Unleash Your Creativity: Summarize Media Article

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Writing your own media article.
You will need write a 350-500 word article (this could be HTML or in written form) that summarises  the research article (will be attached below) or a general audience.
Your writing should read like a newspaper article or blog post for  mainstream consumption. It must be clear, concise and unbiased in its  presentation of the facts. This is, of course, a piece of creative  writing and so you are free to make it as interesting as you can. You  want an engaging media article after all! But make sure you don’t go so  far that you are misleading your audience into believing something that  isn’t true.
You may assume the study has been run in an ethical and unbiased  manner and that the results you have seen are trustworthy (for the  purposes of this assignment). Writing should follow according to criteria attached below. You need to present 22 documents. 1 document should contain writing and other document should contain proof of each sentence i.e. where have you considered from the research article.Clinical Gerontologist
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wcli20
National Survey on the Impact of COVID-19 on the
Mental Health of Australian Residential Aged Care
Residents and Staff
Aida Brydon, Sunil Bhar, Colleen Doyle, Frances Batchelor, Harry Lovelock,
Helen Almond, Leander Mitchell, Maja Nedeljkovic, Steven Savvas & Viviana
Wuthrich
To cite this article: Aida Brydon, Sunil Bhar, Colleen Doyle, Frances Batchelor, Harry
Lovelock, Helen Almond, Leander Mitchell, Maja Nedeljkovic, Steven Savvas & Viviana
Wuthrich (2022) National Survey on the Impact of COVID-19 on the Mental Health of
Australian Residential Aged Care Residents and Staff, Clinical Gerontologist, 45:1, 58-70, DOI:
10.1080/07317115.2021.1985671
To link to this article: https://doi.org/10.1080/07317115.2021.1985671
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CLINICAL GERONTOLOGIST
2022, VOL. 45, NO. 1, 58–70
https://doi.org/10.1080/07317115.2021.1985671
National Survey on the Impact of COVID-19 on the Mental Health of Australian
Residential Aged Care Residents and Staff
Aida Brydon BA (Hons) a, Sunil Bhar PhD a, Colleen Doyle PhD b, Frances Batchelor PhD b,
Harry Lovelock MSSCc, Helen Almond PhD a, Leander Mitchell PhD d, Maja Nedeljkovic PhD a,
Steven Savvas PhD b, and Viviana Wuthrich PhD e
a
Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia; bNational Ageing Research Institute,
Melbourne, Australia; cMental Health Australia, Canberra, Australia; dSchool of Psychology, University of Queensland, Brisbane, Australia;
e
Department of Psychology, Macquarie University, Sydney, Australia
ABSTRACT
KEYWORDS
Objectives: This study is the first to obtain data on the prevalence of, contributors to, and supports
required for, pandemic-related distress within the residential aged care sector in Australia. A nested
mixed-methods approach was used to examine aged care leaders’ opinions about the impact of
COVID-19 on the mental health of aged care residents and staff.
Methods: A total of 288 senior staff of Australian residential aged care facilities (care managers,
clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years, SD = 10.3) completed
an online survey between 10th September and 31st October 2020.
Results: On average, nearly half of their residents experienced loneliness (41%) and a third experienced
anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health
among residents were restrictions to recreational outings and watching news coverage relating to
COVID-19. Participants emphasized the need for increased access to counseling services and improved
mental health training amongst staff. Residential care staff were similarly impacted by the pandemic.
More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19.
Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage
of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios.
Conclusions: Senior staff perceive that the mental health of Australian aged care residents and staff
was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified,
as was the mental health support for aged care communities.
Clinical Implications: This study provides government and policymakers with clear intervention
targets for supporting the sector. Clinicians can support residential aged care communities by
providing on-site or telehealth counseling, and upskill and train residential aged care staff on how
to respond to the emotional needs of residents in response to COVID-19.
COVID-19; mental health;
aged care; older adults;
residential aged care
Introduction
COVID-19 has had a “devastating toll” on the lives
of people living in residential aged care facilities
(RACFs) around the world (United Nations, 2020,
p. 3). Older adults aged 65 and older are at heigh­
tened risk of dying from COVID-19 (Wu &
McGoogan, 2020). The communal living arrange­
ments within RACFs have led to an increased risk
of transmission for both residents and staff
(Gardner, et al., 2020). Australia has had fewer
cases per capita than most other high-income
countries, with just over 29,000 cases in a country
of 25 million people (as of 8th April 2021); however,
75% of the COVID-19 related deaths have occurred
in RACFs (Cousins, 2020; Department of Health,
2021). Australia has one of the highest rates world­
wide of COVID-19 related deaths in residential
aged care as a percentage of total deaths (Cousins,
2020).
