The association between loneliness and mental health disorders in older people after the COVID-19 pandemic

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Methods A cross-sectional survey using the SHARE database was conducted from June to August 2020 amid the COVID-19 pandemic. Results The sample comprised 847 participants, including 393 (46.4%) men, with an overall mean age of 74.6 years (sd = 6.7 years). Concerning mental health indicators, 441 (52.1%) reported feelings of nervousness, 384 (45.3%) experienced sadness or depression, 349 (41.2%) encountered sleeping difficulties, and 280 (33.1%) reported experiencing loneliness often or some of the time. The results revealed increased loneliness feelings for women who had worse health, increased fear of falling, dizziness, heightened fatigue, anxiety, depression, and concurrent health and sleep problems. Notably, age and medication had no impact on feeling lonely. Conclusions The pandemic has adversely affected the mental well-being of older population. These findings provide valuable insights for the development of targeted strategies to prevent mental health problems. Mental health Older people Pandemic Loneliness Depression Anxiety Sleep disorder Figures Figure 1 Background Many European countries and other regions worldwide are poised to confront the challenge of an ageing population in the forthcoming decades. Projections indicate that by 2100, over 30% of European citizens will be aged 65 and older [ 1 ]. Current estimates foresee 176 million older persons residing in European countries in the coming years, mirroring the global trend of an ageing population. In the last five decades, the number of older people aged 65 and over has doubled, escalating from less than one million to over two million in 2022 (2,424,122) [ 2 ]. While ageing itself is not a problem associated with functional loss, accumulating evidence indicates that advancing age increases the likelihood of chronic diseases [ 3 ]. Some mental health problems are not exclusive but are intricately linked to advancing age, such as depression and anxiety, sleep disorders, cognitive decline, and other mental health disorders [ 4 ]. Depression in older people is a disorder with a global impact and an underdiagnosed prevalence of 4–9% worldwide [ 5 ]. This underdiagnosis, coupled with inadequate treatment, typically leads to delayed intervention; therefore, increasing mortality and morbidity in this population group, with some evidence suggesting an escalation in numbers [ 6 ]. Before the advent of the COVID-19 pandemic, Portugal reported a prevalence of depression of 11.8% [ 7 ]. Depression is considered a significant contributor to disability in older people and is frequently associated with cognitive and physical decline, contributing to premature mortality [ 8 ]. An additional mental health concern prevalent in older people is anxiety disorders. Some authors have identified key variables including female gender, cognitive and physical frailty, chronic illnesses, poor perception of health status, limited resources, and coping strategies for complex situations as determining factors in the prevalence of anxiety disorders in older people [ 9 ]. Moreover, in Portugal, the prevalence of anxiety disorders among older people is 9.6% [ 7 ]. Notably, this figure is lower compared to other European countries, where the prevalence among community-dwelling older people ranges between 15% and 52% [ 10 ]. The ageing process is often associated with the onset of chronic illnesses, many of which are deemed incapacitating and impose limitations on activities of daily living. Consequently, ageing is concomitantly associated with mood alterations, often intricately intertwined with poor sleep quality [ 11 – 13 ]. A study conducted by Pires and collaborators highlighted the lack of evidence on sleep patterns in older adults and its potential correlation with the COVID-19 pandemic [ 14 ]. Nevertheless, it is widely acknowledged that the pandemic exposed older persons to additional risks, resulting in hospitalization, mechanical ventilation, and eventually death. The aggravated clinical situation, coupled with chronic diseases and frailty conditions may have induced modifications in sleep architecture, encompassing changes in sleep duration and efficiency, thus elevating the incidence of sleep disorders [ 14 ]. Among the prevailing sleep-related complaints in older people, challenges in maintaining sleep continuity and early awakening predominate, compared to initial insomnia. Some authors identified changes in sleep architecture and circadian rhythm associated with advancing age [ 13 ]. There is extensive evidence indicating a high prevalence of sleep disorders among older individuals, ranging from 5.59–65.45% [ 14 , 15 ], including a notable prevalence of insomnia ranging from 3.88–64.4% [ 16 , 17 ]. A recent systematic review and meta-analysis conducted by Du et al. [ 18 ] showed that approximately half of older people experienced poor sleep quality, namely short sleep duration. Moreover, one in five individuals reported excessive sleepiness, insomnia, and exacerbated sleep issues. Sleep problems were more prevalent in the American region with severe sleep problems reaching a peak in the final phase of the COVID-19 pandemic. The same study indicated that sleep disturbances were equally severe in older persons with SARS-CoV-2 infections [ 18 ]. The global ramifications of the COVID-19 pandemic have also precipitated substantial changes in the lives of millions of people. It directly impacted the physical and mental health of people in general and particularly of older people. Older people characterized as a vulnerable group due to the prevalence of chronic illnesses, limited financial and social resources, and the difficulty in participating in social networks, find themselves more susceptible to situations of isolation and loneliness. Some studies demonstrated that the COVID-19 pandemic has intensified feelings of loneliness among older people, with high levels documented during the pandemic, attributed to social restrictions and the pervasive fear of being infected [ 19 – 23 ]. While ageing is not a determinant variable for loneliness, some studies suggest that older people are confronted by several losses, including relatives and friends, demanding greater efforts to cope with additional physical and mental issues [ 23 , 24 ]. Several authors identified contributing factors to loneliness, including being female, living alone, having limited financial resources, with children, and having low contact with neighbours [ 25 ]. The COVID-19 pandemic demonstrated that women and people with low incomes reported higher levels of loneliness [ 25 ]. Older people were disproportionately and unevenly affected by the COVID-19 pandemic and the preventive measures implemented during this period. The Canadian Longitudinal Study on Ageing (CLSA) conducted by Susan Kirkland and Lauren Griffith [ 26 ] examined the prevalence of loneliness and associated risk factors among older people during the COVID-19 pandemic. The study utilized a sample of older people living in the community before the pandemic, comprising 44,817 participants. Data collection spanned from 2015 to 2018 and continued "during the pandemic", involving 24,114 participants surveyed between September and December 2020. The results showed that the prevalence of loneliness increased to 50.50% during the pandemic, compared to 30.75% before its onset. Loneliness also increased more in women (22.3% vs. 17.0%), in people living in urban areas (20.8% vs. 14.6%), and less in those aged 75 and over (16.1% vs. 19.8% or higher in all other age groups). The same study highlighted a strong association between loneliness during the pandemic and pre-pandemic loneliness and individual-level sociodemographic variables. These variables included (e.g.) living conditions (living alone), residing in an urban region, health status (depression), having two or three or more chronic illnesses and health-related behaviours (drinking regularly or not drinking at all) [ 26 ]. Moreover, the COVID-19 pandemic has been a catalyst for the exacerbation of chronic fatigue with a negative impact on the overall quality of life of older people [ 27 ]. The findings by Aly and Saber revealed that cognitive impairment, fatigue, sadness, stress, sleep disturbances, and recurrent falls in the post-recovery period were significantly associated with chronic fatigue syndrome [ 27 ]. This study aimed to explore the association between loneliness and mental health disorders in older people after the aftermath of the COVID-19 pandemic. Methods Design A cross-sectional study using the SHARE database was conducted. Participants A total of 1,822 individuals participated in the survey. Exclusion criteria included participants aged bellow 65 years or with unknown age (n = 856) and who had missing information in, at least, one of the variables (felt nervous in the last month; sad or depressed in the last month; trouble sleeping recently; how often do you feel lonely, n = 33). Consequently, a final sample of 836 participants was established for this study (Fig. 1 ). Setting/Procedures The Wave 8 COVID-19 Survey 1, Release version: 8.0.0 data set of the SHARE project was employed [ 28 ]. In Portugal, this survey was conducted within panel households from June to August 2020, utilizing computer-assisted telephone interviews (CATI) due to the COVID-19 pandemic and the enforcement of lockdown measures [ 29 ]. Figure 1 . Flowchart of the participants of the study Measures The questions applied in our study included basic demographic information (age and gender). Additionally, questions were made about self-perception of health: “Before the coronavirus outbreak, would you say your health was excellent, very good, good, fair, or poor?”; change in health since the outbreak: “If you compare your health status with that before the coronavirus outbreak, would you say your health has improved, worsened, or remained the same?”; being diagnosed with a major health condition: “Since we last interviewed you, were you diagnosed with a major illness or health condition?” – list of diagnoses: hip fracture, diabetes or high blood sugar, high blood pressure or hypertension, heart attack or other heart problem, chronic lung disease, cancer or malignant tumour, other illness or health condition; “For the past six months, at least, have you been bothered by any of the following health conditions?” – falling more often; fear of falling; dizziness, faints or blackouts; fatigue. Also, participants were queried about the following: (i) “Do you regularly take prescribed drugs?; (ii) “In the last month, have you felt nervous, anxious or on edge?”; (iii) “In the last month, have you been sad or depressed?”; (iv) “Have you had trouble sleeping recently?”; (v)“How much of the time do you feel lonely? Often, some of the time, or hardly ever or never?”. Ethical considerations The SHARE study was reviewed and approved by the Ethics Committee of the University of Mannheim and different Waves were reviewed and approved by the Ethics Council of the Max Planck Society and the Ethics Councils of the participating countries. All this information was entered into a database ( https://share-eric.eu ). Statistical analysis Sample characteristics were obtained based on frequencies (absolute and relative) for qualitative variables and mean and standard deviation for quantitative variables. Groups were compared utilizing the Chi-Square test for qualitative variables and independent t -tests for quantitative variables. Binary logistic regression models (unadjusted and adjusted multivariable) were performed to identify potential factors associated with the outcomes, “nervous” and “feeling sad or depressed”. In the multivariable model, age (the single quantitative variable) was included as z-score. Thus, odds ratios could be used as measures of effect size (all variables were binary: Additionally, Cox & Snell R 2 and Nagelkerke R 2 were reported. All analyses were performed using the software IBM SPSS version 28.0, with a significance level set at 0.05. Results Sample characteristics The sample consisted of 836 participants, including 387 (46.3%) men, with an overall mean age of 74.5 years (sd = 6.7 years old). Concerning the health condition before the COVID-19 pandemic, most participants indicated fair (41.9%) or poor (19.7%) health and 106 (12.7%) reported worse health. A total of 163 participants (19.5%) were diagnosed with at least one major health condition. Also, 136 participants (16.3%) reported frequent falls, 336 (40.2%) had a fear of falling, 238 (28.5%) experienced dizziness, faints, or blackouts, and 402 (48.1%) reported fatigue. Almost all participants were on a regular regimen of prescribed drugs. Regarding mental health, 435 (52.0%) felt nervous, 378 (45.2%) were sad or depressed, 346 (41.4%) had trouble sleeping, and 279 (33.4%) felt lonely often or some of the time (Table 1 ). Table 1 Sample characteristics: demographic and health factors n (%) Gender [male] 387 (46.3) Age, mean (sd) [min-max] 74.5 (6.7) [65–97] How was your health before the outbreak? Excellent 17 (2.0) Very good 39 (4.6) Good 265 (31.7) Fair 350 (41.9) Poor 165 (19.7) Change in your health since the outbreak Improved 21 (2.5) Worsened 106 (12.7) About the same 709 (84.8) Diagnosed with a major health condition [yes] 163 (19.5) Falling more often [yes] 136 (16.3) Fear of falling [yes] 336 (40.2) Dizziness, faints, or blackouts [yes] 238 (28.5) Fatigue [yes] 402 (48.1) Takes prescription drugs regularly [yes] 768 (91.9) Felt nervous [yes] 435 (52.0) Sad or depressed [yes] 378 (45.2) Trouble sleeping recently [yes] 346 (41.4) How often do you feel lonely [often or some of the time] 279 (33.4) sd: standard deviation; min: minimum; max: maximum Gender, health (self-perception and change), fear of falling, dizziness, faints or blackouts, fatigue, and mental health (feeling nervous, sad, or depressed and trouble sleeping) were associated with the group feeling lonely. Women and, in general, participants exhibiting poor physical and mental health displayed a higher percentage of feeling lonely often or some of the time. Table 2 outlines the characteristics of the groups defined by loneliness feeling status. Table 2 Comparison of groups according to the loneliness feeling status Feeling lonely p Often or some of the time Hardly never or never n (%) n (%) Gender [male] 95 (34.1) 292 (52.4) < 0.001 Age, mean (sd) 74.9 (6.8) 74.4 (6.7) 0.238* How was your health before the outbreak? < 0.001 Excellent 4 (1.4) 13 (2.3) Very good 8 (2.9) 31 (5.6) Good 64 (22.9) 201 (36.1) Fair 129 (46.2) 221 (39.7) Poor 74 (26.5) 91 (16.3) Change in your health since the outbreak < 0.001 Improved 6 (2.2) 16 (2.8) Worsened 61 (21.9) 46 (8.1) About the same 212 (76.0) 505 (89.1) Diagnosed with a major health condition [yes] 65 (23.3) 98 (17.6) 0.050 Falling more often [yes] 53 (19.0) 83 (14.9) 0.130 Fear of falling [yes] 135 (48.4) 201 (36.1) < 0.001 Dizziness, faints, or blackouts [yes] 93 (33.3) 145 (26.0) 0.027 Fatigue [yes] 168 (60.2) 234 (42.0) < 0.001 Takes prescription drugs regularly [yes] 260 (93.2) 508 (91.2) 0.322 Feeling nervous [yes] 202 (72.4) 233 (41.8) < 0.001 Sad or depressed [yes] 197 (70.6) 181 (32.5) < 0.001 Trouble sleeping recently [yes] 153 (54.8) 193 (34.6) < 0.001 sd: standard deviation; *: Independent sample t-test Gender, age, fatigue, sleeping disorders and feeling lonely were factors associated with feeling nervous. Specifically, women, aged younger, with fatigue, sleeping troubles, and feeling lonely often or some of the time were more predisposed to feeling nervous. On the other hand, concerning the outcome of “feeling sad or depressed”, women, diagnosed with a major health condition, experiencing fatigue, sleeping troubles, and feeling lonely often or some of the time were more likely to feel sad or depressed. Detailed information on the factors associated with feeling nervous and feeling sad or depressed is presented in Tables 3 and 4 . Table 3 Factors associated with feeling nervous Unadjusted Adjusted OR 95% CI p OR 95% CI p Gender [female] 2.803 2.116–3.712 < 0.001 2.084 1.538–2.824 < 0.001 Age (z-score) 0.941 0.821–1.077 0.377 0.835 0.715–0.974 0.022 Diagnosed with a major health condition [yes] 1.503 1.061–2.129 0.022 1.297 0.883–1.906 0.185 Fatigue [yes] 2.766 2.089–3.662 < 0.001 2.205 1.612–3.017 < 0.001 Trouble sleeping recently [yes] 2.877 2.159–3.835 < 0.001 1.989 1.456–2.717 < 0.001 How often do you feel lonely [often or some of the time]? 3.648 2.671–4.983 < 0.001 2.803 2.011–3.908 < 0.001 R 2 (Cox & Snell) 0.179 R 2 (Nagelkerke) 0.239 OR: odds ratio; CI: confidence interval Table 4 Factors associated with feeling sad or depressed Unadjusted Adjusted OR 95% CI p OR 95% CI p Gender [female] 2.943 2.213–3.912 < 0.001 2.102 1.530–2.887 < 0.001 Age (z-score) 1.107 0.966–1.269 0.144 1.031 0.879–1.209 0.709 Diagnosed with a major health condition [yes] 1.925 1.361–2.724 0.022 1.747 1.177–2.593 0.006 Fatigue [yes] 2.805 2.117–3.717 < 0.001 1.918 1.389–2.648 < 0.001 Trouble sleeping recently [yes] 3.590 2.689–4.793 < 0.001 2.636 1.914–3.630 < 0.001 How often do you feel lonely [often or some of the time]? 4.991 3.651–6.823 < 0.001 3.878 2.772–5.424 < 0.001 R 2 (Cox & Snell) 0.230 R 2 (Nagelkerke) 0.308 OR: odds ratio; CI: confidence interval Discussion This comprehensive study included 836 participants aged 65 years and older. Most participants were women, with an overall mean age of 74.5 years (sd = 6.7 years old). Concerning health conditions, most participants reported fair or poor health before the outbreak (61.6%) and 106 (12.7%) reported worse health since the outbreak. A total of 163 participants (19.5%) were diagnosed with at least one major health condition. Also, 136 participants (16.3%) reported falling more often, 336 (40.2%) expressed a fear of falling, 238 (28.5%) experienced dizziness, faints, or blackouts, and 410 (48.5%) reported fatigue. Almost all participants adhered to a regular regimen of prescribed drugs. Regarding mental health, 435 (52.0%) felt nervous, 378 (45.2%) sad or depressed, 346 (41.4%), experienced sleeping disorders, and 279 (33.4%) felt lonely often or some of the time. The primary findings of this study revealed a significant correlation between heightened feelings of loneliness and women residing alone. This demographic data unveils a concerning trend characterized by poorer health statuses and increased susceptibility to various illnesses. Moreover, these women reported heightened concerns regarding their physical well-being, including an increased fear of falling, experiences of dizziness, increased fatigue, heightened anxiety, depression, and disturbances in sleep patterns. The observed association between living alone and a spectrum of adverse health outcomes