Communication of the Elderly During the COVID-19 Pandemic

Abstract

Background:

Restrictive measures implemented by governments around the world to control the coronavirus have an impact on communication, especially the communication of the elderly.

Objective:

The aim for the article is to determine the attitudes of the elderly towards the ways of communication during the COVID 19 pandemic, and to present the challenges faced by the elderly when using digital ways of communication. The goal is also to point out the importance of providing adequate social support to the elderly.

Methods:

The sample consisted of 71 respondents from Bosnia and Herzegovina, aged over 60 years, divided into two groups. The questionnaire was used to gather information from respondents on their demographic characteristics as well as to examine participants’ attitudes and confidence regarding the manner and risk of communication associated with COVID-19.

Results and Discussion:

The results of this research showed that the elderly are actively using digital technologies, but that they are largely dissatisfied with their skills in using digital technologies. Most of the information during the COVID 19 pandemic is given to elderly people via television and telephone (video) conversations with family members and friends. 57.7% of the elderly stated that they greatly lacked direct communication, and it turned out that people living in elderly homes were in a slightly more favorable position. As many as 4/5 of the respondents reported feelings of anxiety, fear, loneliness, and depression.

Conclusion:

The older part of the population (those over 60 years old), especially in developing countries, including Bosnia and Herzegovina, is facing the challenge of “digitization of communication“. In the context of the COVID-19 pandemic, the elderly are “calling“ for special support and the provision of training and access to technological resources in order to reduce negative psychological consequences and go one step further in creating an “elder-friendly” society.

1. BACKGROUND

The current situation with coronavirus (COVID-19) has changed the way people live around the world in many ways. State and local levels of government in Bosnia and Herzegovina have enacted several protective measures that need to be adhered to in private households and public places during a pandemic (1). Some of these measures include increased hygiene requirements, physical distancing, but also changing the way of communication, where direct communication–face to face is changed by numerous digital ways of communication such as voice calls, video calls and/or sending messages and e-mails (2). Communication is the key to active participation in the community. Communication serves us to transfer desires and needs, as well as exchange knowledge and experience (3). The foregoing suggests that limiting communication can have consequences for a person’s overall functioning.

The most vulnerable category, that is exposed to the highest percentage of complications after coronavirus infection is the population of the elderly, especially those with a history of respiratory diseases (4, 5). The elderly with present chronic diseases have the highest risk of developing a severe clinical condition and severe complications with increased mortality after Covid 19 infection (6). Third age is a risk factor for complications due to COVID-19 and is associated with a higher mortality rate (7). Therefore, the possible negative consequences of coronavirus infection leave a specific psychosocial impact on the elderly with chronic diseases (8).

Maintaining social ties while staying at home and physically distancing oneself is a kind of challenge for everyone, especially the elderly. Older persons, especially those living alone because they do not have living family members or have family members outside the country, often gather in markets, city parks, and places of worship and make social contacts there (9). Legally defined physical distancing, as well as prohibitions on the assembly, have serious consequences for the already present social isolation of elderly (10).

Restrictive measures during the pandemic have greatly changed the ways of communication and emphasized the importance of knowledge and the use of digital technologies (11). Based on Eurostat’s data (12), it is evident that as many as half of older people in Europe are not interested in using the Internet, and almost a third believe that they do not need the Internet in their lives. Financial problems with computer procurement and lack of adequate training are also barriers that older people cite as disruptive factors. Some elderly people use information technology on a daily basis for communication, information, and entertainment (13). However, one part of the elderly still shows a dose of anxiety or at least caution and fear of using digital technology (14).

A certain part of the elderly population experiences some form of hearing loss, which is manifested by difficulties in hearing and understanding the interlocutor, especially if there is some form of background noise (15). Those qiute common hearing problems can impair voice and video calls interaction with family members, friends, and the wider social community (2).

Self-isolation and limited social communication exposes older person to an additional risk of developing feelings of loneliness, fear, anxiety, and depression (9). The problem of depression in the elderly, which unfortunately often goes unnoticed, and thus untreated, is further complicated by the changing conditions of everyday life resulting from the pandemic (16).

Avoiding social contact during covid 19 pandemia is a kind of a priori for the elderly without considering at least mitigating the consequences that such a way of life leaves on people’s mental health (17). It seems that the general population does not attach much importance to the issues of aging, especially the protection of a dignified life with the support of the elderly at the time of the pandemic (16). In addition to protecting older people from coronavirus infection, which is a priority at the time of the pandemic, it is important to try to find adequate support systems to avoid or at least minimize social deprivation and feelings of abandonment (18).

2. OBJECTIVE

The aim for the article is to determine the attitudes of the elderly towards the ways of communication during the COVID 19 pandemic, and to present the challenges faced by the elderly when using digital ways of communication. The goal is also to point out the importance of providing adequate social support to the elderly.

