difficult to have that routine removed from his lifestyle early in the pandemic, he said. The reopening of the center has been a game-changer for his mental health.
"It was kind of opening the door to let the sun in," Coleman said. "You still got a chance to talk to people and see people, but at a distance."
Finding ways to help the aging population with mental health difficulties could reduce health care costs that the system has to pay for later, Ory said.
"You have to understand exchange over time," Ory said. "People who are 60, 80 or 100 today built the communities in which everyone is living and enjoying. It is payback for the contribution that people have made their whole life."
If society doesn't help take care of that population, the full burden falls on adult children and grandchildren.
"We now have a 100-year-old mother with an 80-year-old daughter with a 60-year-old granddaughter and a 40-year-old great-granddaughter," Ory said. "We want to do everything we can to keep older people as healthy and independent as possible."
Yet it is possible the aging population is dealing better with the pandemic than researchers originally theorized it would do, said Dr. Ipsit V. Vahia, medical director of McLean Hospital Geriatric Psychiatry Outpatient programs and a Harvard Medical School assistant professor of psychiatry
"The initial apprehension had been that older adults would be at a higher effect from mental health because they were at the higher risk of the virus itself," Vahia said.
There were fears that other factors, such as restrictions imposed at assisted-living facilities, would harm the mental health of the aging population, Vahia said, but older people appear to have withstood the stress of the pandemic's first few months better than other age groups. Research from China, Italy and the Netherlands has aligned with CDC data, Vahia said.
There are multiple theories on why the older population has been so resilient.
"For many adults, they have had life experiences that have prepared them for coping with stressors," Vahia said. "For many older adults, they have less of a challenge of managing work and life. There has been a suggestion that having fewer everyday responsibilities may also be beneficial."
Coleman, a Little Rock native, says that at the start of the pandemic he felt he was better prepared than younger generations.
LONG-TERM EFFECTS
"I just felt like, 'We're going to deal with it,'" he said. "It is confidence in science. My mindset was I can handle this, but my worry became my children."
Things changed over time, including growing isolation after a positive covid-19 test. Coleman was asymptomatic, but he said the isolation took a toll.
More than 48,400 people in Arkansas 65 or older have tested positive for covid-19, according to the Arkansas Department of Health. It is likely more people have had the illness but were not tested because they did not exhibit symptoms.
Vahia said studies, including one from the CDC, are all from the start of the pandemic and that the aging population could see different mental health effects over time.
"It is well known that long-term stressors lead to long-term effects of depression," Vahia said. "It has been a chronic stressor, and we don't have a good understanding on how mental health will change."
It could take a year or more before there is enough data to evaluate long-term effects, he said.
"The true impact is not yet clear, and it might not be clear for a long time," Vahia said.
Dr. Buster Lackey, executive director of the National Alliance on Mental Illness Arkansas, said the organization has received a flood of calls from family members asking how they can help aging loved ones.
He noted there have been a lot of conversations about covid-19 and the physical effects on the older population, but that too comes with a mental toll.
"We scared them half to death," Lackey said. "We came at them going, 'Oh, if you are between 65 and 100 years old, you need to stay in and don't touch anybody.'"
A woman recently called Lackey concerned about her parents, who hadn't left the house since March 15, 2020. Lackey said the parents wouldn't go out even to check on the flowers in their yard.
"They have been isolating themselves," he said. "They aren't letting her in the house. She puts everything in the garage, and once she is gone they put gloves on, wash it off and then bring it into the house."
It is also possible the older generation isn't aware of the anxiety or depression because of the stigma associated with bad mental health that older generations often face, he said. While he couldn't talk specifically about the CDC data, he said it's possible the stigma could make collecting data difficult.
"You just keep going," Lackey said. "That is a big factor in our older population."
Lackey said he recently had a 77-year-old client in his private practice who fit this description.
"I said, 'How are you coping?' and she said, 'I'm bullheaded. You just get through it,'" Lackey said. "I said, 'Why is today your first day seeing a clinical therapist?' and she said, 'I just got sick of everybody telling me I needed to see a therapist.'"
ADDRESSING NEEDS
The older generation has a feeling they can accomplish anything, he said, but the pandemic may have limited what they could do.
Lackey said even if it's hard for the generation to accept, it's still important to seek treatment. Depression and anxiety aren't things that necessarily disappear on their own after isolation is lifted.
"I was talking to an 80-year-old man last week," Lackey said. "I said, 'What is your plan now that restaurants are opening?' He said, 'Now that I'm watching things, there are a lot of idiots out there and I don't want to be around them.'"
Lackey emphasized that it's also important for mental health to continue to be a part of the discussion as more vaccines become available and businesses reopen.
"If we just let it go, there are a lot of health complications that can arise, from physical to death," Lackey said. "They get so depressed, they don't get out of bed or eat. They don't get treatment from a licensed professional for medication.
"The goal is to alleviate the symptoms so you can return to the level of life you had before."
Luckily, there has been recognition about the hazard of isolation within the community, Ory said, including local agencies across the nation serving older adults through friendly phone visits.
Meredith Hale, a spokeswoman for Care Link, says the Central Arkansas Area Agency on Aging has reworked many of its services to focus more on isolation during the pandemic.
This includes growing a telephone reassurance program as a way to connect with seniors who lack social connections. Hale said the program saw a 930% increase, from 52 participants to 536, since the pandemic started a year ago.
Older workers are paid through grants from the Older Americans Act to make the calls, Hale said. The calls are made daily or a few times a week depending on a person's need.
"Oftentimes it is a little chat," Hale said. "It provides some connection with the outside world. It is a way to exchange a few pleasantries for a few minutes. It is a lifeline. It really helps with depression of older people, but it makes sure their general well-being is good as well."
The program also helps the organization stay connected with the 1,100 Meals on Wheels participants.
Participants were receiving contact with volunteers who delivered one hot meal a day before the pandemic, but as a safety precaution the organization stopped using volunteers. It instead started using staff members to deliver up to seven frozen meals once a week to participants, Hale said, and there was worry this isolated the population even more than usual.
ANIMAL COMPANIONS
The organization also has started helping provide food and supplies for pets of the aging population through its Bone Appetit program. Launched last month, the organization identified 34 pets that needed food, collars, leashes and name tags.
"A pet can have a very positive impact on someone's mental health and physical well-being," Hale said. "Their pet is someone they have at home with them. Someone struggling to do things for themselves can feel a bit of confidence in providing for their pet."
Vahia also noted that population subsections is another caveat to the data. This includes racial minorities or aging individuals with dementia.
"We don't know whether having these challenges means worse outcomes," he said.
Vahia said it is important that programs continue to be built for the aging population and mental health going forward.
"Older adults continue to be some of the most complex populations to care for at the policy level," Vahia said. "As states are building programs, the ability to identify and address mental health conditions in older adults, and especially caregiver roles, should be high-priority."
Arkansas is ranked 19th in the nation with an aging population of about 512,000, or about 17% of the state's total population, according to the Population Reference Bureau.
The Kaiser Family Foundation reports the state spent about $4.4 billion on Medicare in 2019, which ranked 30th in the nation. It also shows the state's Medicare spending increased 6% between 1991 and 2014.
"Not being vigilant from it is likely to impact the cost of care and burden health care systems disproportionately," Vahia said. "We need to anticipate and prepare for it, because it could cause significant stress in the entire health system down the line."