Changes in retirement plans in the English older population during the COVID-19 pandemic: The roles of health factors and financial insecurity.

Over the course of 2020 and 2021, the COVID-19 pandemic disrupted lives globally. In the UK, unemployment rate continued to increase during and post-lockdown periods, and job security and financial wellbeing deteriorated. It is important to understand whether individual decisions related to retirement plans have changed systematically as a result of the pandemic, especially among older adults who experienced greater rates of pandemic unemployment. Using the English Longitudinal Study of Ageing, this article examines changes in retirement plans of older adults during the COVID-19 pandemic and estimates the impact of health and financial circumstances on these changes. In June/July 2020, 5% of 2095 participants reported planning earlier retirement, while 9% reported planning later retirement. We found that poor self-rated health and financial insecurity were associated with intentions to postpone retirement. Additional risk of later retirement associated with poor health was detected among those experiencing financial insecurity. In November/December 2020, 7% of 1845 participants reported planning earlier retirement, while 12% reported planning later retirement. We found that poor health was predictive of a lower relative risk of later retirement, while depressive symptomology and financial insecurity predicted a higher relative risk of later retirement. The findings imply a contextual role of health factors in, and a persistent influence of financial insecurity on, retirement planning in the older population.

Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing.

BACKGROUND: Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. METHODS AND FINDINGS: Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. CONCLUSIONS: Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Health Behaviors and Mental Health during the COVID-19 Pandemic: Evidence from the English Longitudinal Study of Aging.

Stay-at-home and lockdown measures during the COVID-19 pandemic had an impact on health-related behaviors which in turn posed a risk to mental health, particularly among older people. In this study, we investigated how changes to health behaviors (physical activity, sleeping, eating, and drinking) impacted mental health (depression, quality of life, and life satisfaction) during and beyond the initial phase of the COVID-19 lockdown. Using data from Wave 9 (2018/19) and two COVID-19 sub-studies (June/July 2020; November/December 2020) of the English Longitudinal Study of Ageing (N = 4989), we found that health behaviors changes during lockdown were associated with poorer mental health in June/July 2020. However, in November/December 2020, higher depression, lower quality of life, and lower life satisfaction were more likely only among respondents who reported less physical activity, eating more, changes in sleep patterns, and drinking more alcohol. Public health programs should support healthy behaviors as we emerge from the pandemic.

Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England.

This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services during the COVID-19 pandemic. Analyses were conducted using data from the English Longitudinal Study of Ageing (ELSA) COVID-19 sub-study collected in 2020. We report bivariate estimates across our outcomes of interest by cognitive function group along with multivariate regression results adjusting for demographic, socioeconomic, geographic, and health characteristics. Rates of shielding were high across all cognitive function groups and three measured time points (April, June/July, and Nov/Dec 2020), ranging from 74.6% (95% confidence interval 72.9-76.2) for no impairment in Nov/Dec to 96.7% (92.0-98.7) for dementia in April (bivariate analysis). 44.1% (33.5-55.3) of those with dementia experienced disruption in access to community health services by June/July compared to 34.9% (33.2-36.7) for no impairment. A higher proportion of those with mild impairment reported hospital-based cancellations in June/July (23.1% (20.1-26.4)) and Nov/Dec (16.3% (13.4-19.7)) than those with no impairment (18.0% (16.6-19.4) and 11.7% (10.6-12.9)). Multivariate adjusted models found that those with dementia were 2.4 (1.1-5.0) times more likely than those with no impairment to be shielding in June/July. All other multivariate analyses found no statistically significant differences between cognitive function groups. People with dementia were more likely than people with no impairment to be shielding early in the pandemic, but importantly they were no more likely to experience disruption to services or hospital treatment.

Psychological distress, depression, anxiety, and life satisfaction following COVID-19 infection: evidence from 11 UK longitudinal population studies.

