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Multimorbidity Resilience and COVID-19 Pandemic Self-reported Impact and Worry among Older Adults: A Study Based on the Canadian Longitudinal Study on Aging (CLSA)

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2022-02-02
Abstract: 

Background

The Coronavirus Disease-2019 (COVID-19) pandemic has created a spectrum of adversities that have affected older adults disproportionately. This paper examines older adults with multimorbidity using longitudinal data to ascertain why some of these vulnerable individuals coped with pandemic-induced risk and stressors better than others – termed multimorbidity resilience. We investigate pre-pandemic levels of functional, social and psychological forms of resilience among this sub-population of at-risk individuals on two outcomes – self-reported comprehensive pandemic impact and personal worry.

Methods This study was conducted using Follow-up 1 data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit COVID-19 study, conducted between April and December in 2020. A final sub-group of 9211 older adults with two or more chronic health conditions were selected for analyses. Logistic regression and Generalized Linear Mixed Models were employed to test hypotheses between a multimorbidity resilience index and its three sub-indices measured using pre-pandemic Follow-up 1 data and the outcomes, including covariates.

Results

The multimorbidity resilience index was inversely associated with pandemic comprehensive impact at both COVID-19 Baseline wave (OR = 0.83, p < 0.001, 95% CI: [0.80,0.86]), and Exit wave (OR = 0.84, p < 0.001, 95% CI: [0.81,0.87]); and for personal worry at Exit (OR = 0.89, p < 0.001, 95% CI: [0.86,0.93]), in the final models with all covariates. The full index was also associated with comprehensive impact between the COVID waves (estimate = − 0.19, p < 0.001, 95% CI: [− 0.22, − 0.16]). Only the psychological resilience sub-index was inversely associated with comprehensive impact at both Baseline (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]) and Exit waves (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]), in the final model; and between these COVID waves (estimate = − 0.11, p < 0.001, 95% CI: [− 0.13, − 0.10]). The social resilience sub-index exhibited a weak positive association (OR = 1.04, p < 0.05, 95% CI: [1.01,1.07]) with personal worry, and the functional resilience measure was not associated with either outcome.

Conclusions

The findings show that psychological resilience is most pronounced in protecting against pandemic comprehensive impact and personal worry. In addition, several covariates were also associated with the outcomes. The findings are discussed in terms of developing or retrofitting innovative approaches to proactive coping among multimorbid older adults during both pre-pandemic and peri-pandemic periods.

Document type: 
Article

A Novel Intervention for Management of Behavioral and Psychological Symptoms of Dementia in Nursing Home Communal Areas: Results of a Small-Scale Pilot Trial

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-12-09
Abstract: 

Background: Behavioral and psychological symptoms of dementia (BPSD) exhibited by persons with dementia (PwD) in nursing home communal areas are generally managed by segregation and/or pharmacological interventions.

Objective: This study trialed MindfulGarden (MG), a novel digital calming device, in a Canadian nursing home.

Methods: Participants were 15 PwD (mean age = 87.67; 5m,10f; mean MMSE = 11.64±7.85). Each was observed by a research assistant (RA) for an average of 8–10 hours on two separate days. The RA followed them during time spent in communal areas of the nursing home including their unit’s dining space, lounges, and corridors and spaces shared with other units (e.g., gym and gift shop) and documented any BPSD exhibited. Day-1 provided baseline data; on Day-2, residents were exposed to MG if nursing staff considered their BPSD were sufficiently intense or sustained to warrant intervention. Staff rated the impact as positive, neutral, or negative.

Results: On Day-1, 9 participants exhibited both aggressive and non-aggressive behaviors, 4 non-aggressive behaviors only, and 2 no BPSD. On Day-2, 7 exhibiting aggressive behaviors were exposed to MG. Staff reported MG as having distracting/calming effects and gave positive impact ratings to 6/13 exposures; there were no negative ratings. The most common aggressive BPSD on days of observation were pushing/shoving and screaming.

Conclusion: MG may have value as a “psychiatric crash cart” in de-escalating agitation and aggression in care home settings.

Document type: 
Article

Ecological Momentary Assessment of Mood and Movement With Bipolar Disorder Over Time: Participant Recruitment and Efficacy of Study Methods

Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-10-15
Abstract: 

Objectives

Mobile technology and ambulatory research tools enable the study of human experience in vivo, when and where it occurs. This includes cognitive processes that cannot be directly measured or observed (e.g., emotion) but can be reported in the moment when prompted.

Methods

For the Bipolar Affective Disorder and older Adults (BADAS) Study, 50 participants were randomly prompted twice daily to complete brief smartphone questionnaires. This included the Bipolar Disorder Symptom Scale which was developed to briefly measure symptoms of both depression (cognitive and somatic) and hypo/mania (affrontive symptoms and elation/loss of insight). Participants could also submit voluntary or unsolicited app responses anytime; all were time- and GPS-stamped. Herein, we describe BADAS study methods that enabled effective recruitment, adherence and retention.

