A comparative study on mental health and adaptability between older and younger adults during the COVID-19 circuit breaker in Singapore

The Singapore government implemented a partial lockdown, termed locally as ‘circuit breaker’ (CB), from 7 April to 1 June 2020 to curb growing community transmission of the COVID-19 (SARS-CoV-2) virus. The aim was to enforce social distancing measures by reducing movements and interactions in public and private places [1]. The CB measures entailed closing of all non-essential workplaces, schools, recreational venues, tourist attractions and places of worship. Essential services, such as healthcare and grocery stores, remained open to support the daily needs of the people while food establishments were only allowed to offer take-way or home delivery food. A work-from-home and telecommuting policy was also implemented at the same time. Safe distancing measures also included restrictions on the numbers of friends and family members not living together who were allowed for gatherings.

During the early stages of Singapore’s CB, there were concerns that various measures to restrict movements had taken a toll on the mental health of older adults [2]. These measures particularly affected older adults who, not only had challenges keeping up with the rapidly changing safe distancing rules but also, were less able to utilise digital platforms to meet their daily needs such as purchasing essential goods, accessing services, seeking entertainment and socialising [3]. Concerns were raised about whether older adults were less adaptable, and their mental health more adversely affected than the younger groups, during the CB period.

Previous studies indicated that older age is linked with greater emotional well-being and decreased reactivity in the face of stressors [4]. However, at the inception of this study in June 2020, there was limited data showing that age advantages in emotional well-being are maintained in the wake of the COVID-19 pandemic. Theoretical accounts on aging suggested that older adults were more adept at coping with crises through the accumulation of life experiences that build up their coping skills [5, 6]. Findings from a systematic review support such accounts and positive reappraisal, a form of coping strategy, was used more frequently by older adults compared to their younger counterparts with wide-ranging benefits on mental health [7]. Likewise, as a likely consequence of accrued social experience [8, 9], age has also been associated with better emotional regulation [10‐13].

Despite the known advantages of age in emotional experience, the strength and vulnerability integration (SAVI) model posits that such age-related advantages will be attenuated when older adults are faced with inescapable negative situations [14]. According to this model, the restrictions imposed by safe distancing measures and the digital divide faced by older adults for prolonged periods of time, as in the context of the CB in Singapore, could therefore potentially attenuate any age advantages. Given the magnitude of the pandemic and concerns over potential mental health issues in older adults [15‐18], it was of practical importance to examine relevant age-related attitudes and perceptions of the CB period, including the ability to conduct essential activities, use of the various digital platforms, preoccupation with stress concerns, adaptability to the stressors, availability of social support and views on health status.

Furthermore, there has been particular interest on the role of adaptability as it has been considered as a key mental resource that facilitates positive outcomes especially in a rapidly changing environment such as the present pandemic where individuals are subjected to conditions of social and physical restrictions [19]. Adaptability has been defined as “the capacity to make appropriate responses to changed or changing situations; the ability to modify or adjust one’s behaviour in meeting different circumstances” [20]. Being able to adapt successfully is important as one can plausibly recover more quickly from environmental stressors.

The primary aim of this study was to assess and compare the mental health of older and younger adults in Singapore during the CB period and determine if known age advantages would be attenuated in the context of CB. The secondary aims were to examine differences in adaptive behaviours, social support, perceived stress concerns, health status, digital media usage and change in circumstances between the two groups and the relationship between these measures and mental health. Beyond examining differences in adaptability, this study also explored if adaptability influences the postulated age effects on mental health.

This study was conceived when there were concerns that the well-being of older adults would be adversely affected during the unprecedented COVID-19 pandemic. In the context of strict movement restrictions, social isolation and safe distancing measures, the present findings suggest that age advantages in emotional experiences were maintained in community-dwelling older adults. Compared to their younger counterparts, older adults reported significantly lower levels of depression, anxiety, and stress in addition to significantly lower stress concerns. Age advantages persisted despite older adults being less able to run essential activities or leverage on digital resources during the CB period. Auxiliary analyses showed that age advantages persisted and predicted lower odds of experiencing depression, anxiety and stress even after adjusting for significant predictors such as adaptability and health status.

Regulation of emotional well-being has been purported to improve with age [26] but such advantages according to the SAVI model would diminish under inescapable negative situations [14]. This study did not find evidence that age advantages had diminished as a consequence of the restrictions imposed by the CB measures. In line with other recent studies, the association between age and mental health persisted during the pandemic [26‐30].

Given the excess mortality risk of older adults [31] and tight restrictions imposed to curb the spread of COVID-19, it has been proposed that the risk of poorer mental health would be higher for older adults [32]. This risk is further compounded by the ‘digital divide’. Although this study found evidence that older adults were less able to run essential activities such as using online platforms to obtain their daily necessities or to keep up to date on the changing government’s measures and regulations related to COVID-19, it was noteworthy that older adults continued to fare better than younger adults in terms of mental health.

