COVID-19, Social Isolation, and Mental Health Among Older Adults: A Digital Catch-22

Development and Implementation of Strong Foundations, a Digitally Delivered Fall Prevention Program: Usability and Feasibility Pilot Exercise Cohort Study

Background

Falls remain a major public health problem and a significant cause of preventable injury. Maintaining strength and balance by staying active can prevent falls in older adults, and public health advocates support referral to community exercise programs. Given the growth in use and acceptance of technological interfaces, there remains an interest in understanding the role of a synchronous exercise program designed to improve strength, postural alignment, and balance specifically designed to be delivered in a digital environment with respect to usability and feasibility.

Objective

This study aims to design and implement a synchronously delivered digital fall prevention program to adults aged 60 years and older, to understand the usability, feasibility, and attendance.

Methods

The "Strong Foundations" program, a 12-week, live, digitally delivered fall-prevention exercise program was informed from different existing in-person exercises and piloted to older adults who were considered a low fall risk by scores of 4 or less from the Centers for Disease Control and Prevention's (CDC's) Stopping Elderly Accidents and Deaths Initiative (STEADI) Staying Independent questionnaire. The System Usability Scale (SUS) measured usability and feasibility at the completion of this program, and digital measures of age-related function (timed up and go [TUG] and 30-second chair stand [30 CS]) were collected pre- and postintervention. Data were collected in 2021.

Results

A total of 39 older adults were recruited and 38 completed the 12-week program with an average age of 72 years. The average SUS was 80.6, with an 85% attendance rate and an 8.5 (out of 10) self-reported satisfaction score. Digitally collected TUG and 30 CS statistically improved pre- and postintervention by 9% and 24%, respectively; by week 12, 64% (23/36) of participants improved in the timed up and go and 91% (32/35) improved the chair stands.

Conclusions

There was excellent usability and acceptability for Strong Foundations, a novel fall-prevention program designed to be delivered digitally and promising improvement of objective measures of fall risk.

Depression Self-Care Apps' Characteristics and Applicability to Older Adults: Systematic Assessment

BACKGROUND

Depression affects 32% of older adults. Loneliness and social isolation are common risk factors for depression in older adults. Mobile apps can connect users and are also effective in depression management in the general population. However, older adults have specific needs in terms of the content of depression self-care interventions and their accessibility. It remains unknown whether existing apps for depression self-care are applicable to older adults.

OBJECTIVE

The initial aim of this assessment was to systematically identify interactive depression self-care apps specifically designed for older adults. As we did not find any, we assessed the applicability of existing depression self-care apps to the needs of older adult users.

METHODS

Using an established app assessment methodology, we searched for Android and iOS interactive mental health apps providing self-care for depression in English and Chinese in the 42Matters database, Chinese Android app stores, and the first 10 pages of Google and Baidu. We developed an assessment rubric based on extensive revision of the literature. The rubric consisted of the following sections: general characteristics of the apps (eg, developer, platform, and category), app content (eg, epidemiology and risk factors of depression in older adults, techniques to improve mood and well-being), and technical aspects (eg, accessibility, privacy and confidentiality, and engagement).

RESULTS

We identified 23 apps (n=19, 82.6%, English and n=4, 17.4%, Chinese apps), with 5 (21.7%) iOS-only apps, 3 (13%) Android-only apps, and 15 (65.2%) apps on both platforms. None specifically targeted older adults with depression. All apps were designed by commercial companies and were free to download. Most of the apps incorporated cognitive behavior therapy, mood monitoring, or journaling. All but 3 (13%) apps had a privacy and confidentiality policy. In addition, 14 (60.9%) apps covered depression risk factors in older adults, and 3 (13%) apps delivered information about depression epidemiology in older adults via a chatbot. Furthermore, 17 (73.9%) apps mentioned other topics relevant to older adults, such as pain management, grief, loneliness, and social isolation. Around 30% (n=7) of the apps were supported by an online forum. Common accessibility issues included a lack of adaptations for users with visual or hearing impairments and incompatibility with larger font sizes in the phone settings.

CONCLUSIONS

There are no depression apps developed specifically for older adults. Available mobile apps have limited applicability to older adults in terms of their clinical and technical features. Depression self-care apps should aim to incorporate content relevant to older adults, such as grief and loss; include online communities; and improve accessibility to adapt to potential health impairments in older adults.

