Loneliness, social connectedness, and resilience during COVID pandemic among those with and without cognitive impairment

Background Loneliness in older adults is multifactorial. Social connectedness and resilience are protective against loneliness and have been adversely affected by the COVID pandemic. The objective was to measure loneliness in older adults with and without cognitive impairment and to compare the interaction of loneliness with resilience and social connectedness in these subgroups. Methods A cross-sectional study was conducted in community dwelling older adults (N=254) (November 2020-ongoing). Demographic data were collected along with variables related to social determinants of health. Loneliness was assessed with the 3-item loneliness questionnaire, resilience with the Brief Resilience Coping Scale (BRCS) and social connectedness using the 6-item Lubben social network scale. Results Mean age was 74.6 (±8.0) years, 93.7% male, 50.8% rural, 79.5% Caucasian, and 17.3% African American. Mean education was 14 years (±2.4). The majority of the participants reported loneliness (57.5%). Mean Lubben social network score was 14.7 (±7.1) and mean resilience score was 15.0 (±4.1). Loneliness was higher in those living alone compared to those living with someone (5.6 vs. 4.6, p<0.001, 95% CI: -1.6, -0.48). There were strong negative correlations between social connectedness and loneliness (p<0.001, r=-0.43) and resilience and loneliness (p=0.001, r=-0.19). Compared to those without cognitive impairment (N=151), participants with cognitive impairment (N=101) had a significantly lower mean social network score (p=0.007, 95% CI: 0.69, 4.23). Compared to those without cognitive impairment, participants with cognitive impairment had lower mean resilience score, however the difference was not statistically significant (p=0.080, 95% CI: -0.11, 1.97). T-MoCA and FAQ mean scores for the cognitively impaired older adults were 15.2 (±4.6) and 8.0 (±9.3), respectively. The strong negative correlation between resilience and loneliness scores persisted in the subgroup with cognitive impairment (p=0.028, r=-0.22). Conclusions Loneliness was commonly reported among older adults during the COVID pandemic. Loneliness was negatively correlated with social connectedness and resilience. Compared to cognitively intact counterparts, those with cognitive impairment reported significantly lower social connectedness. This finding indicates that those with cognitive impairment may need more attention during natural disasters that foster physical separation.

VA Video Connect for Clinical Care in Older Adults in a Rural State During the COVID-19 Pandemic: Cross-Sectional Study.

BACKGROUND: The COVID-19 pandemic has accelerated the need for telehealth at home. Although the Department of Veterans Affairs is a leading provider of telehealth, disparities may exist in reaching older veterans living in rural areas. VA Video Connect (VVC) is a video conferencing app that enables veterans to connect with their health care provider via a secure and private session. OBJECTIVE: The aim of this study was to examine the capability and willingness of older veterans to participate in a VVC visit during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted on older veterans (N=118) at the Central Arkansas Veterans Healthcare System. Participants were interviewed over the phone and responses to the following items were recorded: availability of internet, email, and an electronic device with a camera; veterans' willingness to complete an appointment via a VVC visit; and availability of assistance from a caregiver for those who were unable to participate in a VVC visit alone. RESULTS: Participants' mean age was 72.6 (SD 8.3) years, 92% (n=108) were male, 69% (n=81) were Caucasian, 30% (n=35) were African Americans, and 36% (n=42) lived in a rural location. The majority reported having access to the internet (n=93, 77%) and email service (n=83, 70%), but only 56% (n=67) had a camera-equipped device. Overall, 53% (n=63) were willing and capable of participating in a VVC visit. The availability of internet access was significantly lower in rural compared to nonrural participants (P=.045) and in those with or less than a high school education compared to those who pursued higher education (P=.02). Willingness to participate in the VVC visit was significantly lower in rural compared to nonrural participants (P=.03). Of the participants who reported they were able and willing to partake in a VVC visit (n=54), 65% (n=35) opted for VVC and 35% (n=19) preferred a phone visit. In total, 77% (n=27) of the scheduled VVC visits were successful. CONCLUSIONS: Despite advances in technology, and willingness on the part of health care systems, there are some lingering issues with capability and willingness to participate in video telehealth visits, particularly among older adults residing in rural areas.

Participant and Caregiver Perspectives on Clinical Research During Covid-19 Pandemic.

BACKGROUND/OBJECTIVES: The COVID-19 pandemic has massively disrupted essential clinical research. Many regulatory organizations have rightfully advocated to temporarily halt enrollment and curtail all face-to-face interactions. Views and opinions of patients and their caregivers are seldom considered while making such decisions. The objective was to study older participants' and their caregivers' perspectives to participate in ongoing clinical research during the COVID-19 pandemic. DESIGN: Cross-sectional. SETTING: VISN-16/Geriatric Research, Education and Clinical Center (GRECC), Department of Veterans Affairs. PARTICIPANTS: Older participants and their caregivers (N = 51) enrolled in ongoing clinical research studies. MEASUREMENTS: Questions about perceptions of safety to attend research visit, the level of panic among the general public, and medical center's preparedness in handling the pandemic. Other questions identified the source of pandemic information and the preference of a phone or in-person visit. RESULTS: Mean age was 69.3 (±9.4) years, 53% were male, 39% were caregivers, and 65% were Caucasian. Majority (78%) of the participants felt safe/very safe attending the scheduled research appointment; 63% felt that the extra screening made them feel safe/very safe; 82% felt that the medical center was prepared/very prepared for the pandemic. Participants split evenly on their preference for phone versus in-person visits. Family members and television news media were the commonly used sources of pandemic information irrespective of their education. Perceptions were influenced by gender and source of information, not by age or education. Females perceived higher level of panic compared to males (P = .02). Those relying on news media felt safer compared to those that relied on family members (P = .008). CONCLUSION: Even though informants felt that the medical center was prepared to handle the pandemic, only half the participants preferred the in-person visit. Pandemic information was obtained from family members or the television news media. Knowing patients' perspectives may help researchers be better prepared for future pandemics. J Am Geriatr Soc 68:E14-E18, 2020.