COVID stress in older adults: Considerations during the Omicron wave and beyond

The Impact of Ageism and Pain on Pandemic-Related Stress in Older Adults: A Structural Equation Modeling and Mediation Analysis

Although research has linked ageism and pain to increased stress in older adults, their influence on stress within the context of pandemics has not been adequately examined. Our objective was to investigate relationships among pain, ageism, and pandemic-related stress in older adults using structural equation modeling (SEM) and mediation analysis. We hypothesized that pain would exert a direct and/or indirect influence on pandemic-related stress, and ageism a direct influence. Data were collected from 486 North American older adults in January 2024. Participants completed measures of pain, ageism, and pandemic-related stress. SEM and mediation analyses yielded evidence suggesting ageism and pain influence pandemic-related stress, although ageism mediated pain's impact on pandemic-related stress. This study underscores how pain and ageism can impact older adults' psychological well-being during pandemics. Findings highlight a potential need for public health interventions to address ageism and pain during future waves of COVID-19 or other global health crises.

Development and internal validation of a depressive symptoms prediction model among the patients with cardiovascular disease who have recovered from SARS-CoV-2 infection in Wuhan, China: a cross-sectional study

BACKGROUND

Middle-aged  and elderly patients with cardiovascular disease (CVD) who have recovered from SARS-CoV-2 infection may experience depressive symptoms due to the physical and psychological impact of the pandemic.

OBJECTIVE

To investigate the prevalence and predictors of depressive symptoms among the middle-aged and elderly with CVD who have recovered from SARS-CoV-2 infection in Wuhan, China, and to develop a prediction model for depressive symptoms.

METHODS

A cross-sectional study was conducted among 462 former SARS-CoV-2 middle-aged and elderly patients with CVD in Jianghan District, Wuhan, China from June 10 to July 25, 2021. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9). Potential predictors of depressive symptoms were selected by the least absolute shrinkage and selection operator (LASSO) regression. A prediction model was developed by random forest (RF) and logistic regression models and compared by the area under the receiver operating characteristic curve (AUROC). The discrimination, calibration, and practical utility of the prediction model were evaluated by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). Bootstrap sampling was used for internal validation.

RESULTS

The prevalence of depressive symptoms among the participants was 35.93%. The prediction model included age, stethalgia after recovery, insomnia after recovery, post-traumatic stress disorder (PTSD), anxiety, fatigue, and perceived social support as predictors. The AUROC of the logistic regression model was 0.909 (95%CI: 0.879 ~ 0.939), indicating good discrimination. The calibration curve showed good calibration. The DCA showed that the prediction model had a net benefit for a wide range of risk thresholds. The internal validation confirmed the stability of the prediction model.

CONCLUSION

Depressive symptoms are common among middle-aged and elderly CVD patients who have recovered from SARS-CoV-2 infection in Wuhan, China. A prediction model with satisfactory performance was developed to estimate the risk of depressive symptoms among this population. Interventions targeting long COVID symptoms and social support should be considered to prevent depressive symptoms in CVD patients.

Psychometric evaluation and item response theory analysis of the COVID Stress Scales in an older adult population

OBJECTIVES

The COVID Stress Scales (CSS) represent a widely used self-report measure of stress and anxiety-related responses to COVID-19. Although the CSS have been validated across various nations and languages, their psychometric properties have not been assessed at the factor- or item-level with older adults. We aimed to psychometrically evaluate the CSS in older adults.

METHOD

The CSS was examined with 486 North American older adults aged 65 years and older. Data were collected in January 2024 using Qualtrics Panels. Reliability was assessed using Cronbach's alpha and McDonald's omega coefficients, structural validity using confirmatory factor analysis, and discriminant validity using a social desirability measure. Item properties were examined using item response theory.

RESULTS

The CSS demonstrated robust internal consistency and a defensible five- and six-factor structure, with the six-factor providing the most optimal model of measurement. All items adequately discriminated among respondents with varying levels of COVID-related stress.

