Introduction
During spring 2020, the coronavirus disease, COVID-19, outbroke globally. To protect populations’ health and the functioning of societies and economy, in many countries, public gatherings were limited to few people, unnecessary traveling was prohibited, and, e.g., libraries, museums, leisure centers, and sport facilities were closed down (WHO
2020; Finnish Government Communications Department, Press Release 140/2020). The Government in Finland declared a state of emergency in March 2020. In addition to restricting the availability of activities in the community, a general guideline was laid out according to which all people aged over 70 years should adopt quarantine-like conditions, i.e., avoid physical contact with others outside one’s household (Finnish Government Communications Department, Press Release 140/2020).
During the COVID-19 restrictions, in the early phase of the pandemic, many forms of out-of-home mobility decreased (Sepúlveda-Loyola et al.
2020; Rantanen et al.
2020). However, physical activity, such as walking for fitness, increased among many Finnish community-dwelling older people, because it was one of the few available hobbies that could spontaneously be done (Rantanen and Portegijs
2020; Portegijs et al.
2021). It is likely that increases in such physical activities were possible only for people with intact mobility.
We recently reported that leading an active life declined during the social distancing recommendations among community-living older people (Rantanen et al.
2020). Active life reflects an individual’s striving to engage in various activities of choice as per one’s goals, functional capacities, and overall opportunities (Rantanen et al.
2019). We refer to this as active aging at the level of individuals. It covers all forms of doing, not just participation in physical activities, and is an important correlate of well-being (Rantanen et al.
2018,
2020). Active aging, as it manifests in individuals’ lives, has not been widely studied, because a validated quantitative instrument to assess it became available only recently (Rantanen et al.
2018). The University of Jyväskylä Active Aging Scale (UJACAS) includes 17 activities defined based on their meaning to an individual rather than external criteria (e.g., enjoying the outdoors, maintaining social relationships, making home cozy, or taking care of one’s appearance). For each activity the will to act, the ability and opportunity to act and the extent of doing the activity are assessed, and the scores are summed.
Cross-sectionally, more severe mobility limitations and lower resilience, previously referred to as self-rated coping abilities, correlate with lower scores (Siltanen et al.
2020). However, during COVID-19 restrictions, opportunities for engaging in different activities were limited for all. It is unknown whether active aging scores declined similarly regardless of physical and psychological resources, or whether those with less physical or psychological resources showed more or less extensive changes considering that their ‘starting points’ differed. In addition, it is unclear whether all active aging components, i.e., will to act, ability to act, opportunity to act, and actual activity, were equally affected by the social distancing recommendations.
Walking difficulties over longer distances are typically the first signs of functional decline among older people (Mänty et al.
2007; Verbrugge and Jette
1994). Walking difficulties make it more burdensome to engage in activities outside home. Eventually, they may evolve to inability and increase the risk of dependency for out-of-home activities, and potentially, gradually lead to giving up on activities considered too arduous. In a cross-sectional setting, walking difficulties were associated with a lower level of active aging, whereas high self-rated resilience was associated with a higher level, thereby compensating at least partly for physical decline (Siltanen et al.
2020). Resilience refers to the ability to adapt positively to adversity (Dyer and McGuinness
1996). The common perception is that resilience, or the attainment of positive adjustment, can only be manifested when a person is exposed to a significant threat or hardship, for example, a global COVID-19 pandemic or mobility decline. Resilience may partially explain why individuals respond differently to these challenges, as individuals’ with higher resilience are prone to look to the future, solve problems effectively (Van Kessel
2013), and compensate for deficits in function (Carpentieri et al.
2017; Siltanen et al.
2020), i.e., utilize various coping strategies.
We expected that higher resilience may prevent or slow down the decline in active aging during social distancing. When facing challenges, people with higher resilience typically stay tenacious and persistent with their pursuits, but at the same time, may show flexibility by downgrading the importance of goals no longer feasible, and start to pursue other more feasible objectives (Brandtstädter and Renner
1990). We have previously shown that when facing mobility limitations, people with higher resilience can modify their activity by substituting out-of-home or social activities by at-home or solitary activities that are still possible to perform (Siltanen et al.
