Impact of coronavirus disease pandemic on performance and satisfaction, physical activity, and quality of life of the elderly

SUMMARY

OBJECTIVE:

The aim of this study was to examine the effects of the coronavirus disease pandemic in the elderly.

METHODS:

A total of 140 elderly with a mean age of 71.30±6.00 years (69 females, 71 males) who spent the coronavirus disease pandemic period at home were included. Canadian Occupational Performance Measure, Visual Analog Scale (for pain intensity at rest and activity), International Physical Activity Questionnaire-Short Form, and EuroQol Five-Dimensional Questionnaire, Three-Level Version Health States were used in the evaluation. Two scores are obtained in Canadian Occupational Performance Measure: one for performance and one for satisfaction. EuroQol Five-Dimensional Questionnaire, Three-Level Version consists of two parts: EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale.

RESULTS:

While female gender (p=0.006, p=0.001), using walking assistant (p=0.001, p=0.001), being single/widow (p=0.031, p=0.007), and history of falling (p=0.004, p=0.001) made difference in Visual Analog Scale (rest, activity), female gender (p=0.013) and being single/widow (p=0.020) made difference in satisfaction scores of Canadian Occupational Performance Measure. Female gender (p=0.001), using walking assistant (p=0.001), and history of falling (p=0.010) made difference in EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system. In addition, performance scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.198, p=0.019; activity r=-0.188, p=0.026) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.327, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.307, p=0.001). Satisfaction scores of Canadian Occupational Performance Measure had a low correlation with Visual Analog Scale (rest r=-0.247, p=0.003; activity r=-0.223, p=0.008) and had a moderate correlation with EuroQol Five-Dimensional Questionnaire, Three-Level Version descriptive system (r=0.399, p=0.001) and EuroQol Five-Dimensional Questionnaire, Three-Level Version Visual Analog Scale (r=0.306, p=0.001).

CONCLUSION:

The elderly who were women, single/widowed, using walking assistant, and having a history of falling were more affected during the coronavirus disease period.

KEYWORDS:
Elderly; COVID-19; Quality of life; Satisfaction

INTRODUCTION

“Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)” is a newly discovered pathogen in humans, responsible for an infection called coronavirus disease (COVID-19)¹. The COVID-19 pandemic has triggered a worldwide public health crisis, affecting every aspect of life, society, healthcare, and individual health outcomes². The COVID-19 pandemic affects all age groups. However, the effect on the health of the elderly is greater than in other age groups³,⁴.

All precautions such as physical distancing, movement restriction, and home quarantine during the COVID-19 pandemic led to negative psychological and physical effects, especially for the elderly. Despite all the relief efforts, the elderly had to endure the heavy consequences of the pandemic⁵,⁶.

Preventing the elderly from going out can cause social isolation and a decrease in their physical levels⁷. They reduced walking activities, increased sitting, spent more time watching television, and had less social interactions with friends or families⁸. According to studies, the physical effects of the COVID-19 pandemic are sarcopenia, increased risk of falling, fragility, diabetes mellitus, hypertension, and increased risk of cardiovascular disease⁹. Armitage and Nellums reported that insufficient physical activity during the quarantine period may cause harmful effects on the mental and emotional health of the elderly. The psychological consequences of isolation are anxiety, depression, dementia, impaired cognitive functions, mental disorientation, increased suicide attempts, and post-traumatic stress disorder¹⁰.

Due to the fact that the elderly stay at home and cannot go out, their need for protection, surveillance, and care has increased, and they have experienced more problems in the fulfillment of daily life activities during the COVID-19 pandemic¹¹.

The Health-Related Quality of Life consists of various dimensions such as basic quality of life, well-being, social and psychological factors, physical function, life satisfaction, and awareness of health status¹². The need to explore the health-related quality of life parameters in social isolation, which intensifies during the pandemic period for the already vulnerable elderly, is the focus of the literature reviews and is considered an urgent need¹³. Due to the availability of information about how the elderly self-assess their general condition during the COVID-19 period, this study was planned to examine the effects of the COVID-19 pandemic on performance and satisfaction, physical activity levels, and quality of life in the elderly.

