Locked down by inequality: Older people and the COVID-19 pandemic

Ageism and the digital divide in Switzerland during COVID-19: Lessons for the post-pandemic world

The COVID-19 pandemic erupted in early 2020. The Swiss Federal Council implemented a semi-lockdown in March 2020, asking people, particularly older adults, to stay at home to limit the transmission of the disease and to use digital tools to maintain their social relations and activities. This study inquired how older adults confronting precarity experienced these restrictions, how digital tools functioned in this context, and what learning could therefore be imbibed for the post-pandemic era. We conducted semi-structured telephone interviews with adults aged between 66 and 90 years living in a rural and mountainous Swiss region. The obtained data were subsequently thematically analyzed. The results revealed that the respondents experienced ageism during the semi-lockdown and reported limited or non-existent opportunities to use digital tools to maintain online social contact. This predicament increased their sense of loneliness and amplified their feelings of rejection by the outside world. These observations elucidate the need for the enhancement of non-ageist social support for older people, including individuals with limited social and material resources. We advocate the adoption of innovative initiatives in the post-pandemic era to better include precarious older people in our localities and neighborhoods.

Physical activity, low-grade inflammation, and psychological responses to the COVID-19 pandemic among older adults in England

Mental health responses to the COVID-19 pandemic have been widely studied, but less is known about the potentially protective role of physical activity (PA) and the impact of low-grade inflammation. Using a sample of older adults from England, this study tested (1) if pre-pandemic PA and its changes during the pandemic were associated with mental health responses; (2) if older adults with low-grade inflammation experienced greater increases in depression and anxiety, compared to pre-pandemic levels; (3) if PA attenuated the association between inflammation and depression/anxiety. The study used data from the English Longitudinal Study of Ageing, a cohort study following a national sample aged 50+. Information on mental health and PA were collected before the pandemic (2016/17 and 2018/19) and during November and December 2020. Inflammation was ascertained using pre-pandemic C-reactive protein (CRP). Analyses were adjusted for sociodemographic and health-related factors and pre-pandemic mental health. Increasing PA from before to during the pandemic was linked to reduced odds of depression (OR = 0.955, 95%CI [0.937, 0.974]) and anxiety (OR = 0.954, 95%CI [0.927; 0.982]). Higher pre-pandemic PA was associated with reduced odds of depression (OR = 0.964, 95%CI [0.948, 0.981]) and anxiety (OR = 0.976, 95%CI [0.953, 1.000]), whereas elevated CRP was associated with 1.343 times higher odds of depression (95%CI [1.100, 1.641]). PA did not attenuate the inflammation-depression association. The findings suggest that PA may contribute to psychological resilience among older adults, independently of inflammation. Further research is needed to explore the psychobiological pathways underlying this protective mechanism.

Impact of the COVID-19 pandemic on hospital episodes for falls and fractures associated with new-onset disability and frailty in England: a national cohort study

BACKGROUND

Older people with frailty are at risk of harm from immobility or isolation, yet data about how COVID-19 lockdowns affected them are limited. Falls and fractures are easily measurable adverse outcomes correlated with frailty. We investigated whether English hospital admission rates for falls and fractures varied from the expected trajectory during the COVID-19 pandemic, and how these varied by frailty status.

METHODS

NHS England Hospital Episode Statistics Admitted Patient Care data were analysed for observed versus predicted outcome rates for 24 January 2020 to 31 December 2021. An auto-regressive integrated moving average time-series model was trained using falls and fracture incidence data from 2013 to 2018 and validated using data from 2019. Models included national and age-, sex- and region-stratified forecasts. Outcome measures were hospital admissions for falls, fractures, and falls and fractures combined. Frailty was defined using the Hospital Frailty Risk Score.

RESULTS

144,148,915 pre-pandemic hospital admissions were compared with 42,267,318 admissions after pandemic onset. For the whole population, falls and fracture rates were below predicted for the first period of national lockdown, followed by a rapid return to rates close to predicted. Thereafter, rates followed expected trends. For people living with frailty, however, falls and fractures increased above expected rates during periods of national lockdown and remained elevated throughout the study period. Effects of frailty were independent of age.

