Introduction

One of the main problems of the elderly is pathological ageing, understood as a process of rapid decline in physical and mental functions. The effects of these changes include decrepitude, inability to function independently and, as a result, the need for support. The most common mental illnesses in the elderly are dementia syndromes and depression. In addition to the effects related to impaired functioning, these problems appear to be multi-causal, chronic, and difficult to treat [1].

The number of people affected by dementia is constantly growing [2], which is a serious encumbrance for families and carers [3]. As regards depression, in most cases, elderly people do not show the symptoms that are typical of it [4]. Numerous researchers emphasise the impact of loneliness on the severity and development of depressive disorders [5].

In France, there have been studies showing a link between loneliness and symptoms of depressed mood [6]. The above-mentioned data highlight the importance of contacting a specialist in order to start diagnostics and implement treatment [7].

In Poland, the elderly have already faced limitations related to access to healthcare and the social support system in the field of dementia [8]. The growing inequality in access to these services is also visible during the global spread of the SARS-CoV-2 virus in other countries, e.g. in Italy [9]. The impact of the pandemic on the mental health of older people has been observed in Spanish studies [10].

Due to the nature of the symptoms of dementia even at its early stage, such as difficulty with learning new things (e.g. telecommunication skills), people affected by this condition may have particular problems with reaching specialists and receiving support in this area [11] as well as healthcare [12].

While controlling transmission of the virus appears to be the main priority, both medical and psychological consequences of the lack of access to medical care, resulting in the progression of dementia and long-term effects in changes in functioning, should be taken into account as well [8]. Social activity appears to be of particular importance for cognitive performance [13].

Therefore, the aim of this study was to answer the following question: are there differences in geriatric patients’ emotional and cognitive states at different stages of the pandemic?

Material and methods

This is a retrospective analysis of medical data routinely obtained from patients hospitalized in a department of geriatrics. The basic socio-demographic data were collected in an routinely medical interview during admission and hospitalization. The patients provided their age and level of education, which is needed for further analysis of cognitive abilities and impairments during geriatric assessment.

The Mini-Mental State Examination (MMSE) by Folstein et al. [14] and the Geriatric Depression Scale: Short Form (GDS-SF) by Yesavage et al. [15] are routinely used to assess the patients in geriatric care. In analysed medical data the MMSE scale was used first, followed by the GDS-FS scale. The above scales are screening methods used to diagnose psychological disorders as part of the Comprehensive Geriatric Assessment.

Results

The analysed data were divided into three periods: 164 patients (31%) were hospitalized between July 2019 and March 2020 (time before the COVID-19 pandemic in Poland); 166 patients (32%) between June 2020 and November 2020 (at the beginning of the pandemic); and 188 patients (36%) between May 2021 and November 2021 (during the pandemic).

In total, there were 371 women (72%) and 147 men (28%). This distribution reflects the general trend in the elderly population in Poland, where women constitute the majority of the geriatric population [18]. Most of the hospitalised patients (n = 213) were aged 81–90 (41%). There were 177 people aged 71–80 (34% of respondents). The study also included data of 99 patients aged 60–70 (19%) and 29 patients aged 90 and over (6%).

As regards the level of education of the analysed elderly people, 34% of them had more than 15 years of education. Thirty-two percent of the respondents had between 12 and 15 years of education. Twenty-three percent of the respondents had 8 to 11 years of education, and the fewest completed their education after a maximum of 7 years (11%).

The analysis of the emotional state of the discussed group showed that the majority of them, n = 379 (73%), did not show symptoms of depressed mood. Among those studied 139 patients (27%) showed symptoms of depression. Moderate depression was confirmed in 121 patients; severe depression in 18.

In Table I presents the characteristics of the study group in terms of sex, age, emotional and cognitive state.

In terms of cognitive state, most of the hospitalized patients (n = 307; 59%) were within normal limits. In the whole sample group, 124 patients (24%) had mild cognitive deficits and 87 patients (17%) presented symptoms of dementia.

Table II summarizes the percentage distribution, means and standard deviations of the emotional state of patients in different periods of the pandemic.

There were statistically significant differences in the results of the patients’ cognitive state tests depending on the time of examination (H = 15.37, p < 0.001). Patients examined before the pandemic tended to demonstrate a better cognitive state than patients at the beginning of the pandemic and in its later stages of the pandemic.

Nevertheless, there are no significant differences in the cognitive functioning of patients examined at the beginning and later in the pandemic. Before the pandemic, almost 3/4 of patients (71%) had normal scores, 18% showed mild cognitive impairments, and 11% had dementia scores. The results of analysis are presented in Table III.

