Impact of COVID-19 in nutritional and functional status of survivors admitted in intensive care units during the first outbreak. Preliminary results of the NUTRICOVID study.

BACKGROUND & AIMS: COVID-19 patients present a high hospitalization rate with a high mortality risk for those requiring intensive care. When these patients have other comorbid conditions and older age, the risk for severe disease and poor outcomes after ICU admission are increased. The present work aims to describe the preliminary results of the ongoing NUTRICOVID study about the nutritional and functional status and the quality of life of adult COVID-19 survivors after ICU discharge, emphasizing the in-hospital and discharge situation of this population. METHODS: A multicenter, ambispective, observational cohort study was conducted in 16 public hospitals of the Community of Madrid with COVID-19 survivors who were admitted to the ICU during the first outbreak. Preliminary results of this study include data retrospectively collected. Malnutrition and sarcopenia were screened at discharge using MUST and SARC-F; the use of healthcare resources was measured as the length of hospital stay and requirement of respiratory support and tracheostomy during hospitalization; other study variables were the need for medical nutrition therapy (MNT); and patients' functional status (Barthel index) and health-related quality of life (EQ-5D-5L). RESULTS: A total of 176 patients were included in this preliminary analysis. Most patients were male and older than 60 years, who suffered an average (SD) weight loss of 16.6% (8.3%) during the hospital stay, with a median length of stay of 53 (27-89.5) days and a median ICU stay of 24.5 (11-43.5) days. At discharge, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, respectively, but only 38% were prescribed MNT. In addition, more than 70% of patients had significant impairment of their mobility and to conduct their usual activities at hospital discharge. CONCLUSIONS: This preliminary analysis evidences the high nutritional and functional impairment of COVID-19 survivors at hospital discharge and highlights the need for guidelines and systematic protocols, together with appropriate rehabilitation programs, to optimize the nutritional management of these patients after discharge.

COVID-19 pandemic lockdown responses from an emotional perspective: Family function as a differential pattern among older adults

Family can be an essential resource at times of loss or vital crisis. Loneliness and isolation in older adults might have serious negative consequences for their mental health. For this reason, this research aims to analyze the role of family function in the anxiety and depression experienced by older adults during the pandemic caused by COVID-19. Participants were 882 Spanish community-dwelling adults over 60 years of age. Sociodemographic characteristics, characteristics related to the coronavirus, self-perceived health, family function, avoidance, depression and anxiety were analyzed. Data suggest a buffering effect of family function on anxiety and depression during the pandemic. Furthermore, being unmarried or a female, greater fear of COVID-19, worse self-perceived health, greater avoidance, and worse family function were associated with higher levels of anxiety. Likewise, greater fear of COVID-19, poorer self-perceived health, greater avoidance, and poorer family function, were associated with greater depression. These results point out that family dysfunction is a predisposing factor for the development of the emotional problems of anxiety and depression in older people in potentially stressful and loss situations. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) La familia puede ser un recurso fundamental en momentos de perdidas y crisis vitales. La soledad y el aislamiento en personas mayores provocan consecuencias negativas para su salud mental. La presente investigacion analiza el rol de la funcion familiar en la ansiedad y depresion experimentadas por personas mayores durante la pandemia ocasionada por el COVID-19. Participaron 882 adultos mayores de 60 anos evaluandose caracteristicas sociodemograficas y del coronavirus, salud, funcion familiar, evitacion, depresion y ansiedad. Los datos sugieren un factor amortiguador de la funcion familiar sobre la ansiedad y depresion durante la pandemia. Ademas, no estar casado, ser mujer, mayor miedo al COVID-19, una peor salud autopercibida, mayor evitacion y una peor funcion familiar se asociaba con mayores niveles de ansiedad. Mientras que mayor miedo al COVID-19, una peor salud autopercibida, mayor evitacion y una peor funcion familiar se relacionaban con mayor depresion. Los resultados permiten senalar que la disfuncion familiar es un factor predisponente para el desarrollo de problemas emocionales de ansiedad y depresion en personas mayores en situaciones potencialmente estresantes y de perdida. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Longitudinal Impact of the COVID-19 Pandemic on Older Adults' Wellbeing

Background The COVID-19 pandemic is a major stressful life event. This pandemic is causing significant changes in older adults' daily life affecting their physical and mental health. Psychological wellbeing is a protective variable when facing adverse circumstances, like the COVID-19 pandemic. This study analyzes the impact of COVID-19 on older adults' psychological wellbeing (personal growth and purpose in life) over time. Materials and Methods One hundred ninety-two people over 60 years old participated in a longitudinal study. Data were collected in three time points: during the lockdown on March 2020, when the lockdown finished (4 months after baseline), and during the third wave (10 months after baseline). We used latent growth curve models to assess the linear longitudinal trajectories of psychological wellbeing. Results Older adults did not show worse psychological wellbeing over time. Age has a positive impact on purpose in life. Furthermore, being a male, worrying about adverse effects of COVID-19, family functioning, resilience, personal growth, and acceptance associated with purpose in life. Discussion These results suggest that despite the difficult circumstances experienced during the COVID-19 pandemic, older adults have used protective variables for their psychological wellbeing.

