Impact of Coronavirus Disease 2019 on Geriatric Psychiatry

Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies

Background

Debate exists about whether extra protection of elderly and other vulnerable individuals is feasible in COVID-19. We aimed to assess the relative infection rates in the elderly vs the non-elderly and, secondarily, in children vs adults.

Methods

We performed a systematic review and meta-analysis of seroprevalence studies conducted in the pre-vaccination era. We identified representative national studies without high risk of bias through SeroTracker and PubMed searches (last updated May 17, 2022). We noted seroprevalence estimates for children, non-elderly adults, and elderly adults, using cut-offs of 20 and 60 years (or as close to these ages, if they were unavailable) and compared them between different age groups.

Results

We included 38 national seroprevalence studies from 36 different countries comprising 826 963 participants. Twenty-six of these studies also included pediatric populations and twenty-five were from high-income countries. The median ratio of seroprevalence in elderly vs non-elderly adults (or non-elderly in general, if pediatric and adult population data were not offered separately) was 0.90-0.95 in different analyses, with large variability across studies. In five studies (all in high-income countries), we observed significant protection of the elderly with a ratio of <0.40, with a median of 0.83 in high-income countries and 1.02 elsewhere. The median ratio of seroprevalence in children vs adults was 0.89 and only one study showed a significant ratio of <0.40. The main limitation of our study is the inaccuracies and biases in seroprevalence studies.

Conclusions

Precision shielding of elderly community-dwelling populations before the availability of vaccines was indicated in some high-income countries, but most countries failed to achieve any substantial focused protection.

Registration

Open Science Framework (available at: https://osf.io/xvupr).

Factors Associated with Mental Health of Medicare Beneficiaries During the COVID-19 Pandemic

OBJECTIVES

This study examined factors associated with the mental health of Medicare beneficiaries during the COVID-19 pandemic.

METHODS

The Medicare Current Beneficiary Survey COVID-19 Supplement administered in the Fall of 2020 of beneficiaries aged ≥65 years was analyzed (n = 6,173). A survey-weighted logistic model, adjusted for socio-demographics and comorbidities, was performed to examine factors (e.g., accessibility of medical/daily needs, financial security, and social connectivity) associated with stress/anxiety.

RESULTS

Of Medicare beneficiaries, 40.8% reported feeling more stressed/anxious during the pandemic. Factors that were associated with this increased stress/anxiety include the inability to get home supplies (95% CI [3.4%, 16.5%]) or a doctor's appointment (95% CI [1.7%, 20.7%]), feeling less financially secure (95% CI [23.1%, 33.2%]) or socially connected (95% CI [19.1%, 25.6%]), and being female (95% CI [7.2%, 12.2%]), when compared with their respective counterparts. Non-Hispanic blacks were less likely to report feeling more stressed/anxious than non-Hispanic whites (95% CI [-19.9%, -9.0%]).

CONCLUSIONS

Our findings highlight that beneficiaries' mental health was adversely influenced by the pandemic, particularly in those who felt financially insecure and socially disconnected.

CLINICAL IMPLICATIONS

It is warranted to screen at risk beneficiaries for stress/anxiety during Medicare wellness visits and advocate for programs to reduce those risk factors.

Effects of the COVID-19 pandemic on suicide attempts in a rural region in Germany, a 5-year observational study

BACKGROUND

The COVID-19 pandemic and public life restrictions may have a negative impact on people's mental health. Therefore, we analyzed whether this condition affected the occurrence of suicide attempts (SA) over 20 months during the pandemic period.

METHODS

We included patient records according to DSM-5 criteria for suicidal behavior disorders (n = 825) between Jan 1, 2017, and Dec 31, 2021. We applied interrupted time-series Poisson regression models to investigate the effect of the pandemic on SA occurrence, time trends, and seasonal patterns in the whole group of patients as well as stratified by age and gender.

RESULTS

There was no significant effect of the pandemic on the occurrence of SA in the overall group. However, we observed a significant impact of the pandemic on the seasonal pattern of SA, also the variance differed significantly (pre-pandemic mean ± variance: 13.33 ± 15.75, pandemic: mean ± variance: 13.86 ± 7.26), indicating less periodic variation in SA during the pandemic. Male patients and young adults mainly contributed to this overall effect. Subgroup analysis revealed a significant difference in SA trends during the pandemic in older adults (>55 years) compared with younger adults (18-35 years); SA numbers increased in older adults and decreased in younger adults as the pandemic progressed.

LIMITATIONS

A few patients may have received initial care in an emergency department after SA without being referred to psychiatry.

CONCLUSIONS

In general, the COVID-19 pandemic and related measures did not significantly affect the occurrence of SA but did significantly affect the dynamics. In addition, the pandemic appeared to affect suicidal behavior differently across age groups as it progressed. Particularly for the older adult group, negative long-term effects of the pandemic on suicidal behavior can be derived from the present results, indicating the need to strengthen suicide prevention for the elderly.