Findings based on the Health and Retirement Survey show COVID-19’s economic and health impacts on aging population

Source: ICPSR Bibliography Team

Recent research based on data from the Health and Retirement Study (HRS) reveals the COVID-19 pandemic’s one-two punch to older Americans’ health and finances. Although COVID-19 may not be the cause of increased indebtedness and worsening health in the aging US population, it has exacerbated them both. For the past 20 years, the HRS has been a leading source of information on the changing health and economic circumstances of adults over age 50 in the United States. Produced at the University of Michigan, the core HRS is a biennial longitudinal panel study that surveys a representative sample of approximately 20,000 people in America. Respondents include those who were born into any of the seven cohort groups between 1998 and 2018. The HRS is well-suited for the examination of cohort patterns in health given the inclusion of additional cohorts of adults aged 51–56 every six years. It is supported by the National Institute on Aging (NIA U01AG009740) and the Social Security Administration.

To measure the impact of COVID-19 on this population, HRS investigators created new data resources. They added COVID-19-related questions to the 2020 core interview and to the psychosocial self-administered questionnaire, originally referred to as the 2020 HRS COVID-19 module. In addition, a new contextual data resource on state-level COVID-19 policies, including stay at home orders, closing of non-essential businesses, and school closures, as well as policies that aim to protect vulnerable populations from the wide range of health and economic consequences of the pandemic, has been added as part of the HRS restricted data products. A supplementary 2021 COVID-19 mailout survey, which contains questions on COVID-19 diagnoses, vaccinations, and everyday life during the pandemic, was fielded through August 2021.

Through its unique and in-depth interviews, the HRS provides an invaluable and growing body of multidisciplinary data that researchers can use to address important questions about the challenges and opportunities of aging. Thousands of studies based on HRS data have been published. What follows is a summary of a small sample of the most recent findings that address the general characteristics, health, and financial well-being of middle-aged and older adults during the COVID-19 pandemic.

General characteristics of the US elderly population during COVID-19

According to a recent New York Times article, rising debt may adversely affect older Americans’ health. At the same time, according to the U.S. News & World Report, seniors in the United States are more likely to have multimorbidity than their parents at the same age. The worsening physical and financial health of seniors provide context for the state of this age group at the outset of the pandemic which disproportionately affected older persons in the US and around the world.

At the start of the pandemic, the risk for death and severe illness with COVID-19 was best predicted by age. Crimmins (2020) notes that “one of the most shocking aspects of the COVID-19 pandemic is how lethal this condition is for the older population.” As displayed on Figure 1 in Crimmins’ article, the risk for death and severe illness with COVID-19 for those contracting the virus rose exponentially with age in all countries where this has been examined. For the five countries assessed around the beginning of June 2020—the US, South Korea, China, Italy and Spain—deaths (measured in the percent of dying among confirmed COVID-19 cases by age) increased sharply after age 50. In Figure 3, Crimmins cites HRS data collected in 2016 to show the growing burden of chronic disease in older American adults. This serves as an explanation for the heightened vulnerability to the virus in this group. However, there are several different aspects of race, ethnicity, and socioeconomic status that also influence the overall impact the COVID-19 pandemic had on the lives of older Americans.

Research using HRS COVID-19 data shows that age, race, and ethnicity intersect to influence Americans’ perceptions of COVID-19. According to Lin and Liu (2022)’s analysis, “Black and Hispanic Americans were more concerned about COVID-19 than their White peers, and were more likely to know someone who had died in summer 2020.” Their sample included 2,879 community-dwelling respondents (aged 50 and older) who were interviewed from June to September 2020. Among them were 1,744 Whites, 637 Blacks, and 498 Hispanics. To better understand the racial-ethnic differences in COVID-19 concerns, the authors tested the potential mediating roles of exposures to COVID-19 risks, preexisting health status, and socioeconomic resources. Based on their results, Black and Hispanic respondents were two or three times more likely to know someone who died of COVID-19. The socioeconomic indicators included in the analysis, such as education, household income, wealth, and healthcare access, couldn’t explain the racial-ethnic differences in COVID-19 concerns. The significantly higher levels of concern about the virus among Black and Hispanic older Americans were most likely the result of higher levels of exposure to COVID-19 in those minority groups, especially as they were more affected by deaths among loved ones.