emphasizes the critical need to address the emotional and physical well-being of women in solitary living arrangements. Implementing targeted interventions and support systems is imperative in alleviating the negative impact of loneliness, promoting better mental health, and ultimately enhancing the overall quality of life for individuals in this demographic [ 29 , 31 ]. While age itself is not a predictor of loneliness, evidence indicates that as people age, they tend to lose some relationships with advanced age. It is crucial to note that socially isolated people are not inherently lonely, and conversely, lonely people are not invariably socially isolated [ 32 , 23 ]. The social distance measures imposed during the COVID-19 pandemic intensified social isolation and loneliness, particularly among older people [ 33 ]. With the pandemic, a new paradigm emerged worldwide, with everyday physical distancing taking its toll, significantly impacting adults aged 65 and above. Social isolation can promote feelings of loneliness and, especially when recurrent, can exacerbate mental health problems and disturbances in overall well-being [ 34 ]. Living alone is associated with a high risk of social isolation and loneliness. Also, living alone, social isolation, loneliness, and limited engagement in social activities carry a higher risk of developing certain forms of dementia at older ages [ 35 ]. Older people living alone are more prone to exhibit poor cognitive function. Living alone restricts opportunities for social engagement, leading to a decreased mobilization of cognitive reserves, ultimately contributing to poorer cognitive function and depression. Furthermore, being widowed, divorced/separated, or single increases the likelihood of living alone, while being married/cohabiting is a protective variable for cognitive function [ 36 , 37 ]. This important finding sheds light on potential implications for the mental well-being of older individuals in solitary lifestyles. It is crucial to comprehend and tackle the distinctive challenges faced by older individuals living alone to develop targeted interventions. By fostering social connections, encouraging mental stimulation, and establishing support structures, we can mitigate the risk of cognitive decline and enhance the overall cognitive well-being of older individuals who either choose or find themselves living alone [ 38 ]. Several studies have noted an escalation in loneliness among the older population since the onset of the COVID-19 pandemic [ 22 , 29 , 39 ]. Loneliness is also a potential risk factor for depression. Thus, assessing signs of loneliness in older adults and implementing strategies to address this loneliness must be prioritized by health professionals [ 36 ]. Recent research aligns with other studies suggesting that the increased risk of depressive symptoms and anxiety are directly associated with loneliness [ 32 , 40 – 42 ]. One of the various consequences of the COVID-19 pandemic on the physical and mental health of older people was sleeping disorders with a negative impact on the mental health of this vulnerable population [ 29 ]. This problem increases the probability of depression, anxiety, and loneliness [ 29 , 36 ]. Corbo et al. [ 30 ] findings further support this, concluding that people diagnosed with mental health disorders are more prone to experiencing poor sleep quality compared to the general population. Another outcome of the COVID-19 pandemic was the risk of falling and fear of falling, a phenomenon linked to prolonged stays at home among older people, increasing fear of movement, low physical activity, and risk of falling [ 43 ]. This relationship between prolonged home confinement and diminished physical well-being underscores a concerning trend with profound implications for the overall health and safety of older individuals. The fear of movement can lead to a reluctance to engage in regular physical activities, fostering a sedentary lifestyle. In turn, this can lead to a decline in muscle strength, balance, and coordination, intensifying the risk of falling and related injuries. Recognizing the importance of addressing these challenges is paramount in developing strategies to promote the health and mobility of older individuals. Implementing interventions that encourage safe and gradual physical activity, cultivating a supportive home environment and addressing the psychological aspects of fear associated with movement are essential in mitigating the risks and enhancing the overall well-being of older individuals spending extended periods at home. These findings align with other studies [ 44 ] showing an increased risk of falling in older people. It is well-established that falls can be associated with the social isolation and loneliness experienced by older people [ 45 ]. Further research is imperative to understand the broader effects of the COVID-19 pandemic on the physical, mental, and social health of older people. The study by Soares et al. demonstrates that changes in social isolation due to the pandemic could contribute to increased sedentary behaviours and loneliness in older adults despite no observed effects on the number of falls [ 46 ]. Furthermore, chronic fatigue syndrome presents a significant concern among older people with a negative impact on global health, with a higher prevalence in women [ 41 ]. The COVID-19 pandemic has particularly affected older people because of the existence of increased comorbidities and overall vulnerability [ 47 ]. The findings from Aly and Saber reported the presence of fatigue and its relationship with cognitive impairment, stress, sadness, sleep disorders, and recurrent falls [ 26 ]. These symptoms were more prevalent in women, with 33% of the respondents experiencing them [ 26 ]. Some limitations in the study merit consideration. Firstly, the cross-sectional nature of the study does not allow us to compare certain variables before and after the COVID-19 pandemic. This limitation is exemplified by the inability to understand the change in health perceived after the beginning of the COVID-19 pandemic. To gain a comprehensive understanding of the evolution of these variables within the general population and, specifically, among this vulnerable group of individuals (older people), further research employing different study methodologies is essential. Additionally, we consider that it may be an additional limitation that we have used a subsample of a survey and therefore cannot be considered a representative sample. Therefore, we recommend that the impact of the COVID-19 pandemic be subjected to more in-depth investigation, particularly concerning its effects on loneliness, sleep, and the physical and mental health of older people. This expanded research can pave the way for the implementation of more preventive and global health programmes. Conclusions The global challenges posed by the COVID-19 pandemic have been pronounced for the more vulnerable population groups, notably older people. The results of this extensive cross-sectional study revealed that among these groups, women with poorer health, increased fear of falling, dizziness, increased fatigue, heightened anxiety, depression, and health and sleep issues were more prone to experiencing loneliness. Enhancing efforts in prevention and intervention is crucial for the identification of risk factors, treatment, and rehabilitation of sleep disorders in promoting healthy ageing. This approach aims to mitigate cognitive and physical decline in older individuals. These study findings provide valuable insights that can significantly impact clinical practice, particularly in addressing the mental health challenges among older people in the aftermath of the COVID-19 pandemic. Integrating these insights into clinical practice can better equip healthcare professionals to support the mental health of older people, especially in the context of the unique challenges posed by the pandemic. Furthermore, these study findings offer valuable contributions to health education, focusing on improving understanding and addressing mental health issues among older people post-COVID-19. Potential contributions to health education include training programmes to identify loneliness indicators and encouraging active ageing initiatives. By incorporating these considerations into health education initiatives, educators can play a pivotal role in fostering a well-informed and compassionate community that actively promotes the mental health and overall well-being of older people in the post-COVID-19 era. Declarations Ethics approval and consent to participate The SHARE study was reviewed and approved by the Ethics Committee of the University of Mannheim. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding This work was financed by national funds through FCT Fundação para a Ciência e a Tecnologia, I.P., within the scope of the project “RISE-LA/P/0053/2020”. Author Contribution Conceptualization, O.A., L.T., C.S., L.S., methodology, L.T., writing - original draft preparation, O.A. and L.T.; writing - review and editing, F.S., L.S., C.S. All authors have read and agreed to the published version of the manuscript. 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Impact of the COVID-19 pandemic on loneliness among older adults. Front Sociol. 2020;5:590935. 10.3389/fsoc.2020.590935 . Aly MAEG, Saber HG. Long COVID and chronic fatigue syndrome: a survey of elderly female survivors in Egypt. Int J Clin Pract. 