Positive health during the COVID-19 pandemic: a survey among community-dwelling older individuals in the Netherlands

Abstract

Background Coronavirus Disease 2019 (COVID-19) reached the Netherlands in February 2020. To minimize the spread of the virus, the Dutch government announced an “intelligent lockdown”. Older individuals were urged to socially isolate completely, because they are at risk of a severe disease course. Although isolation reduces the medical impact of the virus, the non-medical impact should also be considered. Aim To investigate the impact of COVID-19 pandemic and associated restrictive measures on the six dimensions of Positive Health in community-dwelling older individuals living in the Netherlands, and to identify differences within subgroups. Methods In May/June 2020, community-dwelling older individuals aged ≥ 65 years completed an online survey based on Huber’s model of Positive Health. Positive Health was measured regarding the appreciation of the six dimensions (categorized as poor/satisfactory/excellent) and a comparison with a year before (categorized as decreased/unchanged/increased) using frequencies (%) and a chi-square test. Results 834 older individuals participated (51% women, 38% aged ≥ 76 years, 35% living alone, 16% self-rated poor health). Most respondents assessed their bodily functions, mental well-being and daily functioning as satisfactory, their meaningfulness and quality of life (QoL) as excellent, and their social participation as poor. 12% of the respondents reported a deterioration of 4–6 dimensions and 73% in 1–3 dimensions, compared to the past year. Deterioration was most frequently experienced in the dimension social participation (73%), the dimension mental well-being was most frequently improved (37%) and quality of life was in 71% rated as unchanged. Women more often observed a deterioration of 4–6 dimensions than men (15% vs. 8%, p = 0.001), and individuals with self-rated poor health more often than individuals with self-rated good health (22% vs. 10%, p < 0.001). Older individuals living alone experienced more frequently a decrease in meaningfulness compared to older individuals living together. Conclusion The COVID-19 pandemic and associated restrictive measures had a substantial impact on all six dimensions of Positive Health in community-dwelling older individuals, especially in women, respondents living alone and respondents with self-rated poor general health.

Self-Reported Changes in Personal Development and Meaning in Life among Older Adults during the COVID-19 Pandemic: Results from the Longitudinal Aging Study Amsterdam

“…In line with what we found, a recent study in the Netherlands among older adults indicated that the majority of participants reported that their meaning in life remained unchanged during the beginning of the COVID-19 pandemic [21]. Tis suggests that many older adults were resilient and adaptive during the COVID-19 pandemic, which might have helped them to cope with the crisis situation.…”

The impact of the COVID‐19 pandemic on Positive Health among older adults in relation to the complexity of health problems

“…Compared with our earlier cross-sectional study at the end of the first wave, 11 this study showed a similarrated impact on Positive Health, with the exception of common initial improvements in areas such as mental well-being reported in our earlier study. This seems to suggest that rather than more prevalent adverse impacts across more dimensions, the second wave of the pandemic and associated increasingly strict preventive measures 4 was mainly characterized by the absence of previously experienced improvements in certain dimensions.…”

“…Trends across groups were tested by Jonckheere-Terpstra and linear by linear Chisquare tests, as appropriate. Logistic regression models were applied, both crude and adjusted for age and sex, 11,20 to assess dependency on these covariates in the risk of self-rated decrease in Positive Health for those with mild and complex health problems versus those without health problems. To explore additional differences based on use of preventive measures, those with high and low use were compared by Pearson Chi-square tests, overall and in the above subgroups based on complexity of health problems.…”

“…12 As multiple deficits are, for example, associated with increased COVID-19-related concerns and perceived threats, 13 the impact of the pandemic and associated measures on health likely differs between older adults with differing complexities of health problems. To the best of our knowledge, impact studies concerning broad health outcomes such as Positive Health have either not yet compared older adults with differing complexities of health problems 11,14 or have assessed only certain dimensions of Positive Health. [15][16][17][18] We therefore investigated to what degree the impact of the COVID-19 pandemic and related preventive measures on Positive Health differed between community-dwelling older adults without, with mild and with complex health problems, as well as differences flowing from their use of preventive measures.…”

“…11 The first COVID-19 wave had a substantial impact on all dimensions of Positive Health in the overall study population, both adverse and favorable (e.g., 73% of participants experienced a decrease in social participation, whereas 37% experienced an improvement in mental well-being). 11…”