THE RELATIONSHIP BETWEEN RELIGIOUS INVOLVEMENT AND PSYCHOLOGICAL HEALTH DURING THE COVID-19 PANDEMIC: FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING

Background: Religious involvement has been shown to be protective against negative mental health outcomes and encourage positive coping behaviour among older adults. During the COVID-19 pandemic and lockdown in Ireland, public health restrictions created a barrier to in person religious participation. It is important to examine the effect this may have had on psychological health in older adults. Methods: Data were from The Irish Longitudinal Study on Ageing (TILDA). Data from Wave 4 (2016), Wave 5 (2018) and the COVID-19 SCQ (2020) were used for analysis. The final sample was made up of 3,044 community-dwelling adults living in Ireland aged 60 and older. Relationships between religious participation, psychological health and loneliness were modelled using cross-sectional and longitudinal regression analyses. Results: Religious attendance was positively associated with Purpose in Life [Beta(B)=0.01, 95% CI=-0.00, 0.02, p<0.05], Life Satisfaction [B=0.01, 95% CI= 0.00, 0.02, p<0.001] and Anxiety [Incident Rate Ratio= 1.04, 95% CI=1.01-1.08, p<0.01], during COVID-19. Self-Rated Mental Health significantly decreased between Wave 5 and COVID-19 relative to Religious Attendance reported at Wave 4 [OR= 0.87, 95% CI= 0.75, 0.99, p<0.05]. Loneliness also increased between Wave 5 and COVID-19 relative to Prayer Frequency reported at Wave 4 [OR=0.06, 95% CI= 0.02, 0.10, p<0.01]. Conclusion: These results suggest a complex relationship between psychological health and religious participation and the barriers to it during COVID in the older population. While it there was a protective effect carried into the lockdown, there was also a negative effect regarding some domains of religious participation. Future research should focus on measuring the relationship at later stages of the pandemic and the use of alternative forms of religious practice, such as streaming religious services.

DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC

Background: Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program. Methods: A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed. Results: The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination. Conclusion: “Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.

Caring in the time of COVID-19, longitudinal trends in well-being and mental health in carers in Ireland: Evidence from the Irish Longitudinal Study on Ageing (TILDA).

BACKGROUND: The COVID-19 pandemic in 2020 resulted in the older population being asked to remain at home and avoid other people outside their household. This could have implications for both receipt and provision of informal caring. OBJECTIVE: To determine if informal care provision by older carers changed during the first wave of the COVID-19 pandemic from pre-pandemic care and if this was associated with a change in mental health and well-being of carers. DESIGN AND SETTING: Longitudinal nationally representative study of community dwelling adults from The Irish Longitudinal Study on Ageing (TILDA) (Waves 3-COVID-Wave 6). METHODS: We studied a cohort of 3670 adults aged ≥60 in Ireland during the COVID-19 pandemic (July-November 2020) and compared with previous data collections from the same cohort between 2014-2018. Independent variables were caregiving status and caregiving intensity, outcome measures included depressive symptoms (CES-D8), Perceived Stress (PSS4) and Quality of life (CASP12). Mixed models adjusting for socio-demographics and physical health were estimated. RESULTS: Caregiving increased from 8.2% (2014) to 15.4% (2020). Depression, and stress scores increased while quality of life decreased for all participants. Carers reported poorer mental health, and higher caring hours were associated with increased depression and stress and decreased quality of life scores on average, and increased depression was higher for women. CONCLUSIONS: Informal caregiving increased during the pandemic and family caregivers reported increased adverse mental health and well-being and this continued throughout the early months of the pandemic. The disproportionate burden of depression was highest in women providing higher caring hours.

Some Ontological and Epistemological Consequences of the Development of Online Family Therapy and What This Could Mean for Practice

With a focus on 'screen and team' family therapy, we tentatively explore possible practice implications associated with family therapy moving from in-person to online delivery, with the intention of developing questions for further empirical research. By examining some of the affordances and constraints of the online medium in relation to the use of triadic questioning, we set forth a number of the epistemological and ontological consequences of this move. We argue that online therapy has particular features of a dialogical approach and method. We then examine the concept of joint action, the nature of the conversational processes, and the utterance chains that seem to be more likely to emerge when working online. We posit that a major advantage of the move to online delivery of family therapy is the medium's particular utility for generating more invitational, collaborative, and dialogical practices.

