The Impact of Social Distancing on Older Adults in My Behavioral Neurology Practice

Neurology Consultant Advisory Board Member Anamaria Shanley, MSN, APRN-C, discusses the impact of the COVID-19 pandemic, social distancing, and the transition to telemedicine on the older adults she sees in her behavioral neurology practice in Central Florida, as well as other patient populations of concern.

Additional Resources:

Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): for healthcare professionals. Page last reviewed April 7, 2020. Accessed on April 9, 2020.

COVID-19 Care360

Anamaria Shanley, MSN, APRN-C, is a nurse practitioner at the Compass Clinic in Orlando, Florida.


My name is Anamaria Shanley, and I'm a nurse practitioner in Central Florida. I just wanted to discuss how things have changed for myself and my practice here in Central Florida.

I practice primarily in behavioral neurology, and the majority of our patients are over 65. Most of our patients also have dementia. So, once news hit of COVID-19, we decided that it wouldn't be best for our patients to … ask for them to come out for visits.

So, we did close up the practice for visits and implemented telehealth medicine, and it's new for me as well as our practice. And actually, I think it's been great for those patients who have accepted telehealth medicine, which is a minority, and the few patients that I have seen so far–and hopefully that increases–really have had had some anxieties with what's going on and by the option of using telehealth, I can see them and get a feel for their anxieties and mental health status and answer any questions they have on what's going on, as well as educate them on the precautions that they need to take.

We have been successful in the office coordinating with the providers who are working from home and managing any and all the patients’ needs through either video telehealth visits or through the EMR and medication refills, and just typical day-to-day things that patients may need.

I think the stress with my patient population is, the patients socializing and being out with others is so important for their brain health, and with all that's going on, they're more isolated, especially those in the assisted living facilities. And so, this routine that they've had and that they worked so hard to establish has been disrupted, and that saddens me because I know a routine is important for the patients, as well as their caregivers. And when there's not a routine, we may see an increase in behavioral symptoms such as agitation, as well as anxiety and even depression. That concerns me most for my patient population.

Also, there will probably be a decrease in physical exercise, which I stress a lot to help with their brain health, as well as their anxieties on a day-to-day basis. Another concern of mine with my patients are their caregivers, who are those in the sandwich generations who are taking care of their parents. With memory loss or dementia, as well as their children and the caregivers, I feel are going to … be impacted the most as well–dealing with these potential symptoms of agitation or irritability with patients, as well as managing their children and teaching them at home, which many of us are now faced with doing.

It's a new way of life. For me personally, I'm working from home, which I never thought I would be doing as a health care provider, but I feel … that my office has adapted really well and working well together to make sure all the patients get what they need, their questions are answered, and visits can be conducted.

My children are in third and sixth grade. So, we have recreated a little schoolhouse here and with our county, who has provided excellent support and services through virtual homeschooling. This is technically our second day, but it's really working out well. And it's just adjusting to the new schedule. My concern with my family is just not getting the physical activity and exercise they need, which they were getting through school and extracurricular activities, and most importantly, the socializing and playing with their friends.

So again, I'm concerned about the isolation’s impact on children, as well as with my patients who are at the other end of the spectrum, and I am concerned about the isolation and its impact on mental health individuals–those who rely on a support group, either those with anxiety or depression, as well as those with substance use disorder with lack of social support, and for those who can’t access social media or the internet because of financial issues. I'm so concerned about the impact it's having on them, and there will be slipping through the cracks and lack of support services for them.

The impact on children who live in homes with financial constraints, volatile situations, potential abuse–my biggest concern is with them as well. Without the social support or socializing, seeing their teachers on a regular basis, getting maybe support at school that they couldn't get at home … those are certainly situations that will become more noticeable as time goes on, and hopefully the support services will be there for them, as well as for their families and then everyone impacted, not just socially, but also financially.

So, we all work together and do what we need to do as far as being healthcare providers, but also we need to work together in our communities and help each other and get through to the other side. This is definitely a situation hopefully we'll never deal with again, but if we do, we have the experience to overcome it–hopefully not as significant of a situation as we're dealing with now.

Thank you for your time, and good luck to you and stay safe.

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