The guest is Deirdre Johnston, M.B.B.Ch., M.D., who is Assistant Professor, Division of Geriatric Psychiatry and Neuropsychiatry in the Department of Psychiatry at Johns Hopkins School of Medicine, and Medical Director of the PATCH and MIND at Home community-based programs.
BrightFocus Foundation
Maintaining Emotional Health and Vision During the Pandemic
May 27, 2020
1:00 p.m. EDT
Please note: This Chat may have been edited for clarity and brevity.
MICHAEL BUCKLEY: Hello, I’m Michael Buckley with the BrightFocus Foundation, and welcome to today’s BrightFocus Chat, “Maintaining Emotional Health in Vision During the Pandemic.” If you’ve never been on a BrightFocus Chat, welcome. I just want to tell you briefly about what we do. BrightFocus Foundation funds some of the top researchers in the world, trying to find better treatments and cures for macular degeneration, glaucoma, and Alzheimer’s. We like to share the latest findings from research with families that are impacted by these diseases, and that’s why we do the BrightFocus Chat. It’s a chance to bring an expert directly to your home via the telephone, to learn the latest news, to help us get through challenges of age-related diseases, and now on top of that, the pandemic. I’d like to welcome today’s guest; she’s been on BrightFocus Chats a couple of times over the years. It’s Dr. Deirdre Johnston. Dr. Johnston is a geriatric psychiatrist at John Hopkins University in Baltimore, and she is one of the nation’s leading authorities on the impact of isolation and on mental health and other aspects for older Americans. We thought this was a particularly important time to welcome her to the Chat and hear some tips to help all of us during this time. Dr. Johnston, welcome back to the BrightFocus Chat.
DR. DEIRDRE JOHNSTON: Thank you, Michael. It’s good to be here.
MICHAEL BUCKLEY: Thanks. Let’s start kind of big picture. We’re 2, 3 months into the pandemic and the quarantine. What are some of the challenges that older Americans are facing, particularly those who might have age-related vision diseases?
DR. DEIRDRE JOHNSTON: I’ll say, first of all, that in my experience, older adults are a lot more resilient than we give them credit for a lot of the time—obviously, you don’t get to be 80 or 90 by being a pushover. So, I think that it’s important to remind yourself: If you’re that age, you’ve made it that far, so you’re not a pushover, and you’ve dealt with a lot already. At the same time, though, some older adults may have an increased risk of certain types of mental health symptoms, and sometimes those mental health symptoms aren’t diagnosable as a condition; they’re just unsettling and distressing and maybe hard to deal with. So, we’ll talk a little bit about how to cope with those symptoms. Of course, this is new for everybody. We’re all learning as we go along every day. This pandemic is causing us all to have to learn a whole lot of new stuff all at the same time, and, of course, it’s even more difficult if you are dealing with chronic illness already, and visual impairment, and some of the other things that go with living to a good old age. There are more challenges for a lot of people.
MICHAEL BUCKLEY: What are some of the specific signs of some mental health stress … some of the specific signs of the toll that the pandemic is taking on people?
DR. DEIRDRE JOHNSTON: So, a lot of people experience anxiety, and I have to say, that’s normal. That’s a normal reaction to the unknown. When it’s not normal is when the anxiety is getting to the point where it’s interfering with a person’s ability to function. Some people have the fear of not being in control, and that’s very distressing, and often they’re just not sure how to deal with that, even if they can’t put a name on that feeling. But if you think about it, it may be the fear of not being in control. Sometimes people even feel helpless or depressed or even hopeless, or some people can become clinically depressed. That’s not the most common thing, but it can happen in a situation like this.
Some people have trouble sleeping. Some may have appetite changes, and we’re hearing about people who are gaining weight during the pandemic. But there are also people whose appetite is disrupted and they’re not able to eat like they normally would, and they’re losing weight. Or they’re eating junk food, and that’s not good for their nutrition. Some people feel fatigued or their energy is low because they’re stressed, and just being stressed and feeling stressed and anxious actually drains energy, and you can feel fatigued because of it. Some people develop physical symptoms, like gastrointestinal symptoms, cramps, diarrhea, etc., or even constipation, too.