COVID-19 and Mental Distress and Well-Being Among Older People: A Gender Analysis in the First and Last Year of the Pandemic and in the Post-Pandemic Period

The Coronavirus disease 2019 (COVID-19) pandemic seriously threatened the health and well-being of the population. This study aims to investigate the relevance of the COVID-19 pandemic on the stress, mental distress, and well-being of older people in Spain. The design was quantitative repeated cross-sectional. The sample was non-probability and consisted of 1436 persons from the general population divided into two groups: (1) the study group, composed of 718 women (61.3%) and men aged 60 to 89; (2) the comparison group, composed of the same number of women and men aged 30 to 45. All were assessed in three phases of the COVID-19 pandemic: the first pandemic year, the last pandemic year, and the post-pandemic period. The results showed that during the first year of the pandemic, the prevalence of mental distress was higher in older women (50%) than in older men (37.2%), while the rates in the comparison group were 57.2% for women and 53.2% for men. In the post-pandemic period, the rates of mental distress were 30.2% for older women and 29.8% for older men while in the comparison group, the rates were 48.5% for women and 26.5% for men. No significant differences in well-being were found between the groups or between the different phases of the pandemic. The most common stressors reported by older people were illness and death of family and/or loved ones, followed by personal illness. In the post-pandemic period, more stressful events and lower stress resilience were found to predict mental distress in older women and men. Greater perceived vulnerability to infection was another important predictor for women. Low self-esteem and younger age were also predictors of mental distress for men. High self-esteem, high social support, greater stress resilience and fewer stressful events were predictors of well-being for both genders. The results of this study are relevant for the design of policies, programs, and strategies to improve the health and well-being of older people.

The bidirectional relationships between social isolation and cognitive function among older adults in China: separating between-person effects from within-person effects

This study investigates the bidirectional relationship between social isolation and cognitive function among older adults in China, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The baseline survey, which commenced in 2008, tracked 1,662 participants over four waves of data collection spanning a decade. We employed Cross-Lagged Panel Models (CLPM) and Random Intercept Cross-Lagged Panel Models (RI-CLPM) to analyze these relationships at both the between-person and within-person levels. CLPM results indicated significant cross-lagged effects between social isolation (β = - 0.119, p < 0.001; β = - 0.162, p < 0.001) and cognitive function (β = - 0.073, p < 0.001; β = - 0.091, p < 0.001) at the between-person level over the last three waves. Specifically, higher prior levels of social isolation were associated with a significant decline in subsequent cognitive function, and vice versa. Furthermore, RI-CLPM results showed that, after controlling for random intercepts and covariates, only social isolation had a significant negative impact on cognitive function across all waves (β = - 0.051, p < 0.05; β = - 0.047, p < 0.05; β = - 0.028, p < 0.05). Overall, this study demonstrates that, when considering both between-person and within-person effects, social isolation exerts a stronger lag effect on cognitive function among older adults in China. This suggests that, over a specific timeframe, reducing social isolation is crucial for promoting healthy aging in this population.

Older women's well-being during the COVID-19 pandemic: individual, community, and contextual factors

Objective

This article aims to examine the influence of individual and community-contextual factors on the well-being of older women in Zambia during the COVID-19 pandemic, drawing on Bronfenbrenner's process-person-context-time model.

Methods

Secondary data from the nationally representative 2021 SEIA were used, and bivariate and logistic regression analyses were performed to determine factors associated with the well-being of older women during the COVID-19 pandemic.

Results

Overall, 29% (613) of older women reported a decline in their well-being due to COVID-19. Older women in rural areas had lower odds of well-being [Adjusted Odds Ratio (AOR) 0.607, 95% 0455,0.809]. At the individual level, the well-being of older women during COVID-19 was associated with age (AOR O.362, 95% CI: 0.190,0.689) and being in paid work (AOR 0.737, 95% CI: 0.552,0.984). Despite education having a strong relationship with well-being, it had a weak effect on the well-being of older women during COVID-19. Community-level factors significantly associated with the well-being of older women amidst COVID-19 included attendance at public gatherings (e.g., church meetings, funerals) (AOR 1.465, 95% CI: 1.139,1.885) and perceived fear or anxiety due to COVID-19 (AOR 0.522, 95% CI: 0.392,0.696). A significant contextual-level factor was access to transport services during the pandemic (AOR 0.589, 95% CI: 0.390,0.890).

Conclusion

COVID-19 has exposed the inadequacy of systems at different levels in meeting the needs of older women and promoting their well-being during emergencies. At the individual level, there is a need to support older women's livelihoods and educational opportunities. Despite limitations on social interactions during COVID-19, access to social gatherings and interactions supported older women's well-being. However, this was hampered by fear of contracting COVID-19 and the limitations in public transport that compromised their mobility to access services and visit people. A more extensive analysis of individual, community, and contextual factors should identify factors that support or compromise the well-being of older women during emergencies or shocks. There is a need for information about what livelihood strategies during and/or post shocks, or critical events such as COVID-19 could sustainably support older women's well-being.

Graying arts access: crafting creative online programming to promote older adults' artistic engagement in and beyond pandemic time

Introduction

Declared a global pandemic by the World Health Organization (WHO) in March 2020, the COVID-19 virus and attendant patchwork of local, regional, and national government-initiated public health responses to it unexpectedly opened possibilities for greater access to culture for disabled and chronically ill people in ways that were unimagined in pre-pandemic times. During the "emergency" period of the pandemic, the fields of critical disability studies and aging studies independently demonstrated the importance and value of shifting to digital technologies for disabled people and older adults respectively; however, to date, little scholarship has considered the value of digital technologies for older adults aging with and into disabilities beyond pandemic time.

