Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study

BACKGROUND: The COVID-19 pandemic has affected mental health, psychological wellbeing, and social interactions. People with physical disabilities might be particularly likely to be negatively affected, but evidence is scarce. Our aim was to evaluate the emotional and social experience of older people with physical disabilities during the early months of the COVID-19 pandemic in England. METHODS: In this longitudinal cohort study, we analysed data from the English Longitudinal Study of Ageing collected in 2018–19 and June–July, 2020, from participants aged 52 years and older and living in England. Physical disability was defined as impairment in basic and instrumental activities of daily living (ADL) and impaired mobility. Depression, anxiety, loneliness, quality of life, sleep quality, and amount of real-time and written social contact were assessed online or by computer-assisted telephone interviews. Comparisons of experiences during the COVID-19 pandemic of people with and without a physical disability were adjusted statistically for pre-pandemic outcome measures, age, sex, wealth, ethnicity, presence of a spouse or partner, number of people in the household, and chronic pain. All participants with full data available for both surveys were included in the analyses. FINDINGS: Between June 3 and July 26, 2020, 5820 participants responded, 4887 of whom had full data available for both the pre-pandemic measures and the COVID-19 survey and were included in the analysis. During the COVID-19 pandemic, significantly more people with ADL impairment had clinically significant symptoms of depression (odds ratio 1·78 [95% CI 1·44–2·19]; p<0·0001), anxiety (2·23 [1·72–2·89]; p<0·0001), and loneliness (1·52 [1·26–1·84]; p<0·0001) than people without ADL impairment. Significantly more people with ADL impairment also had impaired sleep quality (1·44 [1·20–1·72]; p<0·0001) and poor quality of life than people without ADL impairment. The results were similar when disability was defined by impaired mobility. People with ADL impairment had less frequent real-time contact (0·70 [0·55–0·89]; p=0·0037) and written social contact (0·54 [0·45–0·64]; p<0·0001) with family than people without ADL impairment. Results for social contact were similar when disability was defined by impaired mobility. INTERPRETATION: People with physical disability might be at particular risk for emotional distress, poor quality of life, and low wellbeing during the COVID-19 pandemic, highlighting the need for additional support and targeted mental health services. FUNDING: Economic and Social Research Council/UK Research and Innovation, National Institute on Aging, National Institute for Health Research

Changes in older people's experiences of providing care and of volunteering during the COVID-19 pandemic

Engagement in socially productive activities, such as care provision and voluntary work, make important contributions to society, and may have been especially important during the coronavirus pandemic. They have also been associated with better health, well-being, and longer survival for older people. The ELSA COVID-19 Substudy provided data to allow for an exploration of how changes in caring and volunteering may have occurred during the pandemic, and to examine this in relation to factors such as sex, age, employment status, wealth, COVID-19 vulnerability and symptoms, and pre-pandemic experiences of health. Overall, there have been important changes in both the level of care provided by older people and the extent of their involvement in volunteering, with, on average, care provision more likely to have increased or stayed the same (65% of older carers reported this), and volunteering more likely to have decreased or stopped (61% of older volunteers reported this). However, a large number of older people took on new caring roles for someone outside the household (12%) and 4% of older people registered to volunteer as part of the NHS scheme. Both economic characteristics (such as paid employment and wealth) and health-related characteristics (such as being vulnerable, self-isolating, having experienced COVID-19 symptoms, and reporting functional limitations) were related to changes the frequency of caring and voluntary work. It is yet unclear how these changes in caring and volunteering have influenced older people’s health and well-being during the coronavirus outbreak. Investigating the impact of the pandemic on broader health and well-being outcomes for older people, the role of changes in care provision and volunteering in this, and how we might respond to this, is a crucial next step

Is grandparental childcare socio-economically patterned? Evidence from the English longitudinal study of ageing

