New HomeCare.org Survey Confirms the Severity of Mental Health Issues Among Older Adults During COVID-19

Throughout the coronavirus pandemic, the CDC and Census Bureau have regularly released new data around the state of Americans’ mental health, and the results are in line with what one may expect. Due to the pandemic, mental health has substantially worsened. What may not be expected is just how many more older adults are struggling with mental health issues during COVID-19.

Kaiser Family Foundations’ (KFF) analysis of the Census Bureau’s Household Pulse Survey asserts that the percentage of older Americans (over the age of 65) with anxiety or depression has increased by nearly 120% since 2018 due to the pandemic (11% in 2018 vs. 24% mid-2020).

It’s no doubt that COVID-19 has caused seniors to become much more isolated and lonely, which can lead to, or worsen feelings of anxiety and/or depression. “There’s no question that loneliness has impacted mental health during COVID-19. It’s a dramatic change,” says Dr. Kenneth Robbins, MD, MPH. “It is a really under-appreciated problem.”

A factor that makes the state of mental health among older adults even more concerning is the fact the older generation is more reluctant to identify, talk about, and even seek help for mental health issues. “I don’t think there’s much doubt that if you look at the generation of 75 or 80 or above, they tend to be very reluctant to talk about mental health issues. With the stigma that was attached to mental health issues in their generation, there wasn’t much hope or discussion about mental health,” says Dr. Robbins.

That’s why HomeCare.org is publishing this survey – to provide resources for and raise awareness of the seriousness of mental health problems among older adults. Overall, we found that 34% of adults with older parents noticed signs of anxiety and/or depression in their parents during the COVID-19 pandemic. However, a slightly smaller number (31%) said that their parents mentioned feelings of anxiety or depression. This survey serves as further evidence that seniors are not exempt from the national mental health crisis in America.

Below we will discuss our findings in greater depth, and provide resources for older adults who struggle with mental health and their loved ones. Included is expert-reviewed guidance on how to know if your loved one is struggling with mental health and information on how to find them help.

1 in 3 adults noticed signs of anxiety or depression in their older parents during COVID-19.

When asked whether they noticed signs of suspected depression or anxiety in their parents since the beginning of the COVID-19 pandemic, 34% said that they noticed signs of one condition or both. Specifically, 23.4% said that they noticed signs of suspected anxiety, which was defined as regularly not being able to control or stop worrying. 21.3% said that they noticed signs of suspected depression, which was defined as regularly having little interest or pleasure in doing things.

31% of adults said that their older parents mentioned or expressed feelings of anxiety or depression during COVID-19.

It’s important to note that adult children noticed symptoms of suspected anxiety or depression at a slightly higher rate than what was mentioned or expressed by their parents (34% noticed vs. 31% expressed). This underscores the concern that older adults are likely to underreport feelings of anxiety and depression.

This discrepancy is less of an issue when it comes to anxiety – 23.4% of respondents noticed signs of anxiety in their parent, and 22.5% said that their parents mentioned or expressed feelings of anxiety (regularly feeling nervous, anxious, on edge, etc.). However, 21.3% of respondents noticed signs of suspected depression while only 18% said that their parents mentioned feelings of depression (regularly feeling down or depressed).

As the nation battled the coronavirus pandemic, individuals began to feel the toll of the lifestyle changes brought on by necessary safety measures. Approximately 1 in 3 of our survey respondents said they noticed signs of suspected depression or anxiety in their elderly parents in the last year, a significant increase from 2018 when 1 in 10 older adults reported feeling depressed or anxious.

However, unlike physical illness that often presents visible symptoms, mental health problems are not always as apparent. Additionally, the stigma surrounding mental health can make people hesitant to speak up when they are struggling.

It’s important to be aware of the warning signs for depression and anxiety, especially if your loved one has dealt with excessive isolation or loss during the last year. The compounding factors of the pandemic and typical life stresses created what the American Psychological Association has called “a national mental health crisis that could yield serious health and social consequences for years to come.”

There is no way to prevent mental health struggles entirely, nor is there a foolproof cure. But, identifying early signs of depression and anxiety before they become debilitating can help your loved one avoid severe mental and physical distress. Below, we give some examples of common symptoms of depression and anxiety and risk factors for the condition so you can be proactive in helping your loved ones if they are struggling.

