COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators

Mediating effect of social support and resilience between loneliness and depression in older adults: A systematic review and meta-analytic structural equation modeling

BACKGROUND

Loneliness is a powerful stressor for depression in older adults, and resilience and social support may mediate this relationship, while the evidence is limited. Hence, our study aims to explore the mediating role of social support and resilience between loneliness and depression and to test possible moderators.

METHODS

We searched 12 databases without language and publish time restrictions and obtained the correlation coefficients. This review constructed two-stage meta-analytical structural equality modeling (MASEA) to test the mediating effect of social support and resilience. Additionally, use one-stage MASEA to test the moderator effect of women proportion, published year, and country of study.

RESULTS

This study included 53 studies and 40, 929 older adults. Loneliness directly affected depression (β = 0.28, 95 % CI: 0.20, 0.36). Social support (β = 0.06, 95 % CI: 0.02, 0.09) and resilience (β = 0.15, 95 % CI: 0.12, 0.18) mediated the relationship. The proportion of women in the sample was moderator (χ2(5) = 11.10, p = 0.05). When the proportion exceeded 60 %, the path coefficient of loneliness and social support (β = -0.45, SE = 0.055) was larger than that of the subgroup below 60 % (β = -0.32, SE = 0.041).

LIMITATIONS

It was indefinite whether the evidence would be supported in longitudinal designs. Influenced by the original research data, it is impossible to calculate the model parameters of gender discrepancy.

CONCLUSIONS

Health aging policy-makers adopting social support and resilience intervention will help strengthen the coping skills of older adults confronting loneliness and reduce the risk of depression.

Association between perceived stress, loneliness and sleep disorders among breast cancer patients: the moderating roles of resilience

Sleep disorders are prevalent and often neglected among breast cancer patients. This study aimed to identify the association among perceived stress, loneliness, resilience and sleep disorders and to further explore whether resilience could be a moderator in the association between them and sleep disorders. A cross-sectional study was conducted by 492 female breast cancer patients. Patients were asked in response to the questionnaires including the Pittsburgh Sleep Quality Index, Perceived Stress Scale-10, the Three-Item Loneliness Scale and Resilience Scale-14. The association among perceived stress, loneliness, resilience and perceived stress/loneliness × resilience interaction with sleep disorders were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis. 36.58% of the female breast cancer patients reported sleep disorders in our study. Perceived stress and loneliness were related to sleep disorders. Resilience could moderate the relationship between them and sleep disorders. When resilience was higher, perceived stress and loneliness had a weaker impact on sleep disorders. Medical staff should systematically evaluate the internal environmental factors related to patients' sleep quality and help patients relieve their emotional distress caused by the disease through positive psychological guidance.

Describing Psychiatric Symptoms Experienced by Older Adults in a Skilled Nursing Facility During the COVID-19 Pandemic

There is limited investigation about psychiatric symptoms experienced by older adults with mental health conditions or neurocognitive ones residing in a skilled nursing facility during the COVID-19 pandemic. The objective of this descriptive-design study was to describe the psychiatric symptoms from the year before COVID-19 pandemic to the 1st year of the pandemic for older adults with a mental health condition or a neurocognitive one residing in a skilled nursing facility. A database (n = 84) was established from the extraction of already collected data on the assessment of older adults (n = 84) with mental health conditions or neurocognitive ones living in one skilled nursing facility. The timeframe was from March 1, 2019 to February 28, 2021, eight quarters of extracted data. Psychiatric symptoms were impaired decision making, altered level of consciousness, disorganized thinking, understanding or comprehension, disruptive behaviors, delirium, delusions, hallucinations, inattentiveness, impaired cognition, and depression. Data were analyzed with descriptive statistics. Participants had a mean age of 74.2 ± 10.8. A description of the psychiatric symptoms over the 2 years was a decrease in the level of understanding along with an increase in delusions, disruptive behaviors (physical and verbal), impaired decision making, cognitive impairment, and inattentiveness. The findings focus on the description of the psychiatric symptoms associated with the COVID-19 pandemic. These findings relate to the first step to address a gap in the literature about psychiatric symptoms and COVID-19 for nursing home residents. Future longitudinal and multisite studies are warranted to expound on these findings and the described psychiatric symptoms over time.

Sleep disorders during the COVID-19 pandemic: Results from the second phase of web-based EPICOVID19 study

The COVID-19 pandemic has induced significant impairments, including sleep disturbances. The present study aimed to explore the impact of fear in relation to stress on sleep disorders among Italian adults and older participants in the second phase of the EPICOVID19 web-based survey (January-February 2021). Sleep disturbances during the pandemic were evaluated using the Jenkins Sleep Scale, perceived stress through the 10-item Perceived Stress Scale and fear of contagion and about economic and job situation with four ad hoc items. The strength of the pathways between stress, sleep disturbances and fear was explored using structural equation modelling, hypothesising that stress was related to sleep disturbances and that fear was associated with both stress and sleep problems. Out of 41,473 participants (74.7% women; mean age 49.7 ± 13.1 years), 8.1% reported sleep disturbances and were more frequently women, employed in a work category at risk of infection or unemployed, and showed higher deprivation scores. Considering an a priori hypotheses model defining sleep and stress scores as endogenous variables and fear as an exogenous variable, we found that fear was associated with sleep problems and stress, and stress was associated with sleep problems; almost half of the total impact of fear on sleep quality was mediated by stress. The impact of stress on sleep quality was more evident in the younger age group, among individuals with a lower socioeconomic status and healthcare workers. Fear related to COVID-19 seem to be associated with sleep disturbances directly and indirectly through stress.

Household and housing determinants of sleep duration during the COVID-19 pandemic: Results from the COHESION Study

BACKGROUND

Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19.

METHODS

Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender.

RESULTS

Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income.

CONCLUSION

Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.

Effect of Physical Activity on Association between COVID-19 and Personal Life in Community-Dwelling Older Adults

Our study investigated whether changes in physical activity due to COVID-19 mediate the association between quarantine or hospitalization due to COVID-19 and COVID-19 life impact score. A total of 154 participants (0.23%) were quarantined or hospitalized due to COVID-19. There were mediating effects of changes in physical activity due to COVID-19 (β = -1.63, 95% confidence interval = -0.77 to -2.42). This study suggests that measures to minimize lifestyle changes during the pandemic are required to reduce negative consequences.

Pandemic policies and sleeping problems in older adults

Sleep quality is fundamental to physical and mental health. Recent research shows that the COVID-19 pandemic has affected individuals' sleep quality. This study aims to investigate whether the containment and health policies (Oxford Coronavirus Government Response Tracker indexes) adopted by European countries and Israel during the pandemic are related to sleep problems in people aged 50 and over. A cross-sectional study was conducted using a logistic regression analysis based on data from the Survey of Health, Ageing and Retirement in Europe, collected in 27 European countries and Israel, in 2021. The results show that containment and health policies affect older adults' sleep, once we neutralise the influence of the sociodemographic, economic, and health characteristics of the individuals and close contact with COVID-19. In fact, the more containment and health policies, the fewer chances of sleep problems. A possible explanation for this is that these policies give people over 50 a sense of safety and security in relation to COVID-19, which may reduce sleep problems.

Does Including Facebook Training Improve the Effectiveness of Computerized Cognitive Training? A Randomized Controlled Trial

OBJECTIVE

To determine whether implementing a Facebook training program improves the effectiveness of computerized cognitive training (CCT) in older adults.

