Planning for mental wellbeing in an old age home during the Covid-19 pandemic by homoeopathic institution: Structuring the intervention

INTRODUCTION

Mental health services for older adults face significant challenges in the time of the COVID-19 pandemic as they are most vulnerable to the brunt of the pandemic. General medical complications have received the most attention in the current situation. However, few studies have addressed the potential direct and indirect effects on mental health, despite the fact that the SARS-CoV-1 epidemic (2002–2003) was associated with a number of psychiatric complications.^[1] In the COVID-19 pandemic, care home residents were found to be the most vulnerable. The French Ministry of Health reported that among a total of 24,760 COVID-19-related deaths, 51% (12,511) occurred among old age home (OAH) residents.^[2] Anxiety and distress, often attributed to isolation, were the most prominent mental health complaints during previous pandemics and COVID-19. In addition, post-traumatic stress was surprisingly common and possibly more enduring than depression, insomnia and alcohol misuse.^[3] One likely reason for this inside OAH facilities worldwide was the lack of official guide and regulations in case of natural disasters.

The important psychosocial problems in the elderly are isolation due to sadness, wilting due to solitude, long-term illnesses leading to inactivity and abandonment by relatives. Moreover, during the pandemic, travel restrictions prevented contact between the elderly and their relatives. Outdoor activities were compromised and life was very restricted compared to earlier. All these changes make them very sensitive, often causing loneliness, depression and isolation.^[4] Loneliness and social isolation are consistently identified as risk factors for poor mental and physical health in older people.^[5]

HelpAge India is a non-government organisation (NGO) that works to support disadvantaged elderly people. During the pandemic, they ran a mental well-being programme in OAH facilities across the country. This programme had a fixed format and a specific number of sessions and topics. Preliminary assessment was done using the following three scales: The patient health questionnaire (PHQ:2), generalised anxiety disorder-7 item (GAD 7) and assessment of cognitive impairment through DART questionnaire. Ten general topics were suggested and it was the responsibility of the NGO to implement it in a way suitable to local conditions. Anand Vruddhashram, an OAH at Shirgaon, Palghar, which is served by the Psychiatry and Geriatric Departments of the Rural Homoeopathic Hospital, Palghar, since several years, was selected for one such programme. A series of three papers were planned on this experience. This paper outlines the processes undertaken to conceptualise and plan the programme, the second will focus on the operational issues while evaluating the results and the third will describe the benefits for the multidisciplinary team that organised the series of interventions.

MATERIALS AND METHODS

Methodology

The flow diagram indicates the steps followed for structuring the programme.

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RESULTS

DISCUSSION

The COVID-19 pandemic has shown the critical importance of community services to support health and social care for the ageing population. Community organisations are noting mental health challenges for people experiencing social isolation and stress. Meeting interrelated health and social needs will require sustained efforts by health care and social care providers.^[14] One such study was conducted in Israel to promote positive ageing through practical approaches. Skill training interventions with educational and behavioural components had a significant effect on positive mental health outcomes. Their methodology focused on senior citizens developing positive attitudes toward ageing by making them review their past accomplishments and their current resource and strength. Various positive psychology strategies were used in sessions enabling them to explore personal strengths, practicing ways to use them and invest in significant relationships, keeping a gratitude diary, listing the good things that occurred in a day, practicing mindfulness, seeking out activities to create flow and appreciate learning experiences from their very own stories to live with hope.^[15] In contrast, in our study, we focused on improving quality of life based on behaviour modifications applied through action learning principles. These interventions included meditation, chanting, physical exercise, relaxation exercises, role playing to develop insights through psychoeducation by making them identify their own maladaptive behaviours and group discussions to modify the same. A study by Beauchamp et al., a randomised control trial, reported an online delivered group and personal exercise programme to support less active older adults. The 3-way parallel study was to assess whether group-based exercise versus personal and wait list control (WLC) help to improve psychological health. The participants in the personal condition displayed improved mental health compared to WLC participants, in the same medium effect size (ES) range (ES = 0.293–0.565) over the first 8 weeks, and while the effects were of a similar magnitude at weeks 10 (ES = 0.455, P = 0.069) and 12 (ES = 0.258, P = 0.353), they were not statistically significant. The study indicated the need for a more holistic mental well-being programme with personal engagement and involving caregivers for monitoring.^[16] However, our study included a team of experts in various subjects and topics of workshop, which makes its approach more holistic. The methodology included personal connections with residents and involvement of caregivers and trustees of the OAH for monitoring, regular documentation and communication within the team, which was one of the key factors making the programme more holistic and linked. The preliminary processes of screening, knowledge of the background, interests and temperament of the residents helped to a great extent to cater to their needs. Knowing the residents’ interest areas helped identify the mode of conduct and need to deliver based on action learning principles. We shall present the results of our interventions in the next article of this series.

Any modifications in patterns of thinking, feeling and action were brought out through experiential learning, since the group had little interest in reading and knowledge-based interventions. Hence, the mode of intervention planned was discussion and activity based. Adopting the suitable mode would invite interest and foster group engagement. Few sessions were to include videos, short movies and music where messages were conveyed through entertainment. We attempted to demonstrate simple techniques that could be easily adopted and be made a necessary part of daily living.

Since the psychosocial aspects of older people, their caregivers, psychiatric patients and marginalised communities are affected by this pandemic in different ways, there is an urgent need to develop psychosocial crisis prevention and intervention models by the government, healthcare personnel and other stakeholders.^[17]

CONCLUSION

Understanding the needs of residents of OAH facilities play an important role in planning interventions. Activity-based interventions that ensure wide participation can imbibe dynamism in the group. A readiness to improvise with changing time and circumstance always needs to be kept in mind. Regular and open communication fosters trust and forges strong bonds. Each OAH is different in its composition, history and ethos. Identifying these and selecting suitable strategies play a key role.

Considering the limited possibilities of direct interventions in the pandemic, the project is unique considering the structure and planning required for implementation.