BACKGROUND: Evidence on associations between COVID-19 illness and mental health is mixed. We aimed to examine whether COVID-19 is associated with deterioration in mental health while considering pre-pandemic mental health, time since infection, subgroup differences, and confirmation of infection via self-reported test and serology data. METHODS: We obtained data from 11 UK longitudinal studies with repeated measures of mental health (psychological distress, depression, anxiety, and life satisfaction; mental health scales were standardised within each study across time) and COVID-19 status between April, 2020, and April, 2021. We included participants with information available on at least one mental health outcome measure and self-reported COVID-19 status (suspected or test-confirmed) during the pandemic, and a subset with serology-confirmed COVID-19. Furthermore, only participants who had available data on a minimum set of covariates, including age, sex, and pre-pandemic mental health were included. We investigated associations between having ever had COVID-19 and mental health outcomes using generalised estimating equations. We examined whether associations varied by age, sex, ethnicity, education, and pre-pandemic mental health, whether the strength of the association varied according to time since infection, and whether associations differed between self-reported versus confirmed (by test or serology) infection. FINDINGS: Between 21 Dec, 2021, and July 11, 2022, we analysed data from 54 442 participants (ranging from a minimum age of 16 years in one study to a maximum category of 90 years and older in another; including 33 200 [61·0%] women and 21 242 [39·0%] men) from 11 longitudinal UK studies. Of 40 819 participants with available ethnicity data, 36 802 (90·2%) were White. Pooled estimates of standardised differences in outcomes suggested associations between COVID-19 and subsequent psychological distress (0·10 [95% CI 0·06 to 0·13], I2=42·8%), depression (0·08 [0·05 to 0·10], I2=20·8%), anxiety (0·08 [0·05 to 0·10], I2=0·0%), and lower life satisfaction (-0·06 [-0·08 to -0·04], I2=29·2%). We found no evidence of interactions between COVID-19 and sex, education, ethnicity, or pre-pandemic mental health. Associations did not vary substantially between time since infection of less than 4 weeks, 4-12 weeks, and more than 12 weeks, and were present in all age groups, with some evidence of stronger effects in those aged 50 years and older. Participants who self-reported COVID-19 but had negative serology had worse mental health outcomes for all measures than those without COVID-19 based on serology and self-report. Participants who had positive serology but did not self-report COVID-19 did not show association with mental health outcomes. INTERPRETATION: Self-reporting COVID-19 was longitudinally associated with deterioration in mental health and life satisfaction. Our findings emphasise the need for greater post-infection mental health service provision, given the substantial prevalence of COVID-19 in the UK and worldwide. FUNDING: UK Medical Research Council and UK National Institute for Health and Care Research.

Mental health, financial, and social outcomes among older adults with probable COVID-19 infection: A longitudinal cohort study.

We investigated the immediate and longer-term impact (over 4-6 months) of probable COVID-19 infection on mental health, wellbeing, financial hardship, and social interactions among older people living in England. Data were analysed from 5146 older adults participating in the English Longitudinal Study of Ageing who provided data before the pandemic (2018-19) and at two COVID-19 assessments in 2020 (June-July and November-December). The associations of probable COVID-19 infection (first COVID-19 assessment) with depression, anxiety, poor quality of life (QoL), loneliness, financial hardship, and social contact with family/friends at the first and second COVID-19 assessments were tested using linear/logistic regression and were adjusted for pre-pandemic outcome measures. Participants with probable infection had higher levels of depression and anxiety, poorer QoL, and greater loneliness scores compared with those without probable infection at both the first (ORdepression = 1.62, P-value = 0.005; ORanxiety = 1.59, P-value = 0.049; bpoorQoL = 1.34, P < 0.001; bloneliness = 0.49, P < 0.001) and second (ORdepression = 1.56, P-value = 0.003; ORanxiety = 1.55, P-value = 0.041; bpoorQoL = 1.38, P-value < 0.001; bloneliness = 0.31, P-value = 0.024) COVID-19 assessments. Participants with probable infection also experienced greater financial difficulties than those without infection at the first assessment (OR = 1.50, P-value = 0.011). Probable COVID-19 infection is associated with longer-term deterioration of mental health and wellbeing and short-term increases in financial hardship among older adults. It is important to monitor the mental health of older people affected by COVID-19 and provide additional support to those in need.

