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RESUMO Objetivo: Analisar os fatores associados ao aumento da violência doméstica entre professores no período inicial na pandemia. Métodos: Estudo transversal e analítico, do tipo websurvey , realizado com professores da educação básica pública de Minas Gerais, Brasil. A coleta de dados ocorreu de agosto a setembro de 2020, via formulário digital. A variável dependente foi o autorrelato da violência doméstica. Utilizou-se a Regressão de Poisson. Resultados: Participaram do estudo 539 professores em situação de violência doméstica na pandemia, dos quais 6,3% (n = 34) diminuíram um pouco e muito, 58,3% (n = 314) permaneceram o mesmo e 35,4% (n = 191) aumentaram um pouco e muito. Na análise ajustada, observou-se maior prevalência do aumento da violência doméstica entre os professores que referiram dificuldade com o trabalho docente (RP = 1,38; IC95% 1,01;1,89); com adesão total ao distanciamento social (RP = 1,33; IC95% 1,01;1,76); piora no estado de saúde (RP = 1,70; IC95% 1,23;2,36) e que se sentiram tristes ou deprimidos muitas vezes ou sempre (RP = 1,57; IC95% 1,15;2,16). Conclusão: O aumento da violência doméstica da pandemia em professores foi associado a características laborais e condições de saúde mental.
ABSTRACT Objective: To analyze the factors associated with the increase in domestic violence among teachers in the initial period of the pandemic. Methods: Cross-sectional and analytical study, of the websurvey type, carried out with teachers of public basic education in Minas Gerais, Brazil. Data collection took place from August to September 2020, via a digital form. The dependent variable was self-reported domestic violence. Poisson regression was used. Results: 539 teachers participated in the study in situations of domestic violence in the pandemic, of which 6.3% (n = 34) decreased a little and a lot, 58.3% (n = 314) remained the same and 35.4% (n = 191) increased a little and a lot. In the adjusted analysis, a higher prevalence of increased domestic violence was observed among teachers who reported difficulty with teaching work (PR = 1.38; 95%CI 1.01;1.89); with full adherence to social distancing (PR = 1.33; 95%CI 1.01;1.76); worsening of health status (PR = 1.70; 95%CI 1.23;2.36) and in teachers who felt sad or depressed many times or always (PR = 1.57; 95%CI 1.15;2.16). Conclusion: The increase in domestic violence of the pandemic in teachers was associated with work characteristics and mental health conditions.
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Background: The COVID-19 pandemic has had a substantial impact on the daily life of children and adolescents due to lockdowns, contact restrictions, closings of childcare, schools and leisure facilities. Objective: This article examines the impact of the pandemic on the mental health of children and adolescents in Germany. Material and methods: In the population-based longitudinal COPSY study (COVID-19 and Psychological Health) 1600 parents of children aged 7-17 years old and 1000 children and adolescents aged 11-17 years old completed established questionnaires at 5 online survey points (t1: May and June 2020 to t5: September and October 2022). For comparison, pre-pandemic data were obtained from the representative BELLA study. Results: During the pandemic the portion of children and adolescents, who reported a low health-related quality of life, increased from pre-pandemic 15% to 48% in the first year of the pandemic and improved in year 3 to 27%. This is still substantially above pre-pandemic levels. Similar trajectories were found for mental health problems which rose from 18% (pre-pandemic) to 31% and improved in year 3 to 23%. For anxiety and depression, the changes were similar except that depressive symptoms returned to pre-pandemic levels in year 3. The physical activity of almost one third of the youth was still very low in year 3. Conclusion: The mental health of children and adolescents was ignored during the pandemic for a long time. Now support and allocation of funding is urgently needed to mitigate the negative mental health effects and prevent further impairment by new crises.
