Older Adults' Attitudes Regarding COVID-19 and Associated Infection Control Measures in Shanghai, and Impact on Well-Being (preprint)

This cross-sectional study investigated health management, well-being, and pandemic-related perspectives in Shanghainese adults [≥]50 years during early and strict COVID-19 control measures. A self-report survey was administered via Wenjuanxing between March-April/2020. Items from the Somatic Symptom Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were administered, as well as pandemic-specific questions. 1181 primarily married, retired females participated; Many had hypertension (n=521, 44.1%), coronary artery disease (CAD; n=201, 17.8%) and diabetes (n=171, 14.5%). While most respondents (n=868; 73.5%) were strictly following control measures (including limiting visits with children; n=390, 33.0%) and perceived they could tolerate that beyond 6 months (n=555;47.0%), they were optimistic about the future if control measures were continued (n=969;82.0%), and perceived impact would be temporary (n=646;64.7%). 52 of those with any condition (8.2%) and 19 of those without a condition (3.5%) reported the pandemic was impacting their health. Somatic symptoms were high (29.4+/-7.1/36), with Sleep & Cognitive symptoms highest. 24.4% and 18.9% of respondents had elevated depressive and anxious symptoms, respectively; greater distress was associated with lower income (p=0.018), having hypertension (p=0.001) and CAD (p<0.001), more negative perceptions of global COVID-19 control (p=0.004), COVID-19 spread (p[≤]0.001), impact on life and health (p<0.001), compliance with control measures (p<0.001), and shorter time control measures could be tolerated (p<0.001) in adjusted analyses. In the initial COVID-19 outbreak, most older adults were optimistic and resilient with regard to the epidemic and control measures. However, the distress of older adults is not trivial, particularly in those with health issues.

Impacts of the COVID-19 Pandemic on Cardiac Rehabilitation Delivery around the World (preprint)

Background: To investigate impacts of COVID-19 on CR delivery around the globe, including effects on providers and patients. Methods: In this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April-June/2020. The 50 members of the ICCPR and personal contacts facilitated program identification. Results: Overall, 1062(18.3% program response rate) responses were received from 70/111(63.1% country response rate) countries in the world with existent CR programs. Of these, 367(49.1%) programs reported they had stopped CR delivery, and 203(27.1%) stopped temporarily (mean=8.3; SD=2.8weeks). Alternative models were delivered in 322(39.7%) programs, primarily through low-tech modes (n=226,19.3%). 353(30.2%) respondents were re-deployed, and 276 (37.3%) felt the need to work due to fear of losing their job, despite the perceived risk of contracting COVID-19 (mean=30.0%, SD=27.4/100). 266(22.5%) reported anxiety, 241(20.4%) were concerned about exposing their family, 113(9.7%) reported increased workload to transition to remote delivery, and 105(9.0%) were juggling caregiving responsibilities during business hours. Patients were often contacting staff regarding grocery shopping for heart-healthy foods (n=333,28.4%), how to use technology to interact with the program (n=329,27.9%), having to stop their exercise because they have no place to exercise (n=303,25.7%), and their risk of death from COVID-19 due to pre-existing cardiovascular disease (n=249,21.2%). Respondents perceived staff (n=488,41.3%) and patient (n=453,38.6%) personal protective equipment, as well as COVID-19 screening (n=414,35.2%) and testing (n=411,35.0%) as paramount to in-person service resumption. Conclusion: Approximately 4400 programs ceased service delivery. Those that remain open are implementing new technologies to ensure their patients receive CR safely, despite the challenges.