Internet use and COVID-19 vaccination attitudes among older adults in Switzerland during the pandemic.

This study aimed to investigate the relationship between pre-pandemic objective and subjective cognitive functioning and sustained Internet use during the pandemic among older adults in Switzerland. Data from 1299 respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2019/2020 and a supplementary technology use questionnaire during the pandemic in 2021 were used. Cognitive functioning was assessed in 2019/2020 through objective measures (delayed and immediate memory, verbal fluency) and self-rated memory. Sustained Internet use was defined as having used the Internet at least once in the past seven days in 2019/2020 and reporting daily or weekly use in 2021. We found that 73.1% of respondents consistently used Internet between 2019/2020 and 2021. Using multivariable probit regression models controlling for sociodemographic and health variables, we found that higher global cognition z-scores, especially in immediate and delayed memory, were associated with a higher likelihood of sustained Internet use. Additionally, respondents with good, very good, or excellent self-rated memory were more likely to sustain their Internet use. These findings highlight the potential critical role of cognitive health in shaping older adults’ digital engagement, suggesting that cognitive assessments and training should be further considered in digital literacy initiatives for this population.

COVID-19 vaccine perceptions and hesitancy amongst parents of school-aged children during the pediatric vaccine rollout

The risk for severe illness with COVID-19 increases with age, particularly with older adults at highest risk. However, COVID-19 vaccines currently authorized in the United States (Pfizer-BioNTech, Moderna, and Janssen) have high efficacy in preventing COVID-19 infection and COVID-19-related hospitalizations in older adults. Thus, people who are older or have disabilities are particularly encouraged to be fully vaccinated. In addition to effectiveness of full vaccinations, acceptance of COVID-19 vaccines is critical to end the global pandemic. Among various factors associated with vaccine hesitancy,1-3 the circulation of misleading information on COVID-19 vaccines on social media is considered as one of the important reasons of vaccine hesitancy.4-6 In this study, we tested the hypotheses that use of social media and other informal sources of information (such as friends/family) on the pandemic are associated with higher COVID-19 vaccine hesitancy, and that reliance on multiple sources of information was associated with less vaccine hesitancy among Medicare beneficiaries. The Medicare Current Beneficiary Survey (MCBS) is sponsored by the Centers for Medicare & Medicaid Services and contains data collected from a nationally representative sample of Medicare beneficiaries. We analyzed the MCBS COVID-19 Fall 2020 Rapid Response Supplement, administered between October and November 2020. The study cohort consisted of 7278 sampled beneficiaries enrolled in Medicare, representing a weighted 43,829,153 community-dwelling beneficiaries who answered questions about sources of COVID-19 information and presumptive vaccine uptake. The outcome variable was COVID-19 vaccine hesitancy, defined as 1 if a respondent answered "probably not," "definitely not," or "not sure" to the question "Would you get COVID-19 vaccine if available?" and 0 if the respondent answered "definitely" or "probably." Key independent variables were if a respondent relied on informal versus formal sources of COVID-19 information and the total number of information sources (formal and informal). Informal sources of COVID-19 information include social media, Internet, and friends/family, whereas formal sources of COVID-19 information include traditional news, government guidance, and medical providers. We also included a set of covariates including demographic and socioeconomic characteristics, primary location of care, and comorbidities. We fitted multivariable logistic regression to examine the associations of informal sources of information and number of information sources with the odds of vaccine hesitancy. Predicted probabilities (PPs) were computed using population-averaged estimates. This study was approved by the institutional review board of the University of Rochester, and informed consent was waived because of the use of publicly available, deidentified data. Data were analyzed using Stata version 16 (StataCorp). A two-sided p < 0.05 was considered statistically significant. All analyses were estimated with sampling weights. Thus, the results are nationally representative of Medicare beneficiaries. During the pandemic, 16.9% of respondents (n = 1231) reported use of informal information sources of COVID-19. Vaccine hesitancy rate was 44% among those relying on informal sources of information, and 38% among those with reported use of formal sources of information. On multivariable analysis, relying on informal COVID-19 information sources was associated with 29% higher odds of vaccine hesitancy (odds ratio, 1.29; 95% confidence interval [CI], 1.09–1.54; p = 0.004). Also, relying on more information sources was associated with lower odds of vaccine hesitancy (odd ratio, 0.91 for each additional source used; 95% CI, 0.86–0.95; p < 0.001) (Table 1). Among all beneficiaries, those relying on informal information sources had higher predicted vaccine hesitancy rate than those using formal information sources (PPs, 45% vs. 39%). Also, the predicted vaccine hesitancy rate decreases as the total number of information sources increases (Figure S1). The COVID-19 pandemic has highlighted the importance of communicating COVID-19-related information from reliable sources. Social media and other informal sources of COVID-19 information can affect COVID-19 vaccine confidence and vaccination rates. Our study showed that Medicare beneficiaries using informal COVID-19 information sources, such as social media, Internet, and friends/family, were more hesitant to take vaccine than those using formal sources of information, such as government guidance and medical providers. Also, more balanced sources of information were associated with lower rate of vaccine hesitancy. These results provide insights into future efforts that aim to build up positive attitude toward COVID-19 vaccine and achieve increased vaccine uptake rate. Also, informal sources such as social media may spread fear and share health misinformation with COVID-19 vaccine, possibly encouraging vaccine hesitancy. Thus, precautionary measures are needed to address false anti-vaccination claims that have been identified across social media platforms.7 Study limitations include a lack of ability to access actual vaccine uptake data as well as exclusion of Medicare beneficiaries living in an institution such as a long-term care facility. Yue Li is supported by a NIH grant R01AG069733. None to declare. Concept and design: Jihye Kim. Acquisition, analysis, and interpretation of data: Jihye Kim, Yeunkyung Kim, Yue Li. Preparation of the manuscript: Jihye Kim, Yeunkyung Kim, Yue Li. Revising the article for important intellectual content: all authors. None. Figure S1. Average predicted probabilities of vaccine hesitancy (%).Formal COVID-19 information sources include traditional news, government guidance, and medical providers. Informal sources of COVID-19 information include social media, Internet, and friends/family. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

