Abstracts

Introduction

COVID-19, from the term “coronavirus disease 2019”, is an acute respiratory disease, caused by the novel coronavirus (SARS-CoV-2)⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾, which was declared Public Health Emergency of International Concern and characterized as a pandemic on March 11^th, 2020⁽²2 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO; 2020 [cited Jun 1, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases... ⁾.

Its clinical management and appropriate treatment have not yet been fully recognized⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾. It is known, however, that the virus is highly transmissible and mainly spreads from person to person⁽³3 Mcintosh, K. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis, and prevention. [Internet]. 2020 [cited Jun 1, 2020]. Available from: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-epidemiology-virology-and-prevention
https://www.uptodate.com/contents/corona... ⁾. Transmission occurs through respiratory droplets released through the nose or mouth when an infected person coughs or sneezes⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾. The presence of the virus on objects or surfaces is another form of contagion; hence, people are at risk of becoming infected if they touch their eyes, nose or mouth after touching contaminated objectives or surfaces⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾.

The clinical condition of COVID-19 in most cases is similar to other respiratory infections: fever (≥37.8ºC), running nose, dry cough, and fatigue⁽²2 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO; 2020 [cited Jun 1, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases... ⁾. Approximately 5% of the infected individuals develop the most severe form of the disease, with symptoms such as dyspnea and/or pulmonary bleeding, severe lymphopenia, and renal failure⁽⁴4 Strabelli TMV, Uip DE. COVID-19 and the Heart. Arq Bras Cardiol. [Internet]. 2020 [cited May 29, 2020]. Available from: https://doi.org/10.36660/abc.20200209
https://doi.org/10.36660/abc.20200209... ⁾.

Given the seriousness of the world situation and the need to decrease the spread of COVID-19 and flatten its epidemiological curve, preventive measures were adopted such as hand sanitation, respiratory etiquette, cleaning and disinfection of surfaces and objects, and social distancing⁽²2 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO; 2020 [cited Jun 1, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases... ⁾. Delay in adopting these measures resulted in an epidemiological curve with high mortality rates in Brazil, Italy, Spain, and the United States of America, even surpassing China⁽²2 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO; 2020 [cited Jun 1, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases... ⁾.

Due to the physiological changes inherent to the human aging process, which compromise the immunological system, and the greater number of complications accruing from chronic diseases at old age, the elderly are more susceptible to the more severe manifestations of COVID-19 and, consequently, death⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ^-66 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: https://doi.org/10.1016/S0140-6736(20)30566-3
https://doi.org/10.1016/S0140-6736(20)30... ⁾. Additionally, sociodemographic and economic characteristics, such as advanced age; low educational and income levels; and single-person households, favor the greater vulnerability of elderly individuals to COVID-19. These factors may interfere in the access to information and, consequently, knowledge and implementation of measures to prevent infection by the novel coronavirus⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239...

8 Barber SJ, Kim H. COVID-19 Worries and Behavior Changes in Older and Younger Men and Women. J Gerontol B Psychol Sci Soc Sci. 2020;1-7. doi: https://10.1093/geronb/gbaa068
https://10.1093/geronb/gbaa068...

9 Malloy-Diniz LF, Costa DS, Loureiro F, Moreira L, Silveira BKS, Sadi HM, et al. Saúde mental na pandemia de COVID -19: considerações práticas multidisciplinares sobre cognição, emoção e comportamento. Ver Debates Psiquiatr. 2020 [Acesso 25 mai 2020]. Disponível em: https://d494f813-3c95-463a-898c-ea1519530871.filesusr.com/ugd/c37608_59b07f09964c41cc8bd976bc1cc0e402.pdf
https://d494f813-3c95-463a-898c-ea151953... ^-1010 Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) Epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1-25. doi: 10.3390/ijerph17051729
https://doi.org/10.3390/ijerph17051729... ⁾.

Coupled with these, there has been an increase in the number of elderly individuals living by themselves⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. In Brazil, 15.7% of individuals aged 60 years old or older live alone⁽¹²12 Instituto Brasileiro de Geografia e Estatística. Síntese de Indicadores Sociais. Uma análise das condições de vida da população brasileira. Rio de Janeiro: IBGE; 2016 [Acesso 05 jun 2020]. Disponível em: https://biblioteca.ibge.gov.br/visualizacao/livros/liv101629.pdf
https://biblioteca.ibge.gov.br/visualiza... ⁾; with the South (15.9%) and Southeast (15.7%) presenting the highest percentages⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. Single-person households may be seen as an accomplishment considering that older people can enjoy greater privacy and independence as they age⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾, however, elderly individuals living by themselves may become more vulnerable and deprived of social support when facing health problems⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ^,1313 Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5):E256. doi: https://doi.org/10.1016/S2468-2667(20)30061-X
https://doi.org/10.1016/S2468-2667(20)30... ⁾. Additionally, access to information depends on the context in which individuals live⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ^-88 Barber SJ, Kim H. COVID-19 Worries and Behavior Changes in Older and Younger Men and Women. J Gerontol B Psychol Sci Soc Sci. 2020;1-7. doi: https://10.1093/geronb/gbaa068
https://10.1093/geronb/gbaa068... ⁾ and knowledge regarding preventive measures is one of the crucial factors to prevent the contagion and spread of the novel coronavirus⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾.

