Impact of the COVID-19 pandemic lockdown on physical activity, physiological function, and psychological well-being among community-dwelling older people

An observational study

Abstract

Background: 

Old age is an important period in the development stage of a human being, and the older persons become more vulnerable and are prone to develop physical and psychological ailments. Psychological well-being has been examined as an indicator of successful adaptation during old and really adulthood. Regular physical activity improves mental health reducing the risk of depression, cognitive decline, and delaying the physiological changes during aging.

Purpose: 

The purpose of this study was to find out the impact of coronavirus disease 2019 pandemic lockdown on selected physical, physiological, and psychological variables among community-dwelling older people.

Materials and Methods: 

One hundred and thirty participants were evaluated using the sit and reach test, 30-s chair-rise test, pulmonary function test, 2-min step test, and Ryff's psychological well-being scale.

Results: 

Data were analyzed using GraphPad In Stat version 3.10, 32 bit for Windows. When compared with normative values, a significant difference was found in all the variables (P = 0.005).

Conclusion: 

The patients have changes/alterations in all the physical, physiological, and psychological variables.

INTRODUCTION

Old age is a crucial period within the development stage of a person's being, and therefore, the older persons become more vulnerable and are susceptible to develop physical and psychological ailments. Usually, physical health is the most ordinarily used index to assess the well-being of people. As people get older, they could perceive that their physical health (e.g. the prevalence rates of chronic conditions) is not nearly as good because it has been within the past.

Psychosocial well-being for older adults might be simply defined as they are living well emotionally and socially in adulthood. However, living well means various things to different people, and every individual's experience of adulthood is going to be unique. It is realistic to acknowledge that change or loss might occur in old age, but it is still possible to live well despite this. The satisfaction possessed by a private depends on what proportion they suits and deal with the changes and losses that occur. There are several dimensions of psychosocial well-being, which includes self-reliance, personal growth, purpose, and harmonious relationship. Psychological well-being is a dynamic concept that includes subjective social and psychological dimensions as well as health-related behavior. Contemporary discourse often initially refers to the World Health Organization definition that health is not the mere absence of diseases, but a state of well-being. While this definition links the concepts of health and well-being, it also has a tendency to underplay the significance and complexity of well-being as a concept. Health tended to be located within biomedical and positivist discourses. The Government office for Science Foresight Report on Mental Capital and Well-being (2008) suggests that well-being is a dynamic state that is enhanced when people can fulfill their personal and social goals and achieve a way of purpose in society. Rather than being static, well-being emerges from how people interact with the planet around them at different points in their lives. Psychological well-being has been examined as an indicator of successful adaptation during old and really adulthood. Regular physical activity also improves mental health and can reduce the risk of depression, cognitive decline, delay the physiological changes during aging, and improve overall feelings of well-being. Therefore, the purpose of this study was to find out the impact of coronavirus disease 2019 (COVID-19) pandemic lockdown on selected physical, physiological, and psychological variables among community-dwelling older people.

Need for study

As countries are suffering from COVID-19, the elderly population will soon be told to self-isolate for “a very long time” in many countries, including India.[¹²] As nations around the world impose lockdowns, curfews, and social isolation to prevent the spread of severe acute respiratory syndrome, this decision to safeguard the elderly protects taxed health systems. COVID-19. However, it is documented that social isolation among older adults could even be a “serious public health concern” due to their heightened risk of cardiovascular, autoimmune, neurocognitive, and psychological state problems.[⁷] The COVID-19 pandemic is causing unexpected fear and suffering for older people across the earth. Older persons who are quarantined or locked down with relations or caregivers can also face higher risks of violence, abuse, and neglect. The virus is not just threatening the lives and safety of older persons, it is also threatening their social networks, their access to health services, their jobs, and their pensions. Prolonged periods of isolation could have a significant effect on the psychological state of older persons. The pandemic may significantly lower older persons' incomes and living standards. Physical distancing can take a huge on our mental health. Living alone and being more digitally included than others – the risks are greater for older persons.[¹⁰] Santini et al.[⁸] recently established that social isolation increases the risk of depression and anxiety among older persons. Self-isolation will disproportionately affect elderly people who only interact with others outside of the house, such as at daycare centers, community centers, and places of worship. Those who do not have close relatives or friends and rely on voluntary services or social care for assistance and those who are already lonely, alone, or reclusive may be at a greater risk. Although there may be discrepancies in access to or literacy in digital resources, online technologies could be used to provide social support networks and a sense of belonging.[³] It is even more crucial for people of all ages and abilities to be as active as possible during the COVID-19 pandemic, when so many of us are severely restricted in our movements. Even a little break from sitting, such as walking or stretching for 3–5 min, can assist relieve muscle strain, relieve mental tension, and enhance blood circulation and muscular activity. Physical activity can also assist to keep the day on track and allow you to stay in touch with family and friends.[⁴]