To prevent the spread of coronavirus to residen­
tial aged care populations, severe physical distan­
cing and lockdown measures were imposed in
RACFs in Australia on the 18th March 2020
(Prime Minister of Australia, 2020). These restric­
tions varied between states and territories in
response to community transmission rates. In
CONTACT Aida Brydon
aidabrydon@swin.edu.au
Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC 3133
This article has been republished with minor changes. These changes do not impact the academic content of the article.
Supplemental data for this article can be accessed on the publisher’s website.
© 2021 Taylor & Francis Group, LLC
CLINICAL GERONTOLOGIST
some facilities, visitors and professionals were
restricted from entering the building, while in
others, visits were shortened. In some facilities,
group and leisure activities were ceased, while in
others, excursions were also suspended. In extreme
cases, residents were discouraged from leaving their
private rooms, and telephone and videoconferen­
cing calls between residents and their families or
healthcare providers were restricted due to poor
staff availability (Cousins, 2020). Within the com­
munity, the response to COVID-19 varied by state.
Some Australian states remained completely free of
COVID-19, and the majority of the COVID-19
cases and deaths were in Victoria. Restrictions
imposed in the community included travel restric­
tions, curfews, requirements for social distancing,
requirements to wear masks, and closure of nonessential businesses.
The prevalence rates of pandemic-related dis­
tress within RACFs have now been researched in
several countries, mostly drawing on the obser­
vations of families and staff. In a Dutch study,
more than half of the 811 residents showed
increased agitation, depression, anxiety, and irrit­
ability, according to staff (van der Roest, Prins,
van ger Velder, & Steinmets, 2020). A study con­
ducted in Ireland found that nearly half (48%, n=
225) of residents showed a reduction in mood,
according to family visitors (O’Caoimh et al.,
(2020). A second Dutch study found that the
relatives of aged care residents (n = 1997) were
concerned about increased loneliness (76%), sad­
ness (66%), and decreased quality of life (62%)
for those in aged care (Wammes et al., 2020).
However, such patterns of concern have not
been consistently observed for older adults living
in the community (Luccetti et al, 2021; Palgi et al.,
2020; van Tilburg, 2021). For example, Van
Tilburg, Steinmetz, Stolte, van der Roest, and De
Vries (2021) found that while loneliness worsened
following the implementation of COVID-19 dis­
tancing restrictions for community-dwelling older
adults, other aspects of their mental health did not
appear to be adversely impacted. Some studies have
also suggested that older adults are more resilient
than younger adults in tolerating such restrictions.
For example, several studies have found that older
adults were less affected by anxiety or depression
during COVID-19 compared to younger-aged
59
cohorts during the pandemic (Czeisler, 2020;
González-Sanguino, et al., 2020). These findings
suggest that the effects of COVID-19 on mental
health may be unformed across aged care contexts.
COVID-19 has also had a profound negative
effect on the psychological well-being of aged care
staff (Corpora et al., 2021; Sizoo, Monnier,
Bloemen, Hertogh, & Smalbrugge, 2020; Spilsbury
et al.,). A survey of residential care home staff in
Northern Italy reported 40% of staff reported posttraumatic stress disorder symptoms in response to
COVID-19 and 22% had moderate-to-severe symp­
toms of anxiety (Riello, Purgato, Bove, Mactaggart,
& Rusconi, 2020). Staff interviewed in US-based
nursing homes, reported mental exhaustion and
burnout in response to larger workloads (Corpora
et al., 2021). Such adverse effects have been found
in healthcare workers in hospital settings as well.
Anxiety and social isolation were found to worsen
in a sample of 295 healthcare hospital workers in
the US (Dugani et al., 2020). Similarly, in Australia,
healthcare hospital workers were found to report
higher rates of depression and anxiety compared
with the general population during the pandemic,
with 20–30% reporting moderate to severe symp­
toms. (Dobson et al., 2020).