Methods

Informed by the theoretical insights of scholarship exploring critical access and the aging-disability nexus, this paper draws from empirical data collected during Phase 2 of Direct[Message]: Digital Access to Artistic Engagement, a collaborative, community-based, arts-informed research project based in Southwestern Ontario (Canada). Drawing from 50 qualitative interviews with aging adults from un/under/represented communities, findings explore the intersections of older age and disability, including dynamics related to gender, sexuality, migration, size, race/ethnicity, and other differences, as these relate to access to and enjoyment of creative spaces before, during, and "after" the COVID-19 pandemic.

Results

Results show that older adults aging with/into disabilities in Southwestern Ontario express an overwhelming desire and even urgent need to access interactive arts programming from the relatively safe spaces of their homes both within and outside pandemic time.

Discussion

As the normative world pushed for a return to ableist normative life in 2022, a year marked by "severe" rates of the highly infectious Omicron variant and the loss of effective public measures, such as community masking and widely available testing, participants described the need for continued access to creative and social participation via remote options that sidestepped socially exclusive and physically inaccessible spaces. Findings indicate a need for increased investment in digital arts programming for older adults aging with/into disabilities.

Effectiveness of digital intelligence interventions on depression and anxiety in older adults: A systematic review and meta-analysis

BACKGROUND

Depression and anxiety are common mental disorders in later life. Digital intelligence interventions overcome the limitations of conventional psychotherapy and offer new treatments for depression and anxiety. However, the effectiveness among older adults remains unclear.

METHODS

Databases including Pubmed, Web of Science, the Cochrane Library, Medline, CINAHL, PsycINFO, and Embase were searched for Randomized Controlled Trials (RCTs) from inception to November 22, 2023. Statistical analyses were conducted using Stata 18.0 and Review Manager 5.4.

RESULTS

The initial search found 9369 papers, with 21 meeting the inclusion criteria (e.g., RCTs involving older adults aged 50 and older that assessed digital intelligence interventions on depression and anxiety symptoms). Meta-analyses revealed that, compared to control groups, digital intelligence interventions significantly reduced depression symptoms (SMD: -0.58; 95 % CI: -0.80, -0.35) and anxiety symptoms (SMD: -0.39; 95 % CI: -0.58, -0.19). Subgroup analysis revealed that internet-based Cognitive Behavioral Therapy (iCBT), interventions lasting 7 to 10 weeks, and the use of the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder-7 (GAD-7) scales, especially in other regions, had the most pronounced effects.

CONCLUSIONS

Digital intelligence interventions reduce depressive and anxious symptoms in older adults, supporting the development of evidence-based treatment guidelines in the digital era.

A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients

OBJECTIVES

Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention.

DESIGN SETTING AND PARTICIPANTS

We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework.

RESULTS

Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends.

CONCLUSION

This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

Exploring the association between multidimensional social isolation and heterogeneous cognitive trajectories among older adults: evidence from China

Objective

This study aims to elucidate the heterogeneous cognitive trajectories among older adults in China through a comprehensive, nationally representative longitudinal study. Furthermore, it seeks to investigate the impact of multidimensional social isolation on heterogeneous cognitive trajectories among older adults in China.

Methods

Utilizing data from three successive waves of the Chinese Longitudinal Aging Social Survey (CLASS) spanning 2016 to 2020, this investigation quantified baseline social isolation across three dimensions-family isolation, friend isolation, and subjective isolation-alongside cognitive function scores of older adults, measured across all three waves. Through latent class growth models, heterogeneous cognitive trajectories were delineated. The influence of family isolation, friend isolation, and subjective isolation on these cognitive trajectories was examined employing multinomial logistic regression analysis.

Results

The study included 6,378 participants aged 60 and above, revealing three primary cognitive trajectories: High baseline stable group (68.8%), High baseline but declining group (21.7%), and Low baseline deteriorating group (9.5%). Adjusting for variables such as personal physical characteristics, social networks, living and working conditions, and the surrounding policy environment, the findings indicated that family isolation did not significantly affect cognitive function's high-level decline or low-level deterioration. Conversely, friend isolation markedly increased the risk of high-level cognitive decline (OR = 1.289) and low-level cognitive deterioration (OR = 1.592). Similarly, subjective isolation significantly heightened the risk for both high-level decline (OR = 1.254) and low-level deterioration (OR = 1.29) in cognitive function.

Conclusion

Mitigating friend and subjective isolation among older adults appears to be a more effective strategy in preventing or delaying cognitive decline, potentially reducing the strain on healthcare and social welfare systems.