CONCLUSION

This study is first to demonstrate that the CSS functions as a reliable and valid tool for evaluating COVID-related stress among older adults, a necessary step for supporting its use in assessing mental health impacts of pandemics in a population at high risk of negative post-infection outcomes.

Exploring the moderated mediation of stress and media use: Social support's impact on anxiety among older adults during the COVID-19 pandemic - Insights from a large-scale cross-sectional study in China

BACKGROUND

This study aimed to assess the prevalence of anxiety symptoms among the older adults, explore whether stress mediated the association between social support and anxiety symptoms, and investigate whether media use moderated the direct or indirect effects within the mediation model.

METHODS

Questionnaires and scales were employed to collect data from 1143 individuals aged 60 years and older across 120 cities in China during the COVID-19 pandemic. The collected information encompassed sociodemographic characteristics, social support, anxiety, stress, and media use. Bivariate correlations were then used to analyze the relationships among the study variables. Finally, the mediation and moderated mediation models were examined using the PROCESS macro for SPSS.

RESULTS

During the COVID-19 pandemic, 40.1 % of Chinese elderly experienced anxiety. Social support exhibited a negative correlation with anxiety. And, media use positively influenced both stress and anxiety. Stress partially mediated the relationship between social support and anxiety, with a mediation effect of 50.95 %. Notably, media use moderated the association between social support and anxiety, serving as both an indirect mediator (path a: Social support - Stress: B = 0.071, 95 % CI: 0.022, 0.120) and a direct mediator (path c': Social support - Anxiety: B = -0.066, 95 % CI: -0.111, -0.022).

LIMITATIONS

This study used a cross-sectional design, which restricts the ability to infer causal relationships.

CONCLUSION

Social support is proven to be a potent alleviator of anxiety among the elderly. Stress partially mediated this relationship, while the indirect and direct impact of this mediation was influenced by media use.

BRIEF SUMMARY

This study underscores the heightened anxiety prevalence among Chinese elderly during the COVID-19 pandemic, emphasizing the critical role of social support in mitigating these effects. It discovers that while stress acts as a mediator, media use serves as a significant moderator in this dynamic. These findings advocate for the necessity of bolstering social support networks and encouraging prudent media use to effectively manage anxiety and stress among the elderly, particularly in challenging times like a pandemic.

The double mediating effect of stress regulation and life satisfaction on music use as a coping mechanism and happiness in Chinese older adults during the COVID-19 pandemic

BACKGROUND

This study investigated the relationship between music use as a coping mechanism and subjective happiness among Chinese older adults (COAs) during Coronavirus disease 2019 (COVID-19); it also focused on the mediating effect of stress regulation by music and life satisfaction in this relationship.

METHODS

Participants were 329 male and female Chinese adults aged 60 years or older. Data were collected using the Sojump application for an online survey. The double mediating effect was analyzed using PROCESS Macro 3.5 Model 6.

RESULTS

The results revealed that music use as a coping mechanism and stress regulation by music were not significantly correlated with subjective happiness of COAs, whereas these were positively correlated with their life satisfaction. Additionally, life satisfaction of COAs was positively correlated with subjective happiness. Stress regulation by music and life satisfaction completely mediated the relationship between music use as a coping mechanism and subjective happiness of COAs during COVID-19. In the double mediation model, music use as a coping mechanism positively influenced stress regulation by music (β = 0.704), stress regulation by music positively influenced life satisfaction (β = 0.162), and life satisfaction positively influenced subjective happiness (β = 0.498).

CONCLUSION

Therefore, music can promote happiness in COAs in stressful situations through stress regulation and life satisfaction.

