The Covid-19 pandemic brought a fair deal of stress to everyone, but especially older people worldwide. Between December 2019 and March 2020, 32% of those infected were hospitalised, 2.4% developed acute illness requiring ventilation, and 1.5% – more than 50,000 people – died.
A year and a half into the outbreak, mortality rates across Europe varied significantly. While countries like Sweden and Poland reported fewer than 0.1 deaths per million inhabitants, Spain and the UK saw rates climb to two per million. Democracies worldwide grappled with a difficult dilemma: Should they prioritise protecting the vulnerable and reducing virus-related deaths, or focus on the economy and preserving individual freedoms?
In addition to the direct health risks posed by the virus, restrictions such as lockdowns, school and workplace closures, and stay-at-home orders drastically disrupted daily life. These measures limited access to routine healthcare, increased feelings of loneliness, and contributed to a rise in anxiety and depression. Here too, policies across Europe varied significantly: countries like Greece and Italy adopted strict stay-at-home orders and workplace closures, while Sweden and Estonia only restricted gathering sizes and international travel. This disparity offers a chance to assess how the severity of restrictions affected individuals aged 50 and older, considering cultural, economic, and public health differences.
Our recent paper examined how people perceived the most prominent restrictions and how these perceptions impacted their health. The assessment was based on a single question: “In general, would you say that your health is excellent, very good, good, fair, or poor?” This self-assessment not only captures health trajectories but also serves as a predictor of future healthcare needs and expenditures.
Striking a balance between protection and harm
A key question we sought to answer was whether the restrictions imposed by European governments were seen as protective or harmful to the health of vulnerable groups. We also explored whether having contracted Covid-19 influenced these perceptions. Our hypothesis was that those who had contracted the virus might be more willing to follow strict measures, potentially easing the negative impacts on their well-being caused by restrictions.
To investigate, we analysed data from the Survey of Ageing, Health and Retirement in Europe, which tracks the health, socio-economic status, and family networks of Europeans aged 50 and older in 27 countries, spanning from October 2019 to August 2021. We measured restriction levels using Oxford University’s Stringency Index,a 0-100 scale that tracks government responses in areas such as school closures, travel restrictions, and stay-at-home orders.
Our findings reveal a nuanced relationship between policy strictness and health perceptions. At lower levels of stringency, stricter measures disrupted daily life, limited access to essential services, and increased social isolation, leading to a decline in well-being. However, once policies became more stringent – reaching a threshold of 54 out of 100 – health perceptions began to improve, as older adults started to see these measures as necessary for their protection.
This “bell curve” relationship indicates that the impact of restrictions is not uniform. Understanding the tipping point, where restrictions shift from being perceived as burdensome to protective, is key to applying policies that avoid unnecessary distress.
How personal health influences support for restrictions
One of the most interesting findings is how personal experience with Covid-19 affects attitudes toward restrictions. Those who had contracted the virus seemed more open to stricter measures, likely because they had directly experienced the disease’s severity and saw restrictions as an effective preventive tool.
However, the impact of restrictions also varied based on the initial health of older persons. Stricter policies appeared to protect those in excellent or very good health, while their effects on people in poorer health were less clear. Notably, those in “fair” health experienced negative effects when restrictions became too strict.
Take, for example, someone with some difficulty managing daily tasks, like housekeeping or meal preparation, but who still lives at home with family support. Strict stay-at-home requirements or social distancing could put them at risk of a sharp health decline. Meanwhile, someone already in poor health and living in a nursing home might be less affected by those same policies. In such cases, highly stringent measures can do more harm than good.
A country-by-country divide
These varied effects based on health status are crucial when considering differences across countries. While the tipping point identified in our study applies across Europe, the impact of stricter policies depends on a country’s overall health profile.
In countries like Denmark and Sweden, where fewer than 20% of elderly people report being in poor or fair health, stricter measures are more likely to be protective. In contrast, in Latvia, where only 30% of the elderly population reported being in excellent or very good health before the pandemic, stricter policies could harm the perceived health of a large portion of the population, particularly those in fair or poor health. For countries like France or Germany, with a more evenly distributed health status, it’s vital to assess how different subgroups might be affected by stringent measures.
Policymakers need to weigh more than just the effectiveness of Covid-19 restrictions in reducing deaths – they also have to consider how these measures impact overall well-being, especially for vulnerable groups like the elderly. A balanced approach is key, one that factors in both infection status and individuals’ initial health. For example, people who have experienced Covid-19, particularly those in excellent health, are more likely to follow strict measures, as they may feel they have more to lose in terms of well-being. While we are not prescribing an ideal level of restrictions, our findings highlight the tough choices public officials face: how to balance the needs of those infected, those in poorer health, and those most at risk of declining well-being.
