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This study aimed to evaluate the fear of COVID-19, loneliness, resilience, and quality of life levels in older adults in a nursing home during the pandemic, and the effects of these variables and descriptive characteristics on their quality of life. Data were collected using a participant information form, the Mini Mental State Exam (MMSE), the Brief Resilience Scale, the Fear of COVID-19 Scale (FCV-19S), the Loneliness Scale for Elderly (LSE), and the World Health Organization Quality of Life-BREF Turkish Version (WHOQOL-BREF-TR). Regarding the WHOQOL-BREF-TR scale, being male, history of chronic disease, MMSE score, and the changes in sleep pattern significantly affected the physical dimension (R²=0.353, p<0.01) while age, and MMSE and LSE scores significantly affected the psychological dimension (R²=0.364, p<0.01). Also, the MMSE, FCV-19S, and LSE scores significantly affected the social relations dimension (R²=0.234, p<0.01) while MMSE, FCV-19S, and LSE scores significantly affected the environmental dimension (R²=0.351, p<0.01).
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The effects of fear of COVID-19, loneliness, and resilience on the quality of
life in older adults living in a nursing home
Cemile Savci, PhD
a,
*, Ayse Cil Akinci, PhD
a,b
, Sevinc Yildirim Usenmez, MSc, RN
c
,
Furkan Keles, RN
a
a
Department of Nursing, Faculty of Health Sciences, Istanbul Medeniyet University, Istanbul, Turkey
b
School of Nursing, Loma Linda University, CA, USA
c
Darulaceze Directorate Nursing Home, Istanbul Metropolitan Municipality, Istanbul, Turkey
ARTICLE INFO
Article history:
Received 26 July 2021
Received in revised form 17 September 2021
Accepted 17 September 2021
Available online 25 September 2021
ABSTRACT
This study aimed to evaluate the fear of COVID-19, loneliness, resilience, and quality of life levels in older
adults in a nursing home during the pandemic, and the effects of these variables and descriptive characteris-
tics on their quality of life.
Data were collected using a participant information form, the Mini Mental State Exam (MMSE), the Brief
Resilience Scale, the Fear of COVID-19 Scale (FCV-19S), the Loneliness Scale for Elderly (LSE), and the World
Health Organization Quality of Life-BREF Turkish Version (WHOQOL-BREF-TR). Regarding the WHOQOL-
BREF-TR scale, being male, history of chronic disease, MMSE score, and the changes in sleep pattern signi-
cantly affected the physical dimension (R
2
=0.353, p<0.01) while age, and MMSE and LSE scores signicantly
affected the psychological dimension (R
2
=0.364, p<0.01). Also, the MMSE, FCV-19S, and LSE scores signi-
cantly affected the social relations dimension (R
2
=0.234, p<0.01) while MMSE, FCV-19S, and LSE scores sig-
nicantly affected the environmental dimension (R
2
=0.351, p<0.01).
© 2021 Elsevier Inc. All rights reserved.
Keywords:
COVID-19
Fear
Loneliness
Resilience
Older adults
Nursing home
Quality of life
Introduction
COVID-19 spread quickly across the world following the rst out-
break in Wuhan, China in December 2019. The World Health Organi-
zation (WHO) declared the COVID-19 infectious disease a pandemic
on March 11, 2020.
1
Older adults are the most vulnerable age group
in terms of experiencing more severe symptoms due to physiological
causes (such as decline in immune function, malnutrition, etc.) and
comorbidities (such as hypertension, cardiovascular disease, diabe-
tes, chronic respiratory disease, and chronic kidney disease, etc.), and
having a higher risk of death from COVID-19.
2-5
In Turkey, individuals
aged 65 and over constitute 11% of the reported patient numbers and
72% of deaths.
6
The risk has been reported to be even higher for older
adults living in nursing homes
7
, where approximately two-thirds of
them are infected with COVID-19 within three weeks, and the mor-
tality rate is 33%.
8
The combined effects of the medias constant focus on mortality
rates, especially the high mortality rates in older adults, and the social
isolation, quarantine, and physical distancing measures applied to
prevent the transmission of the disease can adversely affect the psy-
chological health of older adults
9,10
and can be cause vairous prob-
lems, such as fear, anxiety, and loneliness.
2,11,12
Studies have
reported that all older adults groups experienced depression and
anxiety during the COVID-19 pandemic,
13
and the rate of reporting
the fear of COVID-19 increased with age.
14
It has been reported that
the older adults are the age group that is most affected by the fear of
COVID-19 and loneliness in all countries regardless of the levels of
COVID-19 cases and deaths.
15
Studies have indicated that the long-
term restrictive measures implemented around the world, including
Turkey, may lead to increased incidences of loneliness in older adults
living in nursing homes
16
and at home.
9,17
The restrictive measures,
fear, and loneliness could adversely affect the physical, psychological,
mental health, life style, and quality of life (QOL) of older adults.
5,17-20
The term psychological resilience is dened as the ability to adapt
to challenging circumstances in a positive manner.
21
It has been
reported that the restrictions imposed on individuals aged 65 and
over during the COVID-19 pandemic, and the social difculties,
22
fear, stress, and loneliness that the pandemic has generated may
weaken the resilience of older adults and thereby endanger their
health and QOL.
23
According to the WHO, QOL refers to individuals'perceptions of
their position in life and their expectations, standards, and con-
cerns.
24
The concept of QOL in old age has become a major topic of
*Corresponding author at: Istanbul Medeniyet University, Atalar Mah., Sehit Hakan
Kurban Cad., 34862 Cevizli, Kartal/Istanbul, Turkey.
E-mail addresses: cemile.savci@medeniyet.edu.tr (C. Savci), aysecilakinci@gmail.
com (A. Cil Akinci).
https://doi.org/10.1016/j.gerinurse.2021.09.012
0197-4572/$ see front matter © 2021 Elsevier Inc. All rights reserved.
Geriatric Nursing 42 (2021) 14221428
Contents lists available at ScienceDirect
Geriatric Nursing
journal homepage: www.gnjournal.com
interest on account of the current rising population of older adults
and the increase in the length of life. Previous studies have shown
that demographic characteristics,
25
a history of chronic disease,
26
and sleep quality
27
are among the variables that affect the quality of
life of the older adults. A limited number of studies have evaluated
the quality of life of the older adults during the COVID-19 pandemic;
however, their study results have varied from study to study.
1,2
In
one study, half of the older adults over the age of 70 who applied to
the hospital as outpatients during the COVID-19 pandemic reported
that their QOL decreased,
1
while in another study, it was reported
that older adults considered their QOL to be higher compared to that
of the young during the COVID-19 pandemic.
2
In the literature review
conducted for the present study, there was no study found that eval-
uated the QOL and the affecting factors the QOL (such as fear of
COVID-19, loneliness, resilience, age, gender, history of chronic dis-
ease, changing sleep pattern, and mental status, etc.) of older adults
living in nursing homes during the pandemic. Determining the qual-
ity of life of nursing home older adults, one of the groups most vul-
nerable to COVID-19, and the factors that affect their quality of life
will help with planning and implementing interventions to increase
their quality of life. This study aimed to evaluate the fear of COVID-
19, loneliness, resilience, and quality of life levels in older adults in a
nursing home during the pandemic, and the effects of these variables
and descriptive characteristics (age, gender, history of chronic dis-
ease, changing sleep pattern, and mental status) on their QOL.
In this study, the following questions were addressed: i) What are
the fear of COVID-19, loneliness, resilience, and QOL levels of older
adults in nursing homes during the pandemic? ii) Do fear of COVID-
19, loneliness, resilience and descriptive characteristics (age, gender,
history of chronic disease, sleep patterns, and mental health) affect
the QOL of older adults in nursing homes during the pandemic?
Materials and methods
Study design and sample
This study was designed as a descriptive and correlational study.
The study population included 440 older adults residing in a nursing
home afliated with the Istanbul Darulaceze Directorate of Hospice
between April 5, 2021 and May 20, 2021. The inclusion criteria for
the study were as follows: be over 65 years old, voluntarily agree to
participate in the study, have a Standardized Mini Mental Test Score
of 24 or higher, residence within the nursing home for at least one
year, and speak and understand Turkish. Of the population of 440
older adults, 230 did not agree to voluntarily participate in the study,
47 had MMSE test scores below 24, 33 had been living in the nursing
home for less than a year, and 27 had communication problems, and
therefore these individuals were excluded from the study. The nal
sample consisted of the remaining 103 individuals who met the
inclusion criteria for the study.
The older adults residing in the institution where the study was
conducted were housed in a two-storey building that had rooms for
3, 4, 6, 7, and 8 people. A total of 28 nurses, 9 physicians, 2 physio-
therapists, 2 social workers, and 1 food engineer were working in the
nursing home at the time of the study. The in-house psychologist had
recently left the institution at the time of the study. Routine examina-
tions and treatments of the older adults living in the nursing home
were performed in-house, but in cases of emergency or when further
examination was needed, they were referred to the hospital. The
nursing home features a rehabilitation unit where the older adults
are able to socialize, spend their free time, and ply their respective
skills to produce items (knitting, carpet weaving, painting, etc.), for
which they get paid. However, during the collection of the study
data, this unit was closed as a result of the restrictive measures
imposed during the pandemic. The institution has been closed to
visitors during the pandemic, and the older adults residing in the
nursing home have been only allowed to contact their relatives by
telephone.