Depression and Anxiety Warning Signs

The following characteristics are some of the most common warning signs for mental health struggles, specifically depression and anxiety. Keep in mind that this list is not exhaustive- some people can live with depression and anxiety without showing any of these outward symptoms. Similarly, sometimes people can display some of this behavior without struggling with depression or anxiety. However, if you notice multiple warning signs and know that your loved one’s behavior is atypical for them, it may be time to start a conversation with them, or even their caregiver or physician, about seeking mental health treatment.

• Social Withdrawal: Retreating from friends and family is a common symptom of mental health struggles, especially depression. Perhaps you haven’t seen your loved one as often lately, and they’re turning down invitations to family and social gatherings and choosing to isolate themselves, even as the threat of COVID-19 lessens.

• Sleep Changes: Depression, anxiety, and other mental health conditions often impact one’s sleep patterns. This may mean wanting to sleep much more than usual, or your loved one may be sleeping sufficiently but still feels tired and lethargic. In other cases, one may experience insomnia and be unable to fall asleep no matter how tired they feel.

• Weight Fluctuation: Lack of appetite or emotional overeating can occur when struggling with mental health, and rapid weight loss or gain can signify that someone is dealing with mental health challenges. If you notice significant weight changes- either gain or loss- without other contributing factors like a physical illness, it may be a warning sign for depression or anxiety.

• Apathy: Apathy can be described as a lack of interest or enthusiasm, especially regarding things that typically would be exciting. When struggling with mental health, one may start to be disinterested in their favorite activities or subjects or show a general lack of excitement for life. This can also manifest as wearing dirty clothes or neglecting to keep up with one’s grooming.

• Flu-like Symptoms: In addition to fatigue and lack of appetite, depression can cause other flu-like symptoms, including gastrointestinal problems, headaches, and general body pain. If your loved one demonstrates these symptoms for a prolonged period without any indications of flu or other physical illness, it may be a symptom of depression. Gastrointestinal over-activity can also be a symptom of anxiety.

• Physical Discomfort: While depression can lead to head and body aches, anxiety may cause physical discomforts such as nausea, neck tension, or frequent jaw-clenching.

• Increased Substance Use: Some people turn to substances like drugs and alcohol when struggling with their mental health. Increased frequency of substance use may indicate that someone is trying to “numb the pain” of depression or anxiety. While most people associated substance abuse with younger adults, Dr. Robbins notes that the use of alcohol and cannabis is on the rise among seniors, and may contribute to negative mental health outcomes.

Ultimately, only the person themself and qualified mental health professionals can determine when someone is living with diagnosable depression or anxiety, but knowing the warning signs can alert you to potential struggles.

“What you see can be really helpful. If you see someone losing weight, someone having less energy, having trouble sleeping at night… try finding a way to talk about that without sounding overly judgmental and engage them in an honest conversation about it,” says Dr. Robbins.

Isolation Risk Factors

The warning signs described above all typically show themselves after one is already experiencing a mental health struggle. Even if your loved one does not demonstrate any of the warning signs above, there are some risk factors to be aware of that can make your loved one more susceptible to mental health challenges, notably loneliness and isolation.

Due to safety concerns, many people spent the majority of the last year social distancing from people outside of their household. And, seniors were some of the most impacted by social distancing rules. Many seniors live alone, and senior living communities’ strict safety protocols prohibited families from visiting their loved ones. Among our survey respondents, 40% felt that their elderly parents experienced more loneliness since March 2020.

Loneliness and social isolation can lead to depression and a range of other health problems. The National Academies Press reports that social isolation “presents a major risk for premature mortality,” and one meta-analysis concluded that “lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder.” Additionally, the CDC reports that isolation is associated with a 50% increased risk of dementia. These health impacts of isolation are especially worrisome given our survey findings that 49% of adults felt that their parents were more isolated than before the COVID-19 pandemic began.

It’s unreasonable to think that you can prevent your loved one from ever feeling lonely- occasional loneliness is a normal part of life. But, excessive isolation is not, and there are ways to help your elderly loved one avoid it, whether by asking neighbors to stop by or hiring a companion care aide to visit a few times a week. The checklist below can help you determine if your loved one may be at risk for excessive isolation so you can act accordingly. If you want to complete the checklist for yourself, simply rephrase the statements as “I.”

If three or more of these risk factors are present, your loved one may have a higher likelihood of developing health problems like depression as a result of excessive loneliness and isolation. Like the list of warning signs above, this checklist is not exhaustive. But, if you have concerns about an older loved one’s lack of social interaction, the checklist can help you determine if it’s time to take action.