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OBJECTIVES: We explore the experiences of people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (pwME/CFS) during the first UK COVID-19 lockdown period. We specifically probe perceived commonalities and departures in experience between government- and health-imposed lockdowns, application of coping strategies for social isolation, and predictions for inclusion of the chronically ill in post-pandemic society. METHODS AND MEASURES: Thirty semi-structured interviews were conducted in pwME/CFS between June - July, 2020. Responses were qualitatively analysed using an experiential, thematic framework. RESULTS: While participants reported enhancements in digital accessibility during lockdown, they perceived this as an unintentional benefit from changes designed to cater universally. Similarly, their expectation was that the general population's limited experience of restriction would not engender greater understanding for those who would continue to experience health-imposed lockdowns, post-pandemic. Participants described numerous strategies for coping with restriction and isolation, developed during prior health-imposed lockdowns and applied to this novel circumstance, highlighting the presence of acceptance and resilience in the sample. CONCLUSIONS: Our findings suggest that future work may fruitfully examine whether our participant's predictions for post-pandemic societal inclusion have been met, and how resilience and acceptance might be developed and nurtured in chronically ill populations through times of adversity.
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Though immigrants from Bangladesh are a fast-growing and under-resourced immigrant community in the United States, little has been studied about their overall health and social needs. Older immigrant adults from Bangladesh are at increased risk for adverse effects from the COVID-19 pandemic, as they have existing risk factors for isolation including language barriers and more recent immigration. This study examined measures of health and connectedness amongst 297 South Asian adults in New York City who were 60 years or older using a phone-based survey instrument. Surveys were conducted from August 2021 to April 2022. We found that immigrants from Bangladesh were more likely to report a higher effect of the COVID-19 pandemic on financial and food insecurity and faced significantly higher levels of loneliness than South Asian immigrants from other countries. Our findings suggest that older immigrants from Bangladesh disproportionally face social isolation compared to older immigrants from other South Asian countries and our study encourages further research and intervention for this immigrant subgroup.
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INTRODUCTION: Delaying the onset of disability is important for maintaining independence and quality of life in community-dwelling older adults. Given that social isolation is a significant risk factor for disability, effective means associated with social isolation are needed to alleviate disability. Although information and communication technology (ICT) may be a reasonable measure considering the recent social contexts due to the coronavirus disease 2019 pandemic, further insights are required. This study aimed to investigate whether ICT use can alleviate the onset of disability in community-dwelling older adults with and without social isolation. METHODS: This longitudinal cohort study on 4,346 community-dwelling independent Japanese older adults (mean age, 73.5 ± 5.3 years) was conducted between 2017 and 2018. Participants were classified into four groups based on social isolation (the condition where two or more of the following measures were met: domestic isolation, less social contact, and social disengagement) and ICT users (those who had recently used a computer or a smartphone) and followed up to assess disability incidence for 24 months after baseline assessments. Cox proportional-hazards regression models were used to identify the effect of social isolation and ICT use on the risk of disability onset by adjusting for age, sex, education history, number of medications, eye disease, level of annual income, Mini-Mental State Examination, Geriatric Depression Scale 15, and gait speed. RESULTS: The group comprised nonsocial isolation and ICT users (44.7%), social isolation and ICT users (5.4%), nonsocial isolation and ICT nonusers (41.7%), and social isolation and ICT nonusers (8.2%). At the follow-up, 2.2%, 2.4%, 5.5%, and 12.4% of the participants in the above order developed disability (p < 0.01). Cox regression models revealed a significantly higher risk of disability onset in the social isolation and ICT nonusers group than in the social isolation and ICT users group (HR = 2.939; 95% confidence interval (CI) 1.029-8.397; p = 0.044). In the subgroup analysis stratified by social isolation, ICT use significantly reduced the risk of disability onset in the socially isolated group (HR = 0.320; 95% CI 0.109-0.943; p = 0.039), although the same association was not observed in the nonsocially isolated group (HR = 0.845; 95% CI 0.565-1.264; p = 0.411). CONCLUSION: ICT use can alleviate the onset of disability in socially isolated older adults in a community setting. Considering ICT-applied methods for alleviating disability is beneficial for older adults in social isolation.
