Ageism and COVID-19: what does our society's response say about us?

Older Parents to an Adult Child With Intellectual Disability: Balancing Dependence With Separation

This study focuses on the experiences of older parents who have an adult child with intellectual disabilities (ID), specifically exploring their overall experiences and relationships with their offspring. A qualitative methodology incorporating semi-structured interviews was employed. Participants comprised sixteen older parents to an adult child with mild to moderate ID living in a residential village. Participants described various challenges, including physical and health-related difficulties and loneliness. Interviewees also expressed positive life experiences, such as engaging in new activities and pursuits. Parents noted a newfound balance in their parent-child relationships, affording them more time for personal interests in older adulthood, which they found to be unique opportunities distinct from their earlier years. It is recommended that interactions between older and younger parents of children with ID be fostered, facilitating opportunities for the younger generation to benefit from the experiences of their more seasoned counterparts.

Framing Later Life Vulnerability during the COVID-19 Pandemic: A Content Analysis of Newspaper Coverage in Canada and the United States

This study explores vulnerability narratives used in relation to older adults and others during the COVID-19 pandemic. A mixed-method content analysis was conducted of 391 articles published in two major newspapers in Canada and the USA during the first wave of the pandemic. The findings indicated that during the early months of the pandemic, limited attention was directed towards its impact on older adults or other 'vulnerable' subpopulations in both countries. Where evident, intrinsic (individual-level) risk factors were most consistently used to frame the vulnerability of older adults. In contrast, vulnerability was more likely to be framed as structural with regard to other subpopulations (e.g., ethno-racial minorities). These narratives also differed somewhat in Canadian and US newspapers. The framing of older adults as intrinsically vulnerable reflects ageist stereotypes and promotes downstream policy interventions. Greater attention is needed to the role of structural factors in influencing pandemic-related outcomes among older adults.

Key Learnings from 'Seniors of Canada': A Community Project Aimed to Disrupt Ageism

Visual representations of aging have historically relied upon binarized clichés: idealized youthfulness versus frailty and illness. To challenge these oversimplified depictions, graduate students developed a community outreach project titled 'Seniors of Canada'. The aim of this project was twofold: (1) share images and stories of people in later life; and (2) challenge dominant narratives and stereotypes of aging. In this note, we outline the prevailing discourse of what aging 'looks like', how we collected stories and images, and implications for knowledge mobilization and research in Canada. This article highlights insights gained since the inception of the project, including three key learnings: (1) Building bridges across academia and community, (2) Intergenerational connection and digital tools, and (3) The power of visual storytelling. We provide a practical overview of a successful knowledge mobilization/community outreach project and showcase the power of bridging academia and community for social change.

Psychosocial Distress Among Certified Nursing Assistants in Long-Term Care During the COVID-19 Pandemic: A Social Ecological Model Informed Scoping Review

OBJECTIVES

This scoping review maps the literature on psychosocial distress and coping among nursing assistants (CNAs) in long-term care facilities (LTC) during the COVID-19 pandemic onto the Social Ecological Model (SEM) of Occupational Stress.

METHODS

Searches yielded 862 unique studies. Inclusion criteria were sample CNAs or equivalent in LTC; includes psychosocial variable; and collect data from February 2020-. A multi-phasic, meta-synthesis was used to synthesize qualitative data.

RESULTS

We identified 20 studies (13 quantitative, 7 qualitative) conducted between March 2020 and December 2021 from 14 countries. Prevalence rates were reported for perceived stress (31-33%; n = 1 study), post-traumatic stress (42%; n = 1), anxiety (53%; n = 1), depression (15-59%; n = 2), suicidal thoughts (11-15%; n = 1), and everyday emotional burnout (28%; n = 1). Qualitative studies identified factors contributing to psychosocial distress and coping at each SEM level (i.e. individual, microsystem, organization, and peri-/extra-organizational). Quantitative studies primarily measured factors relating to psychosocial distress and coping at the individual and organizational levels.

CONCLUSIONS & CLINICAL IMPLICATIONS

This review identifies specific targets for intervention for psychosocial distress among CNAs in LTC at multiple levels, including job clarity; workload; facility culture; community relations; and policy. These intervention targets remain relevant to the LTC industry beyond the context of the COVID-19 pandemic.

The influencing factors of changes in physical activity levels of pregnant women during pregnancy: From the perspective of continuous care

A comprehensive understanding of physical activity levels (PAL) among Chinese pregnant women and an exploration, from a continuous care perspective, of various factors influencing these activity levels. Investigating the correlations between adverse habits, psychological factors, and PAL in prenatal health management. This study aims to provide substantial guidance for prenatal health management and personalized care, offering recommendations to healthcare professionals and policymakers to enhance the overall health and well-being of pregnant women. This study enrolled 1256 pregnant women as research subjects. Baseline information was collected through a personal information collection form. Subsequently, continuous care was provided during the early, middle, and late stages of pregnancy, documenting the respective influencing factors. Simultaneously, the International Physical Activity Questionnaire (IPAQ) was utilized to assess the PAL of pregnant women across different trimesters. Finally, using the SPSS software version 25.0, a combined approach of generalized linear mixed effects (GLME) models and multivariate logistic regression was used to statistically analyze the collected data, comprehensively exploring the influencing factors of PAL during pregnancy. The proportion of research subjects engaged in low-level physical activity decreased from 60.80% to 40.34% across various stages of pregnancy, while the proportion engaged in moderate-level physical activity ranged from 25.32% to 40.75%. Meanwhile, the proportion engaged in high-level physical activity accounted for 13.88% to 18.91%.There was P = .021 and β = -0.276 for smoking before pregnancy. The P-value of pregnant women who smoke in the second trimester was.035, the Odds Ratio (OR) value was 0.638, and the 95% confidence interval (CI) was (0.406, 0.972). The difference was statistically significant (all P < .05). In China, the physical activity level of pregnant women is generally low, which is related to factors such as smoking, alcohol consumption, sleep disorders, and depression during pregnancy. Medical personnel should improve the living habits of pregnant women and enhance their PAL through measures such as health education and psychological counseling.

The Threefold Path to Equity: Approaches for Health and Aging Researchers

The authors present a model for pursuing equity in research on health and aging, in terms of: (a) community-driven research governance, with reference to examples inside and outside of the United States, (b) a focus on policy change, where policy is defined broadly in terms of all legislative and regulatory change, and (c) equity-focused research practices, at the level of measurement, analysis, and study design. The model is visualized as a "threefold path" that researchers may walk, to achieve changes within our field, and changes in how we interface with other fields, and communities.

