A 70-year-old woman who played pickleball four times a week and is now too weak to pick up a racket. A 65-year-old man suffering anxiety attacks over recurring long-haul COVID problems. A 72-year-old with Post Traumatic Stress Disorder as the result of a near-death hospital episode.

Counseling and treating seniors with mental and emotional post-COVID problems is an evolving challenge, say mental health professionals. Call it a new frontier.

The Mayo Clinic says research shows among those 65-plus, one in four has at least one medical condition that might be due to COVID-19 in the month to one year following the initial infection. Another study reported that older adults with pre-existing psychological challenges were more likely to suffer from post-COVID syndrome’s mental health Impacts.

“Older adults are more likely to focus on their changing functional state,” says Abigail Hardin, Ph.D., Rehabilitation Psychology Postdoctoral Training Director in the psychiatry department at Rush University Medical Center, Chicago. Think about anything from debilitating headaches to difficulty doing household chores. She says that’s as opposed to younger patients much more likely to speak the language of depression.

Other challenges include doctors who are dismissive of long COVID’s mental health consequences on older adults and a stigma surrounding medication and various treatment options among some elderly.

Dawn Potter, a psychologist with the Cleveland Clinic puts it this way, “I think it’s hard to measure (the success rate of such treatment) and research on therapy for long COVID is still in its infancy.”

The many physical (weakness, fatigue, fever, heart, and lung problems) and mental/emotional symptoms (depression, PTSD, anxiety, confusion, insomnia) seem closely intertwined.

“The reality is that our brains don’t exist in a bubble,” said Dr. Heather Murray of the Mayo Clinic on the clinic’s website. “So, if you have systemic inflammation problems or viral syndromes affecting other organs, it makes sense that they would also affect the brain and cause other psychological symptoms.”

Atlanta infectious disease specialist Dr. Joel Rosenstock established a long COVID clinic about two years ago and says dealing with all aspects of the syndrome is daunting.

“In the long COVID world the saying is, ‘if you’ve seen one long COVID patient, you’ve seen one long COVID patient, ‘“he adds.

Mental health professionals are trying a variety of techniques as they seek improvement for their post-COVID patients.

One of them is Cognitive Behavioral Therapy, used to treat a wide variety of disorders by analyzing thought distortions and refuting them to produce changes in thinking and mood.

Potter says that long haulers can readily fall into such thinking as “I can’t go on vacation anymore, I used to be able to go to the beach. I don’t think I can do those things anymore. So, what’s the point?”

Therapists challenge such all-or-nothing thinking by getting patients to perceive that while their lives are difficult at the moment, that they should continue working to do the things they enjoy and are capable of.

Hardin says challenging distorted thoughts like “I’ll never feel better again” means working with a patient to identify evidence for or against the accuracy of thought. She’s also done experiments where evidence from both sides is presented as if a patient is in a court of law.

Nadine Kaslow

Engaging with people, exercising, and taking up a familiar or fresh activity are all important, says Nadine Kaslow, professor of psychology at the Emory University School of Medicine in Atlanta, as well as the chief psychologist for the Grady Health System.

“If you don’t get out to do these things, if you’re not being with people, if you’re not in nature, whatever, your symptoms are just going to get worse,” she says.
Hardin also has utilized Acceptance and Commitment Therapy. She asks patients to identify their five core values, anything from faith and family to beauty.

“Then we work together to identify how they are or aren’t acting in alignment with those values on a certain day,” she says.

Rosenstock says Eye Movement Desensitization and Reprocessing Therapy (EMDR) has helped long haulers with PTSD. Patients move their eyes a specific way while processing traumatic memories in hopes of changing up the emotions and behaviors that arose from the trauma.

Mental health professionals also cite occupational therapy, which is said to target fatigue and brain fog while improving mood and perspective. A study at St. James Hospital in Dublin, Ireland involved two groups of patients in techniques ranging from exercise to stress reduction and sleep hygiene. Their fatigue improved along with concerns about their well-being, says the study’s author.

Mindfulness and meditation practices can also confer benefits Mark Dannenfelser of the Mindfulness Center of Atlanta says a practice fostering being fully present can help cut through so-called “brain fog” and cut stress levels.

On a countervailing note, some studies have shown older adults have greater resilience in dealing with such challenges.

An August 2020 survey of more than five thousand adults by the CDC  revealed that older adults showed a more than six percent lower incidence of anxiety disorder, nearly six percent less depressive disorder, and more than nine percent less trauma and stress.

Will therapy for older long COVID sufferers become a permanent fixture? That’s unclear.

“That typically depends on the severity of the symptoms,” says Corinne Jones-Williams, a clinical social worker and therapist with Rosenstock’s clinic, as well as the level of support that exists around them.

Hardin says staying physically active, connecting socially and learning are the three most important practices in warding off cognitive change.

“And the same is true of rehabilitating from long COVID,” she says.

This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations, and  The Silver Century Foundation.

Mark Woolsey is a freelance writer based in Atlanta.