Abstract
Purpose
The COVID-19 pandemic has had an enormous negative impact on the psychosomatic status of the general population, and especially of more vulnerable populations, such as older people. The present study aimed to assess changes in psychosomatic status before and after the COVID-19 pandemic among emeritus professors over 70 years of age.
Materials/Methods
A total of 56 emeritus professors aged 77.4 ± 6.1 (74.1% male) participated in the study. The study was conducted between September 2022 and January 2023, after approximately two and a half years of the COVID-19 pandemic. Sociodemographic characteristics, including socioeconomic status, were assessed in the questionnaire, along with active involvement in academic life and healthcare/sports. Physical and mental fatigue were assessed using a self-report questionnaire, and the impact of fatigue on physical and cognitive function was measured using the Fatigue Impact Scale. Participants evaluated their physical/mental fatigue and physical/cognitive function before and after the COVID-19 pandemic.
Results
Among the participating emeritus professors, 15% reported higher levels of physical fatigue (Z = −1.992, P = 0.046, r = 0.28) and mental fatigue (Z = −2.154, P = 0.031, r = 0.31) following the COVID-19 pandemic. A significant difference was found in physical function assessed before and after the COVID-19 pandemic, t(51) = −2.986, P = 0.004, g = 0.22, while cognitive function showed a non-significant difference, t(51) = −1.265, P = 0.212, g = 0.12. After the COVID-19 pandemic, 26.9% of participants reported reduced physical function and 19.2% showed reduced cognitive function. Infection with the COVID-19 virus resulted in increased mental fatigue and reduced cognitive function among the participating emeritus professors.
Conclusion
The COVID-19 pandemic (and the introduction of restrictions on social activities) had a substantial and similar impact on the psychosomatic status of emeritus professors at both medical and sports universities. Furthermore, the reduction in physical and mental/cognitive function was exacerbated in those who were infected by SARS-CoV-2. Importantly, however, the overall impact of the COVID-19 pandemic was smaller in the population of emeritus professors than in the general elderly population. This may be due to the better maintenance of physical and mental activity in the former population, thus emphasising the importance of remaining physically and mentally active in old age, especially in the context of critical life events.
Introduction
It is well known that the COVID-19 pandemic has had negative effects on the physical and cognitive function of the general population. During and after the COVID-19 pandemic, people reported increased depression, anxiety, loneliness, social inequalities, risks of comorbidities, physical pain, and cognitive and sleep problems. They also reported a decrease in physical fitness and activity, quality and satisfaction of life, healthy lifestyle, social contacts, and access to rehabilitation services [1–4].
The results of previous studies have shown that a decline in mental and physical function can occur after COVID-19 infection, and that symptoms may persist for a longer time due to post-COVID-19 condition. Post-COVID-19 condition is primarily observed in older adults after a more severe form of COVID-19 infection, although it may also be detected in young people after a mild infection [5–8]. At present, there are specific therapies for this condition, although it is well established that regular physical and mental activity can reduce the onset/progression of various diseases in general, and thus also of post-COVID-19 condition [9–12]. Several studies have shown that physical and mental activity improves the immune system, which provides protection against various diseases, including viral infections [13–15].
Restrictions on movements in daily life were introduced by governments during the COVID-19 pandemic in the hope of reducing the spread of the disease. However, these restrictions also led to a decrease in physical activity, which affected not only people's psychosomatic status but also their immune systems, increasing susceptibility to infections and exacerbating chronic diseases in the older population [16, 17]. The COVID-19 pandemic has also had a significant negative impact on mental health, with older people being more likely to experience reduced quality of life, stress, anxiety, depressive symptoms, and sleep disturbances. These symptoms were exacerbated by infection with the COVID-19 virus [18, 19].
The present study aimed to assess the psychosomatic status of a specific elderly population – namely emeritus professors at medical and sports universities – after the COVID-19 pandemic, as compared to before the pandemic. We hypothesised that because this population is physically and mentally active, they would be in better physical and mental condition than the general elderly population.
