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

Introduction

Scotland has an ageing population. The proportion of ‘older adults’ (65 years old and over) making up the population has increased from 16% in 2000 to 19% in 2020, which reflects 256,600 more older adults in 2020 than in 2000^[1]. The proportion of older adults in Scotland’s population is expected to continue increasing over the next decade, which will likely put greater pressure on public services^[2]. As such, an increased focus on the health of older adults is crucial^[3]. However, regarding mental health and wellbeing, older adults are viewed as being ‘neglected across the spectrum of promotion, prevention and treatment services’ in the UK^[4].

Recognising the wider marginalisation of older adults, the Scottish Government published A Fairer Scotland for Older People^[5] in 2019. To tackle this inequality, this report outlined planned actions relating to communities, accessing services, and financial security. Within these actions, emphasis was placed on addressing mental health issues in older age, specifically by improving the provision of and access to mental health services (e.g., psychological therapy) for people aged 65+.

Ensuring equitable access to mental health support and services for older adults – taking into account the extent to which they can access digital resources – is also stated in the Scottish Government’s COVID-19: Mental Health – Transition and Recovery Plan^[6], published in 2020. Further proposed actions in this plan concerning older adults’ mental health included: 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 report presents the findings from an evidence review and analysis with the overall aim of better understanding Scottish older adults’ mental health and the access to and delivery of older adults’ mental health services. More specifically, the review aimed to address the following three research questions:

• How does older adults’ mental health and the access and delivery of older adults’ mental health services compare with other age groups?
• How has the COVID-19 pandemic affected older adults’ mental health and the access to and delivery of older adults’ mental health services?
• How do individual characteristics (e.g., ethnicity) affect older adults’ mental health and the access to and delivery of older adults’ mental health services?

In this report, ‘older adults’ are defined as 65 years old and over. Regarding the term ‘mental health’, a broad definition is adopted that is inclusive of general mental wellbeing as well as more specific issues and symptoms (e.g., anxiety, depression, loneliness). Similarly, the term ‘older adult mental health services’ is defined broadly and is inclusive of any services (i.e., statutory, third sector) that aim to improve older adults’ mental health. As dementia often takes attention away from older adults’ mental health^[7], the definitions of ‘mental health’ and ‘mental health services’ are not inclusive of dementia symptoms and dementia services, respectively.

Structure of report

The next section outlines the methods used to conduct the evidence review. Focusing on older adults’ mental health, access to, and delivery of older adults’ mental health services separately, the subsequent sections present the findings of the evidence for each of these areas in turn. The final section presents conclusions based on the report findings.