DESIGN

Randomized, controlled, double single-blind trial with parallel groups.

SETTING

Community centers.

SUBJECTS

Eighty-six adults between 60 and 90 years old.

INTERVENTIONS

Nine face-to-face 60-min sessions of CCT with VIRTRAEL for all participants. The experimental group received an additional 30 min of Facebook training per session.

MAIN MEASURES

Attention (d2 Test of Attention); learning and verbal memory (Hopkins Verbal Learning Test-Revised); working memory (Letter-Number Sequencing test), semantic and abstract reasoning (Similarities and Matrix Reasoning tests); and planning (Key Search test).

RESULTS

There was a significant Group*Time interaction in the Hopkins Verbal Learning Test-Revised-Trial 3, Letter-Number sequencing, and Matrix tests. Between groups, post-hoc analyses showed a difference in Matrix reasoning (p < .001; d  =  0.893) at post-intervention in favor of the experimental group. Significant main effects of time were found in the CCT group between baseline and 3-month follow-up for Concentration (F  =  26.431, p ≤ .001), Letters and Numbers (F  =  30.549, p ≤ .001), Learning (F  =  38.678, p ≤ .001), Similarities (F  =  69.885, p ≤ .001), Matrix (F  =  90.342, p ≤ .001), and Key Search (F  =  7.904, p  =  .006) tests.

CONCLUSIONS

The utilization of CCT with VIRTRAEL, a freely accessible tool with broad applicability, resulted in enhanced attention, verbal learning, working memory, abstract and semantic reasoning, and planning among older adults. These improvements were sustained for at least three months post-training. Additional training in Facebook did not enhance the effectiveness of CCT.

Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak

The COVID-19 pandemic posed an unprecedented challenge to public well-being, necessitating an examination of its health impact. This review discusses the relationship between pandemic-induced stressors and individual sleep patterns and quality. The pandemic stressors include lockdown or physical distancing measures, direct virus exposure, and the dissemination of misinformation and disinformation. The pandemic led to delayed sleep-wake cycles, except for healthcare professionals, and worsened sleep quality. The prevalence of insomnia was higher for women due to pre-existing conditions and susceptibility stressors such as lockdown stress and family responsibilities. Healthcare professionals, who experienced worsened work conditions during the pandemic, reported higher rates of insomnia and sleep difficulties due to infection anxiety and post-traumatic stress from direct virus exposure. For the general population, stress stemmed from social isolation under lockdown and overwhelming false information available online, resulting in sleep problems. Taken together, the findings highlight the importance of promoting social interactions, providing psychological support services, and caution in navigating health information. In summary, this review underscores the need for individual- and group-centered approaches in ongoing research and interventions to address pandemic-related stress and sleep issues during COVID-19.

Associations among loneliness, internal locus of control and subjective accelerated ageing in older adults who received the booster vaccination

BACKGROUND

A rise in loneliness among older adults since the COVID-19 outbreak, even after vaccination, has been highlighted. Loneliness has deleterious consequences, with specific effects on perceptions of the ageing process during the COVID-19 pandemic. Coping with stressful life events and the challenges of ageing may result in a perception of acceleration of this process.

AIM

Studies have shown a buffering effect of an internal locus of control in the relationship between COVID-19 stress and mental distress. The current study examined whether loneliness predicts subjective accelerated ageing and whether internal locus of control moderates this relationship.

METHOD

Two waves of community-dwelling older adults (M = 70.44, s.d. = 5.95; age range 61-88 years), vaccinated three times, were sampled by a web-survey company. Participants completed the questionnaire after the beginning of the third vaccination campaign and reported again 4 months later on loneliness, internal locus of control and subjective accelerated ageing level in the second wave.

RESULTS

Participants with higher levels of loneliness presented 4 months later with higher subjective accelerated ageing. Participants with a low level of internal locus of control presented 4 months later with high subjective accelerated ageing, regardless of their loneliness level. Participants with a high level of internal locus of control and a low level of loneliness presented with the lowest subjective accelerated ageing 4 months later.

CONCLUSIONS

The findings emphasise the deleterious effects of loneliness and low internal locus of control on older adults' perception of their ageing process. Practitioners should focus their interventions not only on loneliness but also on improving the sense of internal locus of control to improve subjective accelerated ageing.

Bedtime procrastination related to loneliness among Chinese university students during post-pandemic period: a moderated chain mediation model

BACKGROUND

This study examined the relationship between loneliness and bedtime procrastination among Chinese university students, the mediating effects of COVID-19 risk perception and self-regulatory fatigue, and connectedness to nature's protective role, post pandemic.

METHODS

We recruited 855 students to complete the Loneliness, Perceived Risk of COVID-19 Pandemic, Self-Regulatory Fatigue, Bedtime Procrastination, and Connectedness to Nature Scales. Data for descriptive statistics, correlation analysis, and moderated chain mediation effects were analyzed using SPSS 24.0 and process 3.5 macros.

RESULTS

Loneliness positively correlated with bedtime procrastination, COVID-19 risk perception mediated the impact of loneliness on bedtime procrastination, self-regulatory fatigue mediated the effect of loneliness on bedtime procrastination, and COVID-19 risk perception and self-regulatory fatigue mediated the effect between loneliness and bedtime procrastination. Furthermore, connectedness to nature mediated the impact of COVID-19 risk perception on self-regulatory fatigue.

CONCLUSIONS

The results indicate the effects and potential mechanisms of loneliness on bedtime procrastination after the relaxation of the pandemic prevention and control policy in China from the perspective of self-regulatory resources and provide insights into improving university students' sleep routine and mental health post pandemic.

Subjective Nearness-to-Death and COVID-19 Worries Among Ultra-Orthodox Jews in Israel: The Moderating Role of Israeli Identity and Sense of Community

The Ultra-Orthodox community in Israel is characterized by close everyday contact and a strong sense of community. While the COVID-19 pandemic has resulted in global uncertainty, fear, and fatalities, this group was particularly affected by the pandemic. Accordingly, the current study examines whether subjective nearness-to-death was associated with increased COVID-19 concerns, and whether Israeli identity and sense of community moderate this association. Data were gathered from 255 Israeli Ultra-Orthodox Jews, and results yielded a significant link between subjective nearness-to-death and COVID-19 worries, moderated by both moderators. Results are discussed in line with terror management theory, and theoretical/practical implications are suggested.

Stop (to Work) and Go (to Recover) During Mandatory Work From Home: A Three-Wave Study

During the COVID-19 pandemic, many workers have been forced to work from home. In this situation, the boundaries between work and private life have become particularly blurred, and recovering from work was even more difficult than in traditional times, with negative consequences for workers' health. Among the psychological experiences that might underlie the recovery process, mastery played a crucial role as people sought new stimuli and challenging situations. However, there are few articles that have explored the role of this specific recovery experience, its antecedents, and the health consequences under conditions of work from home. Therefore, in this multiwave study, we aimed to investigate the role of mastery as a mediator between supervisor support and insomnia problems. The study was conducted during the COVID-19 pandemic in Italy and had a three-wave design. A convenience sample of 130 employees (67% women) completed an online questionnaire. Hypotheses were tested using a three-wave autoregressive cross-lagged panel model. According to the results, supervisor support at Time 1 was positively related to mastery at Time 2, which in turn showed a negative association with insomnia at Time 3. The results demonstrated that mastery experiences have played a crucial role during COVID-19 mandatory work from home, which points to some potential implications for workers' health in the adoption of teleworking beyond the emergency situation.