Reducing ageism: comparing the efficacy of videos, written information, and infographics as intervention mediums

Ageism (prejudice, discrimination, and stereotyping directed toward individuals based on age) is pervasive in the U.S. and around the world. Ageism is a significant social issue which negatively impacts general health and well-being. As such, ageism interventions that are scale-able and accessible to many people is paramount. Building on the PEACE (Positive Education about Aging and Contact Experiences) model, undergraduates (n = 497) were randomly assigned to one of three experimental conditions that provided education about aging (which included challenging age stereotypes) and extended positive intergenerational contact via 1) written information, 2) infographics, 3) videos, or 4) a control condition (no stimuli). Participants in all three of the experimental conditions (vs. control condition) reported lower levels of ageism, less negative age stereotypes, and more positive age stereotypes. There were no significant differences in aging anxiety. Out of the experimental conditions, watching videos was the most effective experimental condition. These findings highlight the promise of providing information about aging and depictions of positive intergenerational contact in a variety of different mediums as a way to reduce ageism. Brief online ageism reduction interventions based on the PEACE model are a promising tool for reducing ageism.

The impact of the COVID-19 pandemic on Positive Health among older adults in relation to the complexity of health problems

BACKGROUND

The broad concept of health as "the ability to adapt and self-manage in the face of social, physical and emotional challenges" has been operationalized by "Positive Health," a framework increasingly used in the Netherlands. We explored to what degree the impact of the COVID-19 pandemic and preventive measures on Positive Health differed between community-dwelling older adults without, with mild and with complex health problems, as well as differences flowing from their use of preventive measures.

METHODS

During the second wave in the Netherlands (November 2020-February 2021), a convenience sample of adults aged ≥65 years completed an online questionnaire. Positive Health impact was measured based on self-reported change of current health status, across six dimensions, compared to before the pandemic (decreased/unchanged/increased). The complexity of health problems (past month) was assessed using the validated ISCOPE tool, comparing subgroups without, with mild or with complex health problems. High use of preventive measures was defined as ≥9 of 13 measures and compared to low use (<9 measures).

RESULTS

Of the 2397 participants (median age 71 years, 60% female, and 4% previous COVID-19 infection), 31% experienced no health problems, 55% mild health problems, and 15% complex health problems. Overall, participants reported a median decrease in one Positive Health dimension (IQR 1-3), most commonly in social participation (68%). With an increasing complexity of health problems, subjective Positive Health declined more often across all six dimensions, ranging from 3.3% to 57% in those without, from 22% to 72% in those with mild, and from 47% to 75% in those with complex health problems (p-values for trend <0.001; independent of age and sex). High users of preventive measures more often experienced declined social participation (72% vs. 62%, p < 0.001) and a declined quality of life (36% vs. 30%, p = 0.007) than low users, especially those with complex health problems.

CONCLUSION

As the complexity of health problems increased, the adverse impact of the COVID-19 pandemic and related preventive measures was experienced more frequently across all dimensions of Positive Health. Acknowledging this heterogeneity is pivotal to the effective targeting of prevention and healthcare to those most in need.

Using Twitter to Understand COVID-19 Vaccine-Related Ageism During the Pandemic

BACKGROUND AND OBJECTIVES

During the rollout of coronavirus 2019 (COVID-19) vaccines, older adults in high-income countries were often prioritized for inoculation in efforts to reduce COVID-19-related mortality. However, this prioritization may have contributed to intergenerational tensions and ageism, particularly with the limited supply of COVID-19 vaccines. This study examines Twitter discourse to understand vaccine-related ageism during the COVID-19 pandemic to inform future vaccination policies and practices to reduce ageism.

RESEARCH DESIGN AND METHODS

We collected 1,369 relevant tweets on Twitter using the Twint application in Python from December 8, 2020, to December 31, 2021. Tweets were analyzed using thematic analysis, and steps were taken to ensure rigor.

RESULTS

Our research identified four main themes including (a) blame and hostility: "It's all their fault"; (b) incompetence and misinformation: "clueless boomer"; (c) ageist political slander; and (d) combatting ageism: advocacy and accessibility.

DISCUSSION AND IMPLICATIONS

Our findings exposed issues of victim-blaming, hate speech, pejorative content, and ageist political slander that is deepening the divide of intergenerational conflict. Although a subset of tweets countered negative outcomes and demonstrated intergenerational solidarity, our findings suggest that ageism may have contributed to COVID-19 vaccine hesitancy among older adults. Consequently, urgent action is needed to counter vaccine misinformation, prohibit aggressive messaging, and promote intergenerational unity during the COVID-19 pandemic and beyond.

Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis

BACKGROUND

Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization.

OBJECTIVE

The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship.

METHODS

During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections.

RESULTS

Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student.

CONCLUSIONS

The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students.

Comparing the cross-national impact of the COVID-19 pandemic on care received by community-dwelling older adults in 2020 and 2021: restoring formal home care versus polarizing informal care?

The COVID-19 pandemic has changed the supply of formal and informal home care to older adults in many countries across the world. This study aims to compare the initial picture of how the supply of formal and informal home care to older adults in European countries and Israel changed during the first pandemic year (from mid-2020 to mid-2021) and to examine the changes that these countries made in the provision of adequate care to older adults. Using data from the two COVID-19 waves of SHARE, we show that the provision of formal home care services improved in the investigated period, as in 2021 the share of those who reported difficulties in receiving formal home care dropped significantly compared to the previous year. By contrast, informal care provision patterns experienced a growing polarization, with some countries continuing in reporting a strong support from this source, and others moving towards a remarkable reduction in the help coming from informal networks. These findings can serve as a basis for the development of evidence-based recommendations that can inform future care policies at the national level and to implement more sustainable models for older adults living in the community.

Solidarity and reciprocity during the COVID-19 pandemic: a longitudinal qualitative interview study from Germany

BACKGROUND

While solidarity practices were important in mitigating the Coronavirus Disease 2019 (COVID-19) pandemic, their limits became evident as the pandemic progressed. Taking a longitudinal approach, this study analyses German residents' changing perceptions of solidarity practices during the COVID-19 pandemic and examines potential reasons for these changes.

METHODS

Adults living in Germany were interviewed in April 2020 (n = 46), October 2020 (n = 43) and October 2021 (n = 40) as part of the SolPan Research Commons, a large-scale, international, qualitative, longitudinal study uniquely situated in a major global public health crisis. Interviews were analysed using qualitative content analysis.

RESULTS

While solidarity practices were prominently discussed and positively evaluated in April 2020, this initial enthusiasm waned in October 2020 and October 2021. Yet, participants still perceived solidarity as important for managing the pandemic and called for institutionalized forms of solidarity in October 2020 and October 2021. Reasons for these changing perceptions of solidarity included (i) increasing personal and societal costs to act in solidarity, (ii) COVID-19 policies hindering solidarity practices, and (iii) a perceived lack of reciprocity as participants felt that solidarity practices from the state were not matching their individual efforts.

