**6. Older people and COVID-19**

During the COVID-19 pandemic, older adults have been considered a high-risk group. As such, they became a focus of government guidelines and regulations concerning their day-to-day living, which has undoubtedly impacted significantly on their quality of life. Although COVID-19 is a physical health crisis, within it lies the core precipitating factors for a mental health crisis [34]. It has been suggested that the measures taken by government in relation to social distancing and isolation or 'cocooning', especially targeting groups at risk including older adults, can result in social isolation and indeed loneliness. The latter variables are known to decrease psychological well-being and increase the risk for depression and cognitive dysfunction [35].

COVID-19 has disproportionately affected older people all over the world with utterly devastating consequences. An analysis of confirmed deaths by the Central Statistics Office in Ireland has shown that COVID-19 has had the greatest impact on people aged 65 or over. This age group accounted for almost 92% of confirmed deaths between 11th March to 15th May 2020, while similar trends have been observed in other countries.

#### *Perspective Chapter: Fallout from the Pandemic – A Social and Psychological Description… DOI: http://dx.doi.org/10.5772/intechopen.101499*

People aged 70 and over were instructed to stay indoors, avoid all social visits from friends and family, and largely avoid outdoor exercise – activities that are vital to everyday routine and indeed quality of life. Social interaction, physical activity and behavioural activation are heavily encouraged for older people to ensure psychological and physical well-being and suddenly this was curtailed in many societies with no knowledge or certainty of time frame as to when these restrictions would be lifted and a sense of normality could return. Older adults with regular social interaction demonstrate greater psychological well-being and life satisfaction [35]. The pandemic robbed older adults of this opportunity and, consequently, perpetuated the loneliness and social isolation which older adults often experience and feel.

Socioemotional selectivity theory, a life-span theory of motivation which maintains that age differences in goals results from shrinking time horizons, is an area of interest when considering the importance of social connections in older adults. It proposes that older adults use their social network as a buffer against negative experiences [36]. Earlier in life, physical and mental health are strongly interconnected; however, as we age this association is weakened [36]. As physical health declines, subjective well-being is maintained which may be conceived as 'a paradox of aging'. Older adults place emphasis on emotional well-being and their relationships as a maintaining factor in this.

Not only does meaningful social interaction affect emotional and mental well-being, it impacts on physical health and a lack thereof can precipitate a decline in emotional, mental and physical well-being. Psychologists, sociologists, and epidemiologists have contributed significantly to our understanding of how social processes influence physiological processes, going some way towards explaining the link between social interaction and health. Supportive interactions with other individuals benefit immune, endocrine, and cardiovascular functions and reduce allostatic load, which essentially reflects stress on the body due to chronically overstimulated physiological systems engaged in stress responses [36].

Though necessary and understandable, the restrictions and social isolation enforced on vulnerable at-risk groups such as older adults, may further enhance their vulnerabilities by removing their social connections and their associated benefits. Social connections foster cumulative advantages for older adults over time. The direct impact of COVID-19 and the high mortality rate due to physical illness and complications is apparent but what will be the secondary impact on both physical and mental health? This a serious public health concern.

It is easy to presume that as adults age and they experience bereavements, they become somewhat accustomed to it due possibly to habituation and the expectation that we will continue to experience bereavements as we age. However, research has demonstrated that this is not the case [37]. The grieving process of the elderly is not inherently different to that of any other age group and elderly people will require the type of support and assistance afforded to younger persons during times of grieving. Grieving experiences of the elderly is rarely discussed and explored and this is an emerging area of interest [38]. It is, as yet, unclear what the long-term effects of COVID-related bereavements will be on the older generation, the group who likely experienced the greatest number of COVIDrelated bereavements.

As a group, older adults have been the victims of the majority of deaths due to COVID-19, while also enduring the strictest restrictions vis-à-vis enforced social Isolation. Recent evidence demonstrates the overall death rate from covid-19 has been estimated at 0.66%, rising sharply to 7.8% in people aged over 80 and declining to 0.0016% in children aged 9 and under [39]. Older adults know that they are more vulnerable to death and disability due to COVID-19 than their younger counterparts and that the treatments for COVID-19 are currently rather limited [40].

Older adults have lost loved ones and have not been afforded the opportunity to grieve with support. Moreover, older adults experience anticipatory anxiety and fear of contracting COVID-19 as through public messaging they are all too aware of the possible eventualities should they contract the virus. This anxiety related to fear of death was termed thanatophobia by Sigmund Freud in 1915 in his seminal essays titled: *Thoughts for the Time on War and Death*. Freud believed this to be related to one's unconscious belief in one's own immortality. Death anxiety is a universal and inherent phenomenon, which affects all humans to varying degrees. For the elderly, their fears are based in the actual process of dying and how they will experience dying, rather than death itself where there is thought to be some level of acceptance as regards the transience of life and the inevitability of death [38] This fear is enhanced by COVID-19 as the illness trajectory of the virus is uncertain and unpredictable, with some individuals recovering after a mild illness and others losing their lives rather suddenly after contracting the virus.

On a practical level, this pandemic has upset the lives of older adults in immeasurable ways, given their reliance on external supports. Due to physiological effects of ageing, worsening mobility and the presence of chronic illnesses, many older adults rely on home help, carers and community services for their activities of daily living [41]. Many such services were either reduced or suspended during the peaks of the pandemic. These support services experienced new, substantial challenges in order to maintain services while keeping clients and aides safe from COVID-19 [42]. This disproportionately affects elderly individuals, whose sole social contact may be outside of the home, such as day care venues, community centres, and places of worship. Those who lack close family or friends, and rely on the support of voluntary services or social care, were placed at additional risk of social isolation, as these people may already be lonely, isolated, or secluded. Unfortunately, older adults are anecdotally less accustomed to and involved in the online world of social media and communications. Older adults have experienced difficulties with telecommunications; telephone interaction has not been favourable given the hearing impairment of some older and challenges in engaging individuals and building rapport [43]. Online technologies and resources could be harnessed to provide social support networks and promote future inclusivity for older adults [44].

The traumatic effects of COVID 19 on older adults have been acute, chronic and considerably complex. Older people are the age cohort most at risk of severe physical illness and death. They have been faced with the trauma of death and dying, including vicarious trauma experienced due to the death of their loved ones. They have been under the most severe of restrictions, while services and supports on which they heavily rely have been reduced and suspended.

At the outset of this pandemic, older people and those with pre-established medical conditions were felt to be the most vulnerable to infection with COVID-19. Communal care settings were especially blighted with high disease and mortality rates. The physical and psychological deconditioning and disengagement due to the pandemic and its associated fear will be hard to counteract in this age group. Older people have the least available time of any to recover despite their inherent resilience and life experience. The needs of older adults, and the consequences if these needs are not met, should be strongly considered in public health recommendations and service provision. The negative psychological and social aftermath of the COVID-19 pandemic is playing out and will continually unfold and older people may once again be over-represented in terms of its' detrimental impact.

*Perspective Chapter: Fallout from the Pandemic – A Social and Psychological Description… DOI: http://dx.doi.org/10.5772/intechopen.101499*