Data collection forms
The data of the study were collected using a participant information
form, the Mini Mental State Exam (MMSE), the Brief Resilience Scale
(BRS), the Fear of COVID-19 Scale (FCV-19S), the Loneliness Scale for
Elderly (LSE), and the World Health Organization Quality of Life-BREF
Turkish Version (WHOQOL-BREF-TR). The participating older adults
were asked to respond to the questions and scale items in a manner
that best reected their experiences during the pandemic.
Participant Information Form: This form consists of 11 items
related to the descriptive characteristics of the older adults, including
age, gender, marital status, educational status, economic status, pres-
ence of children, duration of stay in the institution, number of people
in the residing room, history of chronic disease, history of COVID-19,
and sleep patterns during the COVID-19 pandemic.
The Mini Mental State Exam (MMSE): MMSE, which was developed
by Folstein et al. in 1975, is a short, standardized questionnaire that can
be used to evaluate global cognition. The MMSE includes a total of 11
items arranged under ve sub-dimensions, namely, orientation (10
points), recording memory (3 points), attention and accountability (5
points), recall (3 points), and language (9 points), and it is evaluated over
a total of 30 points. Scores between 24-30indicate normal cognitive
level, scores between 21-23indicate mild cognitive impairment, and
scores of 20and below indicate moderate to severe cognitive
impairment.
28,29
The MMSE was adapted to the educated portion of Turk-
ish society by G
ungen et al. in 2002,
28
and to the uneducated portion of
Turkish society by Ertan et al. in 1999.
30
In this study, only those older
adults with an MMSE score of 24 and above were included in the study.
Fear of COVID-19 Scale (FCV-19S): The FCV-19S was developed by
Ahorsu et al.
31
to measure COVID-19-induced fear levels. Designed as a
ve-point Likert-type scale, the FCV-19S has seven items, with total pos-
sible scores from the FCV-19S ranging between 7 and 35 points. High
scores indicate higher levels of COVID-19 fear. The Cronbachs alpha
coefcient of the original scale was reported to be .82, while in the Turk-
ish validity and reliability study conducted by Ladikli et al.,
32
the coef-
cient was .80. In this study, the Cronbachs alpha coefcient was .81.
Loneliness Scale for Elderly (LSE): This 24-question scale, which was
developed by Gierveld and Kamphuis in 1985,
33
was revised by van Til-
burg and de Jong Gierveld in 1999.
34
The 3-point Likert-type scale, con-
sisting of 11 items arranged two sub-dimensions, emotional loneliness
and social loneliness, was developed to measure the loneliness levels of
adults and the elderly. The lowest and highest scores possible from the
scale are 0 and 22, respectively. The level of loneliness increases as the
scale score increases. In the Turkish validity and reliability study of the
scale performed by Akg
ul and Ye¸silyaprak in 2015, the internal consis-
tency coefcients were reported as .79 for emotional loneliness, .81 for
social loneliness and .85 for the total scale.
35
In this study, the Cron-
bachs alpha internal consistency coefcients were .76 for emotional
loneliness, .81 for social loneliness, and .75 for the total scale.
The Brief Resilience Scale (BRS): This scale was developed by Smith
et al. in 2008 to measure the psychological resilience of individuals. BRS
is a 5-point Likert-type, 6-item, self-report measurement tool. The total
possible scores obtainable from the scale vary between 6 and 30, with
higher scores indicating higher psychological resilience.
36
In the Turkish
validity and reliability study of the scale performed by Do
gan in 2015,
the Cronbach'salphacoefcient of the scale was .83.
37
In this study, the
Cronbachs alpha coefcient was .89.
World Health Organization Quality of Life-BREF Turkish Version
(WHOQOL-BREF-TR): This scale was created based on the results of
pilot studies performed in 15 centres around the world. From these
pilot studies, the 5-point Likert-type WHOQOL-BREF, consisting of 26
C. Savci et al. / Geriatric Nursing 42 (2021) 14221428 1423
questions selected from the 100-question WHOQOL-100 scale, was
developed. Physical, psychological, social, and environmental dimen-
sion scores are calculated for all items, except for the rst two general
items. The physical, psychological, social, and environmental dimen-
sion scores calculated using a formula vary between 0-100%, and the
QOL increases as the score increases.
38
The internal consistency coef-
cients of the scale adapted to Turkish were reported as .76, .67, .56
and .74 for the physical, psychological, social, and environmental
dimensions, respectively.
39
In this study, the internal consistency
coefcients were .68, .78, .61 and .76 for the physical, psychological,
social, and environmental dimensions, respectively.
Ethical considerations
This study was conducted in accordance with the principles outlined
in the Declaration of Helsinki. Ethics committee approval (30.12.2020/47)
and institutional permission (01.04.2021/730.10-E.2127) were obtained
for the implementation of the study. The third researcher, who is a nurse
in the institution, shared the Google survey form link with the 333 older
adults in nursing homes who met the inclusion criteria by mobile phone
(e-mail or WhatsApp) in accordance with the principle of voluntary par-
ticipation. In the e-mail/ WhatsApp, participants were informed about
the purpose of the study, and those that marked the I agree with partici-
pating in the surveyexpression at the top of the Google Form were
requested to ll out the form. The researcher, who works at this institu-
tion, helped 70 adults who wanted to complete the form but could not
do so on their own and verbally asked for the help of the researcher, to
partially or fully complete the form. The study was completed with 103
older adults.
Data analysis
To analyse the data, the SPSS 22 (Statistical Package for Social Scien-
ces Inc, IL, USA) package program was used. Number, percentage, mean,
standard deviation, and minimum and maximum values were calcu-
lated in descriptive statistics for categorical and continuous variables.
Shapiro Wilks, skewness and kurtosis values were used to determine
the conformity of the data to the normal distribution, and Pearson cor-
relation coefcient was used to examine the relationship between two
normally distributed quantitative variables. Multiple linear regression
analysis was performed to determine the factors associated with the
physical, psychological, social, and environmental dimensions of the
QOL. The level of signicance was considered as p<0.05.
Results
Participant characteristics
Theageoftheparticipantsrangedfrom65to94years,with
the mean age being 73.33§6.66 years, and the MMSE scores were
between 24 and 30, with a mean score of 27.40§1.90. Further-
more,79.6%oftheparticipantsweremale,95.1%weresingle,
39.8% were primary school graduates, and 86.4% had a moderate
economic status. The duration of stay in the institution for 54.4%
of the participants was 1-5 years, only 17.5% of the participants
had children, and 90.3% of them stayed in a room with four or
more people. Of the almost half (45.6%) the participants who had
COVID-19, 79.6% had a history of chronic disease, and 81.6% of
the participants had no change in sleep patterns during the pan-
demic (Table 1).
Distribution of the mean FCV-19S, LSE, BRS, and WHOQOL-BREF-TR scores
The mean FCV-19S score of the participants was 19.13§4.28 (11-29),
the mean LSE score was 8.92§4.56 (0-20), and the mean BRS score was
18.25§1.73 (15-22). The mean scores on the physical dimension, mental
dimension, social relations dimension, and environmental dimension of
the Short Form WHOQOL-BREF-TR were 60.47§13.06 (17.86-82.14),
67.19§13.52 (33.33-100), 56.71§16.75 (8.33-100), and 66.74§11.10
(37.50-96.88), respectively (Table 2).
Table 1
Characteristics of the participants (N=103).
Characteristics Mean§SD Min-Max
Age (year) 73.33§6.66 (65-94)
MMSE score 27.40§1.90 (24-30)
Characteristics n %
Gender
Male 82 79.6
Female 21 20.4
Marital status
Married 5 4.9
Single (never married,
widowed, divorced)
98 95.1
Educational status
Literate 8 7.8
Primary school 41 39.8
Secondary school 23 22.3
High school 24 23.3
Undergraduate 7 6.8
Economic status
Good 11 10.7
Moderate 89 86.4
Poor 3 2.9
Presence of children
Yes 18 17.5
No 85 82.5
Duration of stay in the institution
1-5 years 56 54.4
6-10 years 24 23.3
More than 11 years 23 22.3
Number of people in the shared room
Three 10 9.7
Four or more 93 90.3
History of chronic disease
Yes 82 79.6
No 21 20.4
History of COVID-19
Yes 47 45.6
No 56 54.4
Sleep patterns during the COVID-19 pandemic
No change. 84 81.6
I sleep less. 11 10.7
I sleep more. 2 1.9
I wake up frequently at night. 2 1.9
I have difculty falling asleep. 4 3.9
Total 103 100
Table 2
Distribution of the mean FCV-19S, LSE, BRS, and WHOQOL-BREF-TR scores.
