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J Appl Gerontol ; 41(12): 2574-2582, 2022 12.
Article in English | MEDLINE | ID: covidwho-2009275


This paper describes the evaluation of a longitudinal peer-support program developed to address loneliness and isolation among low-income, urban community-dwelling older adults in San Francisco. Our objective was to determine barriers, challenges, and successful strategies in implementation of the program. In-depth qualitative interviews with clients (n = 15) and peers (n = 6) were conducted and analyzed thematically by program component. We identified barriers and challenges to engagement and outlined strategies used to identify clients, match them with peers, and provide support to both peers and clients. We found that peers played a flexible, non-clinical role and were perceived as friends. Connections to community resources helped when clients needed additional support. We also documented creative strategies used to maintain inter-personal connections during the COVID-19 pandemic. This study fills a gap in understanding how a peer-support program can be designed to address loneliness and social isolation, particularly in low-income, urban settings.

COVID-19 , Loneliness , Humans , Aged , Implementation Science , Pandemics , Social Support , Social Isolation
J Am Geriatr Soc ; 2022 Aug 25.
Article in English | MEDLINE | ID: covidwho-2008747


BACKGROUND: Loneliness was common early in the COVID-19 pandemic due to physical distancing measures, but little is known about how loneliness persisted into later stages of the pandemic. We therefore examined longitudinal trajectories of loneliness over 18 months of the pandemic and subgroups at risk for persistent loneliness. METHODS: We used data from the COVID-19 & Chronic Conditions study collected between March 27, 2020 to December 10, 2021, including 641 predominantly older adults with ≥1 chronic condition who completed six interviews at approximately 3 month intervals. Participants reported loneliness (defined as some, most, or all of the time) during the past week due to COVID-19. We used trajectory mixture models to identify clusters of individuals following similar trajectories of loneliness, then determined subgroups likely to be classified in different loneliness trajectories using multivariable regression models adjusted for sociodemographic and clinical covariates. RESULTS: Participants were on average 63 years old, 61% female, 30% Black, 20% Latinx, and 29% were living below the poverty level. There was an overall reduction in loneliness over time (March to April/2020: 51% to September to December/2021: 31%, p = 0.01). Four distinct trajectory groups emerged: (1) "Persistent Loneliness" (n = 101, 16%); (2) "Adapted" (n = 141, 22%), individuals who were initially lonely, with feelings of loneliness decreasing over time; (3) "Occasional loneliness" (n = 189, 29%); and (4) "Never lonely" (n = 211, 33%). Subgroups at highest risk of the "Persistently Lonely" trajectory included those identifying as Latinx (aOR 2.5, 95% CI: 1.2, 5.2), or living in poverty (aOR 2.5; 95% CI: 1.4, 4.6). CONCLUSIONS: Although loneliness declined for a majority of older adults during the pandemic in our sample, persistent loneliness attributed to the COVID-19 pandemic was common (1 in 6 adults), particularly among individuals identifying as Hispanic/Latinx or living in poverty. Interventions addressing loneliness can ease pandemic-related suffering, and may mitigate long-term mental and physical health consequences.

JAMA ; 328(1): 19-20, 2022 07 05.
Article in English | MEDLINE | ID: covidwho-1976622

Cause of Death
Journal of Palliative Medicine ; 24(4):481-483, 2021.
Article in English | APA PsycInfo | ID: covidwho-1887832


An estimated 7.3 million elders in the United States are home-limited. Not only are elders generally underrepresented in clinical trials and other research, homebound and seriously ill individuals are historically difficult to engage in patient-centered outcomes research (PCOR) due to functional limitations and digital literacy challenges. We successfully used videoconferencing technology to engage homebound elders and caregivers longitudinally as PCOR stakeholder advisors. Our experiences with remote engagement are relevant for conducting research with isolated or difficult-to-reach populations during and beyond the coronavirus disease 2019 (COVID-19) pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Am J Health Promot ; 36(2): 380-382, 2022 02.
Article in English | MEDLINE | ID: covidwho-1625285
Innovation in Aging ; 5(Supplement_1):219-219, 2021.
Article in English | PMC | ID: covidwho-1584723


