Changes in Older People's Activities During the Coronavirus Disease 2019 Pandemic in Japan.

To the Editor:

The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has led state and local leaders to introduce social/physical distancing and self-isolation. Aggregated mobility data collected by private companies have been available to help understand the impact of such measures on population mobility patterns. However, because the older population is not likely to be represented in such data, partly because of their technology adaptation issues, , we may not know how older adults have reacted to these community/policy messages.

We had access to a unique dataset comprising behavior logs of older adults living in a continuing care retirement community (CCRC), which enabled us to estimate the time spent in common areas and walking distance within the CCRC. We analyzed data from 114 residents aged 67 to 92 years, 70.4% female. All of them were residents in independent apartment units and carried a beacon transmitter daily as part of a research project since September 2018.

During the follow-up period from January 1, 2020, until May 25, 2020, there were 2 major messages related to COVID-19 to senior residents: first, the CCRC announced the cancellation of all upcoming in-facility events/exhibitions and the closure of some common facilities as a precaution measure (February 24, 2020); subsequently, the state of emergency was declared by the prime minister, asking people to stay at home (April 7, 2020), and this was eventually lifted by the end of the follow-up period. Figure 1 shows daily time spent in common areas and daily walking distance over the follow-up period. According to our interrupted time series analysis, the time spent in common areas decreased immediately following the CCRC announcement by 12.7% (10.9 minutes [95% confidence interval (CI) −17.2, −4.5]). After the CCRC announcement until the state of emergency declaration, the time spent in common areas remained at a low level, while the walking distance gradually decreased at a rate of 0.5% [5.4 m/day (95% CI −10.4, −0.4)]. The state of emergency declaration had a further significant acute impact on the time spent in common areas by 7.8% decrease [6.5 min/day (95% CI −11.1, −1.8)] and the daily walking distance by 20.3% decrease [−186.8 m (95% CI −333.0, −40.6)] (Supplementary Table 1).

Fig. 1

Changes in levels and trends of older adults' activities during the COVID-19 pandemic. Means of daily time spent in (A) common area and (B) walking distance between January 1 and May 24, 2020. The left dotted line indicates the day when the CCRC announced the cancellation of all in-facility events and closure of some facilities (February 24, 2020), and the right dotted line represents the day when the state of emergency was declared (April 7, 2020).

Supplementary Table 1

Regression Results of Main and Sensitivity Analyses (N = 134)

	Model 1			Model 2			Model 3
Time
Baseline	86.84	79.31	94.36	86.84	78.31	95.36	86.98	79.21	94.75
Pre CA	−0.02	−0.20	0.16	−0.02	−0.22	0.18	−0.03	−0.21	0.16
(Time at CA)	85.68
Post CA short term	−10.87 (=12.7% of 86.68)	−17.21	−4.52	−10.87	−17.48	−4.26	−10.47	−17.44	−3.51
Post CA long term	−0.08	−0.33	0.18	−0.08	−0.34	0.18	−0.08	−0.35	0.20
(Time at SE)	82.66
Post SE short term	−6.46 (=7.8% of 82.66)	−11.13	−1.80	−6.46	−11.28	−1.65	−6.31	−11.30	−1.31
Post SE long term	0.27	0.06	0.48	0.27	0.06	0.48	0.28	0.05	0.51
Trend: CA	−0.10	−0.28	0.09	−0.10	−0.28	0.09	−0.10	−0.31	0.10
Trend: SE∗	0.18	0.07	0.28	0.18	0.06	0.28	0.17	0.06	0.29
	F (11,134) = 27.3, P < .000			F (11,134) = 27.4, P < .000			F (11,134) = 24.0, P < .000R2 = 0.62, d statistic† = 1.95
Walking distance
Baseline	1097.23	1009.39	1185.06	1097.23	1000.11	1194.34	1096.31	1001.97	1190.66
Pre CA	0.64	−1.38	2.65	0.64	−1.58	2.86	0.65	−1.59	2.89
Distance at CA	1133.60
Post CA short term	−37.70 (=3.3% of 1133.60)	−138.21	62.80	−37.70	−140.87	65.46	−34.00	−146.41	78.41
Post CA long term	−5.37	−10.39	−0.36	−5.37	−10.85	0.10	−5.51	−11.02	−0.01
Distance at SE	918.63
Post SE short term	−186.79 (=20.3% of 918.63)	−333.01	−40.57	−186.79	−348.23	−25.35	−183.69	−341.39	−25.99
Post SE long term	5.61	0.40	10.82	5.61	0.05	11.18	5.70	−0.08	11.48
Trend: CA	−4.73	−9.34	−0.13	−4.74	−9.78	0.31	−4.86	−9.90	0.17
Trend: SE∗	0.87	−1.68	3.43	0.88	−1.61	3.36	0.84	−2.03	3.70
	F (11,134) = 38.3, P < .000			F (11,134) = 46.8, P < .000			F (11,134) = 29.6, P < .000R2 = 0.64, d statistic = 1.97

CA, CCRC announcement; SE, state of emergency.

Confidence intervals in brackets.

Model 1: Regression with Newey-West standard errors without lag indicated (main analyses).

Model 2: Model 1 with 1 day lag indicated.

Model 3: Prais-Winsten autoregressive model. Dummy variables for week are not shown in the tables.

Postintervention linear trend = _b [pre CA] + _b [post CA long term].

Postintervention linear trend = _b [pre CA] +_b [post CA long term] + _b [Post SE long term].

Durbin–Watson d statistic is an indicator of how well the model corrects for first-order autocorrelation; d can take on values between 0 and 4, and under the null hypothesis, d is equal to 2.

The time spent in common areas is likely to be related to face-to-face social interaction, which is usually an important aspect of healthy aging; however, such interaction is to be avoided during the COVID-19 pandemic. The data showed that older adults reduced their social time largely in response to the message from their immediate community, although there was no explicit request to avoid social contact. The state of emergency, which was not enforceable, had a further reducing effect on social time. A known characteristic of Japanese individuals quoted as “the government asked, people listened” has been suggested as one of the possible reasons for the relatively low mortality rate of COVID-19 as of July 15, 2020 in Japan without adopting draconian measures for tackling the virus. Our study seems to support this hypothesis, applicable at least to the population most vulnerable to COVID-19. On the other hand, the reduction of walking distance over the period needs a different interpretation. It is a physical activity conducted individually or as a pair, and residents were under no restrictions in moving in and around the various buildings in the CCRC during the period. Psychological impact from COVID-19-related messages on people's behaviors should be addressed, and the possible health impact of these suppressing social and physical activities during the pandemic could be an important research issue in gerontology in the future.