key: cord-0903835-nitvm4u5
authors: Carr, Deborah
title: COVID 19: Trends, Disparities, and Consequences for Older Adults
date: 2020-12-01
journal: J Gerontol B Psychol Sci Soc Sci
DOI: 10.1093/geronb/gbaa211
sha: 7d67c422ebb1ee46ff4dae5fd0e2dc81e6589998
doc_id: 903835
cord_uid: nitvm4u5

nan

and the presence of hypertension and diabetes, although the magnitude and statistical significance of these risk factors differed slightly in the ‗best' versus ‗worst' case scenarios. Sharma (2021) concludes that rigorous methods and data are critical for promoting public knowledge and trust regarding COVID-19, and for helping health care providers and policymakers to devise evidence-based solutions.

Race and ethnicity have emerged as powerful risk factors for COVID-19 at every stage of the life course including old age. Garcia and colleagues (2021) delineate how structural racism magnifies age-related risks for black and Latinx persons. Drawing on fundamental cause perspectives, they describe three mechanisms through which structural racism affects COVID-19 burden among older adults: (a) risk of exposure, (b) weathering processes, and (c) health care access and quality. They call for federal, state, and local governments to collect and release comprehensive data on COVID-19 cases and deaths by race/ethnicity and age, and urge transformative actions that address structural racism to achieve population health equity.

A c c e p t e d M a n u s c r i p t 4 Latinx older adults' disproportionate risk of COVID-19 poses a particular puzzle for health researchers, as it challenges the well-known Hispanic or Latino -paradox.‖ This paradox is evident in studies documenting that Hispanics have a health and survival advantage relative to non-Hispanic whites in the United States; this finding is considered paradoxical given Latinos' lower levels of education, income, and access to care. To examine whether this paradox persists in the case of COVID-19, Saenz and Garcia (2021) use data from the Centers for Disease Control and Prevention to compute age-specific death rates (ASDRs) for COVID-19 deaths, residual deaths, and total deaths. They find that Latinos have significantly higher ASDRs than non-Latino Whites for COVID-19 deaths. Although the Latino advantage for total deaths persisted during the pandemic, this gap diminished significantly from the prior 20 year period. Saenz and Garcia (2021) conclude that innovative public policies are required to address the disparate burden of the COVID-19 pandemic, particularly among older adults in marginalized communities. Weak, sparse, or compromised social networks may be a pathway contributing to the vast racial divide in COVID-19 outcomes. Gauthier and colleagues (2021) reviewed prior studies on network size, composition, and density to document racial/ethnic disparities in networks both prior to and after the start of the pandemic. They find that racial differentials in social networks intensify long-standing health inequalities and they call for a better understanding of social network inequalities for marginalized older adults, particularly in the context of the COVID-19 health crisis.

While racial and ethnic disparities are the most widely studied source of inequity in older adults' COVID risk, regional differences also are evident. Choi and Yang (2021) examined county-level COVID deaths in more than 3,000 counties in the contiguous United States, and classified each county based on the percentage of residents ages 65+ and the A c c e p t e d M a n u s c r i p t 5 percentage rural. They found that both urban and rural counties with larger age 65+ populations are more vulnerable to COVID-19 and these disadvantages regarding COVID-19 infections intensify more rapidly over time in urban areas. These results call attention to the importance of early preventative steps and interventions to help stem the tide of illness spread.

One of the most widely-heeded public health recommendations to stop the spread of COVID-19 is social distancing. While social distancing measures help protect against contagion, they limit older adults' social engagement and ultimately their emotional wellbeing. Fuller and Huseth-Zosel (2012) carried out a mixed-methods study of 76 older adults in the Midwest during the early weeks of social distancing guidelines. They found that loneliness increased during this period, and the increase was larger for urban versus rural older adults. Feelings of loss and lack of control were common among those reporting increases in loneliness, whereas adults who did not experience intensified loneliness were protected by their use of new social connection modes. The authors suggest that providing different modes of connection for older adults, ranging from video chat to letter writing programs, may help to meet isolated older adults' social needs.