Hair cortisol as a risk marker for increased depressive symptoms among older adults during the COVID-19 pandemic.

Determining pre-existing biological risk markers of incident depression and other mental health sequelae after exposure to a new stressor would help identify vulnerable individuals and mechanistic pathways. This study investigated primarily whether hair cortisol predicted elevated depressive symptoms in middle-aged and older adults during the COVID-19 pandemic, 6 years later. A secondary aim was to deduce whether any association differed by sex. METHODS: We studied 1025 adults aged 50 and older (75% female) as part of The Irish Longitudinal Study on Ageing. Hair cortisol samples were collected at 2014 (Wave 3) and depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression Scale in 2014 (Wave 3), 2016 (Wave 4), 2018 (Wave 5) and again in 2020 as part of TILDA's COVID-19 Study. Hierarchical mixed effects logistic regression models were applied to investigate the association between cortisol levels and clinically significant depressive symptoms before and during the COVID-19 pandemic. RESULTS: In a full covariate adjusted model there was a significant interaction between cortisol and wave on depressive symptoms (χ2 = 8.5, p = .03). Cortisol was positively and significantly associated with elevated depressive symptoms during the COVID-19 Study (OR =1.3, 95% CI 1.11, 1.56, p = .003), and was associated with an increased likelihood of reporting clinically significant depressive symptoms during first year of the COVID-19 pandemic, when compared with before, OR = 1.4, 95% CI 1.05, 1.9, p = .015. There was no evidence of effect modification by sex. CONCLUSIONS: Higher hair cortisol, assessed 6 years previously, predicted clinically significant depressive symptoms among middle-aged and older adults during (but not before) the pandemic. Findings suggest a biological phenotype which denotes increased susceptibility to the negative impact of environmental stress on psychological health.

Caring in the time of COVID-19, longitudinal trends in well-being and mental health in carers in Ireland: evidence from The Irish Longitudinal Study on Ageing (TILDA)

Background : The COVID-19 pandemic in 2020 resulted in the older population being asked to remain at home and avoid other people outside their household. This could have implications for both receipt and provision of informal caring. Objective : To determine if informal care provision by older carers changed during the first wave of the COVID-19 pandemic from pre-pandemic care and if this was associated with a change in mental health and well-being of carers. Design and setting : Longitudinal nationally representative study of community dwelling adults from the Irish Longitudinal Study on Ageing (TILDA) (Waves 3-COVID-Wave 6). Methods : We studied a cohort of 3670 adults aged ≥60 in Ireland during the COVID-19 pandemic (July-November 2020) and compared with previous data collections from the same cohort between 2014-2018. Independent variables were caregiving status and caregiving intensity, outcome measures included depressive symptoms (CES-D8), Perceived Stress (PSS4) and Quality of life (CASP12). Mixed models adjusting for socio-demographics and physical health were estimated. Results : Caregiving increased from 8.2% (2014) to 15.4% (2020). Depression, and stress scores increased while quality of life decreased for all participants. Carers reported poorer mental health, and higher caring hours were associated with increased depression and stress and decreased quality of life scores on average, and increased depression was higher for women. Conclusions : Informal caregiving increased during the pandemic and family caregivers reported increased adverse mental health and well-being and this continued throughout the early months of the pandemic. The disproportionate burden of depression was highest in women providing higher caring hours.

Taking a Break from On-field Soccer Activity May be Beneficial to Collegiate Women Soccer Players

