Impact of the COVID-19 Pandemic on Loneliness Among Older Adults

Social Gaming to Decrease Loneliness in Older Adults: Recruitment Challenges and Attrition Analysis in a Digital Mixed Methods Feasibility Study

BACKGROUND

Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact.

OBJECTIVE

This study aims to evaluate the feasibility of a social gaming app in reducing loneliness among older adults by evaluating recruitment strategies, data collection procedures, and gameplay activity.

METHODS

This mixed methods study recruited participants via newsletters, articles, and a social media campaign. We used semistructured interviews and descriptive analysis of questionnaire answers and game data to assess feasibility. Key measures included recruitment reach and efficiency, participant demographics, in-app activity, and app usability and engagement feedback.

RESULTS

The social media campaign reached 192,641 potential participants, resulting in 1363 game downloads. A total of 155 participants (aged 65 years and older: n=34, 21.9% and aged less than 65 years: n=121, 78.1%) provided informed consent, yielding a conversion rate of 0.08%. The recruitment campaign focusing on distanced playful interaction had a significantly (P<.001) higher click-through rate (1.98%) than a campaign focusing on research participation (click-through rate=0.51%; P<.001). The overall conversion rate from advertisement exposure to research participation was 0.08%. Participants had a mean age of 48 (SD 16) years. The 65 years and older group averaged 70 (SD 5) years, while the less 65 years group averaged 42 (SD 12) years. Additionally, 45.2% (57/126) reported at least moderate levels of loneliness at baseline. Of the initial 554 players, 91 (16.4%) remained active after the first week, and 32 (5.8%) remained active for more than 90 days. Active participants tended to interact with those within their own age group, as indicated by a Pearson correlation of r=0.31 between the ages of the message sender and receiver. Interviews with 12 (48%) participants (aged 65-79 years; female: n=12, 83%) revealed barriers such as excessive chatbot questions and a mismatch between the target group and app design focus. Questionnaire completion rates dropped from 46% at baseline to 10% at follow-up.

CONCLUSIONS

These findings underscore the challenges of recruitment and retention for older adults in a fully digital social gaming intervention. Effective recruitment strategies and targeted app design are crucial for engagement. Based on these insights, future interventions should focus on simplified interfaces, clear guidance for gameplay, and addressing the specific needs and preferences of older adults, thereby enhancing the effectiveness of digital mental health interventions.

Evaluating changes in the well-being of older adults during the COVID-19 pandemic: a longitudinal cohort study

The COVID-19 pandemic affected the lives of older adults. Yet, little is known about changes in well-being among older adults during the pandemic, especially when COVID-19 measures were relaxed. Therefore, we aimed to assess changes in the well-being of older adults during multiple turning points of the pandemic. This longitudinal study included data from Dutch older adults (≥65 years old) participating in the Lifelines COVID-19 cohort. Data consisted of seven questionnaires, administered every 2-4 months between May 2020 and October 2021. The outcomes were quality of life (n = 14 682), physical fitness (n = 14 761), and feelings of isolation (n = 14 611), all graded on a scale from 0 to 10. Changes in well-being were analysed by multivariable linear mixed-effects models. The context of measures was described using the Government Stringency Index. Quality of life and feelings of isolation decreased when measures were tightened and increased when measures were relaxed. For example, when measures relaxed after the first lockdown in May 2020, quality of life increased by 0.23 [95% confidence interval (CI): 0.16-0.29] towards July 2020. Physical fitness decreased by 0.26 [95% CI: 0.15-0.37] during the study period. Differences between subsamples were not found, except for sex in feelings of isolation, which differences diminished after a period of relaxed measures. Changes in quality of life and feelings of isolation improved after periods of stringent COVID-19 measures. Physical fitness did not improve after measures were relaxed, suggesting a possible negative effect of the pandemic on the physical fitness of older adults.

Preventive behaviors and psychological effects of COVID-19 and their associated factors among Iranian older adults: A cross-sectional study

BACKGROUND

The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a variety of psychological complications. One way to control the spread of this pandemic is compliance with health protocols and standards. Considering the limited research into the psychological effects of COVID-19 and the preventive behaviors among older adults, this study aimed to determine these variables and their relationship with associated factors.

MATERIALS AND METHODS

This cross-sectional study was conducted on 153 older adults who were referred to the clinic of Pirouz Hospital in the east of Guilan, in the north of Iran, in 2022. The research instruments included the Impact of Event Scale-Revised (IES-R) and the preventive behavior questionnaires. Descriptive (mean, standard deviation, frequency, and percentage) and inferential (Kruskal-Wallis and Mann-Whitney tests) statistics were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software version 20 with a significant level of 0.05.

RESULTS

The findings showed that the overall mean score for preventive behaviors was 107 ± 10.38. The highest mean score of preventive behaviors was related to personal behavior (43.00 ± 5.58) and instructions to enter the house (30.15 ± 4.84), respectively. The highest mean scores of psychological effects were related to the intrusion dimension (11 ± 5.33) and avoidance dimension (7 ± 4.74), respectively. There was a significant relationship between drug use (F = 27.136, P = 0.028) and the psychological effects of COVID-19.

CONCLUSION

Based on the results, the general condition of the preventive behaviors of older adults was average, and the majority of them were at a normal level of psychological effects. However, administrators and health policymakers should consider planning to develop interventions to encourage and improve preventive behaviors against COVID-19, especially among older adults during the COVID-19 pandemic.

Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: A scoping review

Older people living with dementia or mild cognitive impairment (MCI) are more vulnerable to experiencing social isolation and loneliness due to their cognitive and physical impairments. Increasingly integrating technology into group exercises contributed to the improved resilience and well-being of older adults living with dementia and MCI. The purpose of this scoping review was to identify the various types, feasibility, outcome measures, and impacts of technology-based group exercise interventions for people with dementia or MCI. We utilized the Joanna Briggs Institute approach, a three-step process. A comprehensive literature search on five databases-CINAHL, MEDLINE, Embase, Web of Science, and PsycInfo-until January 2024 yielded 1,585 publications; the final review included 14 publications that recruited a total of 379 participants, with mean age of 69 (SD = 4.21) years to 87.07 (SD = 3.92) years. Analysis of data showed three types of technology-based group exercise interventions for people with dementia or MCI: (a) exergames, (b) virtual cycling or kayak paddling, and (c) video-conferencing platforms. In addition, we identified three key impacts: (a) feasibility and accessibility; (b) physical, psychosocial, and cognitive benefits; and (c) adaptations necessary for persons with dementia or MCI. Our study suggests that technology-based group exercise interventions are feasible and acceptable to persons with dementia or MCI. Future studies should involve individuals with dementia and their caregivers in the design and implementation of technology-based group exercise programs.

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.

Long-term development of loneliness in older people and associations with stringency of COVID-19 measures: an observational cohort study

BACKGROUND

Most longitudinal studies found heightened feelings of loneliness in older people in spring 2020 compared to times before the pandemic. However, longer-term effects are more disputed. We, therefore, investigated changes in loneliness in older people throughout the first 21 months of the COVID-19 pandemic in Switzerland and examined the association between the stringency of COVID-19 measures and feelings of loneliness.

METHODS

We assessed loneliness (3-item University of California Los Angeles (UCLA) loneliness scale) in a nationally representative longitudinal observational online survey. Older people (65-79 years) were surveyed between March 2020 and December 2021. Proportions of people feeling lonely (UCLA loneliness scale >6) were compared in two stringent phases ('lockdown', Oxford University stringency index ≥55) and two less restricted phases. Additionally, we explored the situation of potentially more susceptible subgroups (living alone, women, chronic and mental diseases, low educational level and low income).