2021;75(12):e14886. 10.1111/ijcp.14886 . Kirkland SA, Griffith LE, Oz UE, et al. Increased prevalence of loneliness and associated risk factors during the COVID-19 pandemic: findings from the Canadian Longitudinal Study on Aging (CLSA). BMC Public Health. 2023;23:872. 10.1186/s12889-023-15807-4 . Börsch-Supan A. Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 8. COVID-19 Survey 1. Release version: 8.0.0. SHARE-ERIC. Data set. 2022. 10.6103/SHARE.w8ca.800 . Scherpenzeel A, Axt K, Bergmann M, Douhou S, Oepen A, Sand G, et al. Collecting survey data among the 50 + population during the COVID-19 outbreak: The Survey of Health, Ageing and Retirement in Europe (SHARE). Surv Res Methods. 2020;14(2):217–21. 10.18148/srm/2020.v14i2.7738 . Cha EJ, Jeon HJ. The effect of COVID-19 pandemic on sleep-related problems in adults and elderly citizens: An infodemiology study using relative search volume data. PLoS ONE. 2022;17(7):e0271059. 10.1371/journal.pone.0271059 . Corbo I, Forte G, Favieri F, Casagrande M. Poor sleep quality in aging: The association with mental health. Int J Environ Res Public Health. 2023;20(3):1661. 10.3390/ijerph20031661 . Cacioppo JT, Hawkley LC. Social isolation and health, with an emphasis on underlying mechanisms. Perspect Biol Med. 2003;46(3 Suppl):S39–52. Seifert A, Hassler B. Impact of the COVID-19 pandemic on loneliness among older adults. Front Sociol. 2020;5:590935. 10.3389/fsoc.2020.590935 . Banerjee D, Rai M. Social isolation in Covid-19: The impact of loneliness. Int J Soc Psychiatry. 2020;66(6):525–7. 10.1177/0020764020922269 . Guarnera J, Yuen E, Macpherson H. The impact of loneliness and social isolation on cognitive aging: A narrative review. J Alzheimers Dis Rep. 2023;7(1):699–714. 10.3233/ADR-230011 . Lee SL, Pearce E, Ajnakina O, Johnson S, Lewis G, Mann F, et al. The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study. Lancet Psychiatry. 2021;8(1):48–57. 10.1016/S2215-0366(20)30383-7 . Henriques A, Talih M, Pastor-Valero M, Fraga S, Dias I, Matijasevich A, et al. A multidimensional perspective of the relation between social isolation and depression among Portuguese older adults. Health Soc Care Community. 2022;30(4):1412–21. 10.1111/hsc.13471 . Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. 2011;15(3):219–66. 10.1177/1088868310377394 . González Ortega E, Pinedo González R, Vicario-Molina I, Palacios Picos A, Orgaz Baz MB. Loneliness and associated factors among older adults during COVID-19 lockdown in Spain. J Appl Dev Psychol. 2023;86:101547. 10.1016/j.appdev.2023.101547 . Domènech-Abella J, Mundó J, Haro JM, Rubio-Valera M. Anxiety, depression, loneliness and social network in the elderly: Longitudinal associations from The Irish Longitudinal Study on Ageing (TILDA). J Affect Disord. 2019;246:82–8. 10.1016/j.jad.2018.12.043 . Groarke JM, McGlinchey E, McKenna-Plumley PE, Berry E, Graham-Wisener L, Armour C. Examining temporal interactions between loneliness and depressive symptoms and the mediating role of emotion regulation difficulties among UK residents during the COVID-19 lockdown: Longitudinal results from the COVID-19 psychological wellbeing study. J Affect Disord. 2021;285:1–9. 10.1016/j.jad.2021.02.033 . Okruszek L, Aniszewska-Stańczuk A, Piejka A, Wiśniewska M, Żurek K. Safe but lonely? Loneliness, anxiety, and depression symptoms and COVID-19. Front Psychol. 2020;11:579181. 10.3389/fpsyg.2020.579181 . Atıcı E, Girgin N, Çevik Saldıran T. The effects of social isolation due to COVID-19 on the fear of movement, falling, and physical activity in older people. Australas J Ageing. 2022;41(3):407–13. 10.1111/ajag.13063 . Lage I, Braga F, Almendra M, Meneses F, Teixeira L, Araújo O. Older people living alone: A predictive model of fall risk. Int J Environ Res Public Health. 2023;20(13):6284. 10.3390/ijerph20136284 . Zeytinoglu M, Wroblewski KE, Vokes TJ, Huisingh-Scheetz M, Hawkley LC, Huang ES. Association of loneliness with falls: A study of older US adults using the National Social Life, Health, and Aging Project. Gerontol Geriatr Med. 2021;7:2333721421989217. 10.1177/2333721421989217 . Soares B, Costa D, Xavier J, Viveiro L, Antunes T, Mendes F, et al. Social isolation due to COVID-19: Impact on loneliness, sedentary behavior, and falls in older adults. Aging Ment Health. 2022;26(10):2120–7. 10.1080/13607863.2021.2003296 . Zengarini E, Ruggiero C, Pérez-Zepeda MU, Hoogendijk EO, Vellas B, Mecocci P, et al. Fatigue: Relevance and implications in the aging population. Exp Gerontol. 2015;70:78–83. 10.1016/j.exger.2015.07.011 . Cocuzzo B, Wrench A, O'Malley C. Effects of COVID-19 on older adults: Physical, mental, emotional, social, and financial problems seen and unseen. Cureus. 2022;14(9):e29493. 10.7759/cureus.29493 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4042161","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":283497905,"identity":"5cd6673c-805d-483b-beac-06f482816fb8","order_by":0,"name":"Odete Araújo","email":"","orcid":"","institution":"University of Minho","correspondingAuthor":false,"prefix":"","firstName":"Odete","middleName":"","lastName":"Araújo","suffix":""},{"id":283497906,"identity":"268256f9-0d4a-40e8-a140-f8e570cfa335","order_by":1,"name":"Lia Sousa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYBACPmYYi72xgTgtbHAtPAdRtBjg1gJnSSSgSODRws78gPFHxWF7/pmP2x7+3MEgz89/9pgE444/eBzGZsDMc+Zw4ozbie3GvGcYDGfOyEuTYDyDxxZmBgNmxrbDCQy3E9ukGdsYEgxu8JhJMLbh08L+gfFn22F7+ZsH2yR/ArXYnz9DSAuPAQNv22HGDTcY2yR4QbYw5BDUUnCY50x64sYzIL+0SRjOuJGXbJF4xhinFn7+4xsf/qiwtpc7fvzZw59tNvL8/WcP3vi4Qw6nFhA4ALMRiCWAmIeBIbEBrw6EI6E0UAsjkVpGwSgYBaNgRAAAxJFKnw+IZLkAAAAASUVORK5CYII=","orcid":"","institution":"Cooperativa de Ensino Superior Politécnico e Universitário","correspondingAuthor":true,"prefix":"","firstName":"Lia","middleName":"","lastName":"Sousa","suffix":""},{"id":283497907,"identity":"b0f58228-ed70-48b4-b663-e4c49483c2f2","order_by":2,"name":"Francisco Sampaio","email":"","orcid":"","institution":"Escola Superior de Enfermagem do Porto","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"","lastName":"Sampaio","suffix":""},{"id":283497908,"identity":"7a26d714-70d0-4850-a75c-531bb8556e9c","order_by":3,"name":"Carlos Sequeira","email":"","orcid":"","institution":"Escola Superior de Enfermagem do Porto","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"","lastName":"Sequeira","suffix":""},{"id":283497910,"identity":"7ad20dea-ff81-4f86-852e-c84c8f6297ba","order_by":4,"name":"Laetitia Teixeira","email":"","orcid":"","institution":"University of Porto","correspondingAuthor":false,"prefix":"","firstName":"Laetitia","middleName":"","lastName":"Teixeira","suffix":""}],"badges":[],"createdAt":"2024-03-08 11:08:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4042161/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4042161/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53680851,"identity":"5a730943-c4e7-486c-847d-d55e38014ac7","added_by":"auto","created_at":"2024-03-28 20:29:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":22489,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eFlowchart of the participants of the study\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4042161/v1/b3ec4e1be1877938c4ca2070.png"},{"id":57687070,"identity":"46a60e2a-22f2-448c-9b86-961031a7c06d","added_by":"auto","created_at":"2024-06-04 10:20:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":634425,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4042161/v1/5646de3a-b148-4aca-804d-80bd6d892754.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The association between loneliness and mental health disorders in older people after the COVID-19 pandemic","fulltext":[{"header":"Background","content":"\u003cp\u003eMany European countries and other regions worldwide are poised to confront the challenge of an ageing population in the forthcoming decades. Projections indicate that by 2100, over 30% of European citizens will be aged 65 and older [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Current estimates foresee 176\u0026nbsp;million older persons residing in European countries in the coming years, mirroring the global trend of an ageing population. In the last five decades, the number of older people aged 65 and over has doubled, escalating from less than one million to over two million in 2022 (2,424,122) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While ageing itself is not a problem associated with functional loss, accumulating evidence indicates that advancing age increases the likelihood of chronic diseases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Some mental health problems are not exclusive but are intricately linked to advancing age, such as depression and anxiety, sleep disorders, cognitive decline, and other mental health disorders [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Depression in older people is a disorder with a global impact and an underdiagnosed prevalence of 4\u0026ndash;9% worldwide [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This underdiagnosis, coupled with inadequate treatment, typically leads to delayed intervention; therefore, increasing mortality and morbidity in this population group, with some evidence suggesting an escalation in numbers [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Before the advent of the COVID-19 pandemic, Portugal reported a prevalence of depression of 11.8% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Depression