Despite such data, there is yet to be a national
survey on the impact of COVID-19 on the mental
health of residential aged care staff and aged care
residents. There is also a need to more comprehen­
sively identify the COVID-19 related stressors and
restrictions that may contribute to mental health
impact on residents and staff. Anecdotal reports
have suggested that residents have become
depressed or withdrawn because of long periods
of quarantine and the “lack of physical contact,
exercise, and fresh air seriously affected residents
mental and physical health” (Gilbert, 2020, p. 395).
Van Tilburg et al. (2021) found that poorer mental
health in community-dwelling older people during
the COVID-19 pandemic was associated with the
loss of outdoor activities, unmet needs for social
support, worries about the pandemic, and a decline
in trust in societal institutions.
RACF staff have been reported to be strained by
several factors including increased workloads asso­
ciated with less staff working in facilities, expansion
of their role to support residents isolated from
families (Low et al., Low, et al., (2021); Leontjevas,
60
A. BRYDON ET AL.
et al., 2021; Corpora et al., 2021), worry about
introducing the virus to vulnerable residents, wit­
nessing multiple COVID-19 deaths of residents
(Low, et al., (2021); White, et al., 2021) and restric­
tions imposed within the aged care facilities (Sizoo
et al., 2020). Despite such commentaries, no sys­
tematic research has solicited the opinion of aged
care leaders about the extent to which these factors
are widespread in contributing to the poor mental
health of aged care residents or staff in Australia.
Finally, there is a need to explore what mental
health support is needed. On the 30th
November 2020, the Australian Government
announced $63.3 million in funding to support
the emotional wellbeing of aged care residents
(Australian Government, (2020). As an important
stakeholder group, it is important to understand
what senior aged care staff believes needs to be
included within the mental health response for
both aged care residents and staff.
This study had three aims. First, it examined the
extent to which the mental health of Australian
aged care residents and staff was impacted by
COVID-19, from the perspective of senior aged
care staff. Second, it explored potential contributors
to adverse mental health experiences of aged care
residents and staff. Third, it solicited opinions of
senior staff within Australian RACFs about
resources and programs needed to support the
mental health of aged care residents and staff
through the pandemic. The findings of this study
were anticipated to provide a blueprint in Australia
and other countries for how the residential com­
munity can be impacted by, and supported
through, the pandemic. In the current study, the
opinions from aged care senior staff were obtained.
Senior staff were at the forefront of managing the
practice changes in RACFs and therefore, in our
view would be able to provide an informed opinion
to these study questions.
Methods
Participants
The sample comprised 288 senior staff from RACFs
across six states and territories in Australia (84%
female, 15% male, n= 2 undisclosed; age ranged
from 26 to 76 years, M = 52.7, SD = 10.3).
Participants were facility managers (n = 208;
72%), clinical care coordinators (n = 40; 14%) and
lifestyle team leaders (n= 40; 14%). These positions
typically involve the provision of direct care to aged
care residents, supervision of staff, and administra­
tive duties. Participants had worked in the aged
care sector between 1 and 45 years (M = 15.6,
SD = 9.7). One person from each RACF was invited
to complete the survey, and if more than one
response was received from a facility, the response
from the most senior respondent was retained. We
limited participation to one person per RACF in
order to avoid having our findings being dominated
by responses relating to a few facilities.
Characteristics of facilities represented by the
study sample are listed in Table 1.
Measures
An online survey was created for the study (see
Appendix A in the supplementary material). The
survey was piloted for clarity on three RACF senior
staff before being distributed to the study sample.
The survey consisted of three sections. In the first
section, the perceived impact of COVID-19 on the
mental health of residents and staff was examined.
Table 1. Characteristics of residential aged care facilities.
State or territory
Victoria
New South Wales
Tasmania
Western Australia
Australian Capital Territory
Queensland
South Australia
Northern Territory
Setting
Metropolitan
Inner regional
Outer regional
Remote
Unknown
Type of Facility
For profit
Not for profit
Government
Other
Number of beds
0–20
21–40
41–60
61–80
81–100
> 100
Presence of COVID-19
At least one staff testing positive
At least one resident testing positive
N
%
89
103
8
8
5
47
13
0
30.9
35.8
2.8
2.8
4.5
16.3
4.8
0
112
47
70
40
8
40.4
16.3
24.3
13.9
2.8
75
172
33
5
26.0
59.7
11.5
1.7
0
36
50
64
38
84
0
12.5
17.4
22.2
13.2
29.2
41
16
14
5.6
CLINICAL GERONTOLOGIST
Respondents slid a digital marker to a number
between 0% and 100% to estimate the percentage
of their residents and staff who demonstrated
poorer mental health, anxiety, depression, and
loneliness in response to COVID-19. Respondents
also estimated the percentage of their residents who
showed an increased level of challenging behavior
(e.g., emotional outbursts or agitation), death idea­
tion, and suicidal ideation in response to COVID19. In addition, respondents estimated the percen­
tage of their staff who were on personal leave (unre­
lated to being diagnosed or tested for COVID-19),
who showed lower morale, and who were increas­
ingly in conflict with other staff in response to
COVID-19. Finally, respondents provided qualita­
tive comments about the perceived impact of
COVID-19 on the mental health of residents and
staff.
