No return to normal — Older people’s worsening mental health

“Almost half of adults have reported that their wellbeing has been affected by this pandemic”

As we write, the news is still filled with stories and questions about the Omicron variant of the COVID-19 virus. Many of us are feeling confused, exhausted and newly anxious. For many people in later life, things aren’t improving after a difficult and in some cases devastating two years.

Even Sajid Javid, the Secretary of State for Health and Social Care has acknowledged that the pandemic has harmed many people’s mental health, saying:

‘Around 1 in 5 adults in Britain experienced some form of depression in the first 3 months of [2020]. That’s over double the figure before we started our fight against COVID-19. And almost half of adults have reported that their wellbeing has been affected by this pandemic.’

Reporting on older people’s mental health

It is the pandemic’s impact on older people’s mental health that is the focus of our Mental Health Experiences of Older People During the Pandemic report, produced jointly with the Mental Health Foundation. During our research for this work we heard about stressful and traumatic experiences that many older people have faced, and continue to face as the pandemic rumbles on.

People in later life told us about:

· Fear of being infected and becoming seriously ill with COVID-19, as all people aged 70 and over were told they were at more risk to the virus.

· Bereavement, often in traumatic circumstances.

· Shielding at home for long periods, whether as directed by government or by choice to stay safer.

· Worsening physical health and mobility.

· Isolation, loneliness and struggles to connect socially.

While many of these experiences have affected people of all ages, they are more likely to happen in later life, and are also more likely to happen in combination resulting in people being hit from all sides.

Still shielding

Shielding has affected people of all ages but people aged 60+ made up 59% of people shielding at the last count. The highest number of people shielding during lockdown restrictions was estimated at 2.24m people aged 60+, 1.65m of whom were people aged 70+.

The impacts of shielding are well-documented. A Health Foundation study shows the increased risk of diagnosed depression and/or anxiety among shielders compared with the general population, and we know some people have had anxiety attacks.

Despite official shielding restrictions easing in the summer, ONS data shows that 1 in 5 ‘clinically extremely vulnerable’ people continued to shield by choice in October. And in September an estimated 2.3 million older people said they did not feel comfortable leaving their home due to the pandemic. This was before the Omicron variant emerged, which we think it’s safe to assume will have heighted anxiety for many.

So, despite the ongoing rollout of the vaccine booster programme, it would be a mistake to think that everyone has been able to go ‘back to normal’.

Waves of grief

We estimate that up to 318,000 people aged 65+ in England and Wales were bereaved of their partner — due to any cause — between the first lockdown in March 2020 and the end of many restrictions in May 2021. Bereavement at any time can lead to mental health problems — as we explored in our Good grief report — but the pandemic and resulting lockdown has brought with it even more challenges.

One woman, whose husband of 70 years died during COVID-19, told us ‘I didn’t get to say goodbye to him.’ This is echoed by people up and down the country who weren’t able to be with the person they cared about at the end, or have a funeral to mark their death. These kinds of experiences can lead to prolonged grief disorder.

The pandemic has also disrupted some people’s ways of coping with a bereavement they experienced before the pandemic. One caller to our helpline — whose partner died before 2020 — described herself as ‘a very social animal’ who had been attending various groups to help her deal with her grief. These groups stopped when COVID-19 hit and she had had only herself for company for a year when we spoke to her.

Struggling to get help

In light of these new and exacerbated harms for older people’s mental health, we are concerned that many are not getting the support they need.

One Independent Age community support worker said some older people they work with who have felt big increases in anxiety didn’t know what support, if any, was available. They didn’t use computers and couldn’t get through to their GP. This is backed up by national data which shows that among people with moderate to severe depression, people aged 70+ were the most likely to agree that the pandemic has affected their ‘access to healthcare and treatment for non-coronavirus related issues’ — over half (54%) agreed with this statement.

Some of the people we interviewed for this report spoke about difficulties accessing their GP at the time. This is worrying when considering our Minds that matter research where 72% of respondents to our 2020 survey said their GP was the first professional they spoke to about their mental health. We know GPs can be invaluable, offering a range of help, including medication or referral to talking therapy. However, we also know GPs have faced huge pressures, not least because of their important role in helping to vaccinate the nation. They will need extra resources over the long-term to provide the mental health support so many older people need.

Other barriers we heard about through our research include attitudes of some people in later life themselves, with some thinking ‘this support should go to younger people’, and others fearing that getting help would be the first step to losing their independence.

The missing 7% — access to talking therapy

Another key source of support is talking therapy — counselling and other therapies which are shown to successfully treat anxiety and depression in people of all ages, including those in later life. Again, the pandemic has exacerbated an existing problem that far too few older people currently receive this support through the NHS in England (known as IAPT services).

Back in 2011, the government estimated that people aged 65+ should make up approximately 12% of referrals to IAPT services. In reality, that number has consistently hovered around 6%. The latest annual statistics show this dropped to 5% in 2020–21 — with the actual number of people aged 65+ being referred falling by 29%. Throw in population ageing and the worsening of older people’s mental health during the pandemic, and arguably this ‘expected rate’ of 12% should be even higher — and yet we are going backwards.

This failure of access is a longstanding problem. The NHS has tried different things, including producing the recent positive practice guide for GPs and commissioners. While there are no easy answers, it remains a serious problem that needs to be addressed, especially at a time of ongoing, heightened depression among older people.

Specific marketing campaigns targeting people in later life who could benefit from this intervention would be welcome, but in addition, our conversations with older people and colleagues who run our services have shone a light on ways to make talking therapy more appealing to people who don’t feel it’s for them. These include emphasising that support is about problem solving, making sure people feel in control of the conversation, highlighting the possibility of getting talking therapy at home, and more generally encouraging people slowly towards mental health support and tackling stigma.

Don’t despair — improving access to support

More optimistically, the pandemic has shone a greater light on our mental health, with the government putting more funding into mental health services and publishing a mental health recovery plan.

Specifically, we at Independent Age would like to see:

· More support for GPs — The government needs to give GPs the long-term resources needed (including the workforce) so that everyone can get an appointment when they need one in a way that suits them — online, face to face and telephone all have their place. We also need all our GPs to understand that older people often have mental health problems which can be treated, and to offer a range of support options.

· Improved access to talking therapy — The government and NHS need to come up with new ways to increase older people’s access to talking therapy, which has been shown to improve their lives. The chronic low — and at times further declining — rate of access can’t continue. One way to do this might be a new public campaign that specifically targets older people, addressing the gaps in their knowledge, tackling attitudes that hold them back, and making it clear and easy to get support.

· Older people included in government policy — It sounds simple but people in later life can often feel they are overlooked. For example, the government’s COVID-19 mental health and wellbeing recovery action plan includes valuable insight and plans, and focuses (rightly) on many groups with particular needs — children, young people, families, people with a learning disability, ethnic minority groups, women, offenders, people affected by addition, and others. But there is no dedicated section for older people, despite the particular challenges they face — and the fact that they make up 18% of our population. This needs to change.

You can read the full report, The mental health experiences of older people during the pandemic on our website.

If you would like to share your experiences of how the pandemic has affected your mental health, or your ideas about how to improve support for older people, you can email us at policy@independentage.org.

If you need support for your mental health, see the helpful information on our website, or call our free Helpline on 0800 319 6789.