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Mental health and wellbeing during the COVID-19 pandemic was worse among the over 50s than has been reported to date. New research found older age groups showed increased depression, anxiety and loneliness in the first year of the pandemic. Their quality of life was reduced.

Around the world, the pandemic had a negative effect on adult mental health. Some previous studies have shown that older adults were less affected than younger people. But these studies looked at short-term effects only.

This longer-term study found that, over the course of 2020, adults over 50 had deteriorating mental health and wellbeing. Researchers looked at factors that could play a part. They found that women and people not living with partners were more vulnerable than others to poor mental health. Less wealthy people had the poorest mental health overall. But the most well-off people felt more negative changes through the pandemic.

The researchers conclude that some older adults - such as those living alone - may need more targeted mental health services.

Further information on mental health is available on the NHS website.

What’s the issue?

The COVID-19 pandemic affected the mental health of many adults. In the early months, studies carried out online showed that people were worried about the impact of the disease on health services, employment, money and social contact. But these studies did not show changes over time. And they excluded people without internet access, which meant older people were under represented.

During the pandemic, more elderly people (75+) became vulnerable to social isolation, especially if they could not get out by themselves. People over 50 who did not regularly use computers could struggle to access health care when appointments and booking systems were moved online. Social care was cut, which increased social isolation. These changes might have impacted older people’s physical, mental and emotional health and wellbeing.

Several early studies suggested that the pandemic had not affected the mental health and wellbeing in the over 50s as much as in younger people. Across all age groups, people’s mental health recovered in the summer of 2020, when the first lockdown was lifted in the UK. But people did not regain the health they had before the pandemic started.

Researchers wanted to explore the longer-term impact of the pandemic on mental health (depression and anxiety) and wellbeing (loneliness and quality of life) in older adults. They looked at whether age, sex, having a partner, and wealth made a difference to the impact of the pandemic.

What’s new?

This research included 5146 adults aged 50 years and older who were part of the ongoing English Longitudinal Study of Ageing (ELSA). These people have submitted data every 2 years since 2002. They were 68 years on average and just over half (53%) were women. Most (93%) were White.

Participants responded to telephone and online surveys after the first national lockdown (Summer 2020), and during the second national lockdown (Winter 2020). Researchers compared the answers to data collected before the pandemic.

People’s mental health was poorer in Summer 2020 than before the pandemic. It continued to deteriorate up to Winter 2020.

The surveys showed:

  • depression increased from 13% participants before the pandemic, to 23% in Summer 2020 and 29% by Winter 2020
  • anxiety increased during the pandemic, from 9% participants in Summer 2020 to 11% in Winter 2020
  • loneliness increased and quality of life decreased during the period of the study.

Age might have influenced mental health and wellbeing, but the study found it had little impact. The over 75s had a slightly lower increase in depression than people in their 50s, but changes in anxiety were similar in all age groups.

However, there was a difference according to:

  • gender, with women experiencing worse changes in depression, anxiety, quality of life and loneliness; in men, there was little change in loneliness or anxiety
  • living alone, which increased feelings of loneliness; people living with a partner did not report changes in loneliness
  • wealth, and those with the least had the poorest mental health both before and during the pandemic; however, the wealthiest had worse changes in quality of life and loneliness during the pandemic.

Why is this important?

This study highlights the longer-term impact of the pandemic on older people’s mental health. It was based on telephone as well as online surveys and included older people who were not confident online. The response rate was high and the results are likely to be typical of older adults in England.

The findings suggest that older people may need targeted psychological interventions. Previous research has found that generally, depression and anxiety get better with age. But this analysis shows that the pandemic prevented this natural improvement.

Social inequalities persisted through the pandemic; the poorest people had the worst mental health scores both before and during the pandemic. Steeper declines in mental health and wellbeing among the most wealthy could be because they were more affected by social restrictions. Wealthier people might have more concerns about reduced pension value caused by the pandemic.

What’s next?