In terms of health implications, the impact of the pandemic extends beyond the prospect of contacting the virus. Na (2022) describes how persons aged 50 and over were impacted by decreased access to healthcare and therefore delayed care. Na’s analysis of the Health and Retirement Study (HRS) 2020 Core Early Release data revealed differences between those who were classified as having impairments in activity of daily living (ADL or instrumental ADL, IADL) and those who were not. Na also looked at mediating factors such as socioeconomic status, self-rated health, and clinical diagnoses. Overall, those with ADL impairments reported worse self-rated health and circumstances related to the pandemic, including “greater loneliness, lower levels of perceived financial security, friend support, and personal control.” Even though the most frequently reported (by more than half of the respondents) cause of delay was the doctor’s office canceling or rescheduling the appointment, more impaired older adults delayed care due to financial difficulties and reasons different from scheduling issues. Those with IADL (or ADL) impairment also were more likely to be older, with lower socioeconomic status, poorer self-reported health, and multiple chronic issues. The concerns that more vulnerable populations had about contracting the virus were therefore further exacerbated by delaying care. This delay was a potential driver of additional fatalities in older Americans.

Researchers have also explored how the COVID-19 pandemic exposed older Americans to vulnerabilities—defined as inability to protect oneself from or cope with harm. Fu et al. (2022) assessed the differences in types, intensity, and modes of vulnerability as well as the emotional responses that middle-aged and older Americans gave when faced with them. There is considerable heterogeneity in older adults’ vulnerability, so the authors set out to examine the relationship between vulnerability types, aging attitudes, and emotional responses. The assessed types of vulnerability stemming from the pandemic centered around disease prevention, healthcare utilization, financial resilience, and housekeeping capability. Most respondents, 67 percent, were categorized as having mild vulnerability (MV), while 22 percent of respondents demonstrated healthcare use vulnerability (HV), and 11 percent had dual vulnerability in healthcare use and financial sustainment (DVs). Older adults younger than 65, Hispanics and non-Hispanic Blacks, and those not eligible for Medicaid were more likely to fall into the latter two groups. The relationship between vulnerability and positive emotions was not significant, but those in the more vulnerable groups were likely to have more negative emotions than their mildly vulnerable counterparts. Furthermore, aging attitudes moderated the relationship between vulnerability and emotions. The health-giving effect of positive aging attitudes on emotional well-being was more significant among people with dual vulnerability than those with mild vulnerability. Thus, the authors urge more attention for vulnerable older adults in a pandemic context, but they also noted that “encouraging positive aging attitudes might be helpful for older adults to have better emotional well-being, especially for those with DVs.”

Economic impact and workforce participation

Ankuda et al. (2021) show how material hardship and food insecurity impacted older adults in the US. The study sample reflects data available on November 12, 2020. In the HRS data, material hardship due to COVID-19 was defined to include “receiving money or help paying bills from family/friends; missing payments on rent or mortgage, credit cards or other debt, utilities, insurance, or medical bills; not having enough money to buy food; or other material hardship.” Food insecurity means either not having the money to buy food or not being able to buy food, despite the availability of financial resources. Ankuda et al. find that one in three older adults reported material hardship as a result of the COVID-19 pandemic, while racial minorities, socioeconomically disadvantaged people, and older adults in poorer health and with functional or cognitive impairments are at heightened risk for food insecurity. For example, those receiving food stamps reported higher levels of food insecurity, which the authors attribute to the limitations in using food stamps, especially in a very quickly changing context, where grocery stores shifted to online ordering and delivery. The authors also expressed concerns about the population living with dementia who are most likely underreported in the HRS data, but who are in dire need of targeted support.

Another analysis of HRS COVID-19 data, Choi, Carr, and Namkung (2022), shows older adults with disability were especially vulnerable to food insecurity during the pandemic. The authors look at vulnerability in three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, and income loss) and two types of perceived food insecurity (economic obstacles and logistical obstacles) from HRS data recorded during the early months of the COVID-19 pandemic. The respondents were categorized into four groups, ranging from having no limitations to experiencing three or more functional limitations. The most seriously impaired group was more likely to report food insecurity stemming both from economic and logistical obstacles, as well as from difficulty paying regular and medical bills since the start of the pandemic. Those who lost their jobs since the beginning of the pandemic experienced increased risk of economic insecurity but not food insecurity, which suggests that people prioritized food over paying bills during trying times. Relative to seniors with no limitations, after accounting for all socioeconomic, demographic and health characteristics, the two disparities that persisted for disabled seniors were missing regular bill payments and logistics-related food insecurity. The authors conclude that the efforts to help curb food insecurity for impaired older people should primarily focus on logistical as well as regular financial support.