And then some people develop more severe symptoms, sometimes, that are associated with posttraumatic stress disorder, particularly people who have been in traumatic situations before and are re-experiencing the pandemic as a traumatic situation, and that is really a situation where a person would need to seek help from a mental health provider. Of course, the other thing for older people, particularly people with sensory impairments—like impaired vision or hearing—the lack of social stimulation caused by the pandemic can actually increase your risk of depression and also increase your risk of cognitive impairment. This is one of the reasons it’s very important to maintain that social connection whatever way you can safely.
MICHAEL BUCKLEY: That’s a great point. I always hear people talk about the pandemic as unprecedented, and I don’t even know if “unprecedented” even comes close to describing it, but are there lessons that we can draw from previous traumatic events, whether it’s 9/11 or hurricanes, earthquakes? Are there things about how we can cope—some coping strategies that we can take from other challenging times in our lives?
DR. DEIRDRE JOHNSTON: Yes, for sure. In fact, it’s been compared to many of these disasters; it’s the hurricane or tornado … it’s something that has kind of swept us all up and suddenly changed everything, so it really is like a disaster. The difference between the pandemic and disasters like that are that those disasters tend to be time limited—more time limited than this. Even if it takes a while to recover from them, you know that things are going to be back working again in … within weeks to months. This is a different type of situation, and we have to develop more long-term coping strategies, and it’s making quite a whole set of new demands on us, things that we’ve never had to do before.
So, this can affect us in different ways, and sometimes people are shocked in the beginning. They don’t believe this is happening, and many people may experience denial. And I think we’re seeing a bit of that on the news sometimes. We’re seeing people who are saying, “This isn’t happening.” “It’s not real.” “This is all made up.” That’s actually is a psychological … can be a psychological symptom of denial, and sometimes people will experience that before they’re able to get to the point of dealing with it. They may go from that feeling sort of uncertain or confused and not sure what they should do. Some people may become depressed at that point, but to adapt to it eventually involves letting go of just longing that things could stay the way they were.
If you can get to that point, get beyond the longing that things will stay the way they were and progress to acceptance, then you’re on your way to really dealing with it. And what that requires of you is to accept things as they are and then look for ways of coping with it and find ways—seek out ways—of coping with … find out how other people are coping with it. Find out what resources are there, and then find strategies that you think might work for you. And then, of course, you test those strategies. You find out, “Will this work? Will this? How’s it going to go? What do I have to do differently to make it work better?” And then, eventually, you arrive at a point where you’re actually confident in dealing with this new challenge, and you get there eventually with any challenge. As you know, you’ve lived … most people that are listening to this have lived long enough to have coped with many challenges by now. And this is just another new challenge that we’re all learning to deal with together.
MICHAEL BUCKLEY: I appreciate that, Dr. Johnston. To that point of accepting and trying to move … you hear people talk about focusing on the things you can control. It sounds good. It sounds easy. I’m sure it’s not. Do you have any tips on how we can do better at trying to focus on things we can control?
DR. DEIRDRE JOHNSTON: Yes, that’s very important. It’s called “active coping,” and it’s a much healthier way to approach things than to avoid dealing with them. Sometimes it’s tempting to just hide away and just pretend it’s not happening, and that actually works for a while, but then in the long run, it really puts you in a weaker position and makes it harder for you to cope. So, active coping means focusing on what you can do to make things better. And some of the things you can do is be informed. Find out. Have accurate information—and I’ll talk about where you can get that accurate information—because knowing what you need to know to deal with this is the first step. It’s very important, and it does give you a sense of control when you know what’s happening. And that can be hard to find out these days—where you can find accurate information. And then, of course, taking practical safety measures—like we’ll talk about in a minute or two—that’s very important, because once you have practical safety measures in place, it does restore a sense of security and then focusing on what you can do.
This is a thinking process as much as anything else, and we know that if you dwell on negative thoughts and you become preoccupied with the negative things that can happen, that actually effects how you feel. There’s a process called “mindfulness” that some of you may be familiar with, where you become aware of your thought process, you pay attention to how you’re thinking and what sort of a road you’re going down in your thinking, and if you find yourself going down a negative road, catch yourself doing that and focus more on the practical, everyday, right-now-at-this-moment things that you could do to make things a little better. And it might be a small thing. One of the biggest things you can do to make yourself feel better is to just sit for a minute and take slow, deep breaths and just focus on the sensations around you. That’s the core of mindfulness, and it can be very helpful in getting your body and mind to a calmer place. It can slow down all of the symptoms associated with anxiety—and it takes a little bit of practice—but even just sitting down and doing it when you’re feeling anxious can make a very big difference.