2020). We anticipated that similar modifications may have taken place also during the COVID-19 social distancing, when many destinations of interest or leisure activities in the community were suspended, and avoiding physical contact was recommended.
The purpose of this study was to investigate whether 2 km walking difficulty ascertained prior to the COVID-19 pandemic predicted changes in active aging total score and its subscores during social distancing recommendations compared to 2 years before. We also studied whether self-rated resilience moderated these changes.
Discussion
Earlier we reported that active aging declined during the social distancing recommendations among Finnish community-living older people (Siltanen et al.
2020). The present study shows that the decline was especially remarkable among persons with pre-existing mobility limitation. Higher resilience, here assessed as self-reliance in one’s ability to cope with different adversities of life and ascertained prior to the pandemic, alleviated the negative effects of the COVID-19-related restrictions and declining mobility on active aging, as persons with higher resilience retained higher active aging scores over the follow-up. This mitigating role of resilience was particularly clear for the active aging total score and the activity subscore. Nevertheless, as suggested previously by our cross-sectional analyses (Siltanen et al.
2020), better self-rated resilience did not slow down but instead intensified active aging decline for persons at a more severe phase of mobility decline. This study contributes to the rather scarce literature on the associations of COVID-19-related social distancing with older people’s everyday behavior, and extends previous knowledge, mainly centered on physical activity (e.g., Yamada et al.
2020a;
b; Portegijs et al. unpublished), to a more comprehensive approach to activities of choice among older people.
Decline was observed in all four active aging subscores but it was most pronounced in the opportunity to act subscore, when comparing the situation 2 years before to the situation amid the COVID-19 restrictions. This is logical, because the actions to control the spreading of the Sars-Cov-2 virus included closing down of destinations of interest (e.g., libraries, restaurants, theaters) and suspending most activities where close contact with people outside one’s household could facilitate the viral spreading. This was duly reflected in the responses. The ability to act subscore, in turn, declined markedly among those unable to walk 2 km at the baseline. This implies that the gradually decreasing possibilities to do things among people with more severe mobility limitations were further diminished amid the COVID-19 social distancing. The expected consequences of social distancing, i.e., social isolation and being homebound, synergistically increase the risk of health decline among older people (Sakurai et al.
2019). Moreover, it is worth bearing in mind that the will to engage in different activities among persons unable to walk 2 km did not decline. We have previously studied unmet physical activity need (Rantakokko et al.
2010) and suggest that during social distancing recommendations, people with mobility limitations were experiencing unmet activity needs. This has probably reduced their well-being, because people are naturally motivated to direct their activities to fulfill needs for autonomy, relatedness, and competence (Deci and Ryan
2000), all of which were undermined during social distancing, and especially much among those with mobility limitations. This topic warrants further investigation.
The present findings are in line with our earlier results suggesting that higher resilience compensates for early-phase losses in function and helps older people to maintain their desired activity levels (Siltanen et al.
2020)—even when extreme environmental restrictions take place. People with higher resilience are often tenacious and persistent with their pursuits to achieve personal goals and desires, but also able to adapt to changed circumstances by modifying their goals, for example by switching previous activities into new, more feasible ones (Brandtstädter and Renner
1990). The present participants with higher resilience engaged more frequently in activities that were still available, which is in line with our earlier cross-sectional observations (Siltanen et al.
2020). For example, they participated in many at-home activities, enjoyed the nature, and exercised—even despite walking difficulties. These findings suggest that self-rated resilience may explain the differences in activity that are not accounted for by health and function.