Other researchers focused on the economic disparities brought on or exacerbated by COVID-19 across different racial and ethnic groups. Garcia, Thierry, and Pendergast (2022) use HRS data to show stark racial/ethnic inequalities in the COVID-19 pandemic’s economic impact among US older adults. The authors point out that “while disparities in coronavirus disease 2019 (COVID-19) infections and mortality have been documented for older Black and Latinx populations, pandemic-related economic impacts have been less studied for these groups.” They look at how the pandemic and subsequent economic recession affected the lives of older Black and Latinx adults, with a particular focus on the foreign-born population.

The economic factors included in their analysis are decreased household income and specific economic hardships detailed in the HRS questionnaire, such as “missed any regular payments on rent or mortgage, missed any regular payments on credit cards or other debt, missed any other regular payments such as utilities or insurance, could not pay medical bills, did not have enough money to buy food, or had trouble buying food even though had money.” Based on the authors’ analysis, after controlling for age, those experiencing the worst economic impact were US- and foreign-born older Latinx people, as they reported loss of household income in the greatest proportions. Older Black adults were the group which most often reported an increase in household expenditures. Foreign-born Latinx elderly were the most affected by food insecurity and inability to pay medical bills, while the US-born Latinx adults reported more missed payments on credit card or other debt and falling back on utilities and insurance.

The authors call for policies targeting the doubly disadvantaged Black and Latinx groups, who are disproportionately represented in high-risk, low-income occupations more vulnerable to the physical and economic effects of the pandemic. This analysis also presented evidence that foreign-born individuals had more hardship accessing the government benefits meant to ease the financial burden of the pandemic, such as those included in the CARES Act.

Choi, Harrell, and Watkins (2022) highlighted the impact of the pandemic on a subset of the population assessed by HRS, senior business owners. The authors investigated this group through the lens of racial/ethnic and gender disparities. They found that the COVID-19 pandemic has had a sweeping impact on US older entrepreneurs, affecting nearly 76 percent of the surveyed entrepreneurs, but pointing out that it has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs.

The authors note that the sectors most affected by social distancing restrictions employ a greater share of minority populations and women than the whole of the economy. They also point out that not only employees but also employers carry the burden of the economic downturn. Small businesses faced more difficulties obtaining funds from the Paycheck Protection Program, while greater disparities already existed between Black and White business owners’ access to business loans. The authors included business owners or partners over 51 years old from the HRS COVID-19 sample. Their findings highlight the disparities in the pandemic’s impact on employers. Compared to non-Hispanic White business owners, both non-Hispanic Black and Hispanic entrepreneurs had significantly higher odds of business closure, workers quitting, or problems paying regular bills. Women were also significantly more likely to close their businesses, but after adjusting for race/ethnicity, socioeconomic status, and health status, women entrepreneurs were not more likely to have payment problems or staffing issues than their male counterparts. The authors call for expanded access to financial services for racial/ethnic minorities and women.

As an early answer to the hardships highlighted in the articles above, the CARES Act was aimed at mitigating the adverse effects of the pandemic for American society. Sharma and Babiarz (2022) utilize HRS data in their forthcoming article to examine both older Americans’ overall spending behaviors and how they allocated the 2020 CARES stimulus payments in their finances.

Many Americans received stimulus checks and enhanced unemployment benefits starting in April 2020, thus the HRS COVID-19 module could also collect data on how this historic stimulus package impacted middle-aged and older Americans’ finances. Questions related to the income shock, spending, and stimulus use were all included in the questionnaire. Sharma and Babiarz report that 40 percent of respondents who received the stimulus used it to pay off debt, 32 percent reported saving it, 16 percent spent it, and 12 percent gave it away to family or charities, or used it for other purposes. The income shock could be positive or negative for a given respondent. Those who were negatively impacted reduced their spending and used the stimulus checks to counter the effects of lost income by either spending it or paying off debt. Those who experienced positive shock didn’t change their spending habits.

