key: cord-0797164-405gjd1y
authors: Cihan, Fatma G.; Gökgöz Durmaz, Funda
title: Evaluation of COVID‐19 phobia and the feeling of loneliness in the geriatric age group
date: 2021-03-04
journal: Int J Clin Pract
DOI: 10.1111/ijcp.14089
sha: 16623d75d28a7aa7e6b9956516968eb2ee3159ad
doc_id: 797164
cord_uid: 405gjd1y

OBJECTIVE: Social isolation and quarantine are unusual precautions taken all over the world against the COVID‐19 pandemic. Some legal sanctions were made in order to protect vulnerable age groups such as the geriatric population, to make them stay at home. These measures, which are vital for pandemic management, have negative psychological effects on elderly individuals. The aim of this study was to reveal how pandemic process affected individuals over 65 years old psychosocially. MATERIALS AND METHODS: Socio‐demographic characteristics questionnaire, the COVID‐19 Phobia Scale (C19P‐S) and the Loneliness Scale for the Elderly individuals were used. Descriptive analysis, Mann‐Whitney U‐test, Kruskal‐Wallis test, Pearson correlation analysis were performed for data analysis. RESULTS: A total of 130 elderly people (80 women, 50 men) were included in the study. Of the participants, 61.5% were women, 67.7% were married and mean age was 71.53 ± 5.57 (min. 65‐max. 87) years old. The C19P‐S scores were significantly higher in women, singles, people living alone, those living in an apartment, and those with higher economic and educational level (P = .001). There was a strong positive correlation between age and total loneliness score. Loneliness scores were significantly higher in singles, those with higher levels of education and income, those who live alone, who was a relative of a healthcare worker, and whose relatives were infected with COVID‐19 (P < .05). CONCLUSION: Our study revealed that elderly individuals, who have to comply with social isolation rules, have increased fear and loneliness due to coronavirus. Considering this situation, timely psychological treatment and social support measures should be taken.

of the patient according to the immune status made social isolation inevitable. 4 It is especially necessary for those over the age of 65 to stay at home, to reduce the spread of the virus and to protect this population, which is sensitive to coronavirus as mortality and morbidity of coronavirus infections are higher in this age group. However, this age group is also more affected by the feeling of loneliness, and needs more social and psychological support. 5 This study was planned to determine the fear caused by the disease and the loneliness because of social isolation, which are the social and psychological consequences of the COVID-19 pandemic, in the geriatric population.

Approval of local non-invasive research ethics committee and Turkish Ministry of Health was obtained before starting the study, and informed consents of the participants who agreed to participate were obtained after given brief information about the purpose of the study. Individuals over the age of 65 who were registered to a family practice office and who agreed to participate in the study between June 2020 and October 2020 were included in this crosssectional descriptive study. Those with any psychiatric disease and/ or Alzheimer's Disease and those with advanced presbycusis were excluded from the study.

In order to collect the data needed for research, sociodemographic characteristics questionnaire created in accordance with the relevant literature, COVID-19 Phobia Scale (C19P-S) and

the Scale of Loneliness for the Elderly individuals are used. The questionnaires were applied to the participants by telephone interview method. Psychological, somatic, social and economic sub-dimension scores and total C19P-S scores were calculated. Social loneliness and emotional loneliness subscale scores and total loneliness scores of the loneliness scale for the elderly individuals were calculated.

Socio-demographic characteristics of the respondents were questioned. The demographic characteristics form included questions regarding: age, gender, marital status, education level, economical situation, whether they live alone or not, whether they have chronic illness, whether they have a healthcare worker relative, whether they have any acquaintances who has COVID-19 infection or died from that illness. | 3 of 8 CIHAN et Al. P < .05 was considered statistically significant with a 95% confidence level. Pearson correlation analysis was used.

A total of 130 elderly people, were included in the study. The mean age of the participants is 71.53 ± 5.57 (min 65-max 87) years old.

There was no significant difference between genders in terms of age (P = .215). Socio-demographic characteristics are given in Table 1 .

Participants were asked what is the most challenging measure taken for the COVID-19 outbreak. Of the participants, 84.6% (n = 110) stated that they had difficulty in obeying the curfew, 82.3% (n = 107) of them had difficulty in wearing a mask, 66.9% (n = 87) of them felt it was hard to stay away from their relatives and friends, 13.8% (n = 18) of them had difficulty in running their business from home and 8.5% (n = 11) of the participants were sorry for not attending ceremonies such as weddings and funerals.

No relation was found between gender and the coronaphobia and the loneliness scales (P ˃ .05) except for the psychological subscale, in which women's scores were higher than men (P =.030).