CONCLUSIONS

People living with frailty experienced increased fall and fracture rates above expected during and following periods of national lockdown. These remained persistently elevated throughout the study period.

Can evidence drive health equity in the COVID-19 pandemic and beyond?

Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.

Effect of Age-Friendly Communities Action Plan on Trajectories of Older Canadians' Depressive Symptoms Between 2018 and 2020: Multilevel Results From the Canadian Longitudinal Study on Aging

As the COVID-19 pandemic impacted mental health, this longitudinal study examined the effect of age-friendly communities (AFC) action plan on older adults' depressive symptoms. Using the CLSA, the CLSA COVID-19 Questionnaire study, survey of Canadian municipalities, and the census, the depressive symptoms trajectories were modeled with multilevel multinomial regressions. Most respondents (66.1%) had non-depressed trajectories, 28.1% experienced a moderate increase in depressive symptoms, and 5.8% had a depressed trajectory. AFC action plans did not have a protective effect on these trajectories. Being a female, greater loneliness, lower income, ≥2 chronic conditions, inferior social participation, weaker sense of belonging, COVID-19 infection, and pandemic stressors predicted a depressed trajectory. Neighborhood's deprivation had a weak protective effect on the declining trajectory. Although AFC action plans provided no benefits during the pandemic, volunteers facilitating resource access and social interactions could limit any increase in depressive symptoms.

Urban public health emergencies and the COVID-19 pandemic. Part 2: Infrastructures, urban governance and civil society

COVID-19 had sudden and dramatic impacts on the organisation and governance of urban life. In Part 2 of this Special Issue on public health emergencies we question the extent to which the pandemic ushered in fundamentally new understandings of urban public health, noting that ideas of urban pathology and the relation of dirt, disease and danger in cities, have long informed practices of planning. Emphasising important continuities in the way pandemics are associated with minoritised and vulnerable groups, past and present, we note that public health initiatives can often exacerbate existing health divides, and actually deepen health crises. Against this, we document the emergence of participatory, community-led responses to the pandemic that offered the promise of more inclusive urban policy, often characterised by self-organisation. While we argue that any public health policy needs to be mindful of local contingencies, the promise of inclusive policies is that they will lead to healthier cities for all, not simply protect the health of the wealthy few.

Towards a constructed order of co-governance: Understanding the state-society dynamics of neighbourhood collaborative responses to COVID-19 in urban China

The state-society relationship in neighbourhood governance has been a focal topic in the urban governance literature, though the existing scholarship was primarily drawn from non-crisis situations. Adopting a mixed-methods approach, this study investigates the intricate state-society dynamics manifested at the neighbourhood scale as state and societal actors collaborated during China's COVID-19 responses. Our study reveals a pattern of collaborative rather than confrontational dynamics between resident committees and other stakeholders during pandemic responses, which reflects the emergence of a constructed order of neighbourhood co-governance in urban China. Previous community-building reforms consolidated the political legitimacy, power and capacity of resident committees, which were empowered to play a critical coordinating role in bridging hierarchical state mobilisation and horizontal stakeholders in the collaborative pandemic responses. These findings contribute to a more nuanced understanding of neighbourhood co-governance in the international literature and provide lessons for resilience governance from a comparative lens.

From lockdown to precise prevention: Adjusting epidemic-related spatial regulations from the perspectives of the 15-minute city and spatiotemporal planning

The COVID-19 pandemic challenged emergency management in cities worldwide. Many municipalities adopted restrictive, one-size-fits-all spatial regulations such as lockdowns without fully considering the inhabitants' daily activities and local economies. The existing epidemic regulations' unintended detrimental effects on socioeconomic sustainability necessitate a transition from the "lockdown" approach to more precise disease prevention. A spatially and temporally precise approach that balances epidemic prevention with the demands of daily activities and local economies is needed. Thus, the aim of this study was to propose a framework and key procedures for determining precise prevention regulations from the perspectives of the 15-minute city concept and spatiotemporal planning. Alternative regulations of lockdowns were determined by delineating 15-minute neighborhoods, identifying and reconfiguring facility supplies and activity demands in both normal and epidemic conditions, and performing cost-benefit analyses. Highly adaptable, spatially- and temporally-precise regulations can match the needs of different types of facilities. We demonstrated the process for determining precise prevention regulations in the case of the Jiulong 15-minute neighborhood in Beijing. Precise prevention regulations-which meet essential activity demands and are adaptable for different facility types, times, and neighborhoods-have implications for long-term urban planning and emergency management.