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COVID-19 , Quality of Life , Humans , Aged , Longitudinal Studies , COVID-19/epidemiology , Social Isolation , Cohort Studies , Independent Living , Communication , TechnologyABSTRACT
Only a few studies seem to address suicidality as an effect of the COVID-19 pandemic in persons previously affected by psychiatric disorders. The relationship between fear and stress caused by the COVID-19 pandemic and the level of social support and suicidality in patients diagnosed with affective and stress-induced psychiatric disorders prior to the onset of the COVID-19 pandemic were investigated. This study was observational and involved 100 participants. The examined period was from April 2020 to April 2022. The Fear of COVID-19 Scale (FCV-19S), the Oslo Social Support Scale 3 (OSSS-3) and general psychiatric interviews were used to obtain data. A statistically significant relationship between the impact of COVID-19-related distress on the occurrence of suicidality and the year of the pandemic χ2(2, N = 100) = 8.347, p = 0.015 was observed. No statistically significant correlation was found between suicidal behavior, stress intensity, fear and the score on the social support scale (p > 0.05). Fear related to the COVID-19 pandemic can only be seen as a contributor to suicidality. Overall, social support does not always act protectively. Previously stressful experiences such as wars, poverty and natural disasters seem to play a significant role in the resilience to each new public health crisis.
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The coronavirus (Covid-19) pandemic has influenced people's social relationships around the world in surprising ways. It has also underscored the importance of and accelerated innovation in solutions for social isolation and loneliness. This commentary offers takeaways from emerging research findings and a wide lens on the societal movement underway to create more socially connected communities.
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This qualitative narrative correspondence study investigates older adults' experiences of physical activity (PA) during the 2020 COVID-19 pandemic lockdowns in Aotearoa, New Zealand. This paper presents a reflexive thematic analysis of 501 letters received from 568 participants that discussed PA. Participants described PA as bringing joy and rhythm to daily life under stay-at-home measures. The most frequently discussed forms of PA included exercising, gardening, and housework. Four interconnected conceptual themes identified were as follows: (a) renegotiating environmental relationships, (b) social connection, (c) pleasure and PA, and (d) navigating active aging discourses. This paper emphasizes the important environmental and social motivations for becoming and remaining physically active despite restrictions on movement. Older adults' understandings and performance of PA were heavily shaped by active aging discourses. As such, we suggest that initiatives seeking to promote PA should foreground older adults' feelings of connection, productivity, and pleasure and recognize their diversity. This is contrary to current recommendations focused on duration or intensity of older adults' PA.
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BACKGROUND: Previous studies have suggested links between anxiety response to the novel coronavirus (COVID-19) and depression symptoms in general population. However, a symptom-level investigation has not been reported. OBJECTIVE: This study aimed to use network analysis to identify central symptoms and bridge symptoms that link COVID-19 anxiety and depression. METHODS: Data from 1788 participants were analyzed. Coronavirus anxiety and depression symptoms were measured using the Stress and Anxiety to Viral Epidemics-6 Items Scale and the Patient Health Questionnaire-9, respectively. Network analysis was performed using R. RESULTS: The results revealed 'thoughts of suicide or self-harm' from Patient Health Questionnaire-9 and 'worry about others avoiding me' from Stress and Anxiety to Viral Epidemics-6 Items Scale as bridge symptoms. Findings suggest direct relationship between fear of social isolation and thoughts of suicide or self-harm. 'Feeling tired with little energy' and 'trouble concentrating' are strongly linked to 'thoughts of suicide or self-harm', suggesting these symptoms as risk factors for suicidal or self-injurious thoughts during the pandemic. CONCLUSIONS: The findings suggest fear of social isolation as a risk factor for developing thoughts of suicide or self-harm. These results should be taken into account during evaluation of risk of suicide or mental health interventions for the pandemic.