In this context, the identification of factors related to poor knowledge regarding the COVID-19 preventive measures among the elderly can support the practice of health workers, especially nurses, to combat the novel coronavirus. Nonetheless, even though this is a relevant topic, few scientific studies are addressing the knowledge about measures to prevent COVID-19 and their implementation among elderly individuals living by themselves. Studies addressing the elderly population has investigated the impact of the COVID-19 outbreak in long-term residential facilities for the elderly⁽¹⁴14 McMichael TM, Clark S, Pogosjans S, Kay M, Lewis J, Baer A, et al. COVID-19 in a Long-Term Care Facility - King County, Washington, February 27-March 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):339-42. doi: 10.15585/mmwr.mm6912e1
https://doi.org/10.15585/mmwr.mm6912e1... ^-1515 Gardner W, States D, Bagley N. The Coronavirus and the Risks to the Elderly in Long-Term Care. J Aging Soc Policy. 2020:1-7. doi: https://doi.org/10.1080/08959420.2020.1750543
https://doi.org/10.1080/08959420.2020.17... ⁾; the knowledge held by adult and elderly individuals living in the community and their behavior in the face of COVID-19⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ^-88 Barber SJ, Kim H. COVID-19 Worries and Behavior Changes in Older and Younger Men and Women. J Gerontol B Psychol Sci Soc Sci. 2020;1-7. doi: https://10.1093/geronb/gbaa068
https://10.1093/geronb/gbaa068... ⁾; the beliefs regarding the COVID-19 pandemic held by the population in a Brazilian state⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾; the consequences of social isolation in the lives of elderly individuals⁽¹³13 Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020;5(5):E256. doi: https://doi.org/10.1016/S2468-2667(20)30061-X
https://doi.org/10.1016/S2468-2667(20)30... ^,1717 Kuwahara, Kuroda A, Fukuda Y. COVID-19: Active measures to support community-dwelling older adults. Travel Med Infect Dis. 2020. doi: https://doi.org/10.1016/j.tmaid.2020.101638
https://doi.org/10.1016/j.tmaid.2020.101... ⁾; and the clinical characteristics and prognosis factors among COVID-19 patients aged 60 years old or older⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ^-66 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: https://doi.org/10.1016/S0140-6736(20)30566-3
https://doi.org/10.1016/S0140-6736(20)30... ⁾.

Therefore, the objective was to describe the occurrence of COVID-19 and the health services sought by elderly individuals living alone; identify the knowledge these individuals have concerning the COVID-19 transmission, signs and symptoms and preventive measures, and verify factors associated with poor knowledge of preventive measures according to sociodemographic and clinical variables.

Method

A cross-sectional and analytical study with a quantitative approach using a telephone survey was conducted in May 2020 in the Health Macro-Region of Triângulo Sul in the state of Minas Gerais, which is subdivided into three micro-regions: Araxá and Uberaba, each with eight cities, and Frutal/Iturama with 11 cities (Table 1).

The study population was composed of individuals living by themselves who had been interviewed in the study “Dependence to perform activities of daily living, frailty, and the use of health services among elderly individuals from the Triângulo Sul in the State of Minas Gerais”, which used multistage cluster sampling and interviewed 1,635 elderly individuals living in the community in the Health Macro-Region of the Triângulo Sul in the state of Minas Gerais, Brazil.

Individuals aged 60 years old or older; residing in the urban area of the Health Macro-Region of the Triângulo Sul in the state of Minas Gerais; living by themselves; and having a landline telephone or a mobile phone, were included in the study. Those who no longer lived alone at the time of the interview (n=12) or presented impaired hearing (n=2) were excluded. A total of 279 individuals in the database met the criteria and composed the initial sample. Those who were not found after three attempts (n=134) or refused to participate (n=8) were considered losses. Hence, 123 elderly individuals composed this study’s final sample (Table 1).

Sociodemographic data and morbidities were obtained by applying a structured questionnaire developed by the Collective Health Research Group.

The instrument used to collect data concerning knowledge of the COVID-19 was developed by the authors based on information and recommendations of the Ministry of Health⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾. It contained questions addressing the occurrence of COVID-19, health services used, forms of transmission, signs and symptoms, and preventive measures. A pilot study was conducted by telephone with ten elderly individuals who were the researchers’ acquaintances and lived by themselves, to test, assess, revise, and refine the instrument.

The main COVID-19 preventive measures considered were: using face masks; handwashing with water and soap and/or sanitizing with alcohol gel; protecting the nose and mouth with a tissue or arm when coughing or sneezing; not touching the eyes, mouth or nose; leaving home only when necessary; keeping a minimum distance of 2 meters from other people; not kissing or handshaking; not receiving visits; and removing the shoes whenever returning home and sanitizing them, if possible; removing clothes and putting them in a plastic bag or laundering them; leaving purse, wallet, and keys in a box at the home entrance; keeping the home clean and ventilated; cleaning objects with water and soap or 70% alcohol; washing foods and products when getting back from the grocery store; getting enough sleep and eating healthy; and not sharing personal utensils such as cutlery, towels, plates or glasses⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾.

The variables included: sex (female or male); age range in complete years (60├70; 70├80; 80 or more); marital status (single, widowed, separated, or divorced); schooling years (none; 1├5; 5 or more); individual monthly income in terms of times of minimum wage (no income; ≤1; >1); number of morbidities (0; 1├5; 5 or more); presence of signs and symptoms of COVID-19 (yes; no); health service (primary health care unit; emergency service; private medical office; referral hospital; others); knowledge about COVID-19 (yes; no), forms of transmission (yes; no) and signs and symptoms (yes; no); source of information (TV; radio; family members; friends and internet); whether has left home during the quarantine (yes; no); whether implemented preventive measures when leaving home (yes; no); and average number of preventive measures known and implemented.

Data were collected among elderly individuals living by themselves in May 2020 by telephone. Experienced interviewers were previously trained on ethical issues and on how to conduct the interviews.

The interviews were recorded in an electronic database in Excel^® and then revised by the supervisors. Whenever necessary, the files were sent back to the interviewers to complement the information. After this stage, all interviewers’ databases were consolidated into a single one and transferred to Statistical Package for Social Sciences version 22.0 for analysis.

The absolute and relative frequencies of categorical variables were verified and the means and standard deviations were found for the quantitative variables. A preliminary bivariate analysis was performed using Student’s t-test to verify the factors associated with less knowledge concerning COVID-19 preventive measures. The variables of interest that met the criterion (p≤0.10) were included in the multiple linear regression model (p<0.05). The outcome was the average number of COVID-19 preventive measures the elderly participants were familiar with and the predictive variables were: sex, age range, monthly individual income; schooling; and number of morbidities. The following variables were dichotomized to perform the bivariate and multiple linear regression analyses: age range (60├80 years old; 80 years old or older); monthly individual income, times of minimum wage (>1; ≤1); and number of morbidities (0├5; 5 or more). The schooling variable was used in its quantitative form (complete years of schooling).

