Ella Cohn-Schwartz

Bio: Ella Cohn-Schwartz is an academic researcher from Ben-Gurion University of the Negev. The author has contributed to research in topics: Medicine & Psychology. The author has an hindex of 5, co-authored 20 publications receiving 71 citations. Previous affiliations of Ella Cohn-Schwartz include Bar-Ilan University.

Societal views of older adults as vulnerable and a burden to society during the COVID-19 outbreak: Results from an Israeli nationally representative sample.

Abstract: Objectives To examine the factors associated with older adults' perceptions of ageism in society during the COVID-19 outbreak, in particular the portrayal of older people as a burden and as vulnerable. Method Data are based on a nationally representative survey of adults aged 50+ in Israel, conducted during the COVID-19 outbreak (N = 888). Regression models predicted perceptions of societal ageism. The independent variables were dying anxiety, experiences of age-based discriminations, and social resources. Results Participants who believed older adults were perceived as a burden during the COVID-19 outbreak had higher dying anxiety and reported more age-based discrimination. Living with children and contact with family were protective against perceptions of adults as a burden. Participants who believed older adults were perceived as vulnerable had higher dying anxiety and were less likely to live with children. Discussion The daily lives of older adults can impact their perceptions of societal ageism during the COVID-19 outbreak.

Long-term care settings in the times of COVID-19: challenges and future directions.

Abstract: The term “long-term care settings” (LTCS) encompasses settings that provide a range of services to meet older persons’ needs for social, personal, and/or health care. These settings may include nursing homes or assisted living facilities, which are designed for people who require assistance in performing activities of daily living, such as bathing or transferring; meals, cleaning services, and social activities are also provided. A skilled nursing facility differs from assisted living in that it aims to meet not only the residents’ physical needs but also their medical needs. Hence, this setting provides in-patient medical treatment and rehabilitation services in addition to the services enumerated above (Sanford et al., 2015). Continuing care retirement communities, on the other hand, represent a residential alternative for older persons, who are independent, when first entering the setting. Residents are free to choose a variety of on-site services, including social activities, health care services, cleaning, and prepared meals. Depending on older persons’ evolving needs, more intensive levels of care might be available to allow older persons to age in place (Ayalon, 2016). Hence, LTCS cater to a varied population of older persons, with very different care needs and resources. The nature of the facilities, the quality of care provided, the cost, and the source of funding may vary dramatically across settings.

Pathways From Social Activities to Cognitive Functioning: The Role of Physical Activity and Mental Health.

Abstract: Background and Objectives One of the greatest challenges of old age is the risk of cognitive decline. Engagement in social activities has been identified as a possible protective factor. However, it is not yet clear what are the mechanisms underlying this association. This study aims to elucidate the pathways through which social activities impact cognitive functioning, focusing on physical activity and mental health as possible mediators. Research Design and Methods The study utilized 3 waves of data-the fourth, fifth, and sixth waves of the Survey of Health, Ageing and Retirement in Europe, collected in 2011, 2013, and 2015, respectively. It focused on respondents aged 60 and older. Cognitive functioning was assessed via immediate recall, delayed recall, and fluency. Social activities were measured by volunteering and attending social clubs. Data were analyzed using a structural equation modeling approach. Results The results indicated a significant direct effect of social activities on cognitive functioning. That is, being socially active at baseline was related to better cognitive function 4 years later. The results also indicated the existence of indirect effects. Engaging in social activities was related to better mental health and more physical activities 2 years later, which were related to better subsequent cognitive performance. Discussion and Implications These findings highlight the mediating roles of physical activity and mental health in the effects of social activities on cognitive functioning. Understanding these mechanisms can help optimize social activity interventions to improve cognitive aging.

Physical distancing is related to fewer electronic and in-person contacts and to increased loneliness during the COVID-19 pandemic among older Europeans.

Abstract: During the COVID-19 pandemic older adults are asked to maintain physical distancing, which can be linked to loneliness. While older people are encouraged to use electronic communication to stay socially connected, it remains an open question whether electronic contacts are related to lower loneliness during the pandemic. This study examined the associations of physical distancing during the pandemic with loneliness and the role of in-person and electronic contacts with children and non-kin as explaining these associations across European regions. The study used data from Survey of Health, Ageing and Retirement in Europe (SHARE), collected during the COVID-19 pandemic in 2020. Mediation and moderation analyses tested the direct and indirect associations between physical distancing, contact frequency and loneliness, as well as the differences across European regions. The results indicate that adults who reported higher frequency of physical distancing also felt lonelier during the pandemic. This association was partly explained by social contacts—those who practiced physical distancing maintained less in-person contact with children and non-kin and less electronic contact with non-kin, which were related to feeling lonelier. Adults in Southern European countries felt lonelier and reported more frequent contacts. The moderation analyses showed that the link between physical distancing and loneliness was found in the northern region, but not in the southern and eastern regions of Europe. This study can indicate that attention should be paid to adults who may struggle to maintain social contacts in light of physical distancing guidelines.

