“I Can’t Take Any Chances”: A Mixed Methods Study of Frailty,Isolation,Worry,and Loneliness Among Aging Adults During the COVID-19 Pandemic

Abstract

Little is known about how frailty has shaped experiences of living through the COVID-19 pandemic. In this cross-sectional mixed methods study, we analyzed data from the nationwide COVID-19 Coping Study from December 2020 through January 2021 (N = 2094 US adults aged ≥55) to investigate quantitative associations between frailty and the prevalence of physical isolation, worry about COVID-19, and loneliness. Reflexive thematic analysis explored aging adults’ lived experiences of frailty during the pandemic. In multivariable-adjusted population-weighted modified Poisson regression models, we found that frailty was associated with increased prevalence of physical isolation, worry about COVID-19, and loneliness. Qualitative experiences of aging with frailty during the pandemic were diverse, and encompassed isolation, worry, and loneliness, as well as coping strategies and resilience. The findings may inform individualized multi-factorial strategies (e.g., physical activity, nutrition, and social interaction) to support well-being among adults aging with frailty during the pandemic.

Keywords

frailty,mental health,mixed methods,person-centered care,risk perception

Get full access to this article

View all access options for this article.

References

Belloni

Cesari

(2019). Frailty and intrinsic capacity: Two distinct but related constructs. Frontiers in Medicine, 6, 133. https://doi.org/10.3389/fmed.2019.00133

Boreskie

K. F.

Hay

Duhamel

(2020). Preventing frailty progression during the COVID-19 pandemic. The Journal of Frailty & Aging, 9(3), 130–131. https://doi.org/10.14283/jfa.2020.29

Braun

Clarke

(2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676x.2019.1628806

Braun

Clarke

(2021). One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qualitative Research in Psychology, 18(3), 328–352. https://doi.org/10.1080/14780887.2020.1769238

Chen

A. T.

Cho

Teng

A. K.

Chu

Demiris

Zaslavsky

(2021). Reactions to COVID-19, information and technology use, and social connectedness among older adults with pre-frailty and frailty. Geriatric Nursing, 42(1), 188–195. https://doi.org/10.1016/j.gerinurse.2020.08.001

Cipolletta

Gris

(2021). Older people’s lived perspectives of social isolation during the first wave of the COVID-19 pandemic in Italy. International Journal of Environmental Research and Public Health, 18(22), 11832. https://doi.org/10.3390/ijerph182211832

Clegg

Young

Iliffe

Rikkert

M. O.

Rockwood

(2013). Frailty in elderly people. Lancet, 381(9868), 752–762. https://doi.org/10.1016/s0140-6736(12)62167-9

COVID-19 Recommendations for Seniors . (2020). Alaska department of health and social services. https://dhss.alaska.gov/dph/epi/id/SiteAssets/Pages/HumanCoV/DHSS_HighRiskGroups_Recommendations.pdf

Creswell

J. W.

Clark

V. L. P.

(2017). Designing and conducting mixed methods research. Sage publications.

10.

Creswell

J. W.

Plano Clark

V. L.

Gutmann

M. L.

Hanson

W. E.

(2003). Advanced mixed methods research designs. Handbook of Mixed Methods in Social and Behavioral Research, 209(240), 209–240.

11.

Czeisler

M. É.

Marynak

Clarke

K. E.

Salah

Shakya

Thierry

J. M.

Ali

McMillan

Wiley

J. F.

Weaver

M. D.

Czeisler

C. A.

Rajaratnam

S. M.

Howard

M. E.

(2020). Delay or avoidance of medical care because of COVID-19–related concerns—United States, June 2020. Morbidity and Mortality Weekly Report, 69(36), 1250–1257. https://doi.org/10.15585/mmwr.mm6935e3

12.

Elo

Kyngäs

(2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x

13.

Finlay

J. M.

Kler

J. S.

O'shea

B. Q.

Eastman

M. R.

Vinson

Y. R.

Kobayashi

L. C.

(2021a). Coping during the COVID-19 pandemic: A qualitative study of older adults across the United States. Frontiers in Public Health, 9(April 2021), 323. https://doi.org/10.3389/fpubh.2021.643807

14.

Finlay

J. M.

Meltzer

Cannon

Kobayashi

L. C.

(2021b). Aging in place during a pandemic: Neighborhood engagement and environments since the COVID-19 pandemic onset. The Gerontologist, 62(4), 504–518. https://doi.org/10.1093/geront/gnab169

15.

Flett

G. L.

Heisel

M. J.

(2020). Aging and feeling valued versus expendable during the COVID-19 pandemic and beyond: A review and commentary of why mattering is fundamental to the health and well-being of older adults. International Journal of Mental Health and Addiction, 19(6), 1–27. https://doi.org/10.1007/s11469-020-00339-4

16.

Gale

C. R.

Westbury

Cooper

(2018). Social isolation and loneliness as risk factors for the progression of frailty: The English longitudinal study of ageing. Age and Ageing, 47(3), 392–397. https://doi.org/10.1093/ageing/afx188

17.

Herrera-Badilla

Navarrete-Reyes

A. P.

Amieva

Avila-Funes

J. A.

(2015). Loneliness is associated with frailty in community‐dwelling elderly adults. Journal of the American Geriatrics Society, 63(3), 607–609. https://doi.org/10.1111/jgs.13308

18.

Hoogendijk

E. O.

Suanet

Dent

Deeg

D. J.

Aartsen

M. J.

(2016). Adverse effects of frailty on social functioning in older adults: Results from the Longitudinal Aging Study Amsterdam. Maturitas, 83, 45–50. https://doi.org/10.1016/j.maturitas.2015.09.002

19.