The Institutional Review Board approved the study project on May 13^th, 2020 under protocol No. 4.026.689. The interviews were conducted after the participants’ consent according to the guidelines established by Resolution 510/16, Ministry of Health⁽¹⁸18 Ministério da Saúde (BR). Conselho Nacional da Saúde. Resolução nº 510, de 07 de abril de 2016. Diário Oficial da União. Brasília, 07 abr 2016 [Acesso: 11 mai 2020]. Disponível em: https://conselho.saude.gov.br/resolucoes/2016/Reso510.pdf.
https://conselho.saude.gov.br/resolucoes... ⁾. After the interviews, the participants received instructions regarding preventive measures against COVID-19.

Results

Most elderly individuals were women (69.9%), aged 70├80 years old (45.5%), widowed (67.5%), had 1├5 years of schooling (54.5%), a monthly individual income >1 times the minimum wage (56.3%); and 1├5 morbidities (69.9%).

A larger portion of the participants did not present signs and symptoms of COVID-19 (97.5%) and those who did (n=2) reported dry cough; running nose and fatigue (50.0%); sought a private health service (50.0%), and tested negative for COVID-19 (50.0%).

A total of 96.3% of the elderly individuals were familiar with COVID-19 and their most frequent source of information was TV (96.6%); followed by radio (28.6%); family members (25.2%); friends (15.1%); and Internet (10.9%).

Most individuals were aware of how COVID-19 (86.6%) is transmitted and also about its signs and symptoms (90.8%). The form of transmission most frequently reported was handshaking (79.6%), followed by sneeze (72.8%), contaminated objects and surfaces (70.9%), and saliva droplets (33.0%). Regarding signs and symptoms, the most frequently reported were fever (73.1%); difficulty to breath (59.2%); sore throat, body ache and headache (52.8%); dry cough (26.8%); fatigue (13.9%); running nose (12.0%); loss of taste and smell (10.2%), and diarrhea (4.6%).

A total of 98.3% of the elderly participants were aware of the COVID-19 preventive measures, most frequently the use of face masks and hand sanitizing with soap and water or alcohol gel (Table 2). Among the 17 preventive measures assessed, the participants reported 3.98 (±1.76) on average.

After social distancing began, 85.7% of the elderly individuals left home and followed 2.58 (±1.91) preventive measures on average. Of these, 98.0% implemented preventive measures, mainly the use of face masks and handwashing with soap and water (Table 3).

The following variables met the criterion (p≤0.10) in the bivariate analysis and were included in the multiple linear regression final model: sex, age range, schooling, monthly individual income, and number of morbidities (Table 4).

Being a man, 80 years old or older, and having a lower level of education were associated with poor knowledge of COVID-19 preventive measures (Table 5).

Discussion

The higher percentage of women found in this study is in line with the reports of Brazilian studies⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. One study conducted in a city in Minas Gerais verified that most elderly individuals in the group who lived by themselves were women⁽¹⁹19 Bolina AF, Tavares DMS. Living arrangements of the elderly and the sociodemographic and health determinants: a longitudinal study. Rev. Latino-Am. Enfermagem. 2016;24:1-10. doi: http://dx.doi.org/10.1590/1518-8345.0668.2737
http://dx.doi.org/10.1590/1518-8345.0668... ⁾. The predominance of women among elderly individuals may be explained by the higher life expectancy among women in comparison to men, which is currently 80.25 years old in Brazil⁽²⁰20 Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação. [Internet]. Acesso: 5 jun 2020. Disponível em: https://www.ibge.gov.br/apps/populacao/projecao/
https://www.ibge.gov.br/apps/populacao/p... ⁾.

The larger percentage of widows may be related to the predominance of women and their life expectancy, though women are also more likely to live by themselves than remarrying or being the head of the family⁽²¹21 De Melo NCV, Teixeira KMD, Barbosa TL, Montoya AJA, Silveira MB. Household arrangements of elderly persons in Brazil: analyses based on the national household survey sample (2009). Rev Bras Geriatr Gerontol. [Internet]. 2016 [cited May 25, 2020];19(1):139-51. Available from: http://dx.doi.org/10.1590/1809-9823.2016.15011
http://dx.doi.org/10.1590/1809-9823.2016... ⁾.

Regarding age, similar results were found in a Brazilian study, in which a larger number of individuals aged 75 years old or older lived alone compared to younger individuals (p<0.001)⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. A Brazilian regional study, however, verified that most elderly individuals living by themselves were 60 to 69 years old⁽¹⁹19 Bolina AF, Tavares DMS. Living arrangements of the elderly and the sociodemographic and health determinants: a longitudinal study. Rev. Latino-Am. Enfermagem. 2016;24:1-10. doi: http://dx.doi.org/10.1590/1518-8345.0668.2737
http://dx.doi.org/10.1590/1518-8345.0668... ⁾. Individuals in advanced age living by themselves may face problems to use health services and perform daily tasks, which may become more difficult in the absence of family members⁽¹⁹19 Bolina AF, Tavares DMS. Living arrangements of the elderly and the sociodemographic and health determinants: a longitudinal study. Rev. Latino-Am. Enfermagem. 2016;24:1-10. doi: http://dx.doi.org/10.1590/1518-8345.0668.2737
http://dx.doi.org/10.1590/1518-8345.0668... ⁾.

Similar to these findings, a study verified that most elderly individuals living by themselves had from one to four years of schooling⁽¹⁹19 Bolina AF, Tavares DMS. Living arrangements of the elderly and the sociodemographic and health determinants: a longitudinal study. Rev. Latino-Am. Enfermagem. 2016;24:1-10. doi: http://dx.doi.org/10.1590/1518-8345.0668.2737
http://dx.doi.org/10.1590/1518-8345.0668... ⁾. Divergent data were found in a Brazilian survey in which the percentage of elderly individuals in single-person households (16.9%) had from eight to ten years of schooling⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. A low educational level negatively affects self-care behavior⁽⁹9 Malloy-Diniz LF, Costa DS, Loureiro F, Moreira L, Silveira BKS, Sadi HM, et al. Saúde mental na pandemia de COVID -19: considerações práticas multidisciplinares sobre cognição, emoção e comportamento. Ver Debates Psiquiatr. 2020 [Acesso 25 mai 2020]. Disponível em: https://d494f813-3c95-463a-898c-ea1519530871.filesusr.com/ugd/c37608_59b07f09964c41cc8bd976bc1cc0e402.pdf
https://d494f813-3c95-463a-898c-ea151953... ⁾ due to difficulties to access and assimilate information⁽¹⁰10 Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate Psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) Epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1-25. doi: 10.3390/ijerph17051729
https://doi.org/10.3390/ijerph17051729... ⁾.

