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Ravussin A, Robertson AH, Wolf AS, Blix K, Kjønstad IF, Solum G, Feiring B, Strand BH, Lund-Johansen F, Munthe LA, Magnus P, Trogstad L, Mjaaland S. Determinants of humoral and cellular immune responses to three doses of mRNA SARS-CoV-2 vaccines in older adults: a longitudinal cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e188-e199. [PMID: 37148891 PMCID: PMC10156136 DOI: 10.1016/s2666-7568(23)00055-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Older age is associated with poorer outcomes to COVID-19 infection. The Norwegian Institute of Public Health established a longitudinal cohort of adults aged 65-80 years to study the effects of the COVID-19 pandemic. Here we describe the characteristics of the cohort in general, and specifically the immune responses at baseline and after primary and booster vaccination in a subset of longitudinal blood samples, and the epidemiological factors affecting these responses. METHODS 4551 participants were recruited, with humoral (n=299) and cellular (n=90) responses measured before vaccination and after two and three vaccine doses. Information on general health, infections, and vaccinations were obtained from questionnaires and national health registries. FINDINGS Half of the participants had a chronic condition. 849 (18·7%) of 4551 were prefrail and 184 (4%) of 4551 were frail. 483 (10·6%) of 4551 had general activity limitations (scored with the Global Activity Limitation Index). After dose two, 295 (98·7%) of 299 participants were seropositive for anti-receptor binding domain IgG, and 210 (100%) of 210 participants after dose three. Spike-specific CD4 and CD8 T cell responses showed high heterogeneity after vaccination and responded to the alpha (B.1.1.7), delta (B.1.617.2), and omicron (B.1.1.529 or BA.1) variants of concern. Cellular responses to seasonal coronaviruses increased after SARS-CoV-2 vaccination. Heterologous prime boosting with mRNA vaccines was associated with the highest antibody (p=0·019) and CD4 T cell responses (p=0·003), and hypertension with lower antibody levels after three doses (p=0·04). INTERPRETATION Most older adults, including those with comorbidities, generated good serological and cellular responses after two vaccine doses. Responses further improved after three doses, particularly after heterologous boosting. Vaccination also generated cross-reactive T cells against variants of concern and seasonal coronaviruses. Frailty was not associated with impaired immune responses, but hypertension might indicate reduced responsiveness to vaccines even after three doses. Individual differences identified through longitudinal sampling enables better prediction of the variability of vaccine responses, which can help guide future policy on the need for subsequent doses and their timing. FUNDING Norwegian Institute of Public Health, Norwegian Ministry of Health, Research Council of Norway, and Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Anthony Ravussin
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Hayman Robertson
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway.
| | - Asia-Sophia Wolf
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristine Blix
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Ingrid Fadum Kjønstad
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Guri Solum
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Feiring
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Bjørn Heine Strand
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, Oslo, Norway; ImmunoLingo Convergence Center, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ludvig A Munthe
- Department of Immunology, Oslo University Hospital, Oslo, Norway; KG Jebsen Centre for B cell Malignancies, University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lill Trogstad
- Division of Infection Control, Section for Vaccine Epidemiology and Population Studies, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Mjaaland
- Division of Infection Control, Section for Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Holwerda TJ, Jaarsma E, van Zutphen EM, Beekman ATF, Pan KY, van Vliet M, Stringa N, van den Besselaar JH, MacNeil-Vroomen JL, Hoogendijk EO, Kok AAL. The impact of COVID-19 related adversity on the course of mental health during the pandemic and the role of protective factors: a longitudinal study among older adults in The Netherlands. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-023-02457-5. [PMID: 36964770 PMCID: PMC10039342 DOI: 10.1007/s00127-023-02457-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/27/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE Many studies report about risk factors associated with adverse changes in mental health during the COVID-19 pandemic while few studies report about protective and buffering factors, especially in older adults. We present an observational study to assess protective and buffering factors against COVID-19 related adverse mental health changes in older adults. METHODS 899 older adults (55 +) in the Netherlands were followed from 2018/19 to two pandemic time points (June-October 2020 and March-August 2021). Questionnaires included exposure to pandemic-related adversities ("COVID-19 exposure"), depressive and anxiety symptoms, loneliness, and pre-pandemic functioning. Linear regression analyses estimated main effects of COVID-19 exposure and protective factors on mental health changes; interaction effects were tested to identify buffering factors. RESULTS Compared to pre-pandemic, anxiety symptoms, depression symptoms and loneliness increased. A higher score on the COVID-19 adversity index was associated with stronger negative mental health changes. Main effects: internet use and high mastery decreased depressive symptoms; a larger network decreased anxiety symptoms; female gender, larger network size and praying decreased loneliness. COVID-19 vaccination buffered against COVID-19 exposure-induced anxiety and loneliness, a partner buffered against COVID-19 exposure induced loneliness. CONCLUSION Exposure to COVID-19 adversity had a cumulative negative impact on mental health. Improving coping, finding meaning, stimulating existing religious and spiritual resources, network interventions and stimulating internet use may enable older adults to maintain mental health during events with large societal impact, yet these factors appear protective regardless of exposure to specific adversities. COVID-19 vaccination had a positive effect on mental health.