In the second section of the survey, respondents
selected from a list of potential restrictions and
stressors that might affect the mental health of
residents and staff. Examples included: Family and
friends not allowed in the facility, residents not
allowed to leave the facility, and recreational out­
ings being suspended or reduced. Respondents
indicated if the restrictions were currently or pre­
viously imposed, and the extent to which each
restriction and stressor deteriorated the mental
health of residents and staff, using a 3-point scale
(“not at all” to “very much”). Respondents wrote
other restrictions and stressors that they believed
negatively impacted residents and staff.
In the final section of the survey, respondents’
opinions were solicited about programs and
resources for supporting the mental health of resi­
dents and staff. Respondents selected these from
a predetermined list of programs and resources
including personal protective equipment, staff
training on emotionally helping residents, onsite
mental health services, telehealth mental health
services, and Information Technology support for
video conferencing. Respondents were invited to
write further suggestions.
Respondents completed demographic questions
about themselves (age, gender, role in the RACF,
length of time working in residential aged care),
and the characteristics of the RACF they repre­
sented such as: ownership (e.g., for-profit, not-forprofit, government), number of beds, region, and
61
whether any of their staff or residents had tested
positive for COVID-19. No questions were
compulsory.
Procedure
Ethics approval for the study was granted by
Swinburne University Human Research Ethics
Committee (20,204,161–5130), University of
Queensland (2,020,002,164) and Macquarie
University Human Research Ethics Committee
(52,020,910,520,556). Consent to participate in the
survey was implied if the survey was submitted. The
survey was advertised widely on social media, in
news articles, and through organizational and per­
sonal networks. E-Mail invitations were sent to all
Australian RACFs on three occasions (28th
September 2020, 16th October 2020, and 26th
October 2020) to RACFs listed on the GEN Aged
Care Data service list (Australian Institute of
Health and Welfare, 2020). The survey was open
between 10th September and 31st October 2020,
inclusive.
Data analysis
A nested mixed-methods framework was used for
this study (Shorten & Smith, 2017). Qualitative
narratives were used to complement quantitative
findings. Quantitative analyses comprised descrip­
tive statistics, which were calculated using SPSS
version 27 to summarize the extent to which senior
staff perceive residents and staff were impacted by
COVID-19 and to indicate the impact of restric­
tions and stressors on residents and staff.
Frequency tables were created to provide an over­
view of the resources and programs identified as
potentially helpful. Qualitative analyses were con­
ducted as supplementary to the quantitative find­
ings. Guided by the research questions,
a preliminary analytic coding framework was devel­
oped (Ivankova, Creswell, & Stick, 2006). The
responses to open-ended questions were compiled
under topics relevant to the research questions.
Responses that could not be categorized in the
initial coding framework were given a new code.
Directed descriptive content analysis was con­
ducted (Gale, Heath, Cameron, Rashid, &
Redwood, 2013; Hsieh and Shannon, 2005). All
62
A. BRYDON ET AL.
text-box responses were coded in NVivo 12 by two
independent researchers. Differences in coding
were discussed and resolved. Finally, the coding
team developed summaries of each code and pre­
sented these in tables ranked in order of frequency.
Results
Of 315 surveys returned, 27 were excluded from
analysis, as respondents did not meet the inclusion
criterion of being a RACF facility manager, clinical
care coordinator, or lifestyle team leader (i.e., they
selected the “Other” option; n = 16) or were
received from the same facility (n= 11). The final
sample comprised 288 participants.
Question 1: What was the impact of COVID-19 on
the mental health of aged care residents and staff?