CONCLUSIONS

Maintaining solidarity contributes to maximizing public health during a pandemic. Institutionalized forms of solidarity to support those most in need contribute to perceived reciprocity among individuals, which might increase their motivation to act in solidarity. Thus, rather than calling for individual solidarity during times of crisis, authorities should consider implementing sustaining solidarity-based social support systems that go beyond immediate crisis management.

The Link of COVID-19-Related Beliefs and Information Sources to Ageism: Myth or Reality?

This study aimed to understand ambivalent ageism among younger adults during the pandemic by examining whether younger adults' beliefs around COVID-19 and the sources from which they received COVID-19 information were associated with the intensity of their ageism. For this aim, survey data were collected from individuals ages 18 to 44 between July and September 2021. Multiple hierarchical regression analysis revealed that benevolent ageism was more intense than hostile ageism when two subscales of ambivalent ageism-benevolent and hostile-were compared. Hispanic or Latinx respondents showed less intense ambivalent ageism than non-Hispanic and non-Latinx respondents. The respondents' beliefs about safety measures and the prioritization of medical resources were significantly associated with the intensity of their ageism. Receiving COVID-19 information via traditional media and social media was also significantly associated with more intense ageism. These findings indicate that social work advocacy should continue to combat ageism in times of crisis.

'Ageing well': Discursive constructions of ageing and health in the public reach of a national longitudinal study on ageing

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing.

"Keeping our distance": Older adults' experiences during year one of the COVID-19 pandemic and lockdown in Australia

The first year of the COVID-19 pandemic had a profound impact on everyday life in Australia despite relatively low infection rates. Lockdown restrictions were among the harshest in the world, while older adults were portrayed as especially vulnerable by politicians and the media. This study examines the perceptions and experiences of the pandemic and lockdowns among 31 older Australians. We investigated how participants perceived their own vulnerability, their attitudes towards lockdowns and protective behaviors, and how the pandemic affected everyday life. We found that participants were cautious about COVID-19 and vigilant observers of physical distancing. Despite approving of public health guidelines and lockdowns, participants raised concerns about weakening social ties and prolonged social isolation. Those living alone or lacking strong family ties were most likely to report increased loneliness. Most participants nonetheless regarded themselves as "fortunate": they perceived older age as affording them financial, emotional, and relational stability, which insulated them from the worst impacts of the coronavirus pandemic. In their views, financial independence and post-retirement lifestyles helped them adapt to isolation and the disruption of lockdowns.

No place to go? Older people reconsidering the meaning of social spaces in the context of the COVID-19 pandemic

Under COVID-19 restrictions, older people were advised to avoid social contact and to self-isolate at home. The situation forced them to reconsider their everyday social spaces such as home and leisure time places. This study approached the meaning of social spaces for older people by examining how older people positioned themselves in relation to social spaces during the pandemic. The data were drawn from the Ageing and social well-being (SoWell) research project at Tampere University, Finland, and they consisted of phone interviews collected during the summer of 2020 with 31 older persons aged 64-96 years. The data were analysed using the frameworks of positioning analysis and environmental positioning. Results showed the positions of older people being manifold, flexible and even contradictory. Within home, the participants portrayed themselves as restricted due to limited social contact, but also as able to adapt to and content being alone. Virtual spaces were depicted as spaces for younger and healthy persons, and the participants themselves as sceptical technology users not satisfied with technology-mediated interaction. Within an assisted living facility, the participants described themselves as sensible and responsible persons who wanted to follow the facility's pandemic-related rules but also as independent persons having nothing to do with these rules. In the spaces outside the home, the participants portrayed themselves as persons who followed pandemic instructions but also as persons who were not required to follow the instructions because they could use their own judgement. These self-positions shed light on the social needs of older people in the spaces of their everyday lives. Our results provide useful insights for policy makers and professionals working with older people and will help to promote spaces of living, care and everyday life that can enhance and maintain social interaction and well-being both in times of change and in more stable times.

Impact of COVID-19 on Physical Activity, Fatigue, and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study

This study aimed to describe the level of physical activity and its relation to fatigue and frailty during the COVID-19 pandemic in community-dwelling older adults aged 80 years and over. Three hundred and ninety-one older adults (aged 86.5 ± 3.00) completed a survey including physical activity, the Mobility Tiredness scale, and the FRAIL scale. Linear regression analysis was conducted to assess whether the variables age, sex, and physical activity (independent factors) were significantly related to fatigue and frailty. Respectively, 30.5% and 24.7% of the participants reported a decrease in walking and in energy-intensive activities; 25.4% reported increased sedentary behavior. A lower level of physical activity was associated with higher levels of fatigue and increased frailty risk (p < .05), independently from psychological symptoms. These results are important because participants with lower levels of physical activity and more sedentary behavior are more likely to feel fatigued and have higher risk to be frail.

Walking in their shoes: How primary-care experiences of adults aged 50+ reveal the benefits of e-learning intervention for general practitioners

Patient experiences and activation are increasingly researched. However, related data are limited in three areas: interventions for general practitioners (GPs) working with mature adults (50+), dedicated e-learning interventions for GPs, and assessments of e-learning for medical staff through patient experiences. We examined how e-learning intervention focused on improving GPs' skills in activating communication (understood as promoting engagement and active participation in healthcare) can enhance the experiences of mature patients. The intervention was designed for GPs, yet innovative assessment was based on patient experiences post-visit. Three research conditions for GPs (n = 165) were introduced: (1) e-learning or (2) pdf-article intervention and (3) control. Two independent waves of their patients participated before and after the intervention. Experience measures for patients (n = 1639) included the Patient Expectations Scale (post-visit), perceived GP's Communication Skills scale, and Patient Satisfaction with Visit scale. E-learning intervention compared with the control group had a favorable effect for 5 out of 8 dimensions of patient experience. Change in emotional support and quality of life was particularly visible. Mature patient experiences can be improved with the e-learning intervention for GPs. Measuring patient experience enriches the available knowledge and can help design future research and interventions.

Ageing, the digital and everyday life during and since the Covid-19 pandemic

Introduction

During and since the Covid-19 pandemic there has been an intensified integration of digital technologies into the everyday lives of older people. We do, however, know little about the ways in which older people incorporate digital technologies and communications into their daily lives and their own meanings, embodiment and experiences of the digital during and since the Covid-19 pandemic.

Method

The aim of our research was to explore the use of digital devices during and since the Covid-19 pandemic and to identify facilitators and barriers to incorporating digital devices into everyday life. The research involved a series of online focus groups with people aged between 63 and 86 years living in the United Kingdom and were conducted in 2022. Each focus group lasted around 90 min and data was audio-recorded and transcribed. The data was analysed thematically.

