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.

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.

Establishing a Resource to Assess Musculoskeletal Health in Older Adults in the Post-COVID-19 Era: Time to SaLSA?

Sarcopenia and osteoporosis are associated with morbidity and mortality. The development and progression of these two interrelated conditions are related to genetic and lifestyle factors, including nutrition and physical activity. Restrictions placed on individuals due to the COVID-19 pandemic and infection have led to widespread lifestyle modifications, with data suggesting a negative impact on physical activity levels. There is an urgent need to understand the effect of the pandemic on musculoskeletal health in older adults, at a time when COVID-19 infection and restrictions remain a barrier to research studies. We tested the feasibility of recruiting local community-dwelling older people to establish a new cohort investigating musculoskeletal health—the Southampton Longitudinal Study of Ageing (SaLSA). We invited 1993 community-dwelling older adults registered at the Living Well GP partnership in Southampton, UK, to participate in a study. Questionnaires were completed by participants on health, lifestyle, medication use, comorbidities, physical activity, nutrition, sarcopenia, osteoporosis, and quality of life. Permission was sought for future contact. Descriptive statistics were used on the initial pilot of 175 returned questionnaire data. The median age of participants was 80.4 years in both sexes, 81.3 years (77.9–84) in females, and 81.1 years in males (77.3–83.6). The majority (N = 168/171, 98%) of participants were of white Caucasian background;36/53 (68%) female participants and 38/119 (32%) male participants lived alone. Over 80% (295/353) consented to be contacted for future studies. Recruitment of participants from a primary care practice into a research study was feasible. The next steps are to perform detailed musculoskeletal phenotyping through physical performance measures, grip strength dynamometry, DXA scanning, high-resolution peripheral quantitative computed tomography (HRpQCT), thigh ultrasound, and muscle biopsy, in a subset of participants. Our vision for SaLSA is to build a platform for discovery science and mechanistic studies, with the goal of improving the health care of older people.

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.