is considered a significant contributor to disability in older people and is frequently associated with cognitive and physical decline, contributing to premature mortality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn additional mental health concern prevalent in older people is anxiety disorders. Some authors have identified key variables including female gender, cognitive and physical frailty, chronic illnesses, poor perception of health status, limited resources, and coping strategies for complex situations as determining factors in the prevalence of anxiety disorders in older people [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Moreover, in Portugal, the prevalence of anxiety disorders among older people is 9.6% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Notably, this figure is lower compared to other European countries, where the prevalence among community-dwelling older people ranges between 15% and 52% [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe ageing process is often associated with the onset of chronic illnesses, many of which are deemed incapacitating and impose limitations on activities of daily living. Consequently, ageing is concomitantly associated with mood alterations, often intricately intertwined with poor sleep quality [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A study conducted by Pires and collaborators highlighted the lack of evidence on sleep patterns in older adults and its potential correlation with the COVID-19 pandemic [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nevertheless, it is widely acknowledged that the pandemic exposed older persons to additional risks, resulting in hospitalization, mechanical ventilation, and eventually death. The aggravated clinical situation, coupled with chronic diseases and frailty conditions may have induced modifications in sleep architecture, encompassing changes in sleep duration and efficiency, thus elevating the incidence of sleep disorders [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Among the prevailing sleep-related complaints in older people, challenges in maintaining sleep continuity and early awakening predominate, compared to initial insomnia. Some authors identified changes in sleep architecture and circadian rhythm associated with advancing age [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is extensive evidence indicating a high prevalence of sleep disorders among older individuals, ranging from 5.59\u0026ndash;65.45% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], including a notable prevalence of insomnia ranging from 3.88\u0026ndash;64.4% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A recent systematic review and meta-analysis conducted by Du et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] showed that approximately half of older people experienced poor sleep quality, namely short sleep duration. Moreover, one in five individuals reported excessive sleepiness, insomnia, and exacerbated sleep issues. Sleep problems were more prevalent in the American region with severe sleep problems reaching a peak in the final phase of the COVID-19 pandemic. The same study indicated that sleep disturbances were equally severe in older persons with SARS-CoV-2 infections [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe global ramifications of the COVID-19 pandemic have also precipitated substantial changes in the lives of millions of people. It directly impacted the physical and mental health of people in general and particularly of older people. Older people characterized as a vulnerable group due to the prevalence of chronic illnesses, limited financial and social resources, and the difficulty in participating in social networks, find themselves more susceptible to situations of isolation and loneliness. Some studies demonstrated that the COVID-19 pandemic has intensified feelings of loneliness among older people, with high levels documented during the pandemic, attributed to social restrictions and the pervasive fear of being infected [\u003cspan additionalcitationids=\"CR20 CR21 CR22\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. While ageing is not a determinant variable for loneliness, some studies suggest that older people are confronted by several losses, including relatives and friends, demanding greater efforts to cope with additional physical and mental issues [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral authors identified contributing factors to loneliness, including being female, living alone, having limited financial resources, with children, and having low contact with neighbours [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The COVID-19 pandemic demonstrated that women and people with low incomes reported higher levels of loneliness [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOlder people were disproportionately and unevenly affected by the COVID-19 pandemic and the preventive measures implemented during this period. The Canadian Longitudinal Study on Ageing (CLSA) conducted by Susan Kirkland and Lauren Griffith [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] examined the prevalence of loneliness and associated risk factors among older people during the COVID-19 pandemic. The study utilized a sample of older people living in the community before the pandemic, comprising 44,817 participants. Data collection spanned from 2015 to 2018 and continued \"during the pandemic\", involving 24,114 participants surveyed between September and December 2020. The results showed that the prevalence of loneliness increased to 50.50% during the pandemic, compared to 30.75% before its onset. Loneliness also increased more in women (22.3% \u003cem\u003evs.\u003c/em\u003e 17.0%), in people living in urban areas (20.8% \u003cem\u003evs.\u003c/em\u003e 14.6%), and less in those aged 75 and over (16.1% \u003cem\u003evs.\u003c/em\u003e 19.8% or higher in all other age groups). The same study highlighted a strong association between loneliness during the pandemic and pre-pandemic loneliness and individual-level sociodemographic variables. These variables included (e.g.) living conditions (living alone), residing in an urban region, health status (depression), having two or three or more chronic illnesses and health-related behaviours (drinking regularly or not drinking at all) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMoreover, the COVID-19 pandemic has been a catalyst for the exacerbation of chronic fatigue with a negative impact on the overall quality of life of older people [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The findings by Aly and Saber revealed that cognitive impairment, fatigue, sadness, stress, sleep disturbances, and recurrent falls in the post-recovery period were significantly associated with chronic fatigue syndrome [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. This study aimed to explore the association between loneliness and mental health disorders in older people after the aftermath of the COVID-19 pandemic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eA cross-sectional study using the SHARE database was conducted.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eA total of 1,822 individuals participated in the survey. Exclusion criteria included participants aged bellow 65 years or with unknown age (n\u0026thinsp;=\u0026thinsp;856) and who had missing information in, at least, one of the variables (felt nervous in the last month; sad or depressed in the last month; trouble sleeping recently; how often do you feel lonely, n\u0026thinsp;=\u0026thinsp;33). Consequently, a final sample of 836 participants was established for this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSetting/Procedures\u003c/h2\u003e \u003cp\u003eThe Wave 8 COVID-19 Survey 1, Release version: 8.0.0 data set of the SHARE project was employed [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In Portugal, this survey was conducted within panel households from June to August 2020, utilizing computer-assisted telephone interviews (CATI) due to the COVID-19 pandemic and the enforcement of lockdown measures [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eFlowchart of the participants of the study\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eThe questions applied in our study included basic demographic information (age and gender). Additionally, questions were made about self-perception of health: \u0026ldquo;Before the coronavirus outbreak, would you say your health was excellent, very good, good, fair, or poor?\u0026rdquo;; change in health since the outbreak: \u0026ldquo;If you compare your health status with that before the coronavirus outbreak, would you say your health has improved, worsened, or remained the same?\u0026rdquo;; being diagnosed with a major health condition: \u0026ldquo;Since we last interviewed you, were you diagnosed with a major illness or health condition?\u0026rdquo; \u0026ndash; list of diagnoses: hip fracture, diabetes or high blood sugar, high blood pressure or hypertension, heart attack or other heart problem, chronic lung disease, cancer or malignant tumour, other illness or health condition; \u0026ldquo;For the past six months, at least, have you been bothered by any of the following health conditions?