Disabilities | Free Full-Text | Describing the Function, Disability, and Health of Adults and Older Adults during the Early Coronavirus Restrictions in 2019: An Online Survey
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1. Introduction
The novel coronavirus disease 2019 (COVID-19) was first reported in December 2019, spread globally, and was declared a global pandemic in March 2020 [1,2]. Many jurisdictions introduced restrictions to reduce virus transmission. In Canada, both the severity and unpredictability of the pandemic restrictions have affected Canadians’ daily living [3,4,5,6]. The province of British Columbia, Canada, implemented a first phase occurring from March to May 2020, with highly restrictive preventive measures instituted by the provincial government to achieve physical distancing by avoiding social activities and interactions [7]. The influence of these preventive measures further disadvantaged those who were already disadvantaged, including based on an individual’s underlying health condition, living situation, and skills to cope with the new situation [8,9,10,11,12].
Research has shown the COVID-19 pandemic has broadly harmed people’s well-being. Well-being has been defined by Columbo (1986) and cited by Yarcheski et al. (1994) as “a multidimensional construct incorporating mental/psychological, physical and social dimensions” (p. 288) (quoting from [13]). Studies show that the physical, psychological, and social aspects of well-being are threatened by the COVID-19 pandemic, especially those with specific needs, placing them at increased health risk and limiting activity [14,15,16,17,18,19]. COVID-19 physical distancing measures socially isolated these individuals [20] by disrupting pre-existing social networks [21], and changing their health and social care access [22,23]. Support service disruptions harmed some individuals’ mental health and well-being, which may have contributed to health and social inequities [22,23]. In addition, for some, physical distancing measures and a limited social network meant spending more time at home and/or alone, increasing the risk of substance misuse or worsening anxiety and depression [4,24,25].
The need of people with disabilities and older adults for personal care puts them at risk of COVID-19 infection [25] or restricts their access to such support due to physical distancing measures [4,26]. In addition, for some, physical distancing measures and/or a limited social network mean spending more time at home and/or alone, increasing the risk of substance misuse or worsening anxiety and depression [23,27,28]. For example, a longitudinal study showed a positive and reciprocal association between the loneliness and the depressive syndrome [29]. Furthermore, there exist barriers to learning and adopting online technologies to access social support such as physical barriers and a lack of access or interest [25,30,31].
There have been recent calls for an inclusive pandemic response to minimize the negative effects of COVID-19 preventive measures on people with disabilities and older adults [17,32]. However, few studies to-date comprehensively describe and compare the physical, psychological, and social aspects between each of these groups’ well-being during different pandemic stages. Therefore, the objective of this study was to describe and compare the well-being of older adults with and without disabilities (≥65 years old) and adults with disabilities in terms of key physical, social and psychological factors during the first pandemic phase.
4. Discussion
The scarcity of data on adults with disabilities and older adults with or without disabilities is a barrier to creating inclusive responses [32]. Therefore, this study evaluated the physical, social and psychological aspects of well-being of these two groups living in British Columbia, Canada, during the first COVID pandemic phase. This study’s findings suggested these individuals’ well-being were at risk.
Consistent with other Canadian pandemic studies [3], this research showed substantial mental health challenges, primarily anxiety, among participants. Our sample’s rate of depressive symptoms (16.7%) is comparable to other studies of the general population during the pandemic [3]. However, this study showed a higher prevalence of anxiety (27.8%) than the general Canadian population (20%) during COVID-19 [3]. Moreover, anxiety increased among people with disabilities [48] and older adults [49] during COVID-19. These results suggest the mental health of older adults and individuals with disabilities was threatened by the COVID-19 pandemic. This study showed that older adults had a lower level of depression. Although some studies identified concerns regarding the mental health of older adults [50], this study suggests that they were coping better than adults during the first phase of pandemic. This is in line with result of studies early in the pandemic [51,52]. For instance, the result of a USA cohort study of middle-aged and older adults showed a decrease in prevalence of depressive symptoms and loneliness with increasing age [52,53].
When individuals encounter increased psychological distress such as anxiety, depression, or boredom, they might resort to maladaptive coping mechanisms, including drinking alcohol or consuming various drugs [54]. Of the participants in this study, 15.3% reported an increase in alcohol use during the COVID-19 pandemic; this is consistent with the June 2020 U.S. health tracking pool, which shows a 12% increase in alcohol or drug use during the COVID-19 pandemic [54]. This underlines the importance of enhancing mental health and substance use screening among individuals with a disability and older adults and developing programs to facilitate access to appropriate health care services during a pandemic.
Resilience is a key factor to be examined in a crisis such as the COVID-19 pandemic [55]. Studies have shown that resilience is negatively associated with indicators of mental health issues, including depression and anxiety [56,57]. Furthermore, some studies documented the partially mediating role of resilience between COVID-19 burnout and COVID-19 stress [55,58]. Our study’s participants showed a higher resilience score compared to other groups studied during COVID-19, such as health care workers in Indonesia and France (resilience score of 69) [59,60]. Furthermore, in our study older adults showed a higher resilience. Studies published pre-COVID showed that older adults have better proactive coping which is helpful for managing every day’s hassles [51]. Studies published during COVID showed that this proactive coping might help older adults to deal with COVID-19 related stress too. Their cumulative life experience could contribute to coping with a stressor such as forced physical distancing [52]. Further qualitative and quantitative studies are needed to identify the reason for a high resilience score of these groups and investigate the factors associated with high resilience.
