Community-Level Social Support to Mitigate the Impact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults During the COVID-19 Pandemic: Multilevel Modeling Study.

BACKGROUND: Accumulating research provides evidence that the psychological health of older people deteriorated from before to during the COVID-19 pandemic. Unlike robust individuals, coexisting frailty and multimorbidity expose older adults to more complicated and wide-ranging stressors. Community-level social support (CSS) is also an important impetus for age-friendly interventions, and it is 1 of the components of social capital that is seen as an ecological-level property. To date, we have not found research that examines whether CSS buffered the adverse impacts of combined frailty and multimorbidity on psychological distress in a rural setting during COVID-19 in China. OBJECTIVE: This study explores the combined effect of frailty and multimorbidity on psychological distress in rural Chinese older adults during the COVID-19 pandemic and examines whether CSS would buffer the aforementioned association. METHODS: Data used in this study were extracted from 2 waves of the Shandong Rural Elderly Health Cohort (SREHC), and the final analytic sample included 2785 respondents who participated in both baseline and follow-up surveys. Multilevel linear mixed effects models were used to quantify the strength of the longitudinal association between frailty and multimorbidity combinations and psychological distress using 2 waves of data for each participant, and then, cross-level interactions between CSS and combined frailty and multimorbidity were included to test whether CSS would buffer the adverse impact of coexisting frailty and multimorbidity on psychological distress. RESULTS: Frail older adults with multimorbidity reported the most psychological distress compared to individuals with only 1 or none of the conditions (ß=.68, 95% CI 0.60-0.77, P<.001), and baseline coexisting frailty and multimorbidity predicted the most psychological distress during the COVID-19 pandemic (ß=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (ß=-.16, 95% CI -0.23 to -0.09, P<.001), and increased CSS buffered the adverse effect of coexisting frailty and multimorbidity on psychological distress during the COVID-19 pandemic (ß=-.11, 95% CI -0.22 to -0.01, P=.035). CONCLUSIONS: Our findings suggest that more public health and clinical attention should be paid to psychological distress among multimorbid older adults with frailty when facing public health emergencies. This research also suggests that community-level interventions prioritizing social support mechanisms, specifically improving the average levels of social support within communities, may be an effective approach to alleviate psychological distress for rural older adults who concurrently manifest frailty and multimorbidity.

Social isolation transitions and psychological distress among older adults in rural China: A longitudinal study before and during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic could increase the number of older adults who are socially isolated including community-dwelling older adults, and result in the secondary damage of mental health. This study aimed to examine the longitudinal association between social isolation transitions and psychological distress among the community-dwelling older adults before and during the COVID-19 pandemic in rural China. METHODS: A total of 2749 community-dwelling older adults aged 60 years and older in rural Shandong, China were included. We used the generalized estimating equations (GEE) model to estimate the impact of social isolation transitions on psychological distress before and during the COVID-19 pandemic. RESULTS: The percentage of high and very high psychological distress (K10 ≥ 22) was 23.54% and 31.36% before and during the COVID-19 pandemic, respectively, indicating a 7.82% increase (P < 0.001). Compared with the group remaining nonisolated, "became socially isolated" and "remained isolated" groups were more likely to have a deterioration of psychological distress after experiencing the COVID-19 pandemic (became socially isolated: b = 0.92, P < 0.001; remained isolated: b = 0.98, P < 0.001). LIMITATIONS: The main variables in this study were measured by self-report information, which might result in recall bias. CONCLUSIONS: During the COVID-19 pandemic, psychological distress increased among the community-dwelling older adults in rural China. There was a significant risk of psychological distress among those who had transitioned from nonisolation before the pandemic to social isolation after experiencing the pandemic, thus intervention on social isolation process during the pandemic may be important to protect older adults' mental health.

Family Doctor Contract Services and Awareness of Blood Pressure Measurement Among Hypertension Patients: A Cross-Sectional Study in Rural Shandong, China.