METHODS

Participants

A total of 140 elderly (69 females, 71 males) with a mean age of 71.30±6.00 years who spent the COVID-19 pandemic period at home were included in this study. Inclusion criteria included living at home; 65 years of age and older; being a volunteer; and Hodkinson Mental Test scores of 6 and above. Exclusion criteria included elderly who cannot be contacted for reasons such as Alzheimer's disease, dementia, or psychosis; having a chronic disease that can cause pain; being blind; and having an orthopedic, neurological, or mental disability.

Approval for the study was granted by the Local Ethics Committee (decision no: 19, date: 10.19.2021). All patients were informed verbally, and informed consent forms were signed. All the procedures were in accordance with the ethical standards of the committee responsible for human experimentation and with the Helsinki Declaration of 1975, as revised in 1983.

Evaluations

All evaluations were performed by the same investigator. After the demographic information of the participants (age, gender, marital status, educational level, using walking assistant, and history of falling) was recorded, performance and satisfaction were evaluated with the Canadian Occupational Performance Measure (COPM), pain intensity at rest and activity with Visual Analog Scale (VAS), physical activity levels with International Physical Activity Questionnaire-Short Form (IPAQ-SF), and quality of life with EuroQol Five-Dimensional Questionnaire, Three-Level Version (EQ-5D-3L) Health States. The interview was face-to-face in approximately 40 minutes. Evaluations were made in the home environment of the elderly, wearing masks and protective clothing to reduce the risk of contamination. Sterilization was achieved with disinfectants.

Canadian Occupational Performance Measure (COPM): The administration of the COPM consisted of five steps. First, they were asked to identify the problematic activities in daily life from three performance areas (self-care, work and productivity, and leisure time). Second, the importance of each problem was graded on a 10-point scale (1 is not important; 10 is very important). Then, the participant selected the five most important problems. Finally, for each of these five most important problems, the participant rated their performance (1=not able to do it at all and 10=able to do it extremely well) and satisfaction (1=not satisfied at all and 10=extremely satisfied) on a 10-point scale. Thus, two scores were obtained: one for performance and one for satisfaction¹⁴.

Visual Analog Scale: The pain intensity of the participant at rest and activity was determined as the length of the distance from “0” to “10” (0=“no pain” and 10=“worst possible pain”). The mark made by the participant¹⁵.

International Physical Activity Questionnaire-Short Form (IPAQ-SF): It was used to determine the level of physical activity. This questionnaire consisted of seven questions including the “last seven days.” A score was obtained by multiplying the minute, day, and MET values¹⁶.

EuroQol Five-Dimensional Questionnaire, Three-Level Version (EQ-5D-3L) Health States: It consisted of two parts: EQ-5D-3L descriptive system and EQ-5D-3L VAS. The score of EQ-5D-3L descriptive system ranged from −0.59 to 1. A value of 1 indicated perfect health, while negative values indicated low quality of life. EQ-5D-3L VAS was numbered from 0 to 100 (0: The worst imaginable health state and 100: The best imaginable health state)¹⁷.

Statistical analysis

As a result of the power analysis performed by assuming that the effect size of the relationship between the variables to be examined will be moderate (r=0.3), it was calculated that 80% power could be obtained at the 95% confidence level when a minimum of 64 subjects are included in the study. The data were analyzed using the IBM SPSS Statistics vn.22 software. The Kolmogorov-Smirnov test was used to determine whether the continuous variables were normal distributions. Continuous variables were expressed as mean±SD for normal distributions and median (minimum–maximum) for non-normal distributions. The categorical variables were expressed in numbers and percentages. The Mann-Whitney U test and independent samples test were used to compare the independent group differences. In addition, the relationships between continuous variables were examined with Pearson correlation analysis. Correlation was categorized as low (r:0.10–0.29), moderate (r:0.30–0.49), or high (r:0.50–1.00)¹⁸. A value of p<0.05 was accepted as statistically significant.

RESULTS

The study was first involved 160 elderly. The Hodkinson Mental Test score of three elderly was below 6. Two elderly had rheumatoid arthritis. Fifteen elderly did not want to participate in the study. Consequently, the study was completed with a total of 140 elderly (69 females, 71 males) with a mean age of 71.30±6.00 years. The flowchart of the study is shown in Figure 1.

Figure 1
The flowchart of the study.