During past environmental disasters and pandemics, social support and community ties have played a protective role for mental health [61,62]. However, during the COVID-19 pandemic, messaging was poor, as officials frequently encouraged increased social distancing, when they meant physical distancing; this perhaps led to the perception of needing to isolate oneself socially, which may have lessened social support [61]. The results of this study showed older adults had higher levels of social support from family, friends, and significant others compared to younger adults; however, the amount of social support from family and friends was less than the amount of social support reported amongst the literature on people with disabilities [63] (5.88) and older adults [64] (6.4) before the pandemic. Furthermore, our study showed that older adults have better perceived social support. The literature suggests that although older adults concentrate on a circle of relative and friends that is smaller in size, which reduces their social network [65,66], and this smaller group may have offered more social support during the COVID pandemic when physical distancing measures were in place. Recent studies have shown the positive effect of social support on resilience and reduced depression symptoms of this age group [62].
Digital technologies have potential to mitigate loneliness and social isolation during the pandemic. However, populations such as older adults and patients with sensory disabilities may have difficulty accessing alternative ways to meet life needs and care provided by digital technologies [67,68]. Participants showed more optimism toward technology during this pandemic, compared to pre-pandemic literature from the general population [69]; which is concordant with a recent poll [70]. Increased accessibility, as well as receptiveness, to technology for these groups may facilitate social fulfillment.
Online social networking could improve overall mental health and well-being [24]. This study’s data showed participants used their social networks for socialization purposes to keep in touch with relatives or to become more social and strengthen their interpersonal relationship was the highest reported use. The use of digital technologies for socialization purposes is well known, and these findings suggests that the study sample may have used these technologies to counteract limited in-person interactions during the pandemic. This result helps us understand the needs and preferences of the population of interest for this study with regard to digital technology use, and researchers should consider them when designing future programs and studies.
As participants likely adhered to health authority recommendations to stay home and in place, this may have reduced their life space mobility. Some studies showed a significant reduction in the general population’s life-space mobility during the COVID-19 pandemic [71]. The results of this study indicated that mobility was low during the pandemic.
When comparing the LSA scores of the study groups of this paper with similar groups pre-COVID-19 [72,73], the results showed limited mobility among people with disabilities during COVID-19, with mean LSA scores of 47 among adults with disabilities in this study. Data gathered before the pandemic reported a higher life space score, ranging between 62 and 70 [72,73]. This is consistent with other studies that suggest patients with physical disabilities experienced greater limitation when acquiring goods and services during the pandemic [74].
Social engagement requires the maintenance of social connections and relationships, and involvement in activities [75]. Studies have reported the patterns of social participation of individuals with disabilities and older adults changed because of physical distancing measures and the closure of workplaces [74]. Over eighty percent of study participants experienced a participation restriction during the first COVID-19 pandemic phase, similar to other studies [76]. Additionally, participation restriction was increased during COVID-19 preventive measures [77]. Pre-pandemic studies of older adults reported mobility outside the home was the most common area of participation restriction, and work was the least common area of participation restriction [75,78,79]. However, this study found social life and interpersonal relations were the most frequent participation restrictions during COVID-19.
This study’s novelty stems from our use of the ICF model with a sample of two specific groups of interest during the COVID-19 pandemic. This study showed that individuals with disabilities and older adults with and without self-identified disabilities experienced several challenges of health and function within three components of the ICF model, including: (1) environmental factors and personal factors, (2) body function and structure, and (3) activity and participation. Among all of the components, issues were identified in terms of anxiety, boredom, participation, and life space activity for participants of this study. Furthermore, individuals with disabilities experienced anxiety, depression, boredom, restricted participation, and restricted life space more prominently than participants without disabilities.
Study Strengths and Limitations
A main strength of this study is the timing of data collection, which occurred at the end of the pandemic’s first phase. The rich data of this study provide insight into the status of vulnerable groups’ well-being during a critical period in time. One limitation is that data collection was limited to one geographic area (British Columbia); therefore, the findings are not generalizable to the Canadian population. Furthermore, the small sample size limits the paper’s ability to make conclusive inferences, and the findings should be interpreted with caution. Future works should consider the context of their study and emphasize a more nationally representative sample and targeting rural areas. Additionally, participant recruitment was limited to this study’s databases and social media advertising, which might make the sample of the study less representative of the population at large, and individuals in remote areas or with limited access to digital technologies might have been underrecruited. However, about 96% of Canadians have access to social media and the internet [80].
5. Conclusions
This study described the well-being of two specific groups of individuals during the first phase of the COVID-19 pandemic in British Columbia, Canada. The results revealed that adults with disabilities and older adults with or without self-identified disabilities felt anxiety, boredom, lack of participation, and reduced life space activities; however, their resilience scores were still moderate to high. Generally, there was an increase in substance use during COVID-19, the greatest increase being alcohol. This study’s participants showed a high amount of control, flexibility, and efficiency toward new technologies. However, social support across all study groups was lower than observed by pre-COVID studies. Overall, older adults showed better social support, social network, resilience, and depression symptoms than the adult group.
Based on the study’s findings, further exploration of specific causes of deterioration in mental health, function and activity of these groups is required as well as an investigation into the coping strategies of older adults. To this end, more robust evidence may inform refinements to public mental health services and policies, in order to mitigate the harm to vulnerable individuals. When implementing social distancing and preventative measures in a pandemic, policy makers should consider implementing concurrent actions and policies to decrease the negative consequences on the health of vulnerable population members. Furthermore, future works should consider the context of their study to emphasize a more nationally representative sample and targeting rural areas.
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