1
|
Wister A, Li L, Ferris J, Kim B, Klasa K, Linkov I. Resilience among older adults with multimorbidity using the Connor-Davidson scale in the Canadian Longitudinal Study on Aging: health behaviour, socio-economic, and social support predictors. BMC Public Health 2024; 24:2567. [PMID: 39300381 DOI: 10.1186/s12889-024-19992-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVE Multimorbidity is recognized as a serious health condition faced by a majority of older adults. Research investigating adaptive responses to multimorbidity, termed multimorbidity resilience, has been growing. This paper examines protective and risk factors, with a focus on health behaviours, socio-economic resources, and social support using an established measure of resilience (Connor-Davidson Resilience Scale) among older adults, focusing on older persons with two or more concurrent chronic conditions. METHODS Using Baseline (2011-2015), Follow-up One (2015-2018), and Follow-up Two (2018-2021) data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we tested hypotheses using 13,064 participants aged 65 years and older, who completed all waves and reported two or more of 27 chronic conditions, for the full sample of multimorbid individuals and three multimorbidity clusters: Cardiovascular/Metabolic, Musculoskeletal, and Mental Health. Associations between protective and risk factors and resilience were examined using linear regression to model the Connor-Davidson resilience scale, adjusting for illness context and social determinants of health. RESULTS Among all multimorbid individuals, the strongest associations with resilience were found for higher self-rated health, greater sleep satisfaction, better appetite, higher household income, more relatives and friends, being overweight (compared to normal weight), fewer housing problems, and fewer skipped meals. Weaker associations were found for non-smokers, less alcohol consumption, less pain, sedentary behaviour, being non-married (compared to married), and among Canadian born (compared to foreign). The analyses for the three multimorbidity clusters were largely replicated for the three multimorbidity clusters, but with some nuances depending on the cluster. DISCUSSION This research provides confirmatory evidence for several protective and risk factors affecting the ability to cope and recover from multimorbidity adversity among older adults. There are consistent patterns for the multimorbidity disease clusters, but some distinct relationships arise that are worthy of attention. The implications of the findings for modifiable health behaviours and socio-economic factors are discussed for their public health and clinical relevance.
Collapse
Affiliation(s)
- Andrew Wister
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Lun Li
- School of Social Work, MacEwan University, 9-510A2, 10700 104 Ave NW, Edmonton, AB, T5J 4S2, Canada
| | - Jennifer Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada
- BC Observatory for Population & Public Health, BC Centre for Disease Control, Vancouver, BC, V5Z 4R4, Canada
| | - Boah Kim
- Department of Gerontology, Simon Fraser University, Vancouver, BC, V6B 5K3, Canada
| | - Katarzyna Klasa
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Igor Linkov
- Engineering Research and Development Center, Army Corps of Engineers, Vicksburg, USA
| |
Collapse
|
2
|
Shantz E, Elliott SJ, Sperling C, Buhler K, Costenbader KH, Choi MY. Towards an understanding of the biopsychosocial determinants of CVD in SLE: a scoping review. Lupus Sci Med 2024; 11:e001155. [PMID: 39053931 DOI: 10.1136/lupus-2024-001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a chronic autoimmune condition with significant physical, mental, psychosocial and economic impacts. A main driver of SLE morbidity and mortality is cardiovascular disease (CVD). Both SLE and CVD exhibit disparities related to gender, race and other social dimensions linked with biological outcomes and health trajectories. However, the biospsychosocial dimensions of CVD in SLE populations remain poorly understood. The objective of this study was to systematically investigate the existing literature around known social factors influencing the development of CVD in SLE. METHODS A scoping review protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews guidelines. The search strategy encompassed three main concepts: SLE, CVD and social factors. Four databases were searched (PubMed, SCOPUS, PsychINFO and CINAHL). 682 studies were identified for screening. Articles were screened in two phases (title/abstract and full text) to determine whether they fulfilled the selection criteria. RESULTS Nine studies were included after screening. All were conducted in the USA between 2009 and 2017. Six studies (67%) were cross-sectional and three (33%) were longitudinal. Most employed SLE cohorts (n=7, 78%) and two drew from healthcare databases (n=2; 22%). We identified five main themes encompassing social factors: socioeconomic status and education (n=5; 56%), race and/or ethnicity (n=7; 78%), mental health (n=2; 22%), gender (n=3; 33%) and healthcare quality and/or insurance (n=2; 22%). Overall, low income, fewer years of education, black race and/or ethnicity, depression, male gender, lack of insurance and healthcare fragmentation were all associated with CVD risk factors and outcomes in SLE. CONCLUSIONS While several social factors contribute to CVD in SLE populations, considerable gaps remain as many social determinants remain un(der)explored. There is rich opportunity to integrate social theory, advance conceptualisations of race and/or ethnicity and gender, expand investigations of mental health and explore novel geographical contexts. In healthcare policy and practice, identified social factors should be considered for SLE populations during decision-making and treatment, and education resources should be targeted for these groups.
