Effects of COVID-19 and associated government regulations on physical, mental and social health in older adults

The number of older adults is growing. In the Netherlands, the number of people aged 65 and over will grow from 3.4 million in 2020 to 4.8 million in 2040 (CBS, 2020). Moreover, the number of oldest old (80 years and over) will double. Increasing age coincides with increasing frailty and vulnerability. This has been emphasized during the COVID-19 pandemic. However, a lot of heterogeneity exists in older adults’ health statuses. This heterogeneity ranges from vital community-dwelling older adults who play an active role in society, to those living in a nursing home, needing healthcare throughout the day. Therefore, older adults should not be investigated as a homogeneous group, but interindividual differences should be researched to find disproportionally affected subgroups. It is not yet clear how these subgroups should be defined. For example, older adults living alone, or older adults with a different ethnic background may be more affected.
Although not all older adults are vulnerable to the same degree, it is undeniable that older age poses a higher risk of worse health outcomes as well as a higher mortality rate from the coronavirus (Nanda et al., 2020; Shahid et al., 2020). Clinical outcomes often focus on direct physical health effects of a COVID-19 infection, such as fever, cough and fatigue (e.g. de Souza et al., 2020). Yet, health is more than mere physical symptoms and complaints in response to illness, or the absence of illness. It also entails a mental component, which involves cognitive functioning, psychological wellbeing and resilience, as well as a social component, which involves one’s social network, intimacy and loneliness (Huber et al., 2011). Not only does COVID-19 directly influence older adults’ health through infections, but also indirectly, through restrictions aimed at preventing the spread of the virus: restrictions such as social distancing and periodical lockdowns have an impact on older adults’ health. For example, one study indicated that older adults were lonelier throughout the pandemic (van Tilburg, 2021). In turn, loneliness negatively impacts other components of health, such as mental health and subjective health (Coyle & Dugan, 2012). This emphasizes the need to understand the more complex interplay of health components during COVID19, especially in this group of relatively vulnerable people.
In addition to understanding older adults’ health during the pandemic, we are also interested whether there are determinants that can predict who is likely disproportionately affected by the pandemic, and who is not. In other words, can we find determinants of change? Knowledge on interindividual differences, as well as determinants that predict such differences, can aid in tailoring policies for similar future crises.
The aim of this project is multifold. We will investigate trends in health during the pandemic, to see whether worsening of health indicators coincides with stricter government regulations and/or lockdowns. To assess the direct effect of infection, we will assess how physical, mental and social health changes after a COVID-19 infection, and compare infected with non-infected groups. We will try to identify subgroups that suffer the negative consequences of both the virus and restrictions to a larger degree. Next to a more in-depth subgroup analysis, we will research predictors of negative or positive changes in physical, mental and social health in older adults. To put findings into perspective, we would like to compare older adults’ health during the pandemic to younger age groups and pre-pandemic levels of health.