Loneliness Among US Adults Aged ≥55 Early in the COVID-19 Pandemic : Findings From the COVID-19 Coping Study

Older adults' experiences of wellbeing during the COVID-19 pandemic: a comparative qualitative study in Italy and Switzerland

Background

Particularly at the beginning of the pandemic, adults aged 65 and older were portrayed as a homogeneously vulnerable population due to the elevated health risks associated with contracting the COVID-19 disease. This portrayal, combined with travel restrictions, closures of economic sectors, country-wide lockdowns, and suggestions by governmental authorities to limit social contact, had important implications for the wellbeing of older individuals. However, older adults are a heterogeneous population who relies on different resources to cope with stressful periods, like the COVID-19 pandemic. Simultaneously, countries also employed different measures to contain the virus. Research thus far has focused on the short-term consequences of the pandemic, but studies have yet to address its long-term consequences.

Objectives

We explore older adults' lived experiences nearly 2 years after the pandemic onset. Moreover, we focus on the bordering countries of Switzerland and Italy, who employed contrasting containment measures. This paper analyzes (1) How the COVID-19 pandemic impacted the experiences of wellbeing of older adults in these regions and (2) How older adults coped with the stressors brought about by the pandemic, in particular social distancing.

Methods

The paper draws on 31 semi-structured interviews with 11 Swiss natives residing in Switzerland, 10 Italian migrants residing in Switzerland, and 10 Italian natives residing in Italy. Interviews were conducted from December 2021 to March 2022.

Results

Coping mechanisms of the three groups related to acceptance, hobbies, cognitive reframing, telephone use, vaccine use and social distancing. However, results show heterogeneous experiences of wellbeing, with Swiss natives sharing more positive narratives than the other two groups. Moreover, Italian migrants and Italian natives expressed the long-term negative consequences of the pandemic on their experienced wellbeing.

Does urban greenness reduce loneliness and social isolation among Canadians? A cross-sectional study of middle-aged and older adults of the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Urban greenness has been shown to confer many health benefits including reduced risks of chronic disease, depression, anxiety, and, in a limited number of studies, loneliness. In this first Canadian study on this topic, we investigated associations between residential surrounding greenness and loneliness and social isolation among older adults.

METHODS

This cross-sectional analysis of the Canadian Longitudinal Study on Aging included 26,811 urban participants between 45 and 86 years of age. The Normalized Difference Vegetation Index (NDVI), a measure of greenness, was assigned to participants' residential addresses using a buffer distance of 500 m. We evaluated associations between the NDVI and (i) self-reported loneliness using the Center for Epidemiological Studies Depression Scale, (ii) whether participants reported "feeling lonely living in the local area", and (iii) social isolation. Logistic regression models were used to characterize associations between greenness and loneliness/social isolation while adjusting for individual socio-economic and health behaviours.

RESULTS

Overall, 10.8% of participants perceived being lonely, while 6.5% reported "feeling lonely in their local area". Furthermore, 16.2% of participants were characterized as being socially isolated. In adjusted models, we observed no statistically significant difference (odds ratio (OR) = 0.99; 95% confidence interval (CI) 0.93-1.04) in self-reported loneliness in relation to an interquartile range (IQR) increase of NDVI (0.06). However, for the same change in greenness, there was a 15% (OR = 0.85; 95% CI 0.72-0.99) reduced risk for participants who strongly agreed with "feeling lonely living in the local area". For social isolation, for an IQR increase in the NDVI, we observed a 7% (OR = 0.93; 95% CI 0.88-0.97) reduction in prevalence.

CONCLUSION

Our findings suggest that urban greenness plays a role in reducing loneliness and social isolation among Canadian urbanites.

Loneliness prevalence of community-dwelling older adults and the impact of the mode of measurement, data collection, and country: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it.

DESIGN

Systematic review and meta-analysis.

SETTING

We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021.

PARTICIPANTS

We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with "loneliness" or "lonely" in the title.

MEASUREMENTS

A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries.

RESULTS

Our initial search identified 2,021 studies of which 45 (k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% (n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence.

CONCLUSIONS

This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.

