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Abstract

Background
Despite significant support system disruptions during the coronavirus 2019 (COVID-19) pandemic, little is known about the relationship between social support and symptom burden among older adults following COVID-19 hospitalization.


Methods
From a prospective cohort of 341 community-living persons aged ≥60 years hospitalized with COVID-19 between June 2020 and June 2021 who underwent follow-up at 1, 3, and 6 months after discharge, we identified 311 participants with ≥1 follow-up assessment. Social support prehospitalization was ascertained using a 5-item version of the Medical Outcomes Study Social Support Survey (range, 5–25), with low social support defined as a score ≤15. At hospitalization and each follow-up assessment, 14 physical symptoms were assessed using a modified Edmonton Symptom Assessment System inclusive of COVID-19-relevant symptoms. Mental health symptoms were assessed using Patient Health Questionnaire-4. Longitudinal associations between social support and physical and mental health symptoms, respectively, were evaluated through multivariable regression.


Results
Participants' mean age was 71.3 years (standard deviation, 8.5), 52.4% were female, and 34.2% were of Black race or Hispanic ethnicity. 11.8% reported low social support. Over the 6-month follow-up period, low social support was independently associated with higher burden of physical symptoms (adjusted rate ratio [aRR], 1.26; 95% confidence interval [CI], 1.05–1.52), but not mental health symptoms (aRR, 1.14; 95% CI, 0.85–1.53).


Conclusions
Low social support is associated with greater physical, but not mental health, symptom burden among older survivors of COVID-19 hospitalization. Our findings suggest a potential need for social support screening and interventions to improve post-COVID-19 symptom management in this vulnerable group.

The United States has by far the world's largest population of incarcerated people. More than a million Americans are imprisoned; hundreds of thousands more are held in jails. This vast system has doled out punishment—particularly to people from marginalized groups—on an unfathomable scale. At the same time, it has manifestly failed to secure public safety, instead perpetuating inequalities and recidivism. Why does the United States see punishment as the main response to social harm, and what are the alternatives?This book brings together essays by scholars, practitioners, activists, and writers, including incarcerated and formerly incarcerated people, to explore the harms of this punitive approach. The chapters address a range of issues, from policing to prosecution, and from how people are treated in prison to the consequences of a criminal conviction. Together, they consider a common theme: We cannot reduce our dependence on mass incarceration until we confront our impulse to punish in ways that are excessive, often wildly disproportionate to the harm caused. Essays trace how a maze of local, state, and federal agencies have contributed to mass incarceration and deterred attempts at reform. They shed light on how the excesses of America's criminal legal system are entwined with poverty, racism, and the legacy of slavery. A wide-ranging and powerful look at the failures of the status quo, Excessive Punishment also considers how to reimagine the justice system to support restoration instead of retribution