Older people were disproportionately affected by the emergence and spread of COVID-19, whether in hospital, the community or in care homes. Just taking the period from January to December 2020, 72,178 people died 60 days after testing positive for COVID-19 or with it mentioned on their death certificate – 67, 451 of whom were 60 and over (42,976, 80 and over). In this article, Dr Camilla Lewis, Professor Chris Phillipson, Dr Sophie Yarker and Dr Luciana Lang assess the long-term impacts on both the older population and deprived communities, and make policy recommendations for community-based responses.

• More than 80% of the global COVID-19–related deaths between 2020 and 2021 occurred among people aged 60 years or older. COVID-19 raised particular concerns for older age groups – especially those living alone, those from marginalised backgrounds, people with long-standing illnesses, and individuals living in communities affected by high levels of deprivation
• Over the period March and December 2020, twice as many years of life were lost in the very poorest areas of England compared with the wealthiest. And between May 6 2023 and 12 May 2023 in England, there were 252 deaths with COVID-19 on the death certificate – the majority of these people aged 70 and over.
• Policymakers must work closely with communities, aimed at challenging the deep-rooted inequalities affecting low-income areas, these magnifying the immediate and long-term impact of the COVID-19 pandemic.

Impact of the COVD-19 on older people

The impact of COVID-19 can be measured in a variety of ways – quality of life, mortality, and long-term illness. Reflecting all of these, we know that the pandemic has already accelerated the decline in life expectancy that had started to affect poorer areas over the period 2010-2020.

As a result, establishing new public health policies is necessary to address the inequalities exposed by COVID-19. These policies should be co-developed with communities and groups for whom the effects of the pandemic are likely to stretch for many years to come.

Strategies to control COVID-19 led to various forms of exclusion affecting all age groups, but raised particular issues for older people, for example, around the effects of social distancing, digital exclusion, loss of access to community support, and social isolation. Ethnic inequalities were a feature across all waves, with rates of death highest amongst Bangladeshi and Pakistani communities and white minority groups such as Gypsies and Irish travellers.

COVID-19 has had a long-term impact on the way some people think about their health and well-being, their use of shared spaces, and their social relationships more generally. Long-term strategies must be formed to address these issues and develop interventions to combat the threat both of COVID-19 and future pandemics.

Impact on deprived neighbourhoods

Older people living in socio-economically deprived urban neighbourhoods experienced a ‘double lockdown’ – they were restricted or “locked down” (by both social distancing and existing inequalities) as a result of interrelated social and spatial inequalities associated with COVID-19. Yet, despite the known pressures, little was done to direct extra resources into low-income communities at the start of the pandemic, or to engage directly with organisations working with vulnerable and excluded groups in such areas.

Communities felt the impact of inequalities but also demonstrated ways of mobilising support to help those most affected by COVID-19. Community organisations played a vital role, adapting traditional responses as well as developing new activities, including meal deliveries, IT assistance, telephone befriending schemes, and bereavement counselling.

Developing community-based responses 

The impact of COVID-19 has been exacerbated by dramatic rises in the price of energy and fuel, these hitting hard those living in low-income communities, and those from ethnic minority backgrounds who tend to be poorer, live in over-crowded housing, have lower pensions, and are often in poorer health.

To counter the impact of these crises, emphasis should be given to redistributing financial resources in favour of lower-income areas. This is essential for developing effective policies for tackling the social and geographical inequalities associated with the impact of COVID-19.

To achieve this, four areas of work will be essential:

• Local authorities should make an assessment of additional resources

Local authorities will need to assess what additional resource will be needed by voluntary organisations. These organisations will be under intense pressures to expand the scope of their work – with the cost-of-living crisis adding to COVID-19-related issues. This is especially the case in areas of economic and social deprivation, which experienced the most damaging impact. Meetings with representative groups from these voluntary organisations need to be arranged to identify gaps in support, and priorities for intervention over the short and medium-term.

• Mobilising community participation

Community participation will be vital to support those who continue to be impacted by COVID-19 and to ensure preparedness for any future pandemics. In particular: supporting those working on a voluntary basis within neighbourhoods; assisting new and existing mutual aid groups; ensuring accessible meeting places – the closure of pubs, libraries and community centres depleting for many localities the social networks which sustain community life.

• Community advocates

Given pressures on health and social care, community advocates will be needed for those requiring services but lacking anyone who can speak on their behalf. This may be especially important for groups – such as those from minority ethnic communities and older adults – who may experience various forms of discrimination in accessing services.

• Digital Inclusion

COVID-19 highlighted the importance of digital inclusion, with many services going online. This has created problems for those excluded from accessing IT: the evidence suggests that many older people remain digitally excluded in some way, with Office for National Statistics data for 2021 showing that 57% of people 75 and over had not used the internet over the past three past three months or had never used the internet.

Given this context, more traditional means of communication about future pandemics will most probably be necessary (for example, leaflets in different languages through doors; advertising in shops) to complement digital communication and related approaches. At the same time, policy makers must encourage digital inclusion through training and support for older people and review the benefits of moving an increasing range of services online rather than face-to-face.

Finally, one important lesson from research may be that the idea of the end of COVID-19 is unrealistic for many groups. This certainly applies to people living in poorer neighbourhoods, and is a reminder that community supports of various kinds will continue to be important for many, in recognition of the long-term harm brought about by COVID-19.