RESULTS

Phases with stringent measures were associated with higher levels of loneliness in older people. People living alone, women, people with noncommunicable or mental disease diagnoses and lower income show consistently higher levels of loneliness. However, the differences are not accentuated in phases with more stringent measures. We found little differences between subgroups with varying educational levels.

CONCLUSIONS

Even in a country with relatively less stringent COVID-19 measures like Switzerland, an increase in the proportion of older people that feel lonely could be found during phases with more stringent COVID-19 measures. Lockdown phases should, therefore, be accompanied by evidence-based interventions to relieve loneliness to avoid adverse short- and long-term consequences.

Effects of Anxiety, Stress and Perceived Social Support on Depression and Loneliness Among Older People During the COVID-19 Pandemic: A Cross-Sectional Path Analysis

During the COVID-19 pandemic, older people were exposed to high levels of anxiety and stress leading to loneliness and depressive disorders. The purpose of the present study was to investigate the effects of anxiety, positive coping, perceived social support, and perceived stress on depression and loneliness among older people during the COVID-19 pandemic. This was a cross-sectional online/telephone survey. A non-probability convenience sampling method was used. Participants were 112 people aged 60 years and above, without cognitive impairment, who experienced confinement (from March 2020 onward) and had access to the internet or telephone. A path analysis model showed a direct significant effect of anxiety on both, depression (β = .68, P < .001) and perceived stress (β = .65, P < .001), as well as an indirect effect of anxiety on loneliness via perceived stress (β = .65) * (β = .40); and social support (β = -.21) * (β = -.20). The model showed adequate fit χ2(df = 4) =5.972, P = .201; RMSEA = 0.066 (0.000, 0.169), CFI = 0.992; TLI = 0.970. Anxiety had a significant effect on depressive symptoms as well as on loneliness via perceived social support and perceived stress. According to our findings, in order to reduce depressive symptoms and perceived loneliness, it is essential to develop timely interventions that decrease levels of anxiety and stress and increase levels of perceived social support in older people, particularly when there are any restrictions, physical or contextual, that prevent face-to-face contact. This can be achieved by implementing preventive community-based programs, enhancing accessibility to mental health services, and collaborating with local support groups, among others.

Women's attitudes towards pessary self-care: a qualitative study

INTRODUCTION AND HYPOTHESIS

Patients with vaginal pessaries can learn to care for their pessary by themselves or they can have provider-led care, which requires more frequent follow-up visits. We aimed to understand motivations for and barriers to learning self-care of a pessary to inform strategies to promote pessary self-care.

METHODS

In this qualitative study, we recruited patients recently fitted with a pessary for stress incontinence or pelvic organ prolapse, and providers who perform pessary fittings. Semi-structured, one-on-one interviews were completed to data saturation. A constructivist approach to thematic analysis using the constant comparison method was used to analyze interviews. A coding frame was created following independent review of a subset of interviews by three members of the research team and this frame was used to code interviews and develop themes through interpretive engagement with the data.

RESULTS

Ten pessary users and four health care providers (physicians and nurses) participated. Three major themes were identified: motivators, benefits, and barriers. There were several motivators for learning self-care, including care provider advice, personal hygiene, and ease of care. Benefits of learning self-care included autonomy, convenience, facilitation of sexual relations, avoidance of complications, and decreased burden on the health care system. Barriers to self-care included physical, structural, mental, and emotional barriers; lack of knowledge; lack of time; and social taboo.

CONCLUSIONS

Promotion of pessary self-care should focus on patient education about benefits and ways of mitigating common barriers while focusing on normalizing patient engagement in pessary self-care.

Original Research: The Impact of COVID-19 on Pain Care Among Older Adults

PURPOSE

In this qualitative descriptive study, we sought to understand the professional experiences and perceptions of pain management nurses who cared for older adults in the United States during the height of the COVID-19 pandemic.

METHODS

Data were collected between July 2020 and July 2021 through individual, semistructured interviews with a nonprobability sample of 18 pain management nurses. An inductive content analysis approach, in which categories were derived from a coding process based on a close reading of data extracts from the interview transcripts, was used to reveal the major theme related to the study aim.

RESULTS

Notwithstanding the variable consequences of COVID-19 on patients' health, a single overarching theme was pronounced: "Pain management for older adults remained unchanged during the pandemic despite unpredictable survival, restrictions on human interactions, and communication challenges." This theme was supported by four categories that emerged from the data: unpredictable survival, restriction-induced isolation, perceived continuity and equality of pain management, and communication challenges.

CONCLUSIONS

During the COVID-19 pandemic, pain management nurses stepped in and joined interdisciplinary teams providing general and specialized pain care to ensure that older adults, whether inpatient or outpatient, continued to receive quality care. These study findings highlight the many challenges pain management nurses faced during this unprecedented public health crisis, as well as opportunities to improve the health system and enhance nursing practice to meet the needs of older patients.

Impact of COVID-19 on mental health in Bhutan: a way forward for action

The coronavirus disease 2019 (COVID-19) pandemic continues to impact mental health and wellbeing globally. There is a lack of scientific documentation highlighting the mental health impact of COVID-19 in Bhutan. We present the mental health burdens and control measures taken, and suggest ways to further strengthen mental health services in Bhutan. During the pandemic, a rise in depression and anxiety had been reported in Bhutan. Depression rose from an average prevalence of 9 per 10,000 between 2011 and 2019 to 16 per 10,000 in 2020 and 32 per 10,000 in 2021. Similarly, anxiety rose from an average prevalence of 18 per 10,000, to 29 per 10,000 in 2020, and 55 per 10,000 in 2021. Psychological impacts related to isolation due to lockdowns, economic losses, and poor coping abilities were associated with negative outcomes. Stigma and discrimination towards mental health disorders discouraged mentally distressed people from seeking care. In response to increased demand, Bhutan's government initiated a range of interventions including home delivery of medicines and tele-counselling to people in need of urgent mental health care. Mental health care in Bhutan can be further improved through investment in services and human resources, and decentralization of services to the community.

Older Adults' Views on Social Interactions and Online Socializing Games - A Qualitative Study

Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one's social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barriers and enablers they foresee in digital gaming interventions as network support aids. Two focus groups and 20 semi-structured interviews (N = 29) with older adults (aged 55-87) were held to explore the research questions. Furthermore, a questionnaire was administered (N = 29) containing measures of loneliness, frailty, and social network size. Participants found 'reciprocity', 'in-person contact', and 'personal connection' important in contact with strong ties. Online games were not used much for socializing but may be used in the future, particularly by less mobile older adults. Future social gaming interventions should be challenging, user-friendly, and offer the possibility to communicate. Digital co-designed interventions that are feasible, challenging, intuitive, and trigger meaningful communication may strengthen social interactions in older adults. They may be a relevant social support tool in periods of interaction limitations due to functional impairment or social isolation.

The bi-directional association between loneliness and depression among older adults from before to during the COVID-19 pandemic

BACKGROUND

Older adults have both the highest risk of contracting SARS-CoV-2 and in many jurisdictions have had additional restrictions placed on the social interactions. As a result, the COVID-19 pandemic has led to increased depression and loneliness among older adults. Using data from an established cohort of older adults, the aims of this study was to describe changes in loneliness and depression and to examine the directionality of the association between depression and loneliness over a 5-year period that included the early months of the pandemic.

METHODS

Data were from The Irish Longitudinal Study on Ageing (TILDA), a large cohort of community-dwelling adults aged 54+. We applied an auto-regressive cross-lagged panel modelling approach to estimate the effect of depression on loneliness and vice versa over three time points.