Materials and methods
A total of 56 emeritus professors of medical and sports sciences participated in the study (74.1% male). The participants were over 70 years of age (M = 77.4, SD = 6.1). Emeritus professors were recruited from the College of Emeritus Professors (medical sciences) and the Masters Club (sports sciences). The survey was conducted during their formal monthly/bimonthly meetings, and the inclusion criterion for voluntary participation in the study was membership of the college/club. There were no exclusion criteria.
Data on COVID-19 infection were obtained from the WHO Case Report Form for Post-COVID condition (https://www.who.int/publications/i/item/global-covid-19-clinical-platform-case-report-form-(crf)-for-post-covid-conditions-(post-covid-19-crf-): 1) COVID-19 infection; 2) severity of COVID-19 infection; and 3) COVID-19 vaccination status.
Physical/mental fatigue and physical/cognitive function were evaluated for the situation before and after the COVID-19 pandemic. To evaluate physical and mental fatigue, a self-report questionnaire was used: How physically/mentally tired do you feel in everyday life? Participants reported their physical and mental fatigue on a scale of 1–10, where 1 = not at all and 10 = completely. We also assessed the impact of fatigue on physical and cognitive function using the Fatigue Impact Scale (FIS) [20, 21]. The FIS evaluates the effect of fatigue on physical and cognitive function in daily life based on 20 items scored on a scale of 0–4, where 0 = no problems and 4 = extreme problems.
Finally, sociodemographic characteristics, such as socioeconomic status, were also included in the questionnaire (number of people living in a household, and average or below-/above-average income). In addition, active involvement in academic life (education/research) and healthcare/sports was also assessed before and after the COVID-19 pandemic.
The study was conducted between September 2022 and January 2023, after approximately two and a half years of the COVID-19 pandemic. The data were managed using REDCap electronic data capture tools hosted at Semmelweis University [22, 23]. The study was approved by the Regional and Institutional Committee of Scientific and Research Ethics of Semmelweis University (SE RKEB) (No. SE RKEB 118/2022).
Statistical analysis
To describe the data, descriptive analysis and relative frequency distributions were used. Data were reported as mean ± SD or frequency and proportion. To compare the physical and mental fatigue evaluated before and after the COVID-19 pandemic, the Wilcoxon signed-rank test was used with the calculation of the r effect size measure (
Results
Characteristics of the sample
A total of 56 emeritus professors of medical and sports sciences, aged above 70 years, participated in the study (74.1% male). Most of them were living with a family member in the same household (86.5%, n = 45) and reported average/above-average income (90.8%, n = 49). They were actively involved in academic life, education, and/or research (76.4%, n = 42) and healthcare/sports (77.4%, n = 41) (Table 1).
Characteristics of the sample
Characteristics | %(n)/M(SD) |
Male, %(n) | 74.1 (40) |
Age, M(SD) | 77.4 (6.1) |
Number of members in the same household, %(n) | |
living alone | 13.5 (7) |
living with one family member | 53.8 (28) |
living with more than one family member | 32.7 (17) |
Income, %(n) | |
below average | 9.3 (5) |
average | 59.3 (32) |
above average | 31.5 (17) |
Active involvement in* | |
academic life (education) | 71.7 (38) |
academic life (research) | 59.3 (32) |
healthcare# | 69.6 (16) |
sports life## | 70.0 (21) |
*before the COVID-19 pandemic, # among emeritus professors of medical sciences, ## among emeritus professors of sports sciences.
After the COVID-19 pandemic, active involvement in academic life (68.5%, n = 37) and healthcare/sports life (62.7%, n = 32) did not change significantly. The proportion of participants who were involved in academic life both before and after the COVID-19 pandemic was 85.7% (n = 36), while 76.9% (n = 30) took part in healthcare/sports both before and after the COVID-19 pandemic.