Mental health and social isolation

The articles summarized above paint a detailed picture of the burdens of the pandemic on the physical and financial health of middle-aged and older Americans. Social isolation appeared as a factor in the previous sections on general vulnerability and economic perspectives of COVID-19’s effects. Isolation hinders access to food and other necessities. Mental health emerged as another important aspect of social isolation in the literature on older Americans during the pandemic.

Longitudinal HRS data allows for a comparison of social isolation in the studied population before and after the onset of the pandemic. Peng and Roth (2022) used this advantage of the data to assess the potential impact of social distancing policies during the COVID-19 pandemic on social isolation and loneliness. They examined changes in social isolation, physical isolation, digital isolation, and loneliness in US adults over 50 before and during the lockdown. They looked at within-person change between two waves of HRS data collection, from 2016 to 2020, to examine the impact of social distancing policies during the pandemic. In general, they found that levels of social isolation, loneliness, and digital isolation didn’t increase between the two time points, only physical isolation did. Their results indicate that many adults aged 50 and older remained resilient in the face of social isolation policies and are able to use digital means of socializing. However, those who report greater COVID-19 concerns are significantly more vulnerable to experiencing loneliness.

Curl and Wolf (2022) examine the relationship between the COVID-19 pandemic and increased depressive symptoms and loneliness in middle-aged and older adults, using the Protection Motivation Theory Framework. This framework established factors that determine the engagement in protective behaviors in the face of threats: the degree of potential harmfulness, the likelihood of the event happening, and the efficacy of a protective response. The authors used HRS data collected between March 2020 and May 2021. Their findings only partially support the proposed theoretical framework. However, they highlight the importance of coping strategies in protecting from depression: those who perceived more control over their health and social life had fewer depressive symptoms. On the other hand, those at higher risk for COVID-19 complications or death and those reporting higher overall concern about COVID-19 were at higher risk of mental health issues. In their analysis, knowing someone who died from COVID-19 did not have significant direct effects on depression.

Curl and Wolf found positive correlations between loneliness and depressive symptoms. Younger, single, and lower-educated respondents were more prone to experiencing increased feelings of depression and loneliness. Curt and Wolf assume that middle-aged adults had busier social lives and more interactions before the pandemic, while the seniors already experienced more isolation before the pandemic. The authors recommend that mental health assessments should consider the impact of the pandemic and include measures specifically asking about COVID-19 concerns and experiences.

Apart from physical health, finances also played a very important role in affecting middle-aged and older adults’ mental health. Liu, Zhang, and Chatterjee (2021) focus on pre-retirees and the association between depression and financial hardship in 2020. The younger participants of HRS, between ages 50 and 65, were included in their analysis because they were in an especially precarious position at the start of the pandemic and few studies addressed their financial and mental well-being.

The authors found that financial hardship was positively associated with experiencing depression, but only 12 percent of the sample reported depressive symptoms. Those who were wealthier and had better health were less likely to be depressed. Most respondents who received stimulus payments reported intentions to either save (30 percent) or pay off debt (45 percent). There were marked differences between spending patterns based on racial minority and socioeconomic status. African American households were less likely to increase spending, Hispanic households were more likely to increase savings, and households with lower educational attainment were more likely to pay down debt using their stimulus money. Similarly to Sharma and Babiarz, this article also highlighted the importance of stimulus checks in easing the debt of older Americans, but with the addition of the positive effect of financial assistance on mental well-being.

While many adults could adapt to the changing circumstances and the increased online presence of social life during the pandemic, concerns about the virus and poor mental health might have prohibited some people from more actively participating in social life and even avoiding essential visits to the doctor’s office. Li et al. (2022) show the implications for isolated, lonely elderly populations who are more likely to delay accessing health care. From their analysis of HRS data collected in June 2020, it also becomes clear that those who had higher levels of COVID-19 concerns were more likely to withdraw from or delay care. It was also found that those younger than 65 and with college or higher education were more likely to delay seeking care. But several other factors seem to predispose older adults to delay care, such as having emotional/psychiatric problems, any ADL limitation, more depressive symptoms, or elevated anxiety. The lonelier the adults were, the more likely they were to answer “Decided it could wait,” “Was afraid to go,” and “Couldn’t afford it” as reasons for delayed care. The authors’ most concerning finding is that loneliness in older adults is associated with a 60 percent increase in odds of delay or avoidance of care. Poor physical and mental health can be factors in increased social isolation among the elderly, putting them at higher risk for unmet needs and adverse health outcomes.

