The impact of COVID-19: new insights from the 45 and Up Study

There are many moving parts in a government’s response to a highly infectious disease such as COVID-19. In the acute phase, the focus is rightly on public health strategies to contain the pandemic. But over the longer term, it is critically important for policymakers to understand the impact that the pandemic – and the measures to control it – is having on the general population.

The Sax Institute is helping to answer some of these questions, thanks to a COVID-19 research grant from the NSW government. Our flagship 45 and Up Study, which has tracked the health of over 260,000 NSW people over the age of 45 for the past 15 years, is revealing important insights into the population effects of COVID-19. Study participants are regularly being surveyed to offer a real-time snapshot of health and wellbeing during the COVID-19 pandemic.

To date, over 60,000 participants have completed surveys on a range of topics, including the pandemic’s impact on health, loneliness, lifestyle, physical activity, diet, sleep, alcohol use, access to health services, experiences with telehealth and more – providing data and insights that will help guide policy and health services in the coming months and years. Results from these surveys yield some fascinating insights into the concerns and behaviours of people in this time of pandemic.

Mental health

A key public health concern is how the pandemic and associated measures have affected people’s mental health. Surprisingly, we found that in 2020, a higher proportion of people rated their quality of life as excellent or very good, compared with surveys from the previous two years. However, one in four still said their psychological health was worse because of the pandemic. One in five reported some degree of psychological distress. Men were less likely to suffer from high distress levels, while people between 56 and 65 were more likely to experience high or very high levels of distress (8%) compared with older groups, demonstrating that the pandemic is having very different effects in different parts of the population.

Loneliness due to lockdowns and restrictions, particularly among older people, has been another important issue. In our survey, almost one in ten people were intensely lonely in 2020, with more than 50% missing having other people around. Loneliness is associated with a number of poor health outcomes, including higher mortality and hospitalisation rates. Ninety-two percent of respondents reported reduced personal contact outside their own household in 2020.

The pandemic has had an impact on healthcare provision well beyond the care of people infected with COVID-19. Forty percent of people in the 45 and Up Study surveys reported missed or delayed access to healthcare services, including missed appointments with a dentist (25%), GP (16%) and medical specialist (12%). On the flipside, respondents were largely positive about telehealth, which expanded substantially in 2020. Nearly half of participants said they had received telehealth services, mostly by telephone. And the experience was mostly good, with 56% of people of the opinion that it was just as good or better than a face-to-face visit, compared with only 28% who said it was worse.

Are we getting enough exercise?

During the lockdown, Australians made the most out of their parks and bushlands for exercise and there was a boom in cycling. But were people really doing more exercise? The 45 and Up surveys suggest otherwise: over a quarter of participants reported spending less time on all forms of physical activity compared with the same time in the previous year, while 24% reported spending more time watching TV. 

Are Australians getting the information they need on COVID, and where do they get it? Three in five respondents reported being confused about the COVID information they read or heard, with people from more disadvantaged areas and those aged 56 to 64 more likely to feel this confusion. The most frequently accessed sources of information about COVID in this cohort of people over the age of 45 was public TV and radio (71%), followed by commercial TV/radio (45%) and newspapers (33%). Healthcare providers were the most trusted source of information – and yet the least accessed.

Four in five of those surveyed in 2020 said they would get the COVID vaccination if it became available, with 19% unsure. As Australia now begins its rollout of COVID vaccines, the survey currently in the field will provide vital information on attitudes to immunisation. 

In all, five surveys are planned in this series, and the Sax Institute will continue to share findings as they become available to support an effective response to the pandemic and its impact on the population.


Funding for this project was awarded through the NSW Health COVID Research Grants Round 1. Find out more about the NSW government’s COVID-19 research grants here.

45 and Up COVID Insights has benefited from advice and guidance from the following collaborators:

  • Dr Julia Steinberg, Cancer Council NSW
  • Associate Professor Jill Newby, University of New South Wales
  • Dr Marianne Weber, Cancer Council NSW
  • Professor Dianne O’Connell, Cancer Council NSW
  • Professor Kirsten McCaffery, University of Sydney
  • Professor Julie Leask, University of Sydney
  • Professor Raina MacIntyre, University of New South Wales
  • Professor Catherine D’Este, Australian National University
  • Associate Professor Melody Ding, University of Sydney
  • Professor Bette Liu, University of New South Wales
  • Professor Julie Redfern, University of Sydney

For more information about the 45 and Up Study, click here.