COVID-19 Attitudes and Quality of Life in Older Adults in Puerto Rico: The Mediating Role of Psychological Sense of Community

Background and Purpose: Older adults, especially those from historically disadvantaged populations, are at increased risk for severe illness and death from COVID-19. In Puerto Rico, 78% of COVID-19 deaths have been among adults 60 years and older, although they comprise only 15% of reported cases. The pandemic has also had a deleterious effect on older adults’ quality of life (QOL) due to morbidity, financial strain, and decreased independence. One of the most commonly reported struggles with COVID-19 has been its effects on community social networks, through the severe reduction in the ability to socialize as before the pandemic. Nevertheless, emerging studies have highlighted the importance of psychological sense of community (PSOC), or the perceived connection that individuals have with their community, is an important protective factor for older adults in Puerto Rico. We used a risk and resilience framework to examine the effect of COVID-19 attitudes on QOL among older adults in Puerto Rico and to explore the role of psychological sense of community (PSOC) in this relationship.

Methods: We analyzed data from a nonprobability sample of 191 Puerto Rican adults aged 60+. Interviews were conducted from January through December 2021. Mean age was 72.1 years (SD = 8.8); 56.5% were female, 76.9% were single, and 60.2% reported annual household income under $12,500. We measured QOL with the eight-item EUROHIS-QOL (theoretical range = 0–30; M = 23.1, SD = 5.4). We assessed COVID-19 attitudes, including confidence in government/experts and perceived seriousness, with a theoretically and empirically informed researcher-constructed index of 13 items (theoretical range = 13–39; M = 33.2, SD = 5.3). Finally, we measured PSOC with the eight-item Brief Sense of Community Scale (theoretical range = 0–30; M = 23.7, SD = 7.6). Higher scores indicate higher construct endorsement for each measure. Controlling for age, sex, income, marital status, and self-rated health, we conducted a multiple linear regression model specifying PSOC as a mediator.

Results: The regression model explained 46% of the variance in QOL, F(7, 183) = 2.65, p < .001. Income (b = 1.86, p = .003), self-rated health (b = 2.45, p < .001), COVID-19 attitudes (b = 0.13, p = .041) and PSOC (b = 0.20, p < .001) were positively related to QOL. Mediation results showed that COVID-19 attitudes had a direct and positive effect on PSOC (b = 0.36, p = .001) and an indirect and positive effect on QOL through PSOC (b = 0.07, 95% CI [.03, .13]).

Conclusions and Implications: Our results indicate that COVID-19 attitudes directly affect QOL and that PSOC mediates this relationship. Findings reinforce previous recommendations to prioritize trust in government policies and public health handling of the pandemic, as these attitudes were associated with higher PSOC and greater QOL. The findings also complement often-reported challenges of increased social isolation stemming from public health precautions, as attitudes are socially influenced through community connections. Practitioners and policymakers should buttress community support to improve older adults’ pandemic-related attitudes and QOL.