Scales Min Max Mean§SD
Fear of COVID-19 Scale 11.00 29.00 19.13§4.28
Loneliness Scale for Elderly 0.00 20.00 8.92§4.56
The Brief Resilience Scale 15.00 22.00 18.25§1.73
WHOQOL-BREF-TR
Physical dimension 17.86 82.14 60.47§13.06
Mental dimension 33.33 100.00 67.19§13.52
Social relations dimension 8.33 100.00 56.71§16.75
Environmental dimension 37.50 96.88 66.74§11.10
FCV-19S: Fear of COVID-19 Scale; LSE: Loneliness Scale for Elderly; BRS: The Brief
Resilience Scale; WHOQOL-BREF (TR): World Health Organization Quality of Life BREF
Turkish Version (TR).
1424 C. Savci et al. / Geriatric Nursing 42 (2021) 14221428
Correlation between Age, MMSE, FCV-19S, LSE, BRS, and short form
WHOQOL-BREF-TR
There was a weak, negative correlation between age and the
mean scores on the mental dimension and environmental dimension
of the Short Form WHOQOL-BREF-TR (p<0.05) and a positive correla-
tion between the MMSE and the mean scores on all dimensions of
the Short Form WHOQOL-BREF-TR (p<0.01). A positive, weak corre-
lation was found between FCV-19S and the mean scores on the envi-
ronmental dimension of the Short Form WHOQOL-BREF-TR (p<0.05)
and a weak, negative correlation between the mean total score of the
LSE and the mean scores on all dimensions of the Short Form WHO-
QOL-BREF-TR (p<0.05). There was no statistically signicant correla-
tion between the BRS and Short Form WHOQOL-BREF-TR dimensions
(Table 3).
The factors affecting quality of life
Being male (b: -.045), history of chronic disease (b: -.236), MMSE
score (b: .387), and changes in sleep pattern (b: -.198) signicantly
affected scores on the physical dimension of the QOL scale (R
2
=0.353,
p<0.01). Age (b: -.215), MMSE score (b: .354) and LSE score (b: -.234)
signicantly affected scores on the mental dimension (R
2
=0.364,
p<0.01). MMSE score (b: .277), FCV-19S score (b: .231), and LSE score
(b: -.264) signicantly affected scores on the social relations dimen-
sion. Finally, MMSE score (b: .296), FCV-19S score (b: .319) and LSE
score (b: -.336) signicantly affected scores on the environmental
dimension (R
2
=0.351, p <0.01) (Table 4).
Discussion
The mean FCV-19S score of the older adults residing in a nursing
home in Turkey during the COVID-19 pandemic was 19.13§4.28,
which means that their fear was moderate considering the minimum
and maximum values that the scale can take. In a study conducted in
Greece at the beginning of the COVID-19 pandemic, the FCV-19S
score of older adults was reported to be 18.48§5.32.
40
In another
study conducted in Turkey in June 2020, it was reported that individ-
uals over the age of 65 had a moderate level of fear of COVID-19.
41
The results of both studies are similar to the results of the present
study. The moderate level of fear experienced by the older adults in
the present study could be attributed to the facts that the data for
this study were collected in the latter stages of the pandemic, that
the older adults in the nursing home had information about COVID-
19, that vaccination studies had started, and that approximately half
of them had had COVID-19.
In this study, the older adults had a mean LSE score of 8.92§4.56,
indicating, based on the minimum and maximum values that the
scale can take, that the older adultslevel of loneliness was low. Pre-
vious studies conducted in Turkey before the onset of COVID-19
reported that the level of loneliness of older adults in nursing homes
was low,
42
while studies on this subject conducted during the pan-
demic reported that the loneliness levels of older adults was moder-
ate in Turkey,
43
low in Greece,
40
and moderate in Australia.
44
A study
conducted in the USA reported that 26% of individuals aged 60 and
over experienced loneliness.
45
Although all these results support to
some degree the results obtained from the present study, contrary to
Table 3
Correlation between Age and the mean MMSE, FCV-19S, LSE, BRS, and Short Form WHOQOL-BREF-TR scores.
Physical dimension Mental dimension Social relations dimension Environmental dimension
Age r -.095 -.354** -.150 -.234*
p .339 .000 .130 .017
MMSE r .469*** .432*** .328** .365***
p<.001 <.001 .001 <0.001
FCV-19S r -.109 .118 .173 .221*
p .274 .236 .081 .025
LSE r -.233*-.312** -.223*-.354***
p .018 .001 .024 <0.001
BRS r .117 .133 -.067 .103
p .239 .179 .499 .302
Pearson Correlation.
** ***p<0.001, **p<0.01
*p<0.05, MMSE: The Mini Mental State Exam; FCV-19S: Fear of COVID-19 Scale; LSE: Loneliness Scale for Elderly; BRS: The Brief Resilience Scale; WHOQOL-BREF-TR: World
Health Organization Quality of Life BREF - TR.
Table 4
Multiple linear regression analysis of the factors that affect quality of life.
Physical dimension bMental dimension bSocial relations dimension bEnvironmental dimension b
Age -.055**** -.215*** -.006**** -.076****
Gender -.045*** .030**** .026**** -.027****
History of chronic disease -.236** -.149**** -.134**** -.126****
MMSE .387*.354*.277** .296**
FCV-19S -.013**** .140**** .231*** .319**
Change in sleep pattern -.198*** .041**** -.103**** -.112****
LSE -.155**** -.234*** -.264*** -.336**
BRS -.015**** .090**** -.145**** .031****
R .594 .603 .484 .593
R
2
.353 .364 .234 .351
DR
2
.298 .310 .169 .296
F 6.407* 6.727* 3.599** 6.358*
p<.001 <.001 .001 <.001
*p<0.001.
** p<0.01.
*** p<0.05.
**** p>0.05, Codes are as follows: 0=Female, 1=Male for sex; 0= no change, 1= there is a change for sleep pattern, 0=no, 1=yes for chronic disease.
C. Savci et al. / Geriatric Nursing 42 (2021) 14221428 1425
the present studys results, one study reported that 57% of people
over 70 years of age who were hospitalized during the COVID-19
pandemic experienced loneliness.
46
On the dates during which the
study was conducted, the institution was completely closed to visi-
tors within the scope of the restrictive measures applied to nursing
homes. Moreover, the psychologist had recently left the institution,
and the rehabilitation centre, which plays a key role in the ability of
the older adults living in the nursing home to socialize, was closed.
Such factors could have negatively impacted the QOL of the older
adults in the nursing home. According to a study, in nursing homes,
sharing a room with three to ve friends and having the opportunity
to engage in daily conversations with roommates support social
interaction.
47
Phone calls and video calls involving discussion of posi-
tive topics to make up for the absence of physical visits for older
adults in nursing homes has been reported to be a good form of social
support to eliminate the feeling of loneliness.
48
The fact that the older
adults included in this study stayed in the same room with at least
three people, had social interaction with the personnel who provide
health care, food, and cleaning services in the nursing home, and had
opportunities to communicate with their families and loved ones
with the help of technological tools may have contributed to their
low levels of loneliness.
In this study, the mean BRS score was 18.25§1.73, indicating,
based on the minimum and maximum values that the scale can take,
that the resilience of the older adults was moderate. Similar to the
results obtained from the present study, one study reported that the
mean BRS score was 19.41§2.67 in individuals over the age of 65 dur-
ing the COVID-19 process.
19
Psychological resilience refers to an indi-
vidual's ability to successfully overcome adverse conditions and
adapt to a new situation.
36
While loneliness, negative feelings, and
mental illness negatively affect resilience,
45,49,50
well-being, social
networking, and positive feelings positively affect resilience.
49,50
The
moderate level of psychological resilience seen in this study corre-
sponded with the older adultsmean MMSE scores of 24 and above,
their moderate fear of COVID-19 and low levels of loneliness, and the
negative circumstances they faced during the pandemic, such as sep-
aration from loved ones.
In this study, the QOL of the older adults in the nursing home was
slightly above average according to their scores on the physical
dimension, mental dimension, social relations dimension, and envi-
ronmental dimension of the Short Form WHOQOL-BREF-TR. While
the dimensions of the QOL most affected by the pandemic were the
social relations and physical dimensions, the least affected were the
mental dimension and the environmental dimension. In three studies
conducted with older adults living in nursing homes before the pan-
demic in Turkey
51,52
and in a study conducted with older adults dur-
ing the pandemic in Australia, it was reported that the older adults
had an above average score on the QOL scale, with the highest scores
being in the environmental and physical dimensions and the lowest
score being in the social relations dimension.
44
According to the
results of the present study, the older adultssocial QOL was least
affected by the pandemic, while their mental and environmental QOL
were most affected. The social relations dimension of the scale, which
was a factor used to evaluate the QOL in this study, addresses rela-
tions with other people, sexual life, and satisfaction with the support
of friends. In evaluating the frequency of the responses to these spe-
cic areas, it was determined that the relations with other people
and the level of satisfaction with the support of friends were high,
whereas satisfaction with sexual life was low. These results were
attributed to the fact that 95.1% of the older adults living in the nurs-
ing home were single. In this study, the physical dimension was the
second most affected area of QOL during the COVID-19 pandemic.
