Depression in older adults during the COVID-19 pandemic: A systematic review.

BACKGROUND: Depression affected 5.7% of people aged 60 years and over prior to the pandemic and has increased by approximately 28%. The aim of this study is to identify and describe factors associated with depressive symptoms, the diagnostic assessment instruments and interventions used to evaluate and treat depression in adults aged 60 years and older since the onset of the COVID-19 pandemic. METHODS: Four electronic databases were systematically searched to identify eligible studies published since the beginning of the COVID-19 pandemic. A total of 832 articles were screened, of which 53 met the inclusion criteria. RESULTS: Factors contributing to depressive symptoms in older adults prior to the pandemic were grouped into the following categories: sociodemographic characteristics (i.e., being female); loneliness and weak social support; limitations in daily functioning, physical activity and neurocognitive impairment; and clinical factors. The following groups of factors directly related to the pandemic were found: stress-related factors and feelings or worries related to the pandemic; information access (e.g., receiving news about COVID-19 through the media); factors directly related to COVID-19 (e.g., having infected acquaintances); and factors related to the measures that were taken to reduce the spread of COVID-19 (e.g., confinement measures). The most frequently used instrument to assess depressive symptoms was the Geriatric Depression Scale Short Form (GDS-SF). Four studies implemented interventions during the pandemic that led to significant reductions in depressive symptoms and feelings of loneliness. CONCLUSIONS: Improved understanding of pandemic-associated risk factors for depression can inform person-cantered care. It is important continued mental healthcare for depression for older adults throughout crises, such as the COVID-19 pandemic. Remote delivery of mental healthcare represents an important alternative during such times. It is crucial to address depression in older adults (which often causes disability), since the pandemic situation has increased depressive symptoms in this population.

Sleep Quality between Nurses and the General Population during the COVID-19 Pandemic in Portugal: What Are the Differences?

Although several studies have described the impact of the COVID-19 pandemic, particularly on sleep quality, there are few studies that, in the same time period and using the same assessment tools, compare sleep quality and mental health status between nurses and the general population. Thus, the aim of this study was to (a) examine whether there were differences between nurses and the general population regarding sleep quality and mental health status during the COVID-19 pandemic and (b) identify which factors may explain sleep quality during the COVID-19 pandemic. To do that, we carried out a cross-sectional study in Portugal. Data were collected using an online survey platform during the first COVID-19 wave, from April to August 2020. Nurses presented poorer sleep quality than the general population, as well as higher anxiety levels. Irritability and worries about the future were two of the factors that might explain those differences. Thus, we can conclude that irritability and worries about the future are dimensions of anxiety that were associated with poor sleep quality during the COVID-19 pandemic. Thus, it would be important to adopt regular anxiety and sleep assessments, particularly for nurses, and to implement strategies to reduce this problem.

"Geriatric Proximity" Intervention in COVID-19 Context: Contribution to Reducing Loneliness and Improving Affectivity.

(1) Background: The pandemic context has limited the social and family contacts of institutionalized older adults, and intervention is urgently needed. The aim of this study is to assess the impact of the implementation of a "Geriatric Proximity" intervention on the functioning, satisfaction with social support, affective experience, and feelings of loneliness of institutionalized older adults in the times of the pandemic. (2) Methods: This is a pilot study. An experimental group (subject to the "Geriatric Proximity" intervention) and a control group were constituted. Four assessment instruments were applied to both groups: the satisfaction with social support scale; the elderly nursing core set; the positive and negative affect schedule; and the UCLA loneliness scale. (3) Results: The control group shows no differences between the three measurement instants, while the experimental group shows between first and third measurements (all p < 0.05). We observed a reduction in the scores of loneliness scale, negative affect, and cognition functioning and an increase in satisfaction with social support and positive affect. (4) Conclusions: The intervention "Geriatric Proximity" showed a positive contribution by decreasing loneliness and increasing affectivity, satisfaction with social support, and cognitive function during the pandemic period.

Depression in older adults during the COVID-19 pandemic: a systematic review protocol.