When marital status and coronaphobia scale scores were compared, a statistically significant difference was found only in the economic sub-dimension (P = .046). The economic sub-dimension score was higher in singles than in married ones. Singles also had statistically significantly higher social loneliness sub-dimension (P = .004) and total loneliness scores (P = .040). The total coronaphobia scale scores (P = .001) and loneliness scale scores (P = .001) were found to be higher in those with higher income ( Table 2 ).

There was no correlation between age and total coronaphobia scale scores (r = 0.042, P = .634). A moderate positive correlation was found between age and total loneliness score (r = 0.304, P ˂ .001).

Total coronaphobia scores and loneliness scores were found to be statistically significantly higher in those living alone than those living with their spouse or children (P = .032, P = .002, respectively).

A statistically significant relation was found between where they live (detached house, apartment, family apartment) and total coronaphobia scale scores (P = .001). However, there was no significant relationship between the place of residence and the total loneliness scale scores for the elderly individuals (P = .251) There was statistically significant relationship between the presence of chronic disease and the psychological, somatic, social sub-dimensions and total coronaphobia scores (P = .044, P = .011, P = .029, P = .007, respectively). These scores were higher in patients with chronic disease. There was no statistically significant relationship between the presence of chronic illnesses and the loneliness scale scores for the elderly individuals (P = .577) ( Table 3 ). There was no statistically significant relationship between the existence of a chronic disease and whether she/he lived alone (P = .189).

Correlation analysis was performed between educational status and total coronaphobia scale score and a strong positive correlation was found (r: 0.398, P = .001). There was a positive correlation between educational status and total loneliness score (r: 0.171, P = .05).

No significant relation was found between coronaphobia scale scores in patients with positive COVID-19 test (P = .428). Emotional loneliness, social loneliness and total loneliness scores were found to be statistically significantly higher in COVID positive patients (P = .016, P = .050, P = .013, respectively).

Travelling after the pandemic deceleration significantly affected the somatic, economic sub-dimensions and the total score of the coronaphobia scale (P = .007, P = .001, P = .008, respectively). There was no significant relationship between loneliness scale scores and travel status (P = .900).

All sub-dimension scores and total scores were significantly higher in those who had a contact with Covid19 test positive person (P < .05). The emotional subscale of the loneliness scale for the elderly people and the total loneliness score were also found to be statistically significantly higher in those who had contact with covid-19 positive people (P = .005, P = .036, respectively). The coronaphobia test scores (P = .001), emotional (P = .003) and total loneliness scores (P = .018) were found to be statistically significantly higher in those who had positive COVID-19 test result in one of their acquaintances. Psychological, somatic, economic and total coronaphobia scale scores were found to be significantly higher in those who were relatives of healthcare workers (P = .011, P = .001, P = .001, P = .001, respectively). Emotional loneliness scores were also higher in those (P = .008) ( Table 4) . Somatic, economic sub-dimensions and total coronaphobia scale scores were found to be significantly higher in those whose relatives or friends died due to COVID-19 (P = .009, P = .019, P = .016, respectively). There was no relation between the loneliness total score and whether they have a relative who died due to COVID-19 (P = .308).

The coronaphobia total scores of those who had difficulty in wearing masks (P = .000) and stated that curfews affected them negatively, were found to be higher (P = .000). There was no significant difference between loneliness scale total scores (P > .05). The psychological (P < .001), social (P < .001) and total coronaphobia scores (P = .001) of those who did not like keeping away from friends and relatives were significantly higher. The somatic (P = .019), social (P = .022), economic (P = .012) and total coronaphobia scores (P = .023) of those who were sad for not being able to attend weddings and funerals were significantly higher. The somatic (P = 006), social (P = .003), and total coronaphobia scores (P = .021) of those having difficulty in working from home, were significantly higher. One of the negative emotions that occur in elderly individuals due to social isolation rules during the pandemic process is loneliness. Loneliness is closely related to decreased sense of happiness and satisfaction, depressive mood and pronounced physical complaints. Pandemic has also increased the frequency of pathological TA B L E 4 COVID-19 phobia scale and loneliness scale for elderly individuals scores according to contact

Have a healthcare worker relative conditions associated with loneliness. 9, 10 In our study, the average loneliness score was found to be high, and it was also found that the total loneliness score increased significantly with increasing age.

It was found that the majority of the participants in the study had difficulty in complying with measures such as curfew and wearing mask, and the coronaphobia scale scores of those were also significantly higher.

