Personal Factors
Older adults reported a presence or worsening of psychological symptoms, and greater loneliness because of pandemic-related social isolation [33,38,47,49,51,52,56,57,62,63,77,78, 84,89,90,99,105,114,117,128,135,139,140,148,156,160]. Compared to younger age, older age (ie, ≥60 years) was, however, associated with fewer psychological symptoms [39,44,50,54,57,59,64-67,74,77,89,95,97,98,101,107,109,111,114,116, 120,121,124,125,127,136,138,147,151,153,157,158,161,162,165], lower loneliness [92,95,104,130,140,159], and better mental health and well-being [95,106,126,157,161,162]. Older adults were also shown to be better at regulating their emotions and coping with stressful events [44,61,68]. In contrast, 6 (4.4%) studies reported that older adults had more severe psychological symptoms than participants of other age groups [83,85,86,96,118,156], and some studies noted no psychological symptoms for most participants [42,79,119,165].
Several variables were associated with poor psychological health and well-being, including living alone [117], decreased social interactions [88], feeling close to death, high levels of COVID-19–related health worries [145], stress [70], health concerns and ageism [143], not having cognitive impairments [38], and male status [78]. In contrast, religious faith, exercise, self-care, and time spent in nature were associated with positive psychological well-being [70].
Various worries surrounding the current pandemic were reported in these studies [36,49,105,107,110,155]. For instance, older adults were more worried about COVID-19 [68,75,96,118,167], whereas younger individuals were more concerned about the risks related to social isolation [164]. Older adults were less concerned for their emotional well-being, work goals, and finances [65], and they perceived they had lower chances of “running out of money” [53]. However, more worries about financial difficulties were reported in another study [164]. Older adults perceived the risks of COVID-19 (in comparison to that of the flu) to be higher [48,138], but aged men were less worried about COVID-19 (eg, contracting the virus, dying due to COVID-19, or disruptions to lifestyle) than their younger counterparts [48]. Their concerns were focused on others rather than themselves [144]. Anxiety associated with cancer was lower in older adults than in younger adults [41]. Expectations (eg, income decline, duration and long-term impact of COVID-19) were associated with an experience of stress, which was further associated with other negative effects [69]. Finally, the passage of time during the pandemic was found to be slower for older adults [115].
Regarding the impairment of organic systems, higher age was associated with poorer health status [80] and in some cases, a decline of functional status [163]. Decreases in mobility, functionality, vitality, and physical conditions were also noted [36,148]. An aggravation in neuropsychiatric and physical symptoms was reported in individuals with Alzheimer disease, dementia, and frontotemporal lobar degeneration, as well as in nursing home residents [34,35,37,93,139]. An exacerbation of migraine days and severity was observed among individuals with a migraine diagnosis [45]. One out of six older patients with epilepsy experienced increased seizures, but this frequency increased considerably among younger people with epilepsy [46].
Life Habits
Changes in sleep habits and sleep disturbances were reported to be affected by COVID-19 [37,56,84,87,105,134,160]. Of note, some studies indicated that sleep issues were lower in older adults than in younger adults [122,134,147].
Older adults reported a lower increase in unhealthy food intake, screen use, tobacco use [149], alcohol use [149,154], and cannabis use than did younger adults [123,152], in addition to a lower rise in unhealthy lifestyle changes or drinking [131]. One study indicated that the majority of older individuals consumed a balanced diet, limited their alcohol intake, and had adequate sleep patterns [82], whereas another study reported no change in alcohol use patterns [71]. This finding was contrasted by other studies that found that older adults increased binge drinking, alcohol frequency, alcohol consumption, and cigarette smoking [56,114,132]; changed their eating habits [132,148]; ate more [56,87]; and ate more often [87]. One study reported a higher consumption of unhealthy foods among older adults, as compared with participants of other age groups [149]. Food insufficiency increased in older adults during the pandemic, but to a lesser extent than that among younger adults [73], and decreased care resulted in hunger [47].
Changes in daily routine and plans were reported in a few studies [43,52,58]; however, one study noted no changes in the performance of daily habits among older adults [102]. Behavioral changes, such as buying more food and water than usual, going out less frequently, reducing social contacts, and staying away from public places were noted in several studies [36,47,58,146]. Unemployment increased in older adults, but at a lower rate than that in other age groups [72]. Higher age was associated with fewer sexual activities [108]. Some studies reported a decrease in physical activity [56,132,141,142,149] and a decline in attendance at physical activity workshops [133]. However, studies reported contradictory results regarding physical activity among older adults during the pandemic. Indeed, it was noted that older adults had the lowest levels of physical activity among all age groups [55,100]; however, they had the smallest decrease in physical activity [100], the lowest prevalence of insufficient physical activity [81] and were less likely to have changed their physical activity levels during the pandemic [137]. Moreover, physical activity was associated with higher resilience, positive affect, and lower depressive symptoms [94,141]. Older adults were also reported to have a lesser change in unhealthy movement behaviors [150].
A study indicated that a lot of time was spent learning about COVID-19 [87], and more time was spent using social media [56], internet [144], and electronic products [150]. One study reported a higher usage of electronic products by older people [149], whereas others reported contrasting findings [74,81]. Participants felt blessed, lucky, and fortunate to be able to stay in contact with others through social media [91]. Variation in game use by older adults did not differ from that observed in younger populations [167]. Older adults had fewer positive work events but more remote social interactions, social networks, and outdoor activities [65]. Finally, older adults engaged in more solitary activities and in fewer in-person activities [56].
One study reported that the majority of older adult travelers were planning to travel by air in the next year [103], whereas another found that older adults were canceling out-of-town trips [58]. The COVID-19 pandemic has presented significant challenges to most older adults [58], and compliance to hygiene recommendations was seen as a psychological burden by this population [148].