Social distancing stress, anxiety/depression, COVID-19 diagnosis, gender identity, and immigration status

BACKGROUND

Strict social distancing public health measures to decrease COVID-19 spread increased social distancing stress. However, differences in social distancing stress by anxiety/depression symptoms are understudied, especially based on COVID-19 diagnosis status, gender identity, and immigration status. We examined whether the association between social distancing stress and anxiety/depression symptoms was moderated by COVID-19 diagnosis status, gender identity, and immigration status. We further examined the associations of social distancing stress with anxiety/depression symptoms, gender identity, and immigration status among individuals with and without COVID-19.

METHODS

We utilized data from a national cross-sectional survey among adults aged ≥ 18 years in the United States between May 13, 2021, and January 9, 2022 (n = 5,255). Multivariable logistic regression models were used to examine the associations.

RESULTS

The prevalence of social distancing stress was higher among individuals with COVID-19 (79.23%) than among those without COVID-19 (67.51%). We observed significant associations between social distancing stress and anxiety/depression symptoms, moderated by COVID-19 diagnosis status, immigration status, and gender identity, respectively. Anxiety/depression symptoms were associated with social distancing stress among both individuals with and without COVID-19. Gender identity and immigration status were associated with social distancing stress among only individuals without COVID-19.

CONCLUSIONS

Our findings revealed that the association between social distancing stress and anxiety/depression varied by COVID-19 diagnosis status, gender identity, and immigration status. The findings underscore the need for more targeted psychological distress strategies to reduce social distancing stress and anxiety/depression among diverse US populations, while considering the impacts of COVID-19 diagnosis status, gender identity, and immigration status.

Risk for diagnosis or treatment of mood or anxiety disorders in adults after SARS-CoV-2 infection, 2020-2022

COVID-19 is associated with increased risks for mood or anxiety disorders, but it remains uncertain how the association evolves over time or which patient groups are most affected. We conducted a retrospective cohort study using a nationwide database of electronic health records to determine the risk of depressive or anxiety disorder diagnoses after SARS-CoV-2 infection by 3-month blocks from January 2020 to April 2022. The study population comprised 822,756 patients (51.8% female; mean age 42.8 years) with COVID-19 and 2,034,353 patients with other respiratory tract infections (RTIs) (53.5% female, mean age 30.6 years). First time diagnoses of depressive or anxiety disorders 14 days to 3 months after infection, as well as new or new plus recurrent prescriptions of antidepressants or anxiolytics, were compared between propensity score matched cohorts using Kaplan-Meier survival analysis, including hazard ratio (HR) and 95% confidence interval (CI). Risk of a new diagnosis or prescription was also stratified by age, sex, and race to better characterize which groups were most affected. In the first three months of the pandemic, patients infected with SARS-CoV-2 had significantly increased risk of depression or anxiety disorder diagnosis (HR 1.65 [95% CI, 1.30-2.08]). October 2021 to January 2022 (HR, 1.12 [95% CI, 1.06-1.18]) and January to April 2022 (HR, 1.08 [95% CI, 1.01-1.14]). Similar temporal patterns were observed for antidepressant and anxiolytic prescriptions, when the control group was patients with bone fracture, when anxiety and depressive disorders were considered separately, when recurrent depressive disorder was tested, and when the test period was extended to 6 months. COVID-19 patients ≥65 years old demonstrated greatest absolute risk at the start of the pandemic (6.8%), which remained consistently higher throughout the study period (HR, 1.20 [95% CI, 1.13-1.27]), and overall, women with COVID-19 had greater risk than men (HR 1.35 [95% CI 1.30-1.40]).

Investigating and promoting health behaviors reactivity among Hong Kong older adults in the post-COVID-19 Era: An exploratory network analysis

BACKGROUND

Physical distance has increased the risk of developing a variety of health problems, especially among older people. During the COVID-19 lockdown period, physical activity decreased, screen time increased, food consumption increased, as well as exposure to unhealthy behaviour, leading to poorer sleep quality and more negative emotions, which ultimately led to poorer physical health, mental health, and subjective vitality among older adults. Although there were numerous research studies on changes in health behaviours during COVID-19, only a few were targeted at older adults, and none were conducted in Asian countries.

