Table 4.

The impact of COVID-19 on stress resilience and mental health in elderly people.

Study	Population	Time period/ Wave	Study type and sample size	Objective(s)/Main outcomes	Inclusion criteria	Main findings/ summary
Spalletta et al., 2020	Italian patients with mild and major neurocognitive disorders (NCD)	January - April 2020 (precise period unknown)	Cross-sectional, N = 251 canceled scheduled appointments	Number of canceled appointments for patients with NCD due to COVID-19 compared to these numbers in January – April 2019	Having recorded the number of appointments that were canceled at the Santa Lucia Foundation IRCCS due to the government-enforced reduction of non-urgent healthcare services in Italy during the lockdown	251 scheduled appointments were canceled (follow-up appointments N = 211; first-time appointments N = 40). There was a significant difference in the proportion of canceled follow-up and first-time appointments in March and April 2020 compared to the same periods in 2019.
Rodriguez-Gonzalez et al., 2020	Spanish adults	March 2020, during the lockdown of the COVID-19 first wave (precise period unknown)	Cross-sectional, N = 528 (mean age 69.25 years (±6.75), 64.6% female)	Psychological and social implications and health-related behaviours involved in the lockdown due to the COVID-19 pandemic	Being 60 years or older, living in Galicia (North-West region of Spain, Europe) during the lockdown declared in March 2020 by the Spanish government due to the COVID-19 pandemic	76.5% of sample belonged to active aging organizations before lockdown, but only 33.7% continued to be active during lockdown; 65.7% performed less physical activity than before the lockdown; 25.6% of the sample reported an increase in intellectual activity; 66.3% feel that their physical health will not worsen; 67.6% believe that this situation will not have a positive effect.
Parlapani et al., 2020	Greek adults	The survey was online for a period of three days, three weeks after a national lockdown had been imposed in Greece (March 23 2020,)	Cross-sectional, N = 103 (mean age 69.85 years (±5.26), 61.2% female)	Psychological response of older adults during the acute phase of the pandemic in Greece	Being older than 60 years, having online access to the survey via social media	81.6% reported moderate to severe depressive symptoms; 84.5% reported moderate to severe anxiety symptoms; 37.9% reported disrupted sleep. Females disproportionately reported significantly higher levels of COVID-19–related fear, depression, sleep disturbances, and an intolerance of uncertainty.
Cohen, G. et al., 2020	Argentinian family members of patients of the Aging and Memory Center of FLENI with Alzheimer´s dementia (AD) and related disorders	After the first 8 weeks of quarantine (starting medio March 2020, precise period unknown)	Cross-sectional, N = 119 caregivers of persons with AD or related dementia living at home (mean age of patients 81.16 years (±7.03), 64.7% female)	To study the extent mandatory quarantine due to COVID-19 affected behavioural symptoms in subjects with dementia after the first 8 weeks of quarantine	Being a family member of patients of the Aging and Memory Center of FLENI in Argentina, with AD and related disorders	Family members reported 60.5% new onset or exacerbation of pre-existing behavioural symptoms; 33% anxiety, 12.8% depression, and 14.7% sleep disorders were reported; 40% reported increasing gait difficulties; 20% increased use of antipsychotics, 15% benzodiazepines, 6% hypnotics, and 10% antidepressants. 76% discontinued physical therapy, 91% occupational therapy, and 77% cognitive rehabilitation.
Schweda et al., 2021	German general population	March 1 - May 4 2020, (period in which people lived under the curtailment of their individual freedoms and partly unprecedented governmental restrictions)	Cross-sectional, N = 15,308 (13.9% aged 18–24 years, 24.8% aged 25–34 years, 23.0% aged 35–44 years, 19.0% aged 45–54 years, 14.2% aged 55–64 years, 4.4% aged 65–74 years, 0.8% aged >75 years, 70.7% female)	Psychological reactions in response to real or perceived COVID-19 infection threats	Being involved in social media groups, living under the curtailment of individual freedom between March 10 - May 4 2020,	COVID-19 related fear correlated with generalized anxiety (ρ = 0.377, p < 0.001, 95%-CI = [0.363: 0.391]). COVID-19 related fear increased with age; generalized anxiety decreased with age.
Bidzan-Bluma et al., 2020	German and Polish adults	March 27 - end of April 2020 (during the period of COVID-19 restrictions)	Cross-sectional, N = 494 (mean age 42.97 years (±9.77), 72% female, 80.6% German, 19.4% Polish)	Predictors of quality of life, well-being, sleep, and life satisfaction, including factors such as risk behavior, trait anxiety, feeling of threat, sleep quality, and optimism, during the pandemic in older people from Germany and Poland	Being 18 years or older, having access to the internet in order to fill out the study survey	Older people rated quality of life, life satisfaction, and well-being higher than young people and scored less than young people on anxiety (mean difference= −9.19, SE = 1.90, p < 0.01) and greater than young people on risk tolerance (mean difference = 1.38, SE = 0.33, p < 0.01 difference=0.91, SE = 0.31, p < 0.05).
