1. Introduction
It has been almost 2 years since we first grappled with the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite many attempts to reduce viral transmission, the development of vaccines, new diagnostic methods, antiviral drugs, and treatment strategies, the virus still continues to take its toll. To date, approximately 242 million people have been infected worldwide, while around 5 million of them died due to COVID-19 infection [
1]. The clinical symptoms are cough, high fever, fatigue, and shortness of breath. The elderly, immunocompromised, and/or those with pre-existing chronic diseases are at the highest risk to develop severe respiratory problems, leading to multi-organ failure, pneumonia, and death.
The observed high morbidity and mortality of SARS-CoV-2 have triggered the fear of COVID-19 infection. As an example, in a survey of 44,000 participants conducted in Belgium in April 2020, the number of people who reported anxiety (20%) or depression (16%) had increased substantially compared to the survey conducted in 2018 [
2].
Furthermore, changes in daily lives and behavior and the implementation of social restrictions also led older adults to have increased stress and anxiety levels affecting their mental health conditions [
3]. Studies determined four domains of fear: (1) fear of oneself or their family members getting infected, (2) fear of having economic losses and being unemployed, (3) fear of avoidance behaviors toward gaining knowledge about the pandemic, or (4) fear of making decisions on showing or not showing actions like whether to visit other family members or not, whether to look for information on death rates or not, etc. [
4,
5]. All these doubts may be seen by changes in sleep and eating patterns; worsening of psychiatric conditions including manifestations of passivity, impotence, resignation, exclusion, and anger in older adults; and increased rates of addictions to alcohol, tobacco, drugs, etc. [
6]. Another risk factor associated with mental health concerns of COVID-19 infections is a social disconnection between older adults and their families and friends. The elderly population requires special care when it comes to adapting to new ways of medical consultations via telemedicine, as well as maintaining relationships with friends and families by internet-based technologies, e.g., video conferences [
7,
8]. It was also observed that mental health problems in those concerned about COVID-19 infection are often neglected in favor of psychological consultations with patients with other chronic diseases [
9]. Furthermore, due to implemented social restrictions, the only possible way to update the COVID-19-related information among older adults is through media (TV, radio, newspapers). However, current media is thought to be bombarded by misinformation and false reports about the COVID-19 infection and, in turn, may cause unfounded fears among many netizens [
10,
11]. As older adults tend to spend more time watching television than younger counterparts, this group is at higher risk of expressing fear and anxiety of COVID-19 infection.
Elderly patients and those with pre-existing chronic diseases are at the highest risk of COVID-19 morbidity and mortality, and, hence, the fear and anxiety levels are the highest. Our previous study determined how fear of COVID-19 infection influenced the professional, social, and recreational activities in the elderly population in Poland. For instance, we determined that 10% of participants (50/500; 10%) canceled planned hospitalization due to the fear of COVID-19 infection. It was observed mainly in patients suffering from chronic heart and lung diseases [
12]. This behavior further increases the risk of death, especially among the elderly population with a history of diseases. In this study, we aimed to assess the fear of COVID-19 infection in the elderly population and identify subpopulations that require special care, for instance, through counselling and/or family support.
4. Discussion
The rapid spread of the COVID-19 infection throughout the world has led to the increase of mental health crises, generated by the perception of stress, anxiety, depressive symptoms, insomnia, and anger. Older adults are at the highest risk of COVID-19 morbidity and mortality. The COVID-19 fatality rate for those over 80 years of age increases fivefold [
15], and, hence, it is understandable they are at a higher risk of COVID-19-related fear and stress. The findings from our study showed a significant role of COVID-19 infection in perceiving fears among the older population in Poland, with a mean fear score of 19.3 ± 5.6 on a seven-item fear scale (fear score ranged between 7 to 35) (
Table 4). Furthermore, we observed a great variety in participants’ agreement of the COVID-19 fear scale (
Figure 1), which may result from differential emotional responses to the prevailing pandemic. This phenomenon is likely due to the lack of compliance in the mass media about SARS-CoV-2 epidemiology, routes of transmission, prevention, and/or lack of sufficient knowledge and awareness of individuals about this viral disease [
16,
17,
18].