The most common mental health difficulties
among residents, as reported by participants, were
loneliness, followed by increased anxiety and stress,
unspecified “poor mental health,” and depressive
symptoms. Less common observations were
increased thoughts of death and suicide
(Figure 1). As shown in Figure 1, the most common
mental health reactions by staff to COVID-19, as
observed by participants, were anxiety and stress,
low morale, and “poor mental health.” Less com­
mon observations were loneliness, depressive
symptoms, and workplace conflict.
Participants provided 253 qualitative observa­
tions about additional mental health difficulties of
their residents (134 comments) and staff (119 com­
ments). Comments relating to residents (summar­
ized into 11 themes) suggested that residents felt
a high level of grief and loss (n = 14), loss of
autonomy (n= 9), and apathy (n= 7). The com­
ments related to staff (summarized into 7 themes)
suggested that staff felt fatigued (n= 11), frustrated
(n= 6), and feeling of shame/undervalued (n= 6; see
Table S1 and Table S2 published as supplementary
material online attached to the electronic version of
this paper.
Question 2: What was the impact of COVID-19
restrictions and stressors on mental health?
Of the 288 participants, 279 indicated that their
RACF had implemented restrictions to protect
against transmission of COVID-19 (see Figure 2).
Considering both current and past restrictions, the
most common restrictions used to manage
COVID-19 were suspensions to recreational out­
ings (97.6%), the length of time visitors were
allowed to stay in the facility (94%), and the num­
ber of visitors allowed into the RACF (93%).
Respondents were invited to nominate other types
of restrictions enforced in their facility which
impacted the mental health of residents.
Respondents provided 131 responses, identifying
an additional seven types of restrictions. Most fre­
quently reported additional restrictions were
Figure 1. Percentage of residents and staff per facility demonstrating negative mental health in response to COVID-19, as reported by
senior staff at Australian residential aged care facilities.
CLINICAL GERONTOLOGIST
suspension of non-essential services such as hair­
dressers, entertainers, and volunteers (n= 29),
social distancing (n =18), and the use of personal
protective equipment (n= 14; for the full list of
extracted themes, see Table S3 in the supplemen­
tary material).
Of current and past restrictions, the suspension
or reduction of recreational outings was most com­
monly perceived as damaging the mental health of
residents; 93% of respondents reported that this
restriction negatively affected resident mental
health “very much” or “moderately” (See
Figure 2). The restriction of family and friends
into the facility was the second most frequently
cited contributor to residents’ poor mental health;
92% of participants reported that this factor
impacted the mental health of residents “very
much” or “moderately.”
Respondents were also presented with a list of
“stressors” that may affect the mental health of
residents and staff. They were asked to indicate
the perceived impact of each stressor on a scale of
0– 2 (very much, moderately, not at all), or “don’t
know.” The most commonly selected stressor for
residents was “media reports of COVID-19 out­
breaks,” with 93% of respondents reporting that
this impacted residents “very much” or “moder­
ately” (see Figure 3). The next commonly selected
impactful stressors were “concern about family
63
and friends being infected by COVID-19” and
“concern about being infected by COVID-19,”
respectively.
The most commonly selected impactful stressor
for staff was also “media reports of COVID-19 out­
breaks”; 98% of respondents reported that this item
negatively impacted staff “very much” or “moder­
ately” (see Figure 3). The second and third most
frequently selected stressor for staff were “concern
about accidentally introducing COVID-19 into the
facility” and “Concern about residents being
infected by COVID-19,” with 97% and 95% of
respondents reporting these negatively impacted
staff “very much” or “moderately,” respectively.
Participants were invited to suggest other stres­
sors that may have affected the mental health of
residents and staff. Respondents suggested 10 addi­
tional types of stressors for residents and 10 for staff.
The three most frequently identified factors from
these suggestions for aged care residents were
a reduction in volunteers, hairdressing, and external
entertainment (n = 18), a lack of freedom (n= 6), and
confusion with restrictions (n = 6). The three most
frequently cited factors negatively impacting the
mental health of staff were increased workloads
(n= 18), loss of incomes (n = 11), and the inability
to visit their country of origin (n = 10; for the full list
of extracted themes, see Table S4, for residents, and
Table S5, for staff, in the supplementary material).
Figure 2. Restrictions imposed residential aged care facilities and their impact on mental health of aged care residents, as reported by
senior staff at Australian residential aged care facilities.