INTRODUCTION: Depression is a common mental disorder and is a major cause of years lived with disability. The COVID-19 pandemic has caused an increase in the prevalence of depression worldwide. Our aim is to identify and synthesise the determinants of depression, the diagnostic assessment tools used to evaluate depression, and the interventions carried out since the beginning of the COVID-19 pandemic in the population aged 60 and older. METHODS AND ANALYSIS: A systematic review of the literature will be conducted. The following databases will be searched: CINAHL Plus with Full Text, MedicLatina, MEDLINE with Full Text, and Psychology and Behavioural Sciences Collection. The search strategy will include the following Medical Subject Headings or similar terms: "Depression", "Depressive Disorder", "Depressive Symptoms", "Older Adults", "Aging", "Elderly", Pandemic" and "COVID-19". Two independent reviewers will ascertain whether the resulting articles meet inclusion and exclusion criteria, and perform the analysis of data quality. Disagreements will be resolved by a third reviewer. All studies reported between December 2019 and March 2022 meeting the following criteria will be included: studies in adults aged 60 and over, and articles written in English, Portuguese, Spanish or German. Information on determinants of depression, assessment instruments used to assess depressive symptoms and/or interventions to decrease depression are reported. Studies will not be excluded based on geographical area study context (eg, community, culture or specific environment). All studies related to diagnostic assessment, care planning and/or intervention strategies specifically for older adults with depression will be included. ETHICS AND DISSEMINATION: As only secondary data will be analysed, no ethical approval is required for this study. This scientific article is a systematic review protocol for which data have not yet been extracted or analysed. The results will be disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42022299775.

Safety and Family-Centered Care during Restriction of Hospital Visits due to COVID-19: The Experience of Family Members.

BACKGROUND: Person and Family Centered Care (PFCC) has demonstrated important contributions to health care outcomes. However, in response to the need for safety due to the pandemic COVID-19, measures were taken to restrict hospital visits. So, the aim of this study was to understand the healthcare experience of family members of patients hospitalized during the pandemic period regarding safety and person- and family-centered care. METHODS: Qualitative interpretative study, conducted through semi-structured interviews with six family members of people hospitalized during the pandemic period. Content analysis was performed using Atlas.ti software version 22 (Berlin, Germany) and Bardin's methodology. RESULTS AND CONCLUSIONS: Restrictions on hospital visits due to the pandemic of COVID-19 have led to a distancing of families from the hospital setting and influenced healthcare practice, making it difficult to involve families in the care process. In some cases, healthcare professionals made efforts to provide PFCC, attempting to minimize the impact of the visitation restriction. However, there were reported experiences of care delivery that did not consider social and psychological factors and did not place the person and family at the center of the care process, relying instead on the biomedical model. These practices left out important factors for the provision of safe care. It is crucial, even in pandemic settings, that healthcare professionals provide person- and family-centered care to the extent possible, promoting the safety of care. The family should be involved in the care of the person in the inpatient setting.

Valoración Geriátrica Integral de pacientes mayores y factores asociados de frecuentación en servicios de urgencias en la Era pre-covid19 - Un estudio português Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era – a Portuguese study

Objetivos: Identificar factores asociados con usuarios frecuentadores (≥3 ingresos/año) en un departamento de urgencias (DU), mediante valoración geriátrica integral (VGI) y describir las características de los pacientes mayores de 65 años que acuden a urgencias. Métodos: El estudio transversal se realizó entre Agosto/2017 y Junio/2018 en un DU de Lisboa, Portugal. Se realizó una VGI además de la historia clínica. Se crearon scores clínicas, funcionales, mentales, sociales basándose en el protocolo de cuestionario del grupo de geriatría de la Sociedad Portuguesa de Medicina Interna y se desarrolló un modelo estadístico para identificar los factores asociados con la alta frecuentación. Resultados: Se realizó una VGI a 426 usuarios mayores de un DU. La edad media fue de 79.3 años, siendo 53,8% mujeres con un 84.7% de multimorbilidad, 51,2% de dependencia de las actividades básicas (KATZ), 75,6% instrumentales (Lawton < 5 en mujeres, <3 hombres y 40% de dependencia de la marcha (Holden). El 52% tenían síntomas depresivos (Yessavage), 65.7% tenían deterioro cognitivo (MMSE <24), 63% estaban desnutridos / en riesgo de desnutrición (MNA < 23,5) El 33,1% estaba en riesgo social (Gijón, APGAR familiar). La polifarmacia con el uso de un promedio de 6.5 medicamentos al día. Los scores sociales, clínicas, funcionales y mentales fueron adversos en el 48,6%, 79,6%, 54,9% y 83,1%, respectivamente. Hubo 2,7 admisiones/año y el 39,9% eran usuarios frecuentes de DU (≥3/year). Un modelo de regresión logística fue débil, pero mostró que los pacientes con polifarmacia, índice de comorbilidad de Charlson elevado y un estado nutricional adverso presentaban mayor riesgo de ser usuarios frecuentes. Conclusiones: El 97,1% de los pacientes tenían necesidades que justificarían un plan de intervención específico. Si bien no proporciona un modelo sólido, nuestro estudio ha indicado problemas nutricionales, polifarmacia y un índice de Charlson elevado como las características que se asocian con ser frecuentador del servicio de urgências.