RESULTS

Both depression and loneliness increased significantly in the early months of the pandemic. While the association between loneliness and depression was bi-directional, loneliness was a stronger predictor of depression.

CONCLUSION

The strength and bi-directionality of the association between loneliness and depression suggests that interventions to alleviate loneliness may also help reduce depressive symptoms and vice versa.

Associations Between Changes in Loneliness and Social Connections, and Mental Health During the COVID-19 Pandemic: The Women's Health Initiative

BACKGROUND

Older women have faced significant disruptions in social connections during the coronavirus disease 2019 pandemic. Whether loneliness increased or whether a change in loneliness from pre- to intrapandemic period was associated with mental health during the pandemic is unknown.

METHODS

Older women (n = 27 479; mean age 83.2 [SD: 5.4] years) completed surveys in mid-2020, including questions about loneliness, living arrangements, changes in social connections, and mental health. Loneliness was also previously assessed in 2014-2016. We examined whether loneliness changed from the pre- to intrapandemic period and explored factors associated with this change. In multivariable models, we investigated the association of changes in loneliness and social connections with mental health.

RESULTS

Loneliness increased from pre- to intrapandemic levels. Factors associated with worsening loneliness included older age, experiencing stressful life events, bereavement, histories of vascular disease and depression, and social connection disruptions. Factors associated with a decrease in loneliness included identifying as Black, engaging in more frequent physical activity, being optimistic, and having a higher purpose in life. A 3-point increase in loneliness scores was associated with higher perceived stress, higher depressive, and higher anxiety symptoms. Social connection disruptions showed modest or no associations with mental health.

CONCLUSIONS

Loneliness increased during the pandemic in older women and was associated with higher stress, depressive, and anxiety symptoms. Our findings point to opportunities for interventions targeting lifestyle behaviors, well-being, disrupted social connections, and paying closer attention to those with specific medical and mental health histories that may reduce loneliness and improve mental health.

Psychosocial implications of early COVID-19 restrictions on older adults in a small-town region in Southwestern, Pennsylvania (USA)

OBJECTIVES

The restrictions put in place in 2020 to mitigate the spread of the coronavirus disease 2019 limited or eliminated social connections that are vital for psychosocial well-being. The objectives of this research were to examine the impact of early pandemic-related restrictions on feelings of loneliness, depression, and anxiety as well as social activity disruption and their concomitant associations in a sample of community-dwelling older adults residing in a small-town region in the USA.

DESIGN AND SETTING

Cross-sectional data collected from an ongoing population-based cohort study in Southwestern, Pennsylvania.

PARTICIPANTS

Analyses included 360 adults aged 65 years and older whose annual study assessment occurred during the first 120 days of pandemic-related restrictions.

MEASUREMENTS

Self-reported feelings of loneliness, depression, and anxiety due to the pandemic-related restrictions were each measured using a single question. Depressive symptoms and anxiety were also assessed with the modified Center for Epidemiologic Studies-Depression and Generalized Anxiety Disorder-7 item tools. Disruption in a variety of common social activities was also assessed.

RESULTS

Feeling lonely affected 36% of participants who were more likely to be female, not currently married, and living alone. Giving up in-person visits with family was associated with significantly higher odds of feeling lonely, and feeling lonely was associated with significantly higher odds of feelings of anxiety and depression.

CONCLUSIONS

Loneliness is a serious outcome of pandemic-related restrictions among older adults, potentially linked to loss of connection with family, and may be associated with increased feelings of depression and anxiety.

Changes in loneliness prevalence and its associated factors among Bangladeshi older adults during the COVID-19 pandemic

Aims

Worldwide, loneliness is one of the most common psychological phenomena among older adults, adversely affecting their physical and mental health conditions during the COVID-19 pandemic. This study aims to assess changes in the prevalence of loneliness in the two timeframes (first and second waves of COVID-19 in Bangladesh) and identify its correlates in pooled data.

Methods

This repeated cross-sectional study was conducted on two successive occasions (October 2020 and September 2021), overlapping with the first and second waves of the COVID-19 pandemic in Bangladesh. The survey was conducted remotely through telephone interviews among 2077 (1032 in the 2020-survey and 1045 in the 2021-survey) older Bangladeshi adults aged 60 years and above. Loneliness was measured using the 3-item UCLA Loneliness scale. The binary logistic regression model was used to identify the factors associated with loneliness in pooled data.

Results

We found a decline in the loneliness prevalence among the participants in two survey rounds (51.5% in 2021 versus 45.7% in 2020; P = 0.008), corresponding to 33% lower odds in the 2021-survey (AOR 0.67, 95% CI 0.54–0.84). Still, nearly half of the participants were found to be lonely in the latest survey. We also found that, compared to their respective counterparts, the odds of loneliness were significantly higher among the participants without a partner (AOR 1.58, 95% CI 1.20–2.08), with a monthly family income less than 5000 BDT (AOR 2.34, 95% CI 1.58–3.47), who lived alone (AOR 2.17, 95% CI 1.34–3.51), with poor memory or concentration (AOR 1.58, 95% CI 1.23–2.03), and suffering from non-communicable chronic conditions (AOR 1.55, 95% CI 1.23–1.95). Various COVID-19-related characteristics, such as concern about COVID-19 (AOR 1.28, 95% CI 0.94–1.73), overwhelm by COVID-19 (AOR 1.53, 95% CI 1.14–2.06), difficulty earning (AOR 2.00, 95% CI 1.54–2.59), and receiving routine medical care during COVID-19 (AOR 2.08, 95% CI 1.61–2.68), and perception that the participants required additional care during the pandemic (AOR 2.93, 95% CI 2.27–3.79) were also associated with significantly higher odds of loneliness. However, the odds of loneliness were significantly lower among the participants with formal schooling (AOR 0.71, 95% CI 0.57–0.89) and with a family of more than four members (AOR 0.76, 95% CI 0.60–0.96).

Conclusions

The current study found a decreased prevalence of loneliness among Bangladeshi older adults during the ongoing pandemic. However, the prevalence is still very high. The findings suggest the need for mental health interventions that may include improving social interactions increasing opportunities for meaningful social connections with family and community members and providing psychosocial support to the vulnerable population including older adults during the pandemic. It also suggests that policymakers and public health practitioners should emphasise providing mental health services at the peripheral level where the majority of older adults reside.

The Association Between Social Network and Fear of COVID-19 Among Older Adults

The COVID-19 pandemic and associated restrictions pose a significant health threat to older adults. Fear of COVID-19 is associated with increased disease transmission and numerous psychosocial health challenges. While social support has been studied extensively in gerontological literature, there is a gap in understanding how social networks influence fear of COVID-19. This study drew from a convenience sample of 239 adults 60+ years of age in the United States who completed a 20-min survey. Regression results indicate that higher social network was significantly associated with decreased fear of COVID-19. Identifying as female and as an ethnic minority were associated with increased fear of COVID-19. These findings document the need for social workers to promote enhanced social networks in reducing fear of COVID-19 among older adults and attend to disparate levels of fear among older women and people of color.

Psychosocial Determinants of Loneliness in the Era of the COVID-19 Pandemic-Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic affected the mental health and social behavior of people around the world. Due to epidemiological restrictions, the period of forced isolation contributed to the feeling of loneliness. The aim of the research is to identify factors and conditions associated to the feeling of loneliness in the era of the COVID-19 pandemic.

METHODS

The survey was conducted among 262 people from the north-eastern Polish area, using an online survey. The diagnostic survey method was used, using the De Jong Gierveld Loneliness Measurement Scale, the Generalized Self-Efficacy Scale (GSES), the WHOQoL-Bref questionnaire.

