Resident-to-Resident Elder Mistreatment Intervention for