Older Europeans' health perception and their adaptive behaviour during the COVID-19 pandemic

Influence of grandchildren on COVID-19 vaccination uptake among older adults in China: a parallel-group, cluster-randomized controlled trial

The uptake of COVID-19 booster vaccination among older adults in China is suboptimal. Here, we report the results of a parallel-group cluster-randomized controlled trial evaluating the efficacy of promoting COVID-19 booster vaccination among grandparents (≥60 years) through a health education intervention delivered to their grandchildren (aged ≥16 years) in a Chinese cohort (Chinese Clinical Trial Registry: ChiCTR2200063240 ). The primary outcome was the uptake rate of COVID-19 booster dose among grandparents. Secondary outcomes include grandparents' attitude and intention to get a COVID-19 booster dose. A total of 202 college students were randomized 1:1 to either the intervention arm of web-based health education and 14 daily reminders (n = 188 grandparents) or control arm (n = 187 grandparents) and reported their grandparents' COVID-19 booster vaccination status at baseline and 21 days. Grandparents in the intervention arm were more likely to receive COVID-19 booster vaccination compared to control cohort (intervention, 30.6%; control, 16.9%; risk ratio = 2.00 (95% CI, 1.09 to 3.66)). Grandparents in the intervention arm also had greater attitude change (β = 0.28 (95% CI, 0.04 to 0.52)) and intention change (β = 0.32 (95% CI, 0.12 to 0.52)) to receive a COVID-19 booster dose. Our results show that an educational intervention targeting college students increased COVID-19 booster vaccination uptake among grandparents in China.

Memory effects in disease modelling through kernel estimates with oscillatory time history

We design a linear chain trick algorithm for dynamical systems for which we have oscillatory time histories in the distributed time delay. We make use of this algorithmic framework to analyse memory effects in disease evolution in a population. The modelling is based on a susceptible-infected-recovered SIR-model and on a susceptible-exposed-infected-recovered SEIR-model through a kernel that dampens the activity based on the recent history of infectious individuals. This corresponds to adaptive behavior in the population or through governmental non-pharmaceutical interventions. We use the linear chain trick to show that such a model may be written in a Markovian way, and we analyze the stability of the system. We find that the adaptive behavior gives rise to either a stable equilibrium point or a stable limit cycle for a close to constant number of susceptibles, i.e. locally in time. We also show that the attack rate for this model is lower than it would be without the dampening, although the adaptive behavior disappears as time goes to infinity and the number of infected goes to zero.

Worsened self-rated health in the course of the COVID-19 pandemic among older adults in Europe

BACKGROUND

Governments across Europe deployed non-pharmaceutical interventions to mitigate the spread of coronavirus disease 2019 (COVID-19), which not only showed clear benefits but also had negative consequences on peoples' health. Health inequalities increased, disproportionally affecting people with higher age or lower education. This study analyzed associations between social factors and worsened self-rated health of elderly people in the course of the COVID-19 pandemic, taking different stringencies of government mandates as well as infection rates into account.

METHODS

Data stem from the European SHARE survey. The main outcome was a binary indicator of worsened self-rated health. Analyses included data from two waves (2020 and 2021) during the pandemic (N = 48 356 participants, N = 96 712 observations). Predictors were age, sex, education and living together with a partner, and two macro indicators that reflected the stringency of government response mandates and COVID-19 infection rates. Data were analyzed using logistic mixed-effects regression models.

RESULTS

Older age [odds ratio (OR) 1.73, confidence interval (CI) 1.65-1.81] and female sex (OR 1.26, CI 1.20-1.32) were positively associated and higher education (OR 0.74, CI 0.70-0.79) was negatively associated with worsened self-rated health. Not living together with a partner showed higher odds of worsened self-rated health (OR 1.30, CI 1.24-1.36). Inequalities increased from 2020 to 2021. Associations between worsened self-rated health and government response mandates or infection rates were inconsistent.

CONCLUSION

Self-rated health worsened in the course of the pandemic and health disparities increased. Possible future pandemics require targeted interventions to minimize adverse health outcomes, in particular among old, potentially isolated, and deprived people.

A study on the current state and equity level of the health promotion service demands among older adults in China

BACKGROUND

Meeting the demands of older adults for health promotion services (DOAHPS) is essential for maintaining their health and enhancing their quality of life. The purpose of this study was to construct a model for evaluating DOAHPS to quantitatively evaluate the current state and equity level of DOAHPS in China, as well as to explore the main factors affecting DOAHPS' current state and equity level.

