Introduction: The COVID-19 pandemic disrupted the everyday routines of Brazilians and global populations, leading to significant health challenges, including mental health concerns. The elderly, an expanding demographic, are especially susceptible to these impacts. Studying the cognitive and psychosocial effects on this group, along with chronic conditions and functionality, is essential for reducing consequences and making informed decisions to improve overall well-being. Methodology: This observational cross-sectional research included 417 elderly participants from Ribeirão Preto-SP, Brazil, in the last quarter of 2022. Health professionals and individuals with severe mental impairments were excluded. The study achieved a 95% confidence level with a 5% margin of error, based on the city’s total population of 711,825, which includes 113,652 elderly individuals (Plataforma Brasil approval CAAE 55625822.2.0000.5378). Results and Discussion: Women represented 53.11%, and men 43.88%. Cognitive impairments included worsened orientation (30.70%), memory alterations (32.14%), attention problems (29.50%), slower task execution (30.46%), difficulty in verbal communication and planning (30.46%), diminished emotional recognition (28.30%), impaired calculation skills (25.66%), and decline in language abilities (25.90%). Chronic conditions (66.90%) showed statistically significant correlations with cognitive impairments (p < 0.05, Mann-Whitney Test). Functionality demonstrated a positive link with chronic conditions, with respondents reporting dependence (0.7%), partial dependence (53.8%), and independence (45.5%) (p 0.40, Chi-Square Test). A positive association between functionality and cognitive impairments was also observed across all variables (p < 0.001, Kruskal-Wallis Test). Conclusion: A significant portion of the elderly experienced socio-affective challenges during the COVID-19 lockdown, exceeding the threshold set by the WHO for the need for mental health support. Consequently, implementing Public Health Policies to improve access to mental health services, ensure functionality, and prevent chronic conditions is crucial for maintaining equilibrium and enhancing well-being in their social interactions.