Well-being therapy and sleep hygiene in a non-clinical population of adults reporting poor sleep quality and distress: A remote pilot randomized controlled study

OBJECTIVES

This pilot randomized controlled study evaluates the feasibility and preliminary efficacy of a 7-week remote intervention combining well-being therapy and sleep hygiene to improve sleep and psychological outcomes among adults reporting poor sleep and distress.

METHODS

Thirty-one participants (81% women, 40.2 ± 13.0 y, 48% racial/ethnic minority) were recruited from the community during the COVID-19 pandemic through online and local advertisement, and randomized to well-being therapy+sleep hygiene or sleep hygiene-only. Study outcomes were evaluated by self-reported questionnaires administered at baseline and post-intervention and a daily sleep diary.

RESULTS

Compared to sleep hygiene-only, well-being therapy+sleep hygiene led to greater improvements in wake after sleep onset (time-by-group interaction: 3.6 ± 1.5 min, p = .017), personal growth (β -3.0, 95%CI -5.2, -0.8, p = .01), and purpose in life (β -3.5, 95%CI -6.1, -0.9, p = .009). Anxiety, perceived stress, sleep quality, and insomnia symptoms improved similarly in both groups (between-group differences, p > .05). Improvements in sleep quality, insomnia, and sleep duration were associated with reductions in multiple measures of psychological distress (all p < .05).

CONCLUSIONS

These findings suggest that, in a non-clinical setting of individuals suffering from combined poor sleep and psychological distress, the addition of well-being therapy to sleep hygiene may provide additional benefits for sleep by promoting sleep continuity and well-being.

Impact of COVID-19 infection experience on mental health status of intensive care unit patients' family members: a real-world study

PURPOSE

Family members of patients hospitalized in intensive care unit (ICU) are susceptible to adverse psychological outcomes. However, there is a paucity of studies specifically examining the mental health symptoms in ICU patients' family members with a prior history of coronavirus disease 2019 (COVID-19) infection.

AIM

This study aimed to investigate mental health status and its influencing factors of ICU patients' family members with previous COVID-19 infection experience in China.

DESIGN

Nationwide, cross-sectional cohort of consecutive participants of family members of ICU patients from 10 provinces randomly selected in mainland China conducted between October 2022 and May 2023.

METHODS

The basic information scale, Self-rating depression scale, Self-rating Anxiety Scale, Impact of Event Scale-Revised, Pittsburgh sleep quality index, Perceived Stress Scale, Connor-Davidson resilience scale, Simplified Coping Style Questionnaire were employed to explore mental health status among participants.

RESULTS

A total of 463 participants, comprising 156 individuals in Covid-19 family member cohort (infection group) and 307 individuals in control family member cohort (control group), met inclusion criteria. The infection group exhibited significantly higher incidence of composite mental health symptoms compared to control group (P = 0.017). Multivariable logistic regression analysis revealed that being female, engaging in physical/mental labor, residing in rural areas, and having children were identified as risk factors for the development of depression, anxiety, and post-traumatic stress disorder symptoms, while medical history of surgery was protective factor. A predictive model demonstrated a favorable discriminative ability and excellent calibration.

CONCLUSION

COVID-19 infection experience regarded as new traumatic stressors worsen mental health status of ICU patients' family members.

Exploratory graph analysis on the Connor-Davidson Resilience Scale (CD-RISC) among older adults in China

It is important for healthy aging to understand resilience in depth. This study aims to examine the dimensional structure underlying the Connor-Davidson Resilience Scale (CD-RISC) among Chinese older adults. Exploratory Graph Analysis (EGA) was used to evaluate the dimensional structure of CD-RISC in two large samples: training sample (n = 11,493) and cross-validation sample (n = 7662). Then, Confirmatory Factor Analysis (CFA) was used to compare the fit of the theoretical dimensions with the EGA dimensions. Finially, Generalized Linear Model was used to examine the association between resilience scores and self-rated health (SRH) after controlling other covariates in order to evaluate the predictive value of the EGA dimensions. The EGA indicated two demensions(named foresight and self-adjustment) of the 25-item CD-RISC. The CFA comparison found that the two-demension structure of CD-RISC fit significantly better than the theoretical three-demension structure. After controlling for sociodemographic characteristics, generalized linear model showed that the EGA dimensions has better protective value with SRH. Compared with older adults with lowest quartile of foresight, those with second (odds ratio, OR = 0.68, 95% CI = 0.62 ~ 0.75), third (OR = 0.50, 95% CI = 0.45 ~ 0.56) and fourth quartile (OR = 0.42, 95% CI  =  0.37 ~ 0.48) of foresight had lower odds ratio of poor SRH. Similarly, older adults with the second (OR = 1.11, 95% CI = 1.01 ~ 1.23) and fourth (OR = 0.79, 95% CI = 0.69 ~ 0.90) quartile of self-adjustment also had lower OR of poor SRH than those with lowest quartile of self-adjustment. These findings show that EGA outperforms the traditional methods, which may be helpful to understand resilience deeply. CD-RISC should be interpreted into two aspects among community-dwelling older adults in China, highlighting the significance of the practical value and cultural context of resilience.

Association of COVID-19 Infection with Sociodemographic, Anthropometric and Lifestyle Factors: A Cross-Sectional Study in an Older Adults' Population Aged over 65 Years Old

BACKGROUND

The COVID-19 pandemic has led to unfavorable disruptions to daily living routines by exerting deleterious effects on several aspects of human mental and physical health and quality of life worldwide. The purpose of the current survey is to explore the potential association of COVID-19 infection with multiple sociodemographic, anthropometric, and lifestyle factors of community-dwelling older adults.

METHODS

This is a cross-sectional survey including 5197 older adults aged over 65 years old from 10 geographically diverse regions of Greece. Relevant questionnaires were used to record study the population sociodemographic factor, while anthropometric parameters were also measured. Validated questionnaires were also applied to assess several lifestyle factors such as depression, anxiety, stress, cognitive status, sleep quality, health-related quality of life, physical activity levels, and Mediterranean diet (MD) adherence.

RESULTS

In multivariate regression analysis, COVID-19 infection was significantly, independently related with urban residence (p = 0.0107), regular smoking (p = 0.0218), overweight status and obesity (p = 0.0036), as well as abdominal obesity (p = 0.0008), higher risk of depression (p = 0.0027), anxiety (p = 0.0045), stress (p = 0.0038), inadequate sleep quality (p = 0.0108), lower physical activity levels (p = 0.0012), reduced MD compliance (p = 0.0009), and poor health-related quality of life (p = 0.0002). In univariate analysis, older adults' age (p = 0.0001), male gender (p = 0.0015), living alone (p = 0.0023), lower educational and economic level (p = 0.0175 and p = 0.0294, respectively), and cognition decline (p = 0.0032) were also related with the presence of COVID-19 infection; however, these associations were considerably attenuated at a non-significant level by adjustment for several confounders in multivariate analysis.