METHODS

This study analyzed the DOAHPS data from the "Survey on Chinese Residents' Health Service Demands in the New Era", which included 1542 older adults aged 65 and older. Relationships between evaluation indicators of DOAHPS were explored using Structural Equation Modeling (SEM). The Weighted TOPSIS method and Logistic regression (LR) were used to analyze the current state and factors impacting DOAHPS. The equity level of DOAHPS' allocation among different older adult groups and its influencing factors were determined using the Rank Sum Ratio (RSR) method and T Theil index.

RESULTS

The evaluation score for DOAHPS was 42.57 ± 1.51. Health status, health literacy and behavior were positively correlated with DOAHPS (r = 0.40, 0.38; P < 0.05). The LR results revealed that the most significant determinants of DOAHPS were sex, residence, education level and pre-retirement occupation (all P < 0.05). The number of older adults with very poor, poor, general, high and very high level health promotion service demands accounted for 2.27%, 28.60%, 53.05%, 15.43% and 0.65%, respectively. The total T Theil index of DOAHPS was 2.7433*10^-4, and the intra-group difference contribution rate exceeded 72%.

CONCLUSIONS

Compared to the maximum level, the total DOAHPS level was found to be moderate, although the demands of urban seniors with higher levels of education may be substantially greater. The observed inequities in the allocation of DOAHPS were primarily related to differences in education level and pre-retirement occupation within group. To better address health promotion services for older adults, policymakers could target older males with low education who reside in rural regions.

Longitudinal dynamics of depression in risk groups of older individuals during the COVID-19 pandemic

Background

Older individuals are most at risk of severe COVID-19 and particularly require protection causing (self)restriction of psychosocial interaction in daily living. So far, the impact of psychosocial withdrawal on mental health seems less pronounced in community-dwelling older individuals compared to younger individuals. However, dynamics and adverse long-term effects of the pandemic, such as increases in depression, are still mostly unclear, especially for vulnerable subgroups.

Methods

Pre-pandemic and 3-, 8-, 14-, 20-month peri-pandemic data were analyzed in 877 older participants (age at 3-month peri-pandemic: mean ± SD: 72.3 ± 6.3, range: 58-91 years) of the observational prospective TREND study in Germany. Severity of depression (Beck's Depression Inventory-II scores) and key factors of (mental) health were investigated for cross-sectional associations using path modeling. Risk groups defined by resilience, loneliness, history of depression, stress, health status and fear of COVID-19 were investigated for differences in depression between timepoints.

Findings

The early pandemic (3-month) severity of depression was most strongly associated with history of depression, stress and resilience. Overall increases in clinically relevant depression (mild-severe) from pre- to 3-month peri-pandemic were small (% with depression at pre-/3-month peri-pandemic: 8.3%/11.5%). Changes were most pronounced in risk groups with low resilience (27.2%/41.8%), loneliness (19.0%/28.9%), fear of COVID-19 (17.6%/31.4%), high stress (24.4%/34.2%), a history of depression (27.7%/36.9%), and low health status (21.8%/31.4%). Changes in depression were largely observed from pre- to 3-month and were sustained to the 20-month peri-pandemic timepoint, overall and in stratified risk groups defined by single and cumulative risk factors. Changes between timepoints were heterogenous as indicated by alluvial diagrams.

Conclusion

Only specific risk groups of older individuals showed a large increase in depression during the COVID-19 pandemic. Since these increases occurred early in the pandemic and were sustained over 20 months, these vulnerable risk groups need to be prioritized for counselling and risk mitigation of depression.

Greater knowledge about COVID-19, more negative emotions. Research in adult Poles after 2nd and 5th waves of the pandemic

Introduction: The study investigated the dynamics of cognitive and emotional representation of COVID-19 in adult Poles, following the second (2021) and the fifth (2022) wave of the pandemic. Material and methods: The study involved a total of 303 subjects (N = 198 in Survey 1 in 2021, and N = 105 in Survey 2 in 2022). The following measures were used: a questionnaire covering demographic data and general opinions about COVID-19 as well as the Revised Illness Perception Questionnaire (IPQ-R). Results: After the fifth wave, significantly more respondents were convinced that COVID-19 was a real and dangerous disease. Cognitive deficits were more commonly recognised among symptoms of the viremia. Vaccination against COVID-19 was recognised as an essential preventive measure. Both surveys showed that COVID-19 representation was characterised by negative emotions and low sense of illness coherence. However, there was increased belief that the disease can be controlled through medical interventions. The age of the respondents in Survey 1 and Survey 2 was differently related to beliefs about COVID-19. Conclusions: 1. After 2.5 years of the pandemic, the awareness of Poles about the causes, symptoms and methods of preventing the disease has increased. 2. Failure to vaccinate against COVID-19 has been identified as a significant cause of viremia. 3. Negative emotions and a sense of serious consequences were predominant in both Surveys, but after the fifth wave of the pandemic the scores reflect increased perception of the chronic nature of the disease and belief that the illness can be treated with medication, whereas the sense of personal control was found to decrease. 4. After the fifth wave of the pandemic, older age corresponded to increased belief in the relevance of some preventive measures, and to greater awareness of the viral origin, increased belief in the feasibility of controlling the disease through one's behaviours and a greater sense of illness coherence. 5. The intensification of negative emotions related to the pandemic can be treated as a predictor of the increase in adjustment disorders and risk of mental health deterioration among adult Poles in the following years. Keywords: cognitive and emotional representation of illness, COVID-19 pandemic, Polish adults

