{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T00:48:11Z","timestamp":1793148491587,"version":"4.5.0"},"reference-count":46,"publisher":"Royal College of General Practitioners","issue":"700","license":[{"start":{"date-parts":[[2019,2,12]],"date-time":"2019-02-12T00:00:00Z","timestamp":1549929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br J Gen Pract"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired <jats:italic>t<\/jats:italic>-tests, Wilcoxon\u2019s signed-rank test, and McNemar\u2019s test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were collected from 583 older (\u226560 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having &gt;4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.<\/jats:p><\/jats:sec>","DOI":"10.3399\/bjgp20x713021","type":"journal-article","created":{"date-parts":[[2020,9,29]],"date-time":"2020-09-29T04:25:13Z","timestamp":1601353513000},"page":"e817-e824","source":"Crossref","is-referenced-by-count":335,"title":["Impact of COVID-19 on loneliness, mental health, and health service utilisation: a prospective cohort study of older adults with multimorbidity in primary care"],"prefix":"10.3399","volume":"70","author":[{"given":"Samuel Yeung Shan","family":"Wong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dexing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina Wing Shan","family":"Sit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Hon Kei","family":"Yip","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger Yat-nork","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Ka Man","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dicken Cheong Chun","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kin On","family":"Kwok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart W","family":"Mercer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1987","published-online":{"date-parts":[[2020,9,28]]},"reference":[{"issue":"5","key":"2021030806051071000_70.700.e817.1","doi-asserted-by":"crossref","first-page":"e261","DOI":"10.1016\/S2468-2667(20)30073-6","article-title":"The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study","volume":"5","author":"Prem","year":"2020","journal-title":"Lancet Public Health"},{"key":"2021030806051071000_70.700.e817.2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(20)30061-X"},{"key":"2021030806051071000_70.700.e817.3","doi-asserted-by":"crossref","unstructured":"Clark A Jit M Warren-Gash C (2020) How many are at increased risk of severe COVID-19 disease? Rapid global, regional and national estimates for 2020. medRxiv, DOI: https:\/\/doi.org\/10.1101\/2020.04.18.20064774.","DOI":"10.1101\/2020.04.18.20064774"},{"key":"2021030806051071000_70.700.e817.4"},{"key":"2021030806051071000_70.700.e817.5","unstructured":"Public Health England (2020) Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. https:\/\/www.gov.uk\/government\/publications\/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19\/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 (accessed 15 Sep 2020)."},{"issue":"6","key":"2021030806051071000_70.700.e817.6","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2021030806051071000_70.700.e817.7","unstructured":"Hong Kong\u2019s Information Services Department (2020) Hospital visits suspended. https:\/\/www.news.gov.hk\/eng\/2020\/01\/20200126\/20200126_104654_294.html (accessed 15 Sep 2020)."},{"key":"2021030806051071000_70.700.e817.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027279"},{"key":"2021030806051071000_70.700.e817.9","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610208007552"},{"key":"2021030806051071000_70.700.e817.10","unstructured":"De Jong Gierveld J van Tilburg T (2020) Manual of the Loneliness Scale 1999. https:\/\/home.fsw.vu.nl\/tg.van.tilburg\/manual_loneliness_scale_1999.html (accessed 15 Sep 2020)."},{"key":"2021030806051071000_70.700.e817.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2010.11.002"},{"issue":"10","key":"2021030806051071000_70.700.e817.12","first-page":"381","article-title":"To validate the Chinese version of the 2Q and PHQ-9 questionnaires in Hong Kong Chinese patients","volume":"29","author":"Cheng","year":"2007","journal-title":"HK Pract"},{"key":"2021030806051071000_70.700.e817.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2015.11.005"},{"issue":"10","key":"2021030806051071000_70.700.e817.14","doi-asserted-by":"crossref","first-page":"2350","DOI":"10.1111\/j.1365-2648.2010.05394.x","article-title":"Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people","volume":"66","author":"Yu","year":"2010","journal-title":"J Adv Nurs"},{"issue":"5","key":"2021030806051071000_70.700.e817.15","first-page":"466","article-title":"Depression and anxiety among university students in Hong Kong","volume":"24","author":"Lun","year":"2018","journal-title":"Hong Kong Med J"},{"key":"2021030806051071000_70.700.e817.16","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/34.5.601"},{"issue":"Pt 2","key":"2021030806051071000_70.700.e817.17","first-page":"1183","article-title":"The Hong Kong Hospital Authority\u2019s information architecture","volume":"107","author":"Cheung","year":"2004","journal-title":"Stud Health Technol Inform"},{"key":"2021030806051071000_70.700.e817.18","doi-asserted-by":"crossref","first-page":"110636","DOI":"10.1016\/j.nut.2019.110636","article-title":"Strength and multimorbidity among community-dwelling elderly from southern Brazil","volume":"71","author":"Montes","year":"2020","journal-title":"Nutrition"},{"key":"2021030806051071000_70.700.e817.19","unstructured":"World Health Organization (2015) World report on ageing and health. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/186463\/9789240694811_eng.pdf (accessed 15 Sep 2020)."