Understanding the indirect impact of COVID-19 on older adults’ mental health and well-being. A systematic review and multi-level meta-analysis

Aim To synthesise longitudinal, within-person evidence on the impact of the COVID-19 pandemic on the mental health and psychological well-being of community-dwelling older adults, and to examine demographic, methodological, and country-level moderators of change. Methods Following a registered protocol and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched the World Health Organization (WHO) COVID-19 Research Database, which aggregates 24 electronic databases, for longitudinal studies assessing community-dwelling adults with a mean age of 60 years or above before and after March 2020. Seventy-five studies met inclusion criteria. Standardised mean differences (SMDs) were pooled using multilevel random-effects meta-analysis with robust variance estimation. Results The pandemic was associated with small but significant increases in depression (SMD = 0.23; 95% CI [0.09–0.36]; k = 31), anxiety (SMD = 0.24; 95% CI [0.03–0.45]; k = 22), and stress (SMD = 0.22; 95% CI [0.08–0.37]; k = 5), and a larger increase in loneliness (SMD = 0.40; 95% CI [0.10–0.69]; k = 20). Moderator analyses suggested greater deterioration among adults over 75 and outside Europe, without reaching significance. Conclusion The pandemic produced small but reliable declines in older adults’ mental health and a marked increase in loneliness, while resilience and social activity remained stable. These estimates capture the psychological cost of enforced social disconnection in later life, conditions that recur in epidemics, disasters, and other emergencies. As populations age and such events grow more frequent, these findings offer an enduring evidence base for protecting social connection in crisis responses.