MICHAEL BUCKLEY: That’s a great point. Before we get into some other parts of things you can control, I want to share a listener question that I thought was really interesting and I think a lot of us can relate to. A listener is saying, “A lot of us wake up in the morning, and this is the day I’m going to take charge, and here’s some things that I can do,” and you have this great, big plan and a really long list for things you can do … and then the energy and your enthusiasm wanes. How do you manage trying to take control and do things versus the reality of: We’re all human, we all get tired, and sometimes that can create some disappointment when people set an ambitious agenda and don’t achieve it. Can you comment on that?
DR. DEIRDRE JOHNSTON: That’s a great question, and, in fact, I think a lot of people are dealing with that right now. You feel like you should be doing all of these things, and you have time to do them now that you didn’t have before, but in fact, you really have to be kind to yourself right now. You’re dealing with a lot already. So, my recommendation would be to select one thing—one goal—for the day, and make it the smallest goal you can, just to get rolling—one simple goal. One goal, in fact, that I would strongly encourage people to maintain, actually, is getting up at a consistent time every morning and having structure in your day. And it might even just be having breakfast at a certain time, having some small activity in the morning, having lunch at certain time, and having some enjoyable activity in the afternoon. There’s so much you’re having to deal with right now that, really, if you can create something pleasant in your day, that’s a reasonable goal. Keep a consistent structure to your day; that’s another reasonable goal. Then you can pick among the things that you would like to do, but don’t try to do them all at once. That’s not being kind to yourself, and it’s kind of setting yourself up for failure, really, and there’s no need. There’s no need to do it that way.
MICHAEL BUCKLEY: That’s a great point. Thank you, Dr. Johnston. And I know a lot of us know, at some level, that this is the time we really need to eat healthy, well-balanced meals and exercise. That can seem pretty overwhelming. Any suggestions on how to take care of our body how to get going on that one when it feels kind of overwhelming?
DR. DEIRDRE JOHNSTON: Yes. Of course, the basics are practice hygiene, wash your hands, and do the things that are recommended, including wearing a mask if you have to be around people, minimizing your exposure to places where there are going to be a lot of people—and I’ll come back to that again in a minute—but this is a time to really pay attention to your nutrition and try to select healthier food choices. This is really taking care of yourself, choosing foods that are more likely to help you feel better and function better. A lot of people have a craving for junk food—and that’s partly due to anxiety, because the junk foods can be comforting—but that’s not really a good way to manage anxiety. Again, this comes back to mindfulness and paying attention to what you’re thinking and doing.
Walking—a little bit of exercise—is very essential. It doesn’t have to be a whole lot; I mean even just getting up and walking out in your hallway or your garden—if you have a garden—or your neighborhood, if there’s a place you can walk safely. That really can help a lot. And some exposure to daylight can really change your mood; it can really improve things. That exposure to daylight can actually positively affect your brain, so staying inside all the time and not being exposed to daylight can actually negatively affect your mood. So, those are some things you can do—structure, a little bit of exercise, and smart nutritional selections. Those would be my recommendations.
MICHAEL BUCKLEY: Those are great tips. So, Dr. Johnston, when we talked about some of maybe the predecessors to this in the past—9/11 or earthquakes or other things—I think one of the big differences is: Back then, there might not have been the internet. There might not have been 24-hour news and all that. How does someone balance being a responsible, informed citizen and just the torrent of information out there? It seems like … neither extreme seems healthy. What do you think?
DR. DEIRDRE JOHNSTON: So, that actually is another very important topic. It’s important to be informed, and there are places you can get information from. My recommendation would not be to watch news shows and talk shows all day, because if you notice what they do, they just repeat the same stuff over and over and over again, and they’re sensationalist about it, and they choose topics that are upsetting and that are contentious, whichever channel you’re watching. If it is a talk show, that actually has a very negative affect on your mental health, particularly if you’re already anxious. You won’t get any more information watching those shows, but it will very likely make you feel more anxious. So, my recommendation is: Avoid those talk shows. They’re very bad for your mental health, including and particularly watching the talk shows or the news going to bed.
