BALTIMORE — In the 72 years Dick and Lois Hess have been married, they've watched their country bludgeoned by economic calamities, unrest, corruption and tragedies.

But nothing prepared them for this: eight months of separation, during which they haven't been able to hold hands, hug or sit closer than 6 feet apart, even though they both live in the same Towson, Maryland, retirement community.

It's been a disruptive, difficult and sad period for the pair.

"This pandemic is creating problems with mental health, and the longer it goes, the more people are going to have problems," Dick Hess said.

The ever-lengthening pandemic has stressed the mental health of many segments of society. For seniors, the picture is nuanced: They are resilient, yet eldercare providers and experts in the Baltimore area worry about potential long-term implications for the mental health of some in this age group, particularly those who suffer from dementia or are at risk for it.

Now, amid a national surge in coronavirus cases and fatalities, Maryland and many of its counties are reinstating restrictions on social gatherings — just in time for the holidays, when families would usually come together.

Until January, the Hesses had lived together in a one-bedroom apartment at Edenwald Senior Living. Then came surgery and a stint in the community's health care unit for recuperation. That's how the two found themselves in separate units as the coronavirus pandemic bore down on Maryland and Edenwald began restricting outside visitation and movement between units to help tamp down COVID-19 1/4 u2032s spread.

Since March, Dick Hess, 95, and Lois, 92, have been talking on the phone every day and have tried out FaceTime a few times — something they learned to do from their daughter, who lives in Alabama. They've been able to see each other in person only a handful of times, during socially distanced visits in which they are unable to hold hands or hug.

"Everybody here has been living in a cocoon — that's what's been happening," Dick Hess said.

The Hesses' isolation is a microcosm of the stress felt by many, of all ages.

Across the board, calls to Baltimore's crisis hotline have doubled since April. Nine in 10 respondents to a nationwide survey over the summer spearheaded by University of North Carolina at Chapel Hill Medical School indicated that they had experienced emotional distress related to the pandemic.

Initially, some experts worried that seniors would be at the forefront of any mental health crisis triggered by the pandemic, as older people are more likely than younger people to live alone, and are substantially more at risk of dying or falling severely ill after contracting the coronavirus.

However, a collection of studies published since the start of the pandemic has shown some reasons for hope: One report spanning four cities found no increase in depression or anxiety among older adults with preexisting depressive disorders, and the nationwide UNC survey revealed that adults younger than 50 were much more likely to report an emotional impact from the pandemic than older adults.

Gina Negri is clinical director of the Baltimore office of Visiting Angels, which provides home health care. She expressed particular concern for seniors living alone. Companionship, she said, is one of the leading indicators of health for the elderly. Research has revealed a powerful connection between social isolation and loneliness among older adults and a stream of mental and physical health conditions, including heart disease, depression, high blood pressure and even death.

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Studies have additionally shown that mental health needs spike after large-scale traumatic events, such as natural disasters and acts of terrorism. After an outbreak of Severe Acute Respiratory Syndrome struck Hong Kong in 2003, the country saw an increase in suicide rates among elderly women, who researchers hypothesized were more susceptible to effects from the suspension of health and social services during the outbreak.

Studies have additionally shown that mental health needs spike after large-scale traumatic events, such as natural disasters and acts of terrorism. After an outbreak of Severe Acute Respiratory Syndrome struck Hong Kong in 2003, the country saw an increase in suicide rates among elderly women, who researchers hypothesized were more susceptible to effects from the suspension of health and social services during the outbreak.

Dr. George Rebok, a professor at the Johns Hopkins University who studies mental health and gerontology, said older people experiencing symptoms of depression and anxiety could be at risk of developing full-fledged psychiatric disorders. He also noted that these conditions are both associated with a greater likelihood of developing dementia later in life.

However, he stressed that there are reasons to be positive: A study from the American Psychological Association found that although the loneliness levels of older adults increased slightly in March, they leveled off in April.

"Certainly, there's been a lot of concern that older people are increasingly isolated, they're vulnerable, they are frail," he said. "But on the other hand, if you look at the data, there's a lot of indication that older people are very resilient. ... They've lived through, maybe, the world war, the great economic depression and other disasters, so they know ways to cope."

Democratic City Councilman Zeke Cohen said he worries how the pandemic will affect the mental health of Baltimore-area seniors in the long run. In April, along with several community organizations, he helped launch the Baltimore Neighbors Network to check in on the well-being of elders and offer resources to them. As of Monday, the network had trained 748 volunteers and placed over 25,000 calls.

Although volunteers have heard a great deal of humor, hope and resilience from the seniors they've connected with, Cohen said, they've also heard feelings of profound loneliness, and a sense of doom about when the pandemic will end.

"Our seniors are one of our greatest treasures in the city," he said. "They are a source of knowledge and wisdom, and it behooves us to treat them with respect and dignity, and do everything within our power to support them in this very challenging moment."

For the most part, Edenwald President and CEO Mark Beggs says, residents there have fared better than what many of their families feared at the start of the pandemic. Most of them live independently, and for a period up until earlier this month, they were able to eat meals with one another and enjoy outdoor concerts and other events on Edenwald's green roof. Except for a handful of positive cases, the community has avoided any major outbreaks of the virus, according to data from Edenwald and the state.

Still, Beggs said, staff members have observed cognitive decline and upticks in confusion among some residents, which could signal increased feelings of depression. The pandemic has been especially difficult for those who suffer dementia, Beggs said, as they may not understand why their families aren't coming to see them.

With Thanksgiving little more than a week away, Beggs advised Edenwald residents in a video Monday that, should they participate in any gathering outside the community, they would be looking at more alone time when they return.

"Do what's right for you. I know people are tired. You want to see your family — absolutely," Beggs said in the video. "So do what you need to do — be masked, be socially distanced while you're doing it — but when you come back here, I'm going to ask that you quarantine for 14 days."