Interleukin-6 blocking agents for treating COVID-19: a living systematic review.

Abstract: BACKGROUND: Interleukin 6 (IL-6) blocking agents have been used for treating severe coronavirus disease 2019 (COVID-19). Their immunosuppressive effect might be valuable in patients with COVID-19 characterised by substantial immune system dysfunction by controlling inflammation and promoting disease tolerance. OBJECTIVES: To assess the effect of IL-6 blocking agents compared to standard care alone or with placebo on efficacy and safety outcomes in COVID-19. We will update this assessment regularly. SEARCH METHODS: We searched the World Health Organization (WHO) International Clinical Trials Registry Platform (up to 11 February 2021) and the L-OVE platform, and Cochrane COVID-19 Study Register to identify trials up to 26 February 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating IL-6 blocking agents compared with standard care alone or with placebo for people with COVID-19, regardless of disease severity. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methodology. The protocol was amended to reduce the number of outcomes considered. Two review authors independently collected data and assessed the risk of bias with the Cochrane Risk of Bias 2 tool. We rated the certainty of evidence with the GRADE approach for the critical outcomes such as clinical improvement (defined as hospital discharge or improvement on the scale used by trialists to evaluate clinical progression or recovery) (day (D) 28 / ≥ D60); WHO Clinical Progression Score of level 7 or above (i.e. the proportion of participants with mechanical ventilation +/- additional organ support OR death) (D28 / ≥ D60); all-cause mortality (D28 / ≥ D60); incidence of any adverse events; and incidence of serious adverse events. MAIN RESULTS: We identified 10 RCTs with available data including one platform trial comparing tocilizumab and sarilumab with standard of care. These trials evaluated tocilizumab (nine RCTs including two platform trials; seven were reported as peer-reviewed articles, two as preprints; 6428 randomised participants); and two sarilumab (one platform trial reported as peer reviewed article, one reported as preprint, 880 randomised participants). All trials included were multicentre trials. They were conducted in Brazil, China, France, Italy, UK, USA, and four were multi-country trials. The mean age range of participants ranged from 56 to 65 years; 4572 (66.3%) of trial participants were male. Disease severity ranged from mild to critical disease. The reported proportion of participants on oxygen at baseline but not intubated varied from 56% to 100% where reported. Five trials reported the inclusion of intubated patients at baseline. We identified a further 20 registered RCTs of tocilizumab compared to placebo/standard care (five completed without available results, five terminated without available results, eight ongoing, two not recruiting); 11 RCTs of sarilumab (two completed without results, three terminated without available results, six ongoing); six RCTs of clazakisumab (five ongoing, one not recruiting); two RCTs of olokizumab (one completed, one not recruiting); one of siltuximab (ongoing) and one RCT of levilimab (completed without available results). Of note, three were cancelled (2 tocilizumab, 1 clazakisumab). One multiple-arm RCT evaluated both tocilizumab and sarilumab compared to standard of care, one three-arm RCT evaluated tocilizumab and siltuximab compared to standard of care and consequently they appear in each respective comparison. Tocilizumab versus standard care alone or with placebo a. Effectiveness of tocilizumab for patients with COVID-19 Tocilizumab probably results in little or no increase in the outcome of clinical improvement at D28 (RR 1.06, 95% CI 1.00 to 1.13; I2 = 40.9%; 7 RCTs, 5585 participants; absolute effect: 31 more with clinical improvement per 1000 (from 0 fewer to 67 more); moderate-certainty evidence). However, we cannot exclude that some subgroups of patients could benefit from the treatment. We did not obtain data for longer-term follow-up (≥ D60). The effect of tocilizumab on the proportion of participants with a WHO Clinical Progression Score of level of 7 or above is uncertain at D28 (RR 0.99, 95% CI 0.56 to 1.74; I2 = 64.4%; 3 RCTs, 712 participants; low-certainty evidence). We did not obtain data for longer-term follow-up (≥ D60). Tocilizumab reduces all-cause mortality at D28 compared to standard care alone or placebo (RR 0.89, 95% CI 0.82 to 0.97; I2 = 0.0%; 8 RCTs, 6363 participants; absolute effect: 32 fewer deaths per 1000 (from 52 fewer to 9 fewer); high-certainty evidence). The evidence suggests uncertainty around the effect on mortality at ≥ D60 (RR 0.86, 95% CI 0.53 to 1.40; I2 = 0.0%; 2 RCTs, 519 participants; low-certainty evidence). b. Safety of tocilizumab for patients with COVID-19 The evidence is very uncertain about the effect of tocilizumab on adverse events (RR 1.23, 95% CI 0.87 to 1.72; I2 = 86.4%; 7 RCTs, 1534 participants; very low-certainty evidence). Nevertheless, tocilizumab probably results in slightly fewer serious adverse events than standard care alone or placebo (RR 0.89, 95% CI 0.75 to 1.06; I2 = 0.0%; 8 RCTs, 2312 participants; moderate-certainty evidence). Sarilumab versus standard care alone or with placebo The evidence is uncertain about the effect of sarilumab on all-cause mortality at D28 (RR 0.77, 95% CI 0.43 to 1.36; 2 RCTs, 880 participants; low certainty), on all-cause mortality at ≥ D60 (RR 1.00, 95% CI 0.50 to 2.0; 1 RCT, 420 participants; low certainty), and serious adverse events (RR 1.17, 95% CI 0.77 to 1.77; 2 RCTs, 880 participants; low certainty). It is unlikely that sarilumab results in an important increase of adverse events (RR 1.05, 95% CI 0.88 to 1.25; 1 RCT, 420 participants; moderate certainty). However, an increase cannot be excluded No data were available for other critical outcomes. AUTHORS' CONCLUSIONS: On average, tocilizumab reduces all-cause mortality at D28 compared to standard care alone or placebo and probably results in slightly fewer serious adverse events than standard care alone or placebo. Nevertheless, tocilizumab probably results in little or no increase in the outcome clinical improvement (defined as hospital discharge or improvement measured by trialist-defined scales) at D28. The impact of tocilizumab on other outcomes is uncertain or very uncertain. With the data available, we were not able to explore heterogeneity. Individual patient data meta-analyses are needed to be able to identify which patients are more likely to benefit from this treatment. Evidence for an effect of sarilumab is uncertain and evidence for other anti-IL6 agents is unavailable. Thirty-nine RCTs of IL-6 blocking agents with no results are currently registered, of which nine are completed and seven trials were terminated with no results available. The findings of this review will be updated as new data are made available on the COVID-NMA platform (covid-nma.com).