Concerning monthly individual income, most of the participants living by themselves in a city in the interior of Minas Gerais received from one to three times the minimum wage⁽¹⁹19 Bolina AF, Tavares DMS. Living arrangements of the elderly and the sociodemographic and health determinants: a longitudinal study. Rev. Latino-Am. Enfermagem. 2016;24:1-10. doi: http://dx.doi.org/10.1590/1518-8345.0668.2737
http://dx.doi.org/10.1590/1518-8345.0668... ⁾, a piece of information that is in line with this study’s findings.

In times of COVID-19 pandemic, nurses should pay attention to the sociodemographic characteristics of elderly individuals living by themselves, considering that advanced age and low levels of education and income may hinder the acquisition of knowledge and adherence to preventive measures, as well as limit access to health services and decrease adherence to social isolation.

A similar result was found in a Brazilian study, which reports that 52.4% of the elderly individuals living by themselves presented two or more morbidities⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. This is a relevant aspect when assessing elderly individuals as the scientific literature describes that people with chronic diseases are more susceptible to the more severe manifestations of the COVID-19⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ⁾. The reason is that immunological functions may decrease with age and in the face of comorbidities, favoring the more severe forms of the COVID-19⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ^-66 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: https://doi.org/10.1016/S0140-6736(20)30566-3
https://doi.org/10.1016/S0140-6736(20)30... ⁾.

International studies report that the main signs and symptoms presented by individuals diagnosed with COVID-19 include fever, cough, fatigue, and body ache⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ^,2222 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: https://doi.org/10.1016/S0140-6736(20)30183-5
https://doi.org/10.1016/S0140-6736(20)30... ^-2323 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection in China. New England J Med. 2020. doi: 10.1101/2020.02.06.20020974
https://doi.org/10.1101/2020.02.06.20020... ⁾, the same symptoms presented by this study’s participants. Note that a few participants presented signs and symptoms, which makes sense considering the current COVID-19 panorama in the state of Minas Gerais, with smaller numbers of confirmed and suspected cases and deaths than in the remaining Brazilian states⁽²⁴24 Secretaria do Estado de Saúde de Minas Gerais (BR). Perfil geográfico da COVID-19 no estado de Minas Gerais e Informe Epidemiológico. [Internet]. Acesso em: 1 jun 2020. Disponível em: https://www.saude.mg.gov.br/coronavirus/painel
https://www.saude.mg.gov.br/coronavirus/... ⁾.

Despite the number of elderly individuals presenting signs and symptoms of COVID-19 in this study, this age group presents a less coordinated, less efficient and slower immune response, making them more susceptible to emerging infections such as the new coronavirus⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾. Additionally, some elderly individuals may feel intimidated or discouraged to report symptoms of this disease because society addresses aspects of aging negatively, mainly emphasizing its limitations⁽²⁶26 Hammerschmidt KSA, Santana RF. Saúde do idoso em tempos de pandemia Covid-19. Cogitare Enferm. [Internet]. 2020 [Acesso: 25 mai 2020];25. Disponível em: http://dx.doi.org/10.5380/ce.v25i0.72849
http://dx.doi.org/10.5380/ce.v25i0.72849... ⁾; even considering the provision of priority health care to elderly individuals in comparison to younger individuals unnecessary, which may negatively impact their perception.

In this context, nurses should screen elderly individuals with signs and symptoms of the COVID-19 and verify the need to perform a physical assessment in person and monitor these individuals’ conditions, instructing about the need to comply with the quarantine period and having their condition reassessed until the symptoms disappear completely.

Most of the individuals addressed in this study reported they acquired knowledge about COVID-19 by watching TV. This finding is in line with a Brazilian study addressing the behavior of the elderly, in which 31.2% of those living by themselves watched TV for five or more hours a day. The prevalence of this activity was 40.0% greater among those living by themselves than among elderly individuals who lived with other people⁽¹¹11 Negrini ELD, Nascimento CF, Silva A, Antunes JLF. Elderly persons who live alone in Brazil and their lifestyle. Rev Bras Geriatr Gerontol. [Internet]. 2018 [cited May 26, 2020];21(5):523-31. Available from: https://doi.org/10.1590/1981-22562018021.180101
https://doi.org/10.1590/1981-22562018021... ⁾. Even though watching TV for long periods is sedentary behavior, in this pandemic, it was a considerable source of information among those living by themselves. Note that this behavior may facilitate the acquisition of information concerning COVID-19, and objectively and reliable information can improve the perceived effectiveness of COVID-19-oriented behaviors, positively affecting the adoption of measures prescribed to fight the pandemic⁽⁹9 Malloy-Diniz LF, Costa DS, Loureiro F, Moreira L, Silveira BKS, Sadi HM, et al. Saúde mental na pandemia de COVID -19: considerações práticas multidisciplinares sobre cognição, emoção e comportamento. Ver Debates Psiquiatr. 2020 [Acesso 25 mai 2020]. Disponível em: https://d494f813-3c95-463a-898c-ea1519530871.filesusr.com/ugd/c37608_59b07f09964c41cc8bd976bc1cc0e402.pdf
https://d494f813-3c95-463a-898c-ea151953... ⁾.