Emerson, 2020	US adults aged 60 years and older	March 30 - April 12 2020,	Cross-sectional, N = 833 (age range 60–80 years, 62.8% aged 60–70 years, 80.5% female, 96.0% White, 1.9% Black or African American, 0.2% American Indian or Alaska Native, 1.6% Asian, 2.1% other)	The impact of sheltering in place and social distancing among adults aged 60 and older	Being 60 years or older, living in the US and practicing social distancing between March 30 and April 12, 2020	36% reported being stressed and 42.5% reported being lonely. Loneliness increased with time of social distancing.
Whitehead & Torossian, 2021	US adults aged 60 and older	March 22–23 2020 (period in which stay-at-home orders were beginning to be issued)	Cross-sectional, N = 825 (63.8% aged 60–69 years, 30.7% aged 70–79 years, 5.5% aged ≥80 year, 79,3% female)	Older adults’ reports of what was stressful about the pandemic, and what was joyful and comforting amidst the stress	Being 60 years or older, having access to the online survey	13.2% reported restrictions and resulting confinement as a source of stress and 31.6% mentioned family or friends as the most frequently reported source of joy or comfort. Stress over concern for others, the unknown future, and contracting the virus was significantly associated with poorer psychological well-being; whereas faith, exercise/self-care, and nature were associated with more positive psychological well-being.
Garcia-Fernandez et al., 2020	Spanish adults	March 29 - April 5 2020,, covering the peak of the COVID-19 infection in Spain	Cross-sectional, N = 1639 (N = 150 ≥ 60 years old, 58.7% female, N = 1489 <60 years old, 69.2% female)	COVID-19 outbreak-related emotional symptoms, gender differences, and the relationship between the emotional state and environmental features in the elderly	Not being a healthcare worker, not having a current or past mental illness	The ≥60 age group showed lower depression scores and lower acute distress scores than the <60 age group. There were no gender differences in any of the clinical measures.
Li & Wang, 2020	UK adults aged from 18 to over 65 years old	April 24 – 30 2020	Cross-sectional, N = 15,530	The prevalence and predictors of general psychiatric disorders and loneliness after the first diagnosis of COVID-19	Having participated in the first wave of Understanding Society COVID-19 Study	This study showed high prevalence rates of general psychiatric disorders (29.2%) and loneliness (35.86%) during the COVID-19 pandemic. People with current or past COVID-19-related symptoms or various disadvantaged socioeconomic backgrounds were at significantly higher risks of general psychiatric disorders and loneliness.
Zhang, et al., 2021	Brazilian adults	March 25 –28 2020 (one month after the first COVID-19 case in Brazil	Cross-sectional, N = 638 (18.5% aged 18–25 years, 32.3% aged 26–35 years, 24.4% aged 36–45 years, 13.5% aged 46–55 years, 8.8% aged 56–65 years, 2.5% aged >65 years, 57.7% female)	Mental distress and its associated predictors among adults one month into the COVID-19 crisis in Brazil	Unknown	52% of the sampled adults experienced mild or moderate distress, and 18.8% suffered severe distress. Adults who were female, younger, more educated, and exercised less reported higher levels of distress.
Papadopoulou et al., 2021	Greek adults	April 7 - May 3 2020,	Cross-sectional, N = 5116 (28.15% aged 35–44 years, 23.60% aged 45–54 years, 73.64% female)	Prevalence of suicidal ideation in the community as well as the risk and protective factors of suicidal ideation during restriction measures in Greece	Unknown	5.20% reported suicidal thoughts, 14.17% were potential clinical cases of anxiety, and 26.51% of depression. Participants presented significantly higher suicidal ideation rates during the last two weeks of the lockdown compared to its previous two weeks.
Ozamiz-Etxebarria, et al., 2020	Spanish adults	March 11- 18 2020 (55.8% of participants) and April 2–12 2020. (44.2% of participants)	Cross-sectional, N = 1933 (mean age 33.80 years (± 16.65), 79.5% female)	Psychological state of the general population during the COBID-19 lockdown	Unknown	More than a quarter of the participants reported symptoms of depression (27.5%), anxiety (26.9%) and stress (26.5%) and as the time spent in lockdown has progressed, psychological symptoms have risen.
Elderly with cognitive symptoms and dementia
Di Santo, et al., 2020	Italian adults with mild cognitive impairment (MCI) or subjective cognitive decline (SCD)	April 21 - May 7 2020,	Cross-sectional, N = 126 (N = 70 MCI and N = 56 SCD patients, mean age 74.29 years (6.51±), 81.0% female)	The effects of COVID-19 and quarantine measures on lifestyles and mental health of elderly at increased risk of dementia	Being 60 years or older, having undergone the last study visit in the preceding 18 months, not having a significant functional impairment in the last study visit, having a diagnosis of MCI according to the International Working Group criteria, and having a cognitive impairment, operationalized as a MMSE score ≥ 20 and ≤ 26 (or ≤ 28 for participants with 16 or more years of education) or as a score under the normative cut-off in at least one domain-specific cognitive test from an extensive neuropsychological battery	Over 1/3 of the sample reduced their physical activity and nearly 70% reported an increase in idle time. Adherence to the Mediterranean diet decreased in almost 1/3 of respondents and over 35% reported weight gain. Social activities were abolished and 1/6 of participants also decreased productive and mental-stimulating activities. 19.8% were depressed, 9.5% anxious, and 9.5% apathetic.