key: cord-0730706-bbj0psgk
authors: Macdonald, Birthe; Hülür, Gizem
title: Well-Being and Loneliness in Swiss Older Adults during the COVID-19 Pandemic: The Role of Social Relationships
date: 2020-12-01
journal: Gerontologist
DOI: 10.1093/geront/gnaa194
sha: 5595f023ffb9c5bf2c683f4fa211b3ad394e366b
doc_id: 730706
cord_uid: bbj0psgk

BACKGROUND AND OBJECTIVES: The current COVID-19 pandemic and social distancing measures are an extreme stressor that might result in negative emotional experiences and feelings of loneliness. However, it is possible that social relationships might have a protective effect. In the present study, we examine how the COVID-19 pandemic affected older adults’ well-being and loneliness, and the role of structural and functional characteristics of social relationships. RESEARCH DESIGN AND METHODS: We use data from 99 older adults in Switzerland who participated (a) in a three-week micro-longitudinal study on social relationships and well-being in 2019 and (b) in a weekly online survey during four weeks of the COVID-19 lockdown. RESULTS: Our findings show that the global pandemic had substantial adverse effects on older adults’ emotional well-being and loneliness. In addition, aspects of social relationships were related to loneliness both before and during the pandemic. Only one functional feature of social relationships (satisfaction with communication during the pandemic) buffered adverse effects of the major stressful event. DISCUSSION AND IMPLICATIONS: Although the social distancing measures during COVID-19 presented a major stressor for older adults’ well-being and loneliness, being able to maintain social communication to a satisfactory level during that time reduced this effect. Therefore, enabling older adults to stay in touch with their social circle based on their personal preferences might reduce the impact that any future lockdown might have on their well-being.

A c c e p t e d M a n u s c r i p t 3

In March 2020, the WHO declared Coronavirus Disease-2019 (COVID-19) a worldwide pandemic (WHO, 2020) . While countries world-wide went into lockdown to flatten the curve of new infections and prevent medical systems from collapsing, adults over 65 years of age were considered as particularly vulnerable to developing serious health complications from COVID-19 and advised to adhere to strict social distancing measures (CDC, 2020; Jordan et al., 2020) . Measures to reduce infection risks for the general population typically included recommendations to stay home and experts warned of mental health risks associated with the pandemic and with the adoption social distancing measures (Armitage & Nellums, 2020; Jawaid, 2020) . These include anxiety related to infection and illness, the economic situation, and social isolation due to precautionary measures. Research in lifespan samples shows that the pandemic was associated with changes in mental health (González-Sanguino et al., 2020) and well-being (Zacher & Rudolph, 2020) . A Swedish cohort study of older adults showed that decline in well-being during the pandemic was not universal but associated with higher rates of worry about health and financial issues (Kivi et al., 2020) .

Conversely, higher rates of worry about societal issues as well as higher adherence to social distancing measures were associated with higher well-being (Kivi et al., 2020) . Older adults in a nationwide lifespan sample of adults in the United States showed an increase in loneliness from January to March 2020 during the acute phase of the COVID-19 pandemic (Luchetti et al., 2020) . Levels of loneliness remained stable from March to April 2020. Being younger, negative self-perceptions of aging, lower levels of personal and familial resources, and perceiving oneself as a burden were associated with increased levels of self-reported loneliness in an adult lifespan sample from Spain (Losada-Baltar et al., 2020) .

Because older adults were asked to adhere to strict social distancing measures to protect themselves from COVID-19, they might have been at particular risk of a decline in their well-A c c e p t e d M a n u s c r i p t 4 being. The goal of the present study is to understand the effect of the pandemic on older adults' emotional well-being and loneliness and potential buffering effects of structural and functional components of social relationships.

According to the buffering hypothesis of social support, social relationships can buffer negative impacts of severe stressors (Cohen & Wills, 1985) . Research on social relationships usually differentiates between structural and functional features of social relationships (August & Rook, 2013; Valtorta et al., 2016) . Structural features are related to quantitative aspects of social relationships, such as the size of an individual's social network, type of social network partners (e.g., friend, family member), or frequency of social interaction. Functional features are related to qualitative aspects, including the experience of social support, or satisfaction with one's social relationships.