Table IV presents the cognitive status of patients at different times of the pandemic. At the beginning of the pandemic, 56% of patients were cognitively normal. The rest of the patients had below-normal scores, of these 26% showed mild cognitive impairments and 18% showed dementia.

In the later stages of the pandemic, the upward trend of patients with both mild cognitive impairments and dementia intensified – although the difference is not statistically significant, it can be seen in the qualitative analysis. Nearly half of the patients (52%) received scores outside the normal range, 28% had mild cognitive impairments, and 21% obtained scores indicative of dementia.

Discussion

The presented data are similar to the results of studies assessing the prevalence of depression among the elderly in Poland. According to the Chancellery of the Senate [19], people aged 65 and over are the group with the highest incidence of depression (11.5% of people at this age show symptoms of depression, 4.7% experience severe symptoms of depression, and 6.8% have other symptoms of depression).

Comparing the results of this research with data obtained in the study of long-term care elderly patients, one may observe that in the long-term facility, patients with dementia are the dominant group (over 70% of respondents), with patients affected by moderate dementia being the majority (over 1/4 of patients).

People with mild cognitive impairments (17.2% of respondents) and those within the normal range (10.4%) are a minority in this group [20]. The group of patients hospitalised in the Department of Geriatrics, the majority of whom obtained a normal MMSE score, is characterised by a different profile in terms of cognitive state.

Before the introduction of lockdown (February 2020), long-term care patients were mostly people without symptoms of depression (87.9%). During the period of full isolation (March 2020), 26% of the elderly patients showed symptoms of depression. It should be emphasised that in May 2020, with the use of partial isolation (video calls, letters, photos, ability to see someone while being separated by a glass wall), the percentage of people with symptoms of depression decreased to a level comparable to that before the pandemic. The differences between the analysed groups are statistically significant [20].

This research indicates that patients hospitalised in the geriatrics clinic showed symptoms of depression prior to the pandemic more often (25% of respondents) than patients covered by long-term care. The number of these patients increased even more with the introduction of the visiting ban (up to 31%), but later in the pandemic it returned to the previous level.

Although the differences between the compared groups were not statistically significant, a similar tendency as in patients in the 24-hour care facility is observed, consisting in mood improvement after being able to contact their relatives. This is consistent with other studies conducted in Poland which indicate that during the fourth wave of the COVID-19 pandemic, Poles felt better than during the first wave, which may be evidence of better psychological adaptation or a better response to the reduction of restrictions [21].

Similar conclusions can be drawn from studies carried out in the USA, where despite the increase in the number of COVID patients, there was no increase in depressive symptoms [22]. This may be due to the fact that elderly people show better mental health resilience compared to younger people [23]. However, as highlighted by Wang et al. [24] an intensified increase in psychological distress is associated with multimorbidity.

The generally higher level of depressive symptoms in patients hospitalised in the geriatrics clinic than in people living in the 24-hour care facility may be explained by the observation of Bukhari et al. [5] indicating that elderly people who normally live with their families and suddenly become isolated feel a greater sense of loneliness than those who have lived without a family for a long time.

However, as emphasised by Müller et al. [25], what is associated with depressive symptoms among the elderly population in Germany is loneliness rather than isolation. Thus, the subjective emotional assessment, i.e. the sense of loneliness, appears to be more significant than the objective state of isolation. Similar findings were obtained in Spain, where no association between the state of the pandemic and depressive disorders in the elderly was found [26].

According to the results of research conducted in the US, the elderly appear to be more resistant to anxiety, depression and stress-related mental health disorders compared to younger age groups during the COVID-19 pandemic [27]. Similarly, in the Netherlands, it was found that although elderly people felt lonely during the pandemic, their level of mental health remained unchanged [28].

Conclusions

The number of geriatric patients who showed symptoms of depression increased further after the visitation ban was imposed, but returned to its previous level later in the pandemic. This may indicate psychological adaptation to the situation or reaction to the reduction of restrictions. The obtained results suggest that the perception of one’s own life situation seems to be more important than the objective introduction of limitations.

A new aspect resulting from the COVID-19 pandemic, which affects the emotional and mental state of seniors, was being assessed. The limitations of the study are related to the surveyed population just of hospitalized seniors.

Further research requires expanding the study group to out-of-hospital conditions. It would also be advisable to include information about any previous episodes of affective disorders in the in-depth interview with the patient.