If you want to help your loved one feel less isolated, Dr. Robbins recommends reintroducing some structure to their life, especially when it comes to social activities. “For older people who aren’t working and who have socially withdrawn, are less active and less independent, I think helping them create a schedule to structure their time can be really helpful. I think ideally, including some social time not just on a computer, but time when people are actually interacting really helps,” he said.

Just like mental illness manifests differently for everyone, the right course of treatment will vary, too. Not all people will respond to the same treatment in the same way, and it can be overwhelming to determine the right course of action to take. Despite wanting to help a loved one with their mental health, you may not know how to do so. Our survey found that only 4 out of 10 adult children of elderly adults feel fully equipped to help their parents manage their mental health.

If you’re unsure how to help your parents with their mental health, a non-judgemental, open conversation is a great place to start.

“Trying to help people talk about their mental health issues is really critical and often people are afraid to do that. They think if they talk about depression people will be more depressed… if they start talking about emotional challenges it will make people feel worse about themselves. I think for the vast majority of people this isn’t true,” says Dr. Robbins. But, the way you frame mental health in the conversation is important. “Try to talk about it in a way that does not exacerbate for older generations, that does not feel stigmatizing… Make it clear that these are common problems and you’re just wondering how it’s impacting them.”

Some people may also seek to connect their parents with mental health resources. To help simplify the process of finding mental health assistance, we compiled this list of resources for older adults struggling with their mental health and their loved ones who want to help. We hope that the following resources, including directories of certified care providers, educational guides, and on-demand help, will meet your need, whether you are looking to educate yourself on depression and anxiety, searching for care for an elderly loved one, or need treatment yourself.

Ahmedani, B. K. (2011). Mental Health Stigma: Society, Individuals, and the Profession. Journal of Social Work Values and Ethics, 8(2), 4-1–4-16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/

American Psychological Association. (2020, October). Stress in America 2020: A National Mental Health Crisis. American Psychological Association. Retrieved May 2021, from https://www.apa.org/news/press/releases/stress/2020/report-october

Bethune, S. (2019, January). Gen Z more likely to report mental health concerns. Monitor on Psychology, 50(1), 20. https://www.apa.org/monitor/2019/01/gen-z

Koma, W., True, S., Biniek, J. F., Cubanski, J., Orgera, K., & Garfield, R. (2020, October 9). One in Four Older Adults Report Anxiety or Depression Amid the COVID-19 Pandemic. Kaiser Family Foundation. Retrieved 2021, from https://www.kff.org/medicare/issue-brief/one-in-four-older-adults-report-anxiety-or-depression-amid-the-covid-19-pandemic/

Maes, M. (2009). “Functional” or “psychosomatic” symptoms, e.g. a flu-like malaise, aches and pain and fatigue, are major features of major and in particular of melancholic depression. Neuroendocrinology Letters, 30(5), 564-573. https://pubmed.ncbi.nlm.nih.gov/20035251/

Mayo Clinic Staff. (2019, June 08). Mental illness. Mayo Clinic. Retrieved 2021, from https://www.mayoclinic.org/diseases-conditions/mental-illness/symptoms-causes/syc-20374968

Mental Health America. (n.d). Mental Illness And The Family: Recognizing Warning Signs And How To Cope. Mental Health America. Retrieved May 2021, from https://www.mhanational.org/recognizing-warning-signs

National Academies of Sciences, Engineering, and Medicine. (2020). Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press. https://doi.org/10.17226/25663.

National Association of Area Agencies on Aging. (2020). Expand Your Circles: Prevent Isolation and Loneliness As You Age [Brochure]. The National Association of Area Agencies on Aging. Retrieved 202, from https://www.n4a.org/Files/Isolation%20BrochureFINAL.pdf

National Institute of Mental Health. (2018, February). Depression. National Institute of Mental Health. Retrieved May 2021, from https://www.nimh.nih.gov/health/topics/depression/

Novotney, A. (2019, May). The risks of social isolation. Monitor on Psychology, 50(5), 32. https://www.apa.org/monitor/2019/05/ce-corner-isolation

United States Census Bureau. (2021, May 5). Measuring Household Experiences during the Coronavirus Pandemic. United States Census Bureau. https://www.census.gov/data/experimental-data-products/household-pulse-survey.html