Several structural and functional relationships have been linked to subjective wellbeing and feelings of loneliness across the lifespan, including old age. Although living alone does not necessarily indicate being isolated, people living in single-person households report higher levels of loneliness and social isolation than others (Victor et al., 2000) . Having a large social network (Bruine de Bruin et al., 2020; Chan & Lee, 2006 ) and more frequent social interaction (Amati et al., 2018; Appau et al., 2019) are both related to higher levels of well-being. With regard to functional features of social relationships, research has widely documented associations between social support and psychosocial well-being (Chen & Feeley, 2014; Siedlecki et al., 2014) . A particularly relevant aspect of social support is perceived social support, that is, support that is perceived as available from one's social network when needed.

Research has also examined whether social relationships can buffer adverse effects of stress on well-being. With respect to social support, stress-buffering effects were often observed for perceived availability of support (Hartley & Coffee, 2019; Luszczynska & A c c e p t e d M a n u s c r i p t 5 Cieslak, 2005; Wethington & Kessler, 1986) , whereas received support can have an undermining effect on the individual receiving support (Bolger et al., 2000) . Other functional features of social relationships have also been found to have stress-buffering effects, including companionship (Rook, 1987) and warmth (Lippold et al., 2016) .

In the current study, we examine the effect of the nationwide lockdown on subjective well-being and feelings of loneliness in older adults in Switzerland using data that were obtained before and during the pandemic. The COVID-19 lockdown in Switzerland included the prohibition of gatherings of more than 5 people, the closing of all bars, restaurants, and non-essential stores, as well as sports and entertainment venues such as swimming pools, gyms, cinemas, and theatres. Individuals were advised to remain at a 2-meter distance and not to visit other households. Older adults in particular were advised to stay home, not receive visitors, and to organize any essential shopping to be delivered if possible. We assessed positive and negative affect, as well as loneliness daily for 21 days during 2019, and weekly for 4 weeks during the COVID-19 lockdown in 2020. Based on theoretical perspectives and empirical findings, positive and negative affect are considered independently, as they provide unique information about individuals' affective states (Diener & Iran-Nejad, 1986; Zevon & Tellegen, 1982) .

We hypothesize that positive affect will be lower, and negative affect as well as loneliness will be higher during the first four weeks of lockdown. In accordance with the buffering hypothesis and based on prior research, we expect structural and functional aspects of social relationships to show stress-buffering effects.

A c c e p t e d M a n u s c r i p t 7 ensure a high participation rate and facilitate long-term data collection, for which daily data collection might not be suitable. Participants could enter a raffle to win 50 Swiss Francs as a voucher or to donate to a charity of their choice. In the present study, we consider data obtained during four weeks between March 27, 2020 and April 24, 2020. Out of 120 participants in the earlier study, 99 participants (83%) completed the COVID-19 survey at least once during the four-week period analyzed in the present study. Our study protocol was Predictors. Structural aspects of social relationship included living alone, social network size, and frequency of social interaction. Living alone (assessed in 2019) was a binary variable (1 = yes; 0 = no). Social network size was assessed in 2019 using the Convoy Model (Antonucci, 1986; Antonucci et al., 2014) and defined as the total number of individuals participants included in the convoy diagram. Frequency of social interaction in 2019 was defined as the total number of short questionnaires participants completed on a smartphone after every social interaction during the 21-day data collection period. During the A c c e p t e d M a n u s c r i p t 8 lockdown, participants responded to the items -How frequently did you interact with other personally/by phone/by videochat/by text message?‖ with the response options -never‖ (1), -once‖ (2), -2-3 times‖ (3), -daily‖ (4), -several times per day‖ (5). Frequency of social interaction during COVID-19 lockdown was defined as the response indicating the highest frequency of interaction across interaction modalities. Data were averaged for each participant across available measurement occasions (up to 4 weekly measurement occasions).