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When the COVID-19 pandemic emerged in early 2020, not only did it abruptly impede the progress that was being made toward achieving global targets to end the HIV pandemic, but it also created significant impacts on the physical and mental health of middle-aged and older men who have sex with men living with HIV. Utilizing a qualitative, community-based participatory research approach, we conducted semi-structured, one-on-one interviews with 16 ethnoracially diverse, middle-aged and older men who have sex with men living with HIV residing in Southern Nevada, to examine the different ways the COVID-19 pandemic directly impacted their physical and mental health, and explore how they eventually coped and thrived during the peak of the crisis. Using thematic analysis to analyze our interview data, we identified three prominent themes: (1) challenges to obtaining credible health information, (2) the physical and mental health impacts of the COVID-19-pandemic-imposed social isolation, and (3) digital technologies and online connections for medical and social purposes. In this article, we extensively discuss these themes, the current discourse on these themes in academic literature, and how the perspectives, input, and lived experiences of our participants during the peak of the COVID-19 pandemic could be critical to addressing issues they had already been experiencing prior to the emergence of the pandemic in 2020, and just as importantly, helping us best prepare in stark anticipation of the next potentially devastating pandemic.
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COVID-19 , HIV Infections , Sexual and Gender Minorities , Male , Middle Aged , Humans , Aged , Pandemics , Homosexuality, Male , COVID-19/epidemiology , Adaptation, Psychological , HIV Infections/epidemiologyABSTRACT
This review explored the impact of the COVID-19 pandemic on people with cognitive impairment living in aged care facilities. It also considered policy and organizational responses to COVID-19, and makes recommendations to ameliorate the impact of the pandemic on residents with cognitive impairment in aged care facilities. ProQuest, PubMed, CINAHL, Google Scholar, and Cochrane Central were searched April-May 2022 for peer reviewed articles, and an integrative review of reviews was conducted. Nineteen reviews were identified which referred to people with cognitive impairment living in residential aged care facilities (RACFs) during COVID-19. Negative impacts were highlighted, including COVID-19 related morbidity and mortality, social isolation, and cognitive, mental health and physical decline. Few research articles and policy responses consider people with cognitive impairment in residential aged care. Reviews highlighted that social engagement of residents should be better enabled to reduce the impact of COVID-19. However, residents with cognitive impairment may have inequitable access to communications technology for the purposes of assessment, health care and social engagement, and require more support (along with their families) to access this technology. Greater investment in the residential aged care sector (eg, for workforce and training) is required to address the significant impacts of the COVID-19 pandemic on people with cognitive impairment.
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COVID-19 , Cognitive Dysfunction , Aged , Humans , Pandemics , Cognitive Dysfunction/epidemiology , Homes for the Aged , Delivery of Health CareABSTRACT
The imposition of lockdowns during the COVID-19 pandemic placed individuals under conditions of environmental stress, threatening individual and collective wellbeing. This study aimed to investigate the temporal effects of isolation and confinement during and after the Italian lockdown on decision-making, risk propensity, and cognitive control processes. The present study covered almost the entire Italian lockdown period (each week from the end of March to mid-May 2020), plus a follow-up measure (September 2020). At each time-point, respondents completed online behavioral tasks, which involved measuring risk-propensity (Balloon Analogue Risk Task), decision-making (Iowa Gambling Task), and cognitive flexibility (Category Switch Task). They also filled in questionnaires regarding subjective stress and anxiety. The main findings showed that the decision-making abilities of the respondents were affected as the confinement progressed. Furthermore, individuals who were more subjectively impacted by the lockdown/isolation experience exhibited impaired decision-making, especially during the lockdown. The results of the study highlight that prolonged confinement may affect human decision making, and help understand individuals' misbehaviors during emergencies and develop effective countermeasures aimed at reducing the burden of the healthcare system.
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Background: The COVID-19 pandemic has led to an increased workload and work pressure on nurses owing to the unpredictable changes during this challenging situation. Herein, we explored the relationship between hopelessness and job burnout in nurses working in China against the backdrop of the COVID-19 outbreak. Method: This was a cross-sectional study involving 1216 nurses in two hospitals in Anhui Province. The data was collected using an online survey. The mediation and moderation model was constructed, and the data was analyzed using SPSS PROCESS macro software. Results: Our results showed that the nurses had an average job burnout score of 1.75 ± 0.85. Further analysis revealed a negative correlation between hopelessness and career calling (r = -0.551, P < 0.01) and a positive correlation between hopelessness and job burnout (r = 0.133, P < 0.01). Additionally, a negative correlation was demonstrated between career calling and job burnout (r = -0.138, P < 0.01). Moreover, career calling strongly mediated (by 40.9%) the relationship between hopelessness and job burnout in the nurses. Finally, social isolation in the nurses was a moderating factor for the association between hopelessness and job burnout (ß = 0.028, t = 2.851, P < 0.01). Conclusion: Burnout severity in nurses increased during the COVID-19 pandemic. Career calling mediated the relationship between hopelessness and burnout, with greater burnout levels in nurses who experienced social isolation. Therefore, we suggest that job burnout in nurses can be improved by mitigating the effects of hopelessness and social isolation through psychological interventions and enhancing their sense of career calling through education to strengthen their professional identity.
