My Home is my Castle? The Role of Living Arrangements on Experiencing the COVID-19 Pandemic: Evidence From Germany

During the early months of the COVID-19 pandemic in Germany, social restrictions and social distancing policies forced large parts of social life to take place within the household. However, comparatively little is known about how private living situations shaped individuals experiences of this crisis. To investigate this issue, we analyze how experiences and concerns vary across living arrangements along two dimensions that may be associated with social disadvantage: loneliness and care. In doing so, we employ quantitative text analysis on open-ended questions from survey data on a sample of 1,073 individuals living in Germany. We focus our analyses on four different household structures: living alone, shared living without children, living with a partner and children, and single parents. We find that single parents (who are primarily single mothers) are at high risk of experiencing care-related worries, particularly regarding their financial situation, while individuals living alone are most likely to report feelings of loneliness. Those individuals living in shared houses, with or without children, had the lowest risk of experiencing both loneliness and care-related worries. These findings illustrate that the living situation at home substantially impacts how individuals experienced and coped with the pandemic situation during the first wave of the pandemic.

How Older Adults Learn ICT—Guided and Self-Regulated Learning in Individuals With and Without Disabilities

Learning to use information and communication technologies (ICT) may be more difficult for older people due to decreases in fluid intelligence, generational effects, and other age-related effects. Especially older people with intellectual disabilities (ID) are at a high risk of digital exclusion. To enable all older adults to use ICT, individualized technology training may be provided. However, little is known about the ICT learning preferences among older people with ID. Based on semi-structured interviews with older adults (n = 7, mean age = 76.6 years) and older adults with ID (n = 14, mean age = 62.4 years), this paper analyzes learning strategies, preferences, and learning settings. The results from content analysis show that guided learning with personal explanations in a one-to-one setting is the most preferred learning format in both groups of older adults. While many older adults without ID additionally favor self-regulated learning (i.e., learning with manuals or videos), older adults with ID mostly rely on guided learning with personal assistance. The differences can be explained by different abilities (e.g., reading skills) and social networks (e.g., living situation, having children). Not all older adults have a family or an institutional support network to help them learn ICT and community organizations may provide additional support. Researchers and practitioners should be aware of the diverse knowledge backgrounds and competencies in the group of older adults. ICT training in old age should be ideally composed in a modular way embedding self-regulated learning formats into guided learning modules.

Rethinking Social Relationships in Adulthood: The Differential Investment of Resources Model

Empirical evidence about the development of social relationships across adulthood into late life continues to accumulate, but theoretical development has lagged behind. The Differential Investment of Resources (DIRe) model integrates these empirical advances. The model defines the investment of time and energy into social ties varying in terms of emotional closeness and kinship as the core mechanism explaining the formation and maintenance of social networks. Individual characteristics, acting as capacities, motivations, and skills, determine the amount, direction, and efficacy of the investment. The context (e.g., the living situation) affects the social opportunity structure, the amount of time and energy available, and individual characteristics. Finally, the model describes two feedback loops: (a) social capital affecting the individual’s living situation and (b) different types of ties impacting individual characteristics via social exchanges, social influences, and social evaluations. The proposed model will provide a theoretical basis for future research and hypothesis testing.

Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics

Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho’s indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.

Determinants of trajectories of fatigability and mobility among older medical patients during and after hospitalization; an explorative study

