Factors associated with Peritraumatic Distress among Community Dwelling Older adults during COVID-19

Peritraumatic distress is a negative psychological impact of the COVID-19 pandemic. Peritraumatic distress is emotional and physiological distress experienced during and/or immediately after a traumatic event (1). Peritraumatic distress consists of the negative emotions experienced during or shortly after a traumatic event (2). The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identified from an outbreak in Wuhan, China, in December 2019 (3).The World Health Organization (WHO) declared a Public Health Emergency of International Concern on January 2020 and a pandemic on March 2020 (4).

In Egypt, the number of the population aged above 65 in Egypt is 5,297,000, which accounts for 4.6 per cent of the total population in 2019. CAPMAS 2019 reports that life expectancy in Egypt is around 73.9 years (72.7 years for males, and 75.1 years for females). As of May 31, there were 24,985 confirmed cases of Covid-19 and 959 deaths in Egypt (5). With advanced age, there are a lot of age related changes that can put older adults at risk to develop peritrumatic distress.  Psychosocial changes play a significant role in developing peritrumatic distress among older adults. This is because of role and functional changes and multiple losses that occur with aging, such as retirement, loss of position, decrease income, loss of spouse, increased dependency that decrease autonomy, and decreased social support. In addition, physical changes that occur and the presence of co- morbidities and multiple medications use which decrease independency (6).

Low level of education and health awareness among older adults can be other risk factor for developing peritrumatic distress during COVID-19. Older adult survivors with low educational level have less medical resources and information resources at their disposal and have a less economic status. Accordingly, they may not be able to mobilize more resources and employ more successful strategies and thus be more risky to the development of peritrumatic distress during covid 19 (7). Moreover, the absence of leisure time activities and no practicing of exercise during the day may contribute to develop peritrumatic distress among older adults as a result of the profound negative effect on cognition function, emotional, social and psychological status (8).

The occurrence of peritraumatic distress it has been demonstrated to be associated with a higher risk of developing post traumatic distress and increased its severity, elevated mental health problems, increase depression, anxiety and somatic concerns among community dwelling older adults during covid pandemic. Peritrumatic distress is usually undetectable and its related factors are still unrecognized (9).So, the gerantological nurse plays a significant role to identify the peritrumatic distress among older adults and its associated factors as early as possible to prevent its negative consequences.

Globally, studies found that the outbreak of COVID-19 coronavirus has its impact on global mental health. This outbreak is leading to stress anxiety, depressive symptoms, insomnia, denial, anger and fear (10-11). Peritraumatic distress has its negative consequences in psychological and social aspect among older adults (11). In line with global trends, Egypt’s older adults ‘population is also suffered from COVID-19, and about 6029 of older adult died from COVID19 by  October 10, 2020 (12). Older adults are at significant risk of developing peritrumatic distress during COVID- 19 because of a lot of change related changes which occur as spontaneous changes within aging which has adverse negative effect in psychological and social health domains.

Aim of the study: To identify factors associated with peritraumatic distress among community dwelling older adults during covid-19.

Research questions: What are the factors associated with peritrumatic distress among community dwelling older adults during COVID -19?

Research Design: A descriptive design was used to achieve the aim of the current study.

Setting: The study subjects were selected from outpatient clinic of Shark El-Mdina hospital in Alexandria, Egypt.

Subjects: The study included one hundred (100) older adults admitted to in the previous mentioned settings and who fulfill the following criteria: aged 60 years and above and have normal cognitive function (score range from 0 to 2 on the Short Portable Mental Status Questionnaire (SPMSQ)

Data Collections Tools

Tools: Three tools were used in the current study as follows:

1.   Socio-demographic and Clinical Data of Community Dwelling Older Adults Structured Interview Schedule: This tool was developed by the researcher based on relevant literature to collect information from the study subjects related to:

     Part (I): Socio-demographic data: It used to assess demographic characteristic of the study subjects as age, gender, marital status and educational level … etc.

     Part (II): Medical health history: It used to assess physical status of the older adults, presence of chronic diseases, polypharamcy and hospitalization

    Part (III): life style habits: It used to assess life style habits such as sleeping hours, risk behaviors such as smoking, nutrition statues, practice exercises, mental and social health aspect…etc.