Severity of COVID-19 infection and vaccination status
Among the participants, 49.1% (n = 26) contracted SARS-CoV-2, in most cases (79.2%, n = 19) once; in two cases twice; and in one case three times. In most cases, the severity of acute illness with COVID-19, based on the WHO criteria, was mild (no hypoxia or pneumonia, did not receive oxygen). In one case, the severity was moderate (clinical signs of non-severe pneumonia and SpO2 ≥ 90% on room air, did not receive oxygen). All participants received a COVID-19 vaccine, in most cases three (43.6%, n = 24) or four (45.5%, n = 25) doses.
Physical and mental fatigue before and after the COVID-19 pandemic
The emeritus professors reported significantly higher physical fatigue (Z = −1.992, P = 0.046, r = 0.28) and mental fatigue (Z = −2.154, P = 0.031, r = 0.31) after the COVID-19 pandemic. Most participants reported no difference in the level of physical fatigue (76.9%, n = 40) and mental fatigue (83.7%, n = 41) assessed before and after the COVID-19 pandemic. Only 15.4% (n = 8) reported higher physical fatigue and 14.3% (n = 7) reported higher mental fatigue after the COVID-19 pandemic (Fig. 1).
Self-reported physical fatigue and mental fatigue before and after the COVID-19 pandemic.
Notes. Red dots indicate higher physical/mental fatigue after the COVID-19 pandemic. Green dots indicate lower physical/mental fatigue after the COVID-19 pandemic. Grey dots indicate that physical/mental fatigue was the same before and after the COVID-19 pandemic. Frequency (n) is reported in the dots
Citation: Developments in Health Sciences 7, 1; 10.1556/2066.2024.00060
Physical and mental fatigue before and after COVID-19 infection
Physical fatigue evaluated before and after the COVID-19 pandemic showed a non-significant difference among the emeritus professors, regardless of whether they were infected by SARS-CoV-2 (Z = −0.966, P = 0.334, r = 0.20) or not infected by SARS-CoV-2 (Z = −1.382, P = 0.167, r = 0.28).
In contrast, a significant difference was found among infected participants in terms of the level of mental fatigue assessed before and after the COVID-19 pandemic. They reported higher mental fatigue (Z = −2.060, P = 0.039, r = 0.42).
Although 79.2% (n = 19) of participants evaluated mental fatigue after the COVID-19 pandemic the same as before the COVID-19 pandemic, 20.8% (n = 5) reported higher mental fatigue after the COVID-19 pandemic. Among those who were not infected by SARS-CoV-2, there was a non-significant difference in mental fatigue assessed before and after the COVID-19 pandemic (Z = −0.816, P = 0.414, r = 0.17). Only 9% (n = 2) of those not infected reported higher mental fatigue (Fig. 2).
Physical fatigue and mental fatigue before and after the COVID-19 pandemic among emeritus professors who were and were not infected by SARS-CoV-2.
Notes. Red dots indicate higher physical/mental fatigue after the COVID-19 pandemic. Green dots indicate lower physical/mental fatigue after the COVID-19 pandemic. Grey dots indicate that physical/mental fatigue was the same before and after the COVID-19 pandemic. Frequency (n) is reported in the dots
Citation: Developments in Health Sciences 7, 1; 10.1556/2066.2024.00060
Impact of fatigue on physical and cognitive function
There was a significant difference in physical function assessed before and after the COVID-19 pandemic, t(51) = −2.986, P = 0.004, g = 0.22. Participants showed reduced physical function after the COVID-19 pandemic. There was a non-significant difference in cognitive function assessed before and after the COVID-19 pandemic, t(51) = −1.265, P = 0.212, g = 0.12. At the same time, 26.9% of the emeritus professors showed reduced physical function and 19.2% showed reduced cognitive function after the COVID-19 pandemic. Table 2 shows the most frequently reported problems in terms of physical and cognitive function.