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Resilience, or the ability to bounce back despite facing adversities, may influence parents' abilities to handle the multitude of parent-specific COVID-19-related challenges that have faced them. This cross-sectional study examined (1) the relationship between parents' resilience and their COVID-19-related family stressors;(2) parents' perceptions of their greatest stressors throughout the pandemic;and (3) non-school-related challenges and their resultant impact on parents' and children's resilience. Via an online survey, data was collected from 63 parents (Mage = 37.09;82.54% female). A significant relationship was found between parents' resilience and both their COVID-19-related stressors and family stressors. Parents described stressors challenging their resilience, including impacts on their mental health, managing occupational and educational responsibilities, social isolation, and economic setbacks, while also noting the impacts of social isolation, missing extracurricular activities, and lacking routines for their children. Overall, Ontario parents high in resilience are likely better positioned to adapt to pandemic-related stressors. [ FROM AUTHOR] Copyright of Family Journal is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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Aim: People with type 1 or type 2 diabetes have a higher hospital admission rate following Covid-19 infection. This study aims to determine the degree to which the results of a previous study in Greater Manchester (GM) could be replicated in national-level data for England. Method(s): We focussed on the univariable regression analysis, which shows the association between admission and Covid-19 infection in people with diabetes. Modelling was conducted using logistic regression on data from the Covid-IMPACT database. Odds ratios were compared descriptively with the previous study. Result(s): In people with type 2 diabetes, factors associated with an increased risk of hospitalisation similar to the previous study were: older age, male sex, higher social deprivation, higher body mass index (BMI), higher cholesterol, lower eGFR, taking an ACE-inhibitor/ ARB, not taking metformin, and having asthma or hypertension. Patients with COPD, and those taking aspirin or clopidogrel also had increased risk, but the national data showed a greater risk (GM COPD odds ratio 1.89 [1.63-2.19] vs national 2.34 [2.28-2.40] / aspirin 1.49 [1.34-1.66] vs 1.66 [1.63-1.70] / clopidogrel 1.71 [1.47-1.98] vs 1.99 [1.94-2.04]). Similar results were observed in patients with type 1 diabetes. However, due to the increase in sample size, many factors which were previously not statistically significant have become significant, such as in type 2 diabetes BMI, low HDL-cholesterol. Conclusion(s): We have successfully replicated the methods, results and conclusions of our previous study in relation to factors associated with increased risk of hospital admission in diabetes individuals. Regional databases are suitable for large cohort studies, and in this instance produced similar results to a national database, validating our previous findings.
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Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.
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The SARS-CoV-2 virus triggered a never-before-seen scenario worldwide. Ecuador declared a state of emergency to contain coronavirus transmission by applying social isolation policies and mobility limitations. During this period, noise pollution decreased in Guayaquil city. This study proposes the use of smartphones to collect noise data and generate soundscape maps of Guayaquil during different time slots. The results revealed traffic as the predominant type of noise, followed by vehicles, buses, and people´s voices. This article demonstrates the feasibility of crowdsourcing for the collection of environmental variables. © 2022 National Institute for Space Research, INPE. All rights reserved.
