Psychological intervention with elderly people during the COVID ‐19 pandemic: the experience of a nursing home in Italy

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Italy has been the first European country to face the Covid-19 pandemic in all its dramatic presence.1 According to official national reports, based on the analysis of 32 448 patients died positive for Covid-19 in Italy; the mean age of people who died from this pandemic was 80 years.2 Furthermore, overall the 21.5% and the 59.7% of the sample presented respectively two or three comorbidities with the most frequen being cardiovascular diseases (ischaemic heart disease, atrial fibrillation, heart failure, stroke, hypertension), type-2 diabetes, dementia and chronic obstructive pulmonary disease.2 In nursing homes people with physical or mental disabilities, neurological diseases or older people with different levels of cognitive functioning live together, closely with healthcare personnel. According to the specific characteristics of this population the effect of Covid-19 pandemic can be particularly serious in these contexts that are considered at high risk for epidemic micro-outbreaks.3 This condition has required joint efforts for identifying strategies and guidelines for infection prevention and control, aimed to protect both patients' and healthcare personal's health. In this frame, in the Jewish Nursing Home in Rome, several rules were played out even before the lock-down period, as the limitation of accesses to medical facilities for relatives and not-essential care. The Jewish Nursing Home accommodates 19 patients with a mean age of 84.4 years (SD = 7.3; 85% female) all presenting one or more risk factors for Covid-19, such as old age, chronic diseases and comorbidities. In this situation, since physical presence is not strictly necessary for psychological counselling, as compared to other healthcare activities, psychological intervention has been reorganised in order to provide to patients with teleconsultation instead of face-to-face sessions, as realised in several mental health services.4-6 Thanks to the head nurse's support, patients were informed about the initiative to perform telematics psychological consultations, in the same time slots in which the service was usually provided. This choice was supported by the importance of maintaining routine habits for patients with cognitive impairments. The possibility to perform extra consultations was also introduced in order to contrast the risk of isolation and mood disorders and to support patients strained by the long period of social restrictions, especially in the case of quarantine in the personal room. The patients were invited to give their personal mobile phone numbers in order to be called by the psychologists at set times. The audio modality was the preferred one because it only requires a phone, that usually is owned by patients. However, patients who do not have a personal mobile phone or for which it was preferable to have video-consultation modality, it was possible to use a mobile phone or a tablet freely made available by the administration of the nursing home (sanitised before and after each usage). The video-consultation modality, especially those with the tablet, was particularly useful for patients with hearing loss who need to read lips for better understanding the communication, or for facilitating the recognition of the psychologist by patients with moderate/severe cognitive impairment. The video modality requires especially in the initial phase, help from healthcare personal of the nursing home. In order to perform also cognitive stimulations, crucial in elderly people, several training schedules were sent to the head nurse by email, printed and handed over to the patients they were addressed to. After that, the psychologist illustrated the exercises and in the next session the training was discussed and evaluated. The specific themes emerging during these sessions were interesting and associated with different degrees of cognitive functioning. Specifically, patients presenting deficits in short-term memory, showed problems in remembering that they were experiencing a global health emergency with consequent social limitations. The promotion of the space–time orientation has been crucial also for overcoming the feelings of being abandoned they were experiencing. Patients with a more preserved cognitive functioning, reported feelings of anxiety and fear for themselves and their loved ones that needed to be accepted and explored. In our experience, despite some difficulties in using technology, the telematics psychological service has received great acceptability and appreciation by patients. During almost two months of this service, the 75% of patients usually benefinting of the psychological service were involved in the telematics intervention, thus showing a good feasibility. This result can be considered a success taking into account the specificity of the population we refer to; however, further data are needed to confirm its effectiveness. A special thanks to the Council of “Casa di Riposo Ebraica di Roma”, the President, the College of Auditors, the Commissioner of CRER, the General Director, and all healthcare professionals. Tablet devices were provided by the Union of Italian Jewish Communities which we sincerely thank. This research did not receive any financial support. The authors declare that they have no conflict of interest.

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