COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey

Abstract

Background: The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well-being.

Aims: To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak.

Methods: Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being.

Results: 377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3.

Conclusions: Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic.

Keywords: COVID-19; dementia; mental health; old age psychiatry.

Figure 1

Flow of participation in longitudinal survey. The top boxes indicate how many people completed each survey timepoint. After having removed (1) duplicates (people who completed the survey two times), (2) missing cases (where participants had not completed the Personalised Health Questionnaire 9, Generalised Anxiety Disorder 7, and the Short Warwick-Edinburgh Mental Well-Being Scale or had missing ID codes at T2 and T3) and (3) losses to follow-up (those that had either completed T1 or T1 and T2 only), and (4) incomplete data at T1 yet data at T2 or T3, 377 cases remained in total. Grey boxes indicate the breakdown by subgroup. ¹ Follow-up completion by subgroup by percentage at T2 and T3 compared with T1: people living with dementia (PLWD) 69% (T2), 67% (T3); Current carers 86% (T2), 75% (T3); Former carers 64% (T2), 60% (T3); Older adults 79% (T2), 69% (T3).

Figure 2

Social support service usage pre pandemic and at three survey timeoints. (A) Service usage for the total sample (N=377) in proportion of participants at four different timepoints for some of the most frequently used support services. (B) Proportion of participants within each group at four different timepoints (pre pandemic, T1, T2 and T3) having received any form of social support.

Figure 3

Proportion of the total sample who scored above the cut offs for anxiety and depression at three timepoints.T=Timepoin. The graph shows the proportion of participants from the total sample who completed all three surveys (n=377) and scored above the cut-off on the Generalised Anxiety Disorder 7 and Personalised Health Questionnaire 9 for anxiety and depression, respectively.

Figure 4

Variations in anxiety, depression and quality of life total scores at three timepoints. Figures show the median total score at each timepoint (T1, T2 and T3) for each subgroup—for anxiety (GAD-7), depression (PHQ-9) and quality of life (SWEMWBS). AOs, Older adults; GAD-7, Generalised Anxiety Disorder 7; PHQ-P, Personalised Health Questionnaire 9; PLWD, people living with dementia; SWEMWBS, Short Warwick-Edinburgh Mental Well-Being Scale.