Results

We collected 9600 app responses over 2 year, for an average response rate of 1.4×/day. Over an average of 145 consecutive days (range 2–435 days), BADAS participants reported depression and hypo/mania symptom levels (a.m. and p.m.), sleep quality (a.m.), medication adherence (a.m.) and any significant events of the day (p.m.). They received id="mce_marker"/day for the first 90 days after submitting both a.m. and p.m. questionnaires.

Conclusion

BADAS study methods demonstrates the utility of ecological momentary assessment in longitudinal psychiatric research.

Document type: 
Audio

Demographic and Psychographic Factors of Social Isolation During the COVID-19 Pandemic: The Importance of Technology Confidence

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-10-28
Abstract: 

The COVID-19 pandemic presents an unprecedented situation in which physical distancing and “stay at home” orders have increased the pressures for social isolation. Critically, certain demographic factors have been linked to increased feelings of isolation and loneliness. These at-risk groups for social isolation may be disproportionately affected by the changes and restrictions that have been implemented to prevent viral spread. In our analysis, we sought to evaluate if perceived feelings of social isolation, during the COVID-19 pandemic, was related to demographic and technology-related psychographic characteristics. Older adults across Canada were surveyed about their demographic background, their feelings concerning confidence and proficiency in technology use, and how frequently they have felt isolated during the pandemic. In total 927 responses from Canadians over 65 years old, of varying demographic characteristics were collected. Our data shows that many older adults are feeling isolated “Often” or “Some of the time” in 2020, regardless of most demographic factors that have been previously associated with increased isolation risk. However, feelings of proficiency in using technology was an important factor affecting feelings of isolation. Given that technology proficiency is a modifiable factor, and remained significant after adjustment for demographic factors, future efforts to reduce social isolation should consider training programs for older adults to improve technology confidence, especially in an increasingly digital world.

Document type: 
Article

Prior Social Contact and Mental Health Trajectories during COVID-19: Neighborhood Friendship Protects Vulnerable Older Adults

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-09-23
Abstract: 

Social networking protects mental health during a crisis. Prior contact with social organizations, friends, and non-friend neighbors may be associated with better trajectories of loneliness, depression and subjective memory during COVID-19. Regression analysis was conducted using longitudinal data from a representative sample of n = 3105 US adults aged ≥55 in April–October 2020. Latent profile analysis was also conducted. Prior contact with friends (B = −0.075, p < 0.001), neighbors (B = −0.048, p = 0.007), and social organizations (B = −0.073, p < 0.001) predicted for better mental health during COVID-19. Three profiles were identified: Profile 1 had the best outcomes, with prior contact with social organizations (B = −0.052, p = 0.044) predicting decreasing loneliness. For Profile 2, prior ‘meeting’ contact with friends predicted decreasing loneliness (B = −0.075, p < 0.001) and better subjective memory (B = −0.130, p = 0.011). Conversely, prior contact with neighbors (B = −0.165, p = 0.010) predicted worsening loneliness among Profile 3. The COVID-19 pandemic has had a differential impact on the mental health trajectories of aging adults with social ties of different strengths. Stronger neighborhood networks are important to mitigate poor mental health outcomes among vulnerable older adults during a crisis. Older adults who are living alone and had relied on non-friend neighbors for social connectedness require additional community supports. Policy interventions are required to mitigate the mental health impact of future pandemics.

Document type: 
Article

Technological Interventions for Loneliness and Social Isolation Among Older Adults: A Scoping Review Protocol

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-08-07
Abstract: 

Background

Loneliness and social isolation are prevalent public health concerns among community-dwelling older adults. One approach that is becoming an increasingly popular method of reducing levels of loneliness and social isolation among older adults is through technology-driven solutions. This protocol outlines a research trajectory whereby a scoping review will be initiated in order to illustrate and map the existing technological approaches that have been utilized to diminish levels of loneliness and social isolation among community-dwelling older adults aged 60 years or older. We will address the question: what are the most common and less used technological approaches to reduce loneliness and social isolation among community-dwelling older adults?

Methods

A scoping review of Academic Search Premier, AGEline, Global Health, MEDLINE, PsycINFO, and Web of Science databases will take place using our search terms including the following: loneliness, social isolation, older adults, elderly, Aged, Aged 80 and over, program, evaluation, trial, intervention, technology, computer, information and communication technology, internet, and robot. The initial electronic search will be supplemented by reviewing the reference lists and review articles to identify any missing studies. To meet study inclusion criteria, intervention studies had to pertain to community-dwelling adults aged 60 years or older, include technological interventions, include loneliness and/or social isolation as outcome variables, and be written in the English language. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

Discussion

The information gleaned in this scoping review will be essential to understand the degree to which technological interventions influence social isolation and loneliness among older adults and identify gaps for further research.

Barriers in Health and Social Care Access and Navigation for Elder Orphans: A Scoping Review Protocol

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-05-31
Abstract: 

Introduction Family members have traditionally been relied on to provide informal care to older adults. However, social and demographic changes are resulting in rising numbers of kinless and isolated elderly who are unable to rely on familial caregiving and are without assistance in navigating complex systems of health and social services. Research examining this vulnerable subset of the elderly population, identified as elder orphans, is limited, particularly within the context of health and social care access. The aim of this scoping review is to map and report the evidence available in identifying barriers and facilitating factors in health and social care access and system navigation by elder orphans.