RESULTS

A statistically significant relationship was observed between the feeling of loneliness and areas of quality of life, especially psychological and social, generalized self-efficacy and marital status and way of living (p < 0.05). Higher levels of stress, social distancing, restrictions at work, health status were significantly correlated with an increase in loneliness. Remote work was associated with a lower assessment of the quality of life in the psychological field (p < 0.05).

CONCLUSIONS

Higher levels of loneliness were significantly more likely to affect people living alone and not in a relationship. Higher levels of loneliness were significantly associated with lower quality of life in the social and psychological domains, lower levels of self-efficacy, and remote work.

The Impact of Changing Social Support on Older Persons' Onset of Loneliness During the COVID-19 Pandemic in the United Kingdom

BACKGROUND AND OBJECTIVES

Social distancing measures aimed at controlling the spread of coronavirus disease 2019 (COVID-19) are likely to have increased social isolation among those older than 70 instructed to shield at home. This study examines the incidence of loneliness by gender over the first 10 months of the COVID-19 pandemic among persons aged 70 and older in the United Kingdom, and the impact of changing social networks and perceived social support on the new occurrence of loneliness.

RESEARCH DESIGN AND METHODS

Participants (N = 1,235) aged 70 and older with no reports of loneliness before the pandemic who participated in 7 rounds of the Understanding Society: COVID-19 Study (April 2020-January 2021) and the main Understanding Society Study conducted during 2019. Cox regression analyzed the time to a new occurrence of loneliness.

RESULTS

Among older people who hardly ever/never felt lonely before the pandemic, 33.7% reported some degree of loneliness between April 2020 and January 2021. Living in a single-person household, having received more social support before the pandemic, changes in support receipt during the pandemic, and a deteriorating relationship with one's partner during the pandemic increased the risk of experiencing loneliness. Older women were more likely than older men to report loneliness, even when living with a partner.

DISCUSSION AND IMPLICATIONS

During the 3 COVID-19-related lockdowns in the United Kingdom, changes in older people's social networks and support resulted in a significant onset of loneliness. Findings highlight the risks of shielding older persons from COVID-19 in terms of their mental well-being and the importance of strengthening intergenerational support.

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.

Tailoring cultural offers to meet the needs of older people during uncertain times: a rapid realist review

BACKGROUND

Non-medical issues (e.g. loneliness, financial concerns, housing problems) can shape how people feel physically and psychologically. This has been emphasised during the Covid-19 pandemic, especially for older people. Social prescribing is proposed as a means of addressing non-medical issues, which can include drawing on support offered by the cultural sector.

METHOD

A rapid realist review was conducted to explore how the cultural sector (in particular public/curated gardens, libraries and museums), as part of social prescribing, can support the holistic well-being of older people under conditions imposed by the pandemic. An initial programme theory was developed from our existing knowledge and discussions with cultural sector staff. It informed searches on databases and within the grey literature for relevant documents, which were screened against the review's inclusion criteria. Data were extracted from these documents to develop context-mechanism-outcome configurations (CMOCs). We used the CMOCs to refine our initial programme theory.

RESULTS

Data were extracted from 42 documents. CMOCs developed from these documents highlighted the importance of tailoring-shaping support available through the cultural sector to the needs and expectations of older people-through messaging, matching, monitoring and partnerships. Tailoring can help to secure benefits that older people may derive from engaging with a cultural offer-being distracted (absorbed in an activity) or psychologically held, making connections or transforming through self-growth. We explored the idea of tailoring in more detail by considering it in relation to Social Exchange Theory.

CONCLUSIONS

Tailoring cultural offers to the variety of conditions and circumstances encountered in later life, and to changes in social circumstances (e.g. a global pandemic), is central to social prescribing for older people involving the cultural sector. Adaptations should be directed towards achieving key benefits for older people who have reported feeling lonely, anxious and unwell during the pandemic and recovery from it.

Intergenerational programming during the pandemic: Transformation during (constantly) changing times

Intergenerational programs have long been employed to reduce ageism and optimize youth and older adult development. Most involve in-person meetings, which COVID-19 arrested. ​​Needs for safety and social contact were amplified during COVID-19, leading to modified programming that engaged generations remotely rather than eliminating it. Our collective case study incorporates four intergenerational programs in five US states prior to and during COVID-19. Each aims to reduce ageism, incorporating nutrition education, technology skills, or photography programming. Authors present case goals, participants, implementation methods, including responses to COVID-19, outcomes, and lessons learned. Technology afforded opportunities for intergenerational connections; non-technological methods also were employed. Across cases, programmatic foci were maintained through adaptive programming. Community partners' awareness of immediate needs facilitated responsive programming with universities, who leveraged unique resources. While new methods and partnerships will continue post-pandemic, authors concurred that virtual contact cannot fully substitute for in-person relationship-building. Remote programming maintained ties between groups ready to resume shared in-person programming as soon as possible; they now have tested means for responding to routine or novel cancellations of in-person programming. Able to implement in-person and remote intergenerational programming, communities can fight ageism and pursue diverse goals regardless of health, transportation, weather, or other restrictions.

The effectiveness of synchronous tele-exercise to maintain the physical fitness, quality of life, and mood of older people - a randomized and controlled study

Aim

This study aims to investigate the effects of a synchronous tele-exercise program on physical fitness, quality of life, loneliness, and mood change when applied to older people under social isolation during the coronavirus pandemic.

Findings

Synchronous tele-exercise seems to be an effective method to provide improvements in the physical fitness level of community-dwelling older people and maintain their quality of life. In addition, it can make positive contributions to coping with loneliness in the older people and improve their mood.

Message

To maintain the physical fitness level and quality of life of community-dwelling older people, the exercises can be applied effectively via the synchronous tele-exercise method.

Purpose

The study investigates the effects of synchronized tele-exercise on physical fitness level, quality of life (QoL), loneliness and mood of older people individuals who experience social isolation during the coronavirus pandemic.

Methods

A randomized controlled study was performed with 30 volunteers. A synchronized online exercise protocol was applied to the study group (SG) (n = 15; 10 females, 5 males) (mean age 67.1 ± 3.7 years), while the control group (CG) (n = 15; 7 females, 8 males) (mean age 69.3 ± 5.6 years) was placed on the waiting list. Physical fitness (Senior Fitness Test Battery-SFTB), health-related QoL (Nottingham Health Profile-NHP), loneliness (Loneliness Scale for the Elderly-LSE), and mood changes (Positive and Negative Affect Schedule-PANAS) were evaluated.

Results

There was a significant difference in all the subscales of SFTB (p < 0.05), physical activity and energy subscales, and total scores of NHP (p < 0.05) and PANAS positive emotional status score (p = 0.002) in the study group. While LSE scores worsened in the CG (p = 0.016), there was no significant difference in the SG (p = 0.162).

Conclusion

Synchronous tele-exercise can provide improvements in the physical fitness level and can be used to maintain QoL and to improve the mood of community-dwelling older people.

Precarious ageing in a global pandemic – older adults' experiences of being at risk due to COVID-19

Health authorities worldwide address older adults as a risk group for more serious illness and health complications associated with COVID-19, while social gerontologists have warned that addressing older adults as a risk group of COVID-19 bears the risk of reinforcing ageism. This paper empirically explores to what extent older adults perceive themselves as part of a COVID-19 risk group and how these perceptions influence their everyday lives and experiences of age and ageing. This paper draws upon data from a mixed-methods study on older adults' risk perceptions during COVID-19 in Lower Austria, including a representative survey on 521 adults (60+ years) and data from 20 semi-structured interviews. Approximately two-thirds of the respondents consider themselves at risk of COVID-19 and name age, in addition to pre-existing illness, as a contributing factor in this risk perception. Older adults with health constraints, and especially older men, have a higher probability of perceiving risk due to COVID-19. Additionally, older adults report that they experience being ‘suddenly seen as old’ or ‘being put into a box’ during the pandemic, which influenced their experiences and images of ageing. Our study provides insights into how perceived COVID-19 risk affects the everyday lives of older adults. Age-based categorisations of risk contribute to a shift in images of age and ageing, drawing on insecurity and risk, rather than successful and active ageing, to conceptualise later life.

