Changes in the co-occurrence patterns of negative aging perceptions and psychosocial symptoms among older adults before, during, and after the pandemic

This study analyzed co-occurrence patterns of negative aging perceptions and psychosocial symptoms among adults aged 60 and older across stages of the pandemic using repeated cross-sectional Health and Retirement Study data (2018: n = 5688; 2020: n = 4587; 2022: n = 4377). Although cynical hostility, pessimism, and hopelessness were higher during the pandemic, overall symptom prevalence remained relatively stable, with stress and loneliness being the most common. Association rule mining showed that co-occurrence patterns were more prevalent, diverse, and complex during the pandemic and persisted afterward. Women exhibited consistently higher prevalence and greater complexity, with patterns more sensitive to pandemic stressors and primarily centered on depressive symptoms. Findings suggest lasting pandemic effects on older adults’ psychosocial well-being. Interventions should target persistent loneliness and stress and prioritize evolving symptom co-occurrence, particularly among older women.