Mental Health Status of the Older Adults in Japan During the COVID-19 Pandemic

The pandemic of coronavirus disease 2019 (COVID-19) has had a serious impact worldwide. Abnormal situations such as the fear of being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), restrictions on going outdoors, abundant financial losses, fewer opportunities of communicating with close friends, and conflicting messages from authorities could cause anxiety or depression moods in all ages.^{1 , 2} Older people infected with COVID-19 have been reported to be at an increased risk of death and exacerbations, thereby requiring mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Herewith, older people are more anxious and frightened of COVID-19 than young adults. A study reported that social isolation and loneliness during the COVID-19 pandemic could worsen older adults' anxiety and depression³; however, differences in older adults' mental health prior to and during the COVID-19 pandemic have not been thoroughly studied yet. Therefore, this study investigated the effects of the COVID-19 pandemic on older adults' mental status.

A preliminary analysis for our questionnaire survey named Toyoyama town complex intervention project promoting “Exercise,” “Nutrition improvement,” and “Going out” (TENG project) was conducted. In this study, the physical, mental, and social status of community-dwelling older adults were examined every 6 months starting from October 2018. The study protocol was approved by the local ethics committee (approval no. 2018-0221) and written informed consent was obtained from all participants. The present analysis included the responders in December 2019 and July 2020. Depression and apathy during the first wave of COVID-19 pandemic were examined using the 15-item Geriatric Depression Scale (GDS-15) and apathy scale in the questionnaire.^{4 , 5} The score ranges of the GDS-15 and apathy scale were respectively 0 to 15 points and 0 to 42 points, with higher scores indicating more severe symptoms. Baseline characteristics used in the study included age, sex, comorbidities, living conditions, economic, and frailty status. Economic status was graded as follows: good economic status with no anxiety, fair economic status with minor anxiety, poor economic status with some anxiety, and severe economic status with anxiety, whereas the frailty status was graded using the Kihon checklist, having 0 to 3 points for robust, 4 to 7 points for prefrail, and 8 or more points for frail. The changes in the GDS-15 and apathy scale between December 2019 and July 2020 were assessed using generalized estimation equations that were adjusted with the above-mentioned baseline characteristics. Two subgroups, including individuals who are aged <75 years and who are aged ≥75 years were analyzed using the same methods. Two-sided P <.05 was set as significant, and all analyses were conducted using the R software (version 3.6.1, R Foundation for Statistical Computing, Vienna, Austria).

Overall, 519 participants with valid responses were analyzed. Age at baseline was 74.8 ± 5.3 years, and 259 participants (49.9%) were male. Among them, 149 (28.7%) were prefrail and 68 (13.1%) were frail. Depression and apathy scores both significantly deteriorated in July 2020 compared with December 2019. Depression score values increased from a GDS-15 score of 2.94 ± 3.27 to 3.62 ± 3.41 with an estimated change of 0.21 (95% confidence interval 0.12-0.31). Apathy scores also escalated from 13.65 ± 6.70 to 15.20 ± 6.98 with an estimated change of 0.11 (95% confidence interval 0.06-0.15) (Table 1 ). In subgroup analyses, both the GDS-15 score and apathy scale were significantly increased in those aged <75 years, whereas those aged ≥75 years showed significant change only in the GDS-15 score.

Table 1.

Mental Health Changes Between Before and During the COVID-19 Pandemic

	December 2019	July 2020	Raw Score Change	Estimated Change (95% CI)	P Value
Overall (n=519)
GDS-15	2.94 ± 3.27	3.62 ± 3.41	0.72 ± 3.45	0.214 (0.117-0.311)	<.001
Apathy Scale	13.65 ± 6.70	15.20 ± 6.98	1.63 ± 6.88	0.106 (0.061-0.150)	<.001
Aged <75 y (n=246)
GDS-15	2.46 ± 3.06	3.34 ± 3.25	0.87 ± 3.31	0.300 (0.152-0.447)	<.001
Apathy Scale	12.94 ± 6.34	14.97 ± 7.21	2.17 ± 6.28	0.156 (0.098-0.215)	<.001
Aged ≥75 y (n=273)
GDS-15	3.38 ± 3.39	3.87 ± 3.54	0.57 ± 3.57	0.144 (0.016-0.272)	.027
Apathy Scale	14.29 ± 6.97	15.42 ± 6.76	1.12 ± 7.38	0.061 (−0.004-0.126)	.067

CI, confidence interval.

Data are shown in mean ± standard deviation or estimated value (95% CI). Estimated changes and 95% CIs are calculated with generalized estimating equations. Models are adjusted for sex, comorbidities, living conditions, economic status, and frailty status.

The results showed that the COVID-19 pandemic had worsened depressive mood and apathy among the community-dwelling older adults. The results were remarkable especially in adults aged <75 years. Yamada et al reported the results of an online-based survey revealing that daily physical activity among community-dwelling older adults has decreased during the COVID-19 pandemic.⁶ Higher physical activity is important in maintaining mental health⁷; however, those who were less fit were found to have little deterioration in mood, despite a reduction in their physical activity. Individuals aged ≥75 years might be less affected by COVID-19 because their baseline physical activity was lesser than that of individuals aged <75 years. Additionally, this study suggests that adults aged <75 years, who are usually considered to be relatively robust, are at high risk for worsened depressive mood and apathy. Pfefferbaum et al¹ noted that mental abnormalities in this situation may have continuous effects like post-traumatic stress disorder and suggested the risk of the current lack of mental health screening systems. Therefore, it is warranted to establish a system that could promptly screen and support the mental health of older adults and other mentally vulnerable populations.