CONCLUSIONS

This is one of the few available studies supporting evidence that COVID-19 infection may be associated with diverse sociodemographic, anthropometric, and lifestyle factors in an older adults' population in Greece. This study highlights the strong demand to provide psychological and nutritional counselling and support to older adults diagnosed with COVID-19 infection in order to ameliorate disease symptoms and severity, emphasizing the adaptation of healthy dietary and lifestyle habits as preventing and supplementary therapeutic factors against COVID-19.

Trend in loneliness among Swiss university students during the first year of the COVID-19 pandemic

BACKGROUND

The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic.

PARTICIPANTS AND PROCEDURE

This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests.

RESULTS

Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health.

CONCLUSIONS

Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students' loneliness and well-being.

Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic

Since the outbreak of COVID-19, restrictions to minimize its spread have had a profound effect. Government instigated restrictions, such as social isolation, have affected millions worldwide, and the downstream consequences of perceived loneliness upon mental health and sleep are largely unknown. A total of 1662 individuals participated in an online survey. Loneliness, anxiety, and sleep quality were assessed using the UCLA Loneliness Scale, the Generalized Anxiety Disorders scale, and the Pittsburgh Sleep Quality Index, respectively. Higher levels of perceived loneliness, as well as each one-unit increase in anxiety, were independent predictors of poor sleep quality, where OR = 1.16 (95% CI: 1.03-1.31) and 1.16 (1.11-1.21), respectively, and after adjustment. In our path analysis, we revealed significant direct effects between loneliness and sleep quality (β = 0.25, p < .001), as well as generalized anxiety and sleep quality (β = 0.28, p < .001), and generalized anxiety mediated the relationship between loneliness and sleep quality (β = 0.33, p < .001). Heightened anxiety and perceived loneliness appear to be significant drivers of poor sleep quality during the COVID-19 pandemic. Digital media platforms that encourage support groups for those experiencing social isolation are encouraged, along with self-help and meditative practices, which may minimize an increase of mental health and sleep disorder diagnoses post COVID-19.

Association between COVID-19 and sexual health: an umbrella review

PURPOSE

We conducted this umbrella review to review the current evidence on the relationship between COVID-19 and sexual health in both men and women.

METHODS

We conducted searches in Pubmed, Embase, and the Cochrane dataset for meta-analyses that met our pre-set inclusion criteria. We included studies with detailed information investigating the link between COVID-19 and sexual health in men/women. We did not limit the language.

RESULTS

The results of the included studies frequently relied on the Female Sexual Function Index to assess sexual health in women. For men, the International Index of Male Function and hospital diagnoses were commonly used to assess sexual health. Currently, there is conflicting evidence regarding the impact of COVID-19 on sexual health. However, since most studies were observational in nature, additional study designs are necessary to draw definitive conclusions across different contexts.

CONCLUSION

Our findings highlight the importance of sexual health among COVID-19 patients and people affected due to COVID-19. Further critical studies should investigate the mechanism underlying the association between COVID-19 and sexual health.

A longitudinal examination of the protective effect of resilience against anxiety among older adults with high COVID-related worry

This longitudinal study of community dwelling older adults (N = 453) examined consequences of COVID-related worries on changes in anxiety symptoms before relative to during the pandemic. We further evaluated if pre-COVID psychological resilience (PR) buffered the impact of COVID-related worry. Pre-COVID data were collected in September 2018. COVID-related worry and COVID anxiety symptoms were collected in October 2020 (Wave 2). Controlling for pre-COVID anxiety symptoms, we examined if COVID-related worries (e.g. I'm worried that I might die from COVID-19) were associated with increased anxiety symptoms, and whether pre-COVID PR moderated the association between COVID-related worries and prospective increases in anxiety symptoms. COVID-related worries were associated with increased anxiety symptoms (β = 0.005, p < .01), whereas pre-COVID PR was associated with a decrease in anxiety symptoms (β = -0.029, p < .05). PR moderated the association; COVID-related worries were associated with greater increases in anxiety symptoms among those with low pre-COVID PR (Model η2 = 0.35). Thus, the extent to which COVID-related worries influenced psychological health was dependent on pre-COVID levels of PR. We conclude the combined vulnerabilities of low pre-COVID PR and high COVID-related worries significantly increased the psychological consequences of COVID-19 for our sample of older adults.

Psychosocial and health stressors during the COVID-19 pandemic and their association with sleep quality

OBJECTIVE

We investigated how psychosocial and health stressors and related cognitive-affective factors were differentially associated with sleep quality during the early months of the COVID-19 pandemic.

METHODS AND MEASURES

Adults living in Florida (n = 2,152) completed a Qualtrics survey in April-May 2020 (Wave 1). Participants (n = 831) were reassessed one month later (Wave 2; May-June 2020). At Wave 1, participants reported their level of physical contact with someone they care about, presence of a pre-existing chronic disease, employment status, loneliness, health worry, and financial distress. At Wave 2, participants rated their quality of sleep and insomnia symptoms.

RESULTS

Loneliness, but not health worry or financial distress, directly predicted worse sleep quality. Lack of physical contact was indirectly associated with worse sleep quality via greater levels of loneliness. Further, results showed the presence of a pre-existing chronic disease was associated with both greater health worry and worse sleep quality.

CONCLUSION

Loneliness was the sole cognitive-affective predictor of worse sleep quality when controlling for other psychosocial factors. As expected, adults living with a chronic disease reported impaired sleep quality. Understanding the processes influencing sleep quality during a significant time of stress is important for identifying risk factors, informing treatment, and improving sleep health beyond the pandemic.

Bouncing back from COVID-19: a Western Australian community perspective

Introduction

This study explored the behavioral profiles of residing Western Australians during a COVID-19 lockdown period and transitions in behavior post-lockdown.

Methods

A total of 313 participants (76% female, age: M = 50.1, SD = 15.7 years) completed behavioral and mental health questionnaire items ~2 months after a 3-month COVID-19 lockdown in October 2020, using a retrospective recall to assess their experience during the lockdown period. Latent transition analysis (LTA) was used to identify behavioral profiles and transitions. Indicators were identified by assessing during-post-lockdown group differences (Kruskal-Wallis, chi-square tests) and profiles described using qualitative open-ended questions.

Results

Significant indicators included changes in physical activity, leisure screen time, alcohol intake, psychological distress, and loneliness, but not fast food consumption. The significant indicators were used to form LTA models. The five latent class model showed the best model fit (Log-likelihood = -1301.66, AIC = 426.12, BIC = 609.68). Approximately one in four participants reported a change in their behavior profiles after the lockdown ceased. Key differences between the profiles were age, household income, education, resilience, sense of control, existing mental health issues, and social relations. Washing hands and social distancing were the most recalled and effective health campaigns across the classes, with health campaigns encompassing physical activity/alcohol consumption, or domestic violence having the least attention.

Discussion

Overall, while most participants recovered relatively well after the lockdown period, LTA did identify subgroups such as those who were inactive and lonely experienced more difficulties than other groups, and engagement with public health campaigns differed. The results provide important insights for future public health campaigns on how these campaigns might be diversified to effectively target more people and particular groups to maximize engagement for maintaining people's mental health with additional focus on physical activity, alcohol consumption, and domestic violence.

