Impact of COVID-19 on the Mental Health of Geriatric Residents in Long-Term Care Facilities

COVID-19 pandemic has raised serious concerns about the mental well-being of the older residents of long-term care facilities. The authors discuss the developing mental health crisis in this population, focusing on the major psychiatric manifestations of the COVID-19 and their underlying pathophysiology. Despite early reports of resilience among older persons against the impact of chronic lockdown, current literature suggests an overall negative impact on the mental health in this population.

Examining the effect of perceived fatigability on cognitive function abilities in older adults with MCI

Background Chronic fatigue with cognitive and daily functioning decline is a major public health concern in older adults. The association between fatigue and neurodegenerative conditions (e.g., multiple sclerosis) has been studied for many years. But, it is not known the relationship between Alzheimer's pathology and perceived fatigability, a phenotype characterized by the relationship between an individual's perceived fatigue and the activity level with which the fatigue is associated. We examined the role of fatigability on the link between cognitive function and cognitive function abilities and the effect of sleep on this indirect link in older adults with mild cognitive impairment (MCI). Methods Adults age > 55 years who met the ADNI criteria for MCI were included. Depression assessed by the DSM-V criteria and a GDS>5 was exclusionary. We conducted the study with the PROMIS Cognitive Function-Abilities (CogAb), Sleep Disturbances (SD), Sleep-related Impairment (SRI), and the Neuro-QOL Cognitive Function (CogF) and Fatigue, including Fatigue symptom score (item1-3&7) and Fatigability score (item4-6&8). Linear regression models were fit to Fatigue and Fatigability included sleep outcomes and their interaction as predictors. Mediation models were fit to assess whether fatigability mediated the effect of CogF on CogAb. Results Before the COVID pandemic, 36 subjects were recruited, with the mean age= 68.8 ±9.3, 58.3% female, 78% white, and 15.2% Hispanic. The results revealed that CogF predicted CogAb (b= 0.78, t(34)=4.83, p<0.001). Analysis of the indirect effects showed CogF predicted Fatigability (b=-0.29, t(34)=-3.09, p<0.005), Fatigability predicted CogAb (b= -0.99, t(33)=-4.03, p<0.001), CogF predicted CogAb (b=0.49, t(33)=3.25, p<0.01). The indirect effect of CogF on CogAb mediated through fatigability was significant (95%CI=0.08, 0.44), even after controlling for age and education, and fatigue symptom score. Fatigability was associated with SRI (beta=0.642, t=4.73, p<0.001) but not SD (P>0.05) after controlling for age. SRI had no direct effect on CogAb. Conclusions Perceived fatigability partially mediated the link between CogF and CogAb and sleep outcomes had no significant impact on this indirect link. The results suggested that fatigability could be a biological construct of Alzheimer's pathology, independent from sleep and depression.