Results

From the analysis, three interconnecting whilst analytically distinct themes around the meaning and experiences of using digital devices in everyday life during and since the pandemic, are thematically presented as: (1) Incorporating the digital into everyday life; (2) Social and digital connectivity; and (3) Challenges and limitations of the digital in everyday life.

Discussion

The research has provided insights into the way digital devices were used by older people during and since the Covid-19 pandemic. In particular, we highlight the increasing importance of digital connectivity and the ways in which older people actively engage (and resist) technologies of communication in their daily lives; and the significance of embodied co-presence and the immediacy of shared space and/or time is highlighted.

Character Strengths and Resilience in Older Adults during the COVID-19 Pandemic

During the pandemic, older adults were perceived as a vulnerable group without considering their various strengths. This study explored the associations between character strengths and resilience, and verified if some of these could predict resilience during the COVID-19 pandemic. A sample of 92 participants (women = 79.1%), ≥ 70 years of age (mean = 75.6 years), completed an online version of the Values in Action Inventory of Strengths - Positively keyed (VIA-IS-P) to assess 24 character strengths (grouped under six virtues) and the Connor and Davidson Resilience Scale. Results showed that 20 of the 24 strengths correlated positively and significantly with resilience. A multiple regression analysis revealed that the virtues of courage and transcendence, as well as attitudes toward aging, uniquely predicted the level of resilience. Interventions should be developed to improve certain strengths (e.g., creativity, zest, hope, humor, and curiosity), while reducing ageism, in order to promote resilience.

[La mise en abyme d'un projet intergénérationnel de recherche: Un comité intergénérationnel comme processus et sujet de recherche]

Les projets de nature intergénérationnelle sont aujourd'hui hautement valorisés par les décideurs publics et les responsables académiques. La pandémie de COVID-19 a fait ressurgir l'importance des relations entre les générations et des projets intergénérationnels ancrés dans la communauté. Cet article présente les résultats d'une étude visant à faire travailler ensemble des personnes aînées et des jeunes adultes au sein d'un projet intergénérationnel ancré dans la communauté. La particularité dans cette étude c'est qu'elle utilise une démarche méthodologique co-constructive, c'est-à-dire qu'elle jumelle des chercheurs et des chercheures académiques de différents horizons et des personnes aînées citoyennes tout au long du processus de recherche. Les résultats portent particulièrement sur les attentes des personnes participantes au projet intergénérationnel, la description du déroulement du projet (sur une période de dix mois) et les perceptions des relations intergénérationnelles au cours du projet. Nous terminons l'article par une discussion autour des constats centraux de notre étude et de notre expérience dans le cadre d'une recherche co-constructive.

Stigma of dementia during the COVID-19 pandemic: a scoping review protocol

INTRODUCTION

Dementia-related stigma reduces the quality of life of people living with dementia and their care partners. However, there is a dearth of literature synthesising knowledge on stigma of dementia during the COVID-19 pandemic. This scoping review protocol outlines a methodology that will be used to understand the impact of stigma on people living with dementia during the pandemic. Addressing dementia-related stigma is critical to promoting timely dementia diagnoses and enhancing the quality of life for people living with dementia and their care partners.

METHODS AND ANALYSIS

This review will follow the Arksey and O'Malley methodological framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The review will focus on English-language, peer-reviewed literature published between 13 January 2020 and 30 June 2023. Stigma will be broadly defined according to pre-established components (stereotypes, prejudice and discrimination). We will search six databases including CINAHL, EMBASE, Google Scholar, Medline, PsycINFO and Web of Science. We will also hand-search the reference lists of relevant articles to identify additional manuscripts. Two reviewers will develop the data extraction table, as well as independently conduct the data screening. Any disagreements will be resolved through open discussion between the two researchers, and if necessary, by consulting the full team to achieve consensus. Data synthesis will be conducted using an inductive thematic analysis approach.

ETHICS AND DISSEMINATION

This review will be the first to explore the impact of dementia-related stigma during the COVID-19 pandemic. An advisory panel including a person living with dementia and a care partner will be consulted to inform our review's findings and support the data dissemination process. The results of this scoping review will be shared and disseminated through publication in a peer-reviewed journal, presentations at academic conferences, a community workshop and webinars with various stakeholders.

Alzheimer's early detection in post-acute COVID-19 syndrome: a systematic review and expert consensus on preclinical assessments

Introduction

The risk of developing Alzheimer's disease (AD) in older adults increasingly is being discussed in the literature on Post-Acute COVID-19 Syndrome (PACS). Remote digital Assessments for Preclinical AD (RAPAs) are becoming more important in screening for early AD, and should always be available for PACS patients, especially for patients at risk of AD. This systematic review examines the potential for using RAPA to identify impairments in PACS patients, scrutinizes the supporting evidence, and describes the recommendations of experts regarding their use.

Methods

We conducted a thorough search using the PubMed and Embase databases. Systematic reviews (with or without meta-analysis), narrative reviews, and observational studies that assessed patients with PACS on specific RAPAs were included. The RAPAs that were identified looked for impairments in olfactory, eye-tracking, graphical, speech and language, central auditory, or spatial navigation abilities. The recommendations' final grades were determined by evaluating the strength of the evidence and by having a consensus discussion about the results of the Delphi rounds among an international Delphi consensus panel called IMPACT, sponsored by the French National Research Agency. The consensus panel included 11 international experts from France, Switzerland, and Canada.

Results

Based on the available evidence, olfaction is the most long-lasting impairment found in PACS patients. However, while olfaction is the most prevalent impairment, expert consensus statements recommend that AD olfactory screening should not be used on patients with a history of PACS at this point in time. Experts recommend that olfactory screenings can only be recommended once those under study have reported full recovery. This is particularly important for the deployment of the olfactory identification subdimension. The expert assessment that more long-term studies are needed after a period of full recovery, suggests that this consensus statement requires an update in a few years.

Conclusion

Based on available evidence, olfaction could be long-lasting in PACS patients. However, according to expert consensus statements, AD olfactory screening is not recommended for patients with a history of PACS until complete recovery has been confirmed in the literature, particularly for the identification sub-dimension. This consensus statement may require an update in a few years.

Pandemic justice: fairness, social inequality and COVID-19 healthcare priority-setting

A comprehensive understanding of the ethics of the COVID-19 pandemic priorities must be sensitive to the influence of social inequality. We distinguish between ex-ante and ex-post relevance of social inequality for COVID-19 disadvantage. Ex-ante relevance refers to the distribution of risks of exposure. Ex-post relevance refers to the effect of inequality on how patients respond to infection. In the case of COVID-19, both ex-ante and ex-post effects suggest a distribution which is sensitive to the prevalence social inequality. On this basis, we provide a generic fairness argument for the claim that welfare states ought to favour a healthcare priority scheme that gives particular weight to protecting the socially disadvantaged.

