Telemedicine, Isolation, and Anxiety: The Impact of COVID-19 Lockdowns on an 87-Year-Old Woman

This report describes an 87-year-old female who received cognitive behavioral therapy and medication for anxiety before, during, and after the coronavirus disease 2019 (COVID-19) lockdowns. Our objective is to highlight the impact of isolation, examine the use of telemedicine during the pandemic, and stress the importance of early implementation of this technology. To this end, a chart review of psychotherapy and psychiatry progress notes from 2019 to 2022 and a patient interview were utilized to assess the impact of COVID-19 and telemedicine on the patient's anxiety symptoms, feelings of isolation, and treatment plan. Feelings of isolation, especially, were exacerbated. Prior to the pandemic, the patient was extremely physically and socially active. The reduced ability to interact with others and maintain her independence was detrimental. As a result, COVID-19 impacted the patient's progress significantly and caused regression of symptoms. However, telemedicine allowed for the continuation of therapy and follow-up to the present time. Though telemedicine allowed the patient to receive regular care for the duration of the lockdown and to regain control of anxiety symptoms, she only recently became comfortable with the technology. Now, the patient prefers the convenience and ease of telemedicine, continues to receive care through this modality, and feels that her current care is equivalent to in-person therapy. This case report should serve as a reminder of the effect that isolation can have on older adults with pre-existing anxiety. Notably, isolation may be related to the recent COVID-19 pandemic or other factors, such as reduced mobility or limited access to social services. In any case, isolation has a substantial impact on older patients' mental health. And, despite the availability of telemedicine, clinicians should be aware of the technical challenges surrounding emergency implementation. We suggest early exposure to telemedicine for patients, as well as staff training focused on the potential technical limitations of those patients. We also suggest an assessment of technical literacy, conducted early on as part of a patient's initial intake. The main limitation of this report, and the conclusions drawn herein, is the lack of quantitative measures available. Thus, assessment of the patient's condition and symptoms was restricted to clinician assessment and self-reported measures. We feel though that this remains a useful example of the long-term benefit of telemedicine for older individuals.