Demographic data and the most challenging activities of the participants are shown in Table 1. Descriptive data by groups are given in Table 2.

Table 1
Demographic data and the most challenging activities of the elderly participants according to Canadian Occupational Performance Measure.

Variables		Mean ± SD
Age (years)		71.30±6.00
Hodkinson Mental Test		8.59±1.22
		n (%)
Gender-female		69 (49.3)
	Male	71 (50.7)
Using walking assistant -Yes		33 (23.6)
	No	107 (76.4)
Marital status-Married		105 (75)
	Single/widow	35 (25)
History of falling-Yes		47 (33.6)
	No	93 (66.4)
Educational level-Literate		26 (18.6)
	Primary school	73 (52.1)
	Secondary school	23 (16.4)
	High school	11 (7.9)
	University	7 (5)
COPM Self-care activities -Walking outside (park)		40 (28.6)
	Up and down stairs	26 (18.6)
	Shopping	23 (16.4)
	Taking a bath	21 (15)
	Take a salary	19 (13.6)
	Carrying heavy bags	16 (11.4)
	Paying bills	15 (10.7)
	Shaving (hair, beard)	14 (10)
	Sitting on the toilet	8 (5.7)
	Brush hair	6 (4.3)
	Cut nail	5 (3.6)
	Wear shoe socks	5 (3.6)
	Driving a car	5 (3.6)
	Get dressed	4 (2.9)
	Using technology	2 (1.4)
	Get on and off the car	2 (1.4)
	Carry tray	2 (1.4)
	Work and productivity activities-Cook	26 (18.6)
	Home cleaning	20 (14.3)
	Taking things from the kitchen cabinet	10 (7.1)
	Gardening	9 (6.4)
	Laundry hanging/wash the clothes	4 (2.6)
	Ironing	2 (1.4)
	Sew	2 (1.4)
	Leisure time activities-Visiting neighbors, relatives, and friends	35 (25)
	Taking care of the grand children	21 (15)
	Meeting with friends (such as cafes and coffee shops)	13 (9.3)
	Buy a newspaper	6 (4.3)
	Travel	5 (3.6)
	Go to temple	2 (1.4)

Table 2
Descriptive data and intergroup comparison results.

Variables		Mean±SD Median (min/max)
		VAS (Pain)-rest	VAS (Pain)-activity	IPAQ-SF	EQ-5D-3L descriptive system	EQ-5D-3L VAS	Performance scores of COPM	Satisfaction scores of COPM
Gender-female		2.71±2.36	5.43±2.25	4,389.60±3,347.42	0.65±0.27	64.19±21.08	4.61±1.73	3.36±1.71
		2.5 (0/10)	5 (0/10)	4,509 (49.50/16,192)	0.78 (0.09/1)	60 (0/100)	4.60 (1.40/8)	2.80 (1/7.20)
	Male	1.7±1.85	3.82±2.64	5,539.72±5,176.59	0.79±0.26	70.31±18.43	5.02±2.38	4.63±2.77
		1.5 (0/6)	4 (0/10)	4,621.50 (0/29,673)	0.88 (-0.14/1)	75 (20/100)	5 (1/10)	4.40 (1/12)
p		0.006	0.001	0.404	0.001	0.086	0.330	0.013
Using walking assistant - Yes		3.45±2.55	6.03±2.32	4,474.12±2,773.81	0.54±0.30	61.69±21.26	4.35±1.96	3.25±1.82
		3.6 (0/10)	6 (1/10)	4,504 (0/10,290)	0.70 (-0.14/1)	60 (20/100)	4 (1.40/8)	3.10 (1/7)
	No	1.81±1.89	4.18±2.50	5,138.52±4,796.19	0.78±0.24	69.02±19.30	4.96±2.11	4.24±2.50
		1.20 (0/10)	4 (0/10)	4,621.50 (49.50/29,673)	0.88 (0.2/1)	75 (0/100)	4.80 (1/10)	4 (1/12)
p		0.001	0.001	0.902	0.001	0.073	0.146*	0.053
Marital status-married		2.03±2.23	4.28±2.67	4,912.35±4,812.28	0.74±0.27	69.10±19.30	5±2.18	4.31±2.53
		1.50 (0/10)	4 (0/10)	4,032 (0/29,673)	0.80 (-0.14/1)	75 (20/100)	5 (1/10)	4.20 (1/10)
	Single/widow	2.71±1.93	5.60±1.98	5,204.63±2,978.41	0.65±0.29	61.88±21.15	4.27±1.69	3.08±1.63
		3 (0/6)	5 (0/9)	5,517 (82.50/12,864)	0.70 (0.09/1)	60 (0/90)	4 (1.40/8)	2.80 (1/6.60)
p		0.031	0.007	0.173	0.071	0.084	0.074*	0.020
History of falling-Yes		2.88±2.20	5.60±2.30	4,575.47±3,866.13	0.61±0.32	63.14±21.81	4.52±1.50	3.73±1.74
		3 (0/10)	5.6 (0/10)	4,427 (49.50/16,192)	0.70 (-0.14/1)	60 (0/100)	4.60 (1.4/7.6)	3.75 (1/7.20)
	No	1.85±2.08	4.12±2.58	5,205.19±4,686.75	0.77±0.23	69.39±18.71	4.97±2.32	4.14±2.65
		1 (0/10)	4 (0/10)	4,657.50 (0/29,673)	0.80 (0.02/1)	75 (20/100)	4.80 (1/10)	3.80 (1/10)
p		0.004	0.001	0.595	0.010	0.141	0.174*	0.747