Impact of the early months of the COVID-19 pandemic on the sleep patterns of a Brazilian population sample

Humanitarian and health crisis have drastic effects on the physical and mental well-being of people. The COVID-19 pandemic forced many countries to impose containment measures on its population to halt the spread of the new coronavirus (SARS-CoV-2). This aim of this study was to explore self-reported sleep quality and insomnia symptoms in a sample of the Brazilian population before and during the COVID-19 quarantine period. Our data was collected through online questionnaires, including the Pittsburgh Sleep Quality Index, the Insomnia Severity Index, and the Sleep Hygiene Index. The final sample comprised 1,109 volunteers. Generalized estimating equations (GEE) revealed that during the initial months of the COVID-19 pandemic, alterations in self-reported sleep parameters were observed in the participants. Sleep efficiency and sleep duration increased, but there was a worsening in sleep quality and an increase in symptoms related to insomnia.

Loneliness and older adults: psychological resilience and technology use during the COVID-19 pandemic-a cross sectional study

Introduction: This study investigated how psychological resilience influenced greater technology use among older adults, and whether they moderated the impact of social isolation on loneliness during the COVID-19 pandemic. We also explored whether technology mediates the impact of psychological resilience on loneliness. To explain the relationship between variables, the research drew upon the socio-emotional selective theory, which posits the notion that older adults are more focused on current and emotionally important relationships and goals concerning emotional regulation goals such as psychological well-being. Methods: Using a cross-sectional observational design, data were collected from 92 residents aged 65 to 89 in England from March 2020 to June 2021. Participants completed the Connor-Davidson Resilience Scale, Technology Experience Questionnaire, UCLA Loneliness Scale, and Lubben Social Network Index. Pearson correlation, mediation and moderation analyses were conducted to investigate the hypotheses. Results: Most participants experienced moderate to severe levels of loneliness, displaying higher levels than pre-pandemic. Psychological resilience predicted greater technology use, and lower levels of loneliness. Technology was found to mediate the relationship between psychological resilience and loneliness. Neither technology use, nor psychological resilience was found to moderate the impact of social isolation on loneliness. Discussion: Findings suggested that strategies directed towards screening older adults for psychological resilience levels and low technology experience may help identify those most at risk for adapting poorly when exposed to stressors in situations like the Covid-19 pandemic. Early interventions can be initiated to increase psychological resilience and technology use, including empirical interventions, that may help decrease loneliness, especially in times of elevated risks for loneliness.

Active and Healthy Confinement: Care Recommendations on Activity, Sleep and Relationships

Persons that lived through periods of confinement suffered an impact on their physical and mental health. The adaptation of the lifestyle in relation to activity, sleep and social relationships is key to facing these periods of confinement. The aim is to validate a series of care recommendations aimed at being able to maintain an active and healthy confinement, which serves to prepare the population for future health crises. This study is part of a general strategy based on a care recommendation guide for COVID-19. The validation was carried out by a group of experts using the Delphi technique through a questionnaire that uses the Content Validity Index (CVI) and considers high validation those with a score >0.80. A total of 75 care recommendations are proposed: 30 on activity-exercise (CVI = 0.82), 14 on sleep-rest (CVI = 0.83) and 31 on roles-relationships (CVI = 0.83). Additionally, 49 recommendations achieve high validation. The care recommendations integrate a person-centred model, which addresses individual characteristics (age, health status, professional role). An active and healthy confinement requires respecting social distance measures, maintaining a balance between physical activity and sleep, and using technologies to promote social contact, which promote well-being and avoid depression and anxiety.

Loneliness and associated factors among older adults during COVID-19 lockdown in Spain

Considering the health outcomes of loneliness, it is important to understand the effects of the COVID-19 pandemic for older adults to facilitate detection and intervention. The aim of this study was to examine loneliness among Spanish older adults during the first wave lockdown and associated factors, in comparison to younger adults. An online survey was completed by 3508 adults (401 aged 60 or above). Older adults felt higher social loneliness than younger adults, but lower emotional loneliness. Living alone, poor mental health, and poor healthy habits were related to higher loneliness for both age groups. The results suggest that loneliness should be an important factor in primary care, and prevention efforts should be taken, e.g., by generating open and safe community spaces and contexts for social interaction and promoting the access and ability to use technologies that maintain social connections.

Socioeconomic Background and Self-Reported Sleep Quality in Older Adults during the COVID-19 Pandemic: An Analysis of the English Longitudinal Study of Ageing (ELSA)

The COVID-19 pandemic negatively impacted sleep quality. However, research regarding older adults' sleep quality during the pandemic has been limited. This study examined the association between socioeconomic background (SEB) and older adults' sleep quality during the COVID-19 pandemic. Data on 7040 adults aged ≥50 were acquired from a COVID-19 sub-study of the English Longitudinal Study of Ageing (ELSA). SEB was operationalized using educational attainment, previous financial situation, and concern about the future financial situation. Sociodemographic, mental health, physical health, and health behavior variables were included as covariates. Chi-squared tests and binary logistic regression were used to examine associations between SEB and sleep quality. Lower educational attainment and greater financial hardship and concerns were associated with poor sleep quality. The relationship between educational attainment and sleep quality was explained by the financial variables, while the relationship between previous financial difficulties and sleep quality was explained by physical health and health behavior variables. Greater financial concerns about the future, poor mental health, and poor physical health were independent risk factors for poor sleep quality in older adults during the pandemic. Healthcare professionals and service providers should consider these issues when supporting older patients with sleep problems and in promoting health and wellness.

Short- and Medium-Term Effects of Ageism on Loneliness Experienced During the COVID-19 Pandemic

Loneliness, common in old age, may be partially attributed to ageism. The present study explored the short- and medium-term effect of ageism on loneliness experienced during the COVID-19 pandemic using prospective data derived from the Israeli sample of the Survey of Health, Aging and Retirement in Europe (SHARE) (N = 553). Ageism was measured before the COVID-19 outbreak and loneliness in the summer of 2020 and 2021 using a direct single question. We also tested for age differences in this association. In both the 2020 and 2021 models, ageism was related to increased loneliness. This association remained significant after adjusting for a host of demographic, health, and social variables. In the 2020 model, we also found that the positive association between ageism and loneliness was significant only in people aged 70+. We discussed the results with reference to the COVID-19 pandemic, which drew attention to two global social phenomena: loneliness and ageism.

The relationship between oral health status, loneliness, and sleep quality among the migrant elderly following children in Weifang, Shandong Province, China: A comparative analysis on different migration types

Background

The migrant elderly following children (MEFC) are a vulnerable group that emerged during fast urbanization in China. The MEFC faced physical and psychological discomfort upon their arrival in the inflow city, particularly those who came from rural areas.

Objective

This study aimed to explore the relationship between oral health status, loneliness, and sleep quality among the MEFC in China and to clarify the disparities in the above mentioned relationship by migration type.

Methods

In 2021, a cross-sectional survey was conducted in Weifang, Shandong Province, using multistage cluster random sampling to collect data from the MEFC aged 60 years and over. In total, 613 respondents [525 rural-to-urban (RTU) and 88 urban-to-urban (UTU)] were included in the final database. The chi-square test, t-test, and structural equation modeling (SEM) were used to investigate the relationship between oral health status, loneliness, and sleep quality among the RTU and UTU MEFC.