COVID-19 pandemic in long-term care: An international perspective for policy considerations

This paper identifies key factors rooted in the systemic failings of the long-term care sector amongst four high income countries during the COVID-19 pandemic. The goal is to offer practice and policy solutions to prevent future tragedies. Based on data from Australia, Canada, Spain and the United States, the findings support evidence-based recommendations at macro, meso and micro levels of practice and policy intervention. Key macro recommendations include improving funding, transparency, accountability and health system integration; and promoting not-for-profit and government-run long-term care facilities. The meso recommendation involves moving from warehouses to “green houses.” The micro recommendations emphasize mandating recommended staffing levels and skill mix; providing infection prevention and control training; establishing well-being and mental health supports for residents and staff; building evidence-based practice cultures; ensuring ongoing education for staff and nursing students; and fully integrating care partners, such as families or friends, into the healthcare team. Enacting these recommendations will improve residents' safety and quality of life; families’ peace of mind; and staff retention and work satisfaction.

Association between any underlying health condition and COVID-19-associated hospitalization by age group, Washington State, 2020-2021: a retrospective cohort study

BACKGROUND

Presence of at least one underlying health condition (UHC) is positively associated with severe COVID-19, but there is limited research examining this association by age group, particularly among young adults.

METHODS

We examined age-stratified associations between any UHC and COVID-19-associated hospitalization using a retrospective cohort study of electronic health record data from the University of Washington Medicine healthcare system for adult patients with a positive SARS-CoV-2 test from February 29, 2020, to March 13, 2021. Any UHC was defined as documented diagnosis of at least one UHC identified by the CDC as a potential risk factor for severe COVID-19. Adjusting for sex, age, race and ethnicity, and health insurance, we estimated risk ratios (aRRs) and risk differences (aRDs), overall and by age group (18-39, 40-64, and 65 + years).

RESULTS

Among patients aged 18-39 (N = 3,249), 40-64 (N = 2,840), 65 + years (N = 1,363), and overall (N = 7,452), 57.5%, 79.4%, 89.4%, and 71.7% had at least one UHC, respectively. Overall, 4.4% of patients experienced COVID-19-associated hospitalization. For all age groups, the risk of COVID-19-associated hospitalization was greater for patients with any UHC vs. those without (18-39: 2.2% vs. 0.4%; 40-64: 5.6% vs. 0.3%; 65 + : 12.2% vs. 2.8%; overall: 5.9% vs. 0.6%). The aRR comparing patients with vs. those without UHCs was notably higher for patients aged 40-64 years (aRR [95% CI] for 18-39: 4.3 [1.8, 10.0]; 40-64: 12.9 [3.2, 52.5]; 65 + : 3.1 [1.2, 8.2]; overall: 5.3 [3.0, 9.6]). The aRDs increased across age groups (aRD [95% CI] per 1,000 SARS-CoV-2-positive persons for 18-39: 10 [2, 18]; 40-64: 43 [33, 54]; 65 + : 84 [51, 116]; overall: 28 [21, 35]).

CONCLUSIONS

Individuals with UHCs are at significantly increased risk of COVID-19-associated hospitalization regardless of age. Our findings support the prevention of severe COVID-19 in adults with UHCs in all age groups and in older adults aged 65 + years as ongoing local public health priorities.

Ageing and Loneliness in Times of Pandemic: A Scoping Review

Society is immersed in a process of demographic transformation of great relevance: the ageing of the population. During the ageing stage, relevant changes occur, such as age-related losses, lack of formal and informal support or changes in social roles, which can cause situations of isolation or loneliness in older people. After the Spanish government decreed a state of alarm throughout the national territory in response to the arrival of SARS-CoV2, the confinement of the entire population was established, and only essential services and authorized persons could continue to carry out their daily activities and professional tasks. In addition, since the beginning of the pandemic, older people were considered high-risk people, a circumstance that increased their isolation situation.

OBJECTIVE

Understand, organize and systematically analyse the scientific evidence generated in relation to the impact that the COVID-19 pandemic has had on the processes and feelings of isolation and loneliness of the elderly population, from the beginning of the health crisis until the date of search.

MATERIALS AND METHODS

a scoping review was conducted using the methodology of Arksey and O'Malley, which included a review of the studies available in the online databases Proquest, Scopus and WOS. From the search, information related to the isolation and collective of elderly people during the pandemic was extracted.

RESULTS

a total of 32 articles were included, from which three fundamental areas of analysis emerged and three issues emerged: older people and institutionalisation during the pandemic, ageism and hospitalisation of the elderly during the pandemic, and loneliness and isolation of older people throughout the pandemic.

DISCUSSION

the lack of material resources and infrastructures to be able to face the problem of isolation in institutions was evident. The importance of acquiring, on the part of the elderly, competences, knowledge and skills in new technologies in order to continue with contact with their peer group and family was also observed.

CONCLUSIONS

this study identifies areas already understood, as well as knowledge gaps, that allow for determining opportunities for future research and thus the ability to improve in situations similar to the one that occurred.

Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis

BACKGROUND

The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization.

METHODS

We conducted a multifactorial vignette survey experiment (2⁸-design, i.e., N_Vignettes = 256) in Germany (N_Respondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19.

RESULTS

Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less.

CONCLUSION

Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

Ageism against Older Adults: How do Intersecting Identities Influence Perceptions of Ageist Behaviors?

Most ageism research has focused on prejudice against older people without considering their multiple intersecting identities. We investigated perceptions of ageist acts that targeted older individuals with intersecting racial (Black/White) and gender identities (men/women). Both young (18-29) and older (65+) adult Americans evaluated the acceptability of a variety of instances of hostile and benevolent ageism. Replicating prior work, benevolent ageism was seen as more acceptable compared to hostile ageism, and young adults rated ageist acts as more acceptable than older adults. Small intersectional identity effects were observed such that young adult participants perceived older White men to be the most acceptable targets of hostile ageism. Our research suggests that ageism is viewed differently depending on the age of the perceiver and the type of behavior exhibited. These findings also suggest intersectional memberships should be considered, but further research is needed given the relatively small effect sizes.