COVID-19 associated shelter-in-place orders led to concerns about worsening social isolation and inadequate access to technology among older adults, yet little is known about technology use in this population during the pandemic. We examined older adults’ experiences with technology during shelter-in-place in order to identify lessons learned for a post-pandemic world. We conducted semi-structured in-depth interviews with a purposive sample of 20 community-dwelling older adults in San Francisco. Two independent coders conducted concurrent data analysis using inductive and deductive approaches to identify salient themes. Participants were 78 years on average (range 64-99), 55% female, 25% Black, 75% lived alone, and 60% reported at least one ADL impairment. Technology emerged as core aspect of resilience, indicating whether older adults could navigate pandemic restrictions, with two primary themes identified. First, many participants reported discovery of new technologies to maintain or develop new connections, including Zoom-based community groups and telehealth services (“there’s all kinds of virtual programs where you can exercise”). Second, older adults were resourceful in identifying community resources and enlisting family members to learn (“I had to ask one of my granddaughters how to make the chat thing work”). Despite difficulty navigating passwords, software updates and other common obstacles, most participants expressed gratitude for technology and the connectivity made possible. Many indicated an intention to integrate new technology-based social interactions into everyday life even after restrictions ended. The COVID-19 pandemic has highlighted the role technology can play in fostering resilience among older adults in adapting to external stressors.

Int J Environ Res Public Health ; 18(19)2021 Sep 23.
Article in English | MEDLINE | ID: covidwho-1438592


The COVID-19 global pandemic and subsequent public health social measures have challenged our social and economic life, with increasing concerns around potentially rising levels of social isolation and loneliness. This paper is based on cross-sectional online survey data (available in 10 languages, from 2 June to 16 November 2020) with 20,398 respondents from 101 different countries. It aims to help increase our understanding of the global risk factors that are associated with social isolation and loneliness, irrespective of culture or country, to support evidence-based policy, services and public health interventions. We found the prevalence of severe loneliness was 21% during COVID-19 with 6% retrospectively reporting severe loneliness prior to the pandemic. A fifth were defined as isolated based on their usual connections, with 13% reporting a substantial increase in isolation during COVID-19. Personal finances and mental health were overarching and consistently cross-cutting predictors of loneliness and social isolation, both before and during the pandemic. With the likelihood of future waves of COVID-19 and related restrictions, it must be a public health priority to address the root causes of loneliness and social isolation and, in particular, address the needs of specific groups such as carers or those living alone.

COVID-19 , Loneliness , Cross-Sectional Studies , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Social Isolation
J Am Geriatr Soc ; 69(1): 20-29, 2021 01.
Article in English | MEDLINE | ID: covidwho-1066712


BACKGROUND/OBJECTIVES: Physical distancing during the COVID-19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to investigate (1) experiences of social isolation and loneliness during shelter-in-place orders, and (2) unmet health needs related to changes in social interactions. DESIGN: Mixed-methods longitudinal phone-based survey administered every 2 weeks. SETTING: Two community sites and an academic geriatrics outpatient clinical practice. PARTICIPANTS: A total of 151 community-dwelling older adults. MEASUREMENTS: We measured social isolation using a six-item modified Duke Social Support Index, social interaction subscale, that included assessments of video-based and Internet-based socializing. Measures of loneliness included self-reported worsened loneliness due to the COVID-19 pandemic and loneliness severity based on the three-item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open-ended comments about their social experiences. RESULTS: Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video-based socializing, and 42% minimal Internet-based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID-19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter-in-place orders (4-6 weeks: 46% vs 13-15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open-ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies. CONCLUSION: Many older adults are adjusting to COVID-19 restrictions since the start of shelter-in-place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology-based social interaction.

COVID-19/prevention & control , Independent Living/psychology , Loneliness/psychology , Quarantine/psychology , Social Isolation/psychology , Aged , Aged, 80 and over , Female , Geriatric Assessment , Humans , Longitudinal Studies , Male , Physical Distancing , Psychiatric Status Rating Scales , SARS-CoV-2 , San Francisco