Functional aspects of social relationships included availability of perceived support and satisfaction with communication. Social support was assessed with the perceived available support scale of the Berlin Social Support Scales (BSSS, (Schulz & Schwarzer, 2003) . This scale consists of 8 items (e.g. -Whenever I am not feeling well, other people show me that they are fond of me‖; -I know some people upon whom I can always rely‖) that are rated on a four-point scale (strongly disagree (1), somewhat disagree (2), somewhat agree (3) and strongly agree (4)). Participants completed this scale during data collection in 2019. Individual-specific parameters were modeled as β 0i = γ 00 + u 0i ;

(2) β 1i = γ 10 + u 1i ;

where the γ parameters represent sample-level averages and the u parameters represent individual-specific deviations from these sample-level averages.

In a second step, we examined effects of each predictor on levels of outcome variables as well as moderating effects on change associated with the time period coinciding with the COVID-19 lockdown. Effects were modeled as β 0i = γ 00 + γ 01 (predictor i ) + u 0i ;

M a n u s c r i p t 10 β 1i = γ 10 + γ 11 (predictor i ) + u 1i ;

where the γ 01 parameter indicates the main effect of a predictor on outcome variables (positive affect, negative affect, and loneliness) and the γ 11 parameter indicates moderating effects of this predictor for change associated with the time period coinciding with the COVID-19 lockdown. In a third step, all variables were included in a single model to examine their independent effects. To avoid multicollinearity, satisfaction with communication before and during the COVID-19 pandemic were not included in the same model. To reduce model complexity, only control variables showing significant effects were included in this next step. Predictor and control variables were centered at the sample mean to facilitate interpretation. Pseudo R 2 was calculated as percent reduction in residual error relative to a model that includes fixed and random effects of the intercept only. Models were estimated in R using the nlme package (Pinheiro et al., 2020) . Incomplete data were treated as missing at random (Little & Rubin, 1987) .

99 participants were included in the study (M age = 71 years, SD = 5, range = 65 to 94 years, 62% men). Descriptive statistics and correlations for the current sample are presented in Table 1 during the COVID-19 pandemic showed less decline in positive affect and less increase in negative affect and loneliness, respectively. Across the control variables, only health was consistently related to all outcome variables. Having more health conditions was related to lower positive affect, higher negative affect, and higher loneliness, but unrelated to the response to the COVID-19 lockdown. Higher age was associated with more loneliness. The pattern of findings was identical with those reported in Table 4 (see Supplemental Material, section C6).

This study aimed to examine the effect of the COVID-19 lockdown on older adults' well-being and loneliness and the role of structural and functional features of social relationships. We used data obtained during a 2019 micro-longitudinal study on older adults' social communication and compared participants' self-reported well-being and loneliness to those indicated in an online questionnaire during the first 4 weeks of the lockdown in Switzerland. We found that positive affect decreased during the lockdown, compared with 2019, while negative affect and loneliness increased. This is in line with our hypothesis that the COVID-19 pandemic and associated nationwide social distancing measures presented a substantial stressor which greatly affected older adults' well-being.

Our results show that overall, participants reported lower levels of loneliness if they had a larger social network, reported a higher number of social interactions before and during the pandemic, did not live alone and reported that social support was available to them. In addition, participants reported higher levels of positive affect if they reported a higher number of social interactions before the pandemic. None of these variables moderated the reaction to the COVID-19 pandemic. This pattern of findings suggests that intact social relationships, both at the structural and functional levels, had a positive effect on subjective well-being both in general as well as in a stressful situation.