The knowledge of the participants regarding how COVID-19 is transmitted is consonant with studies reporting the permanence of the virus on surfaces for hours to days⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ⁾ when expelled through cough or sneeze⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ^-2828 Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020;109(102133):1-34. doi: https://doi.org/10.1016/j.jaut.2020.102433
https://doi.org/10.1016/j.jaut.2020.1024... ⁾, and the need to avoid handshaking and touching contaminated surfaces⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ⁾, considering that a single droplet may contain an infectious dose⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ⁾.

An international study reports that 71.7% of elderly individuals had knowledge of three symptoms of COVID-19⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ⁾, which is in line with the mean identified in this study. The infectious condition with the onset of fever is the clinical symptoms more commonly identified in COVID-19⁽²⁹29 Velavan TP, Mayer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-80. doi: http://dx.doi.org/10.1111/tmi.13383
http://dx.doi.org/10.1111/tmi.13383... ^-3030 Nascimento IJB, Cacic N, Abdulazeem HM, Von Groote TC, Jayarajah U, Weerasekara I, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med. 2020;9(4):941-55. doi: https://doi.org/10.3390/jcm9040941
https://doi.org/10.3390/jcm9040941... ⁾, considered essential to screening the disease⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾, which is corroborated by the elderly individuals’ reports. The period in which fever manifests, however, is unknown⁽³⁰30 Nascimento IJB, Cacic N, Abdulazeem HM, Von Groote TC, Jayarajah U, Weerasekara I, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med. 2020;9(4):941-55. doi: https://doi.org/10.3390/jcm9040941
https://doi.org/10.3390/jcm9040941... ⁾. Elderly individuals may present temperatures below that presented by other population groups⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾, which shows the need for monitoring and frequently assessing individuals’ thermal curve and associate it with other complaints of an infectious nature that may be related to COVID-19, such as respiratory symptoms and body ache.

Because it is considered an acute respiratory syndrome, symptoms such as difficulty breathing are commonly identified in the scientific literature⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾, which is similar to what the individuals addressed in this study recognized in themselves, that is, dyspnea may be confounded with some other comorbidity such as heart failure, rather than recognized as a new complaint or suspicion of COVID-19⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾. Additionally, pulmonary changes such as pneumonia accruing from severe infection may exacerbate respiratory symptoms and require hospitalization⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾, leading to greater vulnerability and decreasing the likelihood of survival, especially among the elderly.

Additionally, people may complain of body ache, fatigue, and malaise⁽⁵5 Chen N, Zhou M, Dong X, Jieming Q, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. doi: https://doi.org/10.1016/S0140-6736(20)30211-7
https://doi.org/10.1016/S0140-6736(20)30... ^,2929 Velavan TP, Mayer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-80. doi: http://dx.doi.org/10.1111/tmi.13383
http://dx.doi.org/10.1111/tmi.13383... ⁾. One scoping review and meta-analysis identified that 36% of the patients reported body ache, 12% reported headache, and 10% sore throat⁽³⁰30 Nascimento IJB, Cacic N, Abdulazeem HM, Von Groote TC, Jayarajah U, Weerasekara I, et al. Novel coronavirus infection (COVID-19) in humans: a scoping review and meta-analysis. J Clin Med. 2020;9(4):941-55. doi: https://doi.org/10.3390/jcm9040941
https://doi.org/10.3390/jcm9040941... ⁾. When the percentages are totaled, the results are similar to those found in this study, in which 52.8% of the elderly participants living by themselves reported being aware of these COVID-19 symptoms.

Nurses, together with the multiprofessional team, should encourage elderly individuals to perform self-care and be attentive to the emergency of signs and symptoms related to COVID-19, emphasizing the importance of reporting signs and symptoms to the primary health care team to assess the situation and follow-up of government protocols. The infection by the novel coronavirus among elderly individuals usually presents atypical manifestations, which hinder its early identification and control, so that preventive measures are key to manage and control COVID-19⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾.

One international study verified that 69.8% of the elderly individuals were aware of three preventive measures to combat COVID-19⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ⁾, which is below the number found in this study. Nonetheless, even though most of the elderly participants were familiar with the preventive measures, they reported four measures on average, which is a low number if we consider the 17 measures recommended by the Ministry of Health⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ⁾.

The use of face masks is a measure adopted worldwide to prevent and control COVID-19, which has been widely reported by scientific studies⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ^,3131 Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020;9(29):1-12. doi: http://dx.doi.org/10.1186/s40249-020-00646-x
http://dx.doi.org/10.1186/s40249-020-006... ^-3232 Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet. 2020;7(4):300-2. doi: http://dx.doi.org/10.1016/S2215-0366(20)30073-0
http://dx.doi.org/10.1016/S2215-0366(20)... ⁾ and is in line with this study’s findings. The purpose of wearing masks is to protect all individuals, both healthy individuals and those diagnosed with the disease, to control the transmission and avoid new contaminations⁽³³33 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3... ⁾. The implementation of this practice alone is not sufficient to protect and control the disease, that is, it must be associated with other measures, such as hand washing and the use of alcohol gel⁽³³33 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3... ⁾.

Handwashing, one of the COVID-19 preventive measures, reflects the knowledge reported by elderly individuals living by themselves. The main form the virus is spread is from person to person through droplets, followed by aerosols⁽²⁵25 Nikolich-Zugich J, Knox KS, Rios CT, Natt B, Bhattacharya D, Fain MJ. SARS-CoV-2 and COVID-19 in older adults: what we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience. 2020;42(1013):505-14. doi: 10.1007/s11357-020-00186-0
https://doi.org/10.1007/s11357-020-00186... ⁾, and hands are the main route of cross-contamination⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ⁾. The virus may remain on surfaces and in the environment for different periods, ranging from hours to days⁽³⁴34 Doremalen VN, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1-4. doi: https://doi.org/10.1056/NEJMc2004973
https://doi.org/10.1056/NEJMc2004973... ⁾. For this reason, besides being a low-cost practice, hand sanitation is highly effective and is considered one of the most relevant measures to prevent COVID-19⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ⁾.