Introduction: A typical season for Canadian collegiate women soccer players consists of a pre-season training camp, in-season competitive games, and in-season practices. Over the course of a single season, players are exposed to a high number of subconcussive head impacts (1), which have been hypothesized to lead to cumulative brain trauma (2). Due to the COVID-19 pandemic, collegiate athletes in Canada did not have an inperson pre-season and off-season training was conducted virtually. Players experienced extended time off from the field and thus their training was less focused on soccer-specific training and more focused on fitness retention. The purpose of this study was to investigate the COVID-19 effect of playing time restrictions on brain function (using electroencephalography (EEG) and N-back-2), sleep, anxiety, and depression. Methods: Ten female collegiate soccer players were recruited. EEG, N-Back-2, Pittsburgh Sleep Quality Index (PSQI) and Sleep Condition Indicator (SCI), and the Hospital Anxiety and Depression Scale (HADS) were collected during both the 2019 and 2020 seasons (1-3). Average spectral power density was calculated across five frequency bands. Accuracy and reaction time were evaluated for the N-Back-2. PSQI, SCI and HADS scores were evaluated. Results: When comparing the end of the 2019 season and the beginning of the 2020 season, power analysis of the resting state EEG demonstrated a decrease in power spectral density across the delta, theta, and alpha frequency bands. There was a 9% increase in accuracy and a 3% decrease in reaction time using the N-Back-2. There was no change in sleep quality using the PSQI but a 6% change in sleep condition using the SCI. There was a 25% decrease in depression and a 19% decrease in anxiety. Discussion: This study is unique in our ability to access a significant time off in between two collegiate soccer seasons. Our pilot data suggests that there is an association between brain function, sleep and anxiety and depression after a stoppage in playing time. Varsity athletes are used to playing consistently over the course of their collegiate season, even playing through the summer. Additionally, on-filed practices and games expose players to a high number of subconcussive impacts. This pilot study sheds light on the potential benefit of providing collegiate athletes time off from on-field activities in between their collegiate seasons to fully recover from the strains of the season (4). Additionally, a switch in focus from on-field work to fitness-based activities may help alleviate athlete burnout and may boost overall stressors experienced by high-performance athletes (5,6). This is a preliminary pilot study and data analysis is ongoing. Further analyses will be conducted to better understand these relationships.

Acute-phase bed-rest duration was associated with lower grip strength in a post-covid-19 cohort

Background: Though age-related muscle loss is traditionally associated with older cohorts, strong evidence suggests a life-spanning precipitation of decreasing muscle mass and strength beginning as early as the fourth decade of life, with established deleterious consequences for later-life morbidity and mortality. Periods of low activity and bed rest (LA/BR) can further compound this depletion of muscle strength. Our aim was to examine such associations in a post-COVID-19 cohort. Methods: Participants reporting ongoing symptomatology and fatigue post COVID-19 underwent assessments of grip strength via hand-held dynamometry (2 measures on each hand). Demographics of COVID-19 illness, including time since diagnosis, duration of LA/BR during acute illness, and levels of fatigue were captured via self-reported questionnaires. Independent predictors of mean grip strength were investigated using a linear regression model. Results: Forty-nine participants underwent assessments (69% female, mean age 44(12) years). At the time of assessment, days post COVID-19 diagnosis ranged from 39-522 (mean 262(140)). The mean self-reported period of LA/BR during the acute illness was 15(18) days. In general, participants reported significant levels of fatigue (median Chalder Fatigue Scale score 22(8)). Mean grip strength was 41.3(6.3) Kg for men and 22.8(6.7) Kg for women. When predictors of grip strength were investigated, an increased duration of LA/BR was found to be associated with lower grip strength, independently of age, gender, time since COVID-19 diagnosis, and self-reported fatigue (Beta=-0.158, 95% Confidence Interval-0.242 to -0.074, p=0.001). Conclusion: In this cohort, every day of LA/BR during acute COVID-19 illness was independently associated with subsequent lower grip strength of approximately 150 g. These results underscore the importance of early mobilization and discouraging bed rest in the acute phase of COVID-19. Patients who are isolating should be encouraged to maintain physical activity and muscle strength as part of a modified isolation-friendly rehabilitation programme.

Hair cortisol predicts susceptibility to increased depressive symptoms among older women during the COVID-19 pandemic: implications for the vulnerability-stress model of psychopathology

Background: Determining pre-existing biological risk markers of incident depression after exposure to a new stressor might help identify vulnerable individuals. We investigated whether hair cortisol predicted increased depressive symptoms during the COVID-19 pandemic, 6 years later. Methods: We studied 933 older adults as part of The Irish Longitudinal Study on Ageing. Depressive symptoms were assessed before (time 1) and during (time 2) the COVID-19 pandemic, and hair cortisol was measured 6 years previously. Hierarchical mixed effects poisson regression models were applied to investigate the association between cortisol and any change in symptoms. Results: In a fully covariate adjusted model higher cortisol was not associated with depressive symptoms at time 1 (p =.910) but was at time 2 (IRR= 1.05, p=.020), with a significant effect of the cortisol X time interaction (IRR= 1.06, p=.003). Stratified analyses revealed an effect in women only (IRR = 1.07, p=.001). Conclusions: Higher hair cortisol was associated with increased depressive symptoms among older adults during (but not before) the pandemic. Findings suggest a biological phenotype which denotes increased susceptibility to the negative impact of stress on mental health.