Background: Some studies found that family doctor contract services (FDCSs) had positive impact on the self-measurement behaviors of hypertension patients. However, evidence concerning the association between FDCSs and blood pressure measurement awareness among hypertension patients is not clear. Objective: This study aims to explore the relationship between FDCSs and blood pressure measurement awareness among the hypertension patients, and examine whether there is a difference in this relationship among middle-aged and aged adults in rural Shandong, China. Methods: A multi-stage stratified random sampling was adopted in 2018 in Shandong Province to conduct a questionnaire survey among the sample residents, in which 982 hypertension patients were included in the study. Pearson chi-square test and logistic regression model were employed using SPSS 24.0 to explore the association between FDCSs and blood pressure measurement awareness. Results: 76.8% of hypertension patients would measure blood pressure regularly. The blood pressure measurement awareness of the signing group was significantly higher than that of the non-signing group when controlling other variables (P < 0.001, OR = 2.075, 95% CI 1.391-3.095). The interaction of age and contracting status were significantly correlated with blood pressure measurement awareness (P = 0.042, OR = 1.747, 95% CI 1.020-2.992; P = 0.019, OR = 2.060, 95% CI 1.129-3.759). Factors including gender (P = 0.011, OR = 0.499, 95% CI 0.291-0.855), household income (P = 0.031, OR = 1.764, 95% CI 1.052-2.956), smoking status (P = 0.002, OR = 0.439, 95% CI 0.260-0.739), sports habits (P < 0.001, OR = 2.338, 95% CI 1.679-3.257), self-reported health (P = 0.031, OR = 1.608, 95% CI 1.043-2.477), distance to the village clinic (P = 0.006, OR = 1.952, 95% CI 1.208-3.153) and medications (P < 0.001, OR = 3.345, 95% CI 2.282-4.904) were also found to be associated with the blood pressure measurement awareness of hypertension patients. Conclusion: The government should take efforts to strengthen publicity and education of family doctors and pay more attention to uncontracted, middle-aged, female patients and patients with unhealthy life behaviors to improve the blood pressure measurement awareness.

The Association of Suicidal Ideation With Family Characteristics and Social Support of the First Batch of Students Returning to a College During the COVID-19 Epidemic Period: A Cross Sectional Study in China.

Objective: To investigate the prevalence of suicidal ideation among the first batch of students returning to a college during the COVID-19 epidemic, and to explore the correlation of suicidal ideation with family characteristics and social support. Methods: A cluster sampling survey with a self-designed questionnaire was conducted among the first batch of students returning to a college in Wuhu, China. The Positive and Negative Suicidal ideation (PANSI) and Social Support Scale (SSRS) were used to define students' suicidal ideation and social support, respectively. The influence of family characteristics and social support on the students' suicidal ideation was investigated using multivariate unconditional logistic regression analysis. Results: Two thousand seven hundred valid questionnaires were collected, including 673 males (24.9%) and 2,027 females (75.1%), in this study. A total of 146 students (5.4%) showed suicidal ideation. Male respondents reported higher rates (7.9%) than females (4.6%). Multivariate logistic regression analysis showed that a higher risk level of residence before returning to school and lower objective support were the risk factors for suicidal ideation in males. In contrast, a higher level of maternal education, a poorer relationship with the mother, and lower scores for subjective support and support availability had significant effects on females' suicidal ideation. Limitations: This is a cross-sectional study, and lacks comparison to the time point unaffected by COVID-19. Moreover, it was limited by COVID-19 epidemic prevention and control restrictions, and the differences in returning to school in different regions. Only one college was investigated in this study, and all of the respondents were sophomores, so there may be some limitations in the representativeness of the sample and extrapolation of the results. Conclusion: Family characteristics and social support have had an important influence on suicidal ideation among students returning to school during the COVID-19 epidemic. Some gender differences were identified. Targeted interventions are needed for early prevention and control.

Changes in psychological distress before and during the COVID-19 pandemic among older adults: the contribution of frailty transitions and multimorbidity.

AIM: To investigate changes in psychological distress in community-dwelling older adults before and during the coronavirus disease 2019 (COVID-19) pandemic and the contribution of frailty transitions and multimorbidity in predicting the psychological distress. METHODS: Prospective repeated-measures cohort study on a sample of participants aged 60 and over. A total of 2, 785 respondents at the baseline (May 2019) were followed during the COVID-19 (August 2020). The changes in psychological distress before and during the COVID-19 were assessed using generalised estimation equations with adjusting for sex, age, education, economic status, marital status, tea drinking status, smoking status, alcohol drinking status, sedentary time, sleep quality and activities of daily living. RESULTS: The psychological distress of older people has significantly increased in August 2020 compared with May 2019. Both older adults who remained frail and transitioned into frail state reported more psychological distress during the COVID-19. Similarly, both pre-existing multimorbidity and emerging multimorbidity groups were associated with more psychological distress. The group of frailty progression who reported new emerging multimorbidity showed more increase in psychological distress in comparison with those who remained in the non-frail state who reported no multimorbidity. CONCLUSION: Psychological distress has increased among the community-dwelling older adults during the COVID-19 pandemic, and sustained and progressive frail states as well as multimorbidity were all associated with a greater increase of psychological distress. These findings suggest that future public health measures should take into account the increased psychological distress among older people during the COVID-19 pandemic, and the assessment of frailty and multimorbidity might help in warning of psychological distress.