A New Health Promotion Program That Includes Wadaiko Rhythm Exercise to Maintain the Health of Persons Excluded from Receiving Specific Health Guidance

This study examined the effectiveness of a new health promotion program, which is a collective intervention program aimed at improving lifestyle habits. It was designed as a one-year prospective cohort study. This program targeted non-obese persons at risk of developing lifestyle-related diseases and participants with hypertension, dyslipidemia, or hyperglycemia who were not included in the specific health guidance system in Japan. The Wadaiko rhythm exercise, which is a traditional performing art, is incorporated into this intervention as an enjoyable routine that can help participants continue the program, preventing them from dropping out. After a one-year follow-up, the effectiveness of the health promotion program was evaluated in 18 participants (2 males, 16 females; mean age 65.2 ± 3.4 years) and 92 controls. The results showed that triglyceride in the intervention group significantly decreased (−24.5 mg/dL; p = 0.02; 95% confidence interval [CI], −44.73 to −4.27) and high-density lipoprotein cholesterol significantly increased (+6.1 mg/dL; p < 0.01; 95% CI, 2.46 to 9.65), although levels in the control group did not change. These results suggest that the health promotion program could contribute to lifestyle habit improvements in those who are excluded from receiving specific health guidance.

Associations between loneliness and frailty among older adults: Evidence from the China Health and Retirement Longitudinal Study

Background

Previous studies have demonstrated the associations between loneliness and frailty in late life. However, there is a lack of consensus on the direction of the relationship. The present study aimed to examine the interdependencies between loneliness and frailty over time.

Methods

Data on participants aged 60 years old and above were collected from the 2011, 2013, and 2015 samples of the China Health and Retirement Longitudinal Study (CHARLS). Loneliness was measured by a single question from the Centre for Epidemiological Studies Depression scale, and frailty was assessed by the Physical Frailty Phenotype (PFP) scale. Cross-lagged panel models were utilized to examine the potential bidirectional relationship between loneliness and frailty.

Results

Reciprocal associations were found between loneliness and frailty. Furthermore, we found that baseline frailty and early change in frailty had a significant predictive effect on late change in loneliness. Higher baseline loneliness in older adults may create a potentially vicious cycle that influenced early change in frailty and continued to cause late change in loneliness.

Conclusion

A bidirectional relationship may exist between loneliness and frailty among older Chinese adults over 60 years old. Lonely older adults should be alerted to the potential self-reinforcing cycle of loneliness that affects their health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03044-0.

Loneliness and Depression among Community Older Adults during the COVID-19 Pandemic: A cross-sectional study

BACKGROUND

Social isolation has been recommended for reducing older adults' mortality and severe cases of COVID illness. That has resulted in unavoidable consequences of mental ill-health. This study aimed to examine the impact of the COVID-19 lockdown on the development of loneliness and depression and to analyse the factors associated with these conditions among community-dwelling older adults in Jordan.

METHODS

A cross-sectional survey was conducted with a random sample of 456 community older adults contacted by telephone three weeks after the first pandemic lockdown in April 2020. The study instrument included the screening three-item UCLA Loneliness Scale, the Geriatric Depression Scale, and relevant medical and functional history.

RESULTS

The mean age was 72.48 ± 6.84 years, and 50.2% were women. 41.4% were lonely, and of those 62% had a positive screen for depression. The mean UCLA score was significantly higher during the lockdown than before. Loneliness was significantly associated with being unmarried, having never worked previously, and being functionally dependent. Lonely participants were 1.65 times more likely to have depression. Likewise, a previous history of depression and cognitive impairment, multimorbidity, poor self-perceived health, and concern about contracting COVID infection were significant predictors of depression.

CONCLUSION

The COVID-19 pandemic has had a heavy toll on older adults' mental health, particularly those with multimorbidity, baseline functional dependence, and those with a previous history of depression and cognitive impairment. Targeting these high-risk groups is important in order to minimize loneliness, depression, and subsequent increased morbidity. Using all-inclusive language might minimize ageism and the fear of catching an infection.

Older people's family relationships in disequilibrium during the COVID-19 pandemic. What really matters?

Inter- and intragenerational relationships are known to be important in maintaining the wellbeing of older people. A key aspect of these relationships is the exchange of both emotional and instrumental social support. However, relatively little is known about how this exchange of support changes in the context of widespread disruption. The COVID-19 pandemic provides an opportunity to examine how older people's family relationships are impacted by such social change. The present qualitative study explores how older people in the United Kingdom experienced changes in inter- and intragenerational support during the COVID-19 pandemic. Participants (N = 33) were recruited through a large-scale nationally representative survey (https://www.sheffield.ac.uk/psychology-consortium-covid19). We asked how life had been pre-pandemic, how they experienced the first national lockdown and what the future might hold in store. The data were analysed using constructivist grounded theory. This paper focuses on the importance of family relationships and how they changed as a consequence of the pandemic. We found that the family support system had been interrupted, that there were changes in the methods of support and that feelings of belonging were challenged. We argue that families were brought into disequilibrium through changes in the exchange of inter- and intragenerational support. The important role of grandchildren for older adults was striking and challenged by the pandemic. The significance of social connectedness and support within the family had not changed during the pandemic, but it could no longer be lived in the same way. The desire to be close to family members and to support them conflicted with the risk of pandemic infection. Our study found support for the COVID-19 Social Connectivity Paradox: the need for social connectedness whilst maintaining social distance. This challenged family equilibrium, wellbeing and quality of life in older people.

Living with the aftermaths of a stroke in the era of the COVID-19 pandemic; the significance of home and close surroundings

Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61–91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities–strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.

Venerable vulnerability or remarkable resilience? A prospective study of the impact of the first wave of the COVID-19 pandemic and quarantine measures on loneliness in Swedish older adults with home care

OBJECTIVES

To examine the early impact of the pandemic and of quarantine measures targeting older adults introduced in March 2020 on loneliness among older adults in Sweden.Design Prospective pretest-posttest and controlled interrupted time series designs.

SETTING

The population of older adults receiving home care before and during the emergence of the first COVID-19 pandemic wave in Sweden in Spring 2020.

PARTICIPANTS

Respondents (n=45 123, mean age 85.6 years, 67.6% women) came from two waves of a total population survey targeting all community-dwelling older adults receiving home care for older adults in Sweden in Spring 2019 and 2020.

OUTCOME

Self-reported loneliness.

RESULTS

Results estimated 14% (95% CI: 10 to 19) higher loneliness in Spring 2020 compared with 2019, taking covariates into account. No impact of the quarantine measure was found (1% increase, 95% CI: -1 to 4).

CONCLUSIONS

The results illustrate the broader public health consequences of the COVID-19 pandemic for older adults, but also suggest a relative resilience among older adults in home care to quarantine measures, at least during the first months of the pandemic. Future studies should examine the long-term effects of sustained pandemic and social distancing measures on loneliness among older adults.

