A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA).

Introduction: Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults. Methods: We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression. Results: Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009); higher BMI (p < 0.001); higher DETERMINE (a malnutrition assessment) score (p = 0.004); higher SARC-F score (p = 0.013); and self-reported exhaustion in the previous week on at least 3 days (p = 0.002). Conclusions: Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.

A study of diet in older community-dwelling adults in the UK during the COVID-19 pandemic: Findings from the Southampton Longitudinal Study of Ageing (SaLSA)

Introduction Adequate nutrition is important for health in later life. Older adults are especially vulnerable to adverse outcomes following infection by COVID-19 and have commonly spent a disproportionate time within their own homes to reduce risk of infection. There are concerns that advice to shield may have led to malnutrition as older adults may modify daily routines including usual shopping habits. The aims of this study were to report self-reported pandemic-related changes in diet and examine lifestyle and medical correlates of these changes in older UK community-dwelling adults. Methods We recruited 491 participants from the city of Southampton, UK. Participants completed a postal questionnaire in summer/autumn 2021, over a year after the first UK national lockdown was announced. The questionnaire ascertained demographic and lifestyle factors, in addition to number of comorbidities, nutrition risk scores, and presence of frailty. Associations between these participant characteristics in relation to self-reported changes in diet quality (lower, similar or higher when compared to before the first lockdown) were examined using ordinal logistic regression. Results Median (lower quartile, upper quartile) age was 79.8 (77.0, 83.7) years. Overall, 11 (4.9%) men and 25 (9.4%) women had poorer diet quality compared to before the first UK lockdown. The following participant characteristics were associated with increased risk of being in a worse category for change in diet quality after adjustment for sex: lower educational attainment (p = 0.009);higher BMI (p < 0.001);higher DETERMINE (a malnutrition assessment) score (p = 0.004);higher SARC-F score (p = 0.013);and self-reported exhaustion in the previous week on at least 3 days (p = 0.002). Conclusions Individuals at higher nutritional risk were identified as reporting increased risk of deterioration in diet quality during the pandemic. Further investigation of the factors leading to these changes, and an understanding of whether they are reversible will be important, especially for future pandemic management.

Impact of the COVID-19 pandemic on community-dwelling older adults: A longitudinal qualitative study of participants from the Hertfordshire Cohort Study.

BACKGROUND: Older adults have been especially vulnerable to adverse effects from the COVID-19 pandemic including higher mortality and more severe disease complications. At the same time, social isolation, malnutrition and physical inactivity are serious concerns among older adults. The pandemic and associated restrictions may serve to exacerbate these issues, presenting increased risks to physical and mental health. The aims of this qualitative study were: i) to explore how community-living older people in the UK experienced the first wave of the COVID-19 pandemic, specifically how it impacted their well-being and associated health behaviours; ii) to explore how older people's experiences and behaviours changed over time throughout the first wave. METHODS: Qualitative data were collected by conducting serial telephone interviews, with an interval of approximately three months. Participants were from the Hertfordshire Cohort Study, all aged over 80 years. Discussions were audio-recorded, information related to the COVID-19 pandemic was transcribed verbatim and transcripts analysed thematically. Interviews were conducted from March to October 2020. RESULTS: Data for twelve participants (7 men and 5 women) from a total of 35 interviews were used, comprising two or three timepoints per participant. Analysis identified five overarching themes: 1) shopping strategies and food accessibility, 2) limitations on activities and going out, 3) disruption to healthcare, 4) social and psychological repercussions, and 5) coping strategies. Findings highlight challenges associated with accessing shops, healthcare, and usual activities due to pandemic-related restrictions. Longitudinal findings showed that for some, the ongoing pandemic and related restrictions appeared to aggravate mental health issues (low mood, anxiety) over time, as well as greater feelings of isolation or loneliness, reduced activity and functional limitations; this was despite some relaxation of restrictions later on. Coping strategies used by participants included finding ways to keep busy and to do physical activity safely, maintaining social contact remotely, and having an optimistic or positive outlook, a 'do what you can' attitude. CONCLUSIONS: Interventions are likely to be needed in the wake of the COVID-19 pandemic to support health behaviours, such as increasing physical activity, social engagement and improving mental health among community-living older adults.