\u0026rdquo; \u0026ndash; falling more often; fear of falling; dizziness, faints or blackouts; fatigue. Also, participants were queried about the following: (i) \u0026ldquo;Do you regularly take prescribed drugs?; (ii) \u0026ldquo;In the last month, have you felt nervous, anxious or on edge?\u0026rdquo;; (iii) \u0026ldquo;In the last month, have you been sad or depressed?\u0026rdquo;; (iv) \u0026ldquo;Have you had trouble sleeping recently?\u0026rdquo;; (v)\u0026ldquo;How much of the time do you feel lonely? Often, some of the time, or hardly ever or never?\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The SHARE study was reviewed and approved by the Ethics Committee of the University of Mannheim and different Waves were reviewed and approved by the Ethics Council of the Max Planck Society and the Ethics Councils of the participating countries. All this information was entered into a database (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://share-eric.eu\u003c/span\u003e\u003cspan address=\"https://share-eric.eu\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSample characteristics were obtained based on frequencies (absolute and relative) for qualitative variables and mean and standard deviation for quantitative variables. Groups were compared utilizing the Chi-Square test for qualitative variables and independent \u003cem\u003et\u003c/em\u003e-tests for quantitative variables. Binary logistic regression models (unadjusted and adjusted multivariable) were performed to identify potential factors associated with the outcomes, \u0026ldquo;nervous\u0026rdquo; and \u0026ldquo;feeling sad or depressed\u0026rdquo;. In the multivariable model, age (the single quantitative variable) was included as z-score. Thus, odds ratios could be used as measures of effect size (all variables were binary: Additionally, Cox \u0026amp; Snell R\u003csup\u003e2\u003c/sup\u003e and Nagelkerke R\u003csup\u003e2\u003c/sup\u003e were reported. All analyses were performed using the software IBM SPSS version 28.0, with a significance level set at 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eThe sample consisted of 836 participants, including 387 (46.3%) men, with an overall mean age of 74.5 years (sd\u0026thinsp;=\u0026thinsp;6.7 years old).\u003c/p\u003e \u003cp\u003eConcerning the health condition before the COVID-19 pandemic, most participants indicated fair (41.9%) or poor (19.7%) health and 106 (12.7%) reported worse health. A total of 163 participants (19.5%) were diagnosed with at least one major health condition. Also, 136 participants (16.3%) reported frequent falls, 336 (40.2%) had a fear of falling, 238 (28.5%) experienced dizziness, faints, or blackouts, and 402 (48.1%) reported fatigue. Almost all participants were on a regular regimen of prescribed drugs.\u003c/p\u003e \u003cp\u003eRegarding mental health, 435 (52.0%) felt nervous, 378 (45.2%) were sad or depressed, 346 (41.4%) had trouble sleeping, and 279 (33.4%) felt lonely often or some of the time (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSample characteristics: demographic and health factors\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender [male]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e387 (46.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (sd) [min-max]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74.5 (6.7) [65\u0026ndash;97]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow was your health before the outbreak?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (2.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (4.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e265 (31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e350 (41.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e165 (19.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in your health since the outbreak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21 (2.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorsened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106 (12.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbout the same\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e709 (84.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with a major health condition [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e163 (19.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalling more often [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e136 (16.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of falling [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e336 (40.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness, faints, or blackouts [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e238 (28.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e402 (48.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakes prescription drugs regularly [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e768 (91.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFelt nervous [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e435 (52.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSad or depressed [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e378 (45.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrouble sleeping recently [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e346 (41.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you feel lonely [often or some of the time]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e279 (33.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003esd: standard deviation; min: minimum; max: maximum\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGender, health (self-perception and change), fear of falling, dizziness, faints or blackouts, fatigue, and mental health (feeling nervous, sad, or depressed and trouble sleeping) were associated with the group feeling lonely. Women and, in general, participants exhibiting poor physical and mental health displayed a higher percentage of feeling lonely often or some of the time. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e outlines the characteristics of the groups defined by loneliness feeling status.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eComparison of groups according to the loneliness feeling status\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eFeeling lonely\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c8\" namest=\"c7\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eOften or some of the time\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHardly never or never\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender [male]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e292 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (sd)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e74.9 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e74.4 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.238*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow was your health before the outbreak?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcellent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e13 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery good\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e8 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e31 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e64 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e201 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e129 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e221 (39.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e74 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e91 (16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in your health since the outbreak\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImproved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e16 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorsened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e61 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e46 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbout the same\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e212 (76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e505 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with a major health condition [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e65 (23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e98 (17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFalling more often [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e53 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e83 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of falling [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e135 (48.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e201 (36.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDizziness, faints, or blackouts [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e93 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e145 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e168 (60.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e234 (42.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTakes prescription drugs regularly [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e260 (93.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e508 (91.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFeeling nervous [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e202 (72.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e233 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSad or depressed [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e197 (70.