Results

Total scores [mean ± standard deviation (SD)] for oral health status, loneliness, and sleep quality were 54.95 ± 6.47, 8.58 ± 3.03, and 4.47 ± 3.60, respectively. SEM revealed that, among the RTU and UTU MEFC, oral health status was positively and significantly related to sleep quality; however, the correlation was slightly stronger in the UTU MEFC. In both groups, there was a significant negative correlation between oral health status and loneliness, which was stronger in the UTU MEFC. In the RTU MEFC, a significant negative correlation between loneliness and sleep quality was observed, and in the UTU MEFC, no significant association between loneliness and sleep quality was observed.

Conclusion

The sleep quality among the MEFC in this study was higher compared to previous studies. Oral health status was negatively correlated with loneliness and positively associated with sleep quality, whereas loneliness was negatively correlated with sleep quality. These three associations differed significantly between the UTU and RTU MEFC. The government, society, and families should take measures to improve oral health and reduce loneliness among the MEFC to improve their sleep quality.

The Buffering Role of Self-compassion in the Association Between Loneliness with Depressive Symptoms: A Cross-Sectional Survey Study Among Older Adults Living in Residential Care Homes During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is an ongoing geriatric health emergency with a substantial increase in the prevalence of medical and mental health issues, particularly among older adults living in residential care homes. The knowledge of the risk and protective factors related to the psychological impact of the COVID-19 pandemic on older adults living in residential care homes is based on limited data. This study aimed to investigate whether loneliness mediates the effects of fear generated by a pandemic on depression. Additionally, we hypothesized that self-compassion moderates the effect of loneliness on depression. A sample comprised 323 older adults (females: n = 141, males: n = 182) with mean age = 74.98 years (standard deviation = 6.59, age 65-90) completed a survey comprising the Fear of COVID-19 Scale, De Jung Gierveld Loneliness Scale, the nine-item Patient Health Questionnaire, and the Self-compassion Scale. The results revealed that the total effect of fear on depression was statistically significant, with a medium effect size (Cohen's f 2 = .14) and this association was partially mediated by loneliness (β = .11, SE = .04, P < .001, t = 2.91, 95% CI 0.04-0.19). The self-compassion also moderated the loneliness effect on depression. The findings of this study support COVID-19 evidence, indicating that a greater level of fear generated by the pandemic is linked to depression and loneliness. The findings support the notion that self-compassion mitigates the adverse effects of stressful events in older adults. Customized self-compassion programs may be effective loneliness-mitigating interventions for older adults living in residential care homes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-023-01014-0.

"Be Your Own Doctor" Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study

Background and Purpose: Although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up.This study investigated TAVI patients' experiences with self-care management during the pandemic. Methods: This study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis. Results: The data were grouped under three themes: "vulnerability," "worsening of psychological condition," and "expectations." The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic. Implications for Practice: The pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.

Multimorbidity, COVID-19 and Mental Health: Canadian Longitudinal Study on Aging (CLSA) Longitudinal Analyses

OBJECTIVES

This paper examines the longitudinal effects of the COVID-19 pandemic on older adults (65+) with multimorbidity on levels of depression, anxiety, and perceived global impact on their lives.

METHODS

Baseline (2011-2015) and Follow-up 1 (2015-2018) data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit waves of the CLSA COVID-19 study (April-December, 2020) (n = 18,099). Multimorbidity was measured using: a) an additive scale of chronic conditions; and b) six chronic disease clusters. Linear Mixed Models were employed to test hypotheses.

RESULTS

Number of chronic conditions pre-pandemic was associated with pandemic levels of depression (estimate = 0.40, 95% CI: [0.37,0.44]); anxiety (estimate = 0.20, 95% CI: [0.18, 0.23]); and perceived negative impact of the pandemic (OR = 1.04, 95% CI: [1.02, 1.06]). The associations between multimorbidity and anxiety decreased during the period of the COVID-19 surveys (estimate = -0.02, 95% CI: [-0.05, -0.01]); whereas the multimorbidity association with perceived impact increased (OR = 1.03, 95% CI: [1.01, 1.05]).

CONCLUSIONS

This study demonstrates that pre-pandemic multimorbidity conditions are associated with worsening mental health.

CLINICAL IMPLICATIONS

Clinicians treating mental health of older adults need to consider the joint effects of multimorbidity conditions and pandemic experiences to tailor counseling and other treatment protocols.

Psychological Distress Among Older Adults During the First Wave of SARS-CoV-2 Pandemic: Survey of Health, Ageing, and Retirement in Europe

Objective: To investigate the individual and country-level characteristics associated with the presence and worsening of psychological distress during the first wave of the pandemic among the elderly in Europe. Methods: In June-August 2020, 52,310 non-institutionalized people aged 50+ in 27 SHARE participating countries reported whether feeling depressed, anxious, lonely, and having sleep problems. For this analysis, we combined these symptoms into a count variable reflecting psychological distress. Binary measures of the worsening of each symptom were used as secondary outcomes. Multilevel zero-inflated negative binomial and binary logistic regressions were used to assess the associations. Results: Female sex, low education, multimorbidity, fewer social contacts, and higher stringency of policy measures were associated with increased distress. The worsening of all 4 distress symptoms was associated with younger age, poor health, loss of work due to the pandemic, low social contact, and high national mortality rates from COVID-19. Conclusion: The pandemic exacerbated distress symptoms for socially disadvantaged older adults and those who were already struggling with mental health. The death toll of COVID-19 in a country played a role in symptom worsening.

Sleep quality and the evolution of the COVID-19 pandemic in five European countries

The COVID-19 pandemic has led to lifestyle changes across Europe with a likely impact on sleep quality. This investigation considers sleep quality in relation to the evolution of the COVID-19 pandemic in five European countries. Using panel regressions and keeping policy responses to COVID-19 constant, we show that an increase in the four-week average daily COVID-19 deaths/100,000 inhabitants (our proxy for the evolution of the pandemic) significantly reduced sleep quality in France, Germany, Italy, Spain, and Sweden between April 2020 and June 2021. Our results are robust to a battery of sensitivity tests and are larger for women, parents and young adults. Additionally, we show that about half of the reduction in sleep quality caused by the evolution of the pandemic can be attributed to changes in lifestyles, worsened mental health and negative attitudes toward COVID-19 and its management (lower degree of confidence in government, greater fear of being infected). In contrast, changes in one's own infection-status from the SARS-CoV-2 virus or sleep duration are not significant mediators of the relationship between COVID-19-related deaths and sleep quality.

Older Adults and Social Isolation and Loneliness During the COVID-19 Pandemic: An Integrated Review of Patterns, Effects, and Interventions

A scoping review was conducted to identify patterns, effects, and interventions to address social isolation and loneliness among community-dwelling older adult populations during the COVID-19 pandemic. We also integrated (1) data from the Canadian Longitudinal Study on Aging (CLSA) and (2) a scan of Canadian grey literature on pandemic interventions. CLSA data showed estimated relative increases in loneliness ranging between 33 and 67 per cent depending on age/gender group. International studies also reported increases in levels of loneliness, as well as strong associations between loneliness and depression during the pandemic. Literature has primarily emphasized the use of technology-based interventions to reduce social isolation and loneliness. Application of socio-ecological and resilience frameworks suggests that researchers should focus on exploring the wider array of potential pandemic age-friendly interventions (e.g., outdoor activities, intergenerational programs, and other outreach approaches) and strength-based approaches (e.g., building community and system-level capacity) that may be useful for reducing social isolation and loneliness.

Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults

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.

Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults

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.

Holistic sleep improvement strategies for frontline nurses served during a public health emergency (COVID-19) in Wuhan, China: A quasi-experimental study

AIM

To examine effects of holistic sleep improvement strategies on frontline nurses who served in Wuhan, China, during a public health emergency (COVID-19).

DESIGN

A pre-post-test design with single group was conducted with a convenience sample applied the Transparent Reporting of Evaluations with Non-randomized Designs statement.

METHODS

Fifty-two nurses were recruited from a COVID-19 designated hospital, receiving holistic sleep improvement intervention, which concentrated on scientific human resource management, comfortable sleep environment establishment, self-relaxation and self-adjustment training and humanistic care. Data was collected at baseline and 4-week follow-up post intervention using self-reported questionnaires.

RESULTS

The total score of Pittsburgh Sleep Quality Index scale was 8.69 ± 4.346 at baseline. After 4 weeks of follow-up, the score statistically significantly decreased to 7.48 ± 3.691. Subjective sleep quality (p = .016), sleep efficiency (p = .015), sleep disturbances (p = .007) were statistically significantly improved after the intervention, while there were no statistically significant differences in sleep latency (p = .205), sleep duration (p = .375), sleep medication (p = .723) or daytime dysfunction (p = .747).

The Insomnia and Loneliness of Elderly Individuals and Affecting Factors During the COVID-19 Pandemic in Turkey

This study aims to examine the loneliness and sleep problems of older people and the variables during the COVID-19 in Turkey pandemic and the variables that affect them. Snowball sampling was used in this descriptive and cross-sectional study. Google forms, personal information form, the UCLA Loneliness Scale III and the Insomnia Severity Index were used to collect data in December 2020. The questionnaire link was disseminated by e-mail and social media. By clicking the link, the participants were automatically directed to information about the study and received informed consent forms. The participants were urged to send the questionnaire to as many individuals as they could. This research was conducted with 412 participants. Education level and perceived health status affected their loneliness. The older people had loneliness and sleep problems during the COVID-19 pandemic, and these problems were affected by sociodemographic variables. Loneliness and insomnia are positively correlated, and loneliness affects the severity of insomnia.

Lifestyle pattern changes, eating disorders, and sleep quality in diabetes: how are the effects of 18 months of COVID-19 pandemic being felt?

AIMS

The pandemic resulted in a lifestyle crisis which may negatively affect patients with diabetes. Despite current knowledge, there is a lack of longitudinal studies evaluating this effect. To assess patients' perceptions about changes in lifestyle, and eating and sleeping patterns after 18 months of the COVID-19 pandemic, and to identify if aspects related to the pandemic (social distancing, COVID-19 infection, behavioral changes, and financial difficulties) are predictors of worsening in eating and sleeping parameters.

METHODS

This was a longitudinal study that followed patients with diabetes from April 2020 to July 2021 in Southern Brazil. Individuals with type 1 or type 2 diabetes, aged ≥ 18 years, were included. The outcome of this study was the assessment of daily habits during a 18-month period of the COVID-19 pandemic. Specific questionnaires were applied once participants were included in this study (3 months after the onset of the pandemic) and at the 18-month follow-up, which included the Eating Attitudes Test-26 (EAT-26), the Mini-Sleep Questionnaire (MSQ), and a specific questionnaire on diet, physical activity, and sleep pattern. Data were compared within and between groups (type 1 and type 2 diabetes), and multivariable models were used to identify subgroups of worse outcomes.

RESULTS

A total of 118 (78.6%) participants remained in the study at follow-up (mean age 54.6 ± 13.9 years, 41.3% male). In total, 33.9% of participants perceived weight gain during the pandemic, especially those with type 1 diabetes (43.1% vs 25.0% in type 2 diabetes, P = 0.04). About one in four participants reported emotional eating and changes in their eating habits for financial reasons. Regarding sleep patterns, more than half the participants reported taking naps during the day, out of which 30.5% of them perceived worse sleep quality, with no difference between type 1 and type 2 diabetes groups. There were no within-group differences in MSQ and EAT-26 scores. Among participants with type 2 diabetes, age ≥ 60 years (OR 27.6, 95%CI 2.2-345.7), diabetes duration ≥ 15 years (OR 28.9, 95%CI 1.4-597.9), and perceived emotional eating (OR 10.9, 95%CI 1.1-107.5) were associated with worsened food quality. Worse sleep quality during the pandemic was associated with age ≥ 60 years for both type 2 diabetes (OR 5.6, 95%CI 1.1-31.5) and type 1 diabetes (OR 5.5, 95%CI 1.0-29.9).

CONCLUSIONS

Follow-up data from a cohort of patients with diabetes indicate that at the end of 18 months of social distancing, some lifestyle aspects worsened and some improved, showing that these patients responded differently to the adversities of this period. The evidence of clinical features associated with worsening in food and sleep quality provides new insights to prioritizing actions in crisis situations.

Cross-cultural validation of the Worries about COVID-19 and its consequences Scale (W-COV) in adolescents and young people

The pandemic context presents remarkable psychological challenges for adolescents and young adults. The aim of the present work was to construct and study the psychometric properties of a scale in Spanish language (W-COV) to measure their worries related to the pandemic. Participants were 5559 people aged between 14 and 25 years old (M = 19.05; SD = 3.28). Self-report data were collected using a cross-sectional and cross-cultural design. Participants were from 5 Spanish-speaking countries. Instruments were W-COV to assess worries about COVID-19 and its consequences; DASS-21 for anxiety, depression and stress; and SWLS for life satisfaction. Exploratory, confirmatory and multi-group factor analyses were conducted to determine the factorial structure of the W-COV and its measurement invariance (configural, metric, scalar and error variance). Correlational and regression analyses were also performed to study convergent and predictive validity. The results suggest that W-COV presents a bifactorial structure: (1) a general factor of worries about COVID-19; and (2) three different factors: worries about health, economic and psychosocial consequences from COVID-19. The internal reliability indices Cronbach's α and Omega were adequate. With respect to the invariance results, the instrument can be used interchangeably in the five countries considered, in both genders and in two different age groups (12-17 and 18-25). Regarding validity, W-COV factors were positively associated with anxiety, depression and stress, and negatively predicted life satisfaction. In conclusion, W-COV is a reliable and valid instrument for researchers and health care professionals to assess the psychological impact of the pandemic on mental health of young Ibero-Americans.

Coping strategies moderate the effect of perceived stress on sleep and health in older adults during the COVID-19 pandemic

Stress in the context of the COVID-19 pandemic may have a significant impact on health, including sleep health. Older adults may be particularly vulnerable. This study examined associations between perceived stress and sleep health, mental health, physical health, and overall perceived health outcomes among older adults. We also examined whether specific coping strategies moderate these associations. Older adults (n = 115; M_age  = 68.62) reported perceived stress, coping strategies, global sleep quality, depressive symptoms, and perceived mental, physical, and overall health before and during the COVID-19 pandemic. Stress-health relationships were modelled with hierarchical linear regression. Higher perceived stress was associated with greater depressive symptoms and poorer mental health concurrently and longitudinally. Coping strategies moderated the association of perceived stress with physical health and overall perceived health. For example, higher perceived stress was associated with poorer overall perceived health among those with lower problem-focussed coping, but not among those with higher problem-focussed coping. Older adults may benefit from prevention and intervention strategies targeting stress management. Furthermore, identifying people with low problem-focussed coping might be a useful strategy to prevent worsening health in future public health crises.