Immediate and Longer-Term Changes in the Mental Health and Well-being of Older Adults in England During the COVID-19 Pandemic.

Importance: Despite the emphasis placed on the psychological impact of the COVID-19 pandemic, evidence from representative studies of older adults including pre-COVID-19 data and repeated assessments during the pandemic is scarce. Objective: To examine changes in mental health and well-being before and during the initial and later phases of the COVID-19 pandemic and test whether patterns varied with sociodemographic characteristics in a representative sample of older adults living in England. Design, Setting, and Participants: This longitudinal cohort study analyzed data from 5146 older adults participating in the English Longitudinal Study of Ageing who provided data before the COVID-19 pandemic (2018 and 2019) and at 2 occasions in 2020 (June or July as well as November or December). Exposures: The COVID-19 pandemic and sociodemographic characteristics, including sex, age, partnership status, and socioeconomic position. Main Outcomes and Measures: Changes in depression (8-item Centre for Epidemiological Studies Depression scale), anxiety (7-item Generalized Anxiety Disorder scale), quality of life (12-item Control, Autonomy, Self-realization, and Pleasure scale), and loneliness (3-item Revised University of California, Los Angeles, loneliness scale) were tested before and during the COVID-19 pandemic using fixed-effects regression models. Results: Of 5146 included participants, 2723 (52.9%) were women, 4773 (92.8%) were White, and the mean (SD) age was 67.7 (10.6) years. The prevalence of clinically significant depressive symptoms increased from 12.5% (95% CI, 11.5-13.4) before the COVID-19 pandemic to 22.6% (95% CI, 21.6-23.6) in June and July 2020, with a further rise to 28.5% (95% CI, 27.6-29.5) in November and December 2020. This was accompanied by increased loneliness and deterioration in quality of life. The prevalence of anxiety rose from 9.4% (95% CI, 8.8-9.9) to 10.9% (95% CI, 10.3-11.5) from June and July 2020 to November and December 2020. Women and nonpartnered people experienced worse changes in mental health. Participants with less wealth had the lowest levels of mental health before and during the COVID-19 pandemic. Higher socioeconomic groups had better mental health overall but responded to the COVID-19 pandemic with more negative changes. Conclusions and Relevance: In this longitudinal cohort study of older adults living in England, mental health and well-being continued to worsen as the COVID-19 pandemic progressed, and socioeconomic inequalities persisted. Women and nonpartnered people experienced greater deterioration in mental health.

Changes in Modifiable Health Behaviors During the Pandemic and Effects on Mental Health: Evidence From England

COVID-19 mitigation efforts (including lockdowns and advice to stay at home as much as possible) are likely to have resulted in changes in health behaviours such as the amount of sleep, physical exercise, alcohol use, and eating. To date, little is known about how and to what extent these changes in health behaviours since the beginning of the pandemic are related to mental health. Using pre-pandemic data from Wave 9 (2018/19) and from two Covid-19 sub-studies (with data collection in June/July and November/December 2020) of the English Longitudinal Study of Ageing, we investigate how changes in health behaviour during the initial months of the pandemic are associated with subsequent mental health among older people. In our regression analyses, we considered depression and anxiety and controlled for pre-pandemic measures of mental health. Between March and June/July 2020, about a third of older people reported less physical activity;one in five less sleep;and one in ten eating less food and drinking more. Compared to respondents who did not change their behaviours, those who reported sleeping and eating both more and less, and who mentioned less physical activity were more likely to report depression and anxiety, even taking into account pre-pandemic mental health. An increase in drinking was also marginally associated with higher depression. Policymakers should encourage older people who have engaged in unhealthier behaviours to modify them to reduce the negative long-term effects on their mental health.