The observation that higher self-reliance in one’s ability to cope with different adversities of life at baseline among people unable to walk 2 km predicted steeper active aging decline over the follow-up can be explained by several ways. First, it is possible that over the follow-up, their mobility decline progressed to worse, and they became more dependent on external help. In the present sample, a greater proportion of those unable to walk 2 km lived alone than of those in the other walking ability categories. Hence, it is likely that they have neither had the resources to go outside themselves nor anyone to assist them in doing so. People with more advanced mobility limitations also typically suffer from other functional and health deficits, such as cognitive decline (e.g., Demnitz et al.
2016), which may not only further reduce their possibilities for active aging but also make them a high-risk group for severe COVID-19 infections. It is possible that due to fear of infection, these people have purposely reduced their activity. Another potential explanation for this finding is that during the COVID-19 restrictions, higher resilience among those unable to walk 2 km mostly presented itself as psychological flexibility. Psychological flexibility refers to a coping strategy in which a person gives up on certain blocked goals or downgrades their importance in order to adapt to changed circumstances and adversity (Brandstädter and Renner
1990, Brandstädter and Rothermund
2002). Eventually, this kind of adaptation, i.e., accepting the current situation, leads to greater well-being, but may manifest as lower active aging scores. Lastly, we cannot rule out the possibility that the moderation analysis was underpowered. The category consisting of persons unable to walk 2 km was significantly smaller than the other walking ability categories, and the resilience scores clustered toward the lower end of the scale in this group. Hence, testing the moderation effect at relatively high values of resilience may have been difficult.
Limitations and strengths
This study has its limitations. Notable is that the data collection methods were different at baseline (computer-assisted personal interviewing conducted at participants’ homes) and follow-up (postal questionnaire), which may cause some bias regarding longitudinal analyses. Some downsides relate particularly to the postal questionnaires used amid the COVID-19 pandemic, as it is possible that the participants have misunderstood the questions. In addition, we do not know if it was the intended participant or some proxy, for example a spouse, who filled in the questionnaire. However, it is plausible that the effects of these limitations on the results are minor. It is also possible that selection bias has influenced the results to some extent. Although the sampling method was probability based, the participants of this longitudinal study were rather healthy and high-functioning whereas participants who dropped-out between baseline and follow-up were a little older and in poorer health. Hence, the findings of this study may present an underestimation of the actual influence of walking difficulty on active aging during this pandemic. Finally, it must be noted that although the study design was longitudinal, we cannot draw conclusions on causal relations and rule out the possibility that it was not COVID-19 or related measures that explain the associations found between walking difficulty, resilience, and active aging.
The strengths of the study are that, to the authors’ best knowledge, this was the first study to report on the predictors of decline in leading an active life during the COVID-19 pandemic compared to a situation 2 years before—a research need that has been called for (Rantanen et al.
2020). Other strengths of this study include comprehensive baseline data, a high response rate, and only little missing data. Furthermore, the follow-up data were collected during the early phases of the COVID-19 pandemic when there were rather few cases in the study area (102 confirmed infections in the study area, i.e., in the Central Finland Central Hospital district, population 253,000 inhabitants, 21 municipalities). Hence, the negative associations observed here were likely due to activity restrictions and social distancing, not due to the disease itself.
Conclusions
In conclusion, the findings of this study show that mobility limitations exposed to greater declines in leading an active life during the early-phase COVID-19 pandemic, and that higher self-reliance on own abilities to overcome challenges alleviated this decline among persons with early-phase walking difficulties but not among those with more severe mobility limitations. Compared to previous suggestions on the contribution to resilience, i.e., the ability to positively adapt to adversity, on active aging among persons with early-phase mobility decline, the present study extends to the context of social distancing and reports on the benefits of resilience in the face of a unique, tangible adversity that is similar and present for all respondents. Overall, these findings highlight the importance of promoting utilization of coping strategies that help support resilience, e.g., compensatory actions or social support (Rutter
2006), especially among older people with declining mobility. In the future, it would be interesting to investigate whether persons with higher resilience, regardless of walking difficulties, return to their initial level of active aging quicker than persons with lower resilience, or whether they resume the initial levels of activity in the first place when the pandemic is over.
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