Coronavirus Lockdown: Forced Inactivity for the Oldest Old?

Changes of Oral and Physical Functions in Older Japanese Who Participated in Keyboard Harmonica and Exercise Classes during COVID-19-Related Movement Restrictions

Many older people have restricted activities or movements because of the coronavirus disease 2019 (COVID-19) pandemic, which causes concerns about secondary health problems. This study aimed to investigate how frailty-prevention activities implemented by local governments have changed the health of community-dwelling older people during the COVID-19 pandemic. In this observational study, the participants were 23 older Japanese people who took part in keyboard harmonica or exercise classes in 2021. Oral function examination and physical function tests were conducted at baseline and after 10 months of follow-up. In each class, the participants met 15 times and worked on assignments at home. The results showed that oral diadochokinesis/pa/, which represents lip dexterity, improved during 10 months (from 6.6 to 6.8 times/s, p < 0.046); however, grip strength (p < 0.005) and total skeletal muscle mass (p < 0.017) decreased in the keyboard harmonica group. In the exercise group, a statistically significant difference was found only in grip strength, which decreased (p < 0.003). The oral and physical functions of older people who participated in frailty-prevention activities implemented by local governments characteristically changed. Moreover, activity restrictions during the COVID-19 pandemic may have caused decreased grip strength.

Socio-demographic characteristics and their relation to medical service consumption among elderly in Israel during the COVID-19 lockdown in 2020 as compared to the corresponding period in 2019

PURPOSE

The COVID-19 pandemic has led to the isolation of the population in Israel, including the elderly. The present study aimed to compare the consumption of medical services among adults over the age of 65 in Israel at the time of the first COVID-19 lockdown relative to the corresponding period the year before.

METHODS

We conducted a retrospective longitudinal observational quantitative research based on the Natali Healthcare Solutions Israel database of subscribers. Company subscribers over the age of 65 (N = 103,955) were included in the sample (64.5% women) in two time periods, before the COVID-19 outbreak-P1, in 2019, and during the first COVID-19 lockdown- P2 in 2020. Logistic regression was applied to examine service consumption for study variables.

RESULTS

The average number of referrals to services was lower during the COVID-19 lockdown period (M = 0.3658, SD = 0.781) compared to the corresponding period in the previous year (M = 0.5402, SD = 0.935). The average number of ambulance orders, doctor home visits and service refusals were higher when compared to the same period in the previous year. During both time periods, women (P1- M = 0.5631, SD = 0.951; P2- M = 0.3846, SD = 0.800) required significantly more (p < .000) services than men (P1- M = 0.5114, SD = 0.910; P2- M = 0.3417, SD = 0.753). Older, widowed people, living in non-Jewish/mixed localities, or in average or below average socioeconomic status localities required relatively more services to those with opposite socio-demographic traits (p < .000).

SUMMARY AND CONCLUSIONS

In a large sample of elderly in Israel, findings indicate a decrease in referrals to medical care during the first COVID-19 lockdown period, yet an increase in ambulance orders, doctor visits and service refusals. Socio-demographic characteristics showed a similar effect in both time periods. The period of the first COVID-19 lockdown was characterized by a higher incidence of medical service refusals as compared to the equivalent period in the previous year.

Effect of COVID-19 Pandemic on Older New York City Residents Living at Home

To describe effects of the COVID-19 pandemic on older adults living in non-institutionalized settings in New York City (NYC) we used random digit dial sampling of landlines phones to sample then interview residents 70 years and older in NYC from December 2020–March 2021. Socio-demographic, health characteristics and effects of the COVID-19 pandemic were solicited. Of 676 respondents, the average age was 78, 60% were female, and 63% had ever been tested for SARS-CoV-2, with 12% testing positive. Sixty-three percent of respondents knew someone who had been diagnosed with COVID-19 and 51% reported knowing at least one person who had died from COVID-19. Eight percent of respondents reported sometimes or often not having enough to eat, with 31% receiving food from a food pantry program. Significantly more Latinx respondents (24%) reported a positive SARS-CoV-2 test, whereas 17% of those of another race, 8% of white, and 7% of Black respondents had a positive COVID-19 test (p < 0.01). Forty-three percent of Black and 43% of Latinx respondents reported using a food pantry during COVID-19 pandemic, compared to 35% of respondents of another race and ethnicity and 18% of whites (p < 0.01). Twenty-nine percent of Latinx respondents screened for depression compared to 15% among all other races (p = 0.04). The COVID-19 pandemic has substantial health and social effects on older New Yorkers living in community settings, and experiences differed by race and ethnicity. Beyond older adults in congregate settings, those living at home have experienced wide-ranging effects of COVID-19, necessitating tailored interventions.