64
A. BRYDON ET AL.
Figure 3. Impact of COVID-19 stressors on mental health of residents and staff (number of responses per category), as reported by
senior staff at Australian residential aged care facilities.
Question 3: What support is needed for aged
care residents and staff?
Participants were presented a list of five
resources and were asked to select those that they
believed would support the mental health of aged
care residents and staff. Participants were permitted
to make multiple responses. As shown in Figure 4,
the most endorsed resource for supporting the
mental health of residents was “more on-site men­
tal health services” (50%). The most frequently
endorsed resource for supporting the mental health
of staff was “staff training on emotionally helping
residents” (70%).
Participants suggested 11 other resources for
supporting the mental health of residents (n =
119) and 12 for supporting staff (n = 139 provided
Figure 4. Senior staff perceptions on the mental health support needed for aged care residents and staff (percentages), as reported by
senior staff at Australian residential aged care facilities.
CLINICAL GERONTOLOGIST
additional suggestions for staff) in response to an
open-ended question. The three most frequently
identified themes from qualitative content analysis
of responses for aged care residents were increased
staffing numbers (n = 29), more family interaction
(n = 17), and easing of restrictions (n= 19). The top
three additional supports needed for staff were
financial help (n= 27), increased staffing numbers
(n = 26), and recognition of value (n = 17; for the
full list of extracted themes, see Table S6, for resi­
dents, and Table S7, for staff, in the supplementary
material).
Discussion
This study is the first to quantify the impact of the
COVID-19 pandemic on the mental health of
Australian aged care residents and their staff. This
study examined the mental health consequences of
the pandemic on aged care residents and staff,
explored the impact of COVID-19 related restric­
tions and stressors on their mental health, and
identified interventions needed to support their
mental health needs from the perspective of senior
aged care staff.
The results of the study are that the mental
health of aged care residents and RACF staff has
been severely affected by the COVID-19 pandemic,
in the opinion of senior aged care staff. Results
indicated that in relation to COVID-19, a high
percentage of aged care residents demonstrated
poor mental health, increased loneliness, increased
stress and anxiety, increased challenging behavior,
and increased thoughts of death and suicide, as
reported by senior aged care staff. Overall, accord­
ing to senior aged care staff, resident loneliness and
anxiety/stress were reported to have increased the
most in response to COVID-19, with results show­
ing 41% of residents showing increased loneliness,
and 33% showing increased anxiety/stress. Results
also showed a high prevalence of aged care staff
who demonstrated poor mental health in response
to COVID-19. Overall, according to senior aged
care staff, loneliness and increased anxiety and
stress also increased the most for staff in response
to COVID-19.
The reasons for such high rates of poor mental
health in response to the pandemic are diverse. For
residents, visitation bans, outing restrictions, media
65
exposure to COVID-19 outbreaks, and concerns
for the safety of family of friends appeared to be
the most identifiable precipitants for deterioration
in mental health, reported by senior staff. These
findings support previous research on the mental
health impact of visitation bans, outings, media
exposure to COVID, and concern for friends and
family (Low et al., Low, et al., (2021)). For staff, the
most commonly identified stressors were those
related to media exposure to COVID-19 outbreaks,
concerns about the safety of self, residents and
family, and fear of inadvertently infecting residents.
From the perspective of senior staff, the resources
needed to support residents and staff included hav­
ing more staff training for supporting the mental
health of residents, creating on-site counseling ser­
vices, having access to telehealth counseling ser­
vices, and having IT support for video
conferencing.
The high levels of mental health problems
among aged care residents and staff as reported
by senior aged care staff in this study are con­
sistent with anecdotal comments and news
reports (Pachana, Beattie, Byrne, & Brodaty,
2020; Velayudhan, Aarsland, & Ballard, 2020).
This study has extended these anecdotes in sug­
gesting that according to senior staff, the most
prevalent negative mental health reactions to
COVID-19 amongst aged care residents are
increased loneliness, anxiety, and stress, accord­
ing to the senior staff, and in suggesting that
RACF staff may have also been impacted by
COVID-19 – and have felt increased levels of
anxiety and stress.