Humanistic and Holistic Strategies for Combating Mental Health Sequelae in the Elderly During the Post-COVID Era

Background

The elderly population is rapidly growing worldwide. By the year 2050, the elderly population will increase up to 2.1 billion. Among them, most of the elderly will be from low- to middle-income countries. India and China are the most populated countries in the world, and also they fall in the category of low- to middle-income countries. The elderly population in these two countries is also growing rapidly and creating an economic burden of geriatric care. On the other hand, the COVID-19 pandemic greatly affected the healthcare system. A higher mortality rate was documented among the elderly due to COVID-19; hence, it was a challenge for them to deal with a high load of the elderly population during the pandemic. These challenges never sublimate even during the post-COVID era. Mental health issues, such as stress, anxiety, and depression, are major drawbacks of COVID-19 among the elderly due to excessive fear of getting reinfection of COVID-19 and fear of social withdrawal. These factors are affecting healthy aging among the elderly. Even though WHO has taken few initiatives for healthy aging, proper interventional strategies are required to prevent mental illness and improve mental health among the elderly during the post-COVID era.

Summary

In this review, we have proposed a few mind-body strategies like Yoga, Exercise, Tai-Chi, and Qigong to improve mental health and holistic patient-centric implementation of those practices in the elderly during the post-COVID era.

Key message

Mind-body interventions can be used in a holistic patient-centric manner to prevent infectious diseases, and post-infection consequences. Further, it enhances immunomodulation along with mental health in the elderly.

Exploring the Causal Association between Morning Diurnal Preference and Psychiatric Disorders: A Bidirectional Two-Sample Mendelian Randomization Analysis

BACKGROUND

The causal connection between morning diurnal preference and psychiatric disorders remains enigmatic. Using bidirectional two-sample Mendelian randomization (MR), we aim to explore the potential causal associations between morning diurnal preference and seven prominent psychiatric disorders.

METHODS

MR is a genetic epidemiological method that leverages genetic variants as instrumental variables to infer causal associations between exposures and outcomes. We obtained morning diurnal preference data from genome-wide association study (GWAS) datasets and identified 252,287 individuals as morning people. Psychiatric disorder data were sourced from the FinnGen consortium R9 dataset. Our primary analysis used the inverse-variance weighted (IVW) approach to evaluate the overall causal effect by combining the estimates from each genetic variant. Addition analyses, including weighted median, MR-Egger regression, weighted mode, and simple mode techniques were conducted to ensure robustness.

RESULTS

Being a morning person is related to reduced odds of multiple psychiatric disorders, including depression or dysthymia (OR: 0.93, 95% CI: 0.88, 0.999), anxiety disorders (OR: 0.90, 95% CI: 0.84, 0.96), self-harming behaviors (OR: 0.87, 95% CI: 0.76, 0.99), substance-use disorders (OR: 0.81, 95% CI: 0.71, 0.93), alcohol dependence (OR: 0.82, 95% CI: 0.73, 0.92), alcohol use disorders (OR: 0.85, 95% CI: 0.76, 0.94), acute alcohol intoxication (OR: 0.86, 95% CI: 0.76, 0.96), schizophrenia (OR: 0.77, 95% CI: 0.65, 0.92), and schizophrenia or delusion (OR: 0.80, 95% CI: 0.70, 0.92). Alcohol dependence (OR: 0.97, 95% CI: 0.94, 0.999) and alcohol use disorders (OR: 0.96, 95% CI: 0.94, 0.99) were also related to a lower morning diurnal preference.

CONCLUSIONS

Our study provides evidence that being a morning person is a protective factor for various psychiatric disorders from a genetic perspective. The results provide insights for potential targeted interventions to improve mental wellbeing.

Three Perspectives on Older Adults' Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study

Background

During COVID-19 lockdowns, older adults' engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults' social environments-including their families and health professionals-in influencing their technology use, research into their unique perspectives is lacking.

Objective

This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ≥65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults' family members, and health professionals.

Methods

Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods.

Results

The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19-related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology's transformative power, focusing on the need for technology to get engaged in daily activities.

Conclusions

This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology's uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults' needs and preferences by focusing on motivational and preference-related activities.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication

BACKGROUND

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China.

OBJECTIVE

We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care.

METHODS

We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero).

RESULTS

Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care.

CONCLUSIONS

This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

Exploring the association between social isolation and utilization of primary health services by older adults: evidence from China

Objective

This study aims to investigate the impact of social isolation on the utilization of primary health services among older adults in China.

Methods

Data from the China Longitudinal Aging Social Survey (CLASS) conducted in 2018 were utilized. A binary logistic regression model was established, and propensity score matching (PSM) was employed for analysis.

Results

The results of the binary logistic regression showed that family isolation within social isolation had a significant negative impact on the utilization of primary health services for older adults. In contrast, there was no significant association between friend isolation, community isolation, and the utilization of primary health services. Furthermore, the PSM results, using three matching methods (nearest neighbor matching, radius matching, and kernel matching), confirmed that family isolation significantly reduced older adults' utilization of primary health services, consistent with the baseline regression findings.