Frequency of reduced physical and cognitive function reported by the emeritus professors after the COVID-19 pandemic
Physical function | (%) |
increased physical discomfort | 15.4 |
trouble maintaining physical effort for long periods | 15.4 |
less able to complete tasks that require physical effort | 15.4 |
more frequent or longer periods of rest required | 15.4 |
less motivated to do anything that requires physical effort | 15.4 |
more clumsy and uncoordinated | 13.5 |
need to be careful about pacing physical activities | 13.5 |
muscles feel much weaker than they should | 13.5 |
need to limit physical activities | 13.5 |
worried about how I look to other people | 3.8 |
Cognitive function | (%) |
feel less alert | 13.7 |
find that I am more forgetful | 11.5 |
less able to finish tasks that require thinking | 9.8 |
find it difficult to pay attention for long periods | 7.7 |
feel unable to think clearly | 7.7 |
less motivated to do anything that requires thinking | 7.7 |
find it difficult to make decisions | 7.5 |
find it hard to concentrate | 7.5 |
find it difficult to organise thoughts when doing things at home or work | 5.7 |
feel slowed down in my thinking | 5.7 |
Physical and cognitive function before and after COVID-19 infection
The main effect of physical function (assessed before and after the COVID-19 pandemic) was significant, F(1,47) = 8.789, P = 0.005, η2p = 0.16. Physical function was significantly reduced after the COVID-19 pandemic. Based on simple main effects, there was no significant difference in physical function before and after the COVID-19 pandemic among those emeritus professors who were not infected by SARS-CoV-2, F(1,23) = 3.443, P = 0.076, η2p = 0.13. Participants who were infected by SARS-CoV-2 showed a significant difference in physical function, F(1, 24) = 5.478, P = 0.028, η2p = 0.19, revealing reduced physical function (Fig. 3).
Physical and cognitive function before and after the COVID-19 pandemic among emeritus professors who were and were not infected by SARS-CoV-2
Citation: Developments in Health Sciences 7, 1; 10.1556/2066.2024.00060
Cognitive function showed a non-significant main effect, F(1,47) = 1.561, P = 0.218, η2p = 0.03, and the interaction was also non-significant, F(1,47) = 4.061, P = 0.050, η2p = 0.08. However, based on simple main effects, cognitive function assessed before and after the COVID-19 pandemic showed a significant difference in those participants who were infected by SARS-CoV-2, F(1,25) = 4.974, P = 0.035, η2p = 0.17. These participants showed significantly reduced cognitive function. Among those who were not infected by SARS-CoV-2, there was a non-significant difference in cognitive function assessed before and after the COVID-19 pandemic, F(1,22) = 0.329, P = 0.572, η2p = 0.02 (Fig. 3).
Discussion
The salient findings of the present study are that: 1) 15% of the emeritus professors reported a higher level of physical and mental fatigue after the COVID-19 pandemic; 2) 25% of them showed reduced physical and cognitive function after the COVID-19 pandemic; 3) infection had a significant effect on their mental fatigue and cognitive function; 4) one-fifth of the emeritus professors who were infected by SARS-CoV-2 showed higher mental fatigue and reduced cognitive function; and 5) most emeritus professors showed similar physical and mental fatigue and physical and cognitive function before and after the COVID-19 pandemic.
Impact of SARS-CoV-2 infection/the COVID-19 pandemic on the general older population
Previous studies among the general older population after mild SARS-CoV-2 infection found a significant decline in physical function (walking speed, balance). Decreased levels of physical activity during the COVID-19 pandemic also play an important role in this decline [24, 25]. The general older population reported a higher level of depression and anxiety, as well as sleep problems during the COVID-19 pandemic [26, 27]. These symptoms were more frequent among those who also reported a higher level of loneliness and social isolation [28].