The researchers suggest that everyone should be aware of the impact of the pandemic on mental health. Friends or family are sometimes first to notice signs of depression.

Women and people without partners were most at risk of mental health problems in this study. More targeted mental health screening is needed for these groups, the researchers say. And access to digital mental health services should be improved for older adults who may be less familiar with computers.

The findings are not generalisable to ethnic groups, who are underrepresented among ELSA participants. Further work needs to explore the impact of the pandemic on the mental health and wellbeing of people in these groups.

More research is also needed to find out what effect vaccination has had on these trends in mental health.

You may be interested to read

This NIHR Alert is based on: Zaninotto P, and others. Immediate and longer-term changes in the mental health and well-being of older adults in England during the COVID-19 pandemic. JAMA Psychiatry 2022;79:2

The impact of mental health before the pandemic on services in the early months: Di Gessa G, and others. Pre-pandemic mental health and disruptions to healthcare, economic and housing outcomes during the COVID-19 pandemic: evidence from 12 UK longitudinal studies. The British Journal of Psychiatry 2022;220:1

How pre-pandemic mental health influenced health-related behaviours during the pandemic: Villadsen A, and others. Mental health in relation to changes in sleep, exercise, alcohol and diet during the COVID-19 pandemic: examination of four UK cohort studies. Psychological Medicine 2021; doi:10.1017/S0033291721004657


Funding: This study is funded by the Economic and Social Research Council/UK Research and Innovation, National Institute on Aging, and UK government departments coordinated by the NIHR.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.


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Commentaries

Study author

Several previous studies have shown older people to be resilient to the mental health effects of the pandemic, but they have not looked at the longer-term impact. This new analysis shows that older people’s mental health has been affected. More than that, we have shown that women and people not living with a partner are worst affected. Our results highlight the inequalities between wealthy and non-wealthy, with the least wealthy having the worst mental health scores both before and during the pandemic.

Paola Zaninotto, Associate Professor, University College London 

Researcher 

This paper should raise awareness of the mental health and social needs of older people. It highlights that even those who are sometimes disregarded because they are relatively well off may experience problems.

The findings illuminate a huge problem with services for older people and given the chronic underfunding of services in this area it is hard to envisage a simple solution. Nevertheless, there is perhaps room to provide some start-up funding to enable older people themselves, and those who care about them, to devise novel ways of increasing social contact among each other.

The research is of good quality but the authors acknowledge the poor representation of ethnic minority groups, and that survey data may not properly represent the views of participants. These caveats do not detract substantively from the importance and timeliness of the findings.

Chris Bennett, Research Psychologist, Cambridgeshire 

Former researcher 

As a carer for an older adult and a researcher who used to study loneliness in older adults, I find this research an excellent resource, timely and relevant to all those involved in supporting older adults. Everyone should be made aware of the mental health impact of the pandemic, and the social restrictions, on this group. The paper provides key evidence about the deterioration of mental health.

It also gives insight into the impact on wealthier people, a group traditionally seen as less at risk.

Eleanor Jack, Researcher and University Practice Learning Adviser, Bournemouth University 

Lived experience 

This research gives an important update on how people are feeling and coping. Having said that, I don’t think the results will come as a surprise to most health professionals. I live in Wales and I wonder if the results are generalisable to other UK nations.

There is always a need to keep trying to improve people’s lives. I hope the findings might challenge primary healthcare trusts on their treatment of mental health services and how they are provided.

Carole Bailey, Public Contributor, Denbighshire 

Member of the public 

The research confirms the effects of the pandemic on myself. It makes me interested to find out how to live well during a pandemic, and I wonder if there is a guide for future situations. It confirms that socialising is key to many people’s lives.

This paper will increase awareness, research opportunities, funding for support groups and help to educate the public on keeping healthy. But I am concerned that minority ethnic groups have not been represented and are not discussed. It takes money, effort and creativity to reach minority groups, but excluding them divides people and increases health inequalities.

Njoki Pratt, Public Contributor, Cardiff 

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