Understanding Older Adults’ Response to Pandemics: Lessons Learnt from COVID-19

Dr Tou Nien Xiang's study examined differences in mental health, adaptive behaviours, social support, perceived stress, digital media usage, and perceived change in circumstances between younger and older adults during the circuit breaker in Singapore.  Below is a summary of key findings from Dr Tou's presentation: 

• Older adults were reported to have better mental health and perceived less stress concerns during the circuit-breaker period as compared to their younger counterparts.

• Adaptability is important for maintaining mental well-being especially for younger adults.

• Be mindful of ageism stereotyping in portraying older adults as a homogeneous, vulnerable group.

Dr Serene Nai presented her work on the effect of prolonged social isolation on older adults' mental and physical health. Her study looked at the older persons' attitudes towards technology (ATT) and perceived ease of use of technology (PEOU) to discover how they communicated with others, as well as their general well-being during the circuit breaker in Singapore. Below is a summary of key findings from Dr Nai's presentation:

• Greater acceptance and competency of communication technology was associated with greater emotional support and subjective well-being amongst older adults.

• Older adults do share that a motivation to learn technology is that they understand that technology is essential will be used more often in the future

• Older adults further share that they are usually reluctant to learn technology for fear of mishandling, lack of ability to learn (due to old age), and lack of time

• Finally, older adults reflect that communication technology is easier to use when they are less anxious handling the technology and when they have people around to support their learning

Dr Lee Eng Sing shared his work which explored the use of video consultations to provide care for older adults with multimorbidity during the pandemic. Although the potential of video consultations has been explored in several studies, the pandemic presented an unprecedented opportunity to explore the use of this technological innovation in a time when physical distancing was imperative. Below is a summary of Dr Lee's presentation:

• When compared to in-person consultations, video consultations (VCs) appealed to the first-hand users like family physicians, in terms of improved team dynamics, better queue management and continuity of care. Likewise, patients appreciated the more relaxed environment, no traveling time, better eye-contact and attention from physicians during VC. However, additional tasks for preparation of VC and post VC were incurred by the service providers.

• In order to achieve an optimal VC experience, smooth workflow in the administrative, logistical, technical, executory, and communicative domains are pertinent. Successful implementation of VC also requires institutional readiness to support in terms of the logistical, financial and manpower planning, and to augment the existing technological model to cater to the needs for an improved VC experience.

• The sociocultural, professional, regulatory, legal, and political climate should also be taken into consideration in the transition towards the scale-up of VC. Some key aspects include addressing possible worsening of social deprivation and digital divide, safeguarding professional liabilities of physicians, coordinating the institutional with the national pace of implementation, and aligning governing policies nationwide. 

Dr Christine Fahim and Dr Yu Chou Chuen shared findings from their international study which helped provide guidance on messaging to reduce misinformation, stigma, and fear during an outbreak such as the COVID-19 pandemic. Below is a summary of their presentation:

From the study in Canada

• Participants in Canada feared stigmatization during the COVID-19 pandemic because of various demographic characteristics including race/ethnicity, political beliefs, age, or occupation.

• In our studies, over half of participants surveyed or interviewed encountered misinformation during the pandemic; 58% had challenges identifying or appraising COVID-19 information; differences in perceptions were observed by gender and age.

• The COVID-19 pandemic gave rise to misinformation and stigmatization. Our research provides insights on the channels the public used to obtain information and provides suggestions on how communications during public health emergencies could be optimized to reach subsets of the population while aiming to reduce prevalence of misinformation or stigmatization.

From the study in Singapore

• In Singapore, perceived stigma existed largely towards dormitory workers and healthcare workers. Personal experiences of stigma were not widespread and while majority of participants reported being unafraid of stigmatisation, some were cautious of situations where they could be stigmatised.

• Key drivers of stigma and misinformation were identified, such as fear of infection and overseas information sources.

• Trust in local sources for information, fact-checking, and the manner of information dissemination were suggested to facilitate the prevention or reduction of stigma and misinformation.  

Dr Matthew Chen and Dr Jonathan Gao shared their study where they were able to synthesize available evidence on the effectiveness and safety of COVID-19 vaccines for frail older adults. Their findings were supplemented with gathering informed consensus from experts in geriatric medicine. A summary of their presentation is below:

• Systematic review is generally regarded as the highest level of evidence, but the methodological rigour involved means that conducting such a review is time-consuming and may not meet the time-sensitive needs of stakeholders.

• Rapid review involves streamlining and accelerating the process of a systematic review to provide evidence to stakeholders quickly, and is being used by policymakers and health agencies internationally.

• In cases where there is a lack of clear evidence for a topic (e.g. COVID-19 vaccination for frail older adults), the Delphi technique can be used to supplement the findings of a rapid review by gathering informed consensus among a group of experts to provide preliminary guidance to stakeholders. 

Dr Yu Chou Chuen's presentation examined various factors that shaped the older adults' decisions regarding COVID-19 vaccination in Singapore. Through a Theoretical Domains Framework (TDF) Dr Yu presented on the barriers and facilitators toward vaccination.  Key findings from his presentation are as follows:

• The study showed that four of the eight domains in TDF covered in the survey were significant predictors of a composite measure of overall support in Singapore's vaccination programme. This allows us to understand factors associated with vaccination support. The TDF can potentially be useful in predicting vaccination support in future pandemics.

• Trust in government an important predictor of overall support. Continuing to build and maintain trust in government is important.

• Strong endorsement on vaccine safety not apparent for older adults. This suggests addressing doubts and safety concerns continue to be important.