The physical dimension of the scale addresses the ability to maintain
daily life and the level of satisfaction with this ability. The curfews
and prolonged lockdowns applied to older adults during the
pandemic likely affected their daily life and contributed to their
decrease in the quality of physical life. According to the results of the
study, the older adultsmental and environmental QOL scores after
COVID-19 were at the highest level. The mental dimension of the
scale addresses physical and mental satisfaction with life and self-sat-
isfaction in general. Under the environmental dimension of the scale,
satisfaction with the opportunities offered in the living environment,
the feeling of safety in this environment, and the opportunities to
meet physical, intellectual, and mental needs are addressed in gen-
eral. The activities and care services provided in the nursing home
where the study was conducted and the sharing of a room with at
least three people or living with peers likely contributed to meeting
the physical, intellectual, and mental needs of the older adults in the
study, and therefore, their mental and environmental dimension
scores were high.
In the study, while being male, having a history of chronic disease,
and experiencing a change in sleep patterns negatively affected the
physical dimension of the QOL, high MMSE score had a positive effect
on this dimension. Contrary to the present studys results, other stud-
ies have reported no indication of there being a relationship between
gender and physical health in older adults during the pandemic
44
or
of men having better physical health than that of women.
51,52
The
results from the present study could be attributed to the fact that the
majority of the participating older adults were male. In a study con-
ducted in a nursing home before the pandemic, it was reported that
the physical QOL of those without chronic diseases was higher, which
supports the present studys results.
52
The mean MMSE score of
above 24 obtained by the older adults in the present study indicates
that they easily understood and complied with the information and
measures related to COVID-19, which positively affected their physi-
cal QOL. Older people need fewer hours of sleep. However, they do
need sufcient sleep for physiological and psychological functions
and to keep their quality of life at optimum levels.
53
In a study con-
ducted at an adult day care centre before the pandemic, it was found
that the older adults with sleep disorders were inadequately able to
maintain their physical functions and had physical and emotional
role difculties.
54
Based on this, it could be argued that the lack of
change in sleep patterns of the older adults in this study during the
pandemic helped to sustain their physical ability and satisfaction
with their daily lives in the nursing home.
In the study, age and LSE score negatively affected the mental
dimension of the QOL, while MMSE score positively affected it. The
low mental QOL was believed to be due to the difculties that the
decrease in physical and mental functions attending old age create in
adapting to an adverse situation like the pandemic. In one study, it
was reported that loneliness negatively affected mental health,
44
in
another study, it was reported that loneliness predicted the mental
health dimension of QOL.
52
Accordingly, practices aimed at reducing
loneliness and protecting and improving mental functions of older
adults in nursing homes would be useful for keeping their mental
health at a high level.
In this study, the MMSE score and FCV-19S score positively
affected the scores on the social relations dimension of the QOL,
while the LSE score had a negative effect. The participating older
adultsMMSE scores of 24 and above suggest that they had positive
relations with others. In one of the more surprising results, the older
adults with a high fear of COVID-19 had high scores in the social rela-
tions dimension, which could be attributed to the sense of safety that
these older adults felt as a result of the measures taken in the nursing
home and to their physical, social, intellectual and mental needs
being met in the nursing home. It was reported in one study that
loneliness negatively affected the social health of older adults during
the pandemic, which supports the results of the present study.
44
In a
study conducted in a nursing home before the pandemic in Turkey,
the mean social relations dimension score obtained by older adults
1426 C. Savci et al. / Geriatric Nursing 42 (2021) 14221428
on the QOL was reported to be lower in those who were experiencing
loneliness.
52
These results point to the importance of evaluating indi-
viduals who have a high level of loneliness, as indicated by low social
QOL, and taking measures to reduce the level of loneliness in order to
increase social QOL.
In this study, the MMSE score and the FCV-19S score posi-
tively affected the environmental dimension of the QOL, whereas
theLSEscorehadanegativeeffect.Thestudyparticipants'mean
MMSE score of 24 and above suggests that they were adept at
making lifestyle changes and adapting to the environment. The
older adults who had a high fear of COVID-19 also had a high
score in the environmental dimension, which was surprising. This
high environmental QOL of the older adults who had a fear of
COVID-19 could be attributed to the feeling of safety they had
due to the COVID-19-related restrictions and measures imple-
mented in the nursing home environment. Contrary to the pres-
ent studys results, it was reported in one study that loneliness
was not associated with environmental health.
44
Limitations and strengths of the study
This study has a single-center design and is limited by its small
sample size. The participants includes older adults who are able to ll
out the Google survey form link (sufcient cognitive levels, speak
and understand Turkish) and, therefore, the results cannot be gener-
alized to the overall of older adults in a nursing home during the pan-
demic. However, this study is the rst to evaluate the fear of COVID-
19, loneliness, resilience, and QOL levels in older adults in a nursing
home during the pandemic, and the effects of these variables and
descriptive characteristics on their QOL. The results of the study,
therefore, will ll the gap in the research on this topic.
Conclusion
In this study, COVID-19 fear levels were moderate, loneliness lev-
els were low, resilience levels were moderate, and all dimensions of
QOL in the older adults living in the nursing home during the pan-
demic were slightly above the moderate level. The social relations
and physical dimensions had the most impact on QOL, while the
mental and environmental dimensions had the least. Being male,
having a history of chronic disease, and experiencing a change in
sleep patterns negatively affected the physical dimension of the QOL,
while mental status had a positive effect on it. Age and loneliness
negatively affected the mental dimension of QOL, whereas mental
status had a positive effect, and lastly, mental status and fear of
COVID-19 had positive effects on the social relations and environ-
mental dimensions of QOL, while loneliness had a negative effect.
Based on these results, it is recommended that initiative be
applied to protect the mental status, provide regular sleep patterns,
and reduce loneliness levels in order to increase the QOL of older
adults in nursing homes during the pandemic. It is further recom-
mended that older adults living in nursing homes be provided with
various means of communication, like the telephone, e-mail, and
video chat and mobile applications, to prevent loneliness and
increase QOL. Lastly, due to the positive effect that a high level of fear
was shown to have on the social relations and environmental dimen-
sions of the QOL, it is recommended that fear should be considered as
a protective health factor as opposed to viewing it in the traditional
way as a factor that negatively affects health.
Financial disclosure
The authors declared that this study has received no nancial
support.
Note
Research has not been published in Turkey or abroad, in Turkish
or any other language, or has not been sent to a journal for publica-
tion. It has not been previously communicated at a congress.
Authorship statement
This study was designed and conceptualized by CS, ACA, SYU, FK.
Analysis of research data was done by CS, ACA and CS, ACA, SYU, FK con-
tributed in data gathering and interpretation, agreeing on the design
and scrutinizing the technical content and write ups of the full manu-
script. CS, ACA, SYU, FK after nal review of the revised version of the
manuscript agreed and approved to be submitted for publication.
Ethical considerations
This study was conducted in accordance with the principles out-
lined in the Declaration of Helsinki. Ethics committee approval
(30.12.2020/47) and institutional permission (01.04.2021/730.10-
E.2127) were obtained for the implementation of the study.
Declaration of Competing Interest
The authors declare that there is no conict of interest.
Acknowledgement
The authors would like to thank all participating in this study.
References
1. WHO. Novel Coronavirus (2019-nCoV) Situation Report 51. 2020. Geneva.
2. Altin Z. Covid-19 pandemisinde yaslilar (Elderly people in Covid-19 outbreak).
Tepecik Egit ve Arast Hast Dergisi. 2020;30(Ek sayı):4957. https://doi.org/10.5222/
terh.2020.93723.
3. Wilson N, Kvalsvig A, Barnard LT, Baker MG. Case-fatality risk estimates for COVID-
19 calculated by using a lag time for fatality. Emerg Infect Dis. 2020;26(6):1339
1441. https://doi.org/10.3201/eid2606.200320.
4. Morley JE, Vellas B. COVID-19 and older adults (Editorial). J Nutr Health Aging.
2020;24(4):364365.
5. Girdhar R, Srivastava V, Sethi S. Managing mental health issues among elderly dur-
ing COVID-19 pandemic. J Geriatr Care Res. 2020;7(1):3235.
6. Ministry of Health COVID-19 WeeklyStatus Report 12/10/2020 18/Oct/2020Turkey.
Access date, 01 July 2021, https://covid19.saglik.gov.tr/Eklenti/39168/0/ covid-19-haf-
talik-durumraporu42haftapdf.pdf?_tag1=710A3D148C11F8852B0DDC1FB4EE49-
DAE667F46D.
7. Fallon A, Dukelow T, Kennelly SP, ONeill D. COVID-19 in nursing homes. QJM.
2020;113(6):391392.
8. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, et al. Epide-
miology of Covid-19 in a long-term care facility in King County, Washington. N
Engl J Med. 2020;382(21):20052011. https://doi.org/10.1056/NEJMoa2005412.