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In recent years, the increasing social isolation has become a major problem in Japan because of the growing trend toward nuclear families. In addition, further social isolation is concerned caused by a decrease on face-to-face communication opportunities due to the outbreak of the COVID-19 infection. Therefore, it is necessary to create connections among people. On the other hand, opportunities for people to communicate online have increased rapidly. However, various information obtained the face-to-face is missing online, which degrades the quality of communication and causes physical and mental fatigue to users. To solve these problems, this study aims to minimize the gap that exists between online and the face-to-face, and to propose an Augmented Architectural Space that creates casual connections between people within their living space. By comparing the results of impression evaluation experiments using questionnaires for the face-to-face environment, the video conferencing system environment, and the proposed system environment, we demonstrate the usefulness of the proposed Augmented Architectural Space system for creating casual connections between people. © 2023, Association of American Publishers. All rights reserved.
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Introduction: According to the National Academies of Science, Medicine, and Engineering, even before the pandemic, 24% of Americans 65+ were considered socially isolated, and 43% of adults 60+ were lonely. Both experiences are associated with serious physical and mental health problems, including increased risks of dementia, stroke, depression, and suicidal ideation. As older adults engage in stricter social distancing to protect themselves from COVID-19, their risk of social isolation and loneliness is heightened. According to research by the Kaiser Family Foundation, 46% of adults 65+ reported that the worry and stress caused by pandemic has had a negative impact on their mental health. In order to combat this unique challenge, we must employ innovative, flexible solutions that adapt to the shifting circumstances and an uncertain future. Method(s): WH SeniorLink has developed an innovative program for integrating friendly visiting, mutual aid, needs assessment and case management, all delivered remotely by trained volunteers. The program was conceived, developed and executed since the beginning of COVID-19 restrictions and has grown to become a fully fledged 501(c)(3) organization, and is a model of flexible service delivery during this unusual time. The program operates through a volunteerism-mutual aid model. Volunteers are trained using online modules and quizzes and supervised by a licensed social worker, including training on needs and risk assessment. Volunteers are then matched with an older adult with similar interests and language preferences to provide friendly weekly phone calls, care packages and letters. Older adults with higher needs are referred to WH SeniorLink's service navigation program which operates using the online platform, Apricot, and is staffed by masters level social work interns and supervised by licensed social workers. Service navigation involves conducting comprehensive assessments and identifying resources and referrals. Older adults who express interest are also paired with each other to provide social support. Barriers to program development have included identifying consistent funding sources and volunteer attrition. Result(s): Data shows 169% growth in contacts made with older adults between May and October, with 2.5 times more older adults served in November than in May. Initial responses to the Dejong Gierveld Loneliness Scale and qualitative data collection reflect that older adults continue to feel lonely and isolated in the midst of the pandemic, but that WH SeniorLink is helping. By placing emphasis on empowering older adults to form sustained relationships with volunteers and their peers, WH SeniorLink encourages reciprocal relationships through which older adult participants are valued for their experiences and contributions. Conclusion(s): The mission of WH SeniorLink is to strengthen community ties and improve health outcomes among older New Yorkers by providing social-emotional support and connection to essential services. WH SeniorLink was founded during the COVID-19 pandemic, in response to the myriad of new challenges faced by older adults including greater risk of social isolation and increased disconnection from essential services. However, we recognize that the pandemic has only exacerbated a problem that began long before, and older adults are at risk of being left behind in the coming months and beyond. Funding(s): WH SeniorLink is funded by a starter grant from Columbia School of Social Work and subsequent crowdfunded donations.Copyright © 2021
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Social isolation has been a growing concern since the onset of the COVID-19 pandemic, disproportionately impacting older adults. Social isolation can impact the physical, mental, and emotional health of older adults. The purpose of this study was to examine coping strategies of older adults living in senior living communities, as well as the supportive efforts of the team members working in such communities, to determine best practices for combating social isolation for older adults. This qualitative study was guided by the research question: How do older adults perceive loneliness, social isolation, and social connectedness living in senior living communities? Guided by the theoretical frameworks of socioemotional selectivity theory (SST) and strength and vulnerability integration model (SAVI), this study explored how diminished time horizons impact the prioritization of social connections. This qualitative study collected data through semi-structured interviews from older adults living in senior living communities in the United States. Several themes emerged from the data including Parameters of Social Connection, Dining Room as a Hub of Socialization, Time Horizon Awareness and Compensation, Strategies of Connection, and Loss of Spouse. Several implications for best practices are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)