With the arrival of the SARS-CoV-2 virus and associated Coronavirus Disease 19 (COVID-19) to the U.S. in March 2020 came an extraordinary shift in daily living. Social distancing (SD) and sheltering in place (SIP), while essential in the fight against COVID-19, have created unique challenges for the health and well-being of older adults, and in particular those with mild cognitive impairment (MCI) and Alzheimer?s disease and related dementia (ADRD). Decreased socialization for many community-dwelling older adults has led to increased feelings of isolation and loneliness, both of which has been shown in numerous studies to lead to adverse outcomes. For this supplement application, ?Social Isolation and Loneliness due to COVID-19: Effect on Cognitive, Physical, and Mental Health in Older Adults in the SAGES Study, we propose two related sub- projects: Sub-Project 1 will examine the effects of COVID-19 related loneliness on cognitive, physical, and mental health in the Successful Aging After Elective Surgery (SAGES I) Study (NIA grant P01 AG031720, PI Inouye), an ongoing prospective cohort study of 315 older adults with an average age of 84 years old, who have been followed after elective major non-cardiac surgery with serial cognitive, physical and functional measures. We will use this well-characterized cohort to (1) Examine potential predictors of loneliness resulting from social distancing, (2) Examine the effect of loneliness on cognitive function in persons with and without MCI or ADRD, and (3) Examine the effect of loneliness on physical and mental health in persons with and without MCI or ADRD. We hypothesize that the SIP order due to the SARS-CoV-2 pandemic will increase loneliness in older adults, and for those with pre-existing MCI and ADRD, loneliness will be associated with greater declines in cognitive, physical and mental health compared to those without MCI and ADRD. In addition to their established annual visit, all SAGES follow-up participants will undergo extra telephone interviews for this project, two at the start of the study and two 6 months later. The interview will include measures of loneliness, social network size, social and physical activities, technology use, pre-existing cognitive and functional or mobility impairment, cognition, anxiety, depression, and COVID-19 infection or exposure. Hospitalizations, medical visits, falls, nursing home placement, new prescription medication use, and death will be determined. Sub-Project 2 will allow us to convert study procedures to remote assessments during the time of COVID-19; and to harmonize and validate the SAGES neuropsychological assessment administered via telephone, videoconferencing, and in-person modes. This study will generate statistically comparable scores across our approaches to examine cognitive trajectories over time. Significance: This study will allow us to evaluate the effect of COVID-19 related loneliness on cognitive, physical, and mental health in older adults and in those with MCI or ADRD. Moreover, this study will allow us to adapt our study procedures to remote during COVID-19 and to cross-validate our remote assessment with phone and in-person modes.
The SARS-CoV-2 virus and associated Coronavirus Disease 19 (COVID-19) pandemic has caused an extraordinary shift in our daily living due to mandatory orders to socially distance and shelter-in-place, putting older adults at risk for increased loneliness and subsequent poor cognitive, physical, and mental health. Persons with mild cognitive impairment or Alzheimer?s Disease and Related Disorders (ADRD) may be at particular risk for poor outcomes due to COVID-19 related loneliness.
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