Mental health and COVID-19 in an ageing population | Christian Borg-Xuereb

Dr Christian Borg-Xuereb, Gerontology and Dementia Studies

The world’s population is rapidly ageing. Indeed, the proportion of the world’s older adults is estimated to almost double from about 12% to 22%, between 2015 and 2050. In absolute terms, this is an expected increase from 900 million to 2 billion people over the age of 60.

This is one of the most significant demographic and socioeconomic developments that is happening on a global scale. Malta is not exempt from this phenomenon, as about 20% of the Maltese population is already over the age of 60%.

Ageing is not a homogenous process; indeed, research shows that we become increasingly diverse as we get older.

However, older people sometimes face certain physical and mental health challenges which need to be recognised and addressed. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act as we cope with life. It also helps determine how we handle stress, relate to others, and make choices.

Mental health is important at every stage of life, including as we age. Many older adults are at risk for mental health problems. But this does not mean that mental health problems are a normal part of ageing. Studies show that most older adults feel satisfied with their lives, even though they may have more illnesses or physical problems.

The COVID-19 pandemic has put older people in a disadvantageous position. Ageism and age discrimination violated the human rights of older persons and exacerbated inequalities in different ways, including leaving older persons behind in our increasingly digitalized world. For example, ageist assumptions make it more difficult for older persons to get equal access to medical care. The use of telemedicine and remote technology sharply increased during the pandemic without equivalent attention to improving digital literacy and access to digital technology, infrastructure and devices. This aggravated inequalities in the enjoyment of the right to health and social interactions by older persons owing to the existing digital divide and exclusion from information related to the pandemic and health care when provided only in digital or non-accessible formats.

Many older adults manage to adjust to important life changes, including the death of a loved one, retirement, dealing with a serious illness, or the fear of contracting a disease. However, some older people will have more trouble adjusting, especially due to the demands of COVID-19, such as isolation. This can put them at risk for mental disorders such as depression and anxiety.

The impact of depression on health in older adults can be severe; much research has reported that depression is associated with poorer health outcomes in older people with conditions like heart disease, diabetes, stroke or if they develop dementia.

Depression can complicate the treatment of these conditions, including making it more difficult for someone to care for him- or herself and to seek treatment when needed. In older adults, depression may be disregarded as frailty, or it may be viewed as an inevitable result of life changes, chronic illness, and disability. Older persons themselves may not recognise or understand their symptoms and instead refer to physical symptoms.

Apart from the rampant ageism, the isolation caused by the ongoing pandemic has had a negative impact on many intimate relationships, even more so older people. Restrictions imposed on older people may have isolated this age group specifically from interacting with others.

As opportunities to interact in the outside world become more limited, the risk on developing mental health disorders is exponentially increased.

After almost 2 years into this pandemic, we need to proactively work on systematically assessing the impact of COVID-19 pandemic on older people’s mental health and address it.