• Mann-Whitney U test;
• ^*
  Independent samples test; VAS: Visual Analog Scale; COPM: Canadian Occupational Performance Measure, IPAQ-SF: International Physical Activity Questionnaire-Short Form; EQ-5D-3L: EuroQol Five-Dimensional Questionnaire, Three-Level Version Health States. Bold values denote statistical significance at the p<0.05 level.

Intergroup comparison results

In terms of gender, VAS at rest (p:0.006) and activity (p:0.001) scores were higher, and EQ-5D-3L descriptive system (p:0.001) and satisfaction scores of COPM (p:0.013) were lower for female than male (Table 2).

VAS at rest (p:0.001) and activity (p:0.001) scores were higher, and EQ-5D-3L descriptive system (p:0.001) scores were lower for the elderly who used a walking assistant than the elderly who did not (Table 2).

In terms of marital status, VAS at rest (p:0.031) and activity (p:0.007) scores were higher, and satisfaction scores of COPM (p:0.020) were lower for single/widow than married (Table 2).

VAS at rest (p:0.004) and activity (p:0.001) scores were higher, and EQ-5D-3L descriptive system (p:0.010) scores were lower for elderly with a history of falling than elderly without (Table 2).

There was no difference between groups in IPAQ-SF scores (p>0.05) (Table 2).

Pearson correlation results

Performance and satisfaction scores of COPM had a low negative correlation with VAS at rest and activity and had a moderate positive correlation with EQ-5D-3L descriptive system and EQ-5D-3L VAS (p<0.05) (Table 3).

Table 3
The relationship between performance and satisfaction scores of Canadian Occupational Performance Measure with VAS (pain), IPAQ-SF, and EQ-5D-3L.

		Performance scores of COPM		Satisfaction scores of COPM
		r	p	r	p
Visual Analog Scale (Pain)-rest		-0.198	0.019	-0.247	0.003
	Activity	-0.188	0.026	-0.223	0.008
IPAQ-SF		0.142	0.101	0.082	0.347
EQ-5D-3L descriptive system		0.327	0.001	0.399	0.001
EQ-5D-3L Visual Analog Scale		0.307	0.001	0.306	0.001

• Pearson correlation analysis; COPM: Canadian Occupational Performance Measure; IPAQ-SF: International Physical Activity Questionnaire-Short Form; EQ-5D-3L: EuroQol Five-Dimensional Questionnaire, Three-Level Version Health States. Bold indicates statistically significant values.

There was no correlation between COPM and IPAQ-SF scores (p>0.05) (Table 3).

DISCUSSION

The elderly who were women, single/widow, using walking assistant, and history of falling had higher pain intensity in this study. Also, women and single/widow were less satisfied and the quality of life was lower in women, using walking assistant, and history of falling during the period of COVID-19. In addition, performance and satisfaction decreased, while pain intensity at rest and activity increased. As their performance and satisfaction decreased, their quality of life decreased.