METHOD

The current study is aiming to identify the changes in health behaviours, as well as their associations with older adults' mental health as a result of the COVID-19 pandemic among Hong Kong older adults, using exploratory network analysis. In this study, a random tele-survey was conducted among older adults.

RESULTS

A total of 664 participants have been involved in the telephone survey, with 213 males and 451 females, of which mean age was 74.37. The explored network showed strong centrality and edge stability, thus enabling to reveal an overview of the associations between health behaviours and mental well-being of older adults. The lavaan model has also demonstrated the casual paths within the explored network, which indicated the significant impact of sleeping quality, eating habits and social networking on resilience.

CONCLUSION

The outcomes of the study were able to identify the lifestyle changes of Hong Kong older adults due to COVID-19. Although the present study is not regarded as novel internationally, it may be representative of the Hong Kong community. In order to facilitate active aging during the pandemic, a user-friendly electronic platform for healthy living should include older adults in the future.

Theoretical framework of concerns about falling in older people: the role of health literacy

Adherence and participation can be improved in health programs for older people with concerns about falling. While health literacy empowers older people to have greater control over their health, little is known about the extent to which health literacy influences health behaviours associated with concerns about falling in older people. This study aimed to synthesise current findings on health literacy, concerns about falling and falls to propose a multicomponent theoretical model on health literacy and concerns about falling. The model was developed based on a review of the literature, existing frameworks and models on health literacy and concerns about falling. Existing evidence on the relationship between health literacy and concerns about falling in older people is limited. Evidence from other research areas, however, shows that health literacy is closely related to many of the determinants of concerns about falling. More research is needed to clarify the impact of health literacy on intervention adherence and decision-making processes of older people with concerns about falling. Our model offers a novel perspective on the role of health literacy in health behaviours associated with concerns about falling, suggesting new research directions and providing insights for clinicians to consider health literacy when managing older patients with concerns about falling.

Elder and booster vaccination associates with decreased risk of serious clinical outcomes in comparison of Omicron and Delta variant: A meta-analysis of SARS-CoV-2 infection

BACKGROUND

The COVID-19 pandemic brings great pressure to the public health systems. This meta-analysis aimed to compare the clinical outcomes among different virus variants, to clarify their impact on medical resources and to provide evidence for the formulation of epidemic prevention policies.

METHODS

A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases using the key words "Omicron" and "Delta." The adjusted Risk ratios (RRs), Odds ratios (ORs) and Hazard ratios (HRs) were extracted, and RRs and Rate difference % (RD%) were used to interpret the risk estimates of the outcomes ultimately.

RESULTS

Forty-three studies were included, with 3,812,681 and 14,926,841 individuals infected with SARS-CoV-2 Delta and Omicron variant, respectively. The relative risks of hospitalization, death, ICU admission, and mechanical ventilation use after infection with the Omicron variant were all significantly reduced compared those after infection with the Delta variant (RRhospitalization = 0.45, 95%CI: 0.40-0.52; RRdeath = 0.37, 95%CI: 0.30-0.45; RRICU = 0.35, 95%CI: 0.29-0.42; RRmechanical ventilation = 0.33, 95%CI: 0.25-0.44). The change of both absolute and relative risks for hospitalization was more evident (RR = 0.47, 95%CI: 0.42-0.53；RD% =10.61, 95%CI: 8.64-12.59) and a significant increase was observed for the absolute differences in death in the elderly (RD% = 5.60, 95CI%: 4.65-6.55); the change of the absolute differences in the risk of hospitalization and death were most markedly observed in the patients with booster vaccination (RD%hospitalization = 8.60, 95CI%: 5.95-11.24; RD%death = 3.70, 95CI%: 0.34-7.06).

CONCLUSION

The ability of the Omicron variant to cause severe clinical events has decreased significantly, as compared with the Delta variant, but vulnerable populations still need to be vigilant. There was no interaction between the vaccination doses and different variants.