In older adults, reduced physical health after COVID-19 infection is related to fatigue, lower levels of physical activity, higher levels of pain, difficulties in activities of daily living, and cognitive-communication problems [29]. There is a negative relationship between level of physical activity and fatigue, thus maintaining levels of physical activity can play an important role in regulating the severity of fatigue [30].
Physical activity and social contact are currently regarded as important factors in healthy brain ageing [31, 32]. Based on the results of the Hungarian World-Wide-FINGERS SARS CoV-2 Survey, which involved adults aged 60 years and over without a previous diagnosis of major neurocognitive disorder, older adults who showed subjective cognitive complaints were characterised by a lower level of physical activity before the pandemic and spent less time with family during the pandemic [33].
Impact of SARS-CoV-2 infection/the COVID-19 pandemic among emeritus professors
In the present study, although the COVID-19 pandemic had a negative impact on the psychosomatic status of emeritus professors, it did so to a lesser extent than in the average elderly population examined in previous studies [24–27, 29, 33]. Community activities and social interactions may play an important role in managing the adverse effects of the COVID-19 pandemic, resulting in improved quality of life in older populations [19, 33].
In the present study, the lower increase in physical/mental fatigue and the smaller reduction in physical/cognitive function among emeritus professors may relate to the maintenance of significant physical and/or mental activity.
Importantly, the findings of the present study and previous studies also suggest that future studies should focus on how to ensure that elderly people become more physically and mentally active, paying greater attention to those who have disease conditions and/or disabilities and incorporating regular physical and mental activities in their lifestyles for prevention and rehabilitation. This can probably be done only by means of professional public health strategies and programmes incorporating significant social aspects, such as social engagement, participation, integration, and network developments among elderly people to maximise the positive effects of physical and mental activity for this population.
Limitations
The present study has considerable limitations. There is a possible selection bias as well as a recall bias, since the study was conducted after approximately two and a half years of the COVID-19 pandemic. The study is cross-sectional and used self-report questionnaires and there was no control group from the general elderly population. At the same time, it would be difficult to select an age-matched control group without comorbidities that would affect the results. Notably, there are several confounding factors, such as pre-existing medical conditions or general health status, which were not included in the present study and which perhaps affected the interpretation of our findings. Despite these limitations, and although the sample size was small, we examined a specific, relatively homogeneous elderly population with a higher level of physical and/or mental activity compared to the general elderly population.
Conclusion
The COVID-19 pandemic (and the introduction of restrictions on social activities) had a substantial and similar impact on the psychosomatic status of the emeritus professors at both medical and sports universities.
In addition, physical and mental/cognitive dysfunctions were exacerbated in those infected by SARS-CoV-2. Importantly, however, the overall impact of the COVID-19 pandemic was smaller in the emeritus population than in the general elderly population, which may be due to the better maintenance of physical and mental activity in the former population, thus emphasising the importance of maintaining physical and mental activity in old age, especially in the context of critical life events.
Authors' contribution
Study concept and design: JT, AK. Data collection: DJ. Analysis and interpretation of data: JT, DJ, AK. Drafting of the manuscript: JT, DJ. Critical revision of the manuscript: AK. Statistical analysis and visualization: JT.
Ethical approval
We have been granted a Regional, Institutional Scientific and Research Ethics Committee Semmelweis University (SE RKEB) ethical approval (No. SE RKEB 118/2022).
Conflicts of interest/Funding
The authors declare no conflict of interest. Support by Ministry for Innovation and Technology Hungary, National Research, Development and Innovation Fund, TKP2020-NKA-17, TKP2021-EGA-37, OTKA K 132596 (AK); Hungarian Academy of Sciences Post-Covid 2021–34 (AK and JT); National Research, Development and Innovation Fund, ÚNKP-22-4-II-SE-4, New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund (JT).
JT and AK are members of the Editorial Board of the journal.
Acknowledgement
We would like to thank the emeritus professors for participating in the present study.
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