The auxiliary analyses conducted in this study further supports the position that age effects on mental health persist as this was found to be the case even after adjusting for other predictive variables. The findings on younger adults, which corroborated with other studies, showed that this group reported greater degree of change to their lives due to the imposed restrictive measures [33] and were less effective in coping with stressors during the pandemic [4, 34]. These observed age advantages could plausibly be explained by improved emotion regulation, which was postulated to arise from shifts in motivation and goals as an individual’s perspective of time changes [35]. Hence, older adults may potentially be less reactive to stressors as compared to younger adults [36]. Another plausible explanation could be due to compounded effects of additional stressors common to the life stage of younger adults [33]. The mean age of younger adults in this study is within the “sandwich generation” and hence it is common for these adults in Singapore to care for two generations in the family and in the context of lockdown measures in the pandemic, this would have arguably caused greater stress. As shown in this study, stressors related to finance, emotions and routines were starkly higher than older adults. Additionally, the implementation of CB measures severely disrupted several aspects of the younger adult’s lifestyle including work environment, leisure pursuits and social activities. It was also possible that younger adults had more concerns and responsibilities such as in building their careers, on top of raising a family and supporting their senior parents. In contrast, the lifestyle of older adults remained little changed and more stable, especially for many of the older adults in this study who were retired. Although a recent study suggested that spirituality and religiosity was higher in older adults and could be a protective factor during the pandemic [37], this study did not include measures that delved deeper into these domains. Group differences in religious affiliation in this study however were not found to be significant. Future study could examine in greater detail the effects of religiosity especially in a multi-cultural and multi-religious society such as Singapore.

As the pandemic has strengthened perspectives of older adults as being highly vulnerable [38], findings from this study suggest that this may not be accurate considering how older adults appeared relatively more resilient in their mental health and they continued to be able to adapt psycho-socially. Well-intended public communications aimed at protecting the health of older adults should be mindful of painting an overtly homogenous picture of older adults as being vulnerable requiring help and assistance [39]. This is important given that pandemic messaging can excessively shape the perception of vulnerability for healthy community dwelling older adults causing undue emotional responses that can impact their everyday lives [18, 40, 41]. Beyond the call for better calibration of pandemic messaging for older adults, policy makers should also focus attention on younger adults. Indeed, findings from this study, in line with others, highlighted the importance of tailoring messaging to support younger adults considering how the odds of experiencing adverse mental health (i.e., depression, stress and anxiety) was higher for them.

While the present findings were in line with recent studies [27‐30], which showed that the well-being of older adults persisted during the pandemic, this study sampled only cognitively healthy community-dwelling older adults and, therefore findings may not be generalizable to other groups of such as those living in care facilities or those facing existing mental health issues such as the very frail or suffering from cognitive or sensory impairments [42‐45]. There was also the possibility that age advantages were maintained because conditions imposed by partial lockdown measures may not have created the kind of high arousal state specified by the SAVI model that would impact the mental health of older adults. Nonetheless, this study included a measure showing that older adults reported stress levels worsening compared to 6 months before the pandemic (M = 3.06, see Table 2), hence suggesting that mental health was affected. Future research planning to model after the methodology of this study should consider including holistic measures that would be able to capture intra-individual changes in depression and anxiety.

An important finding of this study was the role of adaptability in maintaining mental well-being during the CB period. It was demonstrated that at all levels of age, those with low adaptability reported higher levels of stress and depression compared to those with high adaptability. This was the case even for older adults although low adaptability was shown to have stronger effects on stress and depression especially for younger adults. These findings suggest that policy makers can consider providing resources to help adults low in adaptability to adjust to stressful circumstances as this may build resilience. In the context of the pandemic, findings from this study suggest helping adults to adjust in some specific domains may be beneficial to their psycho-social well-being. These include (i) social activities (ii) fitness routines, (iii) spending of leisure time (iv) starting new activity to keep oneself occupied and (v) attend to activities important for one’s welfare. As this study did not examine how some adults are more adaptable than others, future research can consider investigating the reasons this is the case in the context of a pandemic since this would further inform policy making.

As the measure of adaptability was developed out of the practical need to understand how locals in Singapore adapt to the various domains, internal validity of the measure needs further testing although Cronbach Alpha was found to be good. Beyond recommending this, future research could also consider studying the effects of adaptability on mental well-being during a pandemic using other dimensions that may not have been captured in this study.

The methodological strength of the present study is the use of door-to-door surveys to reach out to community-dwelling older adults during an on-going pandemic. This approach ensures that views from adults who do not have access to digital resources are represented and add to the literature by complementing findings from other studies using different approaches (e.g., self-administered online, telephone). Moreover, interviewer administered questionnaires allowed for more accurate screening and higher quality of responses from participants. Finally, the cross-sectional survey design was appropriate considering how all adults went through the pandemic and collectively experienced the lived reality of the CB measures. The sampling approach and the use of a nationally representative sample therefore allowed inferences to be made to the wider population that other methods will find it challenging to achieve during the pandemic. This is critical for informing public policy Nevertheless, it is important to acknowledge the limitations of this study beyond the possible bias sample as already raised. Due to its cross-sectional nature, our study was not able to determine the temporality of the findings. Future longitudinal studies are warranted to examine intra-individual changes in well-being as a pandemic evolves over a longer period of time. In addition, all measures of this study were collected from participants’ retrospective recollection of past events. Although findings on age advantages on the whole mirror existing studies, this study cannot conclusively rule out the possibility that responses may be subjected to recall bias.

The present study has provided insight on the mental health status of the older and younger adults in Singapore during the CB period. Our results indicated that older adults had better mental health, perceived less stress concerns and were more adaptable psycho-socially as compared to younger adults. This study helps healthcare policymakers and decision-makers better understand age-related differences of the impact of COVID-19 on mental health and wellbeing as well as inform and guide the former in formulating intervention strategies that address the multidimensional character of this pandemic, which is a crisis of monumental proportions.