Collapse
Affiliation(s)
- Emily Shantz
- Geography & Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | - Susan J Elliott
- Geography & Environmental Management, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Katherine Buhler
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen H Costenbader
- Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - May Y Choi
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
Ramli DB, Shahar S, Mat S, Ibrahim N, Tohit NM. The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review. PLoS One 2024; 19:e0306188. [PMID: 38950029 PMCID: PMC11216600 DOI: 10.1371/journal.pone.0306188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/11/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community. METHODS A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches. RESULTS Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects. CONCLUSION This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic. CLINICAL TRIAL REGISTRATION PROSPERO registration number: CRD42022296919.
Collapse
Affiliation(s)
- Dayang Balkis Ramli
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Public Service Department, Prime Minister’s Office, Putrajaya, Malaysia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norhayati Ibrahim
- Centre for Healthy Aging and Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan, Bangi, Malaysia
| |
Collapse
|
4
|
Lima GS, Figueira ALG, de Carvalho EC, Kusumota L, Caldeira S. Resilience in Older People: A Concept Analysis. Healthcare (Basel) 2023; 11:2491. [PMID: 37761688 PMCID: PMC10531380 DOI: 10.3390/healthcare11182491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Resilience has been presented as a potential protective factor to be promoted in difficult experiences in older people. However, further clarification of the concept of resilience for this population is required, as this is of critical interest for nursing care. (2) Aim: To develop the concept of resilience in older people to establish the elements that refer to the nursing outcome. Personal resilience (1309) from the Nursing Outcomes Classification (NOC), specifically in older people. (3) Methods: Concept analysis using Beth Rodgers' evolutionary model. The attributes, antecedents, consequents, and empirical elements were described in the integrative review, with searches in PubMed, CINAHL, PsycINFO, LILACS, and Embase databases. A total of 2431 citations have been identified, and 110 studies were included. (4) Results: The concept of "resilience in older people" is composed of two attributes, available resources and positive behaviors, and is defined as positive attitudes of older people with the assistance of resources available from experiences of adversity. Conclusion: This analysis and concept development of resilience in older people provided sensitive indicators for nursing care in the context of adversity, considering available resources and with positive attitudes during this phase of life span.
Collapse
Affiliation(s)
- Gabriella Santos Lima
- School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (A.L.G.F.); (E.C.d.C.); (L.K.)
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Ana Laura Galhardo Figueira
- School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (A.L.G.F.); (E.C.d.C.); (L.K.)
| | - Emília Campos de Carvalho
- School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (A.L.G.F.); (E.C.d.C.); (L.K.)
| | - Luciana Kusumota
- School of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (A.L.G.F.); (E.C.d.C.); (L.K.)