Our previous study determined that 10% of all surveyed Polish elderly population (50/500; 10%) canceled planned hospitalizations due to the fear of COVID-19 infection. Untreated for chronic diseases, COVID-19-infected patients are at an increased risk of death. Thus, despite the paradoxical sincere willingness to reduce the rate of SARS-CoV-2 transmission, such situations may adversely affect the clinical health of patients [
12]. In this study, instead of highlighting the consequences of the fear during the COVID-19 pandemic (e.g., changes in behavior), we found subpopulations that are at the highest risk to exhibit health anxiety during the current pandemic.
At first, we found that women are more frequently associated with higher stress, anxiety, and depression due to potential COVID-19 infection (
p = 0.025;
Table 2, and
p = 0.007,
Table 6). This finding is consistent with other studies reporting the gender differences in behavior caused by the prevailing pandemic [
19,
20,
21]. The explanation of the gender-based heterogeneity in contributing fear of COVID-19 was reported by Hosen et al. [
22]. Based on the cross-sectional study, they found more irresponsible behaviors towards the COVID-19 pandemic in males, which significantly decreases their consciousness about the potential infection of the virus. In contrast, women were more inclined to adjust to government-imposed social restrictions, such as movement restrictions, covering the mouth and nose in public places, quarantining, or using disinfectants to reduce viral transmission. This behavior results from increased consciousness and, hence, potential fears of COVID-19 infection [
22]. Furthermore, women are more susceptible to social isolation [
23]. During the current pandemic, more women used psychological counseling than men, and these consultations focused mainly on emotional issues [
24,
25]. Women, especially elderly ones, as caretakers of families, are worried about themselves and their relatives, which intensifies the fear of COVID-19 infection.
Our study indicates that the fear of COVID-19 infection increases in people with pre-existing chronic diseases, such as coronary heart disease (
p < 0.001,
Table 3), COPD (
p = 0.007,
Table 3), and heart failure (
p < 0.001,
Table 3), which is consistent with other studies [
26,
27]. For instance, in a study aiming to assess the levels of fear of COVID-19 infection performed by Al-Rahimi et al., the significant predictors turned out to be the type of chronic disease including Crohn disease, hypertension, and cardiovascular diseases [
28]. It is very likely that COVID-19 may affect the course of the pre-existing diseases and increase mortality because the overall stress caused by the viral infection may influence the cardiac muscle [
29]. Furthermore, the study from the United States also reported that around one-third of infected patients with COVID-19 had at least one chronic disease; the most common were cardiovascular diseases, followed by chronic lung diseases and diabetes [
30]. Thus, these results indicate the fear of COVID-19 infection in people, especially elderly ones, with cardiac and pulmonary problems is justifiable.
Furthermore, an important predictor of the fear of COVID-19 infection is also the number of prescribed medicines. The more drugs taken every day, the higher the levels of health anxiety caused by COVID-19 infection. This was observed mainly in people taking cardiac drugs (
p < 0.001,
Table 4), antihypertensive drugs (
p = 0.011,
Table 4), analgesics (
p = 0.001,
Table 4), digestive ailments’ drugs (
p = 0.005,
Table 4), anticoagulants (
p = 0.004,
Table 4), and antidepressants (
p = 0.043,
Table 4). It is worth noting that people taking anticoagulants were the most frequently concerned about contagion during the COVID-19 pandemic (
p = 0.041,
Table 6). There is mounting evidence that COVID-19 causes abnormalities in blood clotting in the veins and arteries, leading to life-threatening strokes, heart attacks, and pulmonary embolism [
31]. Thus, in this case, fears of COVID-19 infection are also justifiable.
Preventive measures to reduce the spread of COVID-19 transmission (e.g., lockdowns, social distancing, mask wearing, etc.) have paradoxically caused a wide range of negative consequences, including social disconnection, mental health problems, and lifestyle changes [
32], leading to increased fear levels of COVID-19 infection. The US Centers for Disease Control and Prevention (CDC) estimates that, as of June 2020, nearly one-third of US adults were suffering from anxiety or depression [
33]. This result is consistent with our analysis. The fear of COVID-19 infection was increased in people with weakened mental capacity (according to AMTS scale,
p = 0.013,
Table 5) and those feeling depressed (according to the GDS-15 scale,
p < 0.001,
Table 5), lonely (according to the Gierveld Scale,
p = 0.004,
Table 5), and with high levels of anxiety (according to the GAS-10 scale,
p < 0.001,
Table 5) and social isolation (according to the LSNS-6 scale,
p = 0.006,
Table 5). It is worth noting that the highest fear of COVID-19 infection was reported in those exhibiting a high risk of anxiety (
p < 0.001,
Table 6). The current literature confirms this result. For instance, Mistry et al., conducted a cross-sectional study among 1032 older Bangladeshi adults aged ≥60 years. They determined that fear of COVID-19 infection was higher among those who felt socially isolated [
18]. This study, together with our findings, suggests that we should pay more attention to the psychological support of the older community members during the pandemic.