Investigation of the Effects of Home-Based Exercise and Cognitive Training on Cognitive and Physical Functions in Cardiac Patients: The COVEPICARDIO Study Protocol of a Randomized Clinical Trial

Introduction: During the COVID-19 pandemic, confinement measures are likely to produce collateral damage to health (stress, confusion, anxiety), especially in frail individuals and those living with cardiovascular disease (CVD). In cardiac patients in particular, these measures dramatically increase the level of physical inactivity and sedentary lifestyle, which can decrease cardiorespiratory capacity and increase the risk of acute events, rehospitalization, and depressive syndromes. Maintaining a minimum level of physical activity and cognitive stimulation during the COVID-19 crisis is essential for cardiac patients. This study is designed to document the effects of 6 months of home-based physical exercise alone or combined with cognitive training on cognitive and physical functions in patients with CVD over 50 years old.

Methods and Analysis: 122 patients (>50 years old) with stable CVD and no contraindication to perform physical exercise training will be recruited and randomly assigned to one of the 2 following arms: (1) Home-based physical exercise alone, (2) Home-based physical exercise combined with cognitive training. The intervention lasts 6 months, with remote assessments performed prior to, mid and post-training. A follow-up 6 months after the end of the intervention (12 month) is also proposed. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as performances on measures of executive functions, processing speed, and episodic memory. The secondary outcome is physical performance, including balance, gait and mobility, leg muscle strength and estimated cardiorespiratory fitness. Tertiary outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported online questionnaires.

Discussion: With the COVID-19 crisis, there is a critical need for remote exercise and cognitive training, and to further investigate this topic, in particular for cardiac patients. The present context can be viewed as an opportunity to perform a major shift from center-based programs to home-based physical exercise. This is especially important to reach out to older adults living in remote areas, where access to such interventions is limited.

ClinicalTrials.gov: [https://clinicaltrials.gov/ct2/show/NCT04661189], NCT04661189.

To Work or Not to Work, That Is the Question: The Psychological Impact of the First COVID-19 Lockdown on the Elderly, Healthcare Workers, and Virtual Workers

The spread of COVID-19 created a state of emergency all over the world and played a big role in the decline of the mental health of citizens. The context of the workplace became an important variable in the impact of the lockdown on individuals. In this study, we deepened the categories of healthcare workers (HWs), virtual workers (VWs), and the elderly, along with their emotional approach to this emergency. A sample of 257 participants (ElderlyN = 62; HWsN = 104; VWsN = 91) completed: a semi-structured interview on their experience during lockdown via telephone; an online survey with a sociodemographic questionnaire; the Difficulties in Emotional Regulation Scale (DERS); and the Post-Traumatic Growth Inventory (PTGI). Linguistic measures of the Referential Process were utilized to code the interviews. An independent ANOVA explored the variability among groups. The results show more affective language in the Elderly (M = 0.0310, SD = 0.0070) and a growth in spirituality (M = 4.16, SD = 3.17). HWs displayed a higher PTGI (M = 56.84, SD = 20.29), while VWs displayed a lower PTGI (M = 50.02, SD = 21.05). Moreover, VWs presented higher scores in Impulse on the DERS (M = 11.67, SD = 5.05) and a more cognitive/abstract narration (Reflection IREF M = 0.0260, SD = 0.0071; Reorganization IWRRL M = 0.5419, SD = 0.0032; Referential Activity IWRAD M = 0.4978, SD = 0.0029). This study aims to take the work context into consideration to create focused interventions.

