Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic.

Background: The COVID-19 pandemic has disproportionately impacted the most vulnerable and widened the health disparity gap in both physical and mental well-being. Consequentially, it is vital to understand how to best support elderly individuals, particularly Black Americans and people of low socioeconomic status, in navigating stressful situations during the COVID-19 pandemic and beyond. The aim of this study was to investigate perceived levels of stress, posttraumatic growth, coping strategies, socioeconomic status, and mental health between Black and non-Hispanic, White older adults, the majority over the age of 70. Additionally, we investigated which variables, if any, were associated with posttraumatic growth in these populations. Methods: One hundred seventy-six community dwelling older adults (mean age = 76.30 ±8.94), part of two observational studies (The Harvard Aging Brain Study and Instrumental Activities of Daily Living Study) in Massachusetts, US, were included in this cross-sectional study. The survey, conducted from March 23, 2021 to May 13, 2021, measured perceived stress, behavioral coping strategies, posttraumatic growth, and mental health during the COVID-19 pandemic. We investigated associations with post-traumatic growth in a multiple linear regression model and examined their differences by race with t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests. A second multiple linear regression model was used to examine which coping strategies were associated with posttraumatic growth. Findings: Our results indicated no significant difference between the groups in terms of mental health or stress. However, Black participants showed significantly greater posttraumatic growth compared to non-Hispanic, White participants. Additionally, the coping strategies of religion and positive reframing were found to be significantly associated with posttraumatic growth. Furthermore, even with the effects of stress and coping strategies controlled for, race remained significantly associated with posttraumatic growth. Interpretation: The COVID-19 pandemic has differentially impacted Black and non-Hispanic White older adults. These results may help encourage further analysis on geriatric psychiatry as well as understanding how cultural values and adaptations impact posttraumatic growth and mental health in diverse populations. Funding: The Harvard Aging Brain Study (HABS) has been funded by NIH-NIA P01 AG036694 (PI: Reisa Sperling). The IADL study is funded by the National Institute on Aging (R01 AG053184, PI: Gad A. Marshall).

Greater psychological resilience during the COVID-19 pandemic is associated with lower tau burden in cognitively unimpaired individuals

Background The outbreak of the 2019 novel coronavirus SARS-CoV-2, causing the COVID-19 pandemic, along with the global measures used to control the spread of the disease, have been particularly stressful for older individuals. Robust evidence suggests that stress-related physiological processes may play a significant role in the onset of age-related cognitive decline and dementia, such as Alzheimer?s disease (AD). For example, previous animal and human research have shown that stress exacerbates tau pathology and subsequent cognitive impairment. One important factor determining a person?s level of stress is psychological resilience, which refers to a person?s ability to return to equilibrium when difficulties occur. As such, resilience may buffer and protect individuals against the deleterious effects of stress. The objectives of this study were to examine the relationship between psychological resilience and tau burden in cognitively unimpaired individuals, and to evaluate whether amyloid (Aß) pathology modifies this relationship. Method A total of 114 older adults (mean age=74.5;66 females (57.9%)) enrolled in the Harvard Aging Brain Study or the Instrumental Activities of Daily Living study completed an electronic survey online including measures of psychological resilience (Connor-Davidson Resilience Scale-10, where a higher score indicates greater resilience) during the COVID-19 pandemic period (May 2020). We used previously collected (mean time from survey=1.75 year) PET imaging data to assess Aß and tau burden. Results Overall, participants demonstrated high levels of resilience (mean=29.5,range=9-40). Multiple regression analyses (correcting for age, gender and time difference between survey and PET) demonstrated an interaction between resilience and amyloid on tau pathology (ß=-0.01,p=0.015, Figure1). Specifically, in Aß+ individuals (SUVR>1.324), those with higher psychological resilience also had lower tau pathology. No relationship was seen in Aß- individuals. Conclusion Our findings suggest that greater resilience during the pandemic is associated with lower tau burden in individuals at higher risk of cognitive decline (i.e. preclinical AD). Future studies are needed to determine the impact of stress and psychological resilience on prospective pathological brain changes and subsequent cognitive decline. Furthermore, resilience may be an important target for interventions to support older adults navigating stressful situations and to lessen the influence of stressors on AD pathological processes.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America

