key: cord-0048332-jeh2b79c
authors: Peyman, Nooshin; Olyani, Samira
title: Iranian older adult's mental wellbeing during the COVID-19 epidemic
date: 2020-08-02
journal: Asian J Psychiatr
DOI: 10.1016/j.ajp.2020.102331
sha: 28385126ffaf1fa813b949e787927d462f9beba5
doc_id: 48332
cord_uid: jeh2b79c

nan

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In addition to direct impacts of the COVID-19 epidemic on people's physical and mental health, it's indirect impacts like impacts on social determinants of health (economics, employment, income,..) which have triggered serious problems to people's mental health should not be ignored (Qiu et al., 2020) . Unfortunately, due to lock down most of the Iranian businesses, the Iranian economics plummeted into a recession then the rate of unemployment increased dramatically which lead to increased mental health disorders between Iranian families. Therefore, the outbreak of COVID-19 which has a rapid transmission and high death rate could accumulate stress; furthermore, increases fear of death and exacerbate the risk of impairment mental wellbeing especially among older adults. Moreover, increased stress have seen in older adults with underlying mental health problems, who may be isolated from their society, have no access to internet and telephone, and have declined access to their routine therapeutic interventions (Xiang et al., 2020) .

In all over the world, the highest death rate from COVID-19 has reported for older adults and individuals with underlying chronic disease (Tandon, 2020a) . The elderly due to a poor immune system are considered more vulnerable to this new infectious disease (Forlenza and Stella, 2020, Meng et al., 2020) . Unfortunately, infection diseases are severe in older adults, and then the death rate is more prevalent among them, especially for those with at least a chronic underlying disease (Qiu et al., 2020) .

Iran has one of the largest ageing populations in the Middle East. In 2016, around 10% of the total population was older adults (Khami et al., 2020) . Mental health problems are common in older Iranian adults (> 60 years), with the prevalence of severe depressive and anxiety symptoms reported to be 10% in this population (Alizadeh-Khoei et al., 2011) and more than 30% of them are suffering from mental health problems (Gholamzadeh and Pourjam, 2019). As older age is an important factor in observed higher mortality rates, the older average age of the Iranian population could be a significant risk factor for this nation (Tandon, 2020a) .

Regarding the importance of the mental wellbeing of older adults, more attention needs to be paid to them as a vulnerable group when a public health crisis emerges (Meng et al., 2020) .

Efforts not only should be focused on reducing the spread of the disease but also mental health issues of older adults should be considered. We have some recommendations for the future.

First of all, nationwide strategic planning needs to be implemented for mental first aid during a major crisis, including community interventions for screening, monitoring, and referral mental health disorders, therapeutic advice, raising knowledge of the elderly about the new crisis for enabling them to cope effectively, promoting health behaviors to decrease the risk of getting mental problems, providing psycho-education, providing advice on self-care against contracting the disease and mental support. As the speed of transmission in disasters like COVID-19 is very high, contacts must be restricted especially for vulnerable groups, then psychological interventions should be potentially delivered through digital technologies and telemedicine; however, it needs trained individuals, accessibility to technologies, and also the effectiveness of them should be examined.

A second recommendation may be culturally related. Iranian people are family-friendly, and then as they have to restrict their connections, it will damage their more vulnerable groups such as older adults. Most of the Iranian older adults are not living alone or in daily care because they have children and families who never leave them alone. Then, preventive strategy in major public health crises such as isolation could trigger the sense of loneliness in older adults, which could lead to severe depression, anxiety and even suicide. For overcoming this matter, society-connectedness with the aid of digital communication technologies should be established. Although these technologies could not be as effective as direct contacts, maintaining a relationship with others could be helpful. Community supportive interventions should be focused on helping older adults to work with digital technologies. Then, community supportive interventions should put all efforts into declining mental health problems and prevent further psychological problems in disasters. These kinds of strategies could have improved the society-connectedness between older adults.

In short, when older adults are placed under circumstances of threat, they will maintain a normal level of mental wellbeing provided that the strength of society resources exceeds the strength of the threat.

Financial disclosure: None

Declarations of competing interest: None

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