Playing remotely in times of crisis: A program to overcome social isolation

OBJECTIVES

This study aims to examine the feasibility of an intergenerational remote intervention program designed to promote the wellbeing and social connection of vulnerable older adults, mainly people with aphasia and dementia during the COVID-19 pandemic in the south of Brazil. Undergraduate students were guided to lead weekly sessions of clowning, storytelling, dancing, and cooking-related activities for 3 months (from November/2020 to February/2021).

METHOD

The mixed-method design of the study addresses the implementation and feasibility of the program. Data analysis considered both quantitative-number of individuals who accepted the invitation to participate, voluntary dropouts, attendance-and qualitative data-participative observation and thematic analysis of evaluative conversations. An inclusive group of 34 older adults with stroke-induced cognitive impairments, dementia and individuals without any neurological conditions enrolled in the program based on social and racial equity principles. Feasibility and acceptability were addressed in terms of recruitment, implementation, remote evaluation, delivery of remote intervention, adherence, and attendance. Activities and participants' perceptions are described.

RESULTS

The initial period of the program achieved 83.7% of adherence and sustainability for additional 3 months. Preliminary results suggest feasibility and acceptability, considering formal and informal support in digital inclusion. Participatory observations describe that the structure of sessions and activities were well received. The analysis of participants' perceptions detects the thematic saliency of feelings of social connection and a sense of having learned with the group.

CONCLUSIONS

Preliminary results of this study demonstrate the feasibility and acceptability of the program, pointing to its potential mental health benefits.

Management of frailty under COVID-19 pandemic in Japan

Frailty prevention is a cornerstone for the extension of healthy life expectancy. It is a multi-dimensional construct that includes physical, mental, and social aspects. Frailty is reversible and can be attenuated by intervention; therefore, its early detection is important in primary and community care. The mainstream of disability prevention in Japan, which comprises the Japanese and local governments as well as healthcare workers, was a high-risk approach until 2014. Given the revision on Japan's long-term care insurance law, current ageing health policies have shifted to more population centric approach. Implements group activities called "Kayoi-no-ba" has been valued in Japan as disability prevention initiative. The Kihon Checklist - a 25-item questionnaire - has been broadly used by health experts and researchers to assess frailty in Japan. However, a new 15-item questionnaire has been newly developed to identify frailty and other health-related problems in older people of 75 years and above. This will enable providing the necessary support to frail individuals at any healthcare facility in local communities. The increase in frailty prevalence in older people has been concern during the COVID-19 pandemic. Home-based physical exercise programs are expected to be effective for frailty prevention. Utilization of information and communication technologies, social network services, and video calls has attracted attention for being effective tools to facilitate communication for older people during the pandemic. Further, life course approaches are needed to clarify the midlife risk of frailty development in later life.

COVID-19 and the golden years

ABSTRACT

The impact of COVID-19 on older adults may not be readily apparent. Personal protective and social distancing measures can reduce activity levels, increase feelings of isolation and loss, and result in lapsed medical care. NPs must recognize detrimental impacts on overall health and wellness and assist older adults in overcoming them.

Home Confinement in Previously Active Older Adults: A Cross-Sectional Analysis of Physical Fitness and Physical Activity Behavior and Their Relationship With Depressive Symptoms

AIM

The aim of our study was to analyze physical activity levels, sitting time, physical fitness, and their relationship with depressive symptoms after home confinement in previously active older adults.

METHODS

This cross-sectional study sample comprised 68 older adults (74.24 ± 5.67 years) from a community-based exercise program conducted in Porto, Portugal. After home confinement, participants were assessed in person for lower-body strength (30-s chair stand test), cardiorespiratory fitness (6-min walking test), agility/dynamic balance (8-ft up-and-go test), handgrip strength, and anthropometry. Telephone interviews were performed to evaluate depressive symptoms with the Geriatric Depression Scale - 15 items (GDS-15) and physical activity levels through the International Physical Activity Questionnaire (IPAQ-SV). Individuals were also asked to self-report changes in their physical activity levels and time spent sitting.