Grandparents play a vital role in providing childcare to families. Qualitative research and evidence from parents raise concerns that it is grandparents who are socio-economically disadvantaged who provide grandchild care more regularly, perform more intensive tasks, and care out of financial necessity. However, no European studies have investigated these issues at population level. This study is based on grandparents aged 50+ who looked after grandchildren. Data are from wave 8 of the nationally representative English Longitudinal Study of Ageing (2016/2017). We exploit newly collected information on frequency of grandchild care, activities, and reasons for care. Using multinomial regressions, we first examined the extent to which grandparents’ socio-economic characteristics (wealth and education) are associated with frequency of grandchild care. Second, using logistic regressions, we investigated whether wealth and education are associated with activities and reasons for grandchild care. Overall, grandparents from disadvantaged socio-economic backgrounds were more likely to provide more regular childcare. Similarly, grandparents in the lowest wealth quartile were more involved in hands-on activities (cooking, taking/collecting grandchildren to/from school), whereas highly educated grandparents were more likely to help grandchildren with homework. Finally, better-off grandparents were more likely to look after grandchildren to help parents and provide emotional support and less likely to report difficulty in refusing to provide care. Our findings show that grandparental childcare varies by socio-economic status with more intensive childcare activities falling disproportionately on those with fewer resources, and this may act to exacerbate existing socio-economic inequalities in later life

The experience of older people with multimorbidity during the COVID-19 pandemic

The risk of severe COVID-19 disease is known to be higher in older individuals with multiple long-term health conditions (multimorbidity). In this briefing, we report the latest findings from the English Longitudinal Study of Ageing COVID-19 Substudy on the experiences of older people with multimorbidity during the pandemic. Not all people with multimorbidity would be classified as clinically vulnerable. We found that 35% of older individuals with multimorbidity were instructed by the NHS or their GP to shield (staying at home at all times and avoiding any face-to-face contact) on account of their vulnerability, and the majority were largely compliant with this advice. Relative to study members without multimorbidity, respondents with multimorbidity were more likely to report poor sleep quality, eating less, and being worried about not having enough food and other essentials. Unhealthy behaviours (sitting time, physical inactivity etc), poor mental health, and loneliness deteriorated considerably during the lockdown and in the two months following the lockdown. Access to medications among people with multimorbidity was not a problem, however, a fifth of individuals with multimorbidity did not have access to community health, social care services and support from other health professionals (e.g., dentist, podiatrist). When considering policies which advise people to shield or self-isolate because of their COVID-19 risk, it is important for policymakers to acknowledge that older people with multiple long-term health conditions are at higher risk of experiencing greater mental distress and worry, of engaging in unhealthy behaviours and are less likely to access health services when needed; all these factors together could potentially influence disease progression

Becoming a grandparent and its effect on well-being: the role of order of transitions, time, and gender

Objectives Although the majority of older people are grandparents, little is known on whether and how the transition into grandparenthood affects their well-being. Moreover, evidence on whether the order of the transition, the time since grandchild’s birth, and the socio-demographic characteristics of the offspring modify the grandparental well-being is scarce. Taking into account these factors, our study examines the association between becoming a grandparent and subsequent well-being. Methods Our study is based on grandparents aged 50 and over from waves 4-6 of the Survey of Health, Ageing and Retirement in Europe. Using longitudinal analyses, we investigate associations between becoming a grandparent and subsequent life satisfaction, positive affect, and depression controlling for demographic and socio-economic factors as well as health and well-being at baseline. Furthermore, we explore the role of modifying factors such as whether the grandchild was first-born, the time since transition, and socio-demographic characteristics of the offspring who became a parent. Results Becoming a grandparent has a positive effect on well-being only among women who became grandmothers for the first time and via their daughters. Moreover, this effect is particularly strong in the proximity of the birth of the grandchild. No effects were found among first-time grandfathers. Having an additional grandchild does not affect well-being of grandparents, regardless of the offspring’s characteristics

Looking after grandchildren: gender differences in 'when,' 'what,' and 'why': Evidence from the English Longitudinal Study of Ageing