| | - Sílvia Caldeira
- Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| |
Collapse
|
5
|
McGarrigle CA, Ward M, Kenny RA. An investigation of what protective individual- and community-level factors are associated with life satisfaction in middle-aged and older family carers in Ireland. Front Public Health 2023; 11:1207523. [PMID: 37637804 PMCID: PMC10457003 DOI: 10.3389/fpubh.2023.1207523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 08/29/2023] Open
Abstract
Background Family care plays an essential role in providing care in society. However, caring can cause stress, and mental and physical responses to caring vary widely. Different outcomes for carers may reflect different approaches or adaptability to caring and their ability to maintain or recover their mental health and wellbeing following an adverse event (psychosocial resilience). We aim to identify factors that may promote psychosocial resilience, conceptualized as maintaining or recovering subjective wellbeing and operationalized as satisfaction with life, among carers. Methods Data were from 6 Waves (2009-2021) of The Irish Longitudinal Study on Aging (TILDA), a prospective biennial nationally representative longitudinal study of older adults aged ≥50 in Ireland. Family caregiving was assessed in Waves 3-6. Participants were asked if they cared for someone, their relationship to the recipient, and the number of hours per week that they provided care. We used growth mixture modeling to identify latent trajectories of satisfaction with life (SWL) before and after caring was initiated. Regression modeling was then used to identify protective factors (at the individual, family, and community levels) associated with resilient trajectories. Results Overall, 731 (12.2%) participants became carers during follow-up. We identified three trajectories in SWL in carers following initiation of caring, namely, Resilient-Stable (81%), Resilient-Recovery (12%), and Non-recovery (6%). Membership in Resilient-Stable and Resilient-Recovery trajectories was associated with fewer depressive symptoms (OR = 0.86, 95% CI 0.78, 0.94) and chronic conditions (OR = 0.21, 95% CI 0.06, 0.74), larger social networks (OR = 2.03, 95% CI 1.06, 3.86), more close friends and relatives (OR = 1.15, 95% CI 1.01, 1.32), and caring for someone other than a child (OR = 0.19, 95% CI 0.07, 0.51) compared to the Non-recovery group. Conclusion Becoming a family carer was associated with a decline in SWL over time in some carers. However, most carers either did not experience a decline in SWL or recovered their SWL over time. We found that both individual and community-level supports may be protective for carers' wellbeing. These results will inform the priorities for social and community-level services and support for older carers and contribute to the design of new projects and programs to meet these needs.
Collapse
Affiliation(s)
- Christine A. McGarrigle
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
- St James's Hospital, Mercer's Institute for Successful Ageing, Dublin, Ireland
| |
Collapse
|
6
|
Wister A, Li L, Best JR, Cosco TD, Kim B. Multimorbidity, COVID-19 and Mental Health: Canadian Longitudinal Study on Aging (CLSA) Longitudinal Analyses. Clin Gerontol 2023; 46:729-744. [PMID: 35797007 DOI: 10.1080/07317115.2022.2094742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
Collapse
Affiliation(s)
- Andrew Wister
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lun Li
- Gerontology Research Centre, Simon Fraser University, Burnaby, British Columbia, Canada
| | - John R Best
- Gerontology Research Centre, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Theodore D Cosco
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, Burnaby, British Columbia, Canada
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - Boah Kim
- Department of Gerontology, Simon Fraser University, Burnaby, British Columbia, Canada
| |
Collapse
|
7
|
Older Adults and Social Isolation and Loneliness During the COVID-19 Pandemic: An Integrated Review of Patterns, Effects, and Interventions. Can J Aging 2022; 42:199-216. [PMID: 36345649 DOI: 10.1017/s0714980822000459] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
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.
Collapse
|
8
|
Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
Collapse
|
9
|
Reynolds CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry 2022; 21:336-363. [PMID: 36073714 PMCID: PMC9453913 DOI: 10.1002/wps.20996] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.
Collapse
Affiliation(s)
| | - Dilip V. Jeste
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA
| | | | - Dan G. Blazer
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNCUSA
| |
Collapse
|
10
|
Wister A, Li L, Whitmore C, Ferris J, Klasa K, Linkov I. Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging. Front Public Health 2022; 10:896312. [PMID: 36211713 PMCID: PMC9539554 DOI: 10.3389/fpubh.2022.896312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Objective There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters. Methods Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health. Results Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR. Discussion Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.
