ABSTRACT
Background: The spread of COVID-19 has affected the physical and emotional health of individuals globally. While studies have focused on the virus and its effect on health, the emotional impact of COVID-19 on older adults has not been well studied. Methods: We administered an anonymous survey to discern the emotional impact of the current pandemic on community-dwelling adults living in central Arkansas. Participants were surveyed about stress levels and coping strategies as well as their perception of pandemic media coverage. Results: 124 adults (80% women, 20% men) over age 18 completed the survey. 72% were white and 23% were African American. 71% were aged ≥60 years, while 29% were under 60 years old. 30% of younger adults were unemployed or retired, vs. 76% of older adults. 72% of younger adults selected shortages at the store as the greatest stressor, whereas only 45% of older adults selected this option. Also, 78% of younger adults reported that family support helped them deal with stress while only 52% of older adults chose family support and relied equally on friends. Approximately half of older adults, 53% found TV and newspaper coverage on COVID- 19 useful. In contrast, only 31% of younger adults found the media coverage useful and 42% stated that it actually increased their anxiety. These age differences in perspectives and emotional impact were found to be significant (p<0.05). Conclusions: The spread of COVID-19 has brought about new stressors and definitions of social support that has impacted emotional health. Our findings showed some interesting age-associated differences in stress management. Commodity shortages created more stress for younger versus older adults. The majority of younger adults leaned on family support to help them deal with the pandemic stress, while approximately half the older adults coped by talking with their friends. For the most part, younger adults found media coverage of COVID-19 anxiety-provoking while older adults found it to be useful and informative. There might be many underlying reasons why older adults perceived less stress, but it is important to realize that a circle of friends and frequent communication can help older adults perceive less stress than younger adults even during a pandemic.
ABSTRACT
CASE REPORT: A 79-year-old woman with a history of hypertension, anxiety, chronic pain, fibromyalgia, peripheral neuropathy, prior right AKA, and CVA was admitted with acute osteomyelitis and cellulitis of 3rd toe. Initially she was tachycardic at 140, and EKG showed sinus tachycardia. Diastolic BP was around 100. The HR slowed after rehydration, and BP normalized with analgesia. CBC showed mild leukocytosis with neutrophilia of 74%. ESR and CRP were elevated at 56 and 146, respectively. She tested negative for COVID-19, RSV and influenza. CXR showed low lung volumes. Blood cultures were drawn before initiation of antibiotics (Vancomycin and Cefepime). Orthopedics evaluated the patient. On day 1, the patient was found noted to be confused. CT of head showed extensive periventricular and subcortical white matter hypodensities. MRI of brain showed no acute abnormalities. MRA showed no abrupt vessel occlusion of the circle of Willis. Aspirin and statin were recommended by Neurology. On day 6, the Geriatrics team was consulted. The patient was minimally verbal, not following commands. She did have perseveration and answered with 'What' or 'Wait' to most questions. Blood cultures returned showing no growth, and the mild leukocytosis had resolved. Her acute delirium was thought to be multifactorial, due to infection, pain and also possibly some contributing medication (probably Cefepime). Patient's home dose of Gabapentin and Cymbalta were halved and scheduled Tylenol was recommended. Cefepime was discontinued and Rocephin was started. On day 7, the patient underwent left 3rd toe amputation. Her mental status improved and she became more attentive and was able to answer orientation questions correctly by day 8. On day 9, she was back to her baseline mental status. She experienced no worsening of her delirium post-op. CONCLUSION: This case focuses on the importance of recognizing the effects of antibiotics on cognition and mental status in geriatric patients. Cefepime induced encephalopathy can occur even with normal renal function and can lead to marked changes in mental status. For patients presenting with expressive aphasia and changes in mentation, prompt removal of the delirium-contributing drug may allow for rapid resolution of the delirium.