The increase in suicide risk in older adults in Taiwan during the COVID-19 outbreak

BACKGROUND

Studies from Western countries indicated that older adults were more resilient than younger ones to deteriorating mental health during the COVID-19 pandemic. As high late-life suicide rates have been reported in East Asia, it is possible that the pandemic impact might differ between East and West. We investigated the pandemic impact on age-specific suicide patterns in Taiwan.

METHODS

Interrupted time-series analysis was used to model the overall, and age-stratified, monthly suicide rates before (January 1st, 2017 to December 31st, 2019) and after (January 1st 2020 to December 31st 2021) the COVID-19 outbreak. Associations between confirmed COVID-19 deaths and suicide rates were also assessed.

RESULTS

There was a significant decrease in overall suicide rates after the COVID-19 outbreak (p < 0.01) (annual average rates per 100,000 population of 16.4 prior, 15.2 after). The overall decrease was driven by fewer suicide deaths in the young- and older-middle-aged groups (25-44 and 45-64 years). However suicide rates in younger-age group (<25 years) were already increasing pre-pandemic, a trend which continued after the outbreak. Suicide rates for older people (≥65 years) also increased along with the increasing number of COVID-19 deaths during the pandemic period.

LIMITATIONS

Under-reporting and/or misclassification of suicides were possible.

CONCLUSIONS

The overall suicide rates in Taiwan did not change after the COVID-19 outbreak; however, suicide in older adults increased. Public health measures to reduce COVID-19 infections may have unintended and adverse consequences on the psychological wellbeing of older citizens.

Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic

Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao-Scott χ² tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era.

Psychosocial impacts of the COVID-19 pandemic on women with trauma histories: Study of Women's Health Across the Nation (SWAN)

Older adults, particularly those with trauma histories, may be vulnerable to adverse psychosocial outcomes during the COVID-19 pandemic. We tested associations between prepandemic childhood abuse or intimate partner violence (IPV) and elevated depressive, anxiety, conflict, and sleep symptoms during the pandemic among aging women. Women (N = 582, age: 65-77 years) from three U.S. sites (Pittsburgh, Boston, Newark) of the longitudinal Study of Women's Health Across the Nation (SWAN) reported pandemic-related psychosocial impacts from June 2020-March 2021. Prepandemic childhood abuse; physical/emotional IPV; social functioning; physical comorbidities; and depressive, anxiety, and sleep symptoms were drawn from SWAN assessments between 2009 and 2017. There were no measures of prepandemic conflict. In total, 47.7% and 35.3% of women, respectively, reported childhood abuse or IPV. Using logistic regression models adjusted for age; race/ethnicity; education; site; prepandemic social functioning and physical comorbidities; and, in respective models, prepandemic depressive, anxiety, or sleep symptoms, childhood abuse predicted elevated anxiety symptoms, OR = 1.67, 95% CI [1.10, 2.54]; household conflict, OR = 2.19, 95% CI [1.32, 3.61]; and nonhousehold family conflict, OR = 2.14, 95% CI [1.29, 3.55]. IPV predicted elevated sleep problems, OR = 1.63, 95% CI [1.07, 2.46], and household conflict, OR = 1.96, 95% CI [1.20, 3.21]. No associations emerged for depressive symptoms after adjusting for prepandemic depression. Aging women with interpersonal trauma histories reported worse anxiety, sleep, and conflict during the COVID-19 pandemic than those without. Women's trauma histories and prepandemic symptoms are critical to understanding the psychosocial impacts of the pandemic.

Do selected lifestyle parameters affect the severity and symptoms of COVID-19 among elderly patients? The retrospective evaluation of individuals from the STOP-COVID registry of the PoLoCOV study

BACKGROUND

Older individuals tend to include less physical activity in their routine and are more prone to chronic diseases and severe medical complications, making them the most burdened group that is losing years of life due to pandemic-related premature mortality. This research aimed to assess the lifestyle factors that affect the COVID-19 course among patients ≥ 65 years old.

