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COVID-19 May Exacerbate the Negative Impact of Discrimination on the Health of Older Adults

Key findings

  • This secondary analysis of the Positive Minds–Strong Bodies trial examined the mental and physical health within Asian and non-Asian older adult populations before and during the COVID-19 pandemic and associations with everyday discrimination
  • Contrary to expectations, 56 Asian older adults reported fewer experiences of everyday discrimination on average during the pandemic (March 2, 2021, to July 18, 2022) than before (May 2015 to May 2018), although the difference was not significant
  • Symptoms of depression and anxiety among Asian older adults remained stable during COVID-19 compared with pre-pandemic levels, and 109 non-Asian older adults reported lower anxiety and depression symptoms during COVID-19 than before
  • In both older Asians and older non-Asians, discrimination was positively correlated with depression and anxiety symptoms and negatively correlated with the level of physical functioning
  • Social support and social cohesion during the pandemic offset the impact of discrimination on depression symptoms and level of functioning during the pandemic, despite not being directly linked to better mental or physical outcomes

Multiple studies have documented increased discriminatory behaviors against Asian American and Pacific Islanders (AAPIs) since the beginning of the COVID-19 pandemic. Stop AAPI Hate reports that between March 2020 and December 2021, 7.6% of hate incidents reported by AAPI persons targeted adults aged 60 or older.

Massachusetts General Hospital researchers recently conducted a study of the association between anti-Asian COVID-19-related discrimination and health outcomes of older adults that had two major strengths compared with prior research: it included non-Asian populations and pre-pandemic data.

Margarita Alegría, PhD, chief of the Disparities Research Unit, Lulu Zhang, a data manager there, and colleagues present evidence that the COVID-19 pandemic itself had a limited negative effect on older adults' mental health. However, during the pandemic, everyday discrimination negatively affected the health of Asian and non-Asian older adults, according to their report in Frontiers in Public Health.

Study Setting and Participants

The researchers designed a secondary analysis of Positive Minds–Strong Bodies, a clinical trial in which 307 low-income older adults (ages 60+) were randomly assigned to a combined psychosocial/exercise training intervention or enhanced usual care. Eligible participants had minor to moderate physical disability and mild to severe depression or anxiety.

Data were compared for two time periods:

  • Pre-pandemic—Baseline examinations in the trial, conducted between May 2015 and May 2018
  • During the pandemic—Follow-up phone interviews, completed between March 2, 2021, and July 18, 2022

165 of the original participants were reached for follow-up: 56 Asians and 109 non-Asians (74 Latinx, 16 non-Latinx white, 10 non-Latinx Black, one American Indian/Alaska Native, and eight of another race). All Asian people were foreign-born and reported their primary language as Mandarin or Cantonese.


At baseline and during the COVID-19 follow-up assessment, participants completed:

  • The Geriatric Depression Scale–15
  • The Generalized Anxiety Disorder–7
  • The function component of the Late-life Functioning and Disability Instrument
  • A 5-item assessment of sleep difficulties
  • The Everyday Discrimination Scale, which assesses the frequency of unfair treatment that is generally minor
  • A 10-item assessment of social support (frequency of discussing problems with family, friends, and spouse/partner; practical help from those people; frequency of getting together with family and friends; frequency of being cared for by family; and satisfaction with social support)
  • The social cohesion and trust section of the Collective Efficacy Scale, which asks how much the respondent trusts their neighbors, gets along with them, believes neighbors would help them in an emergency, and believes neighbors look out for each other

Changes in Discrimination and Health Outcomes

Some results about self-reported discrimination and health outcomes were unexpected:

  • Everyday Discrimination Scale—Non-Asian people reported more discrimination than Asian people before and during the pandemic; discrimination decreased during the pandemic in both groups, compared with baseline scores, although the changes were not significant
  • Depression—Asian people were more depressed than non-Asian people before and during the pandemic; symptoms decreased significantly in non-Asians but not Asians from before the pandemic to during
  • Anxiety—Asian people were less anxious than non-Asian people before and during the pandemic; symptoms decreased significantly in non-Asians but not Asians from before the pandemic to during
  • Physical functioning—Asian people had better levels than non-Asian people before and during the pandemic; no significant change in either group
  • Sleep difficulties—Asian people were more impaired than non-Asian people before and during the pandemic; no significant change in either group

Associations Between Discrimination and Health Outcomes

Before the pandemic, everyday discrimination was not linked to worse depression or anxiety symptoms, lower levels of functioning, or increased sleep difficulties.

During the pandemic, discrimination was associated with poorer scores on all those measures. The effect of discrimination on depression was statistically significant.

Interestingly, a unit increase in self-reported discrimination during COVID-19 had the same impact on the health of Asians and non-Asians.

Social Support and Social Cohesion As Moderators

Social support and cohesion were not directly associated with less depression, anxiety, or sleep difficulties during the pandemic. Instead, higher levels of social cohesion were associated with better physical functioning and buffered against the negative effects of discrimination on depression.


During the pandemic, older adults may stay home more often and thus be less exposed to situations where they experience discrimination. Even so, the pandemic seems to have exacerbated the negative impact of discrimination on health outcomes, affecting Asian and non-Asian people similarly.

Since social support and social cohesion protect against the negative impact of discrimination, public health interventions aimed at reducing microaggressions and emphasizing social support might improve the health outcomes of all U.S. older adult populations.

Learn more about the Disparities Research Unit

Refer a patient to the Division of Palliative Care and Geriatric Medicine


A randomized controlled clinical trial found that mental health intervention and exercise training administered concurrently by community-based paraprofessionals was associated with improved mood symptoms and physical functioning in older adults of racial/ethnic minorities.


With data collected at organizations and clinics serving low-income older people, Margarita Alegría, PhD, Liao Zhang, MD, PsyaD, and team found no difference between Black and white adults in mental health service use. Still, white people were more likely than older adults of color to seek care at lower levels of need.