3. MATERIAL AND METHODS

3.1. Sample of respondents

The sample consisted of 71 respondents, aged over 60 years. Respondents were divided into two groups, a group of respondents living in private households (41) and a group of respondents residing in nursing homes (30). The average chronological age of the respondents was 73 years, with a minimum of 60 and a maximum of 89 years. The sample represented of 56.3% female respondents and 43.7% of male respondents.

3.2. Method of conducting research and instruments

The research was conducted with elderly people from the general population in Bosnia and Herzegovina. All respondents were examined individually. It took an average of 20 minutes per respondent to answer all questions. Respondents were informed that participation was anonymous and completely voluntary and that they could withdraw at any time, without any justification. The examiner drew attention to conditions that may affect comprehension and response, such as: the presence of hearing impairment, illiteracy, the presence of cognitive deficits, and a history of stroke. The questionnaire was created for this research and consists of 18 questions that respondents need to answer by choosing off the offered answers or giving answers independently. This questionnaire was used to gather information from respondents on their demographic characteristics, including gender, age, and level of education, as well as to examine participants attitudes and confidence regarding the manner and risk of communication associated with COVID-19.

The claims related to the use of the Internet were designed by the authors and are based on similar research. Respondents self-assessed satisfaction with their ability to use digital technologies, then the extent to which they lacked direct communication (face-to-face contact), as well as the fear they felt during the lockdown. Satisfaction with the use of digital technologies, fear of direct communication, and feeling of lack of direct communication were measured by the statements to which the three-point answer scale (not at all, moderately, strongly) was attached.

4. RESULTS

The largest number of respondents in this study had completed high school (39.4%), 18.4% had no formal education, while 15.5% were highly educated, of which 5.6% had higher education and 9, 9% with a university degree. Only 14.1% of respondents have completed only four grades of primary school, and 9.9% have completed eight grades of primary school. As a source of information about COVID-19, 53.5% of respondents cite content from television, and 45.1% of respondents state that their source of information was a combination of content from television, conversations with family and friends, and info from Facebook. During the interview, the residents of retirement homes stated that the medical staff of the Home provided them with information about the protection and precautionary measures, as well as that the same information was printed and available in visible places.

94.4% of respondents believe that there is a corona virus, and only half of the respondents (52.1%) believe that the elderly are at the highest risk of coronavirus infection. There are no major differences in the answers to this question concerning group affiliation. Through the interview, the respondents state that the elderly are very disciplined when it comes to precautionary measures and compliance with the provisions for the protection of the population.

As many as 88.7% of respondents answered “Yes” to the question about owning a mobile device, while only 11.3% of respondents claim that they do not own a mobile device.

However, more than half of the respondents (54.92%) are not satisfied with their abilities to use the Internet, smartphones, and digital technologies, 32.39% of the respondents expressed average satisfaction, and only 12.67% of the respondents are satisfied.57.7% of respondents from the total sample answered that they felt a lack of face-to-face communication, and 15.5% of respondents expressed no feelings of lack of direct communication. Interestingly there is a difference between the feeling of lack of direct communication between respondents who lived in their household and those from the retirement homes, as shown in the table below (Table 1).

Table 1. Distribution of respondents according to levels of communication lack during the COVID-19 pandemic.

			Distribution of answers		not at all
			strongly	medium
Group	Respondents living in households	N	28	11	2
		%	68.3	26.8	4.9
	Respondents living in retirement homes	N	13	8	9
		%	43.3	26.7	30.0
Total		N	41	19	11
		%	57,7	26.8	15,5

The results of the chi-square test showed that there is a significant difference, according to levels of communication lack, between respondents living in their households and those living in retirement homes (χ2 = 8.926; ss = 2; p = 0.012).

54.9% of respondents felt fear of direct communication in the total sample. Again, there are differences between respondents living in their households and respondents living in retirement homes. As many as 63.3% of respondents living in retirement homes answered that they felt “no” fear of direct communication, and the same answer gave less than half of (31.7%) persons living in their households. The distribution of responses to the existence of fear of direct communication is presented in Table 2.

Table 2. Distribution of respondents according to their fear of direct communication during the COVID-19 pandemic.

			Distribution of answers		not at all
			strongly	medium
Group	Respondents living in households	N	10	18	13
		%	24,4	43,9	31,7
	Respondents living in retirement homes	N	6	5	19
		%	20,0	16,7	63,3
Total		N	16	23	32
		%	22,5	32,4	45,1

The results of the chi-square test showed a significant difference between respondents living in their households and those living in retirement homes (χ2 = 7,960; ss = 2; p = 0.019), according the fear of direct communication.

Approximately 1/5 of respondents in both groups had no change in feelings, 22% of respondents living in their household, and 23.3% of respondents living in nursing homes. Others reported feelings of anxiety, fear, loneliness, and depression.