The use of the internet for video chatting, emailing, and information-seeking, may help older adults adapt to social isolation and home confinement. Seifert, Cotton, and Xie (2021) describe how the pandemic has been particularly isolating for older adults who opt not to use the internet, lack necessary devices and network connectivity, or are inexperienced using information and communication technologies (ICT). Older adults who are frail or residing in long-term care facilities are especially vulnerable to the double burden of social and digital exclusion. The authors argue that providing ICTs to groups on the -wrong side‖ of the digital divide may be easy; the difficult part is ensuring that people have the skills to use M a n u s c r i p t 6 ICTs to maintain contact and find information over time. Social ties-particularly family members, friends, and neighbors-can play a pivotal role in enhancing isolated older adults' social support and engagement. Campos-Castillo (2021) brings new data to bear on questions of differential access to ICT, and analyzes national survey data obtained during mid-March 2020. The analysis shows that midlife adults ages 50-64 were more likely than those ages 65+ to search for and share information about COVID-19, and men (regardless of age) were less likely than women to

seek out and share this information. Campos-Castillo (2021) concludes that midlife women's heavy reliance on the internet may reflect their role in caregiving, which may intensify their need for information.

Since the beginning of the pandemic, older adults have been urged to stay home and minimize if not wholly eliminate social contact with others, in an effort to minimize the health risks of disease contagion. However, this loss of close contact, most notably hugs and gentle touching, may undermine older adults' health. Thomas and Kim (2021) analyzed data from the National Social Life, Health, and Aging Project (NSHAP) and found that more frequent physical touch reduced the odds of elevated inflammation among older adults.

Although the data were obtained before the start of the pandemic, Thomas and Kim (2021) conclude that socially isolated older adults could be encouraged to hug or touch just one ortwo low-risk individuals, to bear the benefits of touch without substantially increasing their risk for COVID-19.

Older adults who live alone may be at particular risk of social and physical touch deprivation, as they do not have a source of coresidential social, emotional or practical support. In May and June 2020, Fingerman and colleagues (2021) administered surveys to 226 older adults who had previously participated in the Daily Experiences and Well-being A c c e p t e d M a n u s c r i p t 7 Study (DEWS). They found that older adults residing alone were less likely to see others in person or to receive or provide help. In-person social contacts provided positive emotional boosts in ways that phone contact did not. These results suggest that possible interventions during the pandemic may work best with safe forms of in-person contact, possibly with nonfamily members.

The future of COVID-19 is uncertain. In late November 2020, the CDC lamented that for four consecutive days, the number of daily deaths in the U.S. exceeded 1,000. At the same time, pharmaceutical manufacturers and the federal government announced that a vaccine could be available as early as December. Experts predict that older adults and the front-line workers who care for them will be at the front of the queue to receive the vaccine. Social gerontologists will continue to play a central role in documenting the far-ranging ways that older adults' lives are affected by COVID-19 and the many efforts to mitigate its spread.

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

Gender divides in engagement with COVID-19 information on the internet among US older adults

Centers for Disease Control and Prevention. 2020. Daily Updates of Totals by Week and State: Provisional Death Counts for Coronavirus Disease

Are older populations at a disadvantage? County-level analysis of confirmed COVID-19 cases in urban and rural America

Living alone during COVID-19: Social contact and emotional well-being among older adults

The color of COVID-19: structural racism and the pandemic's disproportionate impact on older racial and ethnic minorities

Exacerbating inequalities: Social networks, racial/ethnic disparities, and the COVID-19 pandemic

The disproportionate impact of COVID-19 on older Latino mortality: The rapidly diminishing Latino paradox

A double burden of exclusion? Digital and social exclusion of older adults in times of COVID-19

Estimating older adult mortality from COVID-19

Lost touch? Implications of physical touch for physical health