Worries, Attitudes, and Mental Health of Older Adults During the COVID-19 Pandemic

Canadian and U.S. Perspectives

Christina Reppas-Rindlisbacher MD; Jessica M. Finlay PhD; Alyson L. Mahar PhD; Shailee Siddhpuria BSc; Julie Hallet MD MSc; Paula A. Rochon MD MPH; Lindsay C. Kobayashi PhD


J Am Geriatr Soc. 2021;69(5):1147-1154. 

In This Article

Abstract and Introduction


Background/Objectives: Differences in older adults' worry, attitudes, and mental health between high-income countries with diverging pandemic responses are largely unknown. We compared COVID-19 worry, attitudes towards governmental responses, and self-reported mental health symptoms among adults aged ≥55 in the United States and Canada early in the COVID-19 pandemic.

Design: Online cross-sectional survey administered between April 2nd and May 31st in the United States and between May 1st and June 30th, 2020 in Canada.

Setting: Nationally in the United States and Canada.

Participants: Convenience sample of older adults aged ≥55.

Measurements: Likert-type scales measured COVID-19 worry and attitudes towards government support. Three standardized scales assessed mental health symptoms: the eight-item Center for Epidemiological Studies Depression Scale, the five-item Beck Anxiety Inventory, and the three-item UCLA loneliness scale.

Results: There were 4453 U.S. respondents (71.7% women; mean age 67.5) and 1549 Canadian (67.6% women; mean age 69.3). More U.S. respondents (71%) were moderately or extremely worried about the pandemic, compared to 52% in Canada. Just 20% of U.S. respondents agreed or strongly agreed that the federal government cared about older adults in their COVID-19 pandemic response, compared to nearly two-thirds of Canadians (63%). U.S. respondents were more likely to report elevated depressive and anxiety symptoms compared to Canadians; 34.2% (32.8–35.6) versus 25.6% (23.3–27.8) for depressive and 30.8% (29.5–32.2) versus 23.7% (21.6–25.9) for anxiety symptoms. The proportion of United States and Canadian respondents who reported loneliness was similar. A greater proportion of women compared to men reported symptoms of depression and anxiety across all age groups in both countries.

Conclusion: U.S. older adults felt less supported by their federal government and had elevated depressive and anxiety symptoms compared to older adults in Canada during early months of the COVID-19 pandemic. Public health messaging from governments should be clear, consistent, and incorporate support for mental health.


Older adults are a high-risk group for severe morbidity and mortality from Coronavirus disease 2019 (COVID-19),[1] but the emotional harms associated with the pandemic are largely unknown for this population.[2] Many countries have implemented physical distancing and shelter-in-place orders, often with specific emphasis on older adults.[3] While evidence from the 2003 Severe Acute Respiratory Syndrome (SARS) pandemic indicated negative mental health effects of quarantine and isolation, there remains a paucity of data on the mental health of older adults during infectious disease pandemics.[4–6] The World Health Organization has emphasized that older adults may become more anxious during the COVID-19 pandemic, due to their greater need for physical isolation.[7] Indeed, older adults in the United States reported worsened loneliness during shelter-in-place orders.[8] These findings highlight the urgency to study the mental health impact of COVID-19 among older adults so that adverse outcomes can be anticipated and minimized by clinicians, health systems and communities.

While nationally representative pre-pandemic data has identified negligible differences in prevalence of mental health diagnoses and depressive symptomology in the United States and Canada,[9,10] the mental health experiences and COVID-19 concerns of older adults in the US and Canada are unknown. These two neighboring countries had vastly different epidemic curves and governmental responses, public health messaging, and social norms about transmission control in the early months of the pandemic.[11,12] Worry about support from or lack of confidence in government during significant societal events such as the COVID-19 pandemic may negatively impact the mental health of older adults.[13] Assessing the relationships of the societal climate and governmental responses with mental health status of older adults in these two countries could have important public policy implications, especially as COVID-19 cases remain relatively low in Canada compared to surges in the United States at the time of writing.[14,15]

We aimed to compare levels of COVID-19-related worry, attitudes towards governmental response, and self-reported mental health symptoms during the early months of the COVID-19 pandemic among older men and women in the United States and Canada. We hypothesized that US respondents, particularly women, would experience worse mental health, greater COVID-19 worry, and feel less supported by their government compared to their Canadian counterparts.