2.   Short Portable Mental Status Questionnaire (SPMSQ: This tool developed by Pfeiffer (1975) (13). It was used to assess the study subjects’ cognitive function. It was translated into Arabic and approved to be valid and reliable by “Abd Elsalam.R 2012” (14)and proved to be valid and reliabler = 0.89. The Arabic version of this scale was used in this study. The total score is 10 and is classified as follows, a score from 0-2 indicates no cognitive impairment, a score from 3-4 indicates mild cognitive impairment, a score from 5-7 indicates moderate cognitive impairment and score from 8-10 indicates severe cognitive impairment.

3.  The COVID-19 Peritraumatic Distress Index (CPDI) PDI:

This tool developed by Qiu (2020) (16).It was used to assess study subjects’ peritrumatic distress during COVID-19. Psychiatrists from the Shanghai Mental Health Center verified the content validity of the CPDI. The Cronbach’s alpha of CPDI is 0.95 (p<0.001) (16). It consists of 24 items included frequency of anxiety, depression, specific phobias, cognitive change, avoidance and compulsive behavior, physical symptoms and loss of social functioning in the past week. It designed to optimize recognition of peritrumatic distress during the pandemic. The total score is 100 and cutoff point is 29 where below twenty nine indicates absence of peritrumatic distress and twenty nine and more  indicates the presences of peritrumatic distress with  rang from 29 to 52 consider mild / moderate distress and from 53 to 100 consider as sever peritrumatic distress. This tool was translated into Arabic by the researchers and tested for its contents validity and reliability r=0.89.

Data Collection Procedure

Permission to carry out the study from the responsible authorities was obtained. Survey was done at the outpatient clinic in Shark El-Mdina hospital by the researcher to obtain contact information of community dwelling older adults who visiting the clinics previously.  The researcher used tool 2and 3 to identify community dwelling older adults fulfilling the study criteria. Because of the limitation of face to face interview during the COVID outbreak, the researcher designed a schedule for data collection by online/telephone interviewed with  who fulfilling the study criteria and collect the required data using tool 1and 4.  Time of interview was 25 – 40 minutes per each study older adult.  Assessment of peritrumatic distress during COVID -19 was carried out by the researcher for each study subject.

Pilot Study

A pilot study was carried out on 10% (10) of the community dwelling older adults to test the clarity, applicability, feasibility and relevance of the tools used and to determine the needed time for the application of the study tools. The patients who were included in the pilot study excluded from the study subjects.

Ethical Consideration

The ethical research considerations in this study included the following:

1.   Approval to carry out the study was obtained from the responsible authorities after appropriate explanation for the purpose of the study.

2.   A verbal consent of each older adult included in the study was obtained after appropriate explanation of the purpose of the study. Study older adults' anonymity and privacy were maintained as well as the confidentiality of the collected data. Older adults were assured for the right to withdraw from the study at any time.

      Table (1): Distribution of the study subjects according to the socio- demographic characteristics and clinical data (n = 100)

SD: Standard deviation

Table (1): Shows that of the 100 community dwelling older adults and included in the study. 43% were 75 to less than 85 years.  Female constituted 56% and 45% were widow. University education and above were reported by 55% of the study older adults.   95% had no work and 80% had adequate income per month.

Table (2): The relationship between COVID-19 Peritraumatic Distress and study subject’s socio demographic characteristics (n = 100)

 c²:  Chi square test           MC: Monte Carlo              *: Statistically significant at p ≤ 0.05       

Table (2): Shows that among the studied older adults 60% developed mild/ moderated peritrumatic distress during COVID-19 while 31% developed sever distress.  Peritrumatic distress during COVID-19 increase significantly with age where 71% who aged 75 years and less than 85 years developed sever peritrumatic distress  while 0.0% had no distress  in the same age p<0.001*. As well, level of education affected significantly the occurrence of peritrumatic distress during COVID-19 among study community dwelling older adults’ p=

0.006*

Table (3): The relationship between COVID-19 Peritraumatic Distress and study subject’s life style habits (n = 100)

c²:  Chi square test             MC: Monte Carlo *: Statistically significant at p ≤ 0.05

Table 3: Shows that irregular and no practice of exercise among study subjects associated significantly with developing of peritrumatic distress during COVID-19 as 51.7% from the study subjects who didn’t practice exercise develop mild/moderate peritrumatic distress and 35.5% develop sever distress p=0.039*.