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Affiliation(s)
- Tjalling J Holwerda
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands.
- Department of Psychiatry, ARKIN Mental Health Care Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC Location Vrije Universiteit, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Eva Jaarsma
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elisabeth M van Zutphen
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Kuan-Yu Pan
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Majogé van Vliet
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Najada Stringa
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Judith H van den Besselaar
- Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Janet L MacNeil-Vroomen
- Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Almar A L Kok
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije Universiteit, De Boelelaan 1117, Amsterdam, The Netherlands
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Hoogendijk EO, Schuster NA, van Tilburg TG, Schaap LA, Suanet B, De Breij S, Kok AA, Van Schoor NM, Timmermans EJ, de Jongh RT, Visser M, Huisman M. Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults. BMJ Open 2022. [PMID: 36323473 DOI: 10.1136/bmjopen-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to develop an index to measure older adults' exposure to the COVID-19 pandemic and to study its association with various domains of functioning. DESIGN Cross-sectional study. SETTING The Longitudinal Aging Study Amsterdam (LASA), a cohort study in the Netherlands. PARTICIPANTS Community-dwelling older adults aged 62-102 years (n=1089) who participated in the LASA COVID-19 study (June-September 2020), just after the first wave of the pandemic. PRIMARY OUTCOME MEASURES A 35-item COVID-19 exposure index with a score ranging between 0 and 1 was developed, including items that assess the extent to which the COVID-19 situation affected daily lives of older adults. Descriptive characteristics of the index were studied, stratified by several sociodemographic factors. Logistic regression analyses were performed to study associations between the exposure index and several indicators of functioning (functional limitations, anxiety, depression and loneliness). RESULTS The mean COVID-19 exposure index score was 0.20 (SD 0.10). Scores were relatively high among women and in the southern region of the Netherlands. In models adjusted for sociodemographic factors and prepandemic functioning (2018-2019), those with scores in the highest tertile of the exposure index were more likely to report functional limitations (OR: 2.24; 95% CI: 1.48 to 3.38), anxiety symptoms (OR: 3.14; 95% CI: 1.82 to 5.44), depressive symptoms (OR: 2.49; 95% CI: 1.55 to 4.00) and loneliness (OR: 2.97; 95% CI: 2.08 to 4.26) than those in the lowest tertile. CONCLUSIONS Among older adults in the Netherlands, higher exposure to the COVID-19 pandemic was associated with worse functioning in the physical, mental and social domain. The newly developed exposure index may be used to identify persons for whom targeted interventions are needed to maintain or improve functioning during the pandemic or postpandemic.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Noah A Schuster
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bianca Suanet
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sascha De Breij
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Almar Al Kok
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Natasja M Van Schoor
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hoogendijk EO, Schuster NA, van Tilburg TG, Schaap LA, Suanet B, De Breij S, Kok AA, Van Schoor NM, Timmermans EJ, de Jongh RT, Visser M, Huisman M. Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults. BMJ Open 2022; 12:e061745. [PMID: 36323473 PMCID: PMC9638742 DOI: 10.1136/bmjopen-2022-061745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop an index to measure older adults' exposure to the COVID-19 pandemic and to study its association with various domains of functioning. DESIGN Cross-sectional study. SETTING The Longitudinal Aging Study Amsterdam (LASA), a cohort study in the Netherlands. PARTICIPANTS Community-dwelling older adults aged 62-102 years (n=1089) who participated in the LASA COVID-19 study (June-September 2020), just after the first wave of the pandemic. PRIMARY OUTCOME MEASURES A 35-item COVID-19 exposure index with a score ranging between 0 and 1 was developed, including items that assess the extent to which the COVID-19 situation affected daily lives of older adults. Descriptive characteristics of the index were studied, stratified by several sociodemographic factors. Logistic regression analyses were performed to study associations between the exposure index and several indicators of functioning (functional limitations, anxiety, depression and loneliness). RESULTS The mean COVID-19 exposure index score was 0.20 (SD 0.10). Scores were relatively high among women and in the southern region of the Netherlands. In models adjusted for sociodemographic factors and prepandemic functioning (2018-2019), those with scores in the highest tertile of the exposure index were more likely to report functional limitations (OR: 2.24; 95% CI: 1.48 to 3.38), anxiety symptoms (OR: 3.14; 95% CI: 1.82 to 5.44), depressive symptoms (OR: 2.49; 95% CI: 1.55 to 4.00) and loneliness (OR: 2.97; 95% CI: 2.08 to 4.26) than those in the lowest tertile. CONCLUSIONS Among older adults in the Netherlands, higher exposure to the COVID-19 pandemic was associated with worse functioning in the physical, mental and social domain. The newly developed exposure index may be used to identify persons for whom targeted interventions are needed to maintain or improve functioning during the pandemic or postpandemic.
