This article reviews the current literature on atypical clinical presentation, clinical management challenges, and the burden of social isolation on geriatric patients. The authors outline clinical presentation of geriatric patients which is centered around mental status that leads into a discussion on challenges in clinical management and the impact on social distancing.

Atypical clinical presentation of COVID-19 in geriatric patients:

• altered mental status as an initial presenting symptom, even in the absence of respiratory symptoms or fever
• Worsening confusion (especially in those with dementia), agitation, disorientation, reusing care, and apathy

Therefore, new onset change of mental status should be treated as a potential initial sign of COVID-19 and managed accordingly.

Clinical management challenges:

• When considering the impact of older adults with pre-existing neurocognitive disorder or other psychiatric issues such as mood disorders
  • Proper treatment must be considered due to underlying conditions due to age in addition to these mentioned
• Setting, age, special situations including alcohol and substance abuse disorder management must be considered in the treatment of older adults

Social distancing and lock downs:

• Cons: Social distancing due to the lock down results in increased isolation and loneliness, disruption of daily routines and activities, strain due to not being able to attend religious services, changing access to essential services such as doctors’ visits, decreased staff mental health.
• Pros: It leads to keeping the high risk geriatric population safe, adopting newer technologies, a renewed focus on enhancing relationships, and identifying resilience

Efficacy of cognitive and behavioral interventions in reducing the burden of isolation has been well established, and recent studies have shown virtual care implementation of these techniques by clinicians can help mitigate worsening of social isolation effects during social distancing.

Finally, the authors bring attention to the importance of examining other countries in moving forward. China and Italy have seen worsening of geriatric psychiatric symptoms under lock down measures. The authors propose that we can use these initial experiences to anticipate and plan care more effectively. Much is yet to be learned about geriatric psychiatry as far as its response to the broader impact of COVID-19 as initial reports and findings will pave the way for future research.

Vahia, I. V. (2020). COVID-19, Aging and Mental Health: Lessons from the First Six Months. The American Journal of Geriatric Psychiatry.