Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care

• Published in: British journal of general practice 2020-11, Vol.70 (700), p.e817-e824
• Main Authors: Wong, Samuel Yeung Shan, Zhang, Dexing, Sit, Regina Wing Shan, Yip, Benjamin Hon Kei, Chung, Roger Yat-Nork, Wong, Carmen Ka Man, Chan, Dicken Cheong Chun, Sun, Wen, Kwok, Kin On, Mercer, Stewart W
• Format: Article
• Language: English
• Subjects: Aged; Anxiety; Anxiety - epidemiology; Betacoronavirus; Cohort analysis; Comorbidity; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; Coronavirus Infections - psychology; COVID-19; Female; Health services utilization; Help-Seeking Behavior; Hong Kong - epidemiology; Humans; Loneliness - psychology; Male; Mental health; Mental Health - trends; Multimorbidity; Noncommunicable Diseases - epidemiology; Noncommunicable Diseases - psychology; Older people; Pandemics - prevention & control; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; Pneumonia, Viral - psychology; Primary Health Care - statistics & numerical data; Primary Health Care - trends; Psychosocial Deprivation; SARS-CoV-2; Sex Factors; Sleep Initiation and Maintenance Disorders - epidemiology; Social Isolation - psychology
• ISSN: 0960-1643; 1478-5242
• DOI: 10.3399/BJGP20X713021

The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable. To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic. Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care. Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired -tests, Wilcoxon's signed-rank test, and McNemar's test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations. Data were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia. Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.