Relationships are everything: The underpinnings of grassroots community action in the COVID-19 pandemic in Toronto

Most government emergency/pandemic response plans feature top-down decision making and communication strategies and a focus on 'hard' (physical) infrastructure. There is nothing about the importance of the ideas and communications originating from communities, the social infrastructure that supports their impact locally and their contribution to the central administration. In this study, we found that the 'soft' (social) infrastructure within communities and between communities and formal institutions is key to an inclusive and more equitable response to large-scale crises like the COVID-19 pandemic. Grassroots leaders in six Toronto neighbourhoods were interviewed between the first and second waves of the COVID-19 pandemic in Toronto about what helped or hindered community action. Three themes emerged: (1) Grassroots leaders and community organizations were able to act as key connection points in a two-way flow of information and resources with residents and service providers; (2) Grassroots leaders and groups were challenged to engage in this work in a sustained capacity without adequate resourcing; and (3) there was a disconnect between community-centred grassroots approaches and the City's emergency response. We conclude that there needs to be pre-disaster investment in community level planning and preparation that fosters two-way connections between all municipal emergency/disaster and pandemic preparedness plans and community-centred organizations and grassroots leaders working in marginalized communities.

The Generation Gap Revisited: Generational Differences in Mental Health, Maladaptive Coping Behaviors, and Pandemic-Related Concerns During the Initial COVID-19 Pandemic

The purpose of this study was to assess differences in mental health symptoms, pandemic-related concerns, and maladaptive coping behaviors among adults in the United States across generations during the initial period of the COVID-19 pandemic. A social media campaign was used to recruit 2696 U.S. individuals to participate in an online survey in April 2020, assessing various validated psychosocial factors, including major depressive disorder, generalized anxiety disorder (GAD), perceived stress, loneliness, quality of life, and fatigue, along with pandemic-specific concerns and changes in alcohol use and substance use. Participants were grouped based on generation status (Gen Z, Millennial, Gen X, and Baby Boomer) and statistical comparisons were conducted based on demographics, psychosocial factors, pandemic-related concerns, and substance use. During the initial period of the COVID-19 pandemic, the younger cohorts (Gen Z and Millennials) rated significantly worse on mental health indices, including major depression, GAD, perceived stress, loneliness, quality of life, and fatigue. Further, the participants in the Gen Z and Millennial generational groups exhibited greater increase in maladaptive coping with substance use, specifically alcohol use and increased use of sleep aids. Our results indicate that during the initial period of the COVID-19 pandemic, members of the Gen Z and Millennial generational cohorts were considered a psychologically vulnerable population due to their mental health and maladaptive coping behaviors. Improving access to mental health resources during early stages of a pandemic is an emerging public health concern.

Social, health and economic impact of COVID-19: Healthy Ageing In Scotland (HAGIS) - a protocol for a mixed-methods study

INTRODUCTION

Public health responses to the COVID-19 pandemic have reaped adverse physical, psychological, social and economic effects, with older adults disproportionally affected. Psychological consequences of the pandemic include fear, worry and anxiety. COVID-19 fear may impact individuals' mitigation behaviours, influencing their willingness to (re)engage in health, social and economic behaviours. This study seeks (1) to develop a robust and evidence-based questionnaire to measure the prevalence of COVID-19 fear among older adults (aged ≥50) in Scotland and (2) to examine the impact of COVID-19 fear on the willingness of older adults to (re)engage across health, social and economic domains as society adjusts to the 'new normal' and inform policy and practice.