Collapse
Affiliation(s)
- Andrew Wister
- Department of Gerontology, Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Lun Li
- School of Social Work, MacEwan University, Edmonton, AB, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jennifer Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- BC Observatory for Population and Public Health, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Igor Linkov
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, MS, United States
- Carnegie Mellon University, Pittsburg, PA, United States
| |
Collapse
|
11
|
Wister A, Klasa K, Linkov I. A Unified Model of Resilience and Aging: Applications to COVID-19. Front Public Health 2022; 10:865459. [PMID: 35685765 PMCID: PMC9170899 DOI: 10.3389/fpubh.2022.865459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Drawing on multidisciplinary research focusing on a spectrum ranging from individual experience to structural system-level risk response and resilience, this article develops a rationale for a Unified Model of Resilience and Aging (UMRA). In response to a broad range of adversities associated with aging, it details the ways in which some individuals are able to bounce back better than others, or adapt better than expected, termed resilience. However, resilience and aging theoretical models have developed out of different disciplinary developments, ranging from individual levels to structural level complex systems, including several gerontological theoretical models addressing adaptation to life course and aging processes. The article reviews and synthesizes prior conceptual and theoretical work, and their empirical groundings, in order to develop an integrated resilience model with wide applications to aging-related problems including chronic illness, mental health, widowhood, poverty, caregiving burden, etc. The article focuses specifically on COVID-19 pandemic risk, response and resilience in order to specify applications of the UMRA, and to suggest avenues for future research and testing of theoretical axioms.
Collapse
Affiliation(s)
- Andrew Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- *Correspondence: Andrew Wister ; orcid.org/0000-0002-0045-7428
| | - Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Igor Linkov
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, MS, United States
- Carnegie Mellon University, Pittsburg, PA, United States
| |
Collapse
|
12
|
Han J, Chan EHW, Yung EHK, Qian QK, Lam PTI. A Policy Framework for Producing Age-Friendly Communities from the Perspective of Production of Space. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2031. [PMID: 35206223 PMCID: PMC8872022 DOI: 10.3390/ijerph19042031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
Given various hindrances in the macro context, how to efficiently develop age-friendly community policies requires further research. Currently, such kinds of frameworks are lacking. This paper aims to develop a policy framework to minimise cost and resolve conflict of interest between different generations in age-friendly community development. The study adopted a scientometric method to review the theoretical development of age-friendly community studies. Firstly, with a search for the keywords "age-friendly" and "community" on Web of Science, 72 English academic papers were found containing explicit theories. Most of the studies were conducted in the Global North. Then, a mixed analytical method was used to find a suitable theory, "the production of space", to develop the policy framework. Lastly, a policy framework was developed to overcome barriers to age-friendly community development strategically. Echoing previous studies, this paper proposes a way to counter financial austerity in age-friendly initiative investment and balance the consideration for older and younger populations in urban development. For practice, the policy framework can provide a reference for more efficient age-friendly community policymaking in different regions. For future research, the framework provides a model for more empirical studies considering the social dynamics in age-friendly community development.
Collapse
Affiliation(s)
- Jianbo Han
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong SAR, China; (J.H.); (E.H.K.Y.); (P.T.I.L.)
| | - Edwin H. W. Chan
- School of Public Administration, Hunan University, Changsha 410082, China
| | - Esther H. K. Yung
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong SAR, China; (J.H.); (E.H.K.Y.); (P.T.I.L.)
| | - Queena K. Qian
- Faculty of Architecture and The Built Environment, Delft University of Technology, 2628 Delft, The Netherlands;
| | - Patrick T. I. Lam
- Department of Building and Real Estate, The Hong Kong Polytechnic University, Hong Kong SAR, China; (J.H.); (E.H.K.Y.); (P.T.I.L.)