BackgroundWhile numerous cross-sectional studies reported that advance directive (AD) completion varies significantly by age, gender, and education level, little is known about the factors that prompt AD completion over time....

COVID-19 and influenza vaccine hesitancy among college students

Objectives: Good knowledge about end-of-life (EOL) care options helps in discussing and planning important aspects of the end of life in advance and contributes to improved well-being among dying patients and their families.Methods: Our study explores knowledge levels of EOL care and planning options and its sociodemographic and regional patterning using nationally representative data from respondents aged 55+ of wave 6 of the Survey of Health, Ageing and Retirement in Europe in Switzerland (n = 2,199).Results: Respondents answered correctly on average to just under four out of eight questions regarding EOL care options. Women, individuals with higher education levels, and those living with a partner showed a higher EOL knowledge score, whereas the score is lower among older adults (75+) and individuals living in French- and Italian-speaking Switzerland.Conclusion: In view of the significant EOL knowledge gaps among older adults in Switzerland, further education efforts on EOL care options are needed, with particular attention to the population groups most affected.

The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals’ preferences regarding their end of life, as well as individuals’ trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one’s relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals’ preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland. We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables. Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations. This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings.

Despite being widely regarded as a major cause of health inequalities, little is known regarding health literacy and its association with certain personal characteristics among older adults in Switzerland. To fill this gap, this study assesses health literacy and its associations with individuals' social, regional, and health characteristics in a nationally representative sample of adults aged 58 years and older in Switzerland. We use data of 1,625 respondents from a paper-and-pencil self-completion questionnaire (cooperation rate: 94.3%) that was administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The scale includes 16 items whose dichotomised responses allow the construction of different indices and sub-indices aimed at measuring various aspects of health literacy. We use multivariable regressions to explore how respondents' sociodemographic characteristics are independently associated with health literacy. Overall, 6.8% of the respondents had inadequate health literacy, 24.6% problematic health literacy, and 68.6% sufficient health literacy. There were significant associations between health literacy and individuals' gender, education, economic situation, and self-rated health. Women had higher levels of health literacy than men (p <0.001). Moreover, a higher education level (p <0.001), fewer financial difficulties (p<0.01), and higher self-rated health (p <0.001) were positively correlated with adequate/higher levels of health literacy. One-third of older citizens have difficulties managing health-related issues in Switzerland. Individuals with low education, financial difficulties, and bad self-rated health are particularly at risk of being disadvantaged due to their inadequate health literacy level. These findings call for targeted interventions, such as using simplified health or eHealth information tools, improved patient-provider communication and shared decision-making, promoting lifelong learnings activities and health literacy screening for older patients to increase low health literacy and mitigate its consequences, thereby alleviating remaining social health inequalities in the Swiss population.

BackgroundMany widely used advance directives templates include direct questions on individuals’ preferences for cardiopulmonary resuscitation (CPR) in case of decision-making incapacity during medical emergencies. However, as knowledge of the survival rates of CPR is often limited, individuals’ advance decisions on CPR may be poorly aligned with their preferences if false beliefs about the survival rates of CPR shape stated preferences for CPR.MethodsWe analyzed nationally representative data from 1,469 adults aged 58+ y who responded to wave 8 (2019/2020) of the Swiss version of the Survey on Health, Ageing, and Retirement in Europe (SHARE) to assess the partial association between knowledge of CPR survival rates and stated preferences for CPR using multivariable probit regression models that adjust for social, health, and regional characteristics. Knowledge of CPR survival rates was assessed by asking how likely it is in general in Switzerland for a 70-y-old to survive until hospital discharge from a CPR performed outside of a hospital. Preferences for CPR were measured by asking respondents if they would wish to be resuscitated in case of cardiac arrest.ResultsOnly 9.3% of respondents correctly assessed the chances for a 70-y-old to survive until hospital discharge from a CPR performed outside of a hospital, while 65.2% indicated a preference to be resuscitated in case of a cardiac arrest. Respondents who correctly assessed CPR survival were significantly more likely to wish not to be resuscitated (average marginal effect: 0.18, P < 0.001).ConclusionsReducing misconceptions concerning the survival rates of CPR could change older adults’ preferences for CPR and make them more likely to forgo such treatments.HighlightsMany older adults in Switzerland overestimate the survival rates of cardiopulmonary resuscitation (CPR).The study reveals that individuals with accurate knowledge of CPR survival rates are more likely to refuse resuscitation in case of cardiac arrest.Overestimation of CPR survival rates may lead to a mismatch between individuals’ preferences for CPR and their actual end-of-life care decisions.Improving the general population’s knowledge of CPR survival rates is crucial to ensure informed decision making and effective advance care planning.

