Anxiety during the Corona Virus Disease (COVID-19): The Lived Experience of Older Adults
Main Article Content
Abstract
This qualitative study explored the lived experience of Maltese older adults experiencing symptoms of anxiety during the coronavirus disease pandemic. The study was carried out through an interpretative phenomenological analysis approach. The participants (7 Maltese older adults) were recruited through purposive and snowball sampling, and semi-structured interviews were utilised to collect data. A cluster of 4 emergent Group Experiential Themes comprising of 13 subthemes highlighted the high levels of fear, as well as the different cognitive processes and attitudes that led to and maintained the experience of anxiety. The challenges of living through the pandemic included social isolation, safety measures, the long-term living outcomes of the pandemic and reflections on vulnerability. Resilience, coping strategies, and support systems played crucial roles throughout this period. Results framed within a Dynamic Biopsychosocial Model revealed that biological, psychological and social factors influencing anxiety evolved with the pandemic, shaping participants' perceptions. Measures supporting older adults to soften the negative mental health outcomes and possible traumas due to death of loved ones or long-term hospitalization should be prioritized.
Keywords:
COVID-19, anxiety, older adults, interpretative phenomenological analysis, lived experience
Article Details
How to Cite
PORTELLI, Pamela; SOLER, Andre.
Anxiety during the Corona Virus Disease (COVID-19): The Lived Experience of Older Adults.
Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5264>. Date accessed: 03 july 2024.
doi: https://doi.org/10.18103/mra.v12i4.5264.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Ferrari A, Santomauro D, Herrera A, Shadid J, Ashbaugh C, Erskine H. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Psychiatry. 2022;9(2):137-150. Doi:10.1016/s2215-0366(21)00395-3
2. COVID-19 risks and information for older adults. Centers for Disease Control and Prevention. Published August 21, 2021. https://www.cdc.gov/aging/covid19/index.html
3. Lewis K, Lewis C, Roberts A, et al. The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness. British Journal of Psychiatry Open. 2022;8(2). Doi:10.1192/bjo.2022.25
4. Armitage CJ, Dawes P, Munro KJ. Prevalence and correlates of COVID-19-related traumatic stress symptoms among older adults: A national survey. Journal of Psychiatric Research. 2022;147:190-193. Doi:10.1016/j.jpsychires.2021.12.054
5. Kira I, Shuwiekh H, Ashby, et al. The impact of COVID-19 traumatic stressors on mental health: Is COVID-19 a new trauma type. International Journal of Mental Health and Addiction. 2021;21(1):51-70. Doi:10.1007/s11469-021-00577-0
6. Cuschieri S. COVID-19: the transition towards a new normal—experiences from the European country of Malta. Journal of Public Health. 2021;30(11):2641-2648. Doi:10.1007/s10389-021-01486-1
7. 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. Published online September 23, 2022. Doi:10.7759/cureus.29493
8. Weekly epidemiological update on COVID-19 - 1 September 2023. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---1-september-2023
9. Centers for Disease Control and Prevention. COVID-19 Mortality Overview. cdc.gov. Published May 16, 2022. Accessed October 3, 2023. https://www.cdc.gov/nchs/covid19/mortality-overview.htm
10. Santomauro D, Herrera A, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(10312):1700-1712. Doi:10.1016/s0140-6736(21)02143-7
11. Formosa M. The Development of Gerontology and Geriatrics in Malta. Advances in Gerontology. 2015;28(1):40-48. https://www.um.edu.mt/library/oar/bitstream/123456789/101184/1/24%20-%202015%20-%20The%20development%20of%20gerontology%20and%20geriatrics%20in%20Malta.pdf
12. Lehman BJ, David D, Gruber JA. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass. 2017;11(8). Doi:10.1111/spc3.12328
13. Baker HJ, Hollywood A, Waite P. Adolescents’ lived experience of panic disorder: an interpretative phenomenological analysis. BMC Psychology. 2022;10(1). Doi:10.1186/s40359-022-00849-x
14. Forward C, Khan HTA, Fox P. The experience of living alone as an older woman in the UK during the Covid pandemic: an interpretative phenomenological analysis. BMC Public Health. 2023;23(1). Doi:10.1186/s12889-023-14988-2
15. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136. Doi:10.1126/science.847460
16. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and Research. 2nd ed. Sage Publications Limited; 2022.
