Mental health and social interactions of older people with physical disabilities in England during the COVID-19 pandemic: a longitudinal cohort study

Abstract

Background The COVID-19 pandemic has affected mental health, psychological wellbeing, and social interactions. People with physical disabilities might be particularly likely to be negatively affected, but evidence is scarce. Our aim was to evaluate the emotional and social experience of older people with physical disabilities during the early months of the COVID-19 pandemic in England.Methods In this longitudinal cohort study, we analysed data from the English Longitudinal Study of Ageing collected in 2018-19 and June-July, 2020, from participants aged 52 years and older and living in England. Physical disability was defined as impairment in basic and instrumental activities of daily living (ADL) and impaired mobility. Depression, anxiety, loneliness, quality of life, sleep quality, and amount of real-time and written social contact were assessed online or by computer-assisted telephone interviews. Comparisons of experiences during the COVID-19 pandemic of people with and without a physical disability were adjusted statistically for pre-pandemic outcome measures, age, sex, wealth, ethnicity, presence of a spouse or partner, number of people in the household, and chronic pain. All participants with full data available for both surveys were included in the analyses. FindingsBetween June 3 and July 26, 2020, 5820 participants responded, 4887 of whom had full data available for both the pre-pandemic measures and the COVID-19 survey and were included in the analysis. During the COVID-19 pandemic, significantly more people with ADL impairment had clinically significant symptoms of depression (odds ratio 1•78 [95% CI 1•44-2•19]; p<0•0001), anxiety (2•23 [1•72-2•89]; p<0•0001), and loneliness (1•52 [1•26-1•84]; p<0•0001) than people without ADL impairment. Significantly more people with ADL impairment also had impaired sleep quality (1•44 [1•20-1•72]; p<0•0001) and poor quality of life than people without ADL impairment. The results were similar when disability was defined by impaired mobility. People with ADL impairment had less frequent realtime contact (0•70 [0•55-0•89]; p=0•0037) and written social contact (0•54 [0•45-0•64]; p<0•0001) with family than people without ADL impairment. Results for social contact were similar when disability was defined by impaired mobility.Interpretation People with physical disability might be at particular risk for emotional distress, poor quality of life, and low wellbeing during the COVID-19 pandemic, highlighting the need for additional support and targeted mental health services.

Disability among Older People: Analysis of Data from Disability Surveys in Six Low- and Middle-Income Countries

“…However, there are a number of findings that deserve consideration in terms of their implications in the context of the ongoing pandemic. Our findings support increasing evidence that older people with disabilities are particularly vulnerable during the COVID-19 pandemic, both in terms of risk of morbidity and mortality and also to suffering adverse effects of control measures [ 14 , 30 ]. First, disability increases with age, as does morbidity and mortality risk from COVID-19.…”

“…Older people with disabilities also reported more participation restriction in all major life areas due to multiple different environmental barriers; this may both limit engagement in COVID-19 response activities and increase the risk of isolation related to pandemic control measures. Together, these findings highlighth that older people with disabilities are likely to be particularly vulnerable to mortality from COVID-19 and to suffer economically during and after the pandemic [ 14 , 30 ]. Consequently, there needs to be a particular focus on older people with disabilities in the ongoing COVID-19 pandemic response.…”

Are older people with disabilities neglected in the COVID-19 pandemic?

“…In the ELSA study, people with physical disabilities were more likely to have received instructions to shield during the pandemic, and even without official instruction, might have decided to be cautious, realising that they faced increased risk. As a result, social contacts will have been reduced more among people with disabilities than among people without disabilities, as Steptoe and Di Gessa show, 3 and shielding did in part explain the effects on loneliness among people with disabilities.…”

“…Most local authorities did not abandon their care obligations; however, qualitative evidence shows that many people with disabilities in the UK had problems with social care during the pandemic. 8 What is striking, as Steptoe and Di Gessa note, 3 is the scarcity of research focusing on people with physical disabilities in the pandemic, also highlighted in a recent www.thelancet.com/public-health Published online April 21, 2021 https://doi.org/10.1016/S2468-2667(21)00077-3 systematic review. 5 There has been little consideration of the social and emotional impact of the COVID-19 pandemic for people with disabilities, and little assessment of COVID-19 risks themselves.…”

“…The ELSA study showed that people with mobility impairments were more than 5 times more likely to be admitted to hospital for COVID-19, although the absolute number of people in the study admitted to hospital was small. 3 Few other data are available on the risk of COVID-19 adverse outcomes among people with physical dis abilities. 9 What we don't value as a society, we don't count, and so these effects remain concealed.…”