PP07.004 End-of-life treatment preference discussions between older people and their physician before and during the COVID-19 pandemic

BackgroundCOVID-19 could lead to hospitalisation and ICU admission, especially in older adults. Therefore, during the pandemic, it became more important to discuss wishes and preferences, such as older peoples' desire for intensive treatment in a hospital in acute situations, or not. This study explores 1) what percentage of Dutch older people aged 75 and over discussed Advance Care Planning (ACP) topics with a physician during the first months of the COVID-19 pandemic and 2) whether this was different in these people before the COVID-19 pandemic.MethodsData of two ancillary data collections of the Longitudinal Aging Study Amsterdam (LASA) were used: the LASA 75 PLUS study and the LASA COVID-19 study. The cross-sectional part of this study consisted of N=428 people aged 75 years and older who completed the LASA COVID-19 questionnaire (first objective). The longitudinal sample consisted of 219 people aged 75 years and older who had data on both the LASA 75 PLUS Study and the LASA COVID-19 study (second objective).ResultsMost older adults had thought about ACP topics during COVID-19 (76,4%), and a minority had also discussed ACP topics with a physician (20.3%). Thinking about ACP topics increased during COVID-19 compared to before COVID-19 in a sample with measurements on both timeframes (82,5% vs 68,0%). People who discussed ACP with others were more likely to discuss ACP with a physician.ConclusionOlder people do think about ACP topics, which is an important first step in ACP, and this has increased during COVID-19. However, discussing ACP topics with a physician is still not that common. General practitioners could therefore take the initiative in broaching the subject of ACP. This can for instance be done by organizing information meetings.

Self-Reported Changes in Personal Development and Meaning in Life among Older Adults during the COVID-19 Pandemic: Results from the Longitudinal Aging Study Amsterdam

Objectives. The aim of this study was to explore self-reported changes in personal development and meaning in life of older adults in the Netherlands during the COVID-19 pandemic and characteristics of the groups that reported these changes. Methods. Older adults from the Longitudinal Aging Study Amsterdam completed a questionnaire on the impact of the COVID-19 pandemic. Participants were asked to rate changes in personal development and meaning in life. These variables were descriptively analysed and logistic regression analyses were used to explore characteristics of the groups that reported these changes. Results. Of the 1099 older adults (aged 62–102 years), 25.7% paid more attention to things one enjoys doing in spare time, 36.6% reflected more on important things in life, and 16.8% made less future plans during the COVID-19 pandemic. Self-reported changes in meaning in life and personal development differed between specific subgroups of older adults. The largest changes in aspects of personal development and meaning in life were reported by older adults who experienced personal adverse experiences such as death of a loved one (ORs 2.03) and/or health problems such as functional limitations (ORs ranging from 1.59 to 2.84) and depression (ORs ranging from 1.69 to 2.77). Discussion and Implications. A substantial share of the participants reported changes in specific aspects of personal development and meaning in life. This was especially true for certain subgroups of older adults. Relatives and caregivers should be aware of changes in personal development and meaning in life since lower scores are known to be associated with poor physical, psychological, and social well-being outcomes.

Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults.

OBJECTIVES: The aim of this study was to develop an index to measure older adults' exposure to the COVID-19 pandemic and to study its association with various domains of functioning. DESIGN: Cross-sectional study. SETTING: The Longitudinal Aging Study Amsterdam (LASA), a cohort study in the Netherlands. PARTICIPANTS: Community-dwelling older adults aged 62-102 years (n=1089) who participated in the LASA COVID-19 study (June-September 2020), just after the first wave of the pandemic. PRIMARY OUTCOME MEASURES: A 35-item COVID-19 exposure index with a score ranging between 0 and 1 was developed, including items that assess the extent to which the COVID-19 situation affected daily lives of older adults. Descriptive characteristics of the index were studied, stratified by several sociodemographic factors. Logistic regression analyses were performed to study associations between the exposure index and several indicators of functioning (functional limitations, anxiety, depression and loneliness). RESULTS: The mean COVID-19 exposure index score was 0.20 (SD 0.10). Scores were relatively high among women and in the southern region of the Netherlands. In models adjusted for sociodemographic factors and prepandemic functioning (2018-2019), those with scores in the highest tertile of the exposure index were more likely to report functional limitations (OR: 2.24; 95% CI: 1.48 to 3.38), anxiety symptoms (OR: 3.14; 95% CI: 1.82 to 5.44), depressive symptoms (OR: 2.49; 95% CI: 1.55 to 4.00) and loneliness (OR: 2.97; 95% CI: 2.08 to 4.26) than those in the lowest tertile. CONCLUSIONS: Among older adults in the Netherlands, higher exposure to the COVID-19 pandemic was associated with worse functioning in the physical, mental and social domain. The newly developed exposure index may be used to identify persons for whom targeted interventions are needed to maintain or improve functioning during the pandemic or postpandemic.