17. Benoot C, Hannes K, Bilsen J. The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory. BMC Medical Research Methodology. 2016;16(1). Doi:10.1186/s12874-016-0114-6
18. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Studies. 2020;44(7):393-401. Doi:10.1080/07481187.2020.1748481
19. Arora A, Jha AK, Alat P, Das SS. Understanding coronaphobia. Asian Journal of Psychiatry. 2020;54:102384. Doi:10.1016/j.ajp.2020.102384
20. Chen SX, Ng JCK, Hui BPH, et al. Dual impacts of coronavirus anxiety on mental health in 35 societies. Scientific Reports. 2021;11(1). Doi:10.1038/s41598-021-87771-1
21. Shafran R, Rachman S, Whittal ML, Radomsky AS, Coughtrey A. Fear and anxiety in COVID-19: Preexisting anxiety disorders. Cognitive and Behavioral Practice. 2021;28(4):459-467. Doi:10.1016/j.cbpra.2021.03.003
22. Alhalal E, Alkhair Z, Alghazal F, Muhaimeed F, Halabi R. Fear of contamination among older adults in the post-COVID-19 era. Geriatric Nursing. 2022;48:1-7. Doi:10.1016/j.gerinurse.2022.08.010
23. Sit RWS, Lai HHK, Dong D, et al. Explaining the Psychosocial Effects of COVID-19 among Older Hong Kong Chinese People—A Qualitative Analysis. Journal of Geriatric Psychiatry and Neurology. 2022;35(2):206-214. Doi:10.1177/08919887221078563
24. Gosselin P, Castonguay C, Goyette M, et al. Anxiety among older adults during the COVID-19 pandemic. Journal of Anxiety Disorders. 2022;92:102633. Doi:10.1016/j.janxdis.2022.102633
25. Freckelton I. COVID-19: Fear, quackery, false representations and the law. International Journal of Law and Psychiatry. 2020;72:101611. Doi:10.1016/j.ijlp.2020.101611
26. Leventhal H, Benyamini Y, Diefenbach M, Leventhal E, Patrick-Miller L, Robitaille C. Illness representations: Theoretical foundations. In: Perceptions of Health and Illness: Current Research and Applications. Harwood Academic Publishers; 1997:19-45.
27. Asmundson GJG, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders. 2020;71:102211. Doi:10.1016/j.janxdis.2020.102211
28. Jagtap S, Shamblaw AL, Rumas R, Best MW. Information seeking and health anxiety during the COVID‐19 pandemic: The mediating role of catastrophic cognitions. Clinical Psychology & Psychotherapy. 2021;28(6):1379-1390. Doi:10.1002/cpp.2684
29. Arntz A, Rauner M, Van Den Hout M. “If I feel anxious, there must be danger”: Ex-consequentia reasoning in inferring danger in anxiety disorders. Behaviour Research and Therapy. 1995;33(8):917-925. Doi:10.1016/0005-7967(95)00032-s
30. Abela A, Grech Lanfranco I. POSITIVE PARENTING: National Strategic Policy 2016-2024. Ministry for the Family and Social Solidarity; 2016. Doi:10.13140/RG.2.2.11787.08482
31. Mahne K, Huxhold O. Grandparenthood and Subjective Well-Being: Moderating effects of educational level. The Journals of Gerontology: Series B. 2014;70(5):782-792. Doi:10.1093/geronb/gbu147
32. Santini ZI, Jose PE, Cornwell EY, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. The Lancet Public Health. 2020;5(1):e62-e70. Doi:10.1016/s2468-2667(19)30230-0
33. Loosen AM, Skvortsova V, Hauser TU. Obsessive–compulsive symptoms and information seeking during the Covid-19 pandemic. Translational Psychiatry. 2021;11(1). Doi:10.1038/s41398-021-01410-x
34. Gao J, Gao Q, Huo L, Yang J. Impaired activity of daily living status of the older adults and its influencing factors: a Cross-Sectional study. International Journal of Environmental Research and Public Health. 2022;19(23):15607. Doi:10.3390/ijerph192315607
35. Bae S, Malcolm MP, Nam S, Hong I. Association between COVID-19 and activities of daily living in older adults. Otjr-occupation Participation and Health. Published online November 14, 2022:153944922211349. Doi:10.1177/15394492221134911