METHODS AND ANALYSIS

This mixed-method study includes a large-scale multimodal survey, focus groups and interviews with older adults (aged ≥50) living in Scotland, and an email-based 'e-Delphi' consultation with professionals working with older adults. The COVID-19 fear scale was developed and validated using exploratory and confirmatory factor analyses. Survey data will be analysed using descriptive and inferential statistics. Thematic analysis will be used to analyse qualitative data. Survey and qualitative findings will be triangulated and used as the starting point for an 'e-Delphi' consensus consultation with expert stakeholders.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the University of Stirling for multimodal survey development, fieldwork methodology and data management. Anonymised survey data will be deposited with the UK Data Service, with a link provided via the Gateway to Global Ageing. Qualitative data will be deposited with the University of Stirling online digital repository-DataSTORRE. A dedicated work package will oversee dissemination via a coproduced project website, conference presentations, rapid reports and national and international peer-reviewed journal articles. There is planned engagement with Scottish and UK policy makers to contribute to the UK government's COVID-19 recovery strategy.

Spatial and deep learning analyses of urban recovery from the impacts of COVID-19

This study investigates urban recovery from the COVID-19 pandemic by focusing on three main types of working, commercial, and night-life activities and associating them with land use and inherent socio-economic patterns as well as points of interests (POIs). Massive multi-source and multi-scale data include mobile phone signaling data (500 m × 500 m), aerial images (0.49 m × 0.49 m), night light satellite data (500 m × 500 m), land use data (street-block), and POIs data. Methods of convolutional neural network, guided gradient-weighted class activation mapping, bivariate local indicator of spatial association, Elbow and K-means are jointly applied. It is found that the recovery in central areas was slower than in suburbs, especially in terms of working and night-life activities, showing a donut-shaped spatial pattern. Residential areas with mixed land uses seem more resilient to the pandemic shock. More than 60% of open spaces are highly associated with recovery in areas with high-level pre-pandemic social-economic activities. POIs of sports and recreation are crucial to the recovery in all areas, while POIs of transportation and science/culture are also important to the recovery in many areas. Policy implications are discussed from perspectives of open spaces, public facilities, neighborhood units, spatial structures, and anchoring roles of POIs.

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.

Emancipatory Visions: Using Visual Methods to Coconstruct Knowledge with Older Adults

This article calls for gerontologists to engage with visual methods in qualitative research as an innovative tool for community-engaged research that has potential to advance social justice in gerontology. Reflections about using visual methods from the intersectional standpoint of the authors, 3 younger women of color, are presented. In Working the Hyphen, J. Yeh shows how interpersonal dynamics are fundamental to visual methods and that attention to identity can provide new insights into aging while also reconstituting existing power dynamics that researchers must carefully consider. In Employing Elicitation Techniques With Experts, L. Reyes discusses how a colonial lens limits understandings of civic participation and erases contributions of Black, Indigenous, and People of Color (BIPOC) older adults, proposing that elicitation techniques offer opportunities for BIPOC older adults to contribute their expertise to the research process and dissemination of findings beyond an academic audience. In Pedagogy and Practicality, H. S. Versey describes promises and complexities of scaling visual methods on multiple levels-teaching future generations of researchers the philosophy and practice of photovoice; negotiating university and community relationships through a service-learning project; and navigating identity between herself, her students, and research participants. In sharing our self-narratives, we integrate reflexivity into the research process and challenge power dynamics in knowledge construction.

COVID-19 challenges and firm responses: Analysis of a city-wide census in a developing country

We use the unique data set of 16,300 firms' responses for the large-scale census survey in an urban area at Ho Chi Minh City (Vietnam) to study how firms perceived their problems and responded to during the COVID-19 pandemic. We provide estimates of 65 cross-associations between a firm's challenges during the pandemic and their responses. We find several firm characteristics that suggest increased likelihood of pandemic response, including some, such as state ownership, which are typically associated with being slow to respond to market conditions. A theoretical model is posited that matches with the rapidly declared survey response.

