Changes in healthcare seeking and lifestyle in old aged individuals during COVID-19 lockdown in Germany: the population-based AugUR study

Abstract

Background: Containment measures in the COVID-19 pandemic protected individuals at high risk, particularly individuals at old age, but little is known about how these measures affected health-related behavior of old aged individuals. We aimed to investigate the impact of the spring 2020 lockdown in Germany on healthcare-seeking and health-related lifestyle in the old aged and to identify susceptible subgroups.

Methods: We conducted a follow-up survey among the pre-pandemically well-characterized participants of our AugUR cohort study, residents in/around Regensburg aged 70+ years and relatively mobile. A self-completion questionnaire on current behavior, perceived changes, and SARS-Cov-2 infection was mailed in May 2020, shortly before contact restrictions ended. Pre-pandemic lifestyle and medical conditions were derived from previous study center visits.

Results: Among 1850 survey participants (73-98 years; net-response 89%), 74% were at increased risk for severe COVID-19 according to medical conditions; four participants reported SARS-CoV-2 infection (0.2%). Participants reported changes in behavior: 29% refrained from medical appointments, 14% increased TV consumption, 26% reported less physical activity, but no systematic increase of smoking or alcohol consumption. When comparing during- and pre-lockdown reports of lifestyle within participant, we found the same pattern as for the reported perceived changes. Women and the more educated were more susceptible to changes. Worse QOL was perceived by 38%.

Conclusions: Our data suggest that the spring 2020 lockdown did not affect the lifestyle of a majority of the mobile old aged individuals, but the substantial proportions with decreased physical activity and healthcare-seeking are markers of collateral damage.

Keywords: AugUR; COVID-19; Coronavirus; Lifestyle factors; Old aged population; Physical activity, smoking, alcohol consumption; Population-based study; Proportion at risk for COVID-19; Quality of life; SARS-CoV-2.

Fig. 1

Flow chart of participant inclusion and response. The AugUR study platform initially included 2449 individuals aged 70+, all with informed consent to participate in AugUR research investigations. The questionnaire was sent out to all, for whom we had no adverse information on survival, contactability, or willingness to participate on May 12th, 2020 (n = 2314), but contactable (i.e. still residing at the noted address and alive) were only 2088. Of these, 89% have answered to the questionnaire until Aug 26th, 2020 (n = 1850)

Fig. 2

Frequency of participants at increased risk for severe COVID-19 beyond old age. Shown are frequencies of individuals with medical conditions assessed at the prior study center visit (among the 1850 participants of this survey): A having a medical condition listed to increase or possibly increase risk for severe COVID-19 [5], B having ≥1 condition listed to increase risk (cancer, chronic kidney disease, chronic bronchitis, obesity, serious heart conditions, type 2 diabetes) [5] by 10-year age-groups and sex (blue and orange), men&women combined by age-group and all combined (gray)

Fig. 3

The SARS-Cov-2 epidemic situation in the study capture area until August 2020 for all inhabitants and those aged 70+. We derived the numbers of SARS-CoV-2 infections and COVID-19 related deaths in the study area (city and county of Regensburg) from the Bavarian Food and Health Safety Authority (Landesamt für Gesundheit und Lebensmittelsicherheit) for the survey observation period (Feb 1st to Aug 26th, 2020). Shown are (A) number of newly reported infected per day, (B) cumulative number of deaths. Those aged 70+ comprise 13% of study region residents, 8% of infected, and 64% of COVID-19 related deaths

Fig. 4

Comparing quantified differences in lifestyle factors and QOL with perceived changes. We derived categories of perceived changes in lifestyle and QOL reported during lockdown (same, less/better now, more/worse now) with the quantified change of the report during lockdown compared to the report pre-lockdown. By category of perceived change, we show the distribution of the quantified change for all participants (prior visit April 2016 – March 2020, n = 1850, mean time before lockdown = 1.76 years, SD = 0.93; left column) and restricted to those with prior visit < 1 year before lockdown (March 2019 – March 2020, n = 524; right column) where information on both perceived and quantified changes was availble. Shown are (A) difference in number of cigarettes smoked daily (among current smokers at survey or prior visit, 43 smokers in left column, 13 smokers in right column), (B) difference in number of alcoholic drinks consumed daily (among alcohol consumers at survey or prior visit, n = 1357 or 385, respectively), (C) difference in QOL score (n = 1657 or 462, respectively)