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e181 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrouble sleeping recently [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e153 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e193 (34.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003esd: standard deviation; *: Independent sample t-test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGender, age, fatigue, sleeping disorders and feeling lonely were factors associated with feeling nervous. Specifically, women, aged younger, with fatigue, sleeping troubles, and feeling lonely often or some of the time were more predisposed to feeling nervous.\u003c/p\u003e \u003cp\u003eOn the other hand, concerning the outcome of \u0026ldquo;feeling sad or depressed\u0026rdquo;, women, diagnosed with a major health condition, experiencing fatigue, sleeping troubles, and feeling lonely often or some of the time were more likely to feel sad or depressed. Detailed information on the factors associated with feeling nervous and feeling sad or depressed is presented in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eFactors associated with feeling nervous\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender [female]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.116\u0026ndash;3.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.538\u0026ndash;2.824\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (z-score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.821\u0026ndash;1.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.715\u0026ndash;0.974\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with a major health condition [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.061\u0026ndash;2.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.883\u0026ndash;1.906\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.766\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.089\u0026ndash;3.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.612\u0026ndash;3.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrouble sleeping recently [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.159\u0026ndash;3.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.456\u0026ndash;2.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you feel lonely [often or some of the time]?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.671\u0026ndash;4.983\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.011\u0026ndash;3.908\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e (Cox \u0026amp; Snell)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e (Nagelkerke)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eOR: odds ratio; CI: confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eFactors associated with feeling sad or depressed\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender [female]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.943\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.213\u0026ndash;3.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.530\u0026ndash;2.887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (z-score)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.966\u0026ndash;1.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.879\u0026ndash;1.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosed with a major health condition [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.361\u0026ndash;2.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.747\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.177\u0026ndash;2.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.117\u0026ndash;3.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.918\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.389\u0026ndash;2.648\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrouble sleeping recently [yes]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.689\u0026ndash;4.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.636\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.914\u0026ndash;3.630\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHow often do you feel lonely [often or some of the time]?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.651\u0026ndash;6.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.772\u0026ndash;5.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e (Cox \u0026amp; Snell)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e (Nagelkerke)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eOR: odds ratio; CI: confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis comprehensive study included 836 participants aged 65 years and older. Most participants were women, with an overall mean age of 74.5 years (sd\u0026thinsp;=\u0026thinsp;6.7 years old). Concerning health conditions, most participants reported fair or poor health before the outbreak (61.6%) and 106 (12.7%) reported worse health since the outbreak. A total of 163 participants (19.5%) were diagnosed with at least one major health condition. Also, 136 participants (16.3%) reported falling more often, 336 (40.2%) expressed a fear of falling, 238 (28.5%) experienced dizziness, faints, or blackouts, and 410 (48.5%) reported fatigue. Almost all participants adhered to a regular regimen of prescribed drugs. Regarding mental health, 435 (52.0%) felt nervous, 378 (45.2%) sad or depressed, 346 (41.4%), experienced sleeping disorders, and 279 (33.4%) felt lonely often or some of the time.\u003c/p\u003e \u003cp\u003eThe primary findings of this study revealed a significant correlation between heightened feelings of loneliness and women residing alone. This demographic data unveils a concerning trend characterized by poorer health statuses and increased susceptibility to various illnesses. Moreover, these women reported heightened concerns regarding their physical well-being, including an increased fear of falling, experiences of dizziness, increased fatigue, heightened anxiety, depression, and disturbances in sleep patterns. The observed association between living alone and a spectrum of adverse health outcomes emphasizes the critical need to address the emotional and physical well-being of women in solitary living arrangements. Implementing targeted interventions and support systems is imperative in alleviating the negative impact of loneliness, promoting better mental health, and ultimately enhancing the overall quality of life for individuals in this demographic [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile age itself is not a predictor of loneliness, evidence indicates that as people age, they tend to lose some relationships with advanced age. It is crucial to note that socially isolated people are not inherently lonely, and conversely, lonely people are not invariably socially isolated [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The social distance measures imposed during the COVID-19 pandemic intensified social isolation and loneliness, particularly among older people [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. With the pandemic, a new paradigm emerged worldwide, with everyday physical distancing taking its toll, significantly impacting adults aged 65 and above. Social isolation can promote feelings of loneliness and, especially when recurrent, can exacerbate mental health problems and disturbances in overall well-being [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLiving alone is associated with a high risk of social isolation and loneliness. Also, living alone, social isolation, loneliness, and limited engagement in social activities carry a higher risk of developing certain forms of dementia at older ages [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Older people living alone are more prone to exhibit poor cognitive function. Living alone restricts opportunities for social engagement, leading to a decreased mobilization of cognitive reserves, ultimately contributing to poorer cognitive function and depression. Furthermore, being widowed, divorced/separated, or single increases the likelihood of living alone, while being married/cohabiting is a protective variable for cognitive function [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis important finding sheds light on potential implications for the mental well-being of older individuals in solitary lifestyles. It is crucial to comprehend and tackle the distinctive challenges faced by older individuals living alone to develop targeted interventions. By fostering social connections, encouraging mental stimulation, and establishing support structures, we can mitigate the risk of cognitive decline and enhance the overall cognitive well-being of older individuals who either choose or find themselves living alone [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have noted an escalation in loneliness among the older population since the onset of the COVID-19 pandemic [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Loneliness is also a potential risk factor for depression. Thus, assessing signs of loneliness in older adults and implementing strategies to address this loneliness must be prioritized by health professionals [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Recent research aligns with other studies suggesting that the increased risk of depressive symptoms and anxiety are directly associated with loneliness [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. One of the various consequences of the COVID-19 pandemic on the physical and mental health of older people was sleeping disorders with a negative impact on the mental health of this vulnerable population [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This problem increases the probability of depression, anxiety, and loneliness [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Corbo et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] findings further support this, concluding that people diagnosed with mental health disorders are more prone to experiencing poor sleep quality compared to the general population.