Sociodemographic effects on pandemic fatigue are multifaceted and context-specific: A longitudinal analysis of physical distancing adherence

Background

Pandemic fatigue emerged early during the COVID-19 pandemic and remains a concern as new variants emerge and ongoing public health measures are needed to control them. A wide range of factors can affect pandemic fatigue, but empiric research indicating which may be most important to adherence in specific populations is lacking.

Design & Methods

We conducted a longitudinal study of changes in physical distancing in two cohorts: adults living with children <18 years and adults ≥50 years old. Six types of non-work, non-household contacts were ascertained at six times from April to October 2020. We used generalized estimating equations Poisson regression to estimate the one-week change in contact rate and how this differed based on sociodemographic characteristics.

Results

The rate of all contact types increased during the middle of the study period and decreased toward the end. Changes in contact rates over time differed according to several sociodemographic characteristics, including age, gender, race/ethnicity, education, household composition, and access to transportation. Furthermore, the factors influencing the rate of change in contact rates differed by the type or setting of the contact, for example contacts as a result of visiting another person's home versus during a retail outing.

Conclusions

These results provide evidence for potential mechanisms by which pandemic fatigue has resulted in lower physical distancing adherence.

Predictors of loneliness onset and maintenance in European older adults during the COVID-19 pandemic

Objectives

Loneliness is a major public health concern. Duration of loneliness is associated with severity of health outcomes, and further research is needed to direct interventions and social policy. This study aimed to identify predictors of the onset vs. the maintenance of loneliness in older adults before and during the pandemic using longitudinal data from the Survey of Health, Age, and Retirement in Europe (SHARE).

Methods

Groupings of persistent, situational, and no loneliness were based on self-reports from an ordinary pre-pandemic SHARE wave and a peri-pandemic telephone interview. Predictors were identified and compared in three hierarchical binary regression analyses, with independent variables added in blocks of geographic region, demographics, pre-pandemic social network, pre-pandemic health, pandemic-related individual, and country level variables.

Results

Self-reported loneliness levels for the persistent, situational, and no loneliness groups were stable and distinct through 7 years preceding the pre-pandemic baseline measure. Shared predictors were chronic diseases, female sex, depression, and no cohabitant partner. Persistent loneliness was uniquely predicted by low network satisfaction (OR: 2.04), functional limitations (OR: 1.40), and a longer country-level isolation period for older adults (OR: 1.24).

Conclusion

Interventions may target persons with depression, functional limitations, chronic health issues, and no cohabitant partner. The added burden of the length of isolation on those who are already lonely should be taken into account when employing social policies that target older adults. Further research should distinguish between situational and persistent loneliness, and seek to identify predictors of chronic loneliness onset.

Impact of social phone programs on loneliness and mood in older adults: a mixed methods systematic review protocol

OBJECTIVE

The objective of this mixed methods review is to examine the effectiveness and experience of social phone programs on loneliness and/or mood in community-dwelling older adults.

INTRODUCTION

There is a large and growing older adult population that is burdened with loneliness. Loneliness affects both physical and mental health, and it is, therefore, imperative to examine ways of mitigating experiences of loneliness. Social phone programs are being offered through multiple organizations as a way of increasing socialization and decreasing loneliness in older adults. There is a need to examine existing data on social phone programs to determine their effectiveness and optimize their implementation.

INCLUSION CRITERIA

Included studies will be original qualitative, quantitative, or mixed methods research, along with gray literature, examining the use of social phone programs to address loneliness and/or mood in older adults.

METHODS

A convergent segregated mixed methods approach will be used, in line with the JBI methodology for mixed methods reviews. Articles will be searched in selected databases, sources of clinical trials, and gray literature. No limits have been set for language or date of publication. Two team members will select studies through title and abstract screening and then full-text screening. Critical appraisal will be performed in accordance with the standard JBI critical assessment tools, although no articles will be excluded based on this appraisal. Quantitative articles will be synthesized using meta-analysis, while a process of meta-aggregation will be used for qualitative articles. The findings will be integrated into a final report.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022335119.

Loneliness is Associated With Lower Coping Self-Efficacy Among Older Adults

To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, sex, body mass index, chronic disease composite score, social support, coping self-efficacy, and depression symptoms. Loneliness was reported in 32.1% of participants and negatively associated with coping self-efficacy (OR = 0.68, 95% CI: 0.50-0.93) while controlling for age, race, sex, chronic disease composite score, and body mass index. Our findings suggest that coping self-efficacy may be a target for intervention involving loneliness in future research; however, the causal relationship between coping self-efficacy and loneliness should be explored further.