Who Became Lonely during the COVID-19 Pandemic? An Investigation of the Socioeconomic Aspects of Loneliness in Japan

The COVID-19 pandemic has impacted social and economic aspects of people’s lives in different ways, causing them to experience different levels of loneliness. This study examines the extent of loneliness among men and women of various ages in Japan during the pandemic and attempts to determine the underlying causes. We used data from Hiroshima University’s nationwide survey conducted before and during the pandemic in Japan. The sample consists of 3755 participants, of which 67% are men and 33% are women with an average age of 51 years (SD = 13.64). Using mean comparison tests and probit regression models, we show that loneliness is a common occurrence among the Japanese population and that a significant number of people became lonely for the first time during the pandemic. In general, loneliness was greater among younger respondents, but older people became lonelier during the pandemic. Simultaneously, we observed significant differences in loneliness across age and gender subsamples. Although depression and subjective health status contributed to loneliness, we found no single explanation for the loneliness experienced by people during the pandemic; rather, subsample analysis revealed that the causes of loneliness for each group differed. Nevertheless, we discovered that older people are at a higher risk of developing loneliness during the pandemic due to a variety of socioeconomic and behavioral factors. The findings of this study suggest that health authorities should not generalize cases of loneliness, but rather intervene individually in each group to avoid further complications.

Wahrgenommene Einschränkungen während der COVID-19-Pandemie bei älteren Personen in der Schweiz

Hintergrund

Die aktuelle Coronapandemie wirkt sich unterschiedlich auf das Alltagsleben älterer Menschen aus. Im Rahmen der pandemiebedingten Schutzmaßnahmen wurden insbesondere Personen ab 65 Jahren gebeten, direkte Kontakte und den Aufenthalt im öffentlichen Raum zu meiden.

Ziel

Die vorliegende Arbeit untersucht, wie sich die Pandemie auf das Gefühl der eingeschränkten täglichen Versorgung, auf die Bewegung im Freien und die sozialen Kontakte bei Personen ab 50 Jahren ausgewirkt hat.

Material und Methode

Zwischen Mai und Juni 2020 wurden 1011 in der Schweiz lebende Personen ab 50 Jahren telefonisch befragt. Das Durchschnittsalter der Befragten liegt bei 65 Jahren, und 53 % der befragten Personen sind Frauen.

Ergebnisse

Die Untersuchung zeigt, dass die befragten Personen insgesamt kaum negative Veränderungen in Bezug auf ihre Versorgung mit Dingen des alltäglichen Gebrauchs oder Bewegung im Freien spürten. Jedoch gaben 43 % der Befragten an, während der Pandemie und den damit verbundenen Schutzmaßnahmen häufiger das Gefühl gehabt zu haben, zu wenig Zeit mit Menschen verbringen zu können, die ihnen wichtig sind. Multivariate Auswertungen zeigen, dass bei der Bewertung der drei Alltagsbereiche der Faktor Bildung eine Rolle spielt.

Schlussfolgerung

Die Studie zeigt mögliche Alltagseinschränkungen älterer Menschen unter Pandemiebedingungen auf und sollte zur Diskussion anregen, um die subjektiven Wahrnehmungen der älteren Menschen in der praktischen gerontologischen Arbeit besser berücksichtigen zu können.

The Association between Trajectories of Loneliness and Physical Frailty in Chinese Older Adults: Does Age Matter?

Background: The present study aimed to examine age differences in the relationship between trajectories of loneliness and physical frailty among Chinese older adults. Methods: A total of 4618 participants aged ≥60 years old were taken from pooled data created from the 2011−2015 China Health and Retirement Longitudinal Study (CHARLS). Loneliness was assessed by a single question from the Centre for Epidemiological Studies scale, whereas physical frailty (PF) was examined by the physical frailty phenotype scale. We characterized trajectories of loneliness and PF using transition types and changes within the survey period. Results: Logistic regression models revealed that baseline loneliness was significantly related to remaining robust PF (OR = 0.55, 95% CI = 0.49−0.63, p < 0.001) and worsening in PF (OR = 1.17, 95% CI = 1.05−1.30, p < 0.01) at follow-up. Baseline PF status was also significantly related to the transitions in loneliness (worsen: OR = 1.41, 95% CI = 1.11−1.78, p < 0.01; improve: OR = 0.65, 95% CI = 0.47−0.91, p < 0.05). The cross-lagged panel model found that baseline PF or loneliness had a significant predictive effect on the changes in each other. The associations between trajectories of loneliness and PF were weakened with age and clustered in the under 75 age groups. Conclusions: Bidirectional associations may exist between trajectories of loneliness and PF among Chinese older adults. Interventions should mainly target the young-old to reduce the adverse reciprocal effects of loneliness and PF.

Relationship Between Psychological Impacts of COVID-19 and Loneliness in Patients With Dementia: A Cross-Sectional Study From Iran

Objectives

Although the COVID-19 pandemic has affected people all around the world, the elderly is at a higher risk of suffering from its consequences. One of the serious concerns is developing loneliness and post-traumatic stress symptoms, which may contribute to cognitive decline at older ages. This study aimed to examine the psychological responses and loneliness in elderly patients diagnosed with dementia.

Methods

Twenty-one patients diagnosed with dementia, with ages older than 40, and 19 caregivers were enrolled in the study. The patients have undergone a comprehensive neuropsychiatric interview and were assessed with De Jong Gierveld Scale for loneliness and Impact of Event Scale-Revised (IES-R). The severity of dementia was assessed by Functional Assessment Staging Tool (FAST Scale) and the Montreal Cognitive Assessment (MoCA).

Results

No significant difference was seen in patients and caregivers in the IES-R and loneliness scales. A higher level of avoidance and social and total loneliness were seen in higher FAST levels (p-value: 0.046). There was a negatively significant correlation between MoCA score and avoidance. Hyperarousal was significantly correlated with emotional loneliness in patients.

Conclusion

We found a direct relationship between cognitive decline and the psychological impacts of COVID-19. Our results highlight the need for more comprehensive studies to further investigate the influence of the pandemic on the worsening of cognitive impairment and loneliness in patients with dementia.

Psychological Distress, Anxiety, Family Violence, Suicidality, and Wellbeing in Pakistan During the COVID-19 Lockdown: A Cross-Sectional Study

Background and Objectives

The purpose of this study was to draw the attention toward the implications of COVID-19 and the related restrictions imposed worldwide especially in Pakistan. The primary objective was to highlight the levels of psychological distress, anxiety, family violence, suicidality, and well-being due to COVID-19 and the secondary objective was to associate it to social demographic factors.

Materials and Methods

It is designed as a cross-sectional study by employing an online questionnaire in the English language and obtaining responses using a snowball sampling technique. We used three validated measures including Kessler Psychological Distress Scale (K10), Generalized Anxiety Disorder (GAD-7) index and World Health Organization Well-Being Index (WHO-5).

Results

A sample of 420 participants was recruited from across Pakistan, with most participants were females (79%), students (89.8%) and belonging to Punjab (54%). Nearly one-fourth of the participants (23.8%) scored above the minimum value set for moderate or high psychological distress (K10 > 12). There was a higher prevalence of distress among females and resident of province Punjab. The majority of individuals reported that they were living with their family (94.5%) and more than half (52.6%) were neutral regarding their satisfaction with their living conditions. 40.5% believed that the lockdown has had a negative impact on their mental health. 31.4% have reported that they themselves have experienced abuse from a family member. 48.6% scored high on the GAD-7 scale and low wellbeing score was found among 80.2%. Students were found to be more vulnerable to mental illness and anxiety.

Conclusion

With the lockdown restrictions, psychosocial distress has become prevalent in Pakistan.