Anxiety and Coping Stress Strategies in Researchers During COVID-19 Pandemic.

The current COVID-19 pandemic has affected the whole world, leading to changes in one's personal and working life. Researchers have undergone extensive changes in their roles, mainly in the area of health care, with research into the virus now the priority. Aim: To assess the anxiety, depression, stress, fears, and coping strategies of Portuguese researchers during the COVID-19 pandemic. Participants and Methods: A total of 243 researchers, with an average age of 37.9 ± 9.6, participated in an online questionnaire. The study was performed between 1 June 2021 and 11 August 2021. The questionnaire included depression, anxiety, and stress (DASS-21), fear of COVID-19 scale (FCV-19S), and coping inventory for stressful situations (CISS). Results: The findings suggest being female and younger seem to be related to more significant fears. Singles and younger researchers showed higher values of stress, depression, and anxiety. Research areas, such as medical and health sciences, presented higher levels in the DASS-21 depression and stress scale (p < 0.05). Also, the results showed a moderate or moderate strong significant positive linear relationship between the scales (p < 0.001): DASS-21 stress, DASS-21 anxiety, and DASS-21 depression (r > 0.70); CISS-21 emotional-oriented with DASS-21 stress (r = 0.683), DASS-21 depression (r = 0.622), and DASS-21 anxiety (r = 0.557); and emotional fear and cognitive fear (r = 0.652). Conclusion: The findings of this study support the growing concern for the psychological well-being of researchers and the need for intervention with more extensive and diverse studies.

The Implications of Family Members' Absence from Hospital Visits during the COVID-19 Pandemic: Nurses' Perceptions.

BACKGROUND: In response to the COVID-19 pandemic, several measures were taken to prevent the transmission of infection in the hospital environment, including the restriction of visits. Little is known about the consequences of these directives, but it is expected that they will have various implications. Thus, this study aimed to understand the consequences of measures to restrict visits to hospitalized individuals. METHODS: A qualitative interpretive study was conducted through semistructured interviews with 10 nurses chosen by convenience. Content analysis was performed using Atlas.ti software, version 22 (Berlin, Germany). RESULTS: Twenty-two categories and eight subcategories were identified and grouped according to their scope: implications for the patient, implications for the family, and implications for care practice. CONCLUSIONS: The identified categories of implications of restricting hospital visits (implications for patients, relatives, and care practices) are incomparably more negative than positive and have a strong potential to cause safety events in the short to long term, also jeopardizing the quality of care. There is the risk of stagnation and even setback due to this removal of families from the hospital environment, not only in terms of safety and quality of care but also with regard to person- and family-centered care.

Anxiety and Coping Stress Strategies in Researchers During COVID-19 Pandemic

The current COVID-19 pandemic has affected the whole world, leading to changes in one's personal and working life. Researchers have undergone extensive changes in their roles, mainly in the area of health care, with research into the virus now the priority. Aim To assess the anxiety, depression, stress, fears, and coping strategies of Portuguese researchers during the COVID-19 pandemic. Participants and Methods A total of 243 researchers, with an average age of 37.9 ± 9.6, participated in an online questionnaire. The study was performed between 1 June 2021 and 11 August 2021. The questionnaire included depression, anxiety, and stress (DASS-21), fear of COVID-19 scale (FCV-19S), and coping inventory for stressful situations (CISS). Results The findings suggest being female and younger seem to be related to more significant fears. Singles and younger researchers showed higher values of stress, depression, and anxiety. Research areas, such as medical and health sciences, presented higher levels in the DASS-21 depression and stress scale (p < 0.05). Also, the results showed a moderate or moderate strong significant positive linear relationship between the scales (p < 0.001): DASS-21 stress, DASS-21 anxiety, and DASS-21 depression (r > 0.70);CISS-21 emotional-oriented with DASS-21 stress (r = 0.683), DASS-21 depression (r = 0.622), and DASS-21 anxiety (r = 0.557);and emotional fear and cognitive fear (r = 0.652). Conclusion The findings of this study support the growing concern for the psychological well-being of researchers and the need for intervention with more extensive and diverse studies.

Patient-Centered Care for People with Depression and Anxiety: An Integrative Review Protocol.

Introduction: Depression and anxiety are mental diseases found worldwide, with the tendency to worsen in the current pandemic period. These illnesses contribute the most to the world's rate of years lived with disability. We aim to identify and synthesize indicators for the care process of the person with depression and/or anxiety disorders, based on patient-centered care, going through the stages of diagnostic assessment, care planning, and intervention. Methods and analysis: An integrative literature review will be conducted, and the research carried out on the following databases: MEDLINE, PsycINFO, Scopus, and Psychology and Behavioral Sciences Collection, CINAHL, Web of Science, TrialRegistry, and MedicLatina. The research strategy contains the following terms MesH or similar: "patient-centered care," "depression," and "anxiety." Two independent revisers will perform the inclusion and exclusion criteria analysis, the quality analysis of the data, and its extraction for synthesis. Disagreements will be resolved by a third revisor. All studies related to diagnostic assessment, care planning, or intervention strategies will be included as long as they focus on care focused on people with depression and anxiety, regardless of the context. Given the plurality of the eligible studies, we used the narrative synthesis method for the analysis of the diagnostic assessment, the care and intervention planning, and the facilitators and barriers. PROSPERO registration number: CRD42021235405.

Portuguese Nurses' Stress, Anxiety, and Depression Reduction Strategies during the COVID-19 Outbreak.

The COVID-19 pandemic has contributed to mental health problems worldwide. Nurses are particularly prone to stress because they directly care for individuals with suspected or confirmed cases of COVID-19. The aims of this study were (a) to explore the association between the mental health promotion strategies used by nurses during the COVID-19 outbreak and their symptoms of depression, anxiety, and stress; (b) to compare the symptoms of depression, anxiety, and stress of mental health nurses to those of non-mental health nurses; and (c) to compare the frequency of use of mental health strategies of mental health nurses to those of non-mental health nurses. A cross-sectional study was conducted with a sample of 821 nurses. Univariate and multivariate regression models were developed to identify potential protective factors of depression, anxiety, and stress. The chi-square test was also used to compare the use of strategies among mental health and non-mental health nurses. Portuguese nurses demonstrated high symptoms of depressive symptoms, stress, and anxiety. Healthy eating, physical activity, rest between shifts, maintaining social contacts, verbalizing feelings/emotions, and spending less time searching for information about COVID-19 were associated with better mental health. Mental health nurses had less depression, anxiety, and stress, and used more strategies to promote mental health than other nurses. We consider it important to promote nurses' mental health literacy by encouraging them to develop skills and strategies aimed at improving their resilience and ability to deal with difficult situations while caring for the population.

The use of mental health promotion strategies by nurses to reduce anxiety, stress, and depression during the COVID-19 outbreak: A prospective cohort study.

OBJECTIVES: To evaluate and compare nurses' depression, anxiety and stress symptoms at the beginning of the COVID-19 pandemic and after six months; to evaluate and compare the frequency of use of mental health promotion strategies during the same period; and to identify the relationship between the frequency of use of mental health promotion strategies, during the same period, with nurses' depression, anxiety and stress symptoms. METHODS: Data collection was carried out in two moments: at baseline and after six months. An online questionnaire was applied to nurses to assess the frequency of use of some mental health promotion strategies and their depression, anxiety, and stress symptoms (through the Depression Anxiety Stress Scales - short version (DASS-21)). RESULTS: The anxiety and stress symptoms significantly decreased over time. The physical activity increased, and a decrease was observed in the remote social contacts after six months. The stress, anxiety and depression scores were significantly lower in nurses who frequently or always used all strategies compared to participants who never or rarely used them, except for one strategy (rejecting information about COVID-19 from unreliable sources). CONCLUSIONS: Mental health promotion strategies, such as physical activity, relaxation activity, recreational activity, healthy diet, adequate water intake, breaks between work shifts, maintenance of remote social contacts, and verbalization of feelings/emotions, are crucial to reduce nurses' stress, anxiety and depression symptoms during the COVID-19 outbreak.