Background Fatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear. The objectives of this study were to identify trajectories of fatigability and mobility over time and to examine the association between demographic and clinical characteristics and these trajectories in medical patients aged 70 years and older admitted to a Dutch tertiary care teaching hospital. Methods In this prospective cohort study with baseline (in-hospital), discharge, three-, and six-months post discharge follow-up measurements, fatigability was assessed by the physical subscale of the Pittsburgh Fatigability Scale (PFS). Mobility was assessed by the De Morton Mobility Index (DEMMI). Group-based trajectory modeling was used to identify joint trajectories of fatigability and mobility. Covariates included demographic (age, sex, living situation, education) and clinical characteristics (functional status, frailty status, depression, comorbidity, length of hospital stay). Results Among 44 patients, three distinct fatigability trajectories and two mobility trajectories were identified over the course from hospital admission up to six months after discharge. Subsequently, three joint trajectories were identified, including low fatigability and high mobility (11%), improving fatigability and high mobility (52%), and high fatigability and low mobility (36%). Controlling for baseline functional status, patients with a lower comorbidity score (OR: 0.27, 95%CI 0.10; 0.74) and higher frailty status (OR: 1.36, 95%CI: 1.07; 1.74) were more likely to be a member of the high fatigability and low mobility trajectories. Conclusions From hospital admission up to six months after discharge, three distinct trajectories of fatigability and mobility were identified among older medical patients. Our results should be interpreted with caution due to the small sample size, but may inspire other researchers to determine the value of fatigability assessment in identifying older medical patients at risk for developing mobility problems.

"Obesity in the City" – urbanization, health risks and rising obesity rates from the viewpoint of human biology and public health

In 2007, for the first time worldwide, more people lived in urban conurbations than in rural settlement structures. This advancing urbanization has dramatically altered the living situation, the use of space, as well as human behavior along with the health situation and disease burden. This process began in Europe as early as the 19th century, while developing and emerging countries in particular are currently exposed to increasing urbanization. The burden of disease is clearly altered by living in a confined space, by environmental pollution in urban areas, the impossibility of producing food oneself, and being lost in an anonymous crowd. While city air made people “free” in medieval times, it often makes them “sick” today. Obesogenic environments represent a special problem in urban areas. A lack of physical activity, adverse dietary habits, and stressful and unsafe neighborhoods increase the risk of becoming overweight and obese in urban centers. Recently, modernization in rural areas and an adaptation to urban habits there increase the obesity rates in rural areas in high-income as well as low- and middle-income countries, too. Within cities, marked spatial differences in the prevalence of overweight and obesity occur. In Vienna, Austria, overweight and obesity rates during childhood and adolescence differ markedly between the individual Viennese districts. Highest overweight and obesity rates occur in districts characterized by a low socioeconomic status.

Social Outcomes of School Leavers With Cerebral Palsy Living in Victoria

Objective: In Australia, the National Disability Strategy provides a framework to guide actions and investment to achieve equity in social inclusion and economic participation for people with disability. We investigated the social outcomes of school leavers with cerebral palsy (CP) in Victoria, Australia and explored the determinants of desirable outcomes.Methods: We used the Victorian CP Register to invite all adults with CP aged 18–25 years (n = 649). On-line and/or paper-based surveys explored participation in education, employment, community activities, living situation, relationships and life satisfaction. Functional and health status data were collected. Social outcomes were summarized descriptively and compared between individuals with CP and non-disabled peers aged 18–25 years from the Household Income and Labor Dynamics in Australia dataset. Within the CP cohort we explored whether physical and mental health and level of functioning were associated with social outcomes. In addition, a descriptive comparison was undertaken between the social outcomes of the current CP cohort with that of a previously reported 2007 cohort.Results: Ninety participants (57% male; mean age 22.4 years (SD: 2.2) in 2020; 61.1% self-reported) provided data for analyses; response rate 16.9%. CP characteristics were similar between respondents and non-respondents. In comparison to similar aged peers, 79.8% had completed secondary school (compared to 83.2%); 32.6% (compared to 75.8%) were in paid work; 87.5% (compared to 48.2%) were living in their parental home; and 3.4% (compared to 31.6%) were married or partnered. Individuals with CP and higher levels of functional capacity and better physical health were more likely to undertake post-secondary education. Higher levels of functional capacity and physical health, as well as lower mental health status were associated with being employed.Conclusions: While foundational education completion rates were similar to non-disabled peers, significant gaps in social outcomes remain, including residence in the parental home and single status. While addressing these issues is challenging, substantial efforts are needed to reduce these disparities—work that needs to be done in collaboration with people with CP and their families.