9. Whitehead BR, Torossian E. Older adultsexperience of the COVID-19 pandemic: a
mixed-methods analysis of stresses and joys. Gerontologist. 2021;61(1):3647.
https://doi.org/10.1093/geront/gnaa126.
10. Birditt KS, Turkelson A, Fingerman KL, Polenick CA, Oya A. Age differences in stress,
life changes, and social ties during the COVID-19 pandemic: implications for psy-
chological well-being. Gerontologist. 2021;61(2):205216. https://doi.org/
10.1093/geront/gnaa204.
11. Van Tilburg TG, Steinmetz S, Stolte E, van der Roest H, de Vries DH. Loneliness and
mental health during the COVID-19 pandemic: a study among Dutch older adults
[published online ahead of print, 2020 Aug 5]. J Gerontol B Psychol Sci Soc Sci. 2020.
https://doi.org/10.1093/geronb/gbaa111.
12. Sarangi A, Nelson J. A descriptive study evaluating the impact of COVID-19 on
delivery of care and mental health of geriatric nursing home staff. Am J Geriatr Psy-
chiatry. 2021;29(4):121122. https://doi.org/10.1016/j.jagp.2021.01.116.
13. Meng H, Xu Y, Dai J, Zhang Y, Liu B, Yang H. Analyze the psychological impact of
COVID-19 among the elderly population in China and make corresponding sugges-
tions. Psychiatry Res. 2020;289: 112983. https://doi.org/10.1016/j.
psychres.2020.112983.
14. Ni~
no M, Harris C, Drawve G, Fitzpatrick KM. Race and ethnicity, gender, and age on
perceived threats and fear of COVID-19: evidence from two national data sources.
SSM - Popul Health. 2021;13: 100717. https://doi.org/10.1016/j.
ssmph.2020.100717.
C. Savci et al. / Geriatric Nursing 42 (2021) 14221428 1427
15. Lo Coco G, Gentile A, Bosnar K, Milovanovi
c I, Bianco A, Drid P, Pi
sot S. A cross-
country examination on the fear of COVID-19 and the sense of loneliness during
the rst wave of COVID-19 outbreak. Int J Environ Res Public Health. 2021;18
(5):2586. https://doi.org/10.3390/ijerph18052586.
16. Madden A, Leen B. Evidence summary: what is the impact of the coronavirus pan-
demic on the mental health of elderly nursing home residents? [v1. 0], 2020.
17. Macdonald B, H
ul
ur G. Well-being and loneliness in swiss older adults during the
COVID-19 pandemic: the role of social relationships. Gerontologist. 2021;61:240
250. https://doi.org/10.1093/geront/gnaa194.
18. Jeste DV, Di Somma S, Lee EE, Nguyen TT, Scalcione M, Biaggi A, et al. Study of lone-
liness and wisdom in 482 middle-aged and oldest-old adults: a comparison
between people in Cilento, Italy and San Diego, USA. Aging Mental Health. 2020:1
11. https://doi.org/10.1080/13607863.2020.1821170.
19. Kaelen S, van den Boogaard W, Pellecchia U, Spiers S, De Cramer C, Demaegd G,
et al. How to bring residentspsychosocial well-being to the heart of the ght
against Covid-19 in Belgian nursing homesa qualitative study. Plos One. 2021;16:
(3) e0249098. https://doi.org/10.1371/journal.pone.0249098.
20. Chakrawarty A, Ranjan P, Klanidhi KB, Kaur D, Sarkar S, Sahu A, et al. Psycho-social
and behavioral impact of COVID-19 on middle-aged and elderly individuals: a
qualitative study. J Educ Health Promot. 2021;10:269. https://doi.org/10.4103/jehp.
jehp_1458_20.
21. Manyena SB. The concept of resilience revisited. Disasters. 2006;30(4):434450.
https://doi.org/10.1111/j.0361-3666.2006.00331.x.
22. Set Z. Covid-19 surecinde 65 yas ve uzeri bireylerin psikolojik saglamlık duzeyleri:
cesitli degiskenler acisindan bir degerlendirme (Psychological resilience levels of
individuals aged 65 and over in the Covid-19 process: An evaluation in terms of
various variables). Electron Turk Stud. 2020;15(6):10511063.
23. Plagg B, Engl A, Piccoliori G, Eisendle K. Prolonged social isolation of the elderly
during COVID-19: between benet and damage. Arch Gerontol Geriatr. 2020;89:
104086. https://doi.org/10.1016/j.archger.2020.104086.
24. WHO, 2015. World Health Organization, World Report on Ageing and Health.
Access date, 01 July 2021, http://apps.who.int/iris/bitstream/10665/186463/
1/9789240694811_eng.pdf.
25. Efklides A, Kalaitzidou M, Chankin G. Subjective quality of life in old age in Greece:
the effect of demographic factors, emotional state and adaptation to aging. Eur
Psychol. 2003;8(3):178191. https://doi.org/10.1027/1016-9040.8.3.178.
26. Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TT, Pham KM, et al. People with
suspected COVID-19 symptoms were more likely depressed and had lower health-
related quality of life: the potential benet of health literacy. J Clin Med. 2020;9
(4):965. https://doi.org/10.3390/jcm9040965.
27. Tel H. Sleep quality and quality of life among the elderly people. Neurol Psychiatry
Brain Res. 2013;19(1):4852. https://doi.org/10.1016/j.npbr.2012.10.002.
28. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for
grading the cognitive state of patients for the clinician. J Psych Res. 1975;12
(3):189198.
29. Gungen CD, Ertan T, Eker E, Yasar R, Engin F. Reliability and validity of The Stan-
dardized Mini Mental State Examination in the diagnosis of mild dementia in Turk-
ish population. Turkish Journal of Psychiatry. 2002;13(4):273281. PMID:
12794644.
30. Ertan T, Eker E, Gungen C. The Standardised Mini Mental State Examination for
illiterate Turkish elderly poupulation: SMMSE-E. 2nd International Symposium on
Neurophysiological and Neuropsychological Assessment of Mental and Behavioral Dis-
orders. Bursa, Turkey: 1999.
31. Ahorsu DK, Lin C-Y, Imani V, Saffari M, Grifths MD, Pakpour AH. The Fear of
COVID-19 Scale: development and initial validation. Int J Mental Health Addict.
2020:19. [Internet]Available from; https://pubmed.ncbi.nlm.nih.gov/32226353.
32. Ladikli N, Bahadir E, Yumusak FN, Akkuzu H, Karaman G, Turkkan Z. Turkish reli-
ability and validity study of the Kovid-19 Fear Scale. International Journal of Social
Sciences. 2020;3(2):7180.
33. De Jong-Gierveld J, Kamphuls F. The development of a Rasch-type loneliness scale. Appl
Psychol Measure. 1985;9(3):289299. https://doi.org/10.1177/014662168500900307.
34. De Jong Gierveld J, Van Tilburg T. Manual of the Loneliness Scale 1999. Amsterdam:
Department of Social Research Methodology, Vrije Universiteit Amsterdam; 1999.
(Updated from the printed version 1801 02: 7-5-2021).
35. Akgul H, Yesilyaprak B. Adaptation of the Loneliness Scale for the Elderlyto Turkish
culture: Validi ty and relia bility study. YaslıSorunlari ArastirmaDergisi. 2015;8(1).
36. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Jennifer Bernard J. The brief resil-
ience scale: Assessing the ability to bounce back. Int J Behav Med. 2008;15:194200.
37. Dogan T. Kisa Psikolojik Saglamlik Olceginin Turkce uyarlaması: Gecerlik ve guve-
nirlik calısmasi (Adaptation of the Brief Resilience Scale into Turkish: a validity
and reliability study). J Happiness Well-Being. 2015;3(1):93102.
38. Group The WHOQOL. Development of the World Health Organization WHOQOL-
BREF quality of life assessment. Psychol. Med. 1998;28(3):551558.
39. Eser E, Fidaner H, Fidaner C, Eser SY, Elbi H, Goker E. WHOQOL-100 ve WHOQOL-
BREFin psikometrik
ozellikleri (Psychometric properties of tlte WHOQOL-100 and
WHOQOLBREF). Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi. 1999;7(Suppl
2):2340.
40. Parlapani E, Holeva V, Nikopoulou VA, Sereslis K, Athanasiadou M, Godosidis
A, et al. Intolerance of uncertainty and loneliness in older adults during the
COVID-19 pandemic. Front Psychiatry. 2020;11:842. https://doi.org/10.3389/
fpsyt.2020.00842.
41. Durmus M, Durar E. The relationship between spiritual well-being and fear of
COVID-19 among Turkish elders. J Relig Spiritual Aging. 2021:114. https://doi.org/
10.1080/15528030.2021.1894627.
42. Eskimez Z, Demirci PY, Tosun Oz IK, Oztunc G, Kumas G. Loneliness and social sup-
port level of elderly people living in nursing homes. Int J Caring Sci. 2019;12
(1):465474.
43. Aung K, Nurumal MS, Bukhari WNSW. Loneliness among elderly in nursing homes.
Int J Stud Child Women Elder Disabl. 2017;2:7278.
44. Strutt PA, Johnco CJ, Chen J, Muir C, Maurice O, Dawes P, et al. Stress and coping in
older Australians during COVID-19: health, service utilization, grandparenting,
and technology use. Clin Gerontol. 2021:113. https://doi.org/10.1080/
07317115.2021.1884158.
45. Sams N, Fisher DM, Mata-Greve F, Johnson M, Pullmann MD, Raue PJ, et al. Under-
standing psychological distress and protective factors amongst older adults during
the COVID-19 pandemic. Am J Geriatr Psychiatry. 2021;29(9):881894. https://doi.
org/10.1016/j.jagp.2021.03.005.
46. Bailey L, Ward M, DiCosimo A, Baunta S, Cunningham C, Romero-Ortuno R, et al.
Physical and mental health of older people while cocooning during the COVID-19
pandemic. QJM. 2021:16. https://doi.org/10.1093/qjmed/hcab015.
47. Chow L. Care homes and COVID-19 in Hong Kong: how the lessons from SARS were
used to good effect. Age Ageing. 2021;50(1):2124. https://doi.org/10.1093/age-
ing/afaa234.
48. Turk A. COVID-19 pandemisi s
urecinde yaslılara yonelik uygulamalar ve yaslilarin
psiko-sosyal durumu uzerine bir degerlendirme. Sosyal Hizmet. 2020:3546.
49. Kaye-Kauderer H, Feingold JH, Feder A, Southwick S, Charney D. Resilience in the
age of COVID-19. BJPsych Adv. 2021;27(3):166178. https://doi.org/10.1192/
bja.2021.5.
50. Rodríguez-Gonz
alez R, Facal D, Martínez-Santos AE, Gandoy-Crego M. Psychologi-
cal, social and health-related challenges in Spanish older adults during the lock-
down of the COVID-19 rst wave. Front Psychiatry. 2020;11:1393. https://doi.org/
10.3389/fpsyt.2020.588949.
51. Baglama SS, Bakir E, Koleoglu S, Disli E, Cirak K. Huzurevinde kalan ya¸slıların
ya¸
sam kalitesi:
Oz
url
ul
uk ve ila¸c kullanımının etkisi? (The life quality of elderly
nursing home residents: disability and the effect of drug use?). ACU Sa
glık Bil Derg.
2019;10(2):277281.
52. Ilhan N, Arpaci S, Havaoglu D, Kalyoncuoglu H, Sari P. Quality of life and factors
affecting the quality of life of elderly nursing home residents. Clin Exp Health Sci.
2016;6(2):5665. https://doi.org/10.5152/clinexphealthsci.2016.0052.
53. Reid KJ, Martinovich Z, Finkel S, Statsinger J, Golden R, Harter K, Zee PC. Sleep: a
marker of physical and mental health in the elderly. Am J Geriatr Psychiatry.
2006;14(10):860866. https://doi.org/10.1097/01.JGP.0000206164.56404.ba.
54. Ozvurmaz S, Asgarpour H, Gunes Z. Yaslilarda uyku kalitesi ve yasam kalitesi ara-
sindaki iliski: kesitsel bir calisma (Relationship of quality of sleep and quality of
life in elderly: crosssectional study). Med Sci. 2018;13(3):7279. https://doi.org/
10.12739/NWSA.2018.13.3.1.
1428 C. Savci et al. / Geriatric Nursing 42 (2021) 14221428
... Higher mortality rates due to the disease were reported worldwide before the vaccine was made widely available, and older adults living in long-term care facilities (nursing homes or residential care facilities) were even more vulnerable [1]. Several countries imposed restrictions on external visits and internal activities to contain the spread of the disease [2][3][4], which was indeed more dangerous within institutions where highly susceptible people were clustered in one place [1] and where higher mortality rates due to the disease were reported [5]. The lack of activities and family visits affected the older adults living in these institutions worldwide, who were further isolated due to the demands of the restrictive measures, presenting increased depressive symptoms and anxiety, reduced mental acuteness, physical capacity, well-being, and quality of life due to the lack of social connectedness and other factors [6,7]. ...
... QoL is measured based on the individuals' perceptions (a subjective measure of well-being), focusing on their overall satisfaction or dissatisfaction with different aspects of their lives, e.g., physical and mental/emotional well-being, social relationships, and environment [18]. A limited number of studies have assessed the QoL of older adults living in long-term care facilities during the COVID-19 pandemics [5,18] using a pre-post intervention design such as in this study. ...
Preprint
Full-text available
Background : The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults’ daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions, although this three-fold effect was not yet investigated. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers. Methods : This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities return and the second round after one month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents’ daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution. Results : Using a Wilcoxon signed-rank test, the analyses indicated improvements after the one month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z -2.332, p< .05), residents their overall health (Z -2.409, p< .05) and employees in their overall QoL perception (Z -2.714, p< .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL. Conclusions : Evidence from this study suggests that volunteers’ return positively impacted different QoL aspects for volunteers, residents, and employees.
... According to the data of Ministry of Health, older adults constitute 11% of the reported patients and 72% of deaths. 9 After the first case was seen in Turkey on March 11, 2020, various measures were taken across the country for all people, but especially for older adults. A partial curfew was introduced for older adults and those with chronic diseases. ...
... There are previous studies conducted before the pandemic regarding health literacy level of older adults, [23][24][25] and several studies related to fear of COVID-19 during the pandemic. 9,13,29,30 However, a gap exists in the literature regarding whether there is a relationship between fear of COVID-19 and health literacy levels in older adults during the pandemic. It is thought that determining the fear of COVID-19, health literacy levels, and the associated factors in older adults could lead to an increase in the awareness of older adults about the prevention and control of the disease, and guide healthcare professionals in their education of older adults. ...
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This study aimed to examine the fear of coronavirus and the health literacy levels of older adults during the pandemic. The sample consisted of 304 older adults from five family health centers in Turkey between April and May 2021. The data were collected using the Fear of COVID-19 Scale and the Health Literacy Scale. The fear of COVID-19 was found to be higher in women, those with chronic diseases, and those who found the epidemic measures insufficient (p < 0.05). The health literacy level was found to be higher in those with high education level, those in the 65-74 age group, and those with not using regular medicine (p < 0.001). The health literacy of older adults was a slightly above moderate level and the fear of COVID-19 was at a moderate level. Health literacy levels of older adults may be increased with written, visual, and verbal health trainings.
... Finally, among the elderly, those institutionalized are worth higher attention, due to the risk of loneliness and social isolation, deriving from the closure of healthcare facilities and the ban of visits by parents, relatives, and friends. For this reason, institutionalization could have contributed to worsening older people's mental health problems, such as internalizing symptoms, and their physical and psychological well-being [64][65][66]. Thus, in the present study, we also compared the living conditions of community-dwelling versus institutionalized older people. ...
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The COVID-19 health emergency and restrictive measures have increased psychological problems, particularly anxiety and depression, in the general population. However, little is known about mental health conditions and the possible risk and protective factors of specific population groups, such as institutionalized vs. community-dwelling elderly. We investigated the abovementioned aspects in a sample of 65–89-year-old people during the third wave of COVID-19 in Italy. We employed a sociodemographic survey and four questionnaires on health-related quality of life (SF-36), loneliness (UCLA), spirituality (FACIT-Sp), and anxiety/depression (HADS). Our findings suggest that the physical, psychological, and spiritual well-being of the elderly had not been seriously impaired by the events related to the pandemic, although most of the participants reported a worsening of their social life and a moderate/high fear of COVID-19. In regression analyses, these two latter aspects turned out to be predictors of higher anxiety, while spiritual well-being and the possibility to get out of the house/institution emerged as protective factors against anxiety and for preserving quality of life, respectively. Our findings help refine the picture of the condition of the elderly in the aftermath of the pandemic, giving some hints about how to continue supporting their well-being and quality of life.
... Various studies have investigated COVID-19 fear and loneliness, particularly among older adults and geriatric groups [21][22][23]. However, comparatively fewer studies have explored COVID-19 fear and loneliness among diverse populations and professional groups [24]. ...
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Fear has been the most common emotional response to the COVID-19 pandemic, and excessive fear is associated with various indices of psychological distress, particularly loneliness. Although most people have experienced pandemic-related fear and distress, certain groups who are on the front of service provision have experienced the pandemic in distinct ways, owing to its impact on the nature of their work. Schoolteachers represent one such group; therefore, it is imperative to identify resources that can safeguard against negative mental-health outcomes in schoolteachers. The current study investigated the potential protective role of sense of coherence (SOC) and resilience in the relationship between COVID-19 fear and loneliness. The participants were South African schoolteachers (N = 355); the participants completed the Fear of COVID-19 Scale, the University of California Loneliness Scale, the Connor-Davidson Resilience Scale-10, and the Sense of Coherence Scale-13. The results indicated that SOC and resilience had significant direct effects on loneliness, thereby suggesting their health-sustaining role. SOC and resilience also fully mediated the relationship between COVID-19 fear and loneliness. Therefore, although the provision of material resources is important, it is equally necessary to enhance people’s ability to comprehend, give meaning to, and manage the challenges associated with the pandemic. A salutogenic approach to mental health promotion in the workplace may be beneficial for enhancing SOC and resilience among schoolteachers. Keywords Loneliness; fear of COVID-19; resilience; sense of coherence; mediator
... Regarding age, the research highlights that older people suffered the most from negative effects such as fear and loneliness 19,20 . Younger individuals had fewer negative emotions because they saw COVID-19 as a less risky disease for them 21 , although they did report anxiety and depression due to the social restrictions imposed 21 . ...
