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

Abstract

Aim To investigate changes in psychological distress in community-dwelling older adults before and during the COID-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 generalized 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 ADL. 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 remained 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 state, 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.

Are Sleep Problems Related to Psychological Distress in Healthy Aging during the COVID-19 Pandemic? A Review

“…In our review, despite the fact a few selected studies found none or little differences on sleep habits during the current pandemic period [68,69], the others observed that the older population, also considering subjects in the healthy aging group, was prone to experience sleep disturbances during the COVID-19 confinement [59][60][61][62][63][64][65][66][67]. In particular, some of the selected studies (4 out of 11) took into consideration the possible association between sleep disturbances and mood changes in the older population during the lockdown period [59][60][61]66].…”

“…Although the cross-sectional nature of the data does not allow us to infer with whether mood changes are precursors to sleep-related issues during the COVID-19 period or whether the lockdown triggered or intensified such psychological aspects, these findings suggest that depression and anxiety seem to be related to sleep disturbances in older adults during the SARS-CoV-2 pandemic. Furthermore, some studies have analyzed other aspects related to psychological changes in wellbeing, such as the level of stress and loneliness [63,[65][66][67]69], which may affect the manifestation of anxiety [88] and depressive symptoms [89], respectively.…”

“…Of these, eight were removed before screening, as duplicates. After the identification and screening phases, 11 studies [59][60][61][62][63][64][65][66][67][68][69] were included and 426 were excluded (See Flowchart, Figure 1). The number and reasons for the exclusion of the articles were the following: 7 failed to meet some inclusion criteria (six did not refer to sleep problems during the SARS-CoV-2 pandemic, one was not in English).…”

“…Two studies [62,63] assessed participants' functionality, in terms of physical activity, frailty status, and autonomy to perform basic or instrumental daily living activities, during the COVID-19 lockdown period.…”

“…In the second study, Wang and colleagues [63] assessed the influence of frailty status and polypathology in psychological distress changes before and during the COVID-19 pandemic in Chinese people 60 years and older (median age: 70 years). A total of 2785 community-dwelling participants, included in the Shandong Rural Elderly Health Cohort study, responded to a face-to-face interview conducted from August to September 2020.…”