Social Isolation Among Older Adults in the Time of COVID-19: A Gender Perspective

We aimed to analyze inequalities in social isolation among older adults in a time of COVID-19 social restrictions, using a gender perspective. A random population-based survey, including 21,543 older adults (65+) was conducted during and post COVID-19 lockdown in France. Our main outcome was a three-dimension indicator of social isolation based on living conditions, i.e., living alone (i) and not having gone out in the past week (ii), completed by an indicator measuring Internet use i.e., never using the Internet (iii). Logistic regressions were used to identify factors associated with isolation for women and men. Women were more likely to live alone (aOR = 2.72 [2.53; 2.92]), not to have gone out in the past week (aOR = 1.53 [1.39; 1.68]), and not to use the Internet (aOR = 1.30 [1.20; 1.44]). In addition to gender effects, being older, at the bottom of the social hierarchy, and from an ethno-racial minority was also associated with social isolation. Preventive policies should take into account these inequalities when addressing the issue of social isolation among older women and men, so as to enable all social groups to maintain social contacts, and access health information.

Using an Intersectional Lens on Vulnerability and Resilience in Minority and/or Marginalized Groups During the COVID-19 Pandemic: A Narrative Review

Throughout the pandemic, the media and scholars have widely discussed increasing social inequality and thereby publicly pointed to often hidden and neglected forms of inequality. However, the "newly" arisen awareness has not yet been put into action to reduce this inequality. Dealing with social inequality implies exploring and confronting social privileges, which are often seen as the other side of inequality. These social constructs, inequality and privilege, are often discussed in light of vulnerability and resilience. This is particularly important in the context of the worldwide coronavirus disease 2019 (COVID-19) pandemic and efforts to end the pandemic, as both constructs are discussed regarding access to healthcare, vaccination, and education and knowledge, misinformation, social resources, economic resources, and so forth. Minority and/or marginalized groups may be particularly vulnerable to the impact of the COVID-19 pandemic. However, resilience factors in these groups may be neglected and underreported. This narrative review aims at illustrating the specific and intertwined aspects of resilience and vulnerability in minority and/or marginalized groups during the COVID-19 pandemic. To achieve this, we use an intersectional lens based on recommendations made by Moradi and Grzanka. A total of 48 articles were included in the narrative review. Most of them were commentaries focusing on social inequality, vulnerability, and/or resilience. Based on the dissection of articles at structural, systemic, and individual levels, we propose three hypothesis on vulnerability and resilience in minority and marginalized individuals and groups: (1) social inequality must be considered at a global level; inequality at a global level translates into a vulnerable context for an individual; (2) vulnerability is historically situated: vulnerability (experienced during the pandemic) is maintained and reinforced by history; (3) strength through collective (historical) hardship: vulnerability is not the opposite of resilience but may serve as an aspect of resilience. The conclusions drawn from this review show that we need to include diverse voices to advance concepts, such as vulnerability and resilience, in minority and marginalized groups. Additionally, these concepts are not necessarily in opposition to each other, but vulnerability should be understood as an integral part of resilience.

Age-Friendly Cities and Communities: Research to Strengthen Policy and Practice

Since the early 2000s, a global age-friendly movement has emerged with aspirations to make environments and systems within localities more supportive of long and healthy lives. Despite growth in the social movement over the past decade, research on how to work toward community change, especially in systematic and comprehensive ways across diverse geo-political and sociocultural contexts, has been relatively slower to develop. This special issue of the Journal of Aging & Social Policy aims to accelerate this area. It features articles that advance knowledge on processes and contexts toward enhancing the age-friendliness of cities and communities. In this introductory essay, we provide background on the age-friendly cities and communities movement - including its accomplishments alongside key challenges. We then discuss the importance of research at the intersection of policy and practice to strengthen the movement into the 21st century. Next, we introduce the articles in this special issue, organized under four themes: implementation and sustainability processes; partnerships and multisectoral collaboration; theory-based program design; and policy and practice diffusion. A final article provides an overview of the career contributions of Dr. Frank Caro, an age-friendly champion and gerontologist to whom this special issue is dedicated.