Our results also show that there was large inter-individual variability in participants' response to the COVID-19 lockdown. The only variable consistently related to participants' response was satisfaction with communication during the COVID-19 pandemic, which was associated with less decline in positive affect and less increase in negative affect and A c c e p t e d M a n u s c r i p t 15 loneliness. This is in line with research showing that various functional aspects of social relationships may have stress-buffering effects (Lippold et al., 2016; Rook, 1987) . It suggests that subjective functional aspects of social relationships and their evaluation is potentially more important to preserve positive affect, particularly during times of high stress such as the COVID-19 pandemic, than structural aspects. Studies examining the effects of the COVID-19 lockdown in different countries have reported similar results showing that subjective factors such as attitudes and worries moderated negative effects of the lockdown (Armitage & Nellums, 2020; González-Sanguino et al., 2020; Kivi et al., 2020) . These and our findings indicate that subjective perceptions can influence individuals' well-being and encouraging people to maintain their social interactions might be an effective way to help maintain their well-being through high-stress situations. This is in line with the buffering hypothesis (Cohen & Wills, 1985) which posits that aspects of social relationships can buffer the negative effects of stress. The within-person aspect of the relationship between subjective satisfaction with communication and affect and loneliness also speaks to that point, i.e., participants reported higher positive affect and lower negative affect and loneliness when they were more satisfied with their interactions than usual. This further highlights the integral role that social relationships might play in older adults' mental health in everyday life and during highly stressful events. These results might be utilized in community or clinical settings, encouraging individuals to maintain their social relationships in accordance with their own subjective social preference during stressful and challenging times.

In contrast to earlier research (Hartley & Coffee, 2019; Luszczynska & Cieslak, 2005; Wethington & Kessler, 1986) , our study did not find that overall perceived available support measured in the 2019 data collection buffered the effects of stress. This may be due to the uniqueness of the COVID-19 stressor, which may make it difficult for individuals to access available support due to social distancing measures. Our study did not explicitly assess Although our outcome variables are highly correlated with one another, and show similar associations with other variables, our findings suggest that considering these outcomes separately provides unique information: For example, changes associated with the time period coinciding with the COVID-19 pandemic were stronger for negative affect and loneliness than for positive affect. In addition, loneliness was more closely related to social variables than positive and negative affect.

A c c e p t e d M a n u s c r i p t 17

In closing, we note some limitations of the present study. Participants reported on daily well-being in 2019 and weekly well-being during the COVID-19 pandemic. This design was chosen to ensure a high participation rate in the online survey during the pandemic and to keep participant burden low. Also, because the 2019 study focused on digital communication, it only included older adults who used digital devices (e.g., smartphone, computers) to communicate with others. Adverse effects of social distancing on well-being may be even stronger among older adults with lower levels of technology proficiency, as they may have more difficulty remaining socially connected. A comparison between the participants of the 2019 study who did and did not also provide data in 2020 revealed that participants who did not take part in 2020 reported fewer social interactions. It is therefore possible that our results would not generalize to less socially active older adults. In addition, a simplified time metric was used: Time was specified as 0 during 2019 because we used these data as the personal pre-pandemic baseline for all individuals. We acknowledge that period effects may exist within the 2019 data collection (April-November) and that there may have been other events during that time that may have affected participants' well-being and loneliness. However, we are not aware of any event that would have effects on positive affect, negative affect, and loneliness that are comparable to the pandemic.

One specific limitation is related to the memory-experience gap: Earlier research has found that people show higher levels of both positive and negative affect when reporting their affective experiences over longer time frames (memory-experience gap, (Miron-Shatz et al., 2009 ). However, several points are to note that make it unlikely that our findings are based purely on methodological artefacts: First, the memory-experience-gap would indicate that participants would report higher levels of positive affect in weekly vs. daily assessments.

However, our findings show the opposite pattern. Second, recent research has shown that the A c c e p t e d M a n u s c r i p t 18 memory-experience gap is weaker among older adults. For example, Neubauer and colleagues (2020) reported that the memory-experience gap in negative affect was not significant for older adults (>65 years old). In older adults, there was a minor memoryexperience gap for positive affect, which, however, was in the opposite direction of our findings. Third, our effect sizes are too large to simply be caused by methodological artefacts.

For example, in the study by Neubauer and colleagues (2020) , the effect size for the memoryexperience gap for negative affect amounted to Cohen's d = 0.20 for the whole sample (weaker in older adults). While we acknowledge that our estimates may be biased, it is unlikely that this possible bias fully explains the results.