So, get your information early in the day, and get it from a reliable source. Don’t go trolling the internet looking for the latest bit of scare information that’s out there. The CDC actually … we’re hearing negative things—we’re hearing all sorts of confusing things, actually—but the CDC actually does have good information on their website. It’s practical information, and it’s up to date, and it’s informed by the most accurate scientific knowledge of the moment. And that’s where to go to get the information you need, not talk shows. Stay away from talk shows.
MICHAEL BUCKLEY: Great, great, great advice, and I think related to that, as part of being responsible and learning the latest about COVID-19, how do you manage—I guess an extreme would be a hypochondriac—it seems like you hear so many different things to keep an eye out for for COVID-19—different indications of problems—how do you manage that? Because it just seems very complicated. How do you manage almost keeping too good of an eye out for symptoms?
DR. DEIRDRE JOHNSTON: Yeah, that’s a great question, Michael, because it is a fine balance. You want to be informed and you want to know what to watch out for, but you don’t want to worry about every symptom you have. So, your primary care doctor is there for you, and if you’re having symptoms, call the primary care doctor and report the symptoms. Now the symptoms to be concerned about—I think you’ve all heard about them—older people can tend to have more unusual symptoms. So, for instance, for many older people—and this, actually, if this happens with or without COVID going on, this would be a reason to call your doctor—a change in level of consciousness, lethargy, increased tendency to fall. Those are kind of nonspecific symptoms that can indicate that an older person is sick, and that would be a reason to call your doctor. And those can be nonspecific symptoms of COVID-19, but they can even be a symptom of a urinary tract infection or pneumonia—any kind of pneumonia. So, those would be reasons to call your doctor, and I think everybody has heard that you can have a cough with this. You can have a fever with it. You can lose your sense of taste or smell. So, if any of those things happen—if you develop a new cough, if you develop a fever, if you notice that your sense of smell or taste has changed or that you’ve lost your sense of smell or taste—those would be reasons to call your doctor. But the way you can, sort of, manage the anxiety about symptoms, about having these symptoms, or constantly worrying about yourself is to do some of these other things that are recommended and to practice the safety measures that the CDC recommends.
MICHAEL BUCKLEY: To your point about working with your doctors, we have a question. A woman from Montana has a question about telemedicine, and I think, understandably, this is a part of medicine that seems like it’s kind of thrust upon a somewhat unprepared America. So, how do you keep in touch with your doctors during this time—like, tips for telemedicine? How do you make this work out okay?
DR. DEIRDRE JOHNSTON: So, you know, actually, there have been some good things that have happened as a result of the pandemic, and one of them is that it has increased access to telemedicine. And for people who have visual impairment, or mobility impairment, or who have difficulty getting to the doctor’s appointments for whatever reason, or whose family can’t get them there, telemedicine is a godsend, because you can see your doctor from your home. And I, myself, have done telemedicine for many years with some of my particularly vulnerable patients, but the nice thing now is that it’s actually become mainstream. And a lot of people might be daunted by the technology—and, you know, we’re all learning how to use the technology, the doctors, too, so the doctors are daunted, as well—but everybody’s learning how to do this and we’re all in the same boat together.
Some doctors’ offices—I think most doctors’ offices—are helping patients set up their device at home and connect. And a lot of the devices that you can use are very readily available, and they’re not so expensive anymore. You can use a desktop with a webcam. If you already have a desktop, you could attach a webcam to it; a webcam costs … like, you can get them for as cheap as about $20—you used to be able to; they may be a little more expensive at the moment, but they’re still worth it. You can use your iPhone or whatever smart phone you use. You can use your daughter’s or your son’s smartphone or your grandkid’s smartphone—and grandkids are great at actually helping you with these issues, so if you are able to be with one of your grandkids or your one of your children, then that person can … you can use their phone, and the doctor will set it up for you to get the call through their phone or get the link through their phone. It’s usually through a link. We’re using a program called Polycom, but we also use the other platforms like Zoom and Doxy.me. And I think everybody around the country is trying out this platform and that platform to see what works best for them. But ask your doctor’s office for help if you’re not sure how to do it.