The elderly individuals living by themselves also reported the use of gel alcohol as a preventive measure, emphasized by health and government organizations since the beginning of the COVID-19 pandemic⁽³³33 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3... ^,3535 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾. Nonetheless, for microorganisms to be inactivated and levels of infection and transmission to decrease, the alcohol needs to present a concentration between 62% and 71%⁽³⁶36 Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. J Hosp Infect. 2020;104(3):246-51. doi: https://doi.org/10.1016/j.jhin.2020.01.022
https://doi.org/10.1016/j.jhin.2020.01.0... ⁾. Its use is necessary in environments outside the home where water and soap are not readily available, whenever one has physical or close contact with people, objects, or surfaces that may be contaminated.

Note that social distancing was not a preventive measure most frequently reported by the elderly individuals, which is opposed to the expressive dissemination in the media and scientific studies of its needs and positive effects in the control of the transmission of COVID-19⁽³²32 Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet. 2020;7(4):300-2. doi: http://dx.doi.org/10.1016/S2215-0366(20)30073-0
http://dx.doi.org/10.1016/S2215-0366(20)... ^,3737 Fiorillo, A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiat. 2020;63(1):1-4. doi: http://dx.doi.org/10.1192/j.eurpsy.2020.35
http://dx.doi.org/10.1192/j.eurpsy.2020.... ⁾.

One study conducted in the state of Ceará, Brazil reports that elderly people partially adhered to social distancing and received visits (62.5%)⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾. The same was found in this study, in which most elderly individuals left their homes during the time social distancing was recommended. Even though the Brazilian authorities emphasize social distancing, specifically for the groups most susceptible to develop the severe form of the disease⁽¹1 Ministério da Saúde (BR). Protocolo de Manejo Clínico para o Novo Coronavírus (2019-nCOV). [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 16 abr 2020]. Disponível em: https://portalarquivos2.saude.gov.br/images/pdf/2020/fevereiro/11/protocolo-manejo-coronavirus.pdf
https://portalarquivos2.saude.gov.br/ima... ^-22 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Geneva: WHO; 2020 [cited Jun 1, 2020]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
https://www.who.int/emergencies/diseases... ^,2626 Hammerschmidt KSA, Santana RF. Saúde do idoso em tempos de pandemia Covid-19. Cogitare Enferm. [Internet]. 2020 [Acesso: 25 mai 2020];25. Disponível em: http://dx.doi.org/10.5380/ce.v25i0.72849
http://dx.doi.org/10.5380/ce.v25i0.72849... ^,3232 Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet. 2020;7(4):300-2. doi: http://dx.doi.org/10.1016/S2215-0366(20)30073-0
http://dx.doi.org/10.1016/S2215-0366(20)... ^,3737 Fiorillo, A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiat. 2020;63(1):1-4. doi: http://dx.doi.org/10.1192/j.eurpsy.2020.35
http://dx.doi.org/10.1192/j.eurpsy.2020.... ⁾, one needs to consider and understand the reasons that lead these individuals to leave their homes.

Individuals living by themselves and without social support need to run errands to meet their needs, such as: go to the grocery store and pay bills, among others, while the information they received may not have been sufficient to convince them of the need to adhere to social distancing. Emotional aspects such as loneliness also need to be considered in addition to beliefs and values. One Brazilian study reports that elderly individuals believed that the pandemic would be less severe in Brazil than in other countries⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾. Note that the way individuals respond to situations, such as a pandemic, vary according to their engagement in preventive care, and how they address problems and search for solutions⁽⁹9 Malloy-Diniz LF, Costa DS, Loureiro F, Moreira L, Silveira BKS, Sadi HM, et al. Saúde mental na pandemia de COVID -19: considerações práticas multidisciplinares sobre cognição, emoção e comportamento. Ver Debates Psiquiatr. 2020 [Acesso 25 mai 2020]. Disponível em: https://d494f813-3c95-463a-898c-ea1519530871.filesusr.com/ugd/c37608_59b07f09964c41cc8bd976bc1cc0e402.pdf
https://d494f813-3c95-463a-898c-ea151953... ⁾. Hence, in this context in which multiple factors may interfere in the low adherence of elderly individuals to social distancing, nurses need to identify the motivations of these individuals and establish joint actions to decrease the likelihood of them being contaminated by the COVID-19, such as: having instrumental and emotional support provided by family members and friends and identifying activities to spend time at home, among others.

The average number of preventive measures adopted by the individuals addressed in this study when leaving home was below the number of measures they reported to be familiar with. The most widely known measures, the use of face masks and handwashing with soap and water, were the ones most frequently adopted, followed by avoiding crowded places.

The use of masks was also verified in a systematic review with meta-analysis, which reports an association between its use and the protection of healthy individuals at home and whenever social interaction is necessary⁽³⁸38 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020. doi: https://doi.org/10.1016/S0140-6736(20)31142-9
https://doi.org/10.1016/S0140-6736(20)31... ⁾. Its use involves a series of measures though, necessary to keep it viable, without becoming an object of new contaminations. For this reason, for a mask to function as a mechanical barrier against the novel coronavirus⁽³⁵35 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾, one should follow recommendations on how to put and remove it, how to sanitize it, and regarding the period it remains viable, up to its discard⁽³⁵35 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾.

The use of masks is coupled with hand sanitation, the second preventive measure the elderly individuals reported, which is consistent with the literature⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ^,3333 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3... ^,3535 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾. Nonetheless, even when implementing the aforementioned measures, agglomerations should be avoided⁽³³33 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3...

34 Doremalen VN, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1-4. doi: https://doi.org/10.1056/NEJMc2004973
https://doi.org/10.1056/NEJMc2004973... ^-3535 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾.

Even though these measures are recommended⁽³³33 World Health Organization. Advice on the use of masks in the context of COVID-19: Interim Guidance. [Internet]. Geneva: WHO; 2020 [cited Jun 7, 2020]. Available from: https://apps.who.int/iris/handle/10665/332293
https://apps.who.int/iris/handle/10665/3...

