The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study (Preprint)

Abstract

BACKGROUND The community environment plays a vital role in the health of older adults. During the COVID-19 epidemic, older adults, who were considered the most impacted and most vulnerable social group, were confined to their homes during the implementation of management and control measures for the epidemic. In such situations, older adults may have to contend with a lack of resources and experience anxiety. Therefore, identifying the environmental factors that are beneficial for their physical and mental health is critical. OBJECTIVE This study aimed to assess the association between community cohesion and the physical and mental health of older adults and to identify the related community services and environmental factors that may promote community cohesion. METHODS This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method was applied to this study. A total of 2036 participants aged ≥60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of scales on 3 dimensions was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community services and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 99.07% (2017/2036) of the participants. Separate logistic regression analysis was conducted to assess the association among community cohesion and physical and mental health factors, related community services, and environmental factors among older adults. RESULTS The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction (odds ratio [OR] 1.27, 95% CI 1.01-1.59 and OR 1.20, 95% CI 1.15-1.27, respectively) and high levels of self-efficacy and psychological resilience (OR 1.09, 95% CI 1.05-1.13 and OR 1.05, 95% CI 1.03-1.06, respectively). The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the education level was negatively associated with community cohesion scores (<i>P</i>=.009). Community cohesion was also associated with low levels of depression and high levels of cognitive function. Community cohesion was significantly associated with community services and environmental factors on 4 dimensions. High levels of community cohesion were associated with transportation services and rehabilitation equipment rental services as well as high levels of satisfaction with community physicians’ technical expertise and community waste disposal (OR 3.14, 95% CI 1.87-5.28; OR 3.62, 95% CI 2.38-5.52; OR 1.37, 95% CI 1.08-1.73; and OR 1.23, 95% CI 1.01-1.50, respectively). CONCLUSIONS Community cohesion was found to be associated with the physical and mental health of older adults. Our research suggests that enhancing community services and environmental resources may be an effective strategy to increase community cohesion during major infectious disease epidemics.