MATERIALS AND METHODS

• Study design: A cross-sectional study
• Study setting: DVVPF's College of Physiotherapy, Ahmednagar, and MAEER's Physiotherapy College, Talegaon Dabhade
• Study population: Community-dwelling older people
• Study duration: 1 year
• Study material: Pulmonary function test (PFT) machine, Sit and Reach Box, Body Fat Analyzer, weighing machine, measuring tape, Ryff's psychological well-being scale, armchair, computer, printer, and mouthpiece
• Sample size: 100
• The sample size was calculated by OpenEpi.com free, web-based, open source, operating systemdeveloped by the Centers for Disease Control and Prevention (CDC)
• Parameters used: PFT
• Population size (n): 10000
• Hypothesized % frequency of outcome factor in the population (p): 10%
• Confidence limit as % of 100 (d): 5%
• Confidence level (%): 85%.

Inclusion criteria

• Age: 65–85 years
• Both male and female participants
• No history of COVID-19 or any respiratory illness
• Homebound during the pandemic.

Exclusion criteria

• Having respiratory disease history before the lockdown
• Having cardiovascular disease history before lockdown
• Known case of diabetes mellitus, hypertension, etc.
• Having any neurological, psychological, and psychiatric disorder.

Outcome measure

1. Physical variables – Sit and Reach test, 30-s chair-stand test

2. Physiological variables – PFT, 2-min step test

Pulmonary function test[⁵]

• PFTs are breathing tests to find out how well you move air in and out of your lungs and how well oxygen enters your blood stream
• Spirometer is one of the most commonly ordered tests of your lung function. The spirometer measures how much air you can breathe into your lungs and how much air you can quickly blow out of your lungs
• This test is done by having you take in a deep breath, and then as fast as you can, blow out all of the air. You will be blowing into a tube (mouthpiece) connected to a machine (spirometer)
• To get the “best” test result, the test is repeated three times. You will be given a rest between tests
• The staff person will work with you to learn how to do the test correctly. It usually takes 30 min to complete this test.

3. Psychological variables – Ryff's psychological well-being scale (18 items).[¹³]

Procedure

Recruitment of samples

Samples were recruited according to the inclusion and exclusion criteria from the older people visiting fitness classes in physiotherapy outpatient department.

Evaluation

• After obtaining clearance from the Institutional Ethical Committee, instructions were given to the participants about the study and its benefits and risks in their own language
• Consent was taken from all the participants
• The participants were selected on the basis of inclusion and exclusion criteria
• Demographic data were taken, such as age, height, and weight.
• The participants were evaluated for the sit and reach test, 30-s chair-rise test, PFT, 2-min step test, and Ryff's psychological well-being scale [Figure 1].

Figure 1: Procedure flow chart

Statistical analysis

Analysis was performed on GraphPad In Stat version 3.10, 32 bit for Windows (GraphPad Prism, GraphPad technology, USA).

Descriptive statistics include means and standard deviations (SDs) for age, gender, height, and weight for the baseline characteristics.

The comparison between the groups was made by unpaired t-test.

This cross-sectional study consisted of 130 community- dwelling older individuals of both genders.

P < 0.05 was considered the level of significance.

RESULTS

Analysis was performed on GraphPad In Stat version 3.10, 32 bit for Windows. Of 130 samples in community-dwelling older people, 76 were male and 54 were female. All the values of the assessment were compared with mean and SD of normal values. After comparison within the groups, no significant difference was found. For physical characteristics like the sit-and-reach test, the normative and obtained mean and SD values were 16.28 3.2[¹⁴] and 13.7 7.22, and for the 30 s chair-stand test, the mean SD was 15.2 4.64[¹⁵] and 13.51 1.14, respectively. Both had P values of 0.005 and 0.005, respectively, which is regarded as statistically significant [https://links.lww.com/JIGIMS/A0https://links.lww.com/JIGIMS/A1https://links.lww.com/JIGIMS/A2https://links.lww.com/JIGIMS/A3]. Physiological variables such as PFT (forced expiratory volume in 1 s (FEV₁), forced vital capacity [FVC], FEV1/FVC, and peak expiratory flow rate) and 2-min step test in community-dwelling older people had been conducted and compared with the normative values, respectively [Table 1]. The PFT values were significantly higher among the elderly who were facing the pandemic lockdown; the physiological capacity was seen to be reduced.[¹⁶] In 2-min step test, compared with normative values [Table 2], a significant difference was seen. The normative and obtained mean ± SD values were 47.2 ± 14.0[⁹] and 67.4 ± 21.9, respectively, (P = 0.005). Psychological well-being has been examined as an indicator of successful adaptation during old and very old age. One of the most widely used survey instruments is Ryff's multidimensional psychological well-being scale. It was specifically defined to measure the positive aspects of psychological functioning along six theoretically-motivated dimensions: independence and self-determination (autonomy); having satisfying, high-quality relationships (positive relations with others); the ability to manage one's life (environmental mastery); being open to new experiences (personal growth); believing that one's life is meaningful (purpose in life); and a positive attitude toward oneself and one's past life (self-acceptance). Respondents rate statements on a scale of 1–6, with 1 indicating strong disagreement and 6 indicating strong agreement. The values are lower on the psychological well-being measure. The mean of the scale was lower, and as we know, lower the values more the psychological affection. The significant difference was shown among psychological well-being [Table 3].

