November 2021

GERIATRICS

IMPROVEMENT IN SELF-EFFICACY AMONG OLDER ADULTS AGING-IN-PLACE DURING COVID-19

Featuring: ​Lee Ann Lindquist, MD, MPH, MBA, Vanessa Ramirez-Zohfeld, MPH, Alaine Murawski, MSW, LCSW ​

INTRODUCTION
Self-efficacy is defined as an individual's belief in their capacity to execute behaviors necessary to produce specific performance attainments. It also reflects confidence in the ability to exert control over one's own motivation, behavior, and environment. 

During the COVID-19 pandemic, older adults who were aging-in-place were stressed with forced isolation, concerns over mortality, and finding alternate means of fulfilling their home-based needs. Lee Ann Lindquist, MD, MPH, MBA, section chief of Geriatric Medicine in the Department of Medicine, George M. Eisenberg Research Professor of Geriatric Medicine and asoociate professor of General Internal Medicie and Geriatrics, Vanessa Ramirez-Zolfeld, research associate under ​Dr. Lindquist , and their research colleagues sought to assess how older adult self-efficacy was affected by the COVID-19 pandemic.

METHODS
The LITCOG cohort is a group of community-dwelling older adults (65 years and older) who have had longitudinally assessment of cognition, health literacy, and functional skills over the past 15 year. As part of a larger study of the LITCOG cohort assessing decision making for aging-in-place, we assessed self-efficacy using validated PROMIS (Patient-Reported Outcomes Measurement Information System) measures with older adults prior to COVID-19 and during the COVID-19 pandemic.

​The surveys started prior to March 2020 (initial COVID-19 illnesses) and COVID-19 pandemic. We compared differences in self-efficacy among subjects in relation to the COVID-19 pandemic using T-tests to evaluate differences {ClinicalTrials.gov:NCT03960476}.

RESULTS
A total of 214 subjects (n=66 pre-COVID-19 pandemic, and n=148 during the COVID-9 pandemic.
  • Nearly half of the sample (48.2%) had either marginal (25.5%) or low health literacy (22.7%).
  • PROMIS General Self-Efficacy was higher among those assessed during the COVID-19 pandemic [45.8 (7.7) pre-COVID vs 43.7 (8.0), p=0.07].
  • PROMIS Self-Efficacy for managing social interactions was higher during the COVID-19 pandemic [45.0 (6.1) pre-COVID-19 vs 48.7 (8.3) during COVID-19, p=0.02]
  • Participants who completed their baseline during the COVID-19 pandemic had significantly higher Self-Efficacy for Managing Social Interactions t-scores   (β:3.02;95%CI:[0.15,5.88]).

DISCUSSION 
During the COVID-19 pandemic, older adults exhibited increased levels of self-efficacy. Significant differences were seen in the Self-Efficacy for Managing Social Interactions    t-scores by time of interview (p=0.002) and trend increases in General Self-Efficacy (p=0.07). This shows that older adults experienced increased confidence in managing their social interactions in the home (as all were restricted to their homes during the COVID-19 pandemic.

This study is limited in that it is difficult to distinguish if COVID-19 was the direct cause of the change in self-efficacy or if there were other socio-demographic factors that led to this difference. We will continue to analyze this data as participants complete their 6-month interviews. Ongoing longitudinal follow-up will determine how this self-efficacy evolves after the COVID-19 pandemic and impacts the ability to age-in-place.

FINANCIAL DISCLOSURE
This study is funded through NIA R01AG05877. Dr. Lindquist also receives funding through the Claude D. Pepper Older American Independence Center (OAIC) at Northwestern University [NIA P30AG059988].
Lee Ann Lindquist, MD, MPH, MBA is a Geriatrician and Chief of Geriatrics in the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine. Her patient-centered research focuses on helping older adults age-in-place, when they develop Alzheimer’s disease, through home and community-based resources and supporting caregivers. She has extensive experience partnering in research with community organizations and community members for recruitment, study implementation, data collection, and dissemination. ​

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