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Affiliation(s)
- Emiel O Hoogendijk
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Noah A Schuster
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Theo G van Tilburg
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bianca Suanet
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sascha De Breij
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Almar Al Kok
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Natasja M Van Schoor
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Erik J Timmermans
- Julius Center for Health Sciences and Primary Care, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam Public Health research institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Delay or postponement of medical care among older adults in the Netherlands at earlier and later stages of the COVID-19 pandemic. Aging Clin Exp Res 2022; 34:2913-2917. [PMID: 36260212 PMCID: PMC9579526 DOI: 10.1007/s40520-022-02266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
Abstract
Aims The aim of the current study was to compare cancellations or postponement of medical care among older adults during the COVID-19 pandemic between 2021 and 2020.
Methods Data of respondents aged ≥ 62 years were used from the longitudinal aging study Amsterdam (LASA), collected in 2020 and 2021, directly after the main COVID-19 waves in the Netherlands. A questionnaire assessed cancellations of medical care and postponed help-seeking behavior. Descriptive analyses were performed.
Results Overall, cancellations declined from 35% in 2020 (sample n = 1128) to 17% in 2021 (sample n = 1020). Healthcare-initiated cancellations declined from 29 to 8%. Respondent-initiated cancellations declined from 12 to 7%. Postponed help-seeking remained around 8%. Conclusions In 2021, less cancellations were reported compared to just after the first wave of the pandemic in 2020, while postponed help-seeking remained the same. It is important to investigate how cancellations and postponed help-seeking can be prevented in future pandemics.
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van den Besselaar JH, MacNeil Vroomen JL, Buurman BM, Hertogh CM, Huisman M, Kok AA, Hoogendijk EO. Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam. J Psychosom Res 2021; 151:110656. [PMID: 34741872 PMCID: PMC8556729 DOI: 10.1016/j.jpsychores.2021.110656] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 10/30/2022]
Abstract
OBJECTIVE Governmental measures to protect older adults from COVID-19 are hypothesized to cause anxiety and depression. Previous studies are heterogeneous and showed small effects. This study aims to assess depressive and anxiety symptoms and perceived mastery just after the first wave of the COVID-19 pandemic compared to previous years in community-dwelling older adults and to identify potential risk groups according to the comprehensive geriatric assessment framework. METHODS Data were used from 1068 Dutch older adults (aged 55-93 at baseline in 2011-2013) participating in the Longitudinal Aging Study Amsterdam, including 4 follow-ups spanning 9 years. Depressive symptoms, anxiety symptoms and feelings of mastery were assessed with the short Center for Epidemiologic Studies Depression scale (CES-D-10), the Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) and the Pearlin Mastery Scale. Linear mixed regression was used to compare outcomes in June-August 2020 to previous years and to examine predictors to identify risk groups. RESULTS Slight increases in CES-D-10 (1.37, 95% Confidence interval [CI] 1.12;1.62), HADS-A (0.74, 95% CI 0.56;0.94) and mastery (1.10, 95% CI 0.88;1.31) occurred during the COVID year compared to previous years. Older adults with functional limitations or with frailty showed a smaller increase in feelings of mastery in the COVID-year. CONCLUSION Our results suggest limited mental health effects on older adults from the first COVID-19 wave. Older adults have perhaps better coping strategies than younger adults, or preventive measures did not have extensive consequences for the daily life of older adults. Further monitoring of depression, anxiety and perceived mastery is recommended.
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Affiliation(s)
- Judith H. van den Besselaar
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Janet L. MacNeil Vroomen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bianca M. Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands,Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Cees M.P.M. Hertogh
- Department of Medicine for Older People, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Department of Sociology, Faculty of Social Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Almar A.L. Kok
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Emiel O. Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Corresponding author at: Department of Epidemiology & Data Science, Amsterdam UMC – location VU University Medical Center, P.O. Box 7057, 1007MB Amsterdam, the Netherlands
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7
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Schuster NA, de Breij S, Schaap LA, van Schoor NM, Peters MJL, de Jongh RT, Huisman M, Hoogendijk EO. Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam. Eur Geriatr Med 2021; 12:1075-1083. [PMID: 34046874 PMCID: PMC8159721 DOI: 10.1007/s41999-021-00514-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022]
Abstract
Aim To investigate the extent to which Dutch older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic. Findings One third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. Message Delay of routine care during the pandemic may impact morbidity and related adverse outcomes in the long term, which should be monitored in future research. Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.
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Affiliation(s)
- Noah A Schuster
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Sascha de Breij
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Laura A Schaap
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Mike J L Peters
- Department of Internal Medicine, Section Geriatrics, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, Section Endocrinology, Amsterdam UMC, Location VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VU University Medical Center, P.O. Box 7057, 1007MB, Amsterdam, The Netherlands.
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