34 Doremalen VN, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1-4. doi: https://doi.org/10.1056/NEJMc2004973
https://doi.org/10.1056/NEJMc2004973... ^-3535 Ministério da Saúde (BR). Máscaras caseiras podem ajudar na prevenção contra o coronavírus. [Internet]. Brasília: Ministério da Saúde; 2020 [Acesso 7 jun 2020]. Disponível em: https://www.saude.gov.br/noticias/agencia-saude/46645-mascaras-caseiras-podem-ajudar-na-prevencao-contra-o-coronavirus
https://www.saude.gov.br/noticias/agenci... ⁾ to ensure greater protection against transmission, one has to implement various measures together⁽²⁷27 Oliveira AC, Lucas TC, Iquiapaza RA. What has the COVID-19 pandemic taught us about adopting preventive measures? Texto Contexto Enferm. [Internet]. 2020 [cited Jun 1, 2020];29:1-15;29:e20200106. Available from: https://doi.org/10.1590/1980-265X-TCE-2020-0106
https://doi.org/10.1590/1980-265X-TCE-20... ^,3131 Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty. 2020;9(29):1-12. doi: http://dx.doi.org/10.1186/s40249-020-00646-x
http://dx.doi.org/10.1186/s40249-020-006... ^-3232 Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet. 2020;7(4):300-2. doi: http://dx.doi.org/10.1016/S2215-0366(20)30073-0
http://dx.doi.org/10.1016/S2215-0366(20)... ⁾, such as those necessary to implement when returning home, which few participants reported.

Considering that behavioral change depends on the context one is inserted in, and is characterized by the unpredictability of different sociodemographic and economic characteristics⁽³⁹39 Lodge EK, Schatz AM, Drake JM. Protective Population Behavior Change in Outbreaks of Emerging Infectious Disease. Europe PMC. [Internet]. 2020 [cited Jun 1, 2020]. Available from: http://dx.doi.org/10.1101/2020.01.27.921536
http://dx.doi.org/10.1101/2020.01.27.921... ⁾, these findings reinforce the need for nurses to implement educational actions together with elderly individuals by using effective communication.

The association identified in this study between being a man and having poor knowledge of measures to prevent COVID-19 is in line with the reports of studies conducted in the United States with adults and elderly individuals living in the community in which elderly men presented less knowledge of preventive measures than women and adult individuals (p<0.001)⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ^-88 Barber SJ, Kim H. COVID-19 Worries and Behavior Changes in Older and Younger Men and Women. J Gerontol B Psychol Sci Soc Sci. 2020;1-7. doi: https://10.1093/geronb/gbaa068
https://10.1093/geronb/gbaa068... ⁾.

The little knowledge of COVID-19 preventive measures among the elderly men may be related to the fact that they do not value self-care; are little concerned with their health, and have difficulties sharing their feelings and verbalizing their needs⁽⁴⁰40 Bibiano AMB, Moreira RS, Tenório MMGO. Factors associated with the use of the health services by elderly men: a systematic review of the literature. Ciênc Saúde Coletiva. 2019;24(6):2263-78. doi: https://doi.org/10.1590/1413-81232018246.19552017
https://doi.org/10.1590/1413-81232018246... ⁾. This context may also affect the mortality rates caused by COVID-19, which are higher among male elderly individuals⁽⁴¹41 Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA. 2020;323(13):1239-42. doi: https://doi.org/10.1001/jama.2020.2648.
https://doi.org/10.1001/jama.2020.2648...

42 Remuzzi A, Remuzzi G. COVID-19 and Italy: What next? Lancet. 2020;395(10231):1225-8. doi: https://doi.org/10.1016/S0140-6736(20)30627-9
https://doi.org/10.1016/S0140-6736(20)30... ^-4343 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Boletim Epidemiológico Especial COE-COVID 19. Semana Epidemiológica 21 (17 a 23/05), 2020. Acesso: 5 jun 2020. Disponível em: https://www.saude.gov.br/images/pdf/2020/May/29/2020-05-25---BEE17---Boletim-do-COE.pdf
https://www.saude.gov.br/images/pdf/2020... ⁾. In Italy, 83.0% of the deaths occurred among 60-year-old or older individuals; 80% of whom were men⁽⁴²42 Remuzzi A, Remuzzi G. COVID-19 and Italy: What next? Lancet. 2020;395(10231):1225-8. doi: https://doi.org/10.1016/S0140-6736(20)30627-9
https://doi.org/10.1016/S0140-6736(20)30... ⁾. The last Epidemiological Bulletin published on May 23^rd, 2020 reports that 69.4% of the deaths caused by COVID-19 in Brazil were among 60-year-old or older individuals, while 60.2% of them were men⁽⁴³43 Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Boletim Epidemiológico Especial COE-COVID 19. Semana Epidemiológica 21 (17 a 23/05), 2020. Acesso: 5 jun 2020. Disponível em: https://www.saude.gov.br/images/pdf/2020/May/29/2020-05-25---BEE17---Boletim-do-COE.pdf
https://www.saude.gov.br/images/pdf/2020... ⁾. According to the Epidemiological Report of the COVID-19 pandemic, published on June 6^th, 2020, 72.7% of the deaths in Minas Gerais were among the elderly, 53.0% of whom were men⁽²⁴24 Secretaria do Estado de Saúde de Minas Gerais (BR). Perfil geográfico da COVID-19 no estado de Minas Gerais e Informe Epidemiológico. [Internet]. Acesso em: 1 jun 2020. Disponível em: https://www.saude.mg.gov.br/coronavirus/painel
https://www.saude.mg.gov.br/coronavirus/... ⁾.

In this context, educational actions in the nursing field should be planned to reach elderly men living by themselves. In addition to educational practices within the healthcare network⁽⁴⁴44 Oliveira HSB, Manso MEG. The iatrogenic triad in a group of elderly women contracted to a health plan. Rev Bras Geriatr Gerontol. [Internet]. 2019 [cited Jun 1, 2020];22(1):e180188. doi: https://doi.org/10.1590/1981-22562019022.180188
https://doi.org/10.1590/1981-22562019022... ⁾, nurses’ competencies such as preventive actions and the early detection of infections by the novel coronavirus should be implemented during gerontological nursing consultations.