Rethinking vaccine hesitancy among minority groups

Journal of Palliative MedicineVol. 26, No. 4 CorrectionOpen AccessCorrection to: Perceptions and Knowledge Regarding Medical Situations at the End of Life among Older Adults in Switzerland by Meier C et al. J Palliat Med 2023;26(1):35–46 (DOI: 10.1089/jpm.2022.0057)is erratum ofPerceptions and Knowledge Regarding Medical Situations at the End of Life among Older Adults in SwitzerlandPublished Online:31 Mar 2023https://doi.org/10.1089/jpm.2022.0057.correxAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In the original article, Open Access had not been established. This is an Open Access article, which has now been corrected to reflect this.The online version has been corrected.The authors regret this error.FiguresReferencesRelatedDetailsRelated articlesPerceptions and Knowledge Regarding Medical Situations at the End of Life among Older Adults in Switzerland30 Dec 2022Journal of Palliative Medicine Volume 26Issue 4Apr 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Correction to: Perceptions and Knowledge Regarding Medical Situations at the End of Life among Older Adults in Switzerland by Meier C et al. J Palliat Med 2023;26(1):35–46 (DOI: 10.1089/jpm.2022.0057).Journal of Palliative Medicine.Apr 2023.601-601.http://doi.org/10.1089/jpm.2022.0057.correxcreative commons licensePublished in Volume: 26 Issue 4: March 31, 2023PDF download

The quest for more COVID-19 vaccinations in Africa

Vaccine hesitancy remains a significant public health challenge, particularly during pandemics when high immunization rates are crucial. While individual psychological antecedents of vaccine hesitancy have been extensively studied, limited empirical evidence exists on how contextual determinants, such as socioeconomic status, political trust, and digital literacy, collectively shape vaccine-related behaviors, particularly in Central European populations. This study explores the key determinants of COVID-19 vaccine hesitancy among Czech adults. A cross-sectional study was conducted using data from the 48th wave of the Czech national panel survey Život během pandemie [Life During Pandemic], carried out in March 2023. The data were obtained via an online questionnaire administered to a nationally representative sample of Czech adults (n = 1,708). Sociodemographic, socioeconomic, and anamnestic variables were examined alongside political attitudes. Psychological antecedents of vaccination were assessed using the 5C model (confidence, complacency, constraints, risk calculation, and collective responsibility), and digital vaccine literacy was measured using seven items covering trust in official sources, trust in social media, and the ability to evaluate and apply vaccine information. Statistical analyses included bivariate tests and multivariable regression models to identify vaccine uptake and intent determinants. Higher trust in constitutional institutions, including the president (OR = 1.55; 95% CI: 1.38–1.74), government (1.60; 1.38–1.85), Chamber of Deputies (1.73; 1.48–2.02), and Senate (1.47; 1.29–1.69), was significantly associated with higher vaccine uptake. Similarly, positive attitudes toward the integration of Ukrainian refugees into Czech society – across domains such as work (1.63; 1.39–1.90), housing (1.59; 1.36–1.86), school (1.64; 1.41–1.92), language (1.57; 1.34–1.84), and culture (1.74; 1.50–2.03) – were positively associated with uptake. Greater confidence in vaccine safety and effectiveness was also a significant predictor (1.51; 1.44–1.58). In contrast, lower education (0.64; 0.56–0.73), lower income (0.91; 0.86–0.95), female sex (0.60; 0.47–0.76), and higher complacency (0.76; 0.73–0.80) were associated with reduced uptake. Respondents with better digital vaccine literacy, particularly those more adept at identifying misinformation, showed significantly greater vaccine confidence (mean score: 3.62 vs. 3.30, p < .001). Beyond psychological antecedents, institutional trust, political orientation, and digital vaccine literacy significantly shape COVID-19 vaccination behaviors. These findings underscore the importance of targeted interventions that address political and digital influences on vaccine hesitancy, and they highlight the need for future research to examine the causal pathways and longitudinal dynamics underlying these associations, particularly within Central and Eastern European contexts.

COVID-19 boosters and building trust among UK minority ethnic communities