The Revised Memory and Behavior Problems Checklist for Nursing Homes: Validation among Different Spanish Territories

Memory and behavioral difficulties among older people living in nursing homes can cause burden and other consequences in professional caregivers. There is a lack of instruments that evaluate these behaviors and their influence in formal caregivers. The aim of this study is to develop and psychometrically test—the Revised Memory and Behavior Problems Checklist for Nursing Homes (RMBPC-NH). A cross-sectional study was carried out. The sample was made up of 312 formal caregivers working in nursing homes from different territories in Spain, 87.5% were women and 12.5% were men. The average age of participants was 39 years (SD = 12.2). The sample was recruited from January 2019 to March 2020. Participants completed a self-administered questionnaire, which included sociodemographic information, and assessed quality of technical equipment, level of training, experience of working with older people, job satisfaction, professional quality of life, burnout, and conception of negative stereotypes held towards aging. The four-factor structure of the RMBPC-NH showed a good fit, namely in relation to memory, functional, and emotional factors, and other problems. It has shown adequate psychometric properties, internal consistency, and validity (correlations with professional quality of life, job satisfaction, burnout, and negative stereotypes). The RMBPC-NH is a useful instrument to evaluate the frequency of older people’s memory and behavior problems and professional caregivers’ burden. The practical application in nursing homes is discussed.

Emotional distress among older adults during the COVID-19 outbreak: understanding the longitudinal psychological impact of the COVID-19 pandemic.

BACKGROUND: Older adults have proven their ability to overcome adversities throughout their life. This study aims to assess the impact of the COVID-19 pandemic on older adults' psychological distress (anxiety and depression) over time. METHODS: A community-dwelling Spaniard population (N = 192) completed a survey and reported on their sociodemographic characteristics, appraisal and personal resources. Older adults took part in a longitudinal online survey collected in April 2020 (during the lockdown restrictions) and at two subsequent time points 3 and 9 months after baseline (without lockdown restrictions and during the third wave of the pandemic respectively). RESULTS: Older adults did not evidence higher emotional distress than during the initial lockdown. Furthermore, depression remained stable and anxiety significantly decreased. Results also suggest that some sociodemographic characteristics, appraisals and personal resources are relevant. Older participants showed less anxiety than younger ones. Furthermore, being a male, resilience, and acceptance were related with the decrease of anxiety. Otherwise, fear of the COVID-19 outbreak and depression were related with the increase of anxiety. CONCLUSION: Older adults may adapt to the adverse pandemic impact by using more adaptive resources that reduce their distress. Efforts to ameliorate older adults' anxiety by focusing on older adults' personal resources should be considered.

Older People's Personal Strengths During the First Wave of the COVID-19 Pandemic.

BACKGROUND: Although several biopsychosocial variables could play an important role as risk and protective factors of mental health, COVID-19 outbreak studies among older people have seldom focused on protective factors. The purpose of this study was to analyze how older adults' personal strengths predict their well-being and emotional distress. METHOD: 783 Spanish people aged 60 and over completed a survey that included sociodemographic characteristics, perceived health, direct or indirect infection by COVID-19, resilience, gratitude, experiential avoidance, family functioning, emotional distress and well-being. Structural Equation Modelling (SEM) was performed. SEM invariance was also used to analyze whether there were differences between older people affected by COVID-19 and those not affected. RESULTS: The best model supports the mediation effect of resilience, gratitude and experiential avoidance on older people's well-being and emotional distress. Whether participants or relatives had been infected by the virus or not did not affect the results. CONCLUSIONS: Variables used as criteria in older adults are related to well-being and emotional distress, but only indirectly and mediated by resilience, gratitude and experiential avoidance. This confirms the importance of considering psychological strengths in older people's well-being. Interventions focused on these personal resources should be considered.

Validation of the professional good care scale in nursing homes (GCS-NH).

BACKGROUND: There is extensive concern about older people's care in institutions, especially recently in the past years. One of the reasons is linked to the cases of elder abuse, not only shown by academic and scientific sources, but also by social and mass media and their impact on public perception of the institutional setting. What is more, current COVID-19 pandemic consequences on older people have provoked alarm and worry especially about what is happening in institutions. METHODS: The sample for this study consists of 286 staff working in nursing homes in Spain. This study aimed to assess the psychometric properties of the Professional Good Care Scale in Nursing Homes (GCS-NH). RESULTS: Results of parallel analyses and exploratory factor analyses (EFAs) showed a four-factor model for the 32-item scale: humanization (9 items), non-infantilization (10 items), respect (7 items) and empowerment (6 items). Then, psychometric properties were tested analysing internal consistency (reliability) and convergent, divergent and criterion validity. High internal consistency (reliability) and different validity evidence were obtained for the total scores of the GCS-NH and its subscales. GCS-NH scores were also capable of detecting risk of probable institutional elder abuse. CONCLUSIONS: Results show that this scale is an appropriate, valid, and reliable multidimensional instrument to evaluate good care in older institutionalized people by staff. Good care is an outcome of a complex construct in which a wide range of factors converge (staff, older people, and environmental characteristics). The GCS-NH has potential to be used as a multidimensional tool to assess good care.