Loneliness Progression Among Older Adults During the Early Phase of the COVID-19 Pandemic in the United States and Canada

OBJECTIVES

Older adults are at high risk for complications from coronavirus disease 2019 (COVID-19). Health guidelines recommend limiting physical contact during the pandemic, drastically reducing opportunities for in-person social exchange. Older adults are also susceptible to negative consequences from loneliness, and the COVID-19 pandemic has likely exacerbated this age-related vulnerability.

METHODS

In 107 community-dwelling older individuals (65-90 years, 70.5% female) from Florida, the United States, and Ontario, Canada, we examined change in loneliness over the course of the pandemic after implementation of COVID-19-related physical distancing guidelines (March-September 2020; T1-T5; biweekly concurrent self-report) using multilevel modeling. We also explored gender differences in loneliness during the early phase of the COVID-19 pandemic at both data collection sites.

RESULTS

Consistent across the 2 sites, levels of loneliness remained stable over time for the full sample (T1-T5). However, our exploratory moderation analysis suggested gender differences in the trajectory of loneliness between the United States and Canada, in that older men in Florida and older women in Ontario reported an increase in loneliness over time.

DISCUSSION

Leveraging a longitudinal, binational data set collected during the early phase of the COVID-19 pandemic, this study advances understanding of stability and change in loneliness among a North American sample of individuals aged 65 and older faced with the unique challenges of social isolation. These results can inform public health policy in anticipation of future pandemics and highlight the need for targeted intervention to address acute loneliness among older populations.

For Better or for Worse? A Scoping Review of the Relationship between Internet Use and Mental Health in Older Adults during the COVID-19 Pandemic

Older adults were advised to avoid social activities during the outbreak of COVID-19. Consequently, they no longer received the social and emotional support they had gained from such activities. Internet use might be a solution to remedy the situation. Therefore, this scoping review sought to map the literature on Internet use and mental health in the older population during the pandemic to examine the extent and nature of the research. A scoping review was conducted using eight databases—PubMed, Scopus, Ebscohost Medline, Ebscohost Academic Search, Ebscohost CINAHL Plus, Ebscohost Cochrane, Ebscohost Psychology and Behavioural Sciences Collection, and Ebscohost SPORTDiscus, according to PRISMA guidelines. Two pre-tested templates (quantitative and qualitative studies) were developed to extract data and perform descriptive analysis and thematic summary. A total of ten articles met the eligibility criteria. Seven out of ten studies were quantitative, while the remainder were qualitative. Five common themes were identified from all the included studies. Our review revealed that Internet use for communication purposes seems to be associated with better mental health in older adults during the COVID-19 pandemic. Directions for future research and limitations of review are also discussed.

Retrospective feelings of loneliness during the COVID-19 pandemic among residents of long-term care facilities

The novel coronavirus disease (COVID-19) has had an incisive effect on residents living in long-term care facilities (LTCFs). Local governments have introduced restrictive measures because of the danger posed by this virus. One increasing negative effect of these implementations among residents living in LTCFs is their subjective feelings of loneliness. This study assumed that these measures weighed heavily particularly on residents living in LTCFs, as this group of older people could not decide for themselves whether or how they should be implemented. Thus, this study investigated the retrospectively reported subjective loneliness of residents living in LTCFs. On a large-scale Swiss survey (N = 828; mean age: 87.78, 75% female), residents of 22 LTCFs filled out a questionnaire on their subjective feelings of loneliness during the pandemic. The retrospective loneliness scores of the residents living in LTCFs were found to exceed those reported in other studies focusing on community-dwelling older people. Multivariate regression analyses showed that females, individuals with lower values of joy in life and life satisfaction, and individuals who were not satisfied with the manner in which their care home coped with the COVID-19 measures significantly felt lonelier. Therefore, the subjective feelings of loneliness of residents in LTCFs should be monitored very carefully. As the measures have still not been completely lifted, residents of LTCFs are assumed to still experience social isolation and be at high risk of encountering prolonged feelings of loneliness, which can be detrimental to their mental health and well-being.

THE INVESTIGATION OF THE PSYCHOLOGICAL BURDEN OF PATIENTS AFTER HOSPITALIZATION FOR COVID 19

OBJECTIVE

The aim: The current Cross-Sectional study investigated the psychosocial effects on recovered Covid 19 patients in a General Hospital in Greece. It was investigated the impact of Covid 19 on levels of social support, loneliness, resilience & PTSD. Furthermore, the correlation between all the above factors was studied.

PATIENTS AND METHODS

Materials and methods: 107 adult patients participated. The questionnaire was fulfilled after signature of consensus form. This happened after their discharge from the hospital, without exclusion of infected on previous time. The questionnaire included 5 particular sections: a) Socio-demographic characteristics, b) social support scale, c) IES Covid 19 scale, d) UCLA scale e) CD-Risc scale. In terms of statistical analysis, the comparison between two groups of quantitative variables was conducted through Student's t-test. Related to examination of relationship between two quantitative variables was used Pearson's correlation coefficient (r). The Statistical analysis package used was SPSS 22.

RESULTS

Results: The 55,1% of sample were women, married (57,9 %) and (39,3%) university graduates. Moreover, the rate of overweight was significant (39,3%). Related to psychosocial factors, observed high level of resilience (70,6), moderate level of loneliness (39,1) and 57,9% of participants showed moderate social support. At last, PTSD level as a result of Covid 19 was moderate (33,5). A strong correlation was observed between higher mental resilience and lower feelings of loneliness.

CONCLUSION

Conclusions: The levels of determining factors of negative psychological effects, reveal the need for a preparation of political improvement policies in relation to mental health of rehabilitated persons, as well as the promotion of actions that would contribute to the development of a more effective supportive framework.

Teaching and Practicing Cognitive-Behavioral and Mindfulness Skills in a Web-Based Platform among Older Adults through the COVID-19 Pandemic: A Pilot Randomized Controlled Trial

The outbreak of the COVID-19 pandemic has led to an acceleration in the development of web-based interventions to alleviate related mental health impacts. The current study explored the effects of a short-term digital group intervention aimed at providing cognitive behavioral and mindfulness tools and skills to reduce loneliness and depression and to increase social support among older adults in Israel. This pilot randomized controlled trial included community-dwelling older adults (n = 82; aged between 65–90 years; 80% female) who were randomized either to an intervention group (n = 64) or a wait-list control group (n = 18). The intervention included seven online sessions, over 3.5 weeks. Depression, loneliness, and social support measures were administered at baseline, immediately post-intervention, and at 1-month follow-up. Repeated measures ANOVA revealed statistically and clinically significant reductions in depression in the intervention group, with results maintained at one-month follow-up. Loneliness levels also significantly decreased post-intervention; however, this benefit was not maintained at one-month follow-up. Social support slightly increased both post-intervention and 1-month follow-up—but these changes were not statistically significant. There were no overall changes for the wait-list control group. Our intervention provided promising evidence regarding the effectiveness of an online group intervention to alleviate mental health effects and to promote the coping of older adults during the COVID-19 pandemic. This relatively simple model can be effectively utilized by communities globally to help connect lonely and isolated older inhabitants, both during the pandemic and in more routine times.