Conclusion

Reducing the occurrence of family isolation among older adults may be a cost-effective intervention measure. Efforts should be directed toward improving family support for older adults, promoting the utilization of primary health services, and strengthening disease prevention.

Social isolation, loneliness, and mental health among older adults during COVID-19: a scoping review

COVID-19 continues to have detrimental effects worldwide, especially on vulnerable populations. The burden of mental health concerns and psychological well-being resulting from social isolation and loneliness induced by COVID-19 are increasingly recognized in old age. The aim is to determine the extent of social isolation and loneliness among older adults, the methodologies used, the effect on mental health during COVID-19, and review intervention strategies and lifestyle changes to improve the current situation through the recommendations of the studies included. The articles published on PubMed, ProQuest, and Scopus databases from December 2019 to December 2021 with the following keywords ("Older Adults" "Social Isolation," "Loneliness," "Mental Health," "COVID-19") in English were included. Older adults have faced a serious burden of social isolation and adverse mental health effects during COVID-19. Anxiety, depression, stress, and insomnia are the major mental health concerns among older adults worldwide. It is suggested that spousal support and social networks, adaptive organizational change, and a responsive public sector are critical in reducing the obstacles to older adults. COVID-19 resilience among the aging population can be remarkable if adequately cared for with senior-friendly pandemic-related intervention strategies, policies and legislation.

The sense of loneliness and meaning in life in post-COVID convalescents-a preliminary study

Introduction

The COVID-19 epidemic has provided opportunity to study the impact of a well-defined severe illness on the development of a depressive episode and the associated sense of loneliness and lack of meaning in life.

Materials and Methods

The aim of the study was to assess the occurrence of a reactive depressive episode, the severity of depression, a sense of loneliness and meaning in life in subjects who approximately a year earlier than the date of the study had suffered from a pulmonary form of SARS-CoV-2 infection with radiologically documented interstitial lesions of the lungs, requiring and not requiring hospitalization compared to people who did not develop the disease as a result of infection with that virus. The study included 63 subjects hospitalized for pulmonary lesions, 67 not hospitalized and 60 healthy controls. The severity of depressive symptoms was measured using a Polish-language standardized version of the Beck Depression Inventory, a sense of loneliness using the De Jong Gierveld Loneliness Scale, and a sense of meaning in life using the Life Attitude Profile-Revised.

Results

The frequency of depression and its severity were found to be the highest in hospitalized patients compared to those treated at home and healthy people. A significant difference in the frequency of depression and its severity between outpatients and healthy people was also observed. The feeling of loneliness turned out to be greatest in the group of hospitalized people. Also, the severity of loneliness was found to be higher in the outpatient compared to the control group. The sense of meaning in life reached its lowest level among hospitalized patients, was moderately reduced in the outpatient group, and typical of the Polish population in the control group.

Discussion

Both pulmonary SARS-CoV-2 infection and hospitalization have been shown to be a risk factor for depression, increased feeling of loneliness and a reduced sense of meaning in life. The effect of trauma and the presence of depression can be the explanation for the increased sense of loneliness after the illness and the partial breakdown of the lifeline manifested by a decrease in the sense of meaning in life.

The Social Context: Social and Behavioral Factors That Affect Health Outcomes

To achieve understanding and best care, screening and treating patients should consider the patient's social environment. Social and behavioral factors influence both positive and negative health behaviors that influence mental and physical health. Primary care providers continually navigate barriers faced by patients and seek solutions that take into consideration social and behavioral factors. The role of the PCP begins with an understanding of common barriers and community resources, then by assessing and responding to the patient's own challenges, and finally by advocating in the clinic and public for changes to the underlying social and structural causes of morbidity and mortality.

Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study

OBJECTIVE

Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+).

METHODS

Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics.

RESULTS

Transcript analysis yielded three topics related to relapse prevention: (1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and (3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content.

DISCUSSION

Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments.

PUBLIC SIGNIFICANCE

Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.

Evaluation of Social Isolation Trajectories and Incident Cardiovascular Disease Among Middle-Aged and Older Adults in China: National Cohort Study

BACKGROUND

Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation.

OBJECTIVE

This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults.

METHODS

This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions.

RESULTS

Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores).

CONCLUSIONS

In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources

BACKGROUND

Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community.

OBJECTIVE

This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults.

METHODS

A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources.

RESULTS

The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services.