Taking Charge: Social Support Dynamics among Older Adults and Their Significant Others in COVID-19 Vaccination and Mitigation Efforts

Older people have been disproportionately affected by the COVID-19 pandemic and are often portrayed as passive victims of this global health crisis. However, older adults do take responsibility for their own health and that of others in large part through social network dynamics. The purpose of this study was to understand the processes whereby older adults' social networks shape their own health behaviors, and vice versa, in the context of COVID-19 vaccination and other mitigation efforts. Qualitative data from 77 older adults between ages 65 and 94 obtained through focus groups or individual interview participants were analyzed. Participant narratives demonstrated the reciprocal nature of social support and health behaviors and provided evidence that COVID-19-related health behaviors in this population were motivated by social support, altruism, and life experience. These findings emphasize older adults' active role as health promoters in their families and communities, keeping themselves and their significant others safe from COVID infection. Implications for the role of older adults in community health promotion efforts are discussed.

Depression risk among community-dwelling older people is associated with perceived COVID-19 infection risk: effects of news report latency and focusing on number of infected cases

Awareness of COVID-19 infection risk and oscillation patterns ('waves') may affect older people's mental health. Empirical data from populations experiencing multiple waves of community outbreaks can inform guidance for maintaining mental health. This study aims to investigate the effects of COVID-19 infection risk and oscillations on depression among community-dwelling older people in Hong Kong.

A rolling cross-sectional telephone survey method was used. Screening for depression risk was conducted among 8,163 older people (age ≥ 60) using the Patient Health Questionnaire-2 (PHQ-2) from February to August 2020. The relationships between PHQ-2, COVID-19 infection risk proxies - change in newly infected cases and effective reproductive number (R_t), and oscillations - stage of a 'wave' reported in the media, were analysed using correlation and regression.

8.4% of survey respondents screened positive for depression risk. Being female (β = .08), having a pre-existing mental health issue (β = .21), change in newly infected cases (β = .05), and screening during the latency period before the media called out new waves (β = .03), contributed to higher depression risk (R² = .06, all p <.01).

While depression risk does not appear alarming in this sample, our results highlight that older people are sensitive to reporting of infection, particularly among those with existing mental health needs. Future public health communication should balance awareness of infection risks with mental health protection.

Covid-19 and age discrimination: benefit maximization, fairness, and justified age-based rationing

Age-based rationing remains highly controversial. This question has been paramount during the Covid-19 pandemic. Analyzing the practices, proposals, and guidelines applied or put forward during the current pandemic, three kinds of age-based rationing are identified: an age-based cut-off, age as a tiebreaker, and indirect age rationing, where age matters to the extent that it affects prognosis. Where age is allowed to play a role in terms of who gets treated, it is justified either because this is believed to maximize benefits from scarce resources or because it is believed to be in accordance with the value of fairness understood as (a) fair innings, where less priority is given to those who have lived a full life or (b) an egalitarian concern for the worse off. By critically assessing prominent frameworks and practices for pandemic rationing, this article considers the balance the three kinds of age-based rationing strike between maximizing benefits and fairness. It evaluates whether elements in the proposals are, in fact, contrary to the justifications of these measures. Such shortcomings are highlighted, and it is proposed to adjust prominent proposals to care for the worse off more appropriately and better consider whether the acquired benefits befalls the young or the old.

Newspaper coverage on solidarity and personal responsibility in the COVID-19 pandemic: A content analysis from Germany and German-speaking Switzerland

Solidarity and personal responsibility have been repeatedly called upon during the COVID-19 pandemic. This study quantifies and contextualizes the use of these terms in newspaper coverage in Germany and German-speaking Switzerland based on n = 640 articles from six functionally equivalent newspapers. The term solidarity in the context of the COVID-19 pandemic was mentioned in 541/640 articles (84.5%) and was primarily used during phases with high death rates and comparatively stringent policies in place, supporting the idea that solidarity was used to explain restrictive measures to the population and motivate people to comply with these measures. German newspapers published more articles on solidarity than Swiss-German newspapers, consistent with more stringent COVID-19 policies in Germany. Personal responsibility was mentioned in 133/640 articles (20.8%), meaning that the term was less frequently discussed than solidarity. Articles covering personal responsibility included more negative evaluations during phases of high infection rates as compared to phases of low infection rates. Findings indicate that the two terms were, at least to some extent, used in newspaper reporting to contextualize and justify COVID-19 policy during phases of high infection rates. Moreover, the term solidarity was used in a high variety of different contexts and the inherent limits of solidarity were rarely mentioned. Policymakers and journalists need to take this into account for future crises to not jeopardize the positive effects of solidarity.

Negative ageism and compassionate ageism in news coverage of older people under COVID-19: how did the pandemic progression and public health responses associate with different news themes?

Previous studies have found negative ageing narratives in the media during the COVID-19 pandemic. However, few have focused on compassionate ageism and how the news responded to the progression of the COVID-19 pandemic. We investigated (a) media themes of negative and compassionate ageism and (b) their relationships with COVID-19 parameters and the public health response. The sample included 1,197 articles relevant to COVID-19 and older people in Hong Kong published between January and December 2020. We used thematic analysis to identify themes from the news articles and structural equation modelling to explore these themes' relationship with the number of older people infected, effective reproduction number, number of COVID-19 deaths and public health response parallel in time. Pandemic-related variables were lagged for a day – the time needed to be reflected in the news. Two negative ageism themes portrayed older people as vulnerable to COVID-19 but counterproductive in combating the pandemic. Two compassionate ageism themes depicted older people as a homogenous group of passive assistance recipients. The theme blaming older people was associated with the number of confirmed infections (β = 0.418, p = 0.002) but vulnerability of older people was not associated with pandemic-related variables. The theme helping older people was negatively associated with the percentage of older people in confirmed infections (β = −0.155, p = 0.019). The theme resources available was negatively associated with confirmed infections (β = −0.342, p < 0.001) but positively associated with the Containment and Health Index (β = 0.217, p = 0.005). Findings suggested that negative and compassionate ageism were translated into narratives about older people in the media as the pandemic evolved but did not address the actual risk they faced. Media professionals should be aware of the potential negative and compassionate ageism prompted by the news agenda and promote adequate health behaviours and responses.

Reducing ageism combining ageing education with clinical practice: A prospective cohort study in health sciences students

AIM

To analyse the impact of an intervention combining ageing education with clinical practice in nursing homes on a nursing cohort's negative stereotypes and prejudices towards ageing.

DESIGN

A prospective cohort study was conducted in September 2019-October 2020 in a population of health sciences students (n = 222).

METHODS

Questionnaire of Negative Stereotypes towards Aging (CENVE) and Aging Semantic Differential (DSE) were used to examine negative stereotypes and prejudices towards ageing in the nursing cohort exposed to the ageing education and practice intervention compared to a medical cohort that received no intervention. Group-by-time interaction, controlled by sex and age, for the effect of the intervention on CENVE and DSE scores was determined by mixed-design ANOVA.

