The impact of COVID-19 on middle-aged people in England

By Stefania D’Angelo, Health and Employment After Fifty (HEAF) Study
October 27, 2021

In the second part of our mini-series looking at the work of the Health and Employment After Fifty (HEAF) Study, Stefania D’Angelo sets out the changes to the delivery, focus and findings of the study surveys amidst the COVID-19 pandemic and national restrictions.

The Health and Employment After Fifty (HEAF) cohort was established in 2013 to assess the health benefits and risks of working at older ages, and to understand whether common health conditions limit work capability in later life. Since the initial baseline postal questionnaire (returned by over 8,000 men and women aged 50-64 years) those who consented to follow-up surveys have been mailed five additional questionnaires annually.

When COVID-19 disrupted our lives in early 2020, the HEAF research team was in the privileged position of being able to explore the impact of the pandemic among an extremely engaged cohort, with the opportunity to investigate changes in several aspects of their lives both prior to and throughout the pandemic.

Under national lockdown, any questionnaire had to be carried out online rather than via post. Since our survey participants were accustomed to receiving postal questionnaires, we sent each a newsletter by post: firstly, to provide our customary update on recent research findings, and secondly, to notify them of the upcoming online survey on COVID-19.

We were pleasantly surprised by the number of subsequent phone calls and emails from participants, who were largely keen to provide their most up-to-date email address so as to facilitate their taking part in the survey.

In early February 2021, HEAF participants were emailed a link to complete the online survey.  Its questions focused on their lives throughout the early stages of the pandemic (March-June 2020) and were categorised by a number of themes: symptoms of COVID-19 and shielding; healthcare utilisation (other than for COVID-19); changes in employment circumstances; finances; measures of health and social isolation; and lifestyle factors.

The section focusing on COVID-19 was introduced to quantify the number of HEAF participants who experienced COVID-19 symptoms, who tested positive, and who amongst them were hospitalised because of infection. The section about shielding has collected information on whether participants were advised to shield, who gave that advice, and whether it had been followed.

Furthermore, the section about healthcare utilisation will quantify the number of healthcare appointments and hospital admissions which have either been cancelled or postponed during lockdown. For the three sections above we have used bespoke questions that we partly adapted from other studies such as the COvid-19 aNd musculoskeleTal heAlth durIng lockdowN (CONTAIN)Veterans CHECK study, the UCL Social Study, and Understanding Society.

Employment changes were assessed by any change that has occurred to participants’ employment position the beginning of lockdown, including furlough, redundancy, or retirement etc. The survey has also collected details about working from home, and the support received from employers while adjusting to this new way of working.

Mental health was measured with the Centre Epidemiological Studies Depression (CES-D), while sleep disturbances were assessed with a 4-item Jenkins scale. We also asked participants to report whether (either during or after lockdown) they had experienced any depression, anxiety or musculoskeletal pain. Wherever possible we have used the same tools as in previous follow-ups in order to be able to track changes over time.

Finally, we added bespoke questions about changes to physical activity, diet, smoking and alcohol consumption that had occurred during the pandemic.

We are delighted to report that over half of our participants returned a valid online questionnaire, which represents an amazing result! We are currently in the process of cleaning the wealth of data collected as well as performing some preliminary analysis, and we will soon be able to disseminate the main findings.

Next steps

We now plan to conduct in-depth interviews with a selected group of participants which will complement the quantitative component of our COVID-19 research. This will give participants the opportunity to tell the story of their own personal experiences and allow us to explore the impact and consequences of the pandemic in greater detail.

We are also planning a second quantitative survey to be sent out at the start of 2022. This survey will seek to understand more fully the long-lasting effects of the pandemic on middle-aged people in England.

Further information

This is the second part of a mini blog series by CLOSER partner study, Health and Employment After Fifty Study introducing the cohort and their COVID-19 response. 

Stefania D’Angelo is a medical statistician and PhD student at the MRC Lifecourse Epidemiology Centre, University of Southampton.

Suggested citation:

D’Angelo, S. (2021). ‘Part 2: The impact of COVID-19 on middle-aged people in England’. CLOSER. 27 October 2021. Available at: