Depression and Anxiety in Old Age during the COVID-19 Pandemic: A Comparative Study of Individuals at Cardiovascular Risk and the General Population.

Our study aims to examine the associations of sociodemographic factors, social support, resilience, and perceptions of the COVID-19 pandemic with late-life depression and anxiety symptoms in a cardiovascular risk group and a matched sample from the German general population during the beginning of the pandemic and draw a comparison regarding psychosocial characteristics. Data of n = 1236 participants (aged 64-81 years) were analyzed, with n = 618 participants showing a cardiovascular risk profile, and n = 618 participants from the general population. The cardiovascular risk sample had slightly higher levels of depressive symptoms and felt more threatened by the virus due to pre-existing conditions. In the cardiovascular risk group, social support was associated with less depressive and anxiety symptoms. In the general population, high social support was associated with less depressive symptoms. Experiencing high levels of worries due to COVID-19 was associated with more anxiety in the general population. Resilience was associated with less depressive and anxiety symptoms in both groups. Compared to the general population, the cardiovascular risk group showed slightly higher levels of depressive symptomatology even at the beginning of the pandemic and may be supported by addressing perceived social support and resilience in prevention programs targeting mental health.

Coping with stress during the COVID-19 pandemic in the oldest-old population.

The aim of the study is to investigate psychosocial factors that are associated with positive and negative coping with stress, as well as with worries about and perceived threat by COVID-19 to enable us to provide adequate support for oldest-old individuals. A paper-pencil-based survey assessed COVID-19 worries and perceived threat, depression, anxiety, somatization, social support, loneliness, resilience, positive and negative coping in a sample of n = 197 oldest-old individuals (78-100 years). Linear multivariate and binary logistic regression analyses were conducted. Individuals with high levels of resilience were more likely to feel self-efficient when coping with stress. High levels of depression, anxiety and loneliness were associated with feeling more helpless when coping with stress. However, oldest-old individuals who felt lonely also experienced situations where they felt competent in stress coping. Being male and experiencing high levels of social support was more likely associated with high levels of worries due to COVID-19. Increased age and higher levels of depression were associated with lower levels of perceived personal threat, whereas higher somatization scores were more likely associated with higher perceived personal threat. Findings suggest that mental health factors may shape the way oldest-old individuals cope with pandemic-related stress. Resilience might be an important factor to take into account when targeting an improvement in positive coping with stress. Oldest-old individuals who have higher levels of depression, anxiety and feel lonely may be supported by adapting their coping skill repertoire to reduce the feeling of helplessness when coping with stress.

Being a frail older person at a time of the COVID-19 pandemic

During the COVID-19 pandemic, older people living with frailty were identified as vulnerable to poor health outcomes. While writing this chapter in December 2020, we reviewed early evidence on what it meant to be a frail older individual in the COVID-19 pandemic from the perspective of three different settings: community, hospitals, and nursing homes. Lessons learned provide opportunities to improve health outcomes, community and health services, and how we want to live as aging societies.

Coping with stress during the COVID-19 pandemic in the oldest-old population

The aim of the study is to investigate psychosocial factors that are associated with positive and negative coping with stress, as well as with worries about and perceived threat by COVID-19 to enable us to provide adequate support for oldest-old individuals. A paper–pencil-based survey assessed COVID-19 worries and perceived threat, depression, anxiety, somatization, social support, loneliness, resilience, positive and negative coping in a sample of n = 197 oldest-old individuals (78–100 years). Linear multivariate and binary logistic regression analyses were conducted. Individuals with high levels of resilience were more likely to feel self-efficient when coping with stress. High levels of depression, anxiety and loneliness were associated with feeling more helpless when coping with stress. However, oldest-old individuals who felt lonely also experienced situations where they felt competent in stress coping. Being male and experiencing high levels of social support was more likely associated with high levels of worries due to COVID-19. Increased age and higher levels of depression were associated with lower levels of perceived personal threat, whereas higher somatization scores were more likely associated with higher perceived personal threat. Findings suggest that mental health factors may shape the way oldest-old individuals cope with pandemic-related stress. Resilience might be an important factor to take into account when targeting an improvement in positive coping with stress. Oldest-old individuals who have higher levels of depression, anxiety and feel lonely may be supported by adapting their coping skill repertoire to reduce the feeling of helplessness when coping with stress.

Multidomain interventions for risk reduction and prevention of cognitive decline and dementia: current developments.

PURPOSE OF REVIEW: The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. RECENT FINDINGS: Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions. SUMMARY: Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.

Being a frail older person at the time of the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, frail older individuals have been identified as a particularly vulnerable group for poor health outcomes, including cognitive decline and dementia. We aimed to reflect on the interaction between frailty and COVID-19 with regards to health consequences. METHOD: Using a rapid literature review approach, we aimed to identify what it means to be a frail older individual in the COVID-19 pandemic from the perspective of three different settings: community, hospitals, and nursing homes. Four researchers from 4 countries (Ireland, France, Germany, and Brazil) reviewed articles from the MEDLINE database and grey literature including public policy briefs from their countries. RESULTS: In the community, some governments advised to practice "cocooning", i.e. stay-at-home-orders for older individuals. This brought unprecedented restrictions to lifestyles, leading to a potential frailty cascade among older adults. Social frailty likely caused mental ill-health, cognitive and functional decline, increasing the risk for dementia. In hospitals, frailty affected from disease onset to survivorship. The clinical presentation was rather atypical, and the biological findings were more heterogenous. Some resource allocation strategies based on the Clinical Frailty Scale remained questionable and should take into account patients' and carers' needs. A quarter of patients had increased care needs at discharge. However, availability of rehabilitation and support services in the community has been reduced. Frail older adults living in nursing homes were the most vulnerable group. Isolating residents and limiting the spread of COVID-19 was a key difficulty. Reduced visits from relatives, cancelled physical activities, and lack of social engagement worsened cognitive, behavioral, and physical conditions of the residents. There were also positive aspects such as the boom of digital literacy and telemedicine and a renewed debate on age and ageing. CONCLUSIONS: The COVID-19 pandemic spotlights the ageing population that is rapidly growing worldwide. Prolonged lifestyle restrictions during the pandemic led to poor health outcomes in frail older individuals, including cognitive decline and dementia. Lessons learned from how frail older individuals are getting through the pandemic provide a unique chance to improve health outcomes, community and health services and how we want to live as ageing societies.

Prevalence of High Resilience in Old Age and Association with Perceived Threat of COVID-19-Results from a Representative Survey.

Little is known about resilience in old age and its manifestation during the COVID-19 pandemic. This study aims to estimate the prevalence of high resilience in the German old age population. We further examine the socio-demographic correlates and whether high resilience reflects on older adults' perception of the threat posed by COVID-19. The data were derived from a representative telephone survey of n = 1005 older adults (≥65 years) during the first COVID-19 lockdown. Assessments included socio-demographic variables, the perceived threat of COVID-19, and high resilience (Brief Resilience Scale; cutoff: ≥4.31). The association between high resilience and threat from COVID-19 was analyzed using ordinal logistic regression. The study sample had a mean age (SD) of 75.5 (7.1) years, and n = 566 (56.3%) were female. The estimated prevalence of high resilience was 18.7% (95% CI = [16.3; 21.2]). High resilience was more prevalent in the younger age group and participants with higher education levels. High resilience was significantly associated with a lower perception of threat from COVID-19. The results of the representative survey in the German old age population showed that one out of five adults aged 65 years and older had high resilience. Older adults with high resilience tended to feel less threatened by COVID-19. Further research on resilience in old age is needed to support vulnerable groups in the context of care.

Social Isolation and Loneliness during COVID-19 Lockdown: Associations with Depressive Symptoms in the German Old-Age Population.

Lockdowns during the COVID-19 pandemic increase the risk of social isolation and loneliness, which may affect mental wellbeing. Therefore, we aimed to investigate associations between social isolation and loneliness with depressive symptoms in the German old-age population during the first COVID-19 lockdown. A representative sample of randomly selected individuals at least 65 years old (n = 1005) participated in a computer-assisted standardized telephone interview in April 2020. Sociodemographic data, aspects of the personal life situation, attitudes towards COVID-19 and standardized screening measures on loneliness (UCLA 3-item loneliness scale), depression (Brief Symptom Inventory/BSI-18), and resilience (Brief Resilience Scale/BRS) were assessed. Associations were inspected using multivariate regression models. Being lonely, but not isolated (ß = 0.276; p < 0.001) and being both isolated and lonely (ß = 0.136; p < 0.001) were associated with higher depressive symptoms. Being isolated, but not lonely was not associated with depressive symptoms. Thus, the subjective emotional evaluation, i.e., feeling lonely, of the social situation during lockdown seems more relevant than the objective state, i.e., being isolated. Normal (ß = -0.203; p < 0.001) and high resilience (ß = -0.308; p < 0.001) were associated with lower depressive symptoms across groups. Therefore, strengthening coping skills may be a support strategy during lockdowns, especially for lonely older individuals.

Impact of the COVID-19 pandemic on statistical design and analysis plans for multidomain intervention clinical trials: Experience from World-Wide FINGERS.

INTRODUCTION: The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. METHODS: World-Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at-risk adults. Individual trials are tailoring successful approaches from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) to local cultures and environments. The network convened a forum for researchers to discuss statistical design and analysis issues they faced during the pandemic. We report on experiences of three trials that, at various stages of conduct, altered designs and analysis plans to navigate these issues. We provide recommendations for future trials to consider as they develop and launch behavioral intervention trials. RESULTS: The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessment protocols. The necessity of these changes add emphasis to the importance, in study design and analysis, of intention to treat approaches, flexibility, within-site stratification, interim power projections, and sensitivity analyses. DISCUSSION: Robust approaches to study design and analysis are critical to negotiate issues related to the intervention. The world-wide network of similarly oriented clinical trials will allow us to evaluate the effectiveness of responses to the pandemic across cultures, local environments, and phases of the pandemic.

Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study-A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline.

Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60-77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.

Mental wellbeing in the German old age population largely unaltered during COVID-19 lockdown: results of a representative survey.

BACKGROUND: Older individuals are at increased risk of a severe and lethal course of COVID-19. They have typically been advised to practice particularly restrictive social distancing ('cocooning'), which has sparked much debate on the consequences for their mental wellbeing. We aimed to provide evidence by conducting a representative survey among the German old population during COVID-19 lockdown. METHODS: A computer-assisted standardized telephone interview was conducted in a randomly selected and representative sample of the German old age population (n = 1005; age ≥ 65 years) during the first lockdown in April 2020. Assessments included sociodemographic factors, aspects of the personal life situation during lockdown, attitudes towards COVID-19, and standardized screening measures on depression, anxiety, somatization, overall psychological distress (Brief Symptom Inventory/BSI-18) and loneliness (UCLA 3-item loneliness scale). Sampling-weighted descriptive statistics and multiple multivariable regression analyses were conducted. RESULTS: Participants were M = 75.5 (SD = 7.1) years old; 56.3% were women. At data collection, COVID-19 lockdown had been in force for M = 28.0 (SD = 4.8) days. Overall, older individuals were worried about COVID-19, but supportive of the lockdown. Mean BSI-18 scores were 1.4 for depression, 1.6 for anxiety and 2.2 for somatization as well as 5.1 for global psychological distress. These figures did not indicate worse mental wellbeing, given normative values established by studies before the pandemic (2.0, 1.6, 2.4, 6.0, respectively). The prevalence of loneliness was 13.1%, which also fell within a range of estimates reported by studies before the pandemic. There were only few significant associations of aspects of the personal life situation during lockdown and attitudes towards COVID-19 with mental wellbeing. Resilience explained a large amount of variance. CONCLUSIONS: In the short-term, the mental wellbeing of the German old age population was largely unaltered during COVID-19 lockdown, suggesting resilience against the challenging pandemic situation. Our results refute common ageist stereotypes of "the weak and vulnerable older adults" that were present during the pandemic. Long-term observations are needed to provide robust evidence.

[Psychosocial Impact of Quarantine Measures During Serious Coronavirus Outbreaks: A Rapid Review]. / Psychosoziale Folgen von Quarantänemaßnahmen bei schwerwiegenden Coronavirus-Ausbrüchen: ein Rapid Review.

OBJECTIVE: Review of the evidence on the psychosocial impact of quarantine measures during serious coronavirus outbreaks before COVID-19. Such information is highly relevant in regard to the COVID-19 pandemic. METHODS: Search of the MEDLINE database for relevant studies related to SARS-CoV and MERS-CoV outbreaks. RESULTS: Across 13 identified studies, quarantine measures were consistently associated with negative psychosocial outcomes, including depressive symptoms, anxiety, anger, stress, posttraumatic stress, social isolation, loneliness and stigmatization. Determinants comprised duration of quarantine measures and income losses. Health care workers constituted a particularly vulnerable group. CONCLUSION: Quarantine measures during serious coronavirus outbreaks have extensive negative consequences for mental health. Prevention and intervention approaches to attenuate the psychosocial impact should be an integral component of crisis response during pandemic conditions.