CONCLUSIONS

A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

Effectiveness of telehealth interventions on psychological outcomes and quality of life in community adults during the COVID-19 pandemic: A systematic review and meta-analysis

Physical distancing and contact restrictions have been implemented in most countries and territories due to the rapid spread of SARS-CoV-2. This has caused physical, emotional, and psychological distress for adults living in the community. Diversified telehealth interventions have been widely applied in health care and have proven to be cost-effective and well accepted by patients and health professionals. Currently, the effectiveness of telehealth interventions on psychological outcomes and quality of life among community adults during the COVID-19 pandemic remains unclear. A literature search was conducted using PubMed, PsycINFO, CINAHL, EMBASE, MEDLINE, and the Cochrane Library from 2019 to October 2022. Twenty-five randomized controlled trials with 3228 subjects were finally included in this review. Two independent reviewers performed the screening, extraction of key data points, and appraisal of the methodological quality. There were positive effects of telehealth interventions on anxiety, stress, loneliness, and well-being among community adults. Participants who were women or older adults were more likely to recover from negative emotions, increase well-being, and improve quality of life. The real-time and interactive interventions and remote cognitive-behavioural therapy (CBT) may be better choices during the COVID-19 pandemic. Based on the findings of this review, health professionals have more options and alternatives for delivering telehealth interventions in the future. Rigorously designed randomized controlled trials (RCTs) with higher statistical power and long-term follow-up should be conducted in the future to strengthen the currently weak evidence.

Pioneering the Metaverse: The Role of the Metaverse in an Aging Population

Amid a worldwide pandemic in the setting of an era of rapidly developing technologies, we turn now to the novel and exciting endeavor of pioneering the metaverse. Described as the conglomeration of augmented reality, virtual reality, and artificial intelligence, the metaverse has widespread applications in multiple settings, including revolutionizing health care. It also holds the potential to transform geriatric medicine, introducing new dimensions through which we can prevent social isolation, encourage health and well-being, and offer a new dimension through which we manage chronic disease. Although it is still a futuristic and novel technology, the metaverse's realization may indeed be closer than we think.

Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users' Perspective and Mixed Methods Study

BACKGROUND

Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits.

OBJECTIVE

This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety.

METHODS

A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis.

RESULTS

A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others.

CONCLUSIONS

Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness.

Introducing and Familiarising Older Adults Living with Dementia and Their Caregivers to Virtual Reality

Virtual Reality (VR) is increasingly being applied in dementia care across a range of applications and domains including health and wellbeing. Despite the commercial availability of VR, informants of design are not always aware of its functionality and capabilities, to meaningfully contribute to VR design. In designing VR applications for people living with dementia, it is recommended that older adults living with dementia and their support persons be involved in the design process using participatory approaches, thereby giving them a voice on the design of technology from the outset. A VR technology probe is a useful means of familiarising older adults living with dementia and their informal caregivers with the knowledge and understanding of interactive VR to employ technology that supports them to maintain their social health. This paper charts the implementation and evaluation of a VR technology probe, VR FOUNDations. To explore their experiences, nine older adults living with dementia and their nine informal caregivers trialled VR FOUNDations and completed semi-structured interviews after its use. Overall, older adults living with dementia and their informal caregivers perceived VR FOUNDations to achieve its aim of increasing understanding and inspiring future design decisions. The findings also identified promising positive experiences using a VR technology probe which may be indicative of its applicability to social health and wellbeing domains. This paper advocates for the structured design and implementation of VR technology probes as a prerequisite to the participatory design of VR applications for the health and wellbeing of people living with dementia. The use of such technology probes may afford older adults living with dementia and their informal caregivers the best opportunity to contribute to design decisions and participate in technology design to support their health and wellbeing.

Job Insecurity According to the Mental Health of Workers in 25 Peruvian Cities during the COVID-19 Pandemic

The pandemic brought various problems among workers, one of them being job insecurity, since many lost their jobs and others had the possibility of being fired, which could influence their mental health. The aim of this analytical cross-sectional study was to determine the relationship between job insecurity and mental health among workers in 25 Peruvian cities during the COVID-19 pandemic. Previously validated surveys were used to inquire about job insecurity and three mental health disorders (depression, anxiety, and stress) as well as other variables. Of the 1855 workers, 14% had moderate or higher levels of stress, 30% had anxiety, and 16% had depression. Having had job insecurity was associated with moderate or higher levels of depression (RPa: 1.71; 95% CI: 1.51–1.94; p-value < 0.001), anxiety (RPa: 1.43; 95% CI: 1.25–1.64; p-value < 0.001), and stress (RPa: 1.77; 95% CI: 1.41–2.22; p-value < 0.001). Depression was also associated with having been fired during the pandemic and associated with eight professions. Anxiety was associated with being a man and having been fired, while stress was associated with three professions. There is a clear association between having job insecurity and suffering from the three mental pathologies evaluated, which highlights the importance of assessing the mental impact.

Normalization of technology for social contact in a Norwegian care facility during COVID-19

BACKGROUND

The COVID-19 pandemic has seen unprecedented growth in the use of interactive technologies in care facilities for social contact between residents and their close contacts due to the need for social distancing. As the pandemic is transitioning into a new phase, there is a need to critically examine the new practices associated with technology usage.