Predictors and Consequences of Not Seeking Healthcare during the COVID-19 Pandemic: Findings from the HEAF Cohort.

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56-71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Pre-pandemic socio-economic status and changes in employment during the first lockdown (2020) on the health of middle-aged people in England: a longitudinal study.

BACKGROUND: The COVID-19 pandemic markedly disrupted people's lives. It caused higher mortality and morbidity amongst individuals from poorer socio-economic position (SEP). It is well-recognised that job loss has a negative impact on health. We hypothesised that health effects of the pandemic on middle-aged people might be different depending on SEP and changes in employment. METHODS: Data are from the Health and Employment After Fifty (HEAF), a cohort recruited 2013-2014 when aged 50-64 through 24 English general practices. At baseline and annually since, participants completed a questionnaire reporting about demographics, employment, health, lifestyle, and finances. In 2021 we sent an e-survey to all contactable HEAF participants, asking about effects of the first lockdown (March-July 2020). Outcomes were participants' perception of worsening of mental, physical health, and self-rated health (SRH) since lockdown. Associations between SEP, COVID-19 related employment changes and health were explored with Poisson regression with robust standard error, with adjustment for age, sex, and pre-pandemic SRH. RESULTS: In total, 2,469 (53%) returned a usable questionnaire, amongst whom 2,344 provided complete information for these analyses (44% men, mean age 65.7 years). Worsening of mental, physical or SRH since lockdown was reported by 21%, 27% and 17% respectively. Mutually adjusted models showed that reporting struggling financially pre-pandemic (versus living comfortably) was associated with an increased risk of deterioration in: mental (RR = 2.0, 95%CI 1.7-2.5), physical health (RR = 2.0, 95%CI 1.6-2.3), and SRH (RR = 1.6, 95%CI 1.2-2.1). Participants working from home during lockdown and those who lost their job (as opposed to those with unchanged employment) were at increased risk of reporting deterioration in mental health and SRH. CONCLUSION: In a cohort of older workers, working from home, job loss and poorer pre-pandemic SEP were all associated with worsening of mental health and SRH since lockdown.

Physical Activity and Diet in a Global Pandemic: An Investigation of the Impact of COVID-19 on Factors Relevant for Musculoskeletal Health at Two Different Stages of the Lifecourse.

Background: Physical activity, nutrition and other lifestyle factors play important roles in maintaining musculoskeletal health. The coronavirus disease (COVID-19) originated in late 2019, spread globally to be declared a pandemic by the World Health Organisation in March 2020, and led to widespread behaviour change. The aim of this study was to use two existing cohorts, the Hertfordshire Cohort Study (HCS) and Health and Employment After Fifty Study (HEAF), to understand how wave one of the COVID-19 pandemic impacted lifestyle factors associated with musculoskeletal health in the UK. Methods: 125 eligible participants, 65 males and 60 females (drawn from the HCS study, median (IQR) age 84.3 (82.4-86.6) years, all Caucasian, and community dwelling) were contacted by telephone and asked to complete a questionnaire administered by a trained researcher. Data collection occurred over the period July 2020 to February 2021. 2469 participants, 1086 men and 1383 women (drawn from the HEAF study, median age 65.7 (62.0-69.3) years, mostly Caucasian and community dwelling) completed an online questionnaire in March 2021. Results: In HCS, 47% respondents reported being less physically active than before the pandemic (and only 5% more so), 27% said they consumed less alcohol compared to pre-pandemic times (and only 3% more so), and 18% reported eating less than before, although quality of diet was generally unchanged over this timeframe surveyed. In HEAF, 44% participants said they were less active than before the pandemic, while 17% reported being more active. The majority of participants reported no changes in alcohol consumption and diet; however, 19% said they drank more than before (32% of which was above recommended levels), 16% said their diet was less healthy, and 19% reported eating more than before. Conclusion: We have reported the experience of the first wave of the COVID-19 pandemic among participants of two Caucasian community dwelling UK cohorts, highlighting the impact of the pandemic on lifestyle factors associated with musculoskeletal health. Changed physical activity levels were reported in a high proportion of respondents in both studies; an investigation of reversibility of these changes is required.

