Understanding and addressing the impact of stressful live events on the mental health of older adults in Colombia

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Colombia has suffered political violence since the 1950s notably la violencia, more recently drug cartel and migrant flows linked. These severely impact citizens. Colombians are now being affected by the global COVID-19 pandemic. It remains unclear how these events are affecting residents' mental health and wellbeing, particularly older adults. The proportion of Colombian older adults is expected to double from 10% to 20% by 2050. This rise increasingly impacting upon Colombians, particularly in regions like Urabá in the Department of Antioquia, that have suffered throughout their history from inequality and lack of development due to inattention from the state and the constant presence of prolonged political conflict that deepens these structural inequalities. Those over 60 years of age have witnessed the history of violence in the country, as victims or perpetrators (for those who were part of armed groups). These account for a complex understanding of the conflict and turn them into the advocates for peace, as they have witnessed the dire consequences of war -they have suffered and survived them. In this sense, the elderly in Colombia are the ones who weave the life-story memories of the conflict, but suffer consequences.Our research centres on the municipality of Turbo, typical of such regions and populations. Uraba Antioqueno has been one of the territories most affected by the Colombian armed conflict in the last six decades. It is considered one of the regions of the Department of Antioquia with the highest numbers of expulsion of people for reasons related to the armed conflict or violence, though at the same time it is one of the main receiving areas for victims from Choco in the Pacific region and the Atlantic coast, as well as the migratory transit of foreigners from Africa and Latin America who seek reaching the United States. In 2020 413,397 inhabitants (78.6% of the total regional population of 525,685) were registered as victims of the armed conflict. In Turbo, the proportion is 64.5% (83,993 victims). In the region, 9.7% (n=14,425) are classed as older adults, living in urban, rural, peri-urban and dispersed rural areas.Our proposal embeds co-production with public and professional advisors throughout. We have already been undertaking consultations with local older residents and professionals in determining the approach and designing the project.This proposal will collect and combine key existing datasets added to new information collected using mental health surveys and both individual interviews and focus groups to map the mental health condition and pressures on older adults, suffering from decades of conflict and now COVID19. These findings will link with a systematic review of interventions to support the mental health of older adults in lower and middle income countries (LMICs), with a particular focus on conflict survivors, linked to in-depth interviews with international academic experts. The evidence summary, combined with quantitative and qualitative data from Turbo will be used to co-design and test a community-based psychosocial care strategy and intervention with, and for, Turbo older residents to reduce and manage mental health problems. It will address the situations identified at family and community levels in the Turbo research phases, linking with different regional health and welfare systems and datasets. This will then be evaluated as a pilot for its cost effectiveness, impact on mental health and other key factors as well as acceptability to professionals and service users. The findings will be used to inform a larger formal trial grant application across wider populations; as well as guides to implementing the approach more widely to support its application across other populations, within Colombia and other LMICs; as well as higher income countries, starting with England, with a focus on addressing the mental health needs of migrants who have experienced conflict.