Finally, COVID-19 lockdown measures in Switzerland were comparably mild to neighboring countries. For example, people were strongly advised to stay at home in Switzerland, while they were prohibited from leaving their place of residence by more than 1 km in France.

It is an open question how these variations in precautionary measures affected people's coping mechanisms.

The COVID-19 lockdown can be considered a major stressor for older adults in our sample, as it was associated with decline in positive affect, increase in negative affect, and increase in loneliness compared with the previous year. In addition, our results indicate that satisfaction with communication was an important resource for well-being during the stressful time-period coinciding with the COVID-19 lockdown in Switzerland, by showing that the impact of the pandemic on well-being was lower for participants who were able to maintain their social interactions at a subjectively satisfactory level during the pandemic.

A c c e p t e d M a n u s c r i p t 19 M a n u s c r i p t M a n u s c r i p t before the pandemic and 371 observations after the pandemic. Time: 0 for observations taken before the COVID-19 pandemic and 1 for observations taken during the COVID-19 pandemic. SE = standard error. SE = standard error. SD = standard deviation. COR = correlation. All models include an intercept and the main effect of time (fixed and random effects), which are omitted from this table for brevity.

A c c e p t e d M a n u s c r i p t 13 Notes: n = 99; 1858 observations before the pandemic and 371 observations after the pandemic. Time: 0 for observations taken before the COVID-19 pandemic and 1 for observations taken during the COVID-19 pandemic. SE = standard error. SD = standard deviation. COR = correlation. AIC = Akaike Information Criterion. BIC = Bayesian Information Criterion.

* p<.05

Social relations and life satisfaction: The role of friends

Hierarchical mapping technique

The Convoy Model: Explaining social relations from a multidisciplinary perspective

Social integration and subjective wellbeing

COVID-19 and the consequences of isolating the elderly. The Lancet Public Health

Social Relationships

Intensive longitudinal methods: An introduction to diary and experience sampling research

Invisible support and adjustment to stress

Age differences in reported social networks and well-being

COVID-19)

Network Size, Social Support and Happinessin Later Life: A Comparative Study of Beijing and Hong Kong

Social support, social strain, loneliness, and well-being among older adults: An analysis of the Health and Retirement Study*

Stress, social support, and the buffering hypothesis

The relationship in experience between various types of affect

Beyond the Hedonic Treadmill: Revising the Adaptation Theory of Well-Being

Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain

Perceived and Received Dimensional Support: Main and Stress-Buffering Effects on Dimensions of Burnout

Rethinking social relationships in old age: Digitalization and the social lives of older adults

Protecting older adults during social distancing

COVID-19: Risk factors for severe disease and death

Up and about: Older adults' wellbeing during the COVID-19 pandemic in a Swedish longitudinal study

Daily stressor reactivity during adolescence: The buffering role of parental warmth. Health Psychology: Official Journal of the Division of Health Psychology

Statistical analysis with missing data

We are staying at home.‖ Association of self-perceptions of aging, personal and family resources, and loneliness with psychological distress during the lock-down period of COVID-19

The trajectory of loneliness in response to COVID-19

Protective, promotive, and buffering effects of perceived social support in managerial stress: The moderating role of personality

Digitalisation and the Social Lives of Older Adults-A Microlongitudinal Study Design

Memories of yesterday's emotions: Does the valence of experience affect the memory-experience gap? Emotion

How was your day? Convergence of aggregated momentary and retrospective end-of-day affect ratings across the adult life span

Social support versus companionship: Effects on life stress, loneliness, and evaluations by others

Soziale Unterstützung bei der Krankheitsbewältigung: Die Berliner Social Support Skalen (BSSS)

The relationship between social support and subjective well-being across age

Loneliness, social isolation and social relationships: What are we measuring? A novel framework for classifying and comparing tools

Being alone in later life: Loneliness, social isolation and living alone

Development and validation of brief measures of positive and negative affect: The PANAS scales

Perceived support, received support, and adjustment to stressful life events

A c c e p t e d M a n u s c r i p t