COVID-19 pandemic experiences of older adults with dementia in community and residential care settings: Results from a US national survey

Introduction

Investigations into consequences of the US COVID-19 pandemic for older adults with dementia have been limited.

Methods

We used the National Health and Aging Trends Study to examine self-reported COVID-19 infection; measures taken to limit its spread; social, behavioral, and emotional responses to the pandemic; and changes in health-care use and provider communication. We compared adults aged ≥70 with and without dementia in community and residential care settings.

Results

In residential care settings, infection was substantially higher and social contact less common for those with dementia. In community and residential care settings, those with dementia had 2 to 3 times the odds of reporting sleeping more often. In residential care settings, those with dementia were less likely to put off care and more likely to start telehealth.

Discussion

Findings highlight the disproportionate social and behavioral consequences of the COVID-19 pandemic for those living with dementia, particularly in residential care settings.

HIGHLIGHTS

Data are from the nationally representative National Health and Aging Trends Study.COVID-19 infection was higher in residential care settings for those with dementia.Social contact was less common for those with dementia in residential care.Pandemic-related coping behaviors differed by dementia and residential status.In residential care, those with dementia were less likely to delay health care.

Trends in major depressive episodes and mental health treatment among older adults in the United States, 2010-2019

BACKGROUND

Despite concerns about increasing trends in depression over the past two decades, little is known about recent trends in depression and mental health (MH) treatment among older adults and whether these trends differ by demographic characteristics.

METHODS

We examined data from a US representative sample of noninstitutionalized adults aged ≥65 from the 2010-2019 National Survey on Drug Use and Health (N = 31,502). We estimated trends in the prevalence of past-year major depressive episode (MDE) overall and by demographic characteristics. We also estimated trends in MH treatment among those with past-year MDE.

RESULTS

From 2010/11 to 2018/19, the estimated prevalence of past-year MDE among older adults increased from 2.0 % (95 % CI: 1.6-2.6) to 3.2 % (95 % CI: 2.7 to 3.7), a 60.0 % increase (p = 0.013). Increases were detected among men (p = 0.038), White individuals (p = 0.018), those who are widowed (p = 0.003), those with an annual household income of <$20,000 (p = 0.020) or $20,000-$49,000 (p = 0.016), and those with some college degree (p = 0.014). Among those with MDE, there were no significant changes detected in any form of past-year MH treatment.

LIMITATIONS

NSDUH does not assess individuals who are institutionalized, incarcerated, or experiencing homelessness, and thus the prevalence of MDE may be underestimated.

CONCLUSIONS

Although the estimated prevalence of depression is increasing among older adults, there has not been a proportional increase in MH treatment among those with depression. These findings call for urgent expansion of treatment services and training of MH professionals with expertise in older adults to meet the needs of this growing, vulnerable population.

Loneliness and its correlates among Bangladeshi older adults during the COVID-19 pandemic

The present study aims to investigate the prevalence of loneliness and its associated factors among older adults during the COVID-19 pandemic in Bangladesh. This cross-sectional study was conducted in October 2020 among 1032 older Bangladeshi adults aged 60 years and above through telephone interviews. A semi-structured questionnaire was used to collect information on participants' characteristics and COVID-19-related information. Meanwhile, the level of loneliness was measured using a 3-item UCLA Loneliness scale. More than half (51.5%) of the older adults experienced loneliness. We found that participants formally schooled [adjusted odds ratio (aOR = 0.62, 95% CI 0.43-0.88)] and received COVID-19-related information from health workers (aOR = 0.33, 95% CI 0.22-0.49) had lower odds of being lonely during the pandemic. However, older adults living alone (aOR: 2.57, 95% CI 1.34-4.94), residing distant from a health facility (aOR = 1.46, 95% CI 1.02-2.08) and in rural areas (aOR = 1.53, 95% CI 1.02-2.23) had higher odds of loneliness than their counterparts. Likewise, odds of loneliness were higher among those overwhelmed by COVID-19 (aOR = 1.93, 95% CI 1.29-2.86), who faced difficulty in earning (aOR = 1.77, 95% CI 1.18-2.67) and receiving routine medical care during pandemic (aOR = 2.94, 95% CI 1.78-4.87), and those perceiving requiring additional care during the pandemic (aOR = 6.01, 95% CI 3.80-9.49). The findings suggest that policies and plans should be directed to reduce loneliness among older adults who require additional care.