Bezerra et al. conducted a study on perceived social isolation during the COVID-19 pandemic in Brazil and found that social interaction was the most affected aspect¹⁹. Experts say being socially connected is critical to health and survival among the elderly¹³,²⁰. The consequences of social isolation and emotional loneliness increase their vulnerability to depression, increase their stress level, and reduce their quality of life²,²¹,²².

Disaggregation of COVID-19 data by age, gender, disability, and underlying health conditions is essential to accurately distinguish risks to the elderly²³. The voices, expertise, and perspectives of elderly people in identifying problems and solutions are sometimes not adequately included in the policy-making process, particularly where elderly people are affected by such decisions. Hence, it is important to expand our partnership to make the voices heard by the elderly, benefit from their knowledge, and ensure their free, active, and meaningful participation²³.

In this study, we examined the perspectives of the elderly, who had to stay at home during the COVID-19 pandemic, on this period and how they evaluated their own situation. We found that the elderly who use a walking assistant and have a history of falling felt more pain intensity and had lower quality of life. With these results, we can say that the elderly who need one or more personal care/partially cannot be self-sufficient are more affected. The elderly who have already withdrawn from social life more than normal individuals may be more affected in terms of psychological influence with more restrictions on their movements. Thus, they may perceive their own situation as worse according to their level of activity. The elderly, who are more dependent on others, may not be able to do their personal care or perform less because they receive less help from their families during this period of restrictions. This situation may even have caused psychological pressure as it may cause further contamination because one of the rules to be considered during the pandemic period was hygiene. Therefore, as a result of our study, the elderly who use a walking assistant and have a history of falling may have higher pain intensities and lower quality of life.

The elderly living alone are at even greater risk for social isolation, which has significantly increased due to the COVID-19 pandemic. The elderly, especially who live alone and lack support, are among the groups most susceptible to discrimination²⁴,²⁵. In our results, we think that the reason why single/widow elderly have more pain intensity and less satisfaction is that they experience the effects of social isolation more intensely. Inter-American Commission on Human Rights called that “to provide the necessary balance between protection from COVID-19 and the special needs of the elderly to connect with their families, and to provide telephone or internet-based communication channels to prevent their emotional state from being adversely affected²⁶.”

Although the studies in the literature showed that men had higher rates than women in terms of biological exposure (passing the disease with more severe symptoms) and death rates, women are more affected in terms of psychological exposure²⁷. Many studies reported that women are routinely affected more severely in mental health due to biological differences in hormone profiles compared to men²⁸–³⁰. As detailed in the policy brief on the impact of COVID-19 on women, elder women often care for elderly relatives and take care of children²³. In our study, we think that the reason for the higher pain intensity and lower satisfaction and quality of life of the elderly women may be because they provide more intensive care during the COVID-19 period and are more affected by the psychological stress caused by this period. Women, who have a longer life expectancy and higher survival rate than men, are particularly highly represented among elderly people in the 80+ age group, and this has important implications for health policies²⁷.

When the average values of the physical activity levels of our sample group are examined, it is seen that they are similar. We attribute this reason why no significant difference was observed in IPAQ-SF scores in correlation and intergroup comparisons. Physical activity provides benefits for the health of the elderly by stimulating muscle contraction and energy expenditure and reducing systemic inflammation, oxidative stress, and the prevalence of chronic diseases. The risk of functional decline is higher in older people who do not participate in regular physical activity. Physical activity is especially important for older people to maintain their level of independence, mental health, and well-being³¹. Therefore, we recommend that they can be encouraged to maintain mobility in old age.

In this study, we observed that the most challenging activities of the elderly evaluated with COPM were “self-care activities.” “Walking outside” is the most challenging activity. This is followed by “visiting neighbors, relatives, and friends.” This shows how much elderly individuals are affected by social isolation. Among the most challenging activities, “shopping, take a salary, and taking care of the grand children” are the activities that attract attention.

Important conclusions can be drawn from this acquired pandemic. Based on the results we obtained from this study, we think that more focus should be placed on social support for the elderly who are women, single/widow, use a walking assistant, and have a history of falls, and special methods should be developed with multidisciplinary studies in order to better manage both the physical and psychological conditions of these people within the scope of observing the rights of the elderly while making difficult decisions regarding health.