OBJECTIVE

Our analysis is based on a case study of how a care facility in western Norway adopted a novel technology called KOMP. We empirically investigate the stability of practices with KOMP for maintaining social communication between residents and their relatives and consider whether these practices are likely to last beyond the pandemic. We draw on normalization process theory (NPT) to interpret our findings and critically examine how stable embedding of new technologies for social communication occurs under extraordinary circumstances.

METHODS

We conducted a case study based on participant observation and interviews, and the data were analyzed through inductive thematic analysis. Participants are health care professionals from a public care facility in western Norway.

RESULTS

Four major themes emerged from the data. The first revolved around the pressing need for communications between residents and relatives with a suitable tool. Second, staff showed engagement through motivation to learn and adapt the technology in their practices. A third theme centered on how staff and the organization could work effectively to embed KOMP in daily practice. Our fourth theme suggested that the professionals continuously assessed their own use of the technology.

CONCLUSION

From the perspective of NPT, practices with KOMP have been partially embedded by developing a shared understanding, engaging through cognitive participation, working collectively with staff and the organization, and reflexively monitoring the benefits of using KOMP. However, staff engagement with the technology was continuously threatened by factors related to diverging staff preferences, the burden of facilitating KOMP for residents with impaired cognitive and physical abilities, issues of privacy and ethics, and the technical skills of the residents' relatives. Our analysis suggests that caring practices via KOMP have become relatively stable despite barriers to engagement and are therefore likely to persist beyond the pandemic.

The Effects of a Digital Well-being Intervention on Older Adults: Retrospective Analysis of Real-world User Data

BACKGROUND

Digital interventions have been shown to be effective for a variety of mental health disorders and problems. However, few studies have examined the effects of digital interventions in older adults; therefore, little is known about how older adults engage with or benefit from these interventions. Given that adoption rates for technology among people aged ≥65 years remain substantially lower than in the general population and that approximately 20% of older adults are affected by mental health disorders, research exploring whether older adults will use and benefit from digital interventions is needed.

OBJECTIVE

This study aimed to examine the extent to which older adults engaged with a digital well-being intervention (Happify) and whether engaging with this program led to improvements in both subjective well-being and anxiety symptoms.

METHODS

In this retrospective analysis, we analyzed data from 375 real-world Happify users aged ≥65 years who signed up for the platform between January 1, 2019, and December 23, 2021. Changes in well-being and anxiety symptoms across 42 to 182 days were assessed using responses to the in-app assessment, which users were prompted to take every 2 weeks, and were compared among users who engaged with the program at the recommended level (ie, 2 or more activities per week) or below the recommended level.

RESULTS

In all, 30% (113/375) of the sample engaged with the platform at the recommended level (ie, completed an average of 2 or more activities per week), and overall, users completed an average of 43.35 (SD 87.80) activities, ranging from 1 to 786, between their first and last assessment. Users were also active on the platform for an average of 19.36 (SD 27.16) days, ranging from 1 to 152 days. Moreover, older adults who engaged at the recommended level experienced significantly greater improvements in subjective well-being (P=.002) and anxiety symptoms (P<.001) relative to those who completed fewer activities.

CONCLUSIONS

These data provide preliminary evidence that older adults engage with and benefit from digital well-being interventions. We believe that these findings highlight the importance of considering older adult populations in digital health research. More research is needed to understand potential barriers to using digital interventions among older adults and whether digital interventions should be modified to account for this population's particular needs (eg, ensuring that the intervention is accessible using a variety of devices). However, these results are an important step in demonstrating the feasibility of such interventions in a population that is assumed to be less inclined toward digital approaches.

Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials

One in five older adults experience symptoms of depression and anxiety. Digital mental health interventions are promising in their ability to provide researchers, mental health professionals, clinicians, and patients with personalised tools for assessing their behaviour and seeking consultation, treatment, and peer support. This systematic review looks at existing randomised controlled trial studies on digital mental health interventions for older adults. Four factors have been found that contributed to the success of digital mental health interventions: (1) ease of use; (2) opportunities for social interactions; (3) having human support; and (4) having the digital mental health interventions tailored to the participants' needs. The findings also resulted in methodological considerations for future randomised controlled trials on digital mental health interventions: (1) having a healthy control group and an intervention group with clinical diagnoses of mental illness; (2) collecting data on the support given throughout the duration of the interventions; (3) obtaining qualitative and quantitative data to measure the success of the interventions; and (4) conducting follow-up interviews and surveys up to 1 year post-intervention to determine the long-term outcomes. The factors that were identified in this systematic review can provide future digital mental health interventions researchers, health professionals, clinicians, and patients with the tools to design, develop, and use successful interventions for older users.

Social isolation transitions and psychological distress among older adults in rural China: A longitudinal study before and during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic could increase the number of older adults who are socially isolated including community-dwelling older adults, and result in the secondary damage of mental health. This study aimed to examine the longitudinal association between social isolation transitions and psychological distress among the community-dwelling older adults before and during the COVID-19 pandemic in rural China.