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The outbreak of COVID-19 forced a dramatic shift in education, from in-person learning to an increased use of distance learning over the past 2 years. Opinions and sentiments regarding this switch from traditional to remote classes can be tracked in real time in microblog messages promptly shared by Twitter users, who constitute a large and ever-increasing number of individuals today. Given this framework, the present study aims to investigate sentiments and topics related to distance learning in Italy from March 2020 to November 2021. A two-step sentiment analysis was performed using the VADER model and the syuzhet package to understand the overall sentiments and emotions. A dynamic latent Dirichlet allocation model (DLDA) was built to identify commonly discussed topics in tweets and their evolution over time. The results show a modest majority of negative opinions, which shifted over time until the trend reversed. Among the eight emotions of the syuzhet package, ‘trust’ was the most positive emotion observed in the tweets, while ‘fear’ and ‘sadness’ were the top negative emotions. Our analysis also identified three topics: (1) requests for support measures for distance learning, (2) concerns about distance learning and its application, and (3) anxiety about the government decrees introducing the red zones and the corresponding restrictions. People’s attitudes changed over time. The concerns about distance learning and its future applications (topic 2) gained importance in the latter stages of 2021, while the first and third topics, which were ranked highly at first, started a steep descent in the last part of the period. The results indicate that even if current distance learning ends, the Italian people are concerned that any new emergency will bring distance learning back into use again.
... Older people suffer most from the negative effects of COVID-19. Restrictive measures, fear, and loneliness have had negative repercussions on the resilience of people aged 65 and over, thus compromising their physical and psychological wellbeing (Plagg et al., 2020;Set, 2020;Savci et al., 2021). Esposito et al. (2021) underline how young participants due to the social restrictions imposed suffered of anxiety and depression; furthermore, Biviá-Roig et al. (2020) found that pregnant women during lockdowns suffered most from anxiety and depression. ...
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Background A growing body of research shows that individuals with non-communicable diseases (NCDs), such as hypertension, diabetes, hypercholesterolemia, and heart disease, are more likely to suffer from severe COVID-19 and, subsequently, death. The purpose of this study was to assess the influence of COVID-19-related knowledge on mental health, healthcare behaviors, and quality of life among the elderly with NCDs in Northern Thailand. Methods In this cross-sectional study, the participants were 450 elderly people with NCDs, living in the Chiang Rai province, Northern Thailand. Random sampling was applied to select the subjects. Data collection included demographic information, COVID-19-related knowledge, healthcare behaviors, the Suanprung Stress Test-20, the Thai General Health Questionnaire (GHQ-28) for the assessment of mental health, and the Thai version of the World Health Organization Quality of Life-BREF. Results Almost half of the participants (45.6%) had poor knowledge about COVID-19. More than half of the sample had high stress (52.0%) and a low score in healthcare behaviors (64.9%), while approximately one-third of the participants had mental health problems (34.0%). The overall quality of life during the COVID-19 pandemic was moderate (70.7%). The score of COVID-19-related knowledge was significantly correlated with scores of stress ( r = −0.85), mental health ( r = −0.74), healthcare behaviors ( r = 0.50), and quality of life ( r = 0.33). Multiple linear regression found that history of COVID-19 detection and COVID-19-related knowledge were associated with scores of stress and quality of life ( p < 0.05). Multiple logistic regression showed that history of COVID-19 detection (OR = 4.48, 95% CI = 1.45–13.84) and COVID-19-related knowledge (OR = 0.23, 95% CI = 0.17–0.31) were associated with mental health problem ( p < 0.05). Discussion The findings emphasize the importance of COVID-19-related knowledge concerning the improvement of self-care behaviors and quality of life in the elderly population with NCDs during the pandemic, especially due to the high rate of stress and mental health problems documented in our sample. Health education interventions for this vulnerable population should be organized.
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Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the COVID-19 pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and if loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19, in association analyses and when adjusting for meaningful covariates. Data were collected from May 12 to August 19, 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78±7.3 years old, 70% female), the median SCREEN-8 score (nutrition risk) was 35 [1st Quartile, 3rd Quartile: 29, 40] and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses controlling for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% CI [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness was associated with nutrition risk in older adults after the first wave of COVID-19, but not mental health and meal assistance. Future research should consider longitudinal associations between loneliness, nutrition, and resilience.
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Kumpfer's resilience framework (KRF) was initially developed from evidence on resilience and its predictors among at-risk youth. This framework has been expanded to guide resilience research in diverse populations facing a variety of stressors. However, KRF's strengths and weaknesses have not been evaluated since its publication. Guided by Walker and Avant's method, an analysis of KRF was conducted drawn from 41 publications. A revised KRF diagram was proposed on the basis of the analysis to improve clarity, consistency, logical structure, and parsimony in the diagram of KRF. Overall, KRF provides a useful, generalizable, and testable theoretical framework for future resilience research.
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Background: COVID-19 may seem to have an impact on middle-aged and elderly people. However, not much is known about the lived experiences of middle-aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID-19 on the lives of these individuals. Materials and methods: Three focus group discussions and seven in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes. Results: There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub-categories formed three major categories-psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID-19 effects on the life of middle-aged and older individuals. Conclusion: Middle-aged and elderly people are affected in many ways due to COVID-19. Addressing the psycho-social and behavioral problems can help in the better adjustment to tide over the pandemic.
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Background Nursing homes (NH) for the elderly have been particularly affected by the Covid-19 pandemic mainly due to their hosted vulnerable populations and poor outbreak preparedness. In Belgium, the medical humanitarian organization Médecins Sans Frontières (MSF) implemented a support project for NH including training on infection prevention and control (IPC), (re)-organization of care, and psychosocial support for NH staff. As psychosocial and mental health needs of NH residents in times of Covid-19 are poorly understood and addressed, this study aimed to better understand these needs and how staff could respond accordingly. Methods A qualitative study adopting thematic content analysis. Eight focus group discussions with direct caring staff and 56 in-depth interviews with residents were conducted in eight purposively and conveniently selected NHs in Brussels, Belgium, June 2020. Results NH residents experienced losses of freedom, social life, autonomy, and recreational activities that deprived them of their basic psychological needs. This had a massive impact on their mental well-being expressed in feeling depressed, anxious, and frustrated as well as decreased meaning and quality of life. Staff felt unprepared for the challenges posed by the pandemic; lacking guidelines, personal protective equipment and clarity around organization of care. They were confronted with professional and ethical dilemmas, feeling ‘trapped’ between IPC and the residents’ wellbeing. They witnessed the detrimental effects of the measures imposed on their residents. Conclusion This study revealed the insights of residents’ and NH staff at the height of the early Covid-19 pandemic. Clearer outbreak plans, including psychosocial support, could have prevented the aggravated mental health conditions of both residents and staff. A holistic approach is needed in NHs in which tailor-made essential restrictive IPC measures are combined with psychosocial support measures to reduce the impact on residents’ mental health impact and to enhance their quality of life.