| |
Collapse
|
13
|
Wister A, Li L, Cosco TD, McMillan J, Griffith LE. Multimorbidity resilience and COVID-19 pandemic self-reported impact and worry among older adults: a study based on the Canadian Longitudinal Study on Aging (CLSA). BMC Geriatr 2022; 22:92. [PMID: 35109803 PMCID: PMC8808267 DOI: 10.1186/s12877-022-02769-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/14/2022] [Indexed: 01/07/2023] Open
Abstract
Background The Coronavirus Disease-2019 (COVID-19) pandemic has created a spectrum of adversities that have affected older adults disproportionately. This paper examines older adults with multimorbidity using longitudinal data to ascertain why some of these vulnerable individuals coped with pandemic-induced risk and stressors better than others – termed multimorbidity resilience. We investigate pre-pandemic levels of functional, social and psychological forms of resilience among this sub-population of at-risk individuals on two outcomes – self-reported comprehensive pandemic impact and personal worry. Methods This study was conducted using Follow-up 1 data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit COVID-19 study, conducted between April and December in 2020. A final sub-group of 9211 older adults with two or more chronic health conditions were selected for analyses. Logistic regression and Generalized Linear Mixed Models were employed to test hypotheses between a multimorbidity resilience index and its three sub-indices measured using pre-pandemic Follow-up 1 data and the outcomes, including covariates. Results The multimorbidity resilience index was inversely associated with pandemic comprehensive impact at both COVID-19 Baseline wave (OR = 0.83, p < 0.001, 95% CI: [0.80,0.86]), and Exit wave (OR = 0.84, p < 0.001, 95% CI: [0.81,0.87]); and for personal worry at Exit (OR = 0.89, p < 0.001, 95% CI: [0.86,0.93]), in the final models with all covariates. The full index was also associated with comprehensive impact between the COVID waves (estimate = − 0.19, p < 0.001, 95% CI: [− 0.22, − 0.16]). Only the psychological resilience sub-index was inversely associated with comprehensive impact at both Baseline (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]) and Exit waves (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]), in the final model; and between these COVID waves (estimate = − 0.11, p < 0.001, 95% CI: [− 0.13, − 0.10]). The social resilience sub-index exhibited a weak positive association (OR = 1.04, p < 0.05, 95% CI: [1.01,1.07]) with personal worry, and the functional resilience measure was not associated with either outcome. Conclusions The findings show that psychological resilience is most pronounced in protecting against pandemic comprehensive impact and personal worry. In addition, several covariates were also associated with the outcomes. The findings are discussed in terms of developing or retrofitting innovative approaches to proactive coping among multimorbid older adults during both pre-pandemic and peri-pandemic periods. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02769-2.
Collapse
Affiliation(s)
- Andrew Wister
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Lun Li
- Gerontology Research Centre, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Theodore D Cosco
- Gerontology Research Centre & Department of Gerontology, Simon Fraser University, 2800-515 Hastings Street, Vancouver, BC, V6B 5K3, Canada.,Oxford Institute of Population Ageing, University of Oxford, 66 Banbury Road, Oxford, OX2 6PR, UK
| | - Jacqueline McMillan
- Department of Medicine, Section of Geriatric Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Lauren E Griffith
- Labarge Centre for Mobility in Aging, McMaster University, Hamilton, ON, Canada.,McMaster Institute for Research on Aging, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | |
Collapse
|
14
|
Galaitsi S, Kurth M, Linkov I. Resilience: Directions for an Uncertain Future Following the COVID-19 Pandemic. GEOHEALTH 2021; 5:e2021GH000447. [PMID: 34825121 PMCID: PMC8602081 DOI: 10.1029/2021gh000447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 06/13/2023]
Abstract
The concept of resilience is multi-faceted. This commentary builds upon the analytical distinctions of resilience provided by Urquiza et al. (2021, https://doi.org/10.1029/2020EF001508). In response to this article, we emphasize several distinctions between resilience and other systems concepts. These include distinctions between resilience, risk, and vulnerability, the tradeoff between resilience and efficiency, resilience contrasted with robustness, the relationship between resilience and sustainability, and finally methods for building resilience-by-design or resilience-by-intervention. Improving understanding of these concepts will enable planners to select resilience strategies that best support their system goals. We use examples from the 2020-2021 coronavirus pandemic to illustrate the concepts and the juxtapositions between them.
Collapse
Affiliation(s)
- Stephanie Galaitsi
- US Army Corps of EngineersEngineer Research & Development CenterEnvironmental LabConcordMAUSA
| | - Margaret Kurth
- US Army Corps of EngineersEngineer Research & Development CenterEnvironmental LabConcordMAUSA
| | - Igor Linkov
- US Army Corps of EngineersEngineer Research & Development CenterEnvironmental LabConcordMAUSA
| |
Collapse
|
15
|
Social Determinants and Health Behaviours among Older Adults Experiencing Multimorbidity Using the Canadian Longitudinal Study on Aging. Can J Aging 2021; 41:327-347. [DOI: 10.1017/s0714980821000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
This study examines associations between lifestyle behavioural factors and appraisals of “healthy aging” among older adults experiencing multimorbidity. A Social Determinants and Health Behaviour Model (SDHBM) is used to frame the analyses. Using baseline data from the Canadian Longitudinal Study on Aging (CLSA), we studied 12,272 Canadians 65 years of age or older who reported 2 or more of 27 chronic conditions. Additional analyses were conducted using three multimorbidity clusters: cardiovascular/metabolic, musculoskeletal, and mental health. Using hierarchical logistic regression, it was found that, for multmorbidity and the three illness clusters, healthy aging is consistently associated with not smoking (except for the mental health cluster), an absence of obesity (except for the cardiovascular and metabolic cluster), better sleep, and a better appetite. It is not associated with inactivity. Several socio-demographic, environmental, and illness covariates were also supported. The findings are examined using the SDHBM coupled with a resilience lens in order to elucidate how modifiable health behaviours can act as resources to mitigate multimorbidity adversities. This has implications for healthy aging for persons with multimorbidity, especially during the COVID-19 pandemic.