RESULTS

Ninety percent of older adults self-reported a decrease in overall physical activity levels, and nearly 65% increased daily sitting time during the home confinement. However, previously active older adults still presented high levels of physical fitness (scores above 50th compared with Portuguese normative values) after 11 weeks of home confinement. Overall, 52.9% of participants scored 5 or more points on GDS-15, which is suggestive of depression. Higher levels of moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness were found in the non-depressed group compared with the depressed group. Finally, results from multiple regression analysis revealed that MVPA was negatively associated with depression. This model explained 16.4% of the variability seen in depression score, controlled for age, gender, and education.

CONCLUSION

Even reporting a decline in physical activity, older adults who previously participated in a formal exercise program, still presented high levels of physical fitness after 11 weeks of home confinement. However, MVPA, but not physical fitness, seems to be an associated depression score in previously active older adults. These results reinforce the importance of older adults to remain physically active, since higher levels of MVPA may have a protective effect on depressive symptoms and, therefore, mitigate the negative impact of home confinement on mental health. Future longitudinal research studies are needed to ascertain these results.

Active Older Adults Keep Aerobic Capacity and Experience Small Reductions in Body Strength During Confinement Due to COVID-19 Outbreak

The objective of this study was to observe the home-confinement effects on physical fitness, physical activity (PA), and body composition in active older adults, and to compare physical fitness and PA according to quality of life (QoL) during confinement. A total of 72 physically active older adults (61.1% females; 74.24 ± 5.57 years) were assessed pre- and postconfinement for aerobic capacity (6-min walk test), lower (30-s sit-to-stand), and upper (30-s arm-curl) body strength, PA (short-version of the International Physical Activity Questionnaire), and QoL (EQ-5D-visual analogue scale). The pre- and postconfinement comparisons show declines in upper (-2.24 ± 0.45 repetitions; p < .001; η2 = .276) and lower body strength (-2.65 ± 0.42 repetitions; p < .001; η2 = .378) in both genders, but not in aerobic capacity. Ninety percentage of older adults perceived a decline in PA. Older adults reporting high QoL increased 19.27 ± 97.04 m in the 6-min walk test, while the participants with low QoL reduced 28.32 ± 63.27 m (p = .018; η2 = .090). Previously active older adults did not have their aerobic capacity decrease significantly despite a decline in upper and lower body strength during an 11-week home confinement period.

Diagnosis and Management of Cognitive Concerns in the Oldest-Old

Purpose of review

The fastest-growing group of elderly individuals is the "oldest-old," usually defined as those age 85 years and above. These individuals account for much of the rapid increase in cases of dementing illness throughout the world but remain underrepresented in the body of literature on this topic. The aim of this review is first to outline the unique contributing factors and complications that must be considered by clinicians in evaluating an oldest-old individual with cognitive complaints. Secondly, the evidence for management of these cognitive concerns is reviewed.

Recent findings

In addition to well-established associations between impaired cognition and physical disability, falls, and frailty, there is now evidence that exercise performed decades earlier confers a cognitive benefit in the oldest-old. Moreover, though aggressive blood pressure control is critical earlier in life for prevention of strokes, renal disease, and other comorbidities, hypertension started after age 80 is in fact associated with a decreased risk of clinical dementia, carrying significant implications for the medical management of oldest-old individuals. The oldest-old are more likely to reside in care facilities, where social isolation might be exacerbated by a consistently lower rate of internet-connected device use. The COVID-19 pandemic has not only highlighted the increased mortality rate among the oldest-old but has also brought the increased social isolation in this group to the forte.

Summary

Differing from the "younger-old" in a number of respects, the oldest-old is a unique population not just in their vulnerability to cognitive disorders but also in the diagnostic challenges they can pose. The oldest-old are more likely to be afflicted by sensory deficits, physical disability, poor nutrition, frailty, and depression, which must be accounted for in the assessment of cognitive complaints as they may confound or complicate the presentation. Social isolation and institutionalization are also associated with impaired cognition, perhaps as sequelae, precipitants, or both. Ante-mortem diagnostic tools remain particularly limited among the oldest-old, especially given the likelihood of these individuals to have multiple co-occurring types of neuropathology, and the presence of neuropathology in those who remain cognitively intact. In addition to the symptomatic treatments indicated for patients of all ages with dementia, management of cognitive impairment in the oldest-old may be further optimized by use of assistive devices, augmentation of dietary protein, and liberalization of medication regimens for risk factors such as hypertension.

Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline

Background: The recent COVID-19 pandemic is not only a major healthcare problem in itself, but also poses enormous social challenges. Though nursing homes increasingly receive attention, the majority of people with cognitive decline and dementia live at home. We aimed to explore the psychosocial effects of corona measures in memory clinic (pre-)dementia patients and their caregivers. Methods: Between April 28th and July 13th 2020, n = 389 patients of Alzheimer center Amsterdam [n = 121 symptomatic (age = 69 ± 6, 33%F, MMSE = 23 ± 5), n = 268 cognitively normal (age = 66 ± 8, 40% F, MMSE = 29 ± 1)] completed a survey on psychosocial effects of the corona measures. Questions related to social isolation, worries for faster cognitive decline, behavioral problems and discontinuation of care. In addition, n = 147 caregivers of symptomatic patients completed a similar survey with additional questions on caregiver burden. Results: Social isolation was experienced by n = 42 (35%) symptomatic and n = 67 (25%) cognitively normal patients and two third of patients [n = 129 (66%); n = 58 (75%) symptomatic, n = 71 (61%) cognitively normal] reported that care was discontinued. Worries for faster cognitive decline were existed in symptomatic patients [n = 44 (44%)] and caregivers [n = 73 (53%)], but were also reported by a subgroup of cognitively normal patients [n = 27 (14%)]. Both patients [n = 56 (46%) symptomatic, n = 102 (38%) cognitively normal] and caregivers [n = 72 (48%)] reported an increase in psychological symptoms. More than three quarter of caregivers [n = 111(76%)] reported an increase in patients' behavioral problems. A higher caregiver burden was experienced by n = 69 (56%) of caregivers and n = 43 (29%) of them reported that a need for more support. Discontinuation of care (OR = 3.3 [1.3-7.9]), psychological (OR = 4.0 [1.6-9.9]) and behavioral problems (OR = 3.0 [1.0-9.0]) strongly related to experiencing a higher caregiver burden. Lastly, social isolation (OR = 3.2 [1.2-8.1]) and psychological symptoms (OR = 8.1 [2.8-23.7]) were red flags for worries for faster cognitive decline. Conclusion: Not only symptomatic patients, but also cognitively normal patients express worries for faster cognitive decline and psychological symptoms. Moreover, we identified patients who are at risk of adverse outcomes of the corona measures, i.e., discontinued care, social isolation, psychological and behavioral problems. This underlines the need for health care professionals to provide ways to warrant the continuation of care and support (informal) networks surrounding patients and caregivers to mitigate the higher risk of negative psychosocial effects.

The Effects of COVID-19 Home Confinement in Dementia Care: Physical and Cognitive Decline, Severe Neuropsychiatric Symptoms and Increased Caregiving Burden

PURPOSE

This study aims to analyze home confinement impact on individuals with neurocognitive disorders (NCD) through informal caregiver's perspective and examine how it has affected caregiving burden.

METHODS

Thirty-six caregivers (64.94 ± 13.54 years, 41.7% female) of individuals with NCD (74.28 ± 6.76 years, 66.7% female) selected from the Body & Brain exercise program were interviewed over the phone. The following instruments were used: Barthel Index (BI) to assess care recipients' ability to function independently on activities of daily living (ADL), the Neuropsychiatric Inventory (NPI) to evaluate neuropsychiatric symptoms, and the CarerQol-7D/ CarerQol-VAS to determine caregiver subjective burden/well-being.

RESULTS

Pre and post-confinement comparisons showed that care recipients significantly declined their independence in ADL (p = 0.003) and increased NPI total score (MD = 5.72; 95% CI: 1.19 to 10.25, p = 0.015). As for caregivers, results also showed an increased caregiving burden (MD = -0.17; 95% CI: -0.27 to -0.08; p = 0.001) and a decline in their well-being (p = 0.015).

DISCUSSION

COVID-19 crisis sheds light on how imperative it is to find solutions and design contingency plans for future crisis, in order to ensure properly sustained support to dementia caregiving dyads and mitigate caregivers' burden.