Social isolation and loneliness are different conditions. However, each of them causes premature death, depression, cardiovascular disease and cognitive decline. In a study conducted by Voitsidis et al, it was shown that anxiety and fear levels increased in elderly individuals who are left alone because of the change of routine life order due to social isolation. Increased health concerns caused by coronaphobia, financial uncertainties, and increased frequency and intensity of insomnia cause depressive mood. 11 In our study, higher coronaphobia scale scores were found in the living alone ones. In addition, due to social isolation, physical activity and sun exposure decrease and screen time increases. This situation increases the stress and anxiety levels and also disrupts the sleep homeostasis. Physical inactivity remains a major health challenge for the older age group even in the frailest and the most vulnerable one. 11, 12 In our study, coronaphobia scale scores were found to be lower in those living in detached houses with gardens than those living in apartments. This may be due to the fact that they can do physical activity in their own garden and exposed to more sunlight without violating the social isolation measures.

Various interventions have been tried to combat the negative consequences of social isolation and loneliness. Various online chat programs, individual and group therapies, joint activity programs, social prescriptions by healthcare providers, and various strategies using information and communication technologies may be some options.

Such research-practice partnerships and interdisciplinary collaborations are necessary to tackle public health challenges such as loneliness and social isolation. Some of these problems are pre-existing social problems that may continue beyond the COVID-19 outbreak. 13 In a study by Dsouza et al 69 suicide cases caused by COVID-19

were presented. Causes of suicide were listed as fear of COVID-19 infection (n = 21) followed by financial crisis (n = 19), loneliness, social boycott and quarantine pressure, work-related stress caused by COVID-19. Psychological effects related to COVID-19 can reach a level that causes suicide, which is an undesirable result. In order to prevent these consequences, there is an urgent need for a timely psychological healthcare service. 14 Shirira et al conducted a study by using the UCLA loneliness scale. In their study, it was found that the feeling of loneliness due to the Covid-19 pandemic was less in the geriatric population who felt younger than their real age (subjective age). Accordingly, developing psychological symptoms was seen more in older people. 15 In our study, psychological symptoms sub-dimension scores of the coronaphobia scale were found to be high in women and those with chronic diseases. However, there was no significant difference between the presence or absence of chronic disease and loneliness scale scores. However, the high incidence of chronic diseases in old age leads to an increase in addiction, getting sick more frequently and must cope with a lot of chronic problems. These diseases or health problems naturally affect the life satisfaction and quality of life of the elderly people and cause to isolate themselves and tend to loneliness.

In our study, there was no statistically significant relationship between the presence of a chronic disease and whether they lived Medications such as corticosteroids used for treatment also have side effects such as worsening anxiety and mental distress. 18 In our study, the somatic and social subscale scores of the coronaphobia scale were found to be significantly higher in patients with chronic disease than those without. In addition, a correlation was found between educational status and all coronaphobia scale scores.

The scores obtained from the scales were found to be significantly higher for those whose education and economic status is good and whose income is more than their expenses. These people are likely to have higher awareness of the pandemic. Education plays an important role in the positive development of societies both economically and socially. The awareness of successful ageing and good adapting to social life is more common in educated individuals. 19 Social isolation, loneliness and social vulnerability are frequent problems in elderly people and can lead to important health consequences. In addition to physical factors such as reduced immune response due to old age and accompanying chronic diseases, loneliness and fear may increase the susceptibility of elderly individuals to COVID-19. Primary care physicians are uniquely positioned to identify lonely and anxious elderly individuals and to initiate services.

Multidisciplinary mental health teams should be established at the regional and national level by health authorities.

Our study has some limitations. The data collection was administered by telephone conversation with elder people who were obliged to stay at home, not face to face. This may have created an obstacle in communication. However, a phone call made in the comfort of a home environment may have enabled the elderly person to express their fears and loneliness more easily. Another limitation was that the sample size was relatively small, since those with Alzheimer's disease and a psychological disorder were not included in the study.

Those with advanced presbycusis could not be included in the study too because of the data were collected by phone call. Nevertheless, our study is important in terms of showing the psycho-sociological negative effects that may develop in the elderly people due to the precautions to be taken against the pandemic.

In conclusion, this study revealed that elderly individuals in the society have fears due to coronavirus and their level of loneliness increased. Psychological, social, economic and somatic coronaphobia scale scores and emotional and social loneliness scale scores had increased in elderly individuals. Within the scope of combating the pandemic, priority should be given to preventive and therapeutic approaches, considering these psychological conditions of elderly individuals.

The authors received no financial support for the research.

The authors declare that there is no conflict of interest.

Fatma G. Cihan https://orcid.org/0000-0001-7393-6860

Funda Gökgöz Durmaz https://orcid.org/0000-0003-3043-5809

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How to cite this article: Cihan FG, Gökgöz Durmaz F. Evaluation of COVID-19 phobia and the feeling of loneliness in the geriatric age group