Older Adults' Perceptions of the Impact COVID-19 Pandemic

Study Overview
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Brief Summary
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This multicentre study will be conduct in several Portuguese institutions, which provide care and supporting services for older adults, with aim to assess the impact of COVID-19 pandemic on the cognitive, emotional and social status of their beneficiaries. Initially, data on global cognitive function, executive function, mood, anxiety, loneliness, and quality of life will be collected. Secondly, a semi-structured interview will be carried out to realize and understand what were the major difficulties experienced by the older adult during the pandemic period.

Detailed Description
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The pandemic COVID-19 imposed the mobilisation of institutions providing care and supporting services for older adults, and the adoption of new habits on a large scale and in a very short period of time. The need to change daily routines proved to be particularly impactful among older adults, since these citizens, due to their vulnerability to adverse health outcomes and the need for additional protection against the exposure to the risk of viral infection, were subjected to more demanding and inflexible containment measures (Organisation for Economic Co-operation and Development, 2020). The confinement measures resulted in considerable restriction of independence and access to supportive social networks, making it necessary to use compensatory solutions, such as the use of digital technologies and the resolution of emerging problems remotely. However, given that, as suggested by recent statistical data (European Commission, 2020; European Union, 2020), a large proportion of older adults do not have access to suitable equipment or lack adequate digital skills, the effective and satisfactory mobilisation of these compensatory solutions depended, in many cases, on the involvement of others. As a result, older adults saw their personal autonomy compromised and their relationships with other people highly limited. The confinement measures also resulted in the abandonment of at least some healthy living habits (moments of conviviality, cognitive stimulation activities, physical exercise and recreational activities carried out in groups, etc.), which are essential for the maintenance of physical and cognitive capacities, contributing to the increase of well-being and quality of life. Taking into account the duration of the COVID-19 pandemic, it is necessary to understand its impact on the cognitive, emotional, and social status of older adults. Our proposal focuses on older adults who benefit from care and support services (e.g., long-term care centres, day and social centres, home support services), in which the pandemic mitigation measures were particularly rigorous, being supported by contingency plans constantly updated according to the guidelines issued by the Portuguese Directorate-General of Health and supervisory entities.

Official Title
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Older Adults' Perceptions About the Impact of COVID-19 Pandemic on Their Cognitive, Emotional and Social Status: A Multicentre Mixed Methods Study in Institutions Providing Care and Supporting Services for Older Adults

Conditions
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COVID-19 Pandemic, Depression, Anxiety, Cognitive Impairment, Quality of Life, Loneliness

Intervention / Treatment
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* Other: Impact COVID-19 pandemic


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 65 or over. Native Portuguese speakers. Have handed in the project informed consent, duly completed and signed, after prior information. Communication and comprehension skills. Have been attending a care and support services for the older adults for at least two years. Exclusion Criteria: Severe sensory and physical limitations or an acute or serious illness preventing participation in the study. Evidence of aggressive and disruptive behaviour, as indicated by the reference technicians of the institution where the participant attends a care and support services. Consumption of psychoactive substances and/or taking neuroleptics or antipsychotics in the last two months. Presence of a score lower than 10 points in the Mini Mental State Examination.

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Screening tests and semi-structured interview<br>Battery of screening tests with semi-structured interview First, the Mini-Mental State Examination will be administered to participants to assess whether they meet the inclusion criteria and an identification code will be assigned to eligible participants. Posteriorly, a clinical psychologist will administer the Frontal Assessment Battery, Center for Epidemiologic Studies Depression Scale, Geriatric Anxiety Inventory, Loneliness Scale 3 Portuguese version, Quality of Life - Alzheimer's Disease, and will conduct a semi-structured interview about the difficulties experienced by the older adult during the pandemic period. | Other: Impact COVID-19 pandemic<br>* Battery of screening tests and the semi-structured interview focusing on the difficulties experienced by the older adult during the pandemic period.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive functioning assessed through Mini-Mental State Examination (MMSE) | Cognitive functioning will be assessed using the MMSE, which is a gold standard for assessing global cognitive function. Scores range from 0 to 30, with higher scores indicating better cognitive functioning. | baseline | 
| Executive functions assessed through Frontal Assessment Battery (FAB) | FAB assesses executive functions such as abstract thinking, mental flexibility, motor programming, interference sensibility, inhibitory control and environmental independence. Scores range between 0 - 18 points. Higher scores indicate better cognitive function. | baseline | 
| Depressive symptomatology assessed through the Center for Epidemiologic Studies Depression Scale (CES-D) | This instrument assesses depressive symptoms based on 20 statements classified on the frequency scale, with reference to the week prior to the assessment. Scores range between 0 and 60 points. Higher scores indicate more severe depressive symptoms. | baseline | 
| Anxiety symptomatology assessed through the Geriatric Anxiety Inventory (GAI) | GAI assesses, in several contexts, the severity of anxiety symptoms in older adults. It consists of 20 dichotomous response items (I agree/disagree) and refers to the subject's feelings in the week prior to the evaluation. One (1) point is assigned to each agree answer and the overall score is obtained by adding the scores of all items. Scores over 10/11 points indicate symptoms of severe anxiety. | baseline | 
| Loneliness assessed through Loneliness Scale 3 Portuguese version (UCLA) | UCLA is composed of 20 items. Each item is answered according to a Likert scale from 1 (never) to 4 (always). Items 1, 5, 6, 9, 10, 15, 16, 19 and 20 are inverse-scored. Scores range from 20 to 80 points. Higher scores indicate a higher level of loneliness or perceived social isolation. | baseline | 
| Quality of life assessed through Quality of Life - Alzheimer's Disease (QoL-AD) | The QoL-AD is used to assess quality of life. This 13-item scale assesses the quality of life in people diagnosed with dementia, gathering information from the patient about the following domains: perceived health, mood, physical condition, interpersonal relationships, hobbies, decision-making skills, and life as a whole. Scores range from 13 to 52, with higher scores indicating better quality of life. | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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older adults, COVID-19, cognitive function, executive function, mood, depression, anxiety, loneliness, quality of life