That, I think, is the most important point I can make here, and don’t be scared of it. There are tips and tricks for setting up your device so that the doctor can see you more easily. One of the things I find … sometimes I’m looking at the top of a person’s head, and I want to see their face, so set up the device so that the doctor can see you. And make sure the light’s falling on your face because if the light is behind you, the doctor will just see you in shadow. So, set up it up so you’re facing the light and that the doctor can actually see your face, because it makes a very big difference for them to be able to do that. And you should be able to see the doctor’s face, too, so if you cannot see the doctors face clearly, ask the doctor to adjust where they’re sitting or adjust the light so that you can see them.
MICHAEL BUCKLEY: That’s great advice, and I think it kind of gets to the beginning of the reopening of society that all parts of the country are starting at varying degrees of speed. As people start to get out a little bit—grocery stores, maybe people who need to take public transportation—any advice for how we balance maybe the mental health urge to get out a little bit—and maybe whether it’s groceries or appointments—but yet the pandemic’s still here. Any tips for how people should gradually reenter their previous life?
DR. DEIRDRE JOHNSTON: Yeah, so, of course, everybody … a lot of people are tired of being cooped up. Now I will say that I have patients who have said to me, “Hey, it’s no problem at all. I’ve been at home most of the time anyway. I’m just not doing very much different now,” so that’s nice for them. A lot of them were already using devices to connect with families and staying home, but if you’re somebody that likes to get out and about and get on with things, you can be sensible about how you do this. And I think a lot of the young people are racing out, and they’re wanting to do everything, and energy is great, but crowds of young people together, that’s not a good situation, because the virus is out there, so you want to stay away from crowds of people or places where there are people packed in, whatever age they are. If there are crowds of people somewhere, that’s not a place you want to be.
I would recommend continuing to wear your mask in public places to minimize the risk. There’s controversy about masks, as you probably know if you’ve been watching TV. There is evidence that wearing a mask reduces your risk of transmitting it if you have it—and you can have it without having symptoms—but it also does reduce your risk of catching it, as long as you wear the mask properly with your nose and mouth covered. And don’t touch the mask. If it’s a cloth mask, wash it when you get home. Wash it regularly, anyway. If it’s a … whatever other kind of mask, just follow the manufacturer’s instructions on how to use it. But one good, important thing to know is don’t touch the outside of your mask when you’re among people, because you’re breathing the air in through that mask and any virus that’s on the air that you’re drawing toward your mouth is going to end up on that mask. And wash your hands often. Try not to touch things when you’re out and about.
And some grocery stores, I think, are still doing special hours for grocery shopping, so I would say to continue to take advantage of that opportunity, and don’t go when the grocery store’s crowded. Buy enough supplies so that you’re not having to go to grocery store too often. Continue to be very cautious here, because the virus is still out there; it has not gone away, and the reason that it’s not … the rate of infection is slowing down is because people have been very careful these last several weeks to months.
MICHAEL BUCKLEY: Great tips. I want to sort of blend your last two answers together where you gave great ideas about telemedicine and some really helpful tips about getting out. As people start going back to their doctor’s office, regardless of the type of medicine, how is that going to work? Do you see ways that … how do you think medical appointments will be different from this point on?
DR. DEIRDRE JOHNSTON: I can tell you, I’m already hearing that the doctors are spacing out appointments so that they’re not filling up the waiting rooms. I think it’s depending how much space they have in their waiting rooms, but they’re trying to keep people out of their waiting rooms. They may ask you to wait in the car before you come in, and then they’ll call you from the car. They are spacing out appointments, so that people’s appointments aren’t overlapping, so there are fewer opportunities for people to be exposed or expose each other. I think that’s going to be one of the changes we’ll see.
I think that it would be reasonable to ask your doctor to continue to use telemedicine if that’s working for you and if it’s appropriate, given whatever you’re being seen for. There are many conditions where your doctor just needs to check in with you and doesn’t need to have you come into the office. And I would recommend asking if you can continue, if it’s not something that you need to be there for. Another tip I can give you, if the doctor needs to have you come in to check your vital signs, you can get a blood pressure cuff. You can get pretty reliable electronic blood pressure cuffs, and you can check your own vital signs and you can have that information available for the doctor when you see the doctor via telemedicine. And all of these things give you a little bit more independence and control over the situation, and it can help again minimize your exposure by having to sit in waiting rooms.
