Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During theCOVID-19Shelter-in-PlaceOrders
Social Isolation and Loneliness Among San Francisco Bay Area Older Adults During theCOVID-19Shelter-in-PlaceOrders
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DOI：
10.1111/jgs.16865
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发表时间：
2020-10-09
影响因子：
6.3
通讯作者：
Perissinotto, Carla M.
中科院分区：
文献类型：
--
作者：
Kotwal, Ashwin A.;Holt-Lunstad, Julianne;Perissinotto, Carla M.
背景/目的2019冠状病毒病大流行期间保持身体距离可能会对老年人的社会隔离和孤独感产生意想不到的有害影响。我们的目的是调查(1)在安置命令期间的社会隔离和孤独经历，以及(2)与社会互动变化相关的未满足的健康需求。设计：每2周进行一次基于电话的混合方法纵向调查。两个社区站点和一个学术老年病学门诊临床实践。参与者共151名居住在社区的老年人。测量方法：我们使用六项修改的杜克社会支持指数、社会互动子量表来测量社会隔离，包括对基于视频和基于互联网的社交的评估。孤独感的衡量标准包括因新冠肺炎大流行而自我报告的孤独感恶化，以及基于加州大学洛杉矶分校（UCLA）孤独感量表的孤独感严重程度。参与者被邀请分享关于他们的社交经历的开放式评论。结果参与者平均年龄为75岁（标准差= 10），50%有听力或视力障碍，64%独居，26%有洗澡困难。参与者在40%的访谈中报告了社会孤立，76%的人报告了基于视频的最少社交活动，42%的人报告了基于互联网的最少社交活动。社会孤立的参与者报告难以在功能需求方面寻求帮助，包括洗澡（20% vs 55%；P= .04）。超过一半（54%）的参与者报告说，由于COVID-19导致的孤独感恶化，与抑郁（62%对9%，P < 0.001）和焦虑（57%对9%，P < 0.001）恶化有关。自安置后，孤独感的平均比例有所改善（4-6周：46% vs 13-15周：27%；P= 0.009），然而，一小部分参与者的孤独感持续存在或恶化。开放式回答揭示了经历持续孤独的小组所面临的挑战，包括情绪应对能力差和对新技术的不适。自实施就地安置令以来，许多老年人正在适应COVID-19限制措施。迫切需要采取更多措施，解决那些长期孤独或在基于技术的社会互动方面存在障碍的人的心理痛苦和未满足的医疗需求。
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.