Mental health and well-being in times of COVID-19: A mixed-methods study of the role of neighborhood parks, outdoor spaces, and nature among US older adults

The role of parks and nature to support well-being during the COVID-19 pandemic is uncertain. To examine this topic, we used mixed-methods data collected in April-May 2020 from US adults aged ≥55 in the COVID-19 Coping Study. We quantitatively evaluated the associations between number of neighborhood parks and depression, anxiety, and loneliness; and conducted qualitative thematic analysis of participants' outdoor experiences. Among urban residents, depression and anxiety were inversely associated with the number of neighborhood parks. Thematic analysis identified diverse engagement in greenspaces that boosted physical, mental, and social well-being. The therapeutic potential of outdoor and greenspaces should be considered for interventions during future epidemics.

Caring for Homebound Veterans during COVID-19 in the U.S. Department of Veterans Affairs Medical Foster Home Program

The onset of the COVID-19 pandemic made older, homebound adults with multiple chronic conditions increasingly vulnerable to contracting the virus. The United States (US) Department of Veterans Affairs (VA) Medical Foster Home (MFH) program cares for such medically complex veterans residing in the private homes of non-VA caregivers rather than institutional care settings like nursing homes. In this qualitative descriptive study, we assessed adaptations to delivering safe and effective health care during the early stages of the pandemic for veterans living in rural MFHs. From December 2020 to February 2021, we interviewed 37 VA MFH care providers by phone at 16 rural MFH programs across the US, including caregivers, program coordinators, and VA health care providers. Using both inductive and deductive approaches to thematic analysis, we identified themes reflecting adaptations to caring for rural MFH veterans, including care providers rapidly increased communication and education to MFH caregivers while prioritizing veteran safety. Telehealth visits also increased, MFH veterans were prioritized for in-home COVID-19 vaccinations, and strategies were applied to mitigate the social isolation of veterans and caregivers. The study findings illustrate the importance of clear, regular communication and intentional care coordination to ensure high-quality care for vulnerable, homebound populations during crises like the COVID-19 pandemic.

Aging in Place During a Pandemic: Neighborhood Engagement and Environments Since the COVID-19 Pandemic Onset

BACKGROUND AND OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic may fundamentally change neighborhood environments and ways of aging in place. This research aimed to investigate perceptions of and engagement in neighborhoods since the pandemic onset among aging Americans.

RESEARCH DESIGN AND METHODS

Data were from the COVID-19 Coping Study, a longitudinal cohort study of health and well-being of U.S. adults aged 55 years or older during the COVID-19 pandemic. In the present analysis, we conducted a qualitative thematic analysis of responses to an open-ended survey question about how respondents felt that COVID-19 has affected their neighborhood and relationships with neighbors. The survey data were collected June-September 2020 and analyzed for a random-stratified subsample of 1,000 study participants. Sampling quotas for age, gender, race/ethnicity, and education aimed to match the U.S. population aged 55 years or older (average age: 67.7 years).

RESULTS

We identified 4 overarching themes: altered neighborly social interactions, support levels, and community environments; and no observed changes. Geographic factors that affected neighborhood engagement included age structure, sociopolitical diversity, urbanicity/rurality, and walkability; while individual factors included age, race/ethnicity, socioeconomic status, political orientation, health status, duration of residence, lifestyle, and personality.

DISCUSSION AND IMPLICATIONS

The results highlight resilience among aging adults and their neighbors, sources of individual and community vulnerability, and opportunities to strengthen social infrastructure to support aging in place since the pandemic onset.

Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis

OBJECTIVES

Pandemics and their public health control measures have generally substantially increased the level of loneliness and social isolation in the general population. Because of the circumstances of aging, older adults are more likely to experience social isolation and loneliness during pandemics. However, no systematic review has been conducted or published on the prevalence of loneliness and/or social isolation among the older population. This systematic review and meta-analysis aims to provide up-to-date pooled estimates of the prevalence of social isolation and loneliness among older adults during the COVID-19 pandemic and other pandemics in the last two decades.