Active ageing profiles among older adults in Spain: A Multivariate analysis based on SHARE study

Background

Following the active ageing model based on the Health, Lifelong Learning, Participation and Security pillars, this research has a twofold objective: i) to classify older adults according to active ageing profiles, taking into account the four pillars, and ii) to ascertain the relationship between the profiles and personal and contextual factors, as well as well-being and quality of life in old age.

Methods

A study sample of 5,566 Spanish older adults who participated in wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was included. Data were analysed in different steps applying several statistical analyses (Principal Component, Cluster, Discriminant, Multiple Correspondence and bivariate analysis with Pearson chi-square and ANOVA).

Results

Five older adult profiles were obtained (I: with moderate activity; II: quasi-dependents; III: with active ageing-limiting conditions; IV: with diverse and balanced activity; V: with excellent active ageing conditions). The first three profiles were characterised by subjects with a high average age, low educational level, who were retired or housewives, and who perceived a moderate level of loneliness, satisfaction with the social network and quality of life, as well as having a larger family network, but living in small households or alone. In contrast, the latter two profiles showed better personal and contextual conditions, well-being and quality of life.

Discussion and conclusions

The multidimensional approach to active ageing followed in this article has revealed the presence of several older adult profiles, which are confined to groups with better or worse active ageing conditions. In this context, if ageing is a process that reflects the previous way of life, intervention priorities will have to consider actions that promote better conditions during the life cycle.

Close kin influence COVID-19 precautionary behaviors and vaccine acceptance of older individuals

The family plays a central role in shaping health behaviors of its members through social control and support mechanisms. We investigate whether and to what extent close kin (i.e., partner and children) have mattered for older people in taking on precautionary behaviors (e.g., physical distancing) and vaccination during the COVID-19 pandemic in Europe. Drawing on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we combine its Corona Surveys (June-August 2020 and June-August 2021) with pre-COVID information (October 2019-March2020). We find that having close kin (especially a partner) is associated with a higher probability of both adopting precautionary behaviors and accepting a COVID-19 vaccine. Results are robust to controlling for other potential drivers of precautionary behaviors and vaccine acceptance, as well as to accounting for co-residence with kin. Our findings suggest that policy makers and practitioners may differently address kinless individuals when promoting public policy measures.

How do appraisal as threat or challenge, efficacy, and environmental quality affect wellbeing in the COVID-19 pandemic?

BACKGROUND

In crises, it is of great relevance to identify mechanisms that help people to maintain a certain level of wellbeing. This paper investigates whether appraising the COVID-19 pandemic as a threat vs. as a challenge has different effects on subjective wellbeing during the pandemic. Furthermore, we study the role of the perceived local environmental quality for individuals' subjective wellbeing.

METHODS

Via online survey study with two times of measurement (N = 758), we investigated (a) the prediction of participants' wellbeing in June 2020 and June 2021 through five variables and (b) how these five variables moderated within-participant differences in subjective wellbeing over time.

RESULTS

Results showed that a stronger perception of the pandemic as a threat (feeling worried) and a lower education in June 2020 predicted a lower subjective wellbeing in 2020 and 2021. A stronger challenge appraisal (feeling confident), higher efficacy expectations, and positive perceptions of the local environmental quality in June 2020 predicted a higher wellbeing in 2020 and 2021. There was no substantial change in participants' aggregated wellbeing over time. However, those who perceived the pandemic more as a threat in June 2020 struggled more with negative changes in their wellbeing, whereas those who perceived the pandemic more as a challenge reported a higher wellbeing.

CONCLUSION

It seems key to support people in activating positive feelings to successfully cope with crises.