Table 1: Relation among physical variables values with normative vales

Table 2: Physiological variables compared with normative values

Table 3: Mean and standard deviations of six aspects of Ryff's psychological well-being scale in community-dwelling older people

DISCUSSION

The COVID-19 epidemic, which began in 2020, drastically affected people's lives and perceptions of the world. COVID-19 is a viral respiratory disease that affects millions of individuals worldwide.

With the United States' aging population expected to grow, a detailed understanding of “normal” aging-related alterations to the respiratory system is essential. With aging, the respiratory system changes anatomically, physiologically, and immunologically. The chest wall and thoracic spine abnormalities are among the structural alterations that impede the overall respiratory system compliance. Senile emphysema is a condition in which the lung parenchyma loses its supporting structure, resulting in airspace dilatation. With age, the power of the respiratory muscles weakens, making it difficult to cough effectively, which is crucial for airway clearance. By the age of 20–25, the lungs have matured, and aging is linked to a steady loss in lung function. With age, the alveolar dead space expands, affecting arterial oxygen, but not carbon dioxide elimination. As age increases, the airway receptors undergo functional changes and are less likely to respond to medications used to treat the same problems in younger population. A respiratory ailment spread fast over the world around the start of 2020. The population most affected by this pandemic is elderly, who have more comorbidity and are more susceptible to illnesses. The virus's combined effects, as well as the virus's containment efforts, have resulted in a greater social isolation, financial insecurity, and worry about the future Van Bavel et al. 2020).[²] The goal of this study was to see if the COVID-19 pandemic had an influence on well-being and if the effect of personality on well-being by the pandemic. There were a few noteworthy discoveries. For starters, it was obvious that during the pandemic, young adults had lower levels of happiness. It effects on both positive and negative impact, and this was the strongest. Other well-being indicators had a smaller influence, although positive relationships, autonomy, and environmental mastery had a slightly higher impact than meaning in life, life satisfaction, and personal progress. Second, the impact of personality on well-being is compatible with the hypothesis of powerful situations. Finally, there was a modest indication that COVID-19 moderated the impact of personality on happiness. Extraversion's benefits on positive effect were reduced.

Numerous commentators have expressed fear that the pandemic may lead to increased levels of depression, loneliness, and suicide (Brooks et al.[³], 2020; Courtet et al., 2020[⁶]; Van Bavel et al., 2020[²]), and many cross-sectional studies indicate that individuals are in distress. While this countermeasure slows the spread of the virus on the one hand, it also reduces physical activity on the other during periods of disuse to maintain muscle mass and function from catabolic crises; sedentariness is linked to a number of unfavorable health consequences, including an increased risk of falls, fractures, and impairments in older persons. Furthermore, the reaction of older persons to physical rehabilitation is muted, and to counteract the loss of skeletal muscle due to disuse, a combination of rigorous resistance training and diet is required. Due to the hyperactive host immune response and inflammatory organ injury, the respiratory system is heavily involved during COVID-19, but there are no signs of organ malfunction in the mid and long term. Impairment of pulmonary function and lower exercise capacity improved over time in the past encounters with Coronavirus lung involvement of SARS radiologic abnormalities, but may be permanent in some for months or even years. The evidence for pulmonary function testing in the elderly, following the COVID-19 pandemic, is still confined to short retrospective studies with small samples.

Limitations

• The most patients were not willing to participate due to pandemic.

CONCLUSION

The patients are having changes/alterations in physical, physiological, and psychological variables during and after the lockdown period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.