The physical and mental health consequences of social isolation and loneliness in the context of COVID-19

PURPOSE OF REVIEW

Social isolation and loneliness are known contributors to all-cause mortality as well as a range of physical and mental health conditions. Therefore, this article reviews current literature pertaining to the effects of social isolation and loneliness on physical and mental health during the current COVID-19 pandemic.

RECENT FINDINGS

Social isolation and loneliness contribute to a myriad of physical and mental health conditions. Specifically social isolation and loneliness contribute to the development of cardiovascular disease, diabetes mellitus, and cancer. However, most research indicated that poor lifestyle factors explained most of the association. Social isolation and loneliness are also associated with cognitive problems including dementia, immune system problems, and mental health conditions. Further social isolation and loneliness also spur behavioral issues that significantly affect physical and mental health.

SUMMARY

Evidence suggests that social isolation and loneliness have significant consequences on the physical and mental health of the individual and that the move toward ending all protections against COVID-19 has significant implications for the vulnerable. Further the similarities between the effects of social isolation and loneliness are compared to some of the conditions evident in long-COVID.

A multiple-group analysis of social Capital and loneliness among community-dwelling older adults in urban China during the outbreak of the COVID-19 pandemic

The present study examined the moderating effects of family social capital on the relationship between community social capital and loneliness among older adults in urban Chinese communities during the COVID-19 outbreak period between January and March 2020.Method: We used quota sampling to recruit 472 community-dwelling older adults aged 60 years or older. A multiple-group analysis was applied to examine the proposed hypotheses.Results: Community-based cognitive social capital was significantly associated with both social and emotional loneliness among older adults with relatively low levels of family social capital. However, these associations were statistically nonsignificant among those with high family social capital levels. Community-based structural social capital was not associated with loneliness in either family social capital group.Conclusion: The findings highlight the role of cognitive social capital in reducing loneliness and support community social capital replacement theory in explaining the mechanism linking social capital to loneliness in later life in the context of the COVID-19 pandemic.

The Value of Contemplative Practices: A Mixed Methods Approach Exploring Associations between Resilience and Experiences of the COVID-19 Pandemic among Older Adults

The aim of this study was to explore the association between resilience and experiences of the COVID-19 pandemic among older adults. We used a sequential explanatory mixed methods study design to recruit older adults who spoke English and were 60 and above during the pandemic. Survey data investigated older adults' resilience, post-traumatic growth, well-being, and demographics. Extreme case purposeful sampling of their resilience score was used to select interviewees. Qualitative data sought to understand the relationship between resilience and how older adults responded to the COVID-19 pandemic. Exploring the relationship between resilience (well-being in the face of challenge) and one's experience of the COVID-19 pandemic revealed that participants categorized as having high resilience had long held behaviors of contemplative practices that helped them effectively adapt to the COVID-19 pandemic. As we continue to face global challenges, we must redefine care, guide interventions, and promote healthy aging by incorporating contemplative practices into the lives of older adults.

Sleep Quality Impairment Is Associated With Pandemic Attitudes During the Coronavirus Disease 2019 (COVID-19) Circuit Breaker Lockdown in England: A Cross-Sectional Study

Objectives

The COVID-19 pandemic has been associated with sleep quality impairment and psychological distress, and the general public has responded to the pandemic and quarantine requirements in a variety of ways. We aimed to investigate whether sleep quality is low during a short-term (circuit break) quarantine restriction, and whether sleep quality is associated with respondents' overall attitudes to the pandemic using a validated scale.

Design and Setting

Online cross-sectional study in England in November 2020.

Participants

The study included 502 respondents over the age of 18.

Measurements

Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and pandemic attitudes were assessed using the Oxford Pandemic Attitudes Scale–COVID-19 (OPAS-C), a validated 20-item, 7-domain scale that assesses pandemic-related stress, fear, loneliness, sense of community, sense of exaggerated concern, non-pharmaceutical interventions, and vaccine hesitancy. Unadjusted and multivariable logistic regression odds ratios of association were assessed between the dependent variable of poor sleep quality (PSQI&gt;5) and risk factors, including OPAS-C score, age, sex, educational status, and income.

Results

The mean (SD) PSQI score was 7.62 (3.49). Overall, 68.9% of respondents met criteria for poor sleep quality using the PSQI cutoff of &gt;5. The mean (SD) OPAS-C score was 60.3 (9.1). There was a significantly increased odds of poor sleep quality in the highest vs. lowest OPAS-C quartiles (OR 4.94, 95% CI [2.67, 9.13], p &lt; 0.0001). Age, sex, income, political leaning, employment status, and education attainment were not associated with poor sleep quality.

Conclusions

More than two-thirds of respondents met criteria for poor sleep quality. The odds of poor sleep quality increased in a dose-response relationship with pandemic attitudes (such as higher levels of pandemic-related stress, fear, or loneliness). The association between poor sleep quality and pandemic attitudes suggests opportunities for public health and sleep medicine interventions, and highlights the need for further research.

Analysis of predictors of stress during confinement by COVID-19 in Spain

Confinement has had a great emotional impact on the population, especially in terms of stress. Factors such as the presence of previous mental or physical illness, resilience or emotional intelligence may influence the occurrence or increase of stress. The aim was to assess predictors of stress by comparing two statistical methodologies (one linear and one non-linear).

Young Adults' Loneliness and Depression During the COVID-19 Pandemic: A Moderated Mediation Model

Since the outbreak of the COVID-19 pandemic in December 2019, millions of people have been infected with the disease. The COVID-19 pandemic also produced severe mental health problems, such as loneliness and depression. The present study aimed to examine the mediating role of cognitive reappraisal and moderating role of resilience in the relationship between young adults’ loneliness and depression during the pandemic by adopting a cross-sectional research approach. In March 2020, 654 young adults (18–29 years old) were recruited to complete the measures for loneliness, depression, emotion regulation, and resilience. Results found that loneliness was positively and moderately associated with depression (r = 0.531, p < 0.001), and that both loneliness and depression were separately negatively associated with cognitive reappraisal (r = −0.348, p < 0.001; r = −0.424, p < 0.001) and resilience (r = −0.436, p < 0.001; r = −0.419, p < 0.001). The results indicated that both loneliness and depression were not associated with expressive suppression (r = 0.067, p = 0.087; r = −0.002, p = 0.961). The moderated mediation model results revealed that only cognitive reappraisal partially mediated the relationship between loneliness and depression (b = −0.301; Boot 95% CI = −0.388, −0.215). In addition, the results of the moderated mediation model indicated that resilience moderated the association between loneliness and depression (b = 0.035, p < 0.001, Boot 95% CI = 0.014, 0.055), while also moderated the impact of cognitive reappraisal on depression (b = −0.031, p < 0.001, Boot 95% CI = −0.058, −0.005). These findings have practical implications that broaden our understanding of depression in young adults and shed light on how to enhance cognitive reappraisal and resilience as a means of combating depression in this age group during the COVID-19 pandemic.

Morbidities Worsening Index to Sleep in the Older Adults During COVID-19: Potential Moderators

Older adults were considered a vulnerable group for the COVID-19 infection and its consequences, including problems with sleep.