\u003c/p\u003e \u003cp\u003eAnother outcome of the COVID-19 pandemic was the risk of falling and fear of falling, a phenomenon linked to prolonged stays at home among older people, increasing fear of movement, low physical activity, and risk of falling [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. This relationship between prolonged home confinement and diminished physical well-being underscores a concerning trend with profound implications for the overall health and safety of older individuals. The fear of movement can lead to a reluctance to engage in regular physical activities, fostering a sedentary lifestyle. In turn, this can lead to a decline in muscle strength, balance, and coordination, intensifying the risk of falling and related injuries. Recognizing the importance of addressing these challenges is paramount in developing strategies to promote the health and mobility of older individuals. Implementing interventions that encourage safe and gradual physical activity, cultivating a supportive home environment and addressing the psychological aspects of fear associated with movement are essential in mitigating the risks and enhancing the overall well-being of older individuals spending extended periods at home. These findings align with other studies [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] showing an increased risk of falling in older people. It is well-established that falls can be associated with the social isolation and loneliness experienced by older people [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Further research is imperative to understand the broader effects of the COVID-19 pandemic on the physical, mental, and social health of older people. The study by Soares et al. demonstrates that changes in social isolation due to the pandemic could contribute to increased sedentary behaviours and loneliness in older adults despite no observed effects on the number of falls [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, chronic fatigue syndrome presents a significant concern among older people with a negative impact on global health, with a higher prevalence in women [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The COVID-19 pandemic has particularly affected older people because of the existence of increased comorbidities and overall vulnerability [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. The findings from Aly and Saber reported the presence of fatigue and its relationship with cognitive impairment, stress, sadness, sleep disorders, and recurrent falls [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These symptoms were more prevalent in women, with 33% of the respondents experiencing them [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome limitations in the study merit consideration. Firstly, the cross-sectional nature of the study does not allow us to compare certain variables before and after the COVID-19 pandemic. This limitation is exemplified by the inability to understand the change in health perceived after the beginning of the COVID-19 pandemic. To gain a comprehensive understanding of the evolution of these variables within the general population and, specifically, among this vulnerable group of individuals (older people), further research employing different study methodologies is essential. Additionally, we consider that it may be an additional limitation that we have used a subsample of a survey and therefore cannot be considered a representative sample.\u003c/p\u003e \u003cp\u003eTherefore, we recommend that the impact of the COVID-19 pandemic be subjected to more in-depth investigation, particularly concerning its effects on loneliness, sleep, and the physical and mental health of older people. This expanded research can pave the way for the implementation of more preventive and global health programmes.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe global challenges posed by the COVID-19 pandemic have been pronounced for the more vulnerable population groups, notably older people. The results of this extensive cross-sectional study revealed that among these groups, women with poorer health, increased fear of falling, dizziness, increased fatigue, heightened anxiety, depression, and health and sleep issues were more prone to experiencing loneliness.\u003c/p\u003e \u003cp\u003eEnhancing efforts in prevention and intervention is crucial for the identification of risk factors, treatment, and rehabilitation of sleep disorders in promoting healthy ageing. This approach aims to mitigate cognitive and physical decline in older individuals.\u003c/p\u003e \u003cp\u003eThese study findings provide valuable insights that can significantly impact clinical practice, particularly in addressing the mental health challenges among older people in the aftermath of the COVID-19 pandemic. Integrating these insights into clinical practice can better equip healthcare professionals to support the mental health of older people, especially in the context of the unique challenges posed by the pandemic. Furthermore, these study findings offer valuable contributions to health education, focusing on improving understanding and addressing mental health issues among older people post-COVID-19. Potential contributions to health education include training programmes to identify loneliness indicators and encouraging active ageing initiatives. By incorporating these considerations into health education initiatives, educators can play a pivotal role in fostering a well-informed and compassionate community that actively promotes the mental health and overall well-being of older people in the post-COVID-19 era.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe SHARE study was reviewed and approved by the Ethics Committee of the University of Mannheim.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was financed by national funds through FCT Funda\u0026ccedil;\u0026atilde;o para a Ci\u0026ecirc;ncia e a Tecnologia, I.P., within the scope of the project \u0026ldquo;RISE-LA/P/0053/2020\u0026rdquo;.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, O.A., L.T., C.S., L.S., methodology, L.T., writing - original draft preparation, O.A. and L.T.; writing - review and editing, F.S., L.S., C.S. 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Cureus. 2022;14(9):e29493. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.29493\u003c/span\u003e\u003cspan address=\"10.7759/cureus.29493\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Mental health, Older people, Pandemic, Loneliness, Depression, Anxiety, Sleep disorder","lastPublishedDoi":"10.21203/rs.3.rs-4042161/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4042161/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcknowledging the exacerbated impact of the COVID-19 pandemic on the mental health status of the general population, particularly the older population, this study aimed to explore the association between loneliness and mental health disorders in older people after the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey using the SHARE database was conducted from June to August 2020 amid the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe sample comprised 847 participants, including 393 (46.4%) men, with an overall mean age of 74.6 years (sd\u0026thinsp;=\u0026thinsp;6.7 years). Concerning mental health indicators, 441 (52.1%) reported feelings of nervousness, 384 (45.3%) experienced sadness or depression, 349 (41.2%) encountered sleeping difficulties, and 280 (33.1%) reported experiencing loneliness often or some of the time. The results revealed increased loneliness feelings for women who had worse health, increased fear of falling, dizziness, heightened fatigue, anxiety, depression, and concurrent health and sleep problems. Notably, age and medication had no impact on feeling lonely.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe pandemic has adversely affected the mental well-being of older population. These findings provide valuable insights for the development of targeted strategies to prevent mental health problems.\u003c/p\u003e","manuscriptTitle":"The association between loneliness and mental health disorders in older people after the COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-28 20:29:01","doi":"10.21203/rs.3.rs-4042161/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a64842d9-6338-4131-b1bc-af080d1e48a2","owner":[],"postedDate":"March 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-04T10:12:27+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-28 20:29:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4042161","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4042161","identity":"rs-4042161","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}