METHODS

A total of 2749 community-dwelling older adults aged 60 years and older in rural Shandong, China were included. We used the generalized estimating equations (GEE) model to estimate the impact of social isolation transitions on psychological distress before and during the COVID-19 pandemic.

RESULTS

The percentage of high and very high psychological distress (K10 ≥ 22) was 23.54% and 31.36% before and during the COVID-19 pandemic, respectively, indicating a 7.82% increase (P < 0.001). Compared with the group remaining nonisolated, "became socially isolated" and "remained isolated" groups were more likely to have a deterioration of psychological distress after experiencing the COVID-19 pandemic (became socially isolated: b = 0.92, P < 0.001; remained isolated: b = 0.98, P < 0.001).

LIMITATIONS

The main variables in this study were measured by self-report information, which might result in recall bias.

CONCLUSIONS

During the COVID-19 pandemic, psychological distress increased among the community-dwelling older adults in rural China. There was a significant risk of psychological distress among those who had transitioned from nonisolation before the pandemic to social isolation after experiencing the pandemic, thus intervention on social isolation process during the pandemic may be important to protect older adults' mental health.

The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis

Background

The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood.

Objective

We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets.

Methods

We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a “no-lockdown” and a “lockdown” stage. COVID-19–related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices.

Results

We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage.

Conclusions

The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions.

Improvised use of a digital tool for social interaction in a Norwegian care facility during the COVID-19 pandemic: an exploratory study

Background

Digital tools for social communication have been deployed in care facilities during the COVID-19 pandemic to facilitate social connectedness between older people and their next of kin in a safe manner. This study explores how and why health care professionals facilitate the ad hoc and prompt use of a technology for social communication, known as KOMP, in care facilities in western Norway to promote communication and social engagement among residents and their next of kin during the crisis.

Methods

To investigate the perspectives and practices of health care professionals, we conducted focus groups, individual interviews, and participant observation in public short- and long-term care facilities in western Norway. An explorative investigation with inductive content analysis was applied to analyse interview transcripts and fieldnotes from participant observation.

Results

The resulting qualitative data reveal that prompt implementation of interactive technology to cope with social distancing during the pandemic added new routines to the staff workload. Using this interactive technology entailed new forms of collaborative work among residents, next of kin, health care professionals and technology facilitators. Additionally, the staff articulated a sense of responsibility towards using KOMP as a meaningful and practical tool for social communication in an extraordinary period of reduced social contact.

Conclusions

Improvised implementation of KOMP as an interactive technology shapes work routines, introduces new tasks and creates additional responsibilities. Despite creative efforts by health care staff, however, using KOMP remains constrained by the physical and cognitive abilities of its users. We suggest that health care managers ask a deceptively simple question when introducing novel technologies in health care contexts, namely: what kind of invisible work do these devices entail?

Digital healthcare in COPD management: a narrative review on the advantages, pitfalls, and need for further research

Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality despite current treatment strategies which focus on smoking cessation, pulmonary rehabilitation, and symptomatic relief. A focus of COPD care is to encourage self-management, particularly during COVID-19, where much face-to-face care has been reduced or ceased. Digital health solutions may offer affordable and scalable solutions to support COPD patient education and self-management, such solutions could improve clinical outcomes and expand service reach for limited additional cost. However, optimal ways to deliver digital medicine are still in development, and there are a number of important considerations for clinicians, commissioners, and patients to ensure successful implementation of digitally augmented care. In this narrative review, we discuss advantages, pitfalls, and future prospects of digital healthcare, which offer a variety of tools including self-management plans, education videos, inhaler training videos, feedback to patients and healthcare professionals (HCPs), exacerbation monitoring, and pulmonary rehabilitation. We discuss the key issues with sustaining patient and HCP engagement and limiting attrition of use, interoperability with devices, integration into healthcare systems, and ensuring inclusivity and accessibility. We explore the essential areas of research beyond determining safety and efficacy to understand the acceptability of digital healthcare solutions to patients, clinicians, and healthcare systems, and hence ways to improve this and sustain engagement. Finally, we explore the regulatory challenges to ensure quality and engagement and effective integration into current healthcare systems and care pathways, while maintaining patients' autonomy and privacy. Understanding and addressing these issues and successful incorporation of an acceptable, simple, scalable, affordable, and future-proof digital solution into healthcare systems could help remodel global chronic disease management and fractured healthcare systems to provide best patient care and optimisation of healthcare resources to meet the global burden and unmet clinical need of COPD.

The Persistence of the Impact of COVID-19-Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study

BACKGROUND

The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures.

OBJECTIVE

We aim to investigate whether COVID-19-related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown.

METHODS

During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19-related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model.

RESULTS

We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood.

CONCLUSIONS

The mental health of a vulnerable population is still challenged by COVID-19-related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods.