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COVID-19 and its Impact on the Mental Health of Older Adults:
A review of the existing literature
Kyra Innocent, 0703449
Trent University Nursing Department
NURS 4204H
Dr. Kimberly Ritchie
November 18, 2022
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COVID-19 and its Impact on the Mental Health of Older Adults:
A review of the existing literature
The COVID-19 pandemic has severely impacted the mental health of older adults across
the globe. In order to mitigate the spread of the virus, significant restrictions have been placed on
society, including physical distancing, restrictions on social gatherings, and orders to stay-athome. Unfortunately, the vulnerable population that these measures were intended to protect the
most in a physical sense (older adults) have been shown to be the population with the most
severe impacts mentally.
According to the literature, lockdowns and social distancing measures have undoubtedly
been one of the most important factors impacting the mental health of older adults during the
pandemic (Sepúlveda-Loyola et al., 2020; Chu et al., 2020; Wu, 2020; Troutman-Jordan &
Kazemi, 2020). The literature suggests that older adults who experience loneliness and isolation
during COVID-19 have significant impacts on their mental health, particularly increasing rates
of psychological problems such as anxiety, depression, stress, cognitive decline, and sleep
disturbances (De Peu et al., 2021; Ingram et al., 2021; & Sepúlveda-Loyola et al., 2020).
Although much literature exists regarding the effects the pandemic has had on the mental
health of older adults, a better understanding of individual experiences during COVID-19 is
needed in order to produce potential solutions for confronting these health impacts. This study
aims to synthesize the existing literature surrounding the impact that COVID-19 has had on the
mental health of older adults. Furthermore, the impact of social isolation, loneliness, and risk
factors will be investigated, and implications for nursing practice will be discussed.
Methods
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The current article is a narrative review of the existing literature on the impacts of
COVID-19 on the mental health of older adults. The following databases were searched for
published studies/ articles in the English language over the period 2012-2022: Trent Omni,
ProQuest, CINAHL, and PsycInfo. The following terms were used to generate the search:
COVID-19, impact, mental health, older adults, elderly, seniors, aging, nursing, nursing
management, psychological and implications. Articles were included if they fulfilled the
following criteria: Published in a peer-reviewed journal, language of the full-text article was
English, reported mental health impacts instead of physical impacts related to COVID-19.
Articles were excluded if they focused mainly on physical health, were not possible to access in
full, or did not meet all of the above-mentioned inclusion criteria. A variety of resource types
such as journal articles, qualitative and quantitative studies and opinion/editorial pieces were
included to ensure a diverse representation of perspectives.
Results
Social Isolation & Loneliness
It has been demonstrated that feelings of loneliness among older adults result from social
isolation measures. In 2020, Emerson provided a glimpse into the impact of social distancing on
older adults. Notably, the author found that older adults reported increases in feelings of
loneliness during social isolation efforts. Contrastingly, Bundy et al. (2021) examined the lived
experiences of older adults who were already lonely prior to COVID-19, in the current context of
social isolation. The authors conducted semi-structured interviews with lonely older adults and
found that their feelings of loneliness were not exacerbated by the COVID-19 lockdowns and
periods of social isolation. The authors highlight possible explanations for this finding,
suggesting that the participants may have been previously living an isolated lifestyle (living
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alone, not many friends/social supports), or may have previously developed coping strategies to
manage their loneliness, causing them to be more prepared. The results of this study suggest that
the experiences of loneliness are not universal among older adults, but instead are unique to each
person. Much of the literature has focused on self-reported feelings of loneliness, however
Bhome et al. (2021) were one of the first to investigate staff perspectives of older adults mental
health impacts in the context of mental health services. Importantly, they found that staff’s
perceptions of loneliness among patients due to social distancing and isolation were high,
supporting Emerson’s (2020) findings.
Implications of these findings suggest a need for solutions to address the impacts of
social isolation on older adults. Wu (2020) proposes several actions, including promoting social
connectedness through technology, providing resources, and having health care workers improve
screening and identification of social isolation and loneliness in health care settings.
Mental Health Effects of COVID-19
A series of recent studies has indicated that the COVID-19 pandemic has led to increases
in mental health conditions in older adults, a finding that deserves serious attention. In a
narrative review of the impacts of social isolation on older adults, Sepúlveda-Loyola et al. (2020)
found higher levels of anxiety, depression, and sleep disturbances during isolation periods.
De Pue et al. (2021) studied the impact of COVID-19 on well-being, activity levels, sleep quality
and cognitive function in older adults. They found significant decreases in all categories, except
for cognitive decline, to which there was a moderate decline compared to pre-pandemic.
Kobayashi et al. (2022), however, determined that there was significantly increased cognitive
decline among older adults during the pandemic, mentioning that importantly, this may influence
future rates of dementia. It is important to note that in the latter study, cognitive decline was a
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function of the degree to which the participants experienced loneliness or anxiety symptoms,
possibly explaining the inconsistency in results with that of De Peu et al. (2021).
A variety of strategies have been suggested in order to mitigate these negative effects on
mental health. For example, Sepúlveda-Loyola et al. (2020) highlight strategies for healthcare
workers such as encouraging social contact by telephone, providing appropriate information and
resources, and educating this population on the importance of maintaining positive life-style
behaviours. Interestingly, although many articles discuss a negative impact of social isolation on
the mental health of older adults, studies have also shown that their younger counterparts are
markedly more affected. Moye (2022) states that much of the literature has found older adults to
be more resilient than their younger counterparts during the pandemic, and discusses various
coping strategies they used to maintain well-being. The author notes that social support, adaptive
coping, and use of technology are key factors that influence resilience in older adults.
Risk Factors
There exists a considerable body of literature on factors that influence or mitigate the
effects of COVID-19 on mental health in older adults. For example, Webb & Chen (2021) &
Kobayashi et al. (2021) discuss demographic factors that influence mental health effects of older
adults during the pandemic. Together, they revealed that sex, age, race, socioeconomic status,
living environment, and pre-existing health conditions impacted reported rates of anxiety or
depression during the pandemic. These findings were replicated by Rodrigues et al. (2022), who
found that risk factors for impairments in psychological well-being in older adults included
living either alone at home or in long-term care facilities, and having pre-existing mental health
conditions. The strictness of isolation level has also been found to influence the pandemic’s
effects on mental health, specifically cognitive decline. D’Cruz & Banerjee (2020) argue that
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strict governmental restrictions placed on older adults has serious implications on their wellbeing, an effect that will likely continue into the future. Ingram et al. (2021) supports these
findings, demonstrating that the amount of cognitive decline experienced by older adults was
dependent on how strict the isolation level was.
Implications for Nursing Practice
The reviewed literature suggests that nurses have a pivotal role to play in the care of older
adults in the context of the COVID-19 pandemic. Calls to action have been put forth by Wu
(2020) and Chu et al. (2020), stating that social isolation presents a significant health risk. Wu
(2020) proposes several actions that healthcare workers should take in order to address the
impacts of social isolation on older adults. The approaches include promoting social
connectedness through technology, providing resources, and having health care workers improve
screening and identification of social isolation and loneliness in health care settings. Chu et al.
(2020) highlight the importance of nurses confronting the impacts of social isolation and reestablishing person-centered care. Taken together, their statements suggest that it is imperative
for nurses caring for older adults to be sensitive to warning signs that suggest the need for
intervention. Troutman-Jordan & Kazemi (2020) state that public health nurses are in a unique
position to provide support to this population, and offer strategies that may be implemented in
the community to promote mental health and ensure older adults maintain connection to the
outside world.
In conclusion, a number of authors have recognized that promoting social connectedness,
improving screening efforts, and utilization of technology are imperative strategies for healthcare
workers to initiate in caring for older adults in order to counterbalance the negative mental health
impacts that have been demonstrated in the literature as the result of COVID-19 (D’Cruz &
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Banjeree, 2020; Rodrigues et al., 2022; Sepúlveda-Loyola et al., 2020; Troutman-Jordan &
Kazemi, 2020; Webb & Chen, 2021; Wu, 2020; Moye, 2022).
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