How Do Older People React to Severe Acute Respiratory Syndrome?

To the Editor: The outbreak of severe acute respiratory syndrome (SARS) has rapidly affected many parts of the world. SARS first attacked healthcare workers looking after patients with SARS but later spread to the community, threatening the lives of thousands of people. Although healthcare workers have a higher risk of becoming infected with SARS, elderly people are considered the most vulnerable group because of the high fatality rate in this group of those who have become infected with SARS (more than 50% aged 65 and older, compared with around 14% overall).1 It is hypothesized that the uncertainty and threats brought about by SARS will affect elderly people. Therefore, this preliminary study aims to explore how older adults of Hong Kong living in the community reacted to SARS. Ethical approval to conduct this research was obtained from the Hong Kong Polytechnic University. Adopting a cross-sectional survey design, a questionnaire consisting of four questions was devised based on the theory of victimization2 to examine respondents' self-appraisal of SARS in the aspects of fear of victimization, perceived risk, perceived control, and ability to cope. The first three questions: “How afraid do you feel of becoming a victim of SARS?”“How safe is the place where you now live?” and “How much control do you have over the SARS situation?” were rated on a 5-point Likert scale (1 = not at all, 5 = very much). The fourth question asked respondents to choose a coping method for a hypothetical situation in which one of their neighbors was infected with SARS (1 = stay at home all the time, 2 = move away, 3 = continue usual daily routines, 4 = have no idea what to do). Respondents were recruited using a convenience sampling of the membership lists of two community centers in Hong Kong (N = 1,800). The findings of a preliminary analysis of the data from 138 respondents are presented here. The mean age ± standard deviation of the respondents was 76 ± 7.60. A majority of them were female (72%) and had no chronic illnesses (83%). About half of the respondents (n = 67) lived alone, and the other half lived with families (n = 64). Of the 138 respondents, 82 were afraid that they would become a victim of SARS, six said the place they lived was not safe, and 18 felt they did not have control over the SARS situation. The mean values for fear of victimization, perceived risk and perceived control were 2.40 ± 1.37, 3.88 ± 0.98 and 3.38 ± 1.18, respectively. Regarding the hypothetical question, 31 respondents would continue their usual daily routines, 21 would stay home, nine had no idea what to do, two would move away, and 75 did not respond to this question. Further analyses were conducted to investigate whether the respondents' living arrangements and health conditions would affect their reactions toward SARS. Independent t tests showed that respondents who lived alone were significantly more worried that they would become a victim of SARS (t = −2.65, df = 114, P = .009) than those who lived with families and that respondents who had chronic illnesses were marginally more afraid than those who did not (t = −2.15, df = 20.172, P = .044). No significant differences were found in questions regarding risk, control, and coping strategies. Although a majority of respondents felt that their living environment and neighborhood were safe, many of them developed the fear that they would become a victim of SARS. This is consistent with the findings of a recent World Health Organization report,1 which stated that, “the fear of SARS has spread faster than the virus, causing great social unease.” Previous research has also shown that fear is not merely a spontaneous reaction to risk3 but is strongly correlated with uncertainty.4,5 The many unanswered questions related to SARS scared people, particularly elderly people who live alone. Chinese people tend to seek family support when faced with a crisis,6 and therefore the “live-alone” group is in need of external support to cope with the uncertainty and fear of SARS. This preliminary study is limited to a small, nonrandomized sample, but it provides some initial indications of how elderly people have perceived and reacted to the sudden outbreak of SARS. Further studies are required to verify these preliminary observations. This report is based on the data collected from the SARS Prevention and Rehabilitation Campaign, which was launched by the Department of Rehabilitation Sciences of The Hong Kong Polytechnic University and coordinated by M. Yau. I thank C. Chan and K. Liu for their contributions and suggestions to this report.