Joyce Li

Background: Few studies describe how gender‐related factors may contribute to polypharmacy and prescribing cascades. Describing these patterns using cross‐national comparisons can improve the robustness of findings and provide lessons on the importance of considering age, sex, and gender in pharmacological research. The aim of the study was to explore the intersection of age, sex, and gender with polypharmacy and co‐prescribing suggesting a potential prescribing cascade. Methods: In this cross‐sectional descriptive study, we assessed polypharmacy and calcium channel blocker and diuretic co‐prescribing suggesting a prescribing cascade in patients aged ≥65 years from five international secondary databases: population‐level community and nursing home (ICES, Maccabi Healthcare Services), clinical trial (SENATOR), and patient registry (Report‐AGE, SHELTER). The intersection of age, sex, and gender was explored. Results: All databases provided age and sex; none included gender‐identity data. Gender‐related sociocultural factors, socioeconomic status (SES) measured as income and educational attainment, and marital status were not uniformly collected. Compared with males, females had lower income, has less educational attainment, and were more frequently widowed. Polypharmacy was more common in men. Co‐prescribing suggesting a prescribing cascade was more frequent in females in four databases and was also more frequent in lower SES and unmarried groups (significant in ICES (community and nursing home) and Maccabi (community), with a nonsignificant trend in Maccabi (nursing home) and three remaining databases). Using two population‐level databases, the prevalence of co‐prescribing suggesting a prescribing cascade was highest among females 85 years and older who were also in the lower SES group (11.0% ICES and 14.6% Maccabi). Gender disparity was highest in this group (ICES Differential Prevalence = 3.0%, Maccabi Differential Prevalence = 3.8%). Conclusion: Older adults with lower SES experienced polypharmacy or co‐prescribing suggesting a prescribing cascade more frequently than those with higher SES. Within the lower SES groups, females more frequently than males had evidence of co‐prescribing suggesting a prescribing cascade. Considering the role of sex and gender‐related sociocultural factors may help to better understand some contributors to polypharmacy and prescribing cascades. The research applications are highlighted in our five lessons learned.

Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection.

BACKGROUND Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. OBJECTIVE This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. METHODS A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. RESULTS Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. CONCLUSIONS Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection.

Objective: Physical distancing and stay-at-home measures implemented to slow transmission of novel coronavirus disease (COVID-19) may intensify feelings of loneliness in older adults, especially those living alone. Our aim was to characterize the extent of loneliness in a sample of older adults living in the community and assess characteristics associated with loneliness. Design: Online cross-sectional survey between May 6 and May 19, 2020 Setting: Ontario, Canada Participants: Convenience sample of the members of a national retired educators’ organization. Primary outcome measures: Self-reported loneliness, including differences between women and men. Results: 4879 respondents (71.0% women; 67.4% 65-79 years) reported that in the preceding week, 43.1% felt lonely at least some of the time, including 8.3% that felt lonely always or often. Women had increased odds of loneliness compared to men, whether living alone (adjusted Odds Ratio (aOR) 1.52 [95% Confidence Interval (CI) 1.13-2.04]) or with others (2.44 [95% CI 2.04-2.92]). Increasing age group decreased the odds of loneliness (aOR 0.69 [95% CI 0.59-0.81] 65-79 years and 0.50 [95% CI 0.39-0.65] 80+ years compared to <65 years). Living alone was associated with loneliness, with a greater association in men (aOR 4.26 [95% CI 3.15-5.76]) than women (aOR 2.65 [95% CI 2.26-3.11]). Other factors associated with loneliness included: fair or poor health (aOR 1.93 [95% CI 1.54-2.41]), being a caregiver (aOR 1.18 [95% CI 1.02-1.37]), receiving care (aOR 1.47 [95% CI 1.19-1.81]), high concern for the pandemic (aOR 1.55 [95% CI 1.31-1.84]), not experiencing positive effects of pandemic distancing measures (aOR 1.94 [95% CI 1.62-2.32]), and changes to daily routine (aOR 2.81 [95% CI 1.96-4.03]). Conclusions: While many older adults reported feeling lonely during COVID-19, several characteristics – such as being female and living alone – increased the odds of loneliness. These characteristics may help identify priorities for targeting interventions to reduce loneliness. Strengths and limitations of this study: This survey study leveraged a strong community-based partnership to obtain timely data from a large sample of older Canadians on the impacts of COVID-19. This study identified several characteristics that increased the odds of loneliness, which may help to identify priorities for targeted interventions to reduce loneliness. The data were based on a convenience sample of retired, educational staff, who are not fully representative of the Canadian population. The perspectives of vulnerable groups who may be at greater risk for loneliness (e.g. those with severe mental health illness, low income, no home internet access, etc.) are likely underrepresented in this sample.