The experiences of community-dwelling older adults during the COVID-19 pandemic: preliminary findings from a qualitative study with hertfordshire cohort study participants

BackgroundThe COVID-19 pandemic has led to dramatic changes in people’s lives globally. Older adults have been especially vulnerable to adverse effects from the pandemic including higher mortality and more severe disease complications. At the same time, social isolation, malnutrition and physical inactivity are serious concerns among older adults. The pandemic and associated restrictions may serve to exacerbate these issues, presenting increased risks to physical and mental health. The aim of this qualitative study was to explore how community-living older people in the UK experienced the first wave of the COVID-19 pandemic and how it impacted their health and well-being, and associated behaviours.MethodsQualitative data were collected by conducting serial telephone interviews, with an interval of approximately three months. Participants were from the Hertfordshire Cohort Study, all aged over 80 years. Discussions were audio-recorded, information related to the COVID-19 pandemic was transcribed verbatim and transcripts analysed thematically. Interviews were conducted from March to October 2020.ResultsTwelve participants were included in the study (7 men and 5 women). Data from a total of 35 qualitative interviews were used, comprising two or three timepoints per participant. Preliminary analysis identified five overarching themes: 1) shopping strategies and food accessibility, 2) limitations on activities and going out, 3) disruption to healthcare, 4) social and psychological repercussions, and 5) coping strategies. Initial findings highlight challenges associated with accessing shops, healthcare, and usual activities due to restrictions. Findings emphasize the issue of loneliness and isolation for some of the participants, especially those living alone, as well as fear of the virus, with restrictions leading to a loss of purpose for some, along with related effects on mental health (e.g. worry, anxiety). For some, these issues appeared to link to a reprioritisation of their behaviours (for example, exercise and diet were deprioritised). Coping strategies used by participants included finding ways to keep busy and to do physical activity safely, maintaining social contact online or by telephone, and having an optimistic or positive outlook, a ‘do what you can’ attitude.ConclusionAnalysis is ongoing and will further aim to explore how older people’s experiences and behaviours might have changed over the duration of the pandemic. The findings from this study could improve understanding of how community-living older adults could be supported to be more resilient in the face of a variety of changing circumstances that might impact their health and well-being.

A survey of the impact of wave one of the COVID-19 pandemic on participants of the hertfordshire cohort study

BackgroundCovid-19, a coronavirus that originated in China in late 2019, spread globally to be declared a pandemic by the World Health Organisation in March 2020. The aim of this study was to usean existing cohort of community-dwelling older adults, the Hertfordshire Cohort Study (HCS), to understand how wave one of the Covid-19 pandemic impacted UK older adults, a group particularly vulnerable to severe disease.Methods71 eligible participants, 39 males and 32 females (drawn from the HCS study, mean age 83.6 (2.5) years, all Caucasian, and community dwelling) were contacted by telephone and asked to complete a questionnaire administered by a trained researcher. Data collection occurred over the period of July to October 2020.ResultsOver a third (37.1%) of respondents lived alone. Of the remainder, 86.4% lived with a spouse while the remaining 13.6% lived with family. Of concern, 19.7% of participants had felt they needed to go out despite not wanting to;47.1% had heard of the NHS Volunteer Responders programme, although only 3 (4.2%) had made use of this or other support services. Almost a third (31%) of participants reported they had access to a smartphone, while 62% reported having unlimited internet access, usually using a tablet or computer. Over two thirds (69.0%) of participants rated their understanding of Covid-19 itself as good. Perhaps unsurprisingly, a large majority (88.7%) of participants said their life was different compared to before Covid-19;80.3% had less social contact and more than half (52%) of respondents reported being less physically active than before the pandemic (and only 4% more so). However, levels of sleep, alcohol consumption and diet were reportedly generally unchanged over the timeframe surveyed.ConclusionWe have reported the experience of the first wave of the Covid-19 pandemic among participants of an older Caucasian community-dwelling UK cohort, highlighting the need to consider this group when developing public health interventions to support health and wellbeing, including those employing smartphone technology. Further larger studies in groups of wider socioeconomic status and more diverse racial background are indicated.