Background In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic?s impact on the well-being and cognition of older adults within and outside of the United States (US). Method 1,747 (646 White, 991 Latino, 77 Black, 33 Asian;72% female) individuals from the US and 14 Latin American countries completed an online survey regarding well-being and cognition during the pandemic. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups, and Latinos living in the US and Latin America. Result Mean age was 66·5 (SD = 7·70) years and mean education was 15·4 (SD = 2·76) years. We found no differences in the pandemic?s overall impact across US ethnoracial groups. Compared to Whites, Latinos reported greater economic impact (p < ·001, ?p2 = .031);while Blacks reported experiencing discrimination more often (p < ·001, ?p2 = .050). Blacks and Latinos reported more positive coping (p < ·001, ?p2 = 040). Latin American Latinos reported greater pandemic impact (p < ·001, ?p2 =.013 ), more positive coping (p =·006, ?p2 =.008 ), and less discrimination than US Latinos (p < ·001, ?p2 = .013 ). Conclusion The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic?s impact.

Resilience and perceived stress in cognitively normal older adults during the COVID-19 pandemic

Background Psychological resilience, a construct representing a person?s ability to return to their baseline when difficulties occur, can play an important role in determining outcomes in the face of stressors. Resilience is a crucial component to consider during times of prolonged stress, such as experienced during the coronavirus disease (COVID-19) pandemic, given that chronic stress has been associated with cognitive decline and dementia. Here, we investigated whether psychological resilience modified levels of perceived stress (assessed over 7 months), as well as examined the influence of demographic variables and Alzheimer?s disease biomarkers on this relationship. Method In May-November 2020 of the COVID-19 pandemic, 39 cognitively normal participants (mean age=78.38;53.85% female) in the Harvard Aging Brain Study (HABS) completed questionnaires assessing stress (Perceived Stress Scale, PSS) and resilience (only at baseline;Connor-Davidson Resilience Scale), higher scores on each measure indicating greater stress and increased resilience, respectively. We used previously collected data to better characterize the cohort, with the Preclinical Alzheimer Cognitive Composite (PACC;mean=0.46, SD=0.79) to assess cognition, and PET imaging data to assess Aß burden. A hierarchical regression model was used to assess whether resilience could predict baseline perceived stress. A separate linear mixed effect model (LME) was used to explore how resilience, time, and their interaction may affect stress. Both models also included age, sex, education, cognition, and Aß status (SUVR>1.324). Result Perceived stress levels were generally low (mean=13.54, SD=8.65, range=0-35), and did not significantly vary over the study period (p>0.5;mean number of timepoints=3.13). Both models demonstrated a main effect of resilience, such that higher resilience was associated with lower stress levels (p<0.001;Figure 1). Perceived stress was not influenced by demographic factors, cognition or Aß status. No significant interaction was found between resilience and time in predicting stress levels longitudinally. Conclusion Our findings confirm that resilience is critical for coping with stress during the COVID-19 pandemic, suggesting that resilience could be an important target for potential interventions in the future. Efforts at increasing resilience could not only help support older adults navigating stressful situations, but may also mitigate negative effects of stress on neurocognitive and mental health.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America.

BACKGROUND: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. METHODS: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. FINDINGS: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. INTERPRETATION: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact. FUNDING: Massachusetts General Hospital Department of Psychiatry.

Stress, resilience, and coping strategies in a sample of community-dwelling older adults during COVID-19.

Assessing the impact of the COVID-19 pandemic on perceived stress in older adults is critical to understanding how to best support elderly individuals navigating stressful situations, with the aim to lessen the impact of stressors on their brain health. Here, we collected measures on perceived stress, resilience, and behavioral coping strategies, in the context of the COVID-19 pandemic, in a cross-sectional sample of 141 community dwelling older adults (mean age = 74.4 ± 8.4, 59% females) who were part of two longitudinal observational studies in Massachusetts, U.S. Our results indicate that participants demonstrated moderate levels of stress related to COVID-19 and showed relatively high levels of resilience. Higher resilience was associated with greater use of adaptive coping behaviors and less use of maladaptive coping behaviors. The use of maladaptive coping strategies was associated with more stress. Moreover, hierarchical regression analyses revealed that resilience was the strongest unique predictor of stress, thus, largely accounting for the observed coping-outcome associations. Individual differences in resilience levels moderated the effects of two coping strategies (planning and self-blame) on stress. Specifically, planning was associated with increased levels of stress for people with low resilience. In contrast, high personal resilience attenuated the negative effect of self-blame on their stress levels. Taken together, our findings suggest that resilience is critical for coping with stress during the COVID-19 pandemic. Future approaches for augmenting resilience could prove to be important potential interventions to help support older adults navigating stressful situations as well as lessen adverse effects on neurocognitive and mental health in the future.