MICHAEL BUCKLEY: That’s great advice. I do think things are going to be different now. I’ve got an interesting question from a listener; I’ll sort of paraphrase. The rest of people’s lives go on during pandemics, in ways good and bad; this caller from Connecticut is wondering: If you have to make sort of bigger decisions, life changes during this time, any tips for how to do that in the best way possible?
DR. DEIRDRE JOHNSTON: Well, that’s a broad question. It depends on what the big decision is, I guess. You know, we should always have advance directives, for instances. That should be something that we do. And a lot of us don’t, because we just don’t think we need to do it, but it’s always a good idea to have designated what you would want done for you if you’re so sick you can’t make your own decisions, or who would you want designate as the person that can make decisions on your behalf. So, that’s something you should take care of anyway. It’s just one good thing to have taken care of and one less worry for you and your family.
In terms of moving or selling your house or those things, that could be a very individual decision, depending on what your present circumstances are and what the plan is; however, if it’s something that’s not absolutely necessary and doesn’t have to happen now, I would say you can wait. Wait a bit, and try to time it at a time when things are a bit safer. I would avoid going on cruises or big trips; I don’t even think you even can go on a cruise at the moment. I wouldn’t be the first one back on a cruise ship if they do open up, I can tell you. Those are situations where you really are exposed to the potential for infection. Big decisions—like getting married or selling a house or moving—I think those are pretty individual decisions. If the question was more specific, I might be able to…
MICHAEL BUCKLEY: The question wasn’t more specific, but, you’re right. There are houses and cars to buy and sell and other personal or professional things that go on in your life. Time for maybe one or two more questions, and then we’ll conclude. A caller from Virginia is wondering about getting together with kids and grandkids; it’s been a long time since people have seen those really special relatives. How should that happen this summer?
DR. DEIRDRE JOHNSTON: That’s a very important question. We’re all missing our grandkids, and we’re all missing our families and friends. I hope everybody is using some kind of video interaction with them, because that can help reduce the loneliness. I would say, again, use discretion and common sense. If your family members are people who have to be in contact with a lot of other people—say, they’re working in a service industry where they have to be in contact with people or if the children are in school or in daycare and you’re an older adult—it might be unwise to start getting together in groups of people. It may be okay to get together out of doors with spacing and wearing masks and handwashing and all that. But I would be cautious. You see people … there’s those pictures on the weekend of the people crowding at the beach; that’s not the way to do it. But seeing your family is important, so if you can make sure that there’s minimal likelihood of them having been exposed and carrying the virus to you and maybe set things up so that you’re not crowded into a small space indoors and you meet with them as a small group, I think that may be a safer way of going about reconnecting with your family.
MICHAEL BUCKLEY: I know a lot of us can’t wait to do it, but we also want to be responsible. So, Dr. Johnston, just any kind of final remarks? You’ve given us some really good perspective and a lot very specific tips that we can do in our lives. Just sort of any kind of general concluding advice for us all?
DR. DEIRDRE JOHNSTON: I think we’re learning new things, which isn’t always a bad thing; we’re facing new challenges, and I’m seeing with my patients that they’re rising to those challenges very well as older adults—my patients tend to be all elderly. And resilience … a lot of the people listening to this call have a good deal of resilience, and as I said, they’ve faced a lot of challenges in their lives before. So, this is just one new challenge, and being … taking care of themselves is very important, and getting accurate information is very important, and keeping structure in the day. Don’t ask too much of yourself at the moment, and stay connected to your friends and family whatever way is the safest for you. Those would be my recommendations.
MICHAEL BUCKLEY: That’s great advice, and to our listeners, our next Chat will be Wednesday, June 24. It will feature a leading ophthalmologist from the Washington, D.C., area who will be able to answer your questions and talk about how the trip to the eye doctor will be different in the future, so please join us again on June 24. Dr. Johnston, on behalf of BrightFocus and on behalf of today’s listeners, I just want to thank you for giving us some great advice. I think today was a very well-timed conversation.
DR. DEIRDRE JOHNSTON: You’re welcome. It was a pleasure.
MICHAEL BUCKLEY: On behalf of BrightFocus, thanks to everybody for joining the BrightFocus Chat, and we will talk with you soon. Thanks.
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