Hunsaker

Hargittai

(2018). A review of Internet use among older adults. New Media & Society, 20(10), 3937–3954. https://doi.org/10.1177/1461444818787348

20.

Internet/Broadband Fact Sheet (2019). Pew research center. https://www.pewresearch.org/internet/fact-sheet/internet-broadband/

21.

Kobayashi

L. C.

O’Shea

B. Q.

Kler

J. S.

Nishimura

Palavicino-Maggio

C. B.

Eastman

M. R.

Vinson

Y. R.

Finlay

J. M.

(2021). Cohort profile: The COVID-19 coping study, a longitudinal mixed-methods study of middle-aged and older adults’ mental health and well-being during the COVID-19 pandemic in the USA. BMJ Open, 11(2), Article e044965. https://doi.org/10.1136/bmjopen-2020-044965

22.

Kremers

E. M.

Janssen

J. H.

Nieuwboer

M. S.

Olde Rikkert

M. G.

Peeters

(2021). The psychosocial adaptability of independently living older adults to COVID-19 related social isolation in The Netherlands: A qualitative study. Health & Social Care in the Community, 30(1), Article e67–e74. https://doi.org/10.1111/hsc.13436

23.

Kuchel

G. A.

(2018). Frailty and resilience as outcome measures in clinical trials and geriatric care: Are we getting any closer? Wiley Online Library.

24.

Lood

Haak

Dahlin-Ivanoff

(2021). Everyday life in a Swedish nursing home during the COVID-19 pandemic: A qualitative interview study with persons 85 to 100 years. BMJ Open, 11(6), Article e048503. https://doi.org/10.1136/bmjopen-2020-048503

25.

McIntyre

C. C.

Prichett

McNabney

M. K.

(2022). Impact of CoViD-19 stay-at-home restrictions on falls in one community of high-risk older adults. Journal of Applied Gerontology, 41(5), 1473–1479. https://doi.org/10.1177/07334648211073607

26.

Mhaolain

A. M. N.

Fan

C. W.

Romero-Ortuno

Cogan

Cunningham

Kenny

R.-A.

Lawlor

(2012). Frailty, depression, and anxiety in later life. International Psychogeriatrics, 24(8), 1265–1274. https://doi.org/10.1017/s1041610211002110

27.

Morley

J. E.

Malmstrom

Miller

(2012). A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. The Journal of Nutrition, Health & Aging, 16(7), 601–608. https://doi.org/10.1007/s12603-012-0084-2

28.

Mudge

A. M.

Hubbard

R. E.

(2018). Frailty: Mind the gap. Age and Ageing, 47(4), 508–511. https://doi.org/10.1093/ageing/afx193

29.

Nicholson

Gordon

A. L.

Tinker

(2017). Changing the way “we” view and talk about frailty. Age and Ageing, 46(3), 349–351. https://doi.org/10.1093/ageing/afw224

30.

People with Certain Medical Conditions . Centers for disease control and prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

31.

Polenick

C. A.

Perbix

E. A.

Salwi

S. M.

Maust

D. T.

Birditt

K. S.

Brooks

J. M.

(2021). Loneliness during the COVID-19 pandemic among older adults with chronic conditions. Journal of Applied Gerontology, 40(8), 804–813. https://doi.org/10.1177/0733464821996527

32.

Russell

D. W.

(1996). UCLA loneliness scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40. https://doi.org/10.1207/s15327752jpa6601_2

33.

Seaman

S. R.

White

I. R.

(2013). Review of inverse probability weighting for dealing with missing data. Statistical Methods in Medical Research, 22(3), 278–295. https://doi.org/10.1177/0962280210395740

34.

Skilbeck

J. K.

Arthur

Seymour

(2018). Making sense of frailty: An ethnographic study of the experience of older people living with complex health problems. International Journal of Older People Nursing, 13(1), Article e12172. https://doi.org/10.1111/opn.12172

35.

Søvde

B. E.

Sandvoll

A. M.

Natvik

Drageset

(2021). In the borderland of the body: How home‐dwelling older people experience frailty. Scandinavian Journal of Caring Sciences, 36(1), 255–264. https://doi.org/10.1111/scs.12984

36.

Steinman

M. A.

Perry

Perissinotto

C. M.

(2020). Meeting the care needs of older adults isolated at home during the COVID-19 pandemic. JAMA Internal Medicine, 180(6), 819–820. https://doi.org/10.1001/jamainternmed.2020.1661

37.

Steptoe

Shankar

Demakakos

Wardle

(2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), 5797–5801. https://doi.org/10.1073/pnas.1219686110

38.

Vervaecke

Meisner

B. A.

(2021). Caremongering and assumptions of need: The spread of compassionate ageism during COVID-19. The Gerontologist, 61(2), 159–165. https://doi.org/10.1093/geront/gnaa131

39.

Warmoth

Lang

I. A.

Phoenix

Abraham

Andrew

M. K.

Hubbard

R. E.

Tarrant

(2016). ‘Thinking you're old and frail’: A qualitative study of frailty in older adults. Ageing & Society, 36(7), 1483–1500. https://doi.org/10.1017/s0144686x1500046x

40.

WHO (2016). WHO Clinical consortium on healthy ageing: Topic focus: Frailty and intrinsic capacity. WHO.

41.

Wortham

J. M.

(2020). Characteristics of persons who died with COVID-19—United States, February 12–May 18, 2020. MMWR. Morbidity and mortality weekly report, 69.

42.

Zou

(2004). A modified Poisson regression approach to prospective studies with binary data. American Journal of Epidemiology, 159(7), 702–706. https://doi.org/10.1093/aje/kwh090

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.45 MB

0.34 MB