Conclusion

For the aging population in the US, the lethal nature of the COVID-19 virus has lessened since the first years of the pandemic, due to the development and dissemination of effective vaccines. But as the HRS continues to collect data, more of the pandemic’s short- and long-term impacts will be revealed. As much of the current literature analyzing HRS data indicates, older Americans’ mental health and financial well-being changed drastically in the past three years. Vulnerable older Americans benefited greatly from legislation like the CARES Act, and in general, many researchers concluded that older Americans, who are from varying socioeconomic backgrounds and levels of ableness, also would benefit from targeted interventions to ensure they remain healthy and do not suffer worse impacts.

Reviewed articles

  1. Crimmins, E. M. (2020). Age-related vulnerability to coronavirus disease 2019 (COVID-19): biological, contextual, and policy-related factors. Public Policy & Aging Report, 30(4), 142-146. https://doi.org/10.1093/ppar/praa023
  2. Lin, Z., & Liu, H. (2022). A national study of racial–ethnic differences in COVID-19 concerns among older Americans: Evidence from the Health and Retirement Study. The Journals of Gerontology: Series B, 77(7), e134–e141. https://doi.org/10.1093/geronb/gbab171
  3. Na, L. (2022). Characteristics of community-dwelling older individuals who delayed care during the COVID-19 pandemic. Archives of Gerontology and Geriatrics, 101, 104710. https://doi.org/10.1016/j.archger.2022.104710
  4. Fu, M., Guo, J., Chen, X., & Zhang, Q. (2021). American older adults in COVID-19 Times: Vulnerability types, aging attitudes and emotional responses. Frontiers in Public Health, 2398. https://doi.org/10.3389/fpubh.2021.778084
  5. Ankuda, C. K., Fogel, J., Kelley, A. S., & Byhoff, E. (2021). Patterns of material hardship and food insecurity among older adults during the COVID-19 pandemic. Journal of General Internal Medicine, 36(11), 3639-3641. https://doi.org/10.1007/s11606-021-06905-3
  6. Choi, S. L., Carr, D., & Namkung, E. H. (2022). Physical disability and older adults’ perceived food and economic insecurity during the COVID-19 pandemic. The Journals of Gerontology: Series B, 77(7), e123–e133. https://doi.org/10.1093/geronb/gbab162
  7. Garcia, M., Thierry, Amy D., & Pendergrast, C. (2022) The devastating economic impact of COVID-19 on older Black and Latinx adults: Implications for health and well-being. Journals of Gerontology, Series B, 77(8), 1501–1507. https://doi.org/10.1093/geronb/gbab218
  8. Choi, S., Harrell, E., & Watkins, K. (2022) The impact of the COVID-19 pandemic on business ownership across racial/ethnic groups and gender. Journal of Economics, Race, and Policy, forthcoming. https://doi.org/10.1007/s41996-022-00102-y
  9. Sharma, M., & Babiarz, P. (2022) Spending behavior and stimulus transfer use in response to income shocks among older Americans: evidence from the COVID-19 pandemic. Applied Economics Letters, forthcoming. https://doi.org/10.1080/13504851.2022.2078774
  10. Peng, S., & Roth, A.R. (2022) Social isolation and loneliness before and during the COVID-19 pandemic: a longitudinal study of US Adults over 50. The Journals of Gerontology: Series B, 77(7),  e185–e190. http://doi.org/10.1093/geronb/gbab068
  11. Curl, A., & Wolf, K. (2022) The impact of COVID-19 on depressive symptoms and loneliness for middle-aged and older adults. Sustainability, 14(10), 6316. https://doi.org/10.3390/su14106316
  12. Liu, Y., Zhang, Y., & Chatterjee, S. (2021) Financial hardship and depression experienced by pre-retirees during the COVID-19 pandemic: the mitigating role of stimulus payments. Applied Economics Letters, forthcoming. https://doi.org/10.1080/13504851.2021.1989364
  13. Li, Y., Cheng, Z., Cai, X., Holloway, M., Maeng, D., & Simning, A. (2022). Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. International Journal of Geriatric Psychiatry, 37(3). https://doi.org/10.1002/gps.5694