Further, this study found that restrictions and
stressors were seen by senior RACF staff as important
contributors to the poor mental health of aged care
residents and staff. From a list of a range of restric­
tions, most respondents selected the suspension of
social visitation and recreational outings as negatively
affecting residents. This finding was consistent with
anecdotes about residents feeling isolated and bored
because of such restrictions (Low et al., Low, et al.,
(2021)). This study has extended these anecdotes by
suggesting that residents’ poor mental health may also
have been related to a range of other stressors, includ­
ing exposure to media reports about COVID-19 out­
breaks and concerns about their family members and
friends being infected by COVID-19.
66
A. BRYDON ET AL.
Such results suggest that residents may benefit
from opportunities to receive visits, go on outings,
be distracted from watching news coverage on
COVID-19, and frequent reassurance about the
health and safety of family and friends. Such
recommendations are to be balanced by the need
to adhere to strict infection control protocols.
Video calls, virtual reality outings, activities for
distraction, and rostered reassurance by staff may
be possible options in some settings to attenuate the
adverse effects of the pandemic on the mental
health of residents.
A wide range of stressors were commonly
selected by participants as impacting staff: these
included media reports about COVID-19 out­
breaks, fear of residents being infected with
COVID-19, and a fear of bringing COVID-19 into
the facility. Extending on the quantitative responses
regarding the media reports of COVID-19 out­
breaks, five qualitative responses reported that
negative portrayal of the aged care sector within
media reports increased distress in staff. Some staff
experienced increased abuse from residents’
families, and this was reported to be due to the
negative portrayal of aged care in the media.
Greater recognition of such stressors is needed.
Several resources were selected as important for
supporting the mental health of residents and staff.
The three most endorsed items for supporting the
mental health of residents were providing staff with
more training on emotional care, with on-site
counseling services, and with telehealth counseling
service. The three most endorsed resources for
supporting staff were on-site counseling services,
telehealth counseling services, and more informa­
tion technology support for videoconferencing.
Clinical implications
These results suggest that there are three ways in
which government can support the residential aged
care sector during the pandemic. First, onsite coun­
seling and psychological support should be pro­
vided to assist both residents and staff. Currently,
on-site mental health programs in Australian
RACFs are primarily focused on resident wellbeing
(Australian Government Department of Health,
2018). Recent government funding in Australia
has been directed to resourcing on-site counseling
through the Medicare Benefits Schedule
(Australian Government Department of Health,
2020) and through expanded funding provided to
a select number of Primary Health Networks (PHN;
Australian Government Department of Health,
2018).
Second, telehealth counseling should be made
more accessible for the residential aged care sector.
During 2020, telehealth has become an important and
recognized mechanism for delivering mental health
services within Australia (Zhou et al., 2020). However,
telehealth has not been easily extended to RACFs due
to staff time needed to facilitate videoconferencing
appointments for residents and poor IT support
such as poor internet connectivity, low availability of
devices, and poor digital literacy amongst staff and
residents (Fearn et al., 2021). Such hindrances to
telehealth need to be addressed through government
and industry initiatives such as having processes for
facilitating telehealth sessions (e.g., rostering tele­
health sessions, dedicated telehealth facilitators) and
improving IT infrastructure (e.g., directing funding to
improve internet connectivity and purchase digital
devices, provide training to staff, family and residents
on digital literacy, developing simple-to-use telehealth
platforms for aged care residents).
Third, participants also indicated a need for
RACF staff to be better trained to emotionally
support residents. Staff working in Australian
RACFs typically do not have adequate training
on identifying mental health problems or on pro­
viding mental health assistance to aged care resi­
dents (Davison., McCabe, Mellor, Karantzas, &
George, 2008). Given the absence of visitors and
the suspension of many activities, many staff were
required to provide companionship and emotional
support to residents in addition to their regular
duties. Training in mental health is needed to
equip staff with strategies to demonstrate empa­
thy, provide emotional support, and de-escalate
situations. In addition to this, staff may need to
be trained to provide residents reassurance and
information about the health and safety of family
and friends.
● These results inform clinicians about the men­
tal health impact of COVID-19 on the residen­
tial aged care community, including the
prevalence of mental health difficulties among
CLINICAL GERONTOLOGIST
aged care and staff, and factors that may be
associated with poorer mental health in aged
care residents and staff.
● Mental health support, either on-site counsel­
ing or telehealth counseling, is needed for aged
care residents and staff in response to the
COVID-19 pandemic.
● Aged care facilities need to have sufficient
dedicated staff to support telehealth counsel­
ing, to ensure its delivery to residents does not
create an unnecessary burden to staff.