METHODS

The study included 568 convalescents (64.1% women and 35.9% men) with persistent clinical symptoms after isolation. The mean age was 70.41 ± 4.64 years (minimum: 65 years; maximum: 89 years). The patients completed the questionnaire during their in-person visit to the medical center. The survey included questions regarding their health status when suffering from COVID-19, basic sociodemographic data, and medical history concerning chronic conditions and lifestyle.

RESULTS

Physical inactivity (p < 0.001) and feeling nervous (p = 0.026) increased the risk of having a severe disease course. Coronary artery disease raised both the risk of a severe disease course (p = 0.002) and the number of present symptoms up to 4 weeks (p = 0.039). Sleep disturbances increased the number of symptoms during infection (p = 0.001). The occurrence of any symptoms was also associated with the female sex (p = 0.004). The severity of the course was associated with longer persistent symptoms (p < 0.001) and a greater number of symptoms (p = 0.004); those with a more severe course were also at a greater risk of persistent symptoms for up to 4 weeks (p = 0.006). Senior citizens in the third pandemic wave suffered with more severe disease (p = 0.004), while illness during the fourth (p = 0.001) and fifth (p < 0.001) waves was associated with a lower risk of persistent symptoms for up to 4 weeks. The disease duration was significantly shorter among vaccinated patients (p = 0.042).

CONCLUSIONS

Elderly COVID-19 patients should re-think their lifestyle habits to consider a physical activity level that is adjusted to their abilities, in order to decrease the risk of a severe disease course and to further limit both the number and duration of symptoms. The research was carried out in accordance with the Declaration of Helsinki, and approval from the Bioethics Committee of Lodz Regional Medical Chamber to conduct the study was obtained (approval number 0115/2021). The PoLoCOV-Study ClinicalTrials.gov identifier is NCT05018052.

Anxiety among older adults during the COVID-19 pandemic

A growing body of research examines the COVID-19 pandemic's effects on well-being. Only few studies focus on older adults or explore the predictors of COVID-19-related anxiety. Intolerance of uncertainty (IU) and some behaviors (e.g., avoidance, procrastination) are linked to anxiety among older adults and could both be relevant to consider in a pandemic context. This study measured the occurrence and anxiety levels among older adults and verified the possible role of IU and behaviors in predicting anxiety symptoms, impairment and distress related to COVID-19 health standards. It also examined the indirect effect of IU on symptoms, impairment and distress through behaviors. Participants aged 60 and over (N = 356) were recruited and administered questionnaires. Anxiety levels and symptom impairment were high and appeared to have increased since the beginning of the pandemic. IU and behavioral manifestations of anxiety were associated with higher anxiety symptoms, impairment and distress related to COVID-19 health standards. The indirect effects of IU on the tendency to worry and COVID-19-related anxiety through behavioral manifestations of anxiety were confirmed. This study provides knowledge on the relationship between COVID-19 and anxiety in older adults and identifies predictors relevant to this population.

Association between COVID-19 testing uptake and mental disorders among adults in US post-secondary education, 2020-2021

Fear and uncertainty have worsened mental health outcomes during the COVID-19 pandemic. COVID-19 testing is essential yet underutilised, and many people may experience difficulties accessing testing if the US federal government fails to sustain the testing capacity. To date, limited evidence exists about the role of COVID-19 testing in mental health. We examined the associations of COVID-19 testing uptake with certain mental disorders, through a nationally representative cohort of adults in US post-secondary education (N = 65 360). Adults with test-confirmed COVID-19 were at significantly lower risk than those with unconfirmed COVID-19 for severe depression, severe anxiety, eating disorders, and suicidal ideation. Findings suggest another potential benefit of public health efforts to encourage COVID-19 testing, namely promoting mental health.