Collapse
|
16
|
Burgaña Agoües A, Serra Gallego M, Hernández Resa R, Joven Llorente B, Lloret Arabi M, Ortiz Rodriguez J, Puig Acebal H, Campos Hernández M, Caballero Ayala I, Pavón Calero P, Losilla Calle M, Bueno Nieto R, Oliver Messeguer L, Madridejos Mora R, Abellana Sangrà R, Perez-Porcuna TM. Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10221. [PMID: 34639522 PMCID: PMC8507792 DOI: 10.3390/ijerph181910221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. METHODS This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. RESULTS Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. CONCLUSIONS SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.
Collapse
Affiliation(s)
- Ander Burgaña Agoües
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Marta Serra Gallego
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Raquel Hernández Resa
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Beatriz Joven Llorente
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Maria Lloret Arabi
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Jessica Ortiz Rodriguez
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Helena Puig Acebal
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Mireia Campos Hernández
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Itziar Caballero Ayala
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Pedro Pavón Calero
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Montserrat Losilla Calle
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Rosario Bueno Nieto
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Laura Oliver Messeguer
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | - Rosa Madridejos Mora
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| | | | - Tomás M. Perez-Porcuna
- Atenció Primària, Fundació Assitencial Mútua Terrassa, 08221 Terrassa, Spain; (A.B.A.); (M.S.G.); (R.H.R.); (B.J.L.); (M.L.A.); (J.O.R.); (H.P.A.); (M.C.H.); (I.C.A.); (P.P.C.); (M.L.C.); (R.B.N.); (L.O.M.); (R.M.M.); (T.M.P.-P.)
| |
Collapse
|
17
|
Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc 2021; 70:49-59. [PMID: 34536288 DOI: 10.1111/jgs.17477] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks. METHODS A nationally representative online survey of 2006 U.S. adults aged 50-80 was conducted in January 2021 to assess changes in health behaviors (worsened physical activity and less daily time spent on feet), social isolation (lack of companionship and perceived isolation), physical function (mobility and physical conditioning), and falls (falls and fear of falling) since March 2020. Multivariable logistic regression was used to assess relationships among physical activity, social isolation, physical function, falls, and fear of falling. RESULTS Among respondents, 740 (36.9%) reported reduced physical activity levels, 704 (35.1%) reported reduced daily time spent on their feet since March 2020, 712 (37.1%) reported lack of companionship, and 914 (45.9%) social isolation. In multivariable models, decreased physical activity (adjusted risk ratio, ARR: 2.92, 95% CI: 2.38, 3.61), less time spent on one's feet (ARR: 1.95, 95% CI: 1.62, 2.34), and social isolation (ARR: 1.51, 95% CI: 1.30, 1.74) were associated with greater risks of worsened physical conditioning. Decreased physical activity, time spent daily on one's feet, and social isolation were similarly associated with worsened mobility. Worsened mobility was associated with both greater risk of falling (ARR: 1.70, 95% CI: 1.35, 2.15) and worsened fear of falling (ARR: 2.02, 95% CI: 1.30, 3.13). Worsened physical conditioning and social isolation were also associated with greater risk of worsened fear of falling. CONCLUSION The COVID-19 pandemic was associated with worsened physical functioning and fall outcomes, with the greatest effect on individuals with reduced physical activity and social isolation. Public health actions to address reduced physical activity and social isolation among older adults are needed.
Collapse
Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Preeti N Malani
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dianne C Singer
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey T Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|