THE ‘WISH TO DIE’ AMONGST OLDER PEOPLE IN IRELAND IN THE CONTEXT OF THE DYING WITH DIGNITY BILL

Background ‘Wish to Die’ (WTD) involves thoughts of or wishes for one’s own death or that one would be better off dead. Assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life. Currently, in Ireland, it is illegal to provide such assistance to people with WTD or suicidal ideation. However, a new bill that would legalise assisted dying for those with terminal illnesses, the Dying with Dignity Bill 2020, is due to be considered by lawmakers in Ireland in the coming months. In order to inform discussion around this complex issue, we examine the prevalence and longitudinal course of WTD in a large population-representative sample of older people. Methods To define WTD, participants were asked: ‘In the last month, have you felt that you would rather be dead?’ Depressive symptoms were measured using the CES-D. Mortality data were compiled by linking administrative death records to individual-level survey data from the study. Results At Wave 1, 3.5% of participants (279/8,174) reported WTD. Both persistent loneliness (OR 5.73 (95% CI 3.41–9.64)) and depressive symptoms (OR 6.12 (95% CI 4.33–8.67)) were independently associated with WTD. Of participants who first reported WTD at Wave 1 or 2, 72% did not report WTD when reassessed after 2 years, and the prevalence of depressive symptoms (−44%) and loneliness (−19%) was more likely to decline in this group at follow-up. Fifteen per cent of participants expressing WTD at Wave 1 died during a 6-year follow-up. Conclusion WTD amongst community-dwelling older people is frequently transient and is strongly linked with the course of depressive symptoms and loneliness. An enhanced focus on improving access to mental health care and addressing social isolation in older people should therefore be a public health priority, particularly in the current context of the Covid-19 pandemic.

Vitamin d and inflammation: potential implications for severity of COVID-19

Background: Recent research has indicated that vitamin D may have immune supporting properties through modulation of both the adaptive and innate immune system through cytokines and regulation of cell signalling pathways. We hypothesize that vitamin D status may influence the severity of responses to Covid-19 and that the prevalence of vitamin D deficiency in Europe will be closely aligned to Covid-19 mortality.

Perspective: Vitamin D deficiency and COVID-19 severity - plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis.

BACKGROUND: SARS-CoV-2 coronavirus infection ranges from asymptomatic through to fatal COVID-19 characterized by a 'cytokine storm' and lung failure. Vitamin D deficiency has been postulated as a determinant of severity. OBJECTIVES: To review the evidence relevant to vitamin D and COVID-19. METHODS: Narrative review. RESULTS: Regression modelling shows that more northerly countries in the Northern Hemisphere are currently (May 2020) showing relatively high COVID-19 mortality, with an estimated 4.4% increase in mortality for each 1 degree latitude north of 28 degrees North (P = 0.031) after adjustment for age of population. This supports a role for ultraviolet B acting via vitamin D synthesis. Factors associated with worse COVID-19 prognosis include old age, ethnicity, male sex, obesity, diabetes and hypertension and these also associate with deficiency of vitamin D or its response. Vitamin D deficiency is also linked to severity of childhood respiratory illness. Experimentally, vitamin D increases the ratio of angiotensin-converting enzyme 2 (ACE2) to ACE, thus increasing angiotensin II hydrolysis and reducing subsequent inflammatory cytokine response to pathogens and lung injury. CONCLUSIONS: Substantial evidence supports a link between vitamin D deficiency and COVID-19 severity but it is all indirect. Community-based placebo-controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID-19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25(OH) vitamin D levels. Meanwhile, vitamin D supplementation should be strongly advised for people likely to be deficient.

Physical and mental health of older people while cocooning during the COVID-19 pandemic.

BACKGROUND: Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health. AIM: To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years. DESIGN: Survey of 150 patients (55% female, mean age 80 years and mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital. METHODS: The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data were presented descriptively. RESULTS: Almost 40% (59/150) reported that their mental health was 'worse' or 'much worse' while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely 'very often'. Half of participants (75/150) reported a decline in their quality of life. Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term 'cocooning'. CONCLUSIONS: Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness and continue physical activity and access timely medical care and rehabilitation services should be a priority.