Vital Service Captivity: Coping Strategies and Identity Negotiation

Nursing homes are the quintessential example of vital service captivity. Consumers need vital services when they can no longer fulfil their basic needs on their own and their only choice is to delegate them to the market (e.g. care services for long-term and chronic illnesses, eating assistance at mealtimes). The service is referred to as ‘captive’ because older people are generally unwilling to use it, and when they have to, their options are limited. For elderly consumers, there is ‘no exit possible’, and as such they must integrate the service into their sense of self. The paper aims to (1) identify strategies for coping with vital service captivity and (2) present the identity negotiation mechanisms that lead people to choose one strategy over another. The study was conducted over a 6-month period in three nursing homes. Data collection includes semi-structured interviews, focus groups, participant observations, and micro-interviews with consumers – elderly residents and their families – and nursing home staff. Its main contribution is to highlight that coping with vital service captivity is a differential process. Consumers implement multiple coping strategies simultaneously, and these strategies are linked to three areas: routinization, socialization, and assimilation of a new social status. Moreover, implementing coping strategies means striking a balance between ‘disengagement’ and ‘engagement’ that not only takes into account former life trajectory, future prospects, and social comparisons, but also any changes in physical or cognitive skills and family support. Understanding these coping strategies and identity negotiation mechanisms highlights some unintended consequences on residents’ well-being, such as the importance of standardizing how the service is organized because it provides a stable framework, or the importance given to the well-being of all stakeholders (other consumers, staff) as a result of the community living situation.

Lifestyle Behaviors and Quality of Life Among Older Adults After the First Wave of the COVID-19 Pandemic in Hubei China

Background: Older adult quality of life (QoL) is facing huge challenges during the COVID-19 pandemic. New normal lifestyle behaviors, including getting adequate physical activity (PA), consuming sufficient fruits and vegetables (FV) and enacting individual preventive behaviors (frequent hand washing, facemask wearing, and social distancing), as a significant determinant for QoL, have not been adequately addressed in older adults during the pandemic. This study aimed to investigate the characteristics of QoL in Chinese older adults after the first wave of the COVID-19 pandemic in Hubei China. The objective of the study was to examine any associations of lifestyle behaviors with QoL, and to identify the moderating role of socioeconomic indicators in the associations identified.Methods: A cross-sectional study was conducted in Hubei, China, from June 15, 2020, to July 10, 2020. Five hundred sixteen older adults completed an online survey (mean age = 67.6 ± 6.6; 57.9% women). The questionnaire consisted of demographic information, covariates (chronic diseases and infected cases of acquaintances), lifestyle behaviors [PA stage, FV intake (FVI) stage and three preventive behaviors], and QoL. T-tests, ANOVA tests, multiple linear regression models with simple slope analyses were used to test the hypotheses.Results: QoL significantly differed in relation to economic situation, chronic diseases, marital status, education, living situation, age group, and professional status. Participants' economic situation (βaverage vs. below average = 0.17, p < 0.01; βabove average vs. below average = 0.15, p < 0.01), chronic diseases (βyes vs. no = 0.19, p < 0.001), FVI stage (β = 0.21, p < 0.001), and preventive behaviors (β = 0.10, p < 0.05) indicated a significant association with QoL. Education level and economic situation significantly interacted with preventive behaviors on QoL, respectively (βpreventive behaviors × educational level = −1.3, p < 0.01; βpreventive behaviors × economic situation = −0.97, p < 0.05).Conclusions: Findings emphasize the importance of enhancing FVI and preventive behaviors on QoL improvement in older adults during the COVID-19 pandemic. Older adults who are in a lower economic situation with lower education levels should be given priority when implementing interventions to improve preventive behaviors and QoL in older adults.