● In addition to providing mental health sup­
port, aged care facilities should seek clinicians
to upskill and train residential aged care staff
on how to respond to the emotional needs of
residents during the pandemic. This training
may benefit the mental health of both aged care
residents and staff.
Limitations
The findings and recommendations of this study
are to be considered in view of three limitations.
First, the results were from the perspectives of
senior staff within aged care rather than from resi­
dents or staff in general. While, in our view, senior
staff were likely to be aware of the overall mental
health of the residents and staff, there may be differ­
ences in accounts from aged care residents and the
staff themselves. Respondent’s own emotional levels
may have subjectively influenced their estimations of
the mental health problems in their faculty. At the
time of the lockdowns, it was considered not feasible
to collect data from the aged care residents or direct
care staff due to restrictions entering aged care pre­
mises and heavy workloads of staff in RACFs.
Further research is needed to substantiate inferred
stressors as identified by senior staff members, and
the poor mental health of residents and staff.
Second, our sample constituted approxi­
mately 11% of the 2717 RACFs in Australia
(Australian Government, 2020). Hence, our
sample may not have adequately represented
the sector and may have included more
RACFs relatively unaffected by the crisis (such
staff may have had time to complete the survey)
67
or conversely, may have included a greater
number of RACFS adversely affected by the
crisis (such staff may have been more motivated
to complete the survey).
Third, our comments regarding the pattern of
responses related to the prevalence of mental health
problems, effects of restrictions and stressors, and
endorsement of resources for supporting mental
health are based on descriptive statistics (percen­
tage averages of endorsements) rather than infer­
ential statistics. Further research is needed to
investigate the extent to which such patterns are
replicable and generalizable across the residential
aged care sector.
Fourth, future research may also explore the
extent to which the results are generalizable across
settings and aged care facilities. Our findings may
be specific to residential aged care populations,
rather than to older adults living in community
settings – who have been found to be particularly
resilient in response to COVID-19 restrictions
(Losada-Baltar et al., 2021; Luccetti et al., 2021;
Palgi et al., 2020). Further research is also needed
to examine the extent to which the results are
generalizable across a range of aged care facility
characteristics (e.g., number of staff/residents test­
ing positive to COVID-19, number of deaths
within the facility).
Conclusion
This study has extended the international lit­
erature and local anecdotal reports by
a nationwide survey of the impact of COVID19 on the mental health of aged care residents
and staff in Australia as reported by senior aged
care staff. The study has provided a quantitative
and qualitative account of senior aged care staff
opinions on how COVID-19 has disrupted the
wellbeing of aged care residents and RACF
staff. It has also identified the key restrictions
and stressors that have contributed to the poor
mental health of residents and staff, according
to senior aged care staff. Finally, it has identi­
fied the resources required to buffer against the
adverse effects of the pandemic of mental health
68
A. BRYDON ET AL.
of residents and staff. Results from this study
are important to inform policy and practices to
better support aged care residents and staff
through the current pandemic and future lock­
downs in Australia and internationally.
Acknowledgments
The authors thank all the participants in the study. We also
thank Dr Oliver Holmes for contributing to this project as an
independent coder of qualitative responses, and to Sofie
Dunkerley for assisting with data collection. We also thank
the two anonymous reviews whose suggestions helped
improve and clarify this manuscript.
Description of authors’ roles
AB was responsible for collecting data, carrying out the
statistical and qualitative analyses, and wrote the article.
SB supervised data collection and assisted with writing the
article. All authors contributed to formulating the research
questions, designing the study, and assisted with writing the
article.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This research was supported by the Australian Government
Research Training Scholarship
ORCID
Aida Brydon BA (Hons)
http://orcid.org/0000-0003-17902898
Sunil Bhar PhD
http://orcid.org/0000-0001-9260-7368
Colleen Doyle PhD
http://orcid.org/0000-0001-8319-4944
Frances Batchelor PhD
http://orcid.org/0000-0002-73027293
Helen Almond PhD
http://orcid.org/0000-0001-8918-7091
Leander Mitchell PhD
http://orcid.org/0000-0003-35952100
Maja Nedeljkovic PhD
http://orcid.org/0000-0003-09630335
Steven Savvas PhD
http://orcid.org/0000-0002-0925-0925
Viviana Wuthrich PhD
http://orcid.org/0000-0001-7227229X
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