Background: Grandparents play a vital role in providing childcare to families. However, little is known about when grandmothers and grandfathers look after grandchildren, what they do with them, and why. / Objective: Using novel questions on grandparenting, we first describe the periodicity of grandchild care, activities undertaken with/for grandchildren, and motivations for such care to then assess if there are gender differences. / Methods: We used wave 8 (2016/17) of the nationally-representative English Longitudinal Study of Ageing. The extent to which the periodicity, activities, and motivations are gendered was assessed using logistic regressions. Analyses were carried out on the entire sample of grandparents who provide childcare as well as on coresiding grandparent couples where both grandparents provide grandchild care. / Results: More than 50% of grandparents looked after grandchildren, with the majority doing so throughout the year and about one in four during school holidays. Few gender differences were observed in the periodicity of grandchild care and reasons for looking after grandchildren, with almost two-thirds reporting that they wanted to help parents go to work and give them a break. However, when activities undertaken for/with grandchildren were analysed, clear gender differences emerged. Overall, grandmothers were more likely to report caring and helping activities (e.g., cooking, caring when sick, helping with homework, and collecting them from school) than grandfathers, even when they coresided. / Contribution: Our study is the first to document, at a population level, gender differences in the periodicity of grandchild care, what grandparents do when they look after grandchildren, and why they provide such care

Multimorbidity, access to services and diagnosis of new health conditions during the COVID-19 pandemic

Excess deaths from conditions other than COVID-19 have been reported during the COVID-19 pandemic. Reduced access to health and social care services during lockdown may have disproportionately affected older people and those with multiple medical conditions. The English Longitudinal Study of Ageing COVID-19 Substudy provided an opportunity to evaluate older people’s experiences of receiving needed health and social care, and changes in reported anxiety, depression and loneliness. We found that the rates of diagnosis of new conditions during the pandemic in the second half of 2020 were substantially different from the pre pandemic rates reported in 2018 to 2019. Rates of newly diagnosed dementia dropped to below half the pre pandemic rate for reasons that are not clear. The increased isolation during lockdown may have meant that cognitive decline went unnoticed by friends and relatives, or barriers to accessing healthcare may have been experienced more by those with early dementia. Conversely, other conditions were diagnosed more frequently than before the pandemic, including arthritis, chronic lung disease, diabetes and hypertension. Again, the reasons for these increases are not clear, but fewer opportunities for physical activity and social interaction may have played a part. Those with multiple medical conditions were more likely to be unable to access healthcare, and 1 in 5 of them had a hospital operation or treatment STUDY RESULT 2 cancelled. We found that mental health worsened during the pandemic, with higher reported rates of anxiety, depression and loneliness, and again the rise was steeper for respondents with multimorbidity. These results show that older people experienced poor mental health and difficulty accessing basic health care during the pandemic, and those with multiple conditions and early dementia had the greatest difficulties. Particular attention should be paid to the health needs of these vulnerable groups as health care access improves and the backlog of cancelled and delayed care is addressed

Paid employment and common mental disorders in 50–64-year olds: analysis of three cross-sectional nationally representative survey samples in 1993, 2000 and 2007

Associations between employment status and mental health are well recognised, but evidence is sparse on the relationship between paid employment and mental health in the years running up to statutory retirement ages using robust mental health measures. In addition, there has been no investigation into the stability over time in this relationship: an important consideration if survey findings are used to inform future policy. The aim of this study is to investigate the association between employment status and common mental disorder (CMD) in 50–64-year old residents in England and its stability over time, taking advantage of three national mental health surveys carried out over a 14-year period. Data were analysed from the British National Surveys of Psychiatric Morbidity of 1993, 2000 and 2007. Paid employment status was the primary exposure of interest and CMD the primary outcome – both ascertained identically in all three surveys (CMD from the revised Clinical Interview Schedule). Multivariable logistic regression models were used. The prevalence of CMD was higher in people not in paid employment across all survey years; however, this association was only present for non-employment related to poor health as an outcome and was not apparent in those citing other reasons for non-employment. Odds ratios for the association between non-employment due to ill health and CMD were 3.05 in 1993, 3.56 in 2000, and 2.80 in 2007, after adjustment for age, gender, marital status, education, social class, housing tenure, financial difficulties, smoking status, recent physical health consultation and activities of daily living impairment. The prevalence of CMD was higher in people not in paid employment for health reasons, but was not associated with non-employment for other reasons. Associations had been relatively stable in strength from 1993 to 2007 in those three cross-sectional nationally representative samples