Ageism in the time of COVID-19

Abstract: In this article, we outline how the response to the coronavirus (COVID-19) pandemic has the potential to fundamentally change how we think and feel about our own age, and how we think and feel about other age groups. Specifically, we outline how discourse surrounding the pandemic has strengthened the homogeneous view of older adults as vulnerable, has socially stigmatized being an older adult, and has exacerbated hostile and benevolent expressions of ageism. We explore the impact of these changing dynamics on intergenerational cohesion and relations, and propose that understanding theories of ageism will be essential for how we handle future pandemics in order to reduce the potential negative impact of crises on individuals as well as on communities and societies.

Challenging behavior of nursing home residents during COVID-19 measures in the Netherlands.

Abstract: OBJECTIVES: From the perspective of the nursing home (NH) practitioners, to gain understanding of (1) whether challenging behavior in NH residents changed during the COVID-19 measures, (2) whether the practitioners' involvement in the treatment of challenging behavior changed, (3) what can be learned from the experience of NH staff. METHODS: A mixed methods study with a survey in 323 NH practitioners (psychologists, elderly care physicians, nurse practitioners) in the Netherlands, and in-depth interviews in 16 NH practitioners. Nonparametric analyses were used to compare estimated proportions of residents with increased and with decreased challenging behavior. Content analyses were conducted for open-ended questions and in-depth interviews. RESULTS: Participants reported changes in challenging behavior with slightly higher proportions for increased (Q1/Mdn/Q3: 12.5%, 21.7%, 30.8%) than for decreased (8.7%, 14.8%, 27.8%, Z = -2.35, p = .019) challenging behavior. Half of the participants reported that their work load increased and work satisfaction worsened during the measures. Different strategies were described to respond to the effects of COVID-19 measures, such as video calls, providing special areas for residents to meet their loved ones, adjusting activities, and reducing the exposure to negative news. CONCLUSIONS: Because COVID-19 measures resulted in both increased and decreased challenging behavior in NH residents, it is important to monitor for their potential long lasting effects. Increased work load and worsened work satisfaction of the NH staff, together with the changes in type of challenging behavior, indicate that the harmful effects of the anti-pandemic measures should be taken seriously.

Predictors and consequences of loneliness during the COVID-19 Pandemic.

Abstract: The COVID-19 pandemic has created a global context in which social isolation has become normative in order to reduce the risk of COVID-19 transmission. As a result of social distancing policies, the risk for loneliness and associated decline in quality of life has increased. The current study examined factors associated with loneliness and quality of life during the COVID-19 pandemic cross-sectionally (n = 797) and longitudinally (n = 395). Older age and larger social network size were associated with less loneliness, whereas having multiple physical or mental health diagnoses was associated with greater loneliness. Greater virtual social contact was also associated with increased loneliness. Greater loneliness was associated with all domains of quality of life both cross-sectionally and longitudinally. Understanding factors associated with loneliness is critical to developing effective strategies at reducing loneliness and improving quality of life during the pandemic. Contrary to popular perceptions, older age was associated with less loneliness and more virtual social contact was associated with more loneliness. Thus, it may be prudent to deemphasize virtual social contact in public campaigns and to emphasize safe methods of interacting in person.