DESIGN

EMBASE, PsychoINFO, Medline, and Web of Science were searched for relevant studies from January 1, 2000 to November 31, 2021 published in a variety of languages. Only studies conducted during the COVID-19 pandemic were selected in the review.

RESULTS

A total of 30 studies including 28,050 participants met the inclusion criteria. Overall, the pooled period prevalence of loneliness among older adults was 28.6% (95% CI: 22.9-35.0%) and 31.2% for social isolation (95% CI: 20.2-44.9%). Prevalence estimates were significantly higher for those studies conducted post 3-month from the start of the COVID-19 pandemic compared to those conducted within the first 3 months of the pandemic.

CONCLUSIONS

This review identifies the need for good quality longitudinal studies to examine the long-term impact of pandemics on loneliness and social isolation among older populations. Health policymaking and healthcare systems should proactively address the rising demand for appropriate psychological services among older adults.

Personal Social Networks of Community-Dwelling Oldest Old During the Covid-19 Pandemic-A Qualitative Study

The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.

Using system thinking methodologies to address health care complexities and evidence implementation

BACKGROUND

Despite health care advances, artificial intelligence and government interventions aiming to improve the health and wellbeing of citizens, huge disparities and failures in care provision exist. This is demonstrated by the rising number of medical errors, increase in readmission rates and mortality rates, and the failure of many health systems to successfully cope with events, such as pandemics and natural disasters. This shortfall is in part because of the complexity of the health care system, the interconnectedness of various parts of service, funding models, the complexity of patients' conditions, patient and carer needs, and the clinical processes needed for patients via multiple providers.

OBJECTIVE

The objective of this paper is to describe the use of system thinking methodologies to address complex problems such as those in the public health and health services domains.

METHOD

A description of the system thinking methodology and its associated methods including causal loop diagrams, social network analysis and soft system methodology are described with examples in the health care setting.

RESULTS

There are various models of knowledge translation that have been employed including the Joanna Briggs Institute model of implementation of evidence into practice, the triple C, and the Promoting Action on Research Implementation in Health Services. However, many of these models are neither scalable nor sustainable, and are most effective for localized projects implemented by trained clinicians and champions in relevant settings.System thinking is essentially a modelling process, which aims to create opportunities for change via an appreciation of perspective, and recognition that complex problems are a result of interconnected factors. The article argues that systems thinking applications need to move beyond that of addressing complex health issues pertaining to a population, and rather consider complex problems surrounding the delivery of high-quality health care.

CONCLUSION

It is important that methods to implement systems thinking methodologies in health care settings are developed and tested.

The Mediating Role of Resilience and Extraversion on Psychological Distress and Loneliness Among the General Population of Tyrol, Austria Between the First and the Second Wave of the COVID-19 Pandemic

Background: During the first 3 weeks of the COVID-19 pandemic, the federal state of Tyrol, Austria had one of the strictest curfews in Austria and worldwide. The aim of the current study was to investigate the assumingly protective role of resilience and extraversion and its impact on mental health following such an uncertain and unpredictable situation. Methods: Between the first and the second wave of the pandemic, adult residents of Tyrol were invited to participate in an online survey. Next to the assessment of sociodemographic and COVID-19-related variables the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Resilience Scaled, and the Big Five Inventory were used to assess psychological distress, loneliness, resilience, and extraversion. Mediation analysis was used to investigate the role of resilience and extraversion in the context of age-, sex-, and partnership- related differences in psychological distress and loneliness. Results: One hundred and forty-five participants took part in the survey (68.2% female). Overall, psychological distress and severe loneliness were more often detected in women and singles. They also were less resilient, while men and singles presented with a lower degree of extraversion. Study participants under the age of 30 experienced severe loneliness more frequently than older people, whereas psychological distress, resilience, and extraversion were comparable between age groups. Resilience significantly mediated the relationship between both study participants' sex and partnership situation on one hand and psychological distress and severe loneliness on the other. In addition, extraversion significantly mediated the relationship between participants' partnership situation and psychological distress. Discussion: Our findings suggest that women, singles, and young people may be particularly affected by the measures and sequelae of the COVID-19 pandemic. Interventions promoting resilience and extraversion among these groups are urgently needed to foster mental health. Ideally, they can be utilized at home in case of renewed mobility restrictions or quarantine in the future.