Methods and analysis Arksey and O’Malley’s six-staged methodology framework will guide the conduct of this scoping review. The primary author will conduct a systematic search and an initial screen of titles and abstracts from six electronic databases (CINAHL Complete, ASSIA, Pubmed, Scopus, Web of Science and PsycINFO) from January 2005 to the date of commencement, to identify English language peer reviewed studies of various methodologies. Subsequently, two reviewers will independently screen a shorter list of studies for inclusion. We will also search the reference lists of eligible studies. Data from the selected studies will be extracted and charted by two independent reviewers. Findings will be summarised in a tabulated format and accompanied by a narrative synthesis.

Document type: 
Article

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

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-05-01
Abstract: 

One of the most at-risk groups during the COVID-19 crisis is older adults, especially those who live in congregate living settings and seniors’ care facilities, are immune-compromised, and/or have other underlying illnesses. Measures undertaken to contain the spread of the virus are far-reaching, and older adults were among the first groups to experience restrictions on face-to-face contact. Although reducing viral transmission is critical, physical distancing is associated with negative psychosocial implications, such as increased rates of depression and anxiety. Promising evidence suggests that participatory digital co-design, defined as the combination of user-centered design and community engagement models, is associated with increased levels of engagement with mobile technologies among individuals with mental health conditions. The COVID-19 pandemic has highlighted shortcomings of existing technologies and challenges in their uptake and usage; however, strategies such as co-design may be leveraged to address these challenges both in the adaptation of existing technologies and the development of new technologies. By incorporating these strategies, it is hoped that we can offset some of the negative mental health implications for older adults in the context of physical distancing both during and beyond the current pandemic.

Document type: 
Article

A Systematic Review of the Latent Structure of the Center for Epidemiologic Studies Depression Scale (CES-D) Amongst Adolescents

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-04-19
Abstract: 

Background

The Centre for Epidemiologic Studies Depression Scale (CES-D) is a commonly used psychometric scale of depression. A four-factor structure (depressed affect, positive affect, somatic symptoms, and interpersonal difficulties) was initially identified in an American sample aged 18 to 65. Despite emerging evidence, a latent structure has not been established in adolescents. This review aimed to investigate the factor structure of the CES-D in adolescents.

Methods

We searched Web of Science, PsychINFO and Scopus and included peer-reviewed, original studies assessing the factor structure of the 20-item CES-D in adolescents aged ≤18. Two independent researchers screened results and extracted data.

Results

Thirteen studies met the inclusion criteria and were primarily from school-based samples in the USA or Asia. Studies that conducted confirmatory factor analysis (CFA; n = 9) reported a four-factor structure consistent with the original factor structure; these studies were primarily USA-based. Conversely, studies that conducted exploratory factor analysis (EFA) reported distinct two or three factor structures (n = 4) and were primarily based in Asia.

Limitations

Studies in a non-English language and those that included individuals aged > 18 years were excluded. Ethnic or cultural differences as well as different analytical methods impacted generalisability of results. The use of CFA as the primary analysis may have biased towards a four-factor structure.

Conclusions

A four-factor CES-D structure was an appropriate fit for adolescents in Western countries; further research is required to determine the fit in in Asian countries. This has important implications for clinical use of the scale. Future research should consider how cultural differences shape the experience of depression in adolescents.

Document type: 
Article

Help-Seeking Behaviours Among Older Adults: A Scoping Review Protocol

File(s): 
Peer reviewed: 
Yes, item is peer reviewed.
Date created: 
2021-02-02
Abstract: 

Introduction Despite evidence that illustrates the unmet healthcare needs of older adults, there is limited research examining their help-seeking behaviour, of which direct intervention can improve patient outcomes. Research in this area conducted with a focus on ethnic minority older adults is also needed, as their help-seeking behaviours may be influenced by various cultural factors. This scoping review aims to explore the global literature on the factors associated with help-seeking behaviours of older adults and how cultural values and backgrounds may impact ethnic minority older adults’ help-seeking behaviours in different ways.

 

Methods and analysis The scoping review process will be guided by the methodology framework of Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews guidelines. The following electronic databases will be systematically searched from January 2005 onwards: MEDLINE/PubMed, Web of Science, PsycINFO, CINAHL and Scopus. Studies of various designs and methodologies consisting of older adults aged 65 years or older, who are exhibiting help-seeking behaviours for the purpose of remedying a physical or mental health challenge, will be considered for inclusion. Two reviewers will screen full texts and chart data. The results of this scoping review will be summarised quantitatively through numerical counts and qualitatively through a narrative synthesis.

 

Ethics and dissemination As this is a scoping review of published literature, ethics approval is not required. Results will be disseminated through publication in a peer-reviewed journal.

 

Discussion This scoping review will synthesise the current literature related to the help-seeking behaviours of older adults and ethnic minority older adults. It will identify current gaps in research and potential ways to move forward in developing or implementing strategies that support the various health needs of the diverse older adult population.

Document type: 
Article