RESULTS

The nursing cohort significantly reduced negative stereotypes and prejudices towards ageing when compared to the medical cohort in total (F = 26.926; p < 0.001), health factor (F = 16.812; p < 0.001), motivational and social factor (F = 11.266; p = 0.001), and character and personality factor (F = 19.202; p < 0.001) scores of CENVE scale and in DSE (F = 7.826; p = 0.006).

Upholding dignity during a pandemic via Twitter

Background: This article investigates how people invoked the concept of dignity on Twitter during the first year of the COVID-19 pandemic, with a secondary focus on mentions of dignity in the context of older adults and ageing. Methods: We report the results of a study that combines text analytic and interpretive methods to analyze word clusters and dignity-based themes in a cross-national sample of 1,946 original messages posted in 2020. Results: The study finds that dignity discourse on Twitter advances five major themes: (a) recognize dignity as a fundamental right, (b) uphold the dignity of essential workers, (c) preserve the dignity of at-risk populations, (d) prevent cascading disasters that exacerbate dignity's decline, and (e) attend to death, dignity, and the sanctity of life. Conclusions: Moreover, messages focusing on older adults lamented the disproportionate death toll, the terrible circumstances in long-term care homes, the added impact of suspended meal delivery services and the status of older people living below the poverty line.

Ageism and the Pandemic: Risk and Protective Factors of Well-Being in Older People

The COVID-19 pandemic has particularly affected the older population both in terms of the high number of victims and the psychological impact. Moreover, the pandemic has made older people more vulnerable to isolation and loneliness, and victims of ageism. The aim of the present study was to investigate the risk and protective factors for the well-being of older people during the pandemic. The role of positive affect, confidence in the future, current physical health, social isolation, loneliness, and ageism were analysed. A self-report questionnaire was administered to 1301 participants (mean age: 77.3 years, DS: 5.46), almost equally distributed by gender (56.1% female). Descriptive and correlational analyses were performed, together with SEM. The results showed that perceived age discrimination positively predicts loneliness and negatively and indirectly predicts well-being. Furthermore, positive affect, confidence in the future, and current physical health are protective factors, while loneliness, social isolation, and ageism are risk factors. Future emergency policies must take into account the impact of such actions on the well-being of this segment of the population.

Life after lockdown: The experiences of older adults in a contactless digital world

Introduction

The digital response to the Coronavirus (COVID-19) pandemic and its effects on the lives of older adults has been well-documented, but less is known about how they experienced the post-lockdown re-emergence into a relatively contactless digital society.

Methods

We report the findings from a qualitative survey (n = 93) and subsequent interviews (n = 9) with older adults aged 50+, where they describe their struggles with some of the newly implemented digital interactions. These struggles cover a range of settings but include using contactless payments, QR codes and apps to facilitate transactions in cafes, bars, and restaurants.

Results

A thematic analysis of our data revealed the intrinsic (e.g. digital literacy) and extrinsic (e.g. malfunctioning technology) factors that limited social inclusion for these participants, and that sometimes even led to moments of public humiliation.

Discussion

Our findings shed light on some of the motivational factors that underpin the age-related digital divide, whilst also highlighting the role of self-directed agism in limiting motivations to learn new digital routines.

International human rights law and the intangible face of ageism

Purpose

The purpose of this paper is to show the potential of international human rights law to raise awareness of the international community about ageism and its three aspects – old age discrimination, stereotyping and prejudices against older persons. The author evaluates the ability of international human rights law to encourage states to take action against these phenomena and looks for new solutions. The author also intends to examine if there are international law instruments compelling states to reject stereotypes and prejudices on older persons if there is no treaty devoted to them.

Design/methodology/approach

The author applies methods relevant to legal science. The core human rights treaties, soft law documents and activities of human rights bodies are selected, analysed and interpreted.

Findings

The core human rights treaties require going beyond their literal interpretation to observe older persons' rights. States should interpret them in good faith, relying on the ageing mainstreaming approach. Instruction to states on how to do so lies in the soft law and output of the international human rights bodies. However, there is also room for improvement. Therefore, the author proposes adopting a targeted resolution on counteracting ageism and its components, updating positions by international treaty bodies, and involving various human rights procedures and specialised agencies in the fight against intangible dimensions of ageism.

Originality/value

It is the first study analysing awareness about stereotyping and prejudices against older persons from international human rights law. The author indicates untapped possibilities of the fight against ageism and its intangible dimensions under international law.

Living with COVID-19 and preparing for future pandemics: revisiting lessons from the HIV pandemic

In April, 2020, just months into the COVID-19 pandemic, an international group of public health researchers published three lessons learned from the HIV pandemic for the response to COVID-19, which were to: anticipate health inequalities, create an enabling environment to support behavioural change, and engage a multidisciplinary effort. We revisit these lessons in light of more than 2 years' experience with the COVID-19 pandemic. With specific examples, we detail how inequalities have played out within and between countries, highlight factors that support or impede the creation of enabling environments, and note ongoing issues with the scarcity of integrated science and health system approaches. We argue that to better apply lessons learned as the COVID-19 pandemic matures and other infectious disease outbreaks emerge, it will be imperative to create dialogue among polarised perspectives, identify shared priorities, and draw on multidisciplinary evidence.

A scoping review of ageism towards older adults in cancer care

INTRODUCTION

Ageism towards older adults with cancer may impact treatment decisions, healthcare interactions, and shape health/psychosocial outcomes. The purpose of this review is twofold: (1) To synthesize the literature on ageism towards older adults with cancer in oncology and (2) To identify interventions that address ageism in the healthcare context applicable to oncology.

MATERIALS AND METHODS

We conducted a scoping review following Arksey and O'Malley and Levac methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted an exhaustive multi-database search, screening 30,926 titles/abstracts. Following data abstraction, we conducted tabular, narrative, and textual synthesis.

RESULTS

We extracted data on 133 papers. Most (n = 44) were expert opinions, reviews, and letters to editors highlighting the negative impacts of ageism, expressing the need for approaches addressing heterogeneity of older adults, and calling for increased clinical trial inclusion for older adults. Qualitative studies (n = 3) described healthcare professionals' perceived influence of age on treatment recommendations, whereas quantitative studies (n = 32) were inconclusive as to whether age-related bias impacted treatment recommendations/outcomes or survival. Intervention studies (n = 54) targeted ageism in pre/post-licensure healthcare professionals and reported participants' improvement in knowledge and/or attitudes towards older adults. No interventions were found that had been implemented in oncology.

DISCUSSION

Concerns relating to ageism in cancer care are consistently described in the literature. Interventions exist to address ageism; however, none have been developed or tested in oncology settings. Addressing ageism in oncology will require integration of geriatric knowledge/interventions to address conscious and unconscious ageist attitudes impacting care and outcomes. Interventions hold promise if tailored for cancer care settings. 249/250.

