Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study.
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Authors
Jones, Linda A
Jiang, Shan
Jin, Huajie
Dong, Dong
Chen, Xi
Wang, Dan
Zhang, Yun
Xiang, Li
Zhu, Anna
Cardinal, Rudolf N
Publication Date
2022-03-04Journal Title
BMC Geriatr
ISSN
1471-2318
Publisher
Springer Science and Business Media LLC
Volume
22
Issue
1
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Chen, S., Jones, L. A., Jiang, S., Jin, H., Dong, D., Chen, X., Wang, D., et al. (2022). Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study.. BMC Geriatr, 22 (1) https://doi.org/10.1186/s12877-022-02799-w
Abstract
BACKGROUND: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure. METHODS: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers' corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness. RESULTS: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19. CONCLUSION: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.
Keywords
Activities Of Daily Living, Older Adults, Domiciliary Care, Covid-19, Live Alone, Humans, Activities of Daily Living, Longitudinal Studies, Aged, Female, Male, Pandemics, COVID-19, SARS-CoV-2, Home Environment
Sponsorship
Medical Research Council (MC_PC_17213)
MRC (via Swansea University) (DATAMIND 106893)
National Institute for Health Research (IS-BRC-1215-20014)
Medical Research Council (MR/W014386/1)
Identifiers
35246064, PMC8894568
External DOI: https://doi.org/10.1186/s12877-022-02799-w
This record's URL: https://www.repository.cam.ac.uk/handle/1810/335769
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