In line with this study, one international study addressing adult and elderly individuals in the community reports that individuals of advanced age and those living by themselves presented a lower level of knowledge of COVID-19 (p<0.001)⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ⁾, showing that older individuals are more vulnerable to the infection caused by the novel coronavirus⁽⁶6 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. doi: https://doi.org/10.1016/S0140-6736(20)30566-3
https://doi.org/10.1016/S0140-6736(20)30... ⁾. These circumstances reinforce the need for actions and specific interventions for 80 years-old or older individuals living by themselves, as they may need more complex care with greater investment in health, like in the case of the infection caused by the novel coronavirus⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ⁾.

The bond established between long-lived individuals and health workers was associated with preventive measures to combat COVID-19 (p=0.008) in a study conducted in the state of Ceará, Brazil⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾. This bond contributes to elderly individuals being more pro-active in the health-disease continuum and also promote the delivery of comprehensive health care⁽⁴⁵45 Sousa FJD, Gonçalves LHT, Paskulin LGM, Gamba MA. Sociodemographic profile and social support of elderly persons in primary care. Rev Enferm UFPE On Line. 2018;12(4):824-31. doi: https://doi.org/10.5205/1981-8963-v12i4a22855p824-831-2018
https://doi.org/10.5205/1981-8963-v12i4a... ⁾. The primary health care policy provides for the establishment of bonding and co-accountability between health teams and the population, ensuring the continuity of actions as well as establishing the service as a reference for these individuals⁽⁴⁶46 Brasil. Portaria nº 2.436, de 21 de setembro de 2017. Estabelece a revisão de diretrizes da Política Nacional de Atenção Básica (PNAB), no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União, 22 set 2017. Acesso em: 2 jun 2020. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html
https://bvsms.saude.gov.br/bvs/saudelegi... ⁾. From this perspective, bonding emerges as a fundamental element to favor the adherence of elderly individuals who live by themselves to the COVID-19 preventive measures.

One study conducted in the United States also found that elderly individuals (p<0.001), as well as those living alone (p<0.001), and with a low educational level (p<0.001), presented the worst level of knowledge concerning COVID-19⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ⁾. The low educational level of the elderly individuals may be considered a risk factor for the dissemination of viral infections and death⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ^,1616 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾, considering that it may negatively influence the way elderly individuals understand and perform self-care⁽⁴⁷47 Chaves JRF. Educação ao longo da vida: perspectivas para uma sociedade que envelhece. In: Câmara dos Deputados. Centro de Estudos e Debates Estratégicos. Brasil 2050: Desafios de uma nação que envelhece. Brasília; 2017. p. 103-20. (Estudos Estratégicos, n. 8). Acesso em: 1 jun 2020. Disponível em: http://bd.camara.leg.br/bd/bitstream/handle/bdcamara/31619/desafios_envelhece_conle.pdf?sequence=1
http://bd.camara.leg.br/bd/bitstream/han... ⁾. Additionally, a low educational level may be associated with an individual’s social status, suggesting that lifestyle, living conditions, and knowledge concerning COVID-19 influence its prognosis⁽⁷7 Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis LM, Benavente JY, et al. Awareness, Attitudes, and Actions Related to COVID-19 Among Adults With Chronic Conditions at the Onset of the U.S. Outbreak: A Cross-sectional Survey. Ann Intern Med. [Internet]. 2020 [cited May 25, 2020]. Available from: https://doi.org/10.7326/M20-1239
https://doi.org/10.7326/M20-1239... ^,1616 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾. Therefore, less educated elderly individuals would be more prone to the infection caused by the novel coronavirus because they use crowded public transportation and have poor access to medical resources⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾.

This context represents a challenge for health workers, especially nurses providing care to elderly individuals living by themselves with a low educational level. For this reason, strategies that favor the knowledge and adherence to measures that prevent the spread and transmission of COVID-19 are needed⁽¹⁶16 Lima DLF, Dias AD, Rabelo RS, Cruz ID, Costa SC, Nigri FMN, et al . Covid-19 in the State of Ceará: behaviors and beliefs in the arrival of the pandemic. Ciênc Saúde Coletiva. [Internet]. 2020 [cited Jun 2, 2020];25(5):1575-86. Available from: https://doi.org/10.1590/1413-81232020255.07192020.
https://doi.org/10.1590/1413-81232020255... ⁾. Nurses should attempt to use efficient communication with these individuals, using clear and objective language when addressing the care necessary to prevent this disease. Communication in the nursing scope is an essential strategy in the care provided to elderly individuals because it encourages individuals to trust health workers and expose their needs, promoting positive interaction between care recipients and nurses⁽⁴⁸48 Silva JPG, Costa KNFM, Silva GRF, Oliveira SHS, Almeida PC, Fernandes MGM. Nursing consultation for the elderly: instruments of communication and nursing roles according to Peplau. Esc Anna Nery. [Internet]. 2015 [cited May 25, 2020];19(1):154-61. Available from: https://doi.org/10.5935/1414-8145.20150021
https://doi.org/10.5935/1414-8145.201500... ⁾.

One of this study’s limitations refers to its cross-sectional design, which does not allow for the establishment of causal effects, and its sample, which was restricted to individuals who had a landline phone or a mobile. The results, however, contribute to the advancement of scientific knowledge, supporting the practice of nurses providing care in times of pandemic to elderly individuals living by themselves. This study’s findings reinforce the need for health actions promoting measures to prevent the COVID-19 infection among the elderly, paying attention and implementing strategies that are specific to elderly men, aged 80 years old or older, with a low educational level. Additionally, the results can also direct the practice of nurses working in the primary health care network and having greater contact with these individuals, to perform nursing actions intended to prevent the infection by the novel coronavirus.

Conclusion

A higher percentage of elderly individuals living by themselves did not present any signs or symptoms of COVID-19 and were aware of its forms of transmission. The form of transmission most frequently reported was shaking hands and the most frequently reported symptom was fever.

The elderly participants reported knowledge of four preventive measures on average; while the use of masks prevailed. The implementation of three measures on average was reported by the elderly individuals when they left their homes though, the most frequent of which was the use of face masks.

Being an 80-year-old or older man and having a low educational level were associated with having less knowledge regarding the COVID-19 preventive measures.

These results can support the planning of social and health actions directed to the elderly population living alone in the face of the COVID-19 pandemic.

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