Loneliness and Social Isolation During the COVID-19 Pandemic

Abstract. The outbreak of the global COVID-19 pandemic has drastically altered people’s lives. Loneliness and social isolation were publicly discussed as possible psychological consequences of the measures taken to slow the virus spread. These public discussions have sparked a surge in empirical studies on loneliness and social isolation. In this study, we first provide a systematic review synthesizing recent literature on the prevalence and correlates of loneliness and social isolation during the early phase of the COVID-19 pandemic ( k = 53 studies). We found that most quantitative studies included in the systematic review were cross-sectional. The few longitudinal studies mainly reported increases in loneliness, especially when the pre-pandemic measurement occasions were months or years before the COVID-19 pandemic. Studies with pre-pandemic measures weeks or days before the pandemic reported relatively stable or even decreasing loneliness trends. Second, we enrich the systematic review with an empirical investigation on daily changes in the perceived quality and quantity of social relationships during the pandemic compared to before the pandemic ( N = 4,823). This empirical investigation showed that, on average, the quality of social relationships was perceived worse during the pandemic than before. This perception got slightly stronger over the first 2 weeks of the pandemic but stagnated thereafter. Regarding the quantity of social relationships, participants reported on average that they had fewer social interactions at the beginning of the study than before the pandemic. This perceived reduction in the quantity of social interactions linearly decreased over time.

Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States. Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions. Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences. Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

Physical distancing is related to fewer electronic and in-person contacts and to increased loneliness during the COVID-19 pandemic among older Europeans

PURPOSE

During the COVID-19 pandemic older adults are asked to maintain physical distancing, which can be linked to loneliness. While older people are encouraged to use electronic communication to stay socially connected, it remains an open question whether electronic contacts are related to lower loneliness during the pandemic. This study examined the associations of physical distancing during the pandemic with loneliness and the role of in-person and electronic contacts with children and non-kin as explaining these associations across European regions.

METHODS

The study used data from Survey of Health, Ageing and Retirement in Europe (SHARE), collected during the COVID-19 pandemic in 2020. Mediation and moderation analyses tested the direct and indirect associations between physical distancing, contact frequency and loneliness, as well as the differences across European regions.

RESULTS

The results indicate that adults who reported higher frequency of physical distancing also felt lonelier during the pandemic. This association was partly explained by social contacts-those who practiced physical distancing maintained less in-person contact with children and non-kin and less electronic contact with non-kin, which were related to feeling lonelier. Adults in Southern European countries felt lonelier and reported more frequent contacts. The moderation analyses showed that the link between physical distancing and loneliness was found in the northern region, but not in the southern and eastern regions of Europe.

CONCLUSION

This study can indicate that attention should be paid to adults who may struggle to maintain social contacts in light of physical distancing guidelines.

Doing time in care homes: insights into the experiences of care home residents in Germany during the early phase of the COVID-19 pandemic

Residents of care homes across the globe are affected by the spread of SARS-CoV-2 as they have been identified as a high-risk group and because they experienced strict social isolation regulations during the first wave of the pandemic. Social isolation of older people with poor physical and mental health is strongly associated with mental health problems and decreased life expectancy. Other research has shown that older people managed to adapt to the changes brought about by the pandemic and have linked this to the concept of resilience. The aim of this research project was to investigate how this applied to residents in care home settings during the first phases of the contact ban in Germany from sociology, developmental psychology and environmental gerontology perspectives, and to gain in-depth understanding of residents’ experiences. This paper draws on structured interview data collected from residents in two care homes during early June 2020 in Frankfurt am Main, Germany. The findings show that their experiences were shaped by three factors: care home settings and the approach of staff to handling the contact ban; biographical sense of resilience; and a hierarchy of life issues. The findings highlight the importance of locally specific response mechanisms in care homes, agency and belonging of residents despite health-related limitations and the importance of a critical (gendered) lens on understanding their experiences.

Loneliness during the COVID-19 Pandemic: A Comparison between Older and Younger People

The precautionary measures and uncertainties surrounding the COVID-19 pandemic have serious psychological impacts on peoples' mental health. We used longitudinal data from Hiroshima University to investigate loneliness before and during the pandemic among older and younger people in Japan. We provide evidence that loneliness among both older and younger people increased considerably during the pandemic. Although loneliness among younger people is more pervasive, the magnitude of increase in loneliness during the pandemic is higher among older people. Our logit regression analysis shows that age, subjective health status, and feelings of depression are strongly associated with loneliness before and during the pandemic. Moreover, household income and financial satisfaction are associated with loneliness among older people during the pandemic while gender, marital status, living condition, and depression are associated with loneliness among younger people during the pandemic. The evidence of increasing loneliness during the pandemic is concerning for a traditionally well-connected and culturally collectivist society such as Japan. As loneliness has a proven connection with both physical and mental health, we suggest immediate policy interventions to provide mental health support for lonely people so they feel more cared for, secure, and socially connected.

Perceived Loneliness and Severe Sleep Disorders in Adult Women during the Covid-19 Quarantine: A Cross-Sectional Study in Colombia

Background:

Quarantine is a measure to control COVID-19 spread, resulting in an increased perception of loneliness. In turn, sleep disorders (SD) may be more frequently reported in uncertain circumstances.

Objectives:

To identify the association between loneliness and severe SD, in women quarantined due to the COVID-19 pandemic.

Methods:

A cross-sectional study carried out in women, between 40 and 79 years and living in Colombia. The women were invited through social network to complete 5 digital instruments: de Jong Gierveld Loneliness Scale, Menopause Rating Scale, Fear of COVID-19 Five-item Version, Coronavirus Anxiety Scale, and Francis Religion Scale. Bivariate analysis and adjusted logistic regression between loneliness and SD were performed.

Results:

1133 women participated, half of them under 50 years old. 43.1% had emotional loneliness, 39.9% social loneliness and 43.3% general loneliness. SD were identified in 6 out of 10 women, those with mild SD presented an OR of 1.84, 1.85, and 1.64, for emotional, social and general loneliness, respectively. Loneliness was associated twice with moderate SD, and more than twice with severe SD. Very severe SD reached OR:5.81 for emotional loneliness, OR:4.38 social loneliness and OR:4.02 general loneliness. In the presence of religiosity, fear and anxiety due to COVID-19, statistical significance was retained for associations, except intense SD with general loneliness.

Conclusions:

SD were significantly associated with loneliness in our study population. It is important to assess sleep quality and perception of loneliness in middle-aged women, especially during periods of quarantine due to a pandemic to avoid health implications.

Online assessment of the perception of loneliness and associated factors in Colombian climacteric women during the COVID-19 pandemic: A cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) pandemic has generated changes due to confinement, this measure can increase the perception of loneliness. The objective was to estimate the frequencies of emotional, social and general loneliness and their association with fear and anxiety with COVID-19, religiosity and severe deterioration of quality of life in middle-aged women. Methods: A cross-sectional study in Colombian women (40-59 y, n=984) surveyed with an electronic form that included sociodemographic characteristics and validated measures (Menopause Rating Scale, de Jong Gierveld Loneliness Scale, fear of COVID-19 scale, Coronavirus Anxiety Scale and Francis Scale for Religiosity). Associations of emotional, social and general loneliness (dependent variables) with severe somatic, psychological, urogenital and quality of life deterioration, as well as with high religiosity, anxiety and high fear of COVID-19 (independent variables), were estimated. Results: The median age was 47 years old, and 39.2% [95% CI: 36.2-42.3] postmenopausal. Severe deterioration in somatic, psychological, urogenital domains and quality of life in women with emotional, social and general loneliness was found (P <0.001). In adjusted models, high fear of COVID-19, severe deterioration of psychological and urogenital domains and quality of life were associated with emotional, social and general loneliness. Anxiety with COVID-19, somatic domain and high religiosity were not associated with loneliness. Conclusion: Emotional, social and general loneliness were identified in 4/10 middle-aged Colombian women surveyed, and the associated factors were high fear of COVID-19, severe deterioration of quality of life and psychological and urogenital domains. Professionals who care for climacteric women should explore the perception of loneliness when assessing menopausal symptoms.

[COVID-19 in old age-The geriatric perspective]

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.