Older adults' mental health before and during the COVID-19 pandemic: Evidence paper

Executive summary

Background

Scotland has an ageing population. The proportion of ‘older adults’ (65 years old and over) in the population has increased from 16% in 2000 to 19% in 2020. This is expected to continue increasing over the next decade, putting more pressure on public services. Regarding mental health and wellbeing, older adults are viewed as being neglected across the spectrum of promotion, prevention and treatment services in the UK.

The need for improvement in the provision of and access to mental health services for people aged 65+ was emphasised within the Scottish Government report, A Fairer Scotland for Older People, published in 2019. The Scottish Government’s COVID-19: Mental Health – Transition and Recovery Plan, published in 2020, further emphasised the need to ensure equitable access to mental health support and services for older adults. The plan includes: supporting the development of peer support approaches to maintain good mental health; developing actions to support people experiencing loneliness; and improving the understanding of how COVID-19 has affected older people’s mental health.

Aims

This evidence paper has been prepared by analysts from the Health and Social Care Analysis Division. It aims to establish a better understanding of Scotland’s older adults’ mental health and the access to and delivery of older adults’ mental health services. It aims to address the following three research questions:

1. How does older adults’ mental health and the access and delivery of older adults’ mental health services compare with other age groups?

2. How has the COVID-19 pandemic affected older adults’ mental health and the access to and delivery of older adults’ mental health services?

3. How do individual characteristics (e.g., ethnicity) affect older adults’ mental health and the access to and delivery of older adults’ mental health services?

Methods

The findings presented in this report were generated by identifying and reviewing existing quantitative and qualitative evidence and analysing data from the four annual Scottish Health Surveys (SHeS) conducted between 2016 and 2019. This provided insights into the differences between older adults based on age and other demographic characteristics (e.g. sex, Scottish Index of Multiple deprivation). The review focused on six mental health outcomes from SHeS 2016-2019: mental wellbeing; a possible psychiatric disorder; depression symptoms; anxiety symptoms; a suicide attempt in the last 12 months; and an incidence of self-harm in the last 12 months. These were assessed using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), the General Health Questionnaire (GHQ-12) and the Revised Clinical Interview Schedule.

Key findings

1. Need for more evidence

There is currently a lack of evidence relating to older adults’ mental health, particularly relating to LGBTI identities, ethnic and religious backgrounds, caring responsibilities and finances and deprivation. There is also little evidence specifically concerning non-statutory mental health services. Inconsistency in the methods used to generate evidence and small sample sizes in many studies make it challenging to draw strong conclusions.

2. Older adults compared to other age groups

Older adults appear to report better mental health outcomes than younger adults; however, this might reflect that they are less likely to report poor mental health, particularly due to more stigmatising views of mental health amongst older people and reliance on self-reported data. Findings also indicate that age-related stigma affects older adults in various ways, such as how they are treated in mental health services and how they engage with these services (e.g., not accessing services due to not wanting to be a burden).

3. Avoid viewing older adults as a homogenous group

Findings from the research indicate differences between older adults of different ages (e.g., 65-69 and 75+). However, older adults were commonly grouped into one broad category in survey data, which prevents an understanding of how mental health experiences and needs from services change over the course of older adulthood. Findings from available data indicated differences between older adults (e.g., older men/women, living alone/with others). Consequently, the diversity of older adults as a group should be considered and reflected in evidence, policy and services. Older adults with a physical health condition (compared with those without), and who live alone (compared to living with other) indicated poorer mental health for some specific outcomes, (e.g., mental wellbeing, loneliness).

4. Distinguish between dementia and mental health

A clear distinction should be made between dementia and mental health, particularly in older adulthood. Evidence indicates that an older adults’ mental health issues might be neglected if they are diagnosed with dementia. Mixed wards (i.e., patients with dementia, mental health issues or both) are viewed as detrimental for older adults with mental health issues. Without making a clear distinction between these, a clearer understanding of each is impeded.

5. Challenges for older adults’ mental health services

Several challenges for older adults’ mental health services were identified, including the varied approach to older adults transitioning from adult to older adult services and the low availability and quality of services.

6. Impact of COVID-19

The COVID-19 pandemic appeared to have a detrimental effect on older adults’ mental health, particularly loneliness. However, in terms of psychological therapy referrals, waiting lists and new patients, older adults’ mental health services show signs of recovering following a decrease in these rates during the COVID-19 pandemic.