Due to the lack of a regular source of income and insufficient savings during the COVID-19 period, many individuals are facing financial crises¹⁹. One of the limitations of our study is that data on the source of income and its effects were not collected.

CONCLUSION

In the elderly population, female gender, using walking assistant, being single/widow, and history of falling were more affected in terms of pain intensity, satisfaction, and quality of life during the COVID-19 period. Performance and satisfaction scores of COPM had a correlation with pain intensity and quality of life.

• Funding: none.

REFERENCES

• ¹
  Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. https://doi.org/10.1056/NEJMoa2001017
  » https://doi.org/10.1056/NEJMoa2001017
• ²
  Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a national academies report. Am J Geriatr Psychiatry. 2020;28(12):1233-44. https://doi.org/10.1016/j.jagp.2020.08.005
  » https://doi.org/10.1016/j.jagp.2020.08.005
• ³
  Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: a comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-8. https://doi.org/10.1016/j.jinf.2020.03.005
  » https://doi.org/10.1016/j.jinf.2020.03.005
• ⁴
  Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-ınfected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585
  » https://doi.org/10.1001/jama.2020.1585
• ⁵
  Pant S, Subedi M. Impact of COVID-19 on the elderly. JPAHS. 2020;7(2):32-8. https://doi.org/10.3126/jpahs.v7i2.31104
  » https://doi.org/10.3126/jpahs.v7i2.31104
• ⁶
  Omura T, Araki A, Shigemoto K, Toba K. Geriatric practice during and after the COVID-19 pandemic. Geriatr Gerontol Int. 2020;20(7):735-7. https://doi.org/10.1111/ggi.13958
  » https://doi.org/10.1111/ggi.13958
• ⁷
  Ekici E. Care management of elderly people during covid 19 pandemic. Halic Uni J Health Sci. 2020;3(3):145-52.
• ⁸
  Oliveira MR, Sudati IP, Konzen VM, Campos AC, Wibelinger LM, Correa C, et al. Covid-19 and the impact on the physical activity level of elderly people: a systematic review. Exp Gerontol. 2022;159:111675. https://doi.org/10.1016/j.exger.2021.111675
  » https://doi.org/10.1016/j.exger.2021.111675
• ⁹
  Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis. 2020;63(3):386-8. https://doi.org/10.1016/j.pcad.2020.03.009
  » https://doi.org/10.1016/j.pcad.2020.03.009
• ¹⁰
  Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5):e256. https://doi.org/10.1016/S2468-2667(20)30061-X
  » https://doi.org/10.1016/S2468-2667(20)30061-X
• ¹¹
  Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5):e256. https://doi.org/10.1016/S2468-2667(20)30061-X
  » https://doi.org/10.1016/S2468-2667(20)30061-X
• ¹²
  Akyol Y, Durmuş D, Doğan C, Bek Y, Canturk F. Quality of life and level of depressive symptoms in the geriatric population. Turk J Rheumatol. 2010;25:165-73. https://doi.org/10.5152/tjr.2010.23
  » https://doi.org/10.5152/tjr.2010.23
• ¹³
  Holt-Lunstad J. The double pandemic of social ısolation and COVID-19: cross-sector policy must address both. Health Affairs Blog. [cited on Jan 05, 2022]. https://www.healthaffairs.org/do/10.1377/hblog20200609.53823/full/
  » https://www.healthaffairs.org/do/10.1377/hblog20200609.53823/full/
• ¹⁴
  Law M, Baptiste S, Carswell A, McColl MA, Polatajko H, Pollock N. Canadian occupational performance measure. 3rd ed. Ottawa: CAOT Publications ACE; 1998.
• ¹⁵
  Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227-36. https://doi.org/10.1002/nur.4770130405
  » https://doi.org/10.1002/nur.4770130405
• ¹⁶
  Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB
  » https://doi.org/10.1249/01.MSS.0000078924.61453.FB
• ¹⁷
  EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208. https://doi.org/10.1016/0168-8510(90)90421-9
  » https://doi.org/10.1016/0168-8510(90)90421-9
• ¹⁸
