COVID-19 has changed the whole perspective of year 2020 throughout the whole world, affecting various sectors and industries, such as health, education, finance, and manufacturing . On 21 March 2020, some countries like Turkey had announced that a curfew would be imposed for people aged 65 years and older in the scope of COVID-19 measures. Although the number of cases decreased as a result of the measures, the continued announcement of new cases and deaths daily had negative impact on the mental health of individuals and on the society as a whole .
This study aimed to assess the prevalence of fear of COVID-19 infection among elderly population and its relation to depressive and anxiety symptoms among elderly population in Egypt. This cross sectional study enrolled 161 participants who responded through online self -administrated questionnaire. Any person who is 60 or above was included in the study.
Most of the participants were females (57.1%), married (70.8%), and with chronic diseases (67.1%). 48.4% of the participants were ranging from 60 to 64 years old and 48.4% of all participants had not been infected with COVID-19.
The current study showed that the total score of fear of COVID-19 scale was 17.7 ± 5.4, females scored higher than males, though the difference was not mounting to a statistically significant but these findings may be contributed to the higher number of stressful and traumatic life experiences in women than in men and the differences in nerve circuits that affect emotional reactivity between males and females ,the hormonal effect (too high or too low estrogen levels) in women and the fact that anxiety disorders are more common in females that males  and this was also confirmed when females scored significantly higher on anxiety subscale of HADS in the current study. A Cuban study revealed that women experience fear of COVID-19 more than men, and female gender is a predictor of fear of COVID-19. In the same study, the mean scores of the fear of COVID-19 scale in women were found to be higher than men by 4.00 points .
Moreover, as regards the relation between fear of COVID-19 scale and socio-demographics, the current study showed a statistically significant difference between the mean score of fear of COVID-19 scale and education where the post graduate participants showed higher mean score (p = 0.001). This finding might be related to being more well educated and having more sufficient knowledge and information regarding the disease transmission and dangerousness which might make them more fearful.
Age was significantly associated with depression subscale of HADS (p = 0.026), where the participants who were 75 years old or more had higher mean score of depression. This might be related to the relation between perceived health status of older adults (where most of the participants in the study had chronic diseases) and their mental health which indicates that health status does directly relate with their mental health. Older adults who have poor health status may be more prone to depression and anxiety
These results were concordant with Kemal J et al. 2021 which was done in Ethiopia and showed that females and older age participants (80–91 years old) developed more depressive and anxiety symptoms . The current study was inconsistent with Subjash et al. 2021, which was done in Chandigarh City on 92 elderly participants and also inconsistent with Vahia et al. 2020 which showed that the elderly had lower levels of anxiety and depression and that higher age was associated with lesser psychological impact as well as higher resilience among them. The difference in the results might be related to the differences in the economic status and social support offered by the community and caregivers in different countries as well as the number of participants that were enrolled, also the higher number male participants included in SubJash et al. 2021 study compared to the current study might be one of the causes of inconsistencies between studies as males have more coping mechanisms and can withstand stress more than the females [28, 29].
Also, older adults with poor physical health have challenges with physical activity and in addition to poor lifestyle that may have negative impact on their mental health. Furthermore, people who do not practice physical activity are reportedly two times more likely to exhibit symptoms of depression and anxiety compared to those who perform physical activity regularly as well as the influence of isolation withstand the especially with social connectedness during COVID-19 locking down. The absence of personal social interactions and the lack of physical activities for a long time due to the pandemic have increased the requirement of the society for psychiatric support and aggravated existing psychiatric symptoms [8, 25].
As regards correlation between anxiety, depression subscales, and total score of HADS with fear of COVID-19 scale, the current study showed that a high statistically significant positive correlation (< 0.001, < 0.001, < 0.001) respectively. These results were concordant with Ahorsu et al. 2020 in Qazvin which was done on old age group participants and showed fear of COVID-19 can affect the mental health on this group . In another studies by Rossi et al. 2020 done in Italy and Han et al. 2021 in Singapore, it showed a link between anxiety symptoms with both the fear of COVID-19 as well as its association with consequent depressive symptomatology [31, 18].
These results can be explained as fear is a neurological process that help individuals to maintain their integrity in the presence of a threat. It can cause psychiatric disorders like posttraumatic stress disorders, anxiety disorders, depressive disorders, as well as impairment in the ability to suppress a previously learned fear and the capacity to learn safety behaviors.
The relationship between fear of COVID-19 and affective symptoms could be related to catastrophizing, a cognitive error that is commonly associated with anxiety and depression. Catastrophizing is a negative thinking style where one expects the worst possible outcome in a given situation. In COVID-19 pandemic, there was a negative outlook on reality which was accompanied by negative mood and emotion including the high levels of fear. The association among the three variables seems to suggest the presence of a negative reinforcing loop and increased negativity may lead to higher fear levels toward COVID-19, which may in turn contribute to higher levels of depressive and anxiety symptoms .
The psychological assessment was based on an online survey and on self-administrated measures. The use of clinical interviews in future studies will give a more comprehensive psychiatric assessment of the participants. Moreover, further studies with a larger randomized sample would help to give more precise data representing the study group.
The fear of COVID-19 scale, which is a short scale and was applied to participants by social media, revealed that people with higher fear of COVID-19 are in need for psychological help and support. This support can be done through phone calls by professional teams for those who had higher risk. These interventions will decrease the levels of fear in older age groups resulting from an increased level of knowledge and sharing. The World Health Organization (WHO) recommends regular connection with loved ones via phone, e-mail, or video calls; regular routines and schedules such as sleeping, eating, and engaging in favorite home activities; regular and daily activities to maintain mobility; and getting support from family, friends, or neighbors for a minimum of 1-month stock of food and medicines to protect the mental health of older individuals. In China, online counseling services were provided every day of the week by professionals from universities and various medical institutions in many cities during the pandemic [33, 34]. There is a possible plan to provide psychological support to people suffering from the emotional problems due to COVID-19 and other COVID-19-related issues in order to reduce the psychological burden of the pandemic .