Symptoms of depression, anxiety, and perceived mastery in older adults before and during the COVID-19 pandemic: Results from the Longitudinal Aging Study Amsterdam.

OBJECTIVE: Governmental measures to protect older adults from COVID-19 are hypothesized to cause anxiety and depression. Previous studies are heterogeneous and showed small effects. This study aims to assess depressive and anxiety symptoms and perceived mastery just after the first wave of the COVID-19 pandemic compared to previous years in community-dwelling older adults and to identify potential risk groups according to the comprehensive geriatric assessment framework. METHODS: Data were used from 1068 Dutch older adults (aged 55-93 at baseline in 2011-2013) participating in the Longitudinal Aging Study Amsterdam, including 4 follow-ups spanning 9 years. Depressive symptoms, anxiety symptoms and feelings of mastery were assessed with the short Center for Epidemiologic Studies Depression scale (CES-D-10), the Hospital Anxiety Depression Scale - Anxiety subscale (HADS-A) and the Pearlin Mastery Scale. Linear mixed regression was used to compare outcomes in June-August 2020 to previous years and to examine predictors to identify risk groups. RESULTS: Slight increases in CES-D-10 (1.37, 95% Confidence interval [CI] 1.12;1.62), HADS-A (0.74, 95% CI 0.56;0.94) and mastery (1.10, 95% CI 0.88;1.31) occurred during the COVID year compared to previous years. Older adults with functional limitations or with frailty showed a smaller increase in feelings of mastery in the COVID-year. CONCLUSION: Our results suggest limited mental health effects on older adults from the first COVID-19 wave. Older adults have perhaps better coping strategies than younger adults, or preventive measures did not have extensive consequences for the daily life of older adults. Further monitoring of depression, anxiety and perceived mastery is recommended.

Older adults report cancellation or avoidance of medical care during the COVID-19 pandemic: results from the Longitudinal Aging Study Amsterdam.

PURPOSE: Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. METHODS: Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. RESULTS: 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09-3.50; hospital OR = 1.86, 95% CI = 1.28-2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04-4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06-1.24). CONCLUSION: About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.

Multiple domains of functioning in older adults during the pandemic: design and basic characteristics of the Longitudinal Aging Study Amsterdam COVID-19 questionnaire.

The Longitudinal Aging Study Amsterdam (LASA) is an ongoing cohort study among older adults in the Netherlands. Respondents are usually interviewed approximately every 3 years. Because of the exceptional situation of the COVID-19 pandemic, it was decided to add an extra assessment in between, consisting of a postal/digital questionnaire with measures assessing the impact of the COVID-19 situation, as well as a selection of measures from regular LASA measurement cycles covering the physical, social and mental domains. In total, 1128 LASA respondents aged 62-102 years provided data, just after the first wave of the pandemic in 2020. This paper describes the methods and design of the LASA COVID-19 questionnaire, as well as the basic characteristics of the sample, including an overview of impactful situations experienced by older adults during the first months of the pandemic. The data of the questionnaire may be used to study the impact of the COVID-19 pandemic on multiple domains of functioning in older adults.

Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life.

BACKGROUND/OBJECTIVES: Frailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality. DESIGN: Prospective cohort study. SETTING: The Longitudinal Aging Study Amsterdam. PARTICIPANTS: Community-dwelling older adults aged 65 and older (n = 1,427). MEASUREMENTS: Frailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995-2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking. RESULTS: Frailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40-1.48; P < .01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HRFL = 1.83; 95% confidence interval [CI] = 1.42-2.37; HRFS = 1.77; 95% CI = 1.36-2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings. CONCLUSION: Frail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well-being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.