  Cohen J, Cohen P, West SG, Aiken LS. Applied multiple regression/correlation analysis for the behavioral sciences. Routledge; 2013.
• ¹⁹
  Bezerra ACV, Silva CEMD, Soares FRG, Silva JAMD. Factors associated with people's behavior in social isolation during the COVID-19 pandemic. Cien Saude Colet. 2020;25(suppl 1):2411-21. https://doi.org/10.1590/1413-81232020256.1.10792020
  » https://doi.org/10.1590/1413-81232020256.1.10792020
• ²⁰
  Chen YR, Schulz PJ. The effect of information communication technology interventions on reducing social isolation in the elderly: a systematic review. J Med Internet Res. 2016;18(1):e18. https://doi.org/10.2196/jmir.4596
  » https://doi.org/10.2196/jmir.4596
• ²¹
  Smith BJ, Lim MH. How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Res Pract. 2020;30(2):3022008. https://doi.org/10.17061/phrp3022008
  » https://doi.org/10.17061/phrp3022008
• ²²
  Economic Commission for Latin America and the Caribbean (ECLAC), on the basis of Infobae, “Cómo preservar la salud mental de los adultos mayores durante la cuarentena”, Buenos Aires, Accessed 09 April 2021. https://www.infobae.com/tendencias/2020/05/26/comopreservar-la-salud-mental-de-los-adultos-mayores-durante-la-cuarentena/; Center for Disease Control and Prevention (CDC), “People with disabilities”, [Internet] Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html
  » https://www.infobae.com/tendencias/2020/05/26/comopreservar-la-salud-mental-de-los-adultos-mayores-durante-la-cuarentena/» https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-disabilities.html
• ²³
  World Health Organization. COVID-19 strategy update, 14 April 2020. [cited on Jan 15, 2022]. https://www.who.int/publications-detail/covid-19-strategy-update---14-april-2020
  » https://www.who.int/publications-detail/covid-19-strategy-update---14-april-2020
• ²⁴
  Cisternas M, Pineda V. Declaración conjunta: gobiernos locales y personas con discapacidad en relación al COVID-19. New York, United Nations. [cited on Jan 01, 2022]. https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2020/05/Decl-Gobiernos-locales-y-pcd-Covid-19-5mayo-F.pdf
  » https://www.un.org/development/desa/disabilities/wp-content/uploads/sites/15/2020/05/Decl-Gobiernos-locales-y-pcd-Covid-19-5mayo-F.pdf
• ²⁵
  Huenchuan S. COVID-19: recomendaciones generales para la atención a personas mayores desde una perspectiva de derechos humanos (LC/MEX/TS.2020/6/Rev.1), Mexico City, Economic Commission for Latin America and the Caribbean (ECLAC); 2020.
• ²⁶
  Inter-American Commission on Human Rights (IACHR). IACHR urges states to guarantee the rights of older people during the COVID-19 pandemic. Press Release, Washington DC. [cited on Jan 04, 2022]. https://www.oas.org/en/iachr/media_center/PReleases/2020/088.asp
  » https://www.oas.org/en/iachr/media_center/PReleases/2020/088.asp
• ²⁷
  Cepal NU. Challenges for the protection of older persons and their rights during the COVID-19 pandemic; 2020. p. 34.
• ²⁸
  US. Department of Health and Human Services. Mental health: a report of thesurgeon general—executive summary. Rockville (MD): US. Department of Healthand Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, NationalInstitute of Mental Health; 1999. p. 4.
• ²⁹
  Nakamura R. Workshop report: surgeon general's workshop on women's mental health. Denver, Colorado; 2005. p. 5.
• ³⁰
  Schreiber R. Understanding and helping depressed women. Arch Psychiatr Nurs. 1996;10(3):165-75. https://doi.org/10.1016/s0883-9417(96)80018-5
  » https://doi.org/10.1016/s0883-9417(96)80018-5
• ³¹
  Sun F, Norman IJ, While AE. Physical activity in older people: a systematic review. BMC Public Health. 2013;13:449. https://doi.org/10.1186/1471-2458-13-449
  » https://doi.org/10.1186/1471-2458-13-449

Publication Dates

• Publication in this collection
  26 June 2023
• Date of issue
  2023

History

• Received
  16 Jan 2023
• Accepted
  23 Feb 2023