While many protocols and guidelines to physically protect the elderly from the Covid-19 pandemic are in place, further measures need to be developed to better care for the mental health and wellbeing of those staying in residential care homes, the Office of the Commissioner for Mental Health said.

Commissioner for Mental Health John Cachia, as well as Senior Allied Health Practitioner Gertrude Buttigieg spoke with The Malta Independent about the effects of Covid-19 on elderly people staying in residential care homes and the practical recommendations and innovative practices that should be considered.

Safeguarding the mental health of all individuals, including the elderly, is of prime importance to the Office of the Commissioner, Cachia said, adding that the Covid-19 pandemic brought with it yet another burden on the mental health of the elderly who may have already been dealing with other chronic conditions.

Cachia (above) and Buttigieg (below) remarked that many elderly people were still very independent and active in their communities, but in order to protect themselves from the virus followed public health guidelines and began self-isolating. This, they said, had a tremendous impact on their social lives.  

Many elderly people who were residents in residential care homes did not have a choice and had to adhere to the strict regimes which were implemented in these institutions in order to keep not only themselves, but others safe.

Initially, many considered this as a heroic way of contributing to minimising the spread the pandemic, however with what seems to be a much longer sacrifice to carry, many are now looking at this with a different perspective, they said.

Due to the current situation and the number of Covid-19 cases which are still very much soaring – 2,322 active cases – many care homes are still limiting visiting hours and taking other precautions, leading to many elderly residents spending most of their days without the company or physical contact of their loved ones.

 

Cachia and Buttigieg highlighted that many have gone through serious emotional difficulties without the comfort of having their family around them to provide them with the support they need, thus leading to them facing further emotional distress.

Buttigieg said that some paid carers and staff went beyond their duties to make the situation more bearable for those entrusted in their care, but it may not have been enough to allay the fear of the unknown.

With regards to the mental health situation, which is not only affecting elderly people but many others across the world, the World Health Organisation (WHO) has acknowledged the fact that “we are already experiencing a second and parallel pandemic to the Covid-19 pandemic – a mental health pandemic caused by fear, uncertainty and isolation.”

Many reports have been published abroad reporting a number of stories about elderly in residential care homes who are slowly dying, not due to the virus but because they have been isolated for so long that they have lost their desire to live, Cachia said.

In light of such an impact on the mental health of elderly people, the commissioner of mental health has a moral obligation to push all the relevant stakeholders and take this matter at hand, Cachia said.

Buttigieg and Cachia added that the presence of Covid-19 is a reality that has been living with all of us for almost a year, and it seems that it will remain with us for much longer.

As the Commissioner for Mental Health, expert advice has been offered in the past months whenever consulted and “we are open to continue offering such advice whenever needed,” Cachia said.

Both Cachia and Buttigieg said that innovative practices undertaken in the early months, such as the use of social media and interactive events between residents must continue and further initiatives need to be explored.

They also said that other practical recommendations include monitoring weight loss or weight gain, since appetite often reflects mood, while highlighting the need to monitor other signs including decrease in mobility, cognitive decline, decrease in communication and depression.

Although they expressed their understanding of the added burden of care which is being carried by the management and staff in the care homes, the Commissioner said that he believes maintaining good communication with relatives could help both the elderly people themselves and also the staff.

In addition, other practical recommendations include allowing relatives to share practical tips about the likes and dislikes of elderly residents with the staff and also about the ‘simple’ things which can make the life of that person much easier.

Buttigieg and Cachia suggested that the elderly residents keep their personal mobile phone close to them, take any incoming phone calls, and that they call anyone they like if they are capable of doing so themselves.

Allowing them to bring in personal items (with safety precautions) such as precious photographs, a one-off favourite meal, the newspaper, a book or a gadget if they are capable of managing one, are also little things that can make a great difference, they said.

The Office of Commissioner for Mental Health encouraged all stakeholders to make their best efforts to protect the mental wellbeing of the elderly, together with their physical care.

“We are willing to collaborate with any entity which seeks our advice,” the Commissioner said.

Buttigieg and Cachia went on to say that each entity – particularly the Department for Active Ageing and Community Care, the Social Care Standards Authority and the management of the respective care homes have the sole responsibility of developing care protocols.

“As the Commission for Mental Health, we do not have the authority, power or remit to impose such protocals, but expert advice is always given whenever consulted,” Cachia said.

In addition, there is no ‘legal obligation’ to request specific guidelines or protocols to ensure the safeguarding of mental health of elderly people in residential care homes.

Measures proposed by the Mental Health Commissioner to help cope with the situation:

The first, is to remain connected with loved ones. Although the elderly are physically distant, it is highly encouraged to still keep them involved in decision-making at familial levels and to keep them ‘surrounded’ by a caring attitude by those who know the person best. Even if this has to be done virtually or remotely.

Precautionary measures need to be explained to the elderly in simple relevant terms to ensure peace of mind and quality of life.  It is also crucial that measures within care homes or hospitals are explained to the elderly in a way they understand to avoid them feeling anxious or stress.

In addition, providing adequate emotional support is vital to those living alone as this will help them stay free from stress and fight loneliness.

Another recommendation is acknowledging existing health problems, ensuring that any medical treatment is followed and making sure that medical appointments are not missed.

Another recommendation is limiting the amount of time spent watching, reading, or listening to news on Covid-19, browsing the internet or using social media. It is important that information on the pandemic is obtained from trusted sources, once or twice a day.

For those who are prescribed regular medication, they are to continue doing so and that their medication does not change or stop without the necessary medical advice. Drugs (including prescription drugs) or alcohol should not be used as self-medication to alleviate stress or anxiety.

Elderly people are encouraged to use support lines available such as 1772 (for loneliness issues) and 1770 (for mental health issues).

In addition, families and caregivers need to be sensitive to the increased needs of those with pre-existing disorders like dementia, depression and other neurological disorders.

Another recommendation is to look after one’s physical health.