Helping Behavior of Older Adults during the Early COVID-19 Lockdown in Belgium

This study aimed to understand whether older adults not only received but also provided help during the first COVID-19 lockdown in Belgium, which factors motivated them to help, and whether older adults differed from younger age groups in terms of helping behavior and motives. Bivariate analyses were performed using data generated from an online cross-sectional survey in Belgium (N = 1892).The results showed that older adults who received help also provided it. This "interdependence" - mutual or reciprocal dependence - occurred regardless of age. In terms of motives for providing help, both older adults and their younger peers were primarily motivated by present-oriented and emotion-related motivation: older people were motivated to provide help by altruistic values and humanism, and enhancement motives linked to self-development.Policy implications of these results entail: during crisis situations, make use of the bond between older adults and their neighbors, such as caring communities.

Differences in urban and suburban/rural settings regarding care provision and barriers of cancer care for older adults during COVID-19

PURPOSE

Care for older adults with cancer became more challenging during the COVID-19 pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of as well as barriers to cancer care for older adults with cancer between urban and suburban/rural settings.

METHODS

Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Respondents were recruited through organizational listservs, email blasts, and social media messages. Descriptive statistics and chi-square tests were used.

RESULTS

Complete data was available from 271 respondents (urban (n = 144), suburban/rural (n = 127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and > 85, respectively, compared to 13% and 15.4% of suburban/rural providers (Ps = 0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults over older adults than suburban/rural providers (10.4% vs. 3.1%, p = 0.04) during the pandemic. The top concerns reported were similar between the groups and related to patient safety, treatment delays, personal safety, and healthcare provider mental health.

CONCLUSION

These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.

The Impact of COVID-19 on Nursing Homes: Study Design and Population Description

Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment-220 in private nursing homes and 227 in public nursing homes-participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies.

The Initial Response to COVID-19 Disruptions for Older People with HIV in Ukraine

Ukraine imposed a COVID-19 lockdown in March 2020. From April to June 2020, we surveyed 123 older people with HIV (OPWH) by phone to assess their mental health, engagement in HIV and other healthcare, and substance use using standardised scales. Variables of key interest were symptoms of depression and symptoms of anxiety. Univariate and multivariable Firth logistic regression models were built to assess factors associated with: (1) symptoms of depression, and (2) symptoms of anxiety. Findings indicated high suicidal ideation (10.6%); 45.5% met the screening criteria for moderate to severe depression; and 35.0% met the criteria for generalised anxiety disorder (GAD). Independent correlates of having moderate to severe depression included being female (AOR: 2.83, 95%CI = 1.19-7.05), having concerns about potential barriers to HIV treatment (AOR: 8.90, 95%CI = 1.31-104.94), and active drug use (AOR: 34.53, 95%CI = 3.02-4885.85). Being female (AOR: 5.30, 95%CI = 2.16-14.30) and having concerns about potential barriers to HIV treatment (AOR: 5.33, 95%CI = 1.22-28.45) were independently correlated with GAD, and over half (58.5%) were willing to provide peer support to other OPWH. These results highlight the impact of the COVID-19 restrictions in Ukraine on mental health for OPWH and support the need to screen for psychiatric and substance use disorders, potentially using telehealth strategies.

Intersections of ageism toward older adults and other isms during the COVID-19 pandemic

The COVID-19 pandemic is a significant global issue that has exacerbated pre-existing structural and social inequalities. There are concerns that ageism toward older adults has intensified in conjunction with elevated forms of other "isms" such as ableism, classism, heterosexism, racism, and sexism. This study offers a systematic review (PRISMA) of ageism toward older adults interacting with other isms during the COVID-19 pandemic. Articles were searched in 10 databases resulting in 354 ageism studies published between 2019 and August 2022 in English, French, Portuguese, or Spanish. Only 32 articles met eligibility criteria (ageism together with other ism(s); focus on the COVID-19 pandemic); which were mostly review papers (n = 25) with few empirical papers (n = 7), reflecting almost all qualitative designs (n = 6). Articles discussed ageism with racism (n = 15), classism (n = 11), ableism (n = 9), sexism (n = 7), and heterosexism (n = 2). Authors represented numerous disciplines (gerontology, medicine, nursing, psychology, social work, and sociology) and countries (n = 14) from several continents. Results from this study underscore that ageism intersects with other isms in profoundly negative ways and that the intersections of ageism and other isms are understudied, requiring more research and intervention efforts.

Current and Future Needs of Gerontological Social Work Practice in Alberta: Findings from the World Café at the Gerontological Symposium in Edmonton, Canada

The growing aging population in Canada has multi-faceted psycho-social needs. Social workers are well-positioned to address these needs, despite many challenges. This paper reports findings from the World Café at the Gerontology Symposium in Alberta, Canada, held in 2018. The goal was to learn from social work practitioners, researchers, and educators (N = 49) about current and future needs of gerontological social work in Alberta. There were two research questions: 1) What strategies do social workers need on the micro, mezzo, and macro levels to help better serve the growing older adult population in Alberta? (R1) 2) How can social workers promote the value and contribution of gerontological social work within the interprofessional community? (R2) The data were analyzed using qualitative content analysis. Ten R1-related themes emerged: personal traits of a social worker; professional skills; bio-psycho-social needs of older adults; community connections; access to benefits; gerontological social work education; integrated healthcare; aging policy; ageism; and advocacy to strengthen the voice of older adults. The three R2-related themes include strengthening the status of the social work profession; building trust through demonstrated skills; and interprofessional education and practice.

Depressive Symptoms and Coping Strategies in Community-Dwelling Older People Amidst the COVID-19 Pandemic: A Mixed-Method Study

This study aimed to examine depressive symptoms of community-dwelling older people amidst COVID-19 and explore how naturally occurring coping strategies were associated with depression. A mixed-method cross-sectional telephone survey was conducted with 375 older people aged 60 years and above between March and May 2020 in Hong Kong. Trained social workers interviewed participants and assessed depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). Attribute coding and thematic analysis were adopted for qualitative data analyses. Generalized linear models (GLM) were used to examine the effects of demographics, self-reported risk factors and coping strategies on PHQ-9 scores. Participants' average PHQ-9 score was 1.9 (SD = 2.9), suggesting a low risk for depression in general. Over half of the participants reported adaptive coping strategies, including learning new things, staying physically, mentally, and socially active, and having a positive mind-set. GLM results indicated that living with family members (other than spouse) and/or others, maladaptive coping, and self-reported risk factors were significantly associated with higher PHQ-9 scores, while adaptive coping was significantly associated with lower PHQ-9 scores. Our study contributed to the growing literature on older people's resilience and adaptive coping during the pandemic, and the results may have implications for mental health promotion and community care.