},{"key":"2021030806051071000_70.700.e817.20","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-15-61"},{"key":"2021030806051071000_70.700.e817.21","doi-asserted-by":"publisher","DOI":"10.1157\/13069762"},{"issue":"1","key":"2021030806051071000_70.700.e817.22","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1177\/1468794104041110","article-title":"Comparing telephone and face-to-face qualitative interviewing: a research note","volume":"4","author":"Sturges","year":"2016","journal-title":"Qualitative Research"},{"key":"2021030806051071000_70.700.e817.23","doi-asserted-by":"publisher","DOI":"10.21203\/rs.2.16804\/v1"},{"issue":"9","key":"2021030806051071000_70.700.e817.24","doi-asserted-by":"crossref","first-page":"807.e1","DOI":"10.1016\/j.jamda.2017.05.009","article-title":"Regular source of care for the elderly: a cross-national comparative study of Hong Kong with 11 developed countries","volume":"18","author":"Wong","year":"2017","journal-title":"J Am Med Dir Assoc"},{"key":"2021030806051071000_70.700.e817.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2004.05.006"},{"key":"2021030806051071000_70.700.e817.26","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.maturitas.2020.04.004","article-title":"COVID-19: the forgotten priorities of the pandemic","volume":"136","author":"Mesa Vieira","year":"2020","journal-title":"Maturitas"},{"key":"2021030806051071000_70.700.e817.27","unstructured":"Hong Kong Government (2020) Coronavirus disease (COVID-19). https:\/\/www.news.gov.hk\/eng\/categories\/covid19\/index.html (accessed 15 Sep 2020)."},{"key":"2021030806051071000_70.700.e817.28","unstructured":"Busby M (Apr 28, 2020) \u2018It\u2019s very lonely\u2019: older people\u2019s fears of extended lockdown The Guardian, https:\/\/www.theguardian.com\/uk-news\/2020\/apr\/28\/older-people-in-uk-anxious-about-being-put-in-longer-lockdown (accessed 17 Sep 2020)."},{"issue":"6","key":"2021030806051071000_70.700.e817.29","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1097\/PSY.0000000000000710","article-title":"Loneliness, living alone, and all-cause mortality: the role of emotional and social loneliness in the elderly during 19 years of follow-up","volume":"81","author":"O\u2019S\u00failleabh\u00e1in","year":"2019","journal-title":"Psychosom Med"},{"key":"2021030806051071000_70.700.e817.30","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.12051"},{"key":"2021030806051071000_70.700.e817.31","doi-asserted-by":"publisher","DOI":"10.1177\/1745691614568352"},{"issue":"1","key":"2021030806051071000_70.700.e817.32","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.1016\/S2468-2667(19)30230-0","article-title":"Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis","volume":"5","author":"Santini","year":"2020","journal-title":"Lancet Public Health"},{"key":"2021030806051071000_70.700.e817.33","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308790"},{"key":"2021030806051071000_70.700.e817.34","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbw037"},{"key":"2021030806051071000_70.700.e817.35","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00164"},{"key":"2021030806051071000_70.700.e817.36","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2016048"},{"key":"2021030806051071000_70.700.e817.37","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1379"},{"key":"2021030806051071000_70.700.e817.38","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30460-8"},{"key":"2021030806051071000_70.700.e817.39","unstructured":"Richtel M (Feb 6, 2020) W.H.O fights a pandemic besides coronavirus: an \u2018infodemic\u2019 New York Times, https:\/\/www.nytimes.com\/2020\/02\/06\/health\/coronavirus-misinformation-social-media.html (accessed 15 Sep 2020)."},{"key":"2021030806051071000_70.700.e817.40","doi-asserted-by":"crossref","first-page":"102081","DOI":"10.1016\/j.ajp.2020.102081","article-title":"Patients with chronic illness urgently need integrated physical and psychological care during the COVID-19 outbreak","volume":"51","author":"Kang","year":"2020","journal-title":"Asian J Psychiatr"},{"key":"2021030806051071000_70.700.e817.41","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m998"},{"issue":"152","key":"2021030806051071000_70.700.e817.42","first-page":"1","article-title":"Gender differences in patients with COVID-19: focus on severity and mortality","volume":"8","author":"Jin","year":"2020","journal-title":"Front Public Health"},{"key":"2021030806051071000_70.700.e817.43","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000093481.93107.C2"},{"issue":"1","key":"2021030806051071000_70.700.e817.44","doi-asserted-by":"crossref","first-page":"15","DOI":"10.12809\/hkjo-v23n1-TE","article-title":"Non-attendance behavior at a general ophthalmic outpatient clinic in Hong Kong \u2014 the patient\u2019s perspective","volume":"10","author":"Wong","year":"2006","journal-title":"Hong Kong J Ophthalmol"},{"key":"2021030806051071000_70.700.e817.45","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12939-015-0137-3","article-title":"A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance","volume":"14","author":"Hung","year":"2015","journal-title":"Int J Equity Health"},{"key":"2021030806051071000_70.700.e817.46","unstructured":"Hong Kong Government (2020) Information technology usage and penetration. https:\/\/www.censtatd.gov.hk\/hkstat\/sub\/sp120.jsp?productCode=C0000031 (accessed 15 Sep 2020)."}],"container-title":["British Journal of General Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3399\/bjgp20X713021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,25]],"date-time":"2022-02-25T19:56:33Z","timestamp":1645818993000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjgp.org\/lookup\/doi\/10.3399\/bjgp20X713021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,28]]},"references-count":46,"journal-issue":{"issue":"700","published-online":{"date-parts":[[2020,10,29]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.3399\/bjgp20X713021"],"URL":"https:\/\/doi.org\/10.3399\/bjgp20x713021","relation":{},"ISSN":["0960-1643","1478-5242"],"issn-type":[{"value":"0960-1643","type":"print"},{"value":"1478-5242","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,28]]}}}