The rapid spread of the COVID-19 disease leading to high daily rates of new cases and deaths together with the bombardment of information to which citizens are submitted through the media can influence the development of mood disorders. This affects mainly the elderly population, which tends to spend more time watching the media (radio, television, newspapers) than younger people. Moreover, the inability to visit loved ones and be visited by them due to social restrictions also increases fear and anxiety [
20]. According to our study, from a total of 500 patients, 190 of them declared that watching and reading news about COVID-19 on social media made them feel nervous and scared (155/500, 31.0% agreed; and 35/500, 7.0% strongly agreed with this statement) (
Figure 1,
Table 2). The observed relationship between media exposure and the fear of the COVID-19 infection creates opportunities for policy makers and journalists to affect excessive worries. For instance, all information about SARS-CoV-2 epidemiology, prevention, and treatment should be provided unambiguously, without sensationalism and disturbing images. Furthermore, it is crucial to advise the elderly to restrict their exposure to media coverage of the COVID-19 crisis and avoid sensational media, which may increase stress and decrease the well-being of individuals [
34,
35,
36].
As we are now after the third wave of the COVID-19 pandemic (late summer and autumn 2021) and including the fact that data were collected during the second wave (November–December 2020), the question appears if there are some changes in perceiving fears due to COVID-19 infection between these two different seasons. The first wave of the COVID-19 pandemic (spring 2020) raised the alarm in society, mainly because of the lack of knowledge about the pathogenicity and routes of transmission of SARS-CoV-2. The second wave identified the country differences in incidence, prevalence, and mortality rates of COVID-19. Although there was a significant impact of developed vaccinations, the third wave further exposed varying social and financial differences in different countries [
37]. Several studies focused on the characteristics of effects of viral disease in different seasons [
38,
39,
40,
41], but no study highlighted changes in perceiving fears of COVID-19 infection during different waves. For instance, Iftimie et al. reported differences in age range and severity of the disease between two periods of COVID-19 infection (March–June 2020 and July–October 2020). Patients in the second wave were younger, and the duration of hospitalizations and case fatality rates were lower than those in the first wave. Furthermore, more children, pregnant and post-partum women, and people with renal and gastrointestinal symptoms were COVID-19 infected in the second wave than in the first wave of the COVID-19 pandemic [
38]. It is worth noting that the analysis of the differential perception of fear of COVID-19 infection is quite challenging because different study groups referred to different periods as waves of the COVID-19 pandemic, depending mainly on the country where the study was performed.
To reduce the fear of COVID-19, it would also be beneficial to implement effective and informative campaigns about the disease, focused on its prevention. This solution could be crucial for the elderly population, which feels defenseless to face the problematic situation of the pandemic and is afraid to be COVID-19 infected. Furthermore, older adults should be provided with support plans with effective measures to improve their standard of living, eating habits, and living conditions [
20]. This strategy may contribute to enhancing their ability to cope with the prevailing pandemic. It would be advisable for clinic authorities and health professionals to instantly design and implement measures to alleviate these effects, which harm the mental health of their patients. It is already determined that those who received COVID-19-related information from health workers had lower fear scores [
18]. This result shows health workers are trusted among the older population and provide information in a sympathetic manner. Thus, the role of health workers in decreasing the fear of COVID-19 infection and enhancing the well-being among the elderly population is incontestable.
Limitations
Our study has some limitations. At first, data were obtained by completing the questionnaire based on recorded telephone calls and the response rate was relatively low, 40%. The second limitation is the cross-sectional nature of the study based on self-reports. This may limit the generalizability of our results to a wider population and claims about the directionality of the results. Additionally, the authors could not assess if there were any differences between those who did and did not reply to the telephone survey as no information regarding nonrespondents was available. Furthermore, respondents recalled answers to questions. These answers may be subject to recall bias. This increases the risk of overreporting or underreporting the actual fear of COVID-19 infection.