5. DISCUSSION

Communication is imperative for creating connections with the social environment, maintaining social contacts, and inclusion in social flows, and encase of lack of communication, the person can be exposed to social exclusion (19). Venter considers communication as “fundamental to human existence” (20). To help maintain social interaction during a pandemic, it is necessary to detect the communication needs of the elderly as early as possible (21). Following the results of this research are claims that the majority of older people living in Bosnia and Herzegovina and neighboring countries have a lower level of education (illiterate, only literate or have primary school) (22,23).

It is important to recall that the perception of the risk mainly affects a person’s behavior. And risk perception correlates with the number of available sources of information (24). Unfortunately, the media, especially digital media and social networks are full of (dis) information about COVID 19. This (dis) information has a wide range, from how to protect against coronavirus, how to transmit, symptoms, to leads to the existence of viruses (25). An unverified and false news about the coronavirus is spreading on social media at almost the same speed as true information, which is an additional problem and aggravating circumstance in the defense against COVID-19 (26). Medical staff and health care professionals as members of society with roles of trust are most invited to disseminate accurate information, answer a number of questions and, through their active participation, contribute to resolving doubts (27). The results of a study conducted in Italy showed that there is a higher perception of risk in people who know someone who has been infected with the coronavirus, but that there is a negative correlation between risk perception and age, with older respondents to younger participants (24).

Figure 1. In lockdown seniors are turning to tech. Illustration: Isabel Seliger (29).

In the neighboring country, the Republic of Croatia, there has been an increase in the use of digital communication in all age groups, peculiarly an increase in Internet use in the age group 55 to 64 (28). Although Croatia is still among the poorer countries in the European Union when looking at the number of elderly using the Internet (12). There are no precise, comprehensive data for Bosnia and Herzegovina.

More than 2,000 seniors in the six locations where Senior Planet operates were contacted by organizers of the internet platform Senior Planet when countries started issuing their regulations for social isolation during Covid19 pandemic. They were asked what they required during the period of social isolation. The responses were diverse, requesting especially training on a wide range of topics, including telemedicine, ride-sharing apps, and gaming software in addition to the very popular Zoom application. Through online social organizations, fitness programs, and even dating apps, elderly wanted to maintain contact with the outside world (29). This is in accordance with the answers given by respondents in Bosnia and Herzegovina, who expressed a great interest and need for the use of digital information technology, especially during emergency situations, such as pandemics, but also the need for additional education.

Information and communication technologies show a positive impact on the communication of the elderly, ie they help the elderly to maintain social contacts (30). However, the +60 generation still feels a kind of discomfort during digital interaction, and enjoys face-to-face communication more (20). Elderly people, as opposed to younger people, have been shown to have more difficulty adopting new content (31). It is predicted that in the future, older people will be able to better advocate for themselves and their needs when using various services, including in the field of technology use (30). The above results points to the potential advantage of living in retirement homes. Social contacts within retirement homes have a positive effect on the feeling of better aging and reduce the experience of social isolation, the possibility of developing feelings of loneliness and depression (32). Friendships in the third age have a considerable impact on maintaining social cohesion, as well as a positive impact on the health and well-being of the person (33). Research indicates that physical distancing and staying home positively correlated with increased depression rates, sleep problems, and increased stress (34). Feelings such as anxiety, isolation, distress, and concern should not be ignored and should be taken seriously by researchers, clinicians, and politicians (35). Feelings of loneliness and isolation are among the main risk factors associated with poor physical and mental health (36). Since the third age is a kind of a risk factor for the development of feelings of loneliness and social isolation, we suggest systematic monitoring of the psychological consequences of the pandemic for this population (37).

6. CONCLUSION

Pandemia poses additional challenges to government officials, and all community members, especially those involved in health care systems. One of those challenges is finding ways to provide social support for the elderly. It is necessary to furnish access to technological resources, and training for the elderly to mitigate the potential social consequences of long-term isolation. Promoting safe communication within the community and demonstrating that the elderly are considered important members of society has to be one of the goals. Also, good health, in addition to the physical aspect, includes caring for the mental state of the person. There is an imperative to find mechanisms to strengthen the mental health of the community, especially in times of acutely changed social (with emphasis on communication) conditions.

Author’s contribution:

All authors in this paper have contributed. All authors discussed the results and approved the final version. Silva Banovic: concept and design of article; acquisition of data, analysis and interpretation of data; literature searches, writing manuscript. Osman Sinanovic: comments on the concept of article and the theoretical framework; analysis and interpretation of data; writing some parts of manuscript. Slavica Jankovic: comments on the concept of article, involved in revising the manuscript for important intellectual content. Nedim Patkovic: contributed to implementation of research with first author, designed the model and the computational framework. Samir Smajlovic: comments on the concept of article, literature searches.

Conflict of interest:

There are no conflicts of interest.

Financial support and sponsorship:

Nil.