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Introduction COVID-19 has had an unprecedented global impact on public health and socio-economic matters. The magnitude of COVID-19 has undoubtedly affected every aspect of daily life and highlighted the need for increased preparedness, coordination, and monitoring. Amongst all social groups, the elderly is by far the most affected age group in morbidity and mortality [1]. Approximately 1.3 million individuals live in 15,600 nursing home facilities in the United States [2]. In fact, the beginning of COVID-19 may be marked by the 25 deaths in a single King County facility in Washington state. Nursing homes have faced the rapid spread of COVID-19 among residents and staff and have been at the center of the public health emergency during the pandemic. Factors that contribute to this rapid spread include crowding, sharing of bathroom facilities, and gathering in common areas that are not set up for infection control. Nursing homes, in particular, provide ideal environments for devastating infections to spread. Nursing homes, in particular, have essentially been in complete lockdown, not unlike inmates, who both deeply lack social interaction and are currently unable to exist outside the walls of their respective institutions. Those who do not have close family or friends, and rely on the support of voluntary services or social workers, could be at additional risk [6]. To lessen the chance of infection among older people in nursing homes, more local authorities are banning visitors to nursing homes and long-term care facilities. Furthermore, restrictions on group activities such as playing board games, watching TV in a common space, and engaging in art therapy, may harm residents’ mental and physical well-being [8]. Nursing home residents are already susceptible to loneliness, and the lack of social interaction due to decreased visitation from family and friends further compounds the traumatization of COVID-19 on daily living. Methods METHODS: This is a descriptive study over a period of 1 month conducted among nursing home staff in Lubbock, TX during the COVID-19 pandemic. Agreeable nursing home staff will have access to a survey (Qualtrics) accessing various aspects relating to the consequences of COVID-19. The survey will be open for a period of 1 month until which the participants will have the opportunity to complete the survey. Data from the surveys will then be collected and analyzed. The survey consists of a self-developed questionnaire along with the validated Perceived Stress Scale (PSS). The scale which was originally developed in 1983 by author Sheldon Cohen is one of the most widely used tools to measure the perception of stress. It has been used in studies assessing the stressfulness of situations and is widely available in the public domain [12]. Type of study: Descriptive mixed method triangulation design study Subjects: Healthcare staff with direct patient care Inclusion criteria: 1. Geriatric Nursing home staff in Lubbock, TX 2. Staff agreeable to participate in survey regardless of color, creed, age or sex. 3. Staff in direct contact with patients (Nursing and Physicians) Exclusion criteria: 1. Ancillary staff not involved in direct patient care 2. Staff who refuse to give voluntary consent to participate in survey Design: This will be a descriptive, mixed method triangulation design studyutilizing an online, self-administered survey tool created using Qualtrics platform. An information sheet explaining the research project will be given to the nursing home staff. It will include: participation is completely voluntary, that participation will not affect their employment in anyway, and their employer will not have access to the results. It will also explain that by submitting an anonymous survey they are agreeing to take part in the research study. The survey questions will gauge mental health impact on staff and their perspectives on the impact on patients and their own mental health. The survey will contain a mix of 10 close- and open-ended questions. Results Outcomes: To determine the impact of COVID-19 on nursing home staff mental health and gather information that may be utilized to create measures to better deliver care in nursing homes.Survey will be sent to 40 members with an expected response rate of about 20 percent and possibly higher. Results will be available by March 2020 for further analysis and distribution. Conclusions Ultimately, COVID-19 has taught painful lessons in the difficulties of isolating the elderly. The need for controlling infection may come at a high cost to the mental health and well-being of patients and staff, which is a critical public health issue. We hope that the results of this study will help us better understand the challenges geriatric nursing facilities have faced during the COVID-19 pandemic and help us develop better strategies for similar threats in the future. Funding No funding was obtained for the purposes of this study
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The aim of the current study is to examine gender, age. and cross-country differences in fear of COVID-19 and sense of loneliness during the lockdown, by comparing people from those countries with a high rate of infections and deaths (e.g., Spain and Italy) and from countries with a mild spread of infection (e.g., Croatia, Serbia, Slovakia, Slovenia, and Bosnia and Herzegovina). A total of 3876 participants (63% female) completed an online survey on “Everyday life practices in COVID-19 time” in April 2020, including measures of fear of COVID-19 and loneliness. Males and females of all age groups in countries suffering from the powerful impact of the COVID-19 pandemic reported greater fear of COVID-19 and sense of loneliness. In less endangered countries, females and the elderly reported more symptoms than males and the young; in Spanish and Italian samples, the pattern of differences is considerably more complex. Future research should thoroughly examine different age and gender groups. The analysis of emotional well-being in groups at risk of mental health issues may help to lessen the long term social and economic costs due to the COVID-19 outbreak.
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Resilience is broadly defined as the ability to bounce back from adversity or trauma. Recent advances in resilience research have shifted away from merely describing individual characteristics towards focusing on the complex interactions between individuals and their dynamic personal, community and cultural contexts. It is clear that resilience involves both neurobiological and cultural processes. Neurobiological contributions include genes, epigenetics, stress-response systems, the immune system and neural circuitry. Culture helps to elucidate collective systems of belief and accepted positive adaptations. Importantly, resilience can also be affected by evidence-based interventions and deliberate practice on the part of the individual. This review seeks to understand resilience as a complex and active process that is shaped by neurobiological profiles, developmental experiences, cultural and temporal contexts, and practical training. It uses the COVID-19 pandemic as a case example to better understand individual and group responses to tragedy. We suggest practical recommendations to help populations around the world cope and recover from the global threat of COVID-19.
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Background Cocooning or shielding, i.e. staying at home and reducing face-to-face interaction with other people, was an important part of the response to the COVID-19 pandemic for older people. However, concerns exist regarding the long-term adverse effects cocooning may have on their physical and mental health. Aim To examine health trajectories and healthcare utilization while cocooning in a cohort of community-dwelling people aged ≥70 years. Design Survey of 150 patients (55% female, mean age 80 years, mean Clinical Frailty Scale Score 4.8) attending ambulatory medical services in a large urban university hospital. Methods The survey covered four broad themes: access to healthcare services, mental health, physical health and attitudes to COVID-19 restrictions. Survey data was presented descriptively. Results Almost 40% (59/150) reported that their mental health was ‘worse’ or ‘much worse’ while cocooning, while over 40% (63/150) reported a decline in their physical health. Almost 70% (104/150) reported exercising less frequently or not exercising at all. Over 57% (86/150) of participants reported loneliness with 1 in 8 (19/150) reporting that they were lonely ‘very often’. Half of participants (75/150) reported a decline in their quality of life (QOL). Over 60% (91/150) agreed with government advice for those ≥70 years but over 40% (61/150) reported that they disliked the term ‘cocooning’. Conclusions Given the likelihood of further restrictions in coming months, clear policies and advice for older people around strategies to maintain social engagement, manage loneliness, continue physical activity and access timely medical care and rehabilitation services should be a priority.
Article
The aim of this research is to determine the relationship between spiritual well-being levels and coronavirus fear levels of individuals over 65 years old during the COVID-19 outbreak. The study adopted a cross-sectional and corelational design. The research was conducted between July 1–30 in the city of Muş in Turkey’s Eastern Anatolia Region. The universe of the study consisted of 1780 individuals over 65 years old enrolled in a family practice center located in the city center between the specified dates. Personal information form, Spiritual Well-being Scale (FACIT-Sp) and Coronavirus Phobia Scale (C19P-S) were used to collect data. Data coding and analysis were performed in the computer environment with SPSS 25 package program. Analysis of data used number, mean, percentage distribution and Pearson correlation analysis. Participants had mean total points for the spiritual well-being scale of 28.61 ± 5.54, with mean coronavirus fear points of 59.66 ± 15.40. There was a moderate level correlation between spiritual well-being and coronavirus fear in individuals, with meaning and belief levels above the mean. Individuals with chronic disease had psychological fear levels above the mean, with somatic, economic and social fear levels below the mean. A significant negative relationship was found not only between the spiritual meaning subdimension and individuals’ fear of coronavirus but also between the peace sub-dimension and their fear of coronavirus. The data show that as individuals’ spirituality increases, their fear of coronavirus levels decrease.
Article
Objectives This study examined the emotional distress and loneliness during COVID-19 and the roles of resiliency and activities. Design A cross-sectional national survey. Setting Amazon Mechanical Turk (mTurk) and Prolific Research Platforms. Participants 501 US dwelling English-speaking adults 60 years old and older. Measurements Participants completed an online survey with the PHQ-9; GAD-7; Short Health Anxiety Inventory; 3-item UCLA Loneliness scale; PROMIS measures of global health, instrumental, and emotional support; 10-item Connor-Davidson Resilience Scale; and COVID-19 needs assessment. Results Across the sample 13% reported moderate depressive symptoms, 9% reported moderate anxiety symptoms, and 26% endorsed being “lonely.” The emotionally distressed group endorsed more loneliness, lower resiliency, less physical exercise, and worse physical health. The low SES group endorsed less loneliness, less likely to engage in physical exercise and worse physical health.The lonely group endorsed less resilience, less physical exercise, and worse physical health. A multiple logistic regression found that resilience, socioeconomic status, and physical health were significant predictors of loneliness, whereas global health was the best predictor of emotional distress. Conclusions Even after prolonged social distancing, older adults in this study did not report greater psychological distress compared to earlier studies of older adults during COVID-19. Older adults with lower SES, worse physical health, and less resiliency, were more likely to report more loneliness. It is this group that should be the focus of intervention.
Article
Objectives: This study examined the impacts of COVID-19 lockdown on health and lifestyle factors for older adults in Sydney, Australia. The study examined demographic differences, social engagement, loneliness, physical activity, emotion regulation, technology use, and grandparenting experiences and their contribution to emotional health and quality of life during lockdown. Methods: Participants were 201 community-dwelling older adults (60–87 years, M = 70.55, SD = 6.50; 67.8% female) who completed self-report scales measuring physical and emotional health outcomes, quality of life, health service utilization, changes in diet and physical activity, impacts on grandparenting roles, and uptake of new technology. Results: One-third of older adults experienced depression, and 1 in 5 experienced elevated anxiety and/or psychological distress during lockdown. Specific emotion regulation strategies, better social and family engagement, and new technology use were associated with better emotional health and quality of life; 63% of older adults used new technologies to connect with others. Conclusions: Older adults were adaptable and resilient during lockdown, demonstrating high uptake of new technologies to remain connected to others, while negative emotional health outcomes were linked to loneliness and unhelpful emotion regulation. Clinical Implications: Further diversifying use of video technologies may facilitate improved physical and emotional health outcomes.