What about the mental health of the elderly in this period of confinement? What is the “syndrôme de glissement” currently observed in nursing homes?
Interview with Prof. Stéphane Adam, head of the Psychology of Senescence Unit at the University of Liège. In the interview, he also refers to two concrete initiatives that ULiège has put in place which are focused on senior citizens: an online platform for psychological support and a call for student volunteers.
Generally speaking, mental health has always been under-considered in the context of ageing, and probably even more so in institutional settings. The health crisis has exacerbated this even more.
A number of facts support this point. First, the Minister of Public Health, Maggie De Block, recently introduced a policy allowing the first eight psychologist appointments to be reimbursed by the Social Security. However, as this policy "costs" it is only accessible to those between the ages of 18 and 64![1] And what about senior citizens? It should be noted, however, that in the context of the COVID-19 crisis, and the clear evidence of the lack of consideration about "psychological distress" and "loneliness", on 2nd April Maggie De Block suggested to extend access to this reimbursement for psychological consultations to those over 65.[2]
Secondly, in institutions for the elderly, mental health problems are mainly addressed from a medical and medication point of view. A recent survey by a group of “mutuelles” here in Belgium showed a widespread tendency to over-prescribe antidepressants and antipsychotics, and not always in a way that could be considered appropriate.[3] It should be noted that recent studies suggest many deleterious effects these treatments in the elderly, as they increase the risk of falls, could lead to the development of pathologies such as Alzheimer's disease, and can even result in the patient’s death! Indeed, researchers often highlight the need to favour non-medicinal approaches. Paradoxically, however, there are very few psychologists working in institutions for the elderly. Structures involving a psychologist are rather the exception than the rule. In any case, there is no obligation for a care structure to include a psychologist on their staff. In comparison, there is practically no structure for people with disabilities that does not include at least one psychologist.
This syndrome has always intrigued professionals in the geriatric field. When the clinical situation is the same (for example, two elderly patients with the same medical condition), how can we explain the spectacular recovery of one of them (we then talk about the resilience of the elderly patient) but the rapid death of the other, with the impression that this patient let themself die. This is where the concept of "slipping away" (glissement) comes into play. The “syndrôme de glissement” therefore corresponds to the rapid deterioration of an elderly patient's general state, accompanied by anorexia and a more or less directly expressed desire for death - a passive renunciation of life. The patient refuses care and food, and, as a result, death can occur very quickly, within a few days or at most a few weeks.
It seems essential to us to address these issues of loneliness and psychological distress directly and openly with residents. We sometimes tend to avoid these subjects believing that this could fuel the problem rather than solve it. On the contrary, avoidance is the worst solution. This is why we have made a very simple questionnaire for professionals available on our site. The interest of this tool is precisely to question, and therefore to clearly address, these elements with the elderly. Moreover, it makes it easier to identify the residents who suffer more from loneliness, and therefore to target an action as a priority for them, either through psychological consultations or by reinforcing contact with the family. This contact can be made through the use of new technologies, if it cannot be done physically.
Above all, if we are clearly faced with a “syndrôme de glissement”, it seems essential to us to enable families, as far as possible, to be at the bedside of the elderly person (subject to the necessary health precautions).
A number of calls for volunteers have been organised in universities and colleges. Often these calls have been directed towards students who could provide technical assistance to the institutions (medical and paramedical professions come to mind). The idea for us was to extend this call for volunteers to all students regardless of their training or age. Despite the particular context for students (especially with their upcoming exams), 120 responded to this call. We were touched by their response. More than 50% of the respondents have no technical skills, and they come from all domains. Their help could nevertheless be very useful in using technologies (videoconferencing, etc.) with residents in order to promote the family/resident link, or even to simply be in contact with the residents, and thus limit their feelings of loneliness.
[1] https://pro.guidesocial.be/articles/actualites/soins-psychologiques-rembourses-et-les-+-de-65-ans-alors.html
(in French)
[2] https://www.maggiedeblock.be/fr/remboursement-de-laide-psychologique-pour-les-plus-jeunes-et-les-seniors/ (in French)
[3] https://www.mc.be/actualite/communique-presse/2018/antidepresseurs-maison-repos (in French)
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