36. Rosenstock IM, Strecher VJ, Becker MH. Social Learning Theory and the health belief model. Health Education Quarterly. 1988;15(2):175-183. Doi:10.1177/109019818801500203
37. Bergman YS, Cohen-Fridel S, Shrira A, Bodner E, Palgi Y. COVID-19 health worries and anxiety symptoms among older adults: the moderating role of ageism. International Psychogeriatrics. 2020;32(11):1371-1375. Doi:10.1017/s1041610220001258
38. Jaul E, Barron J. Characterizing the heterogeneity of aging: A vision for a staging system for aging. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.513557
39. González‐Castro JL, Landa SU, Puente-Martínez A, Leiva MG. Perceived vulnerability and severity predict adherence to COVID-19 protection measures: the mediating role of instrumental coping. Frontiers in Psychology. 2021;12. Doi:10.3389/fpsyg.2021.674032
40. Satariano B, Curtis S. The experience of social determinants of health within a Southern European Maltese culture. Health & Place. 2018;51:45-51. Doi:10.1016/j.healthplace.2018.02.011
41. Upenieks L. Unpacking the relationship between prayer and anxiety: A consideration of prayer types and expectations in the United States. Journal of Religion & Health. 2022;62(3):1810-1831. Doi:10.1007/s10943-022-01708-0
42. Giordmaina J, Zammit L. Shaping the Identity of the New Maltese through Ethics Education in Maltese Schools. Education Sciences. 2019;9(4):253. Doi:10.3390/educsci9040253
43. Finlay J, Kler JS, O’Shea B, Eastman MR, Vinson YR, Kobayashi LC. Coping during the COVID-19 Pandemic: A qualitative study of older adults across the United States. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.643807
44. Bentzen JS. In crisis, we pray: Religiosity and the COVID-19 pandemic. Journal of Economic Behavior and Organization. 2021;192:541-583. Doi:10.1016/j.jebo.2021.10.014
45. Chen S, Aruldass AR, Cardinal RN. Mental health outcomes after SARS-CoV-2 vaccination in the United States: A national cross-sectional study. Journal of Affective Disorders. 2022;298:396-399. Doi:10.1016/j.jad.2021.10.134
46. Holwerda TJ, Jaarsma EA, Van Zutphen EM, et al. The impact of COVID-19 related adversity on the course of mental health during the pandemic and the role of protective factors: a longitudinal study among older adults in The Netherlands. Social Psychiatry and Psychiatric Epidemiology. 2023;58(7):1109-1120. Doi:10.1007/s00127-023-02457-5
47. Köverová M, Ráczová B, Holevová BK. Predictors of anxiety, stress, and concern of COVID-19 infection in older adults during the first and the second waves of the COVID-19 pandemic in Slovakia. Gerontology and Geriatric Medicine. 2021;7:233372142110476. Doi:10.1177/23337214211047642
48. Lasota A, Mróz J. Positive Psychology in Times of Pandemic—Time Perspective as a Moderator of the Relationship between Resilience and Meaning in Life. International Journal of Environmental Research and Public Health. 2021;18(24):13340. Doi:10.3390/ijerph182413340
49. Dindo L, Liew JR, Arch JJ. Acceptance and Commitment Therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546-553. Doi:10.1007/s13311-017-0521-3
50. Hasheminasab M. Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder. Iranian Journal of Public Health. 2015;44(5):718-719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537636/
51. Jovančević A, Milićević N. Optimism-pessimism, conspiracy theories and general trust as factors contributing to COVID-19 related behavior – A cross-cultural study. Personality and Individual Differences. 2020;167:110216. Doi:10.1016/j.paid.2020.110216
52. Goins RT, Anderson E, Minick H, Daniels H. Older Adults in the United States and COVID-19: A Qualitative study of perceptions, finances, coping, and emotions. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.660536
53. Wei M. Social Distancing and Lockdown – An Introvert’s Paradise? An Empirical Investigation on the Association Between Introversion and the Psychological Impact of COVID19-Related Circumstantial Changes. Frontiers in Psychology. 2020;11. Doi:10.3389/fpsyg.2020.561609
54. Formosa M. COVID-19 and older persons: Reflections on human rights, ageism, isolation, dementia care, and gender. International Journal on Ageing in Developing Countries. 2021;6(1):5-19. https://www.researchgate.net/publication/353043782_COVID-19_and_older_persons_Reflections_on_human_rights_ageism_isolation_dementia_care_and_gender
55. Choi J, Rajaguru V, Shin J, Kim KI. Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Archives of Gerontology and Geriatrics. 2023;104:104831. Doi:10.1016/j.archger.2022.104831
2. COVID-19 risks and information for older adults. Centers for Disease Control and Prevention. Published August 21, 2021. https://www.cdc.gov/aging/covid19/index.html
3. Lewis K, Lewis C, Roberts A, et al. The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness. British Journal of Psychiatry Open. 2022;8(2). Doi:10.1192/bjo.2022.25
4. Armitage CJ, Dawes P, Munro KJ. Prevalence and correlates of COVID-19-related traumatic stress symptoms among older adults: A national survey. Journal of Psychiatric Research. 2022;147:190-193. Doi:10.1016/j.jpsychires.2021.12.054
5. Kira I, Shuwiekh H, Ashby, et al. The impact of COVID-19 traumatic stressors on mental health: Is COVID-19 a new trauma type. International Journal of Mental Health and Addiction. 2021;21(1):51-70. Doi:10.1007/s11469-021-00577-0
6. Cuschieri S. COVID-19: the transition towards a new normal—experiences from the European country of Malta. Journal of Public Health. 2021;30(11):2641-2648. Doi:10.1007/s10389-021-01486-1
7. 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. Published online September 23, 2022. Doi:10.7759/cureus.29493
8. Weekly epidemiological update on COVID-19 - 1 September 2023. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---1-september-2023
9. Centers for Disease Control and Prevention. COVID-19 Mortality Overview. cdc.gov. Published May 16, 2022. Accessed October 3, 2023. https://www.cdc.gov/nchs/covid19/mortality-overview.htm
10. Santomauro D, Herrera A, Shadid J, et al. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet. 2021;398(10312):1700-1712. Doi:10.1016/s0140-6736(21)02143-7
11. Formosa M. The Development of Gerontology and Geriatrics in Malta. Advances in Gerontology. 2015;28(1):40-48. https://www.um.edu.mt/library/oar/bitstream/123456789/101184/1/24%20-%202015%20-%20The%20development%20of%20gerontology%20and%20geriatrics%20in%20Malta.pdf
12. Lehman BJ, David D, Gruber JA. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass. 2017;11(8). Doi:10.1111/spc3.12328
13. Baker HJ, Hollywood A, Waite P. Adolescents’ lived experience of panic disorder: an interpretative phenomenological analysis. BMC Psychology. 2022;10(1). Doi:10.1186/s40359-022-00849-x
14. Forward C, Khan HTA, Fox P. The experience of living alone as an older woman in the UK during the Covid pandemic: an interpretative phenomenological analysis. BMC Public Health. 2023;23(1). Doi:10.1186/s12889-023-14988-2
15. Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196(4286):129-136. Doi:10.1126/science.847460
16. Smith JA, Flowers P, Larkin M. Interpretative Phenomenological analysis: Theory, Method and Research. 2nd ed. Sage Publications Limited; 2022.
17. Benoot C, Hannes K, Bilsen J. The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory. BMC Medical Research Methodology. 2016;16(1). Doi:10.1186/s12874-016-0114-6
18. Lee SA. Coronavirus Anxiety Scale: A brief mental health screener for COVID-19 related anxiety. Death Studies. 2020;44(7):393-401. Doi:10.1080/07481187.2020.1748481
19. Arora A, Jha AK, Alat P, Das SS. Understanding coronaphobia. Asian Journal of Psychiatry. 2020;54:102384. Doi:10.1016/j.ajp.2020.102384
20. Chen SX, Ng JCK, Hui BPH, et al. Dual impacts of coronavirus anxiety on mental health in 35 societies. Scientific Reports. 2021;11(1). Doi:10.1038/s41598-021-87771-1
21. Shafran R, Rachman S, Whittal ML, Radomsky AS, Coughtrey A. Fear and anxiety in COVID-19: Preexisting anxiety disorders. Cognitive and Behavioral Practice. 2021;28(4):459-467. Doi:10.1016/j.cbpra.2021.03.003
22. Alhalal E, Alkhair Z, Alghazal F, Muhaimeed F, Halabi R. Fear of contamination among older adults in the post-COVID-19 era. Geriatric Nursing. 2022;48:1-7. Doi:10.1016/j.gerinurse.2022.08.010
23. Sit RWS, Lai HHK, Dong D, et al. Explaining the Psychosocial Effects of COVID-19 among Older Hong Kong Chinese People—A Qualitative Analysis. Journal of Geriatric Psychiatry and Neurology. 2022;35(2):206-214. Doi:10.1177/08919887221078563
24. Gosselin P, Castonguay C, Goyette M, et al. Anxiety among older adults during the COVID-19 pandemic. Journal of Anxiety Disorders. 2022;92:102633. Doi:10.1016/j.janxdis.2022.102633
25. Freckelton I. COVID-19: Fear, quackery, false representations and the law. International Journal of Law and Psychiatry. 2020;72:101611. Doi:10.1016/j.ijlp.2020.101611
26. Leventhal H, Benyamini Y, Diefenbach M, Leventhal E, Patrick-Miller L, Robitaille C. Illness representations: Theoretical foundations. In: Perceptions of Health and Illness: Current Research and Applications. Harwood Academic Publishers; 1997:19-45.
27. Asmundson GJG, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders. 2020;71:102211. Doi:10.1016/j.janxdis.2020.102211
28. Jagtap S, Shamblaw AL, Rumas R, Best MW. Information seeking and health anxiety during the COVID‐19 pandemic: The mediating role of catastrophic cognitions. Clinical Psychology & Psychotherapy. 2021;28(6):1379-1390. Doi:10.1002/cpp.2684
29. Arntz A, Rauner M, Van Den Hout M. “If I feel anxious, there must be danger”: Ex-consequentia reasoning in inferring danger in anxiety disorders. Behaviour Research and Therapy. 1995;33(8):917-925. Doi:10.1016/0005-7967(95)00032-s
30. Abela A, Grech Lanfranco I. POSITIVE PARENTING: National Strategic Policy 2016-2024. Ministry for the Family and Social Solidarity; 2016. Doi:10.13140/RG.2.2.11787.08482
31. Mahne K, Huxhold O. Grandparenthood and Subjective Well-Being: Moderating effects of educational level. The Journals of Gerontology: Series B. 2014;70(5):782-792. Doi:10.1093/geronb/gbu147
32. Santini ZI, Jose PE, Cornwell EY, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. The Lancet Public Health. 2020;5(1):e62-e70. Doi:10.1016/s2468-2667(19)30230-0
33. Loosen AM, Skvortsova V, Hauser TU. Obsessive–compulsive symptoms and information seeking during the Covid-19 pandemic. Translational Psychiatry. 2021;11(1). Doi:10.1038/s41398-021-01410-x
34. Gao J, Gao Q, Huo L, Yang J. Impaired activity of daily living status of the older adults and its influencing factors: a Cross-Sectional study. International Journal of Environmental Research and Public Health. 2022;19(23):15607. Doi:10.3390/ijerph192315607
35. Bae S, Malcolm MP, Nam S, Hong I. Association between COVID-19 and activities of daily living in older adults. Otjr-occupation Participation and Health. Published online November 14, 2022:153944922211349. Doi:10.1177/15394492221134911
36. Rosenstock IM, Strecher VJ, Becker MH. Social Learning Theory and the health belief model. Health Education Quarterly. 1988;15(2):175-183. Doi:10.1177/109019818801500203
37. Bergman YS, Cohen-Fridel S, Shrira A, Bodner E, Palgi Y. COVID-19 health worries and anxiety symptoms among older adults: the moderating role of ageism. International Psychogeriatrics. 2020;32(11):1371-1375. Doi:10.1017/s1041610220001258
38. Jaul E, Barron J. Characterizing the heterogeneity of aging: A vision for a staging system for aging. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.513557
39. González‐Castro JL, Landa SU, Puente-Martínez A, Leiva MG. Perceived vulnerability and severity predict adherence to COVID-19 protection measures: the mediating role of instrumental coping. Frontiers in Psychology. 2021;12. Doi:10.3389/fpsyg.2021.674032
40. Satariano B, Curtis S. The experience of social determinants of health within a Southern European Maltese culture. Health & Place. 2018;51:45-51. Doi:10.1016/j.healthplace.2018.02.011
41. Upenieks L. Unpacking the relationship between prayer and anxiety: A consideration of prayer types and expectations in the United States. Journal of Religion & Health. 2022;62(3):1810-1831. Doi:10.1007/s10943-022-01708-0
42. Giordmaina J, Zammit L. Shaping the Identity of the New Maltese through Ethics Education in Maltese Schools. Education Sciences. 2019;9(4):253. Doi:10.3390/educsci9040253
43. Finlay J, Kler JS, O’Shea B, Eastman MR, Vinson YR, Kobayashi LC. Coping during the COVID-19 Pandemic: A qualitative study of older adults across the United States. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.643807
44. Bentzen JS. In crisis, we pray: Religiosity and the COVID-19 pandemic. Journal of Economic Behavior and Organization. 2021;192:541-583. Doi:10.1016/j.jebo.2021.10.014
45. Chen S, Aruldass AR, Cardinal RN. Mental health outcomes after SARS-CoV-2 vaccination in the United States: A national cross-sectional study. Journal of Affective Disorders. 2022;298:396-399. Doi:10.1016/j.jad.2021.10.134
46. Holwerda TJ, Jaarsma EA, Van Zutphen EM, et al. The impact of COVID-19 related adversity on the course of mental health during the pandemic and the role of protective factors: a longitudinal study among older adults in The Netherlands. Social Psychiatry and Psychiatric Epidemiology. 2023;58(7):1109-1120. Doi:10.1007/s00127-023-02457-5
47. Köverová M, Ráczová B, Holevová BK. Predictors of anxiety, stress, and concern of COVID-19 infection in older adults during the first and the second waves of the COVID-19 pandemic in Slovakia. Gerontology and Geriatric Medicine. 2021;7:233372142110476. Doi:10.1177/23337214211047642
48. Lasota A, Mróz J. Positive Psychology in Times of Pandemic—Time Perspective as a Moderator of the Relationship between Resilience and Meaning in Life. International Journal of Environmental Research and Public Health. 2021;18(24):13340. Doi:10.3390/ijerph182413340
49. Dindo L, Liew JR, Arch JJ. Acceptance and Commitment Therapy: a transdiagnostic behavioral intervention for mental health and medical conditions. Neurotherapeutics. 2017;14(3):546-553. Doi:10.1007/s13311-017-0521-3
50. Hasheminasab M. Acceptance and Commitment Therapy (ACT) For Generalized Anxiety Disorder. Iranian Journal of Public Health. 2015;44(5):718-719. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4537636/
51. Jovančević A, Milićević N. Optimism-pessimism, conspiracy theories and general trust as factors contributing to COVID-19 related behavior – A cross-cultural study. Personality and Individual Differences. 2020;167:110216. Doi:10.1016/j.paid.2020.110216
52. Goins RT, Anderson E, Minick H, Daniels H. Older Adults in the United States and COVID-19: A Qualitative study of perceptions, finances, coping, and emotions. Frontiers in Public Health. 2021;9. Doi:10.3389/fpubh.2021.660536
53. Wei M. Social Distancing and Lockdown – An Introvert’s Paradise? An Empirical Investigation on the Association Between Introversion and the Psychological Impact of COVID19-Related Circumstantial Changes. Frontiers in Psychology. 2020;11. Doi:10.3389/fpsyg.2020.561609
54. Formosa M. COVID-19 and older persons: Reflections on human rights, ageism, isolation, dementia care, and gender. International Journal on Ageing in Developing Countries. 2021;6(1):5-19. https://www.researchgate.net/publication/353043782_COVID-19_and_older_persons_Reflections_on_human_rights_ageism_isolation_dementia_care_and_gender
55. Choi J, Rajaguru V, Shin J, Kim KI. Comprehensive geriatric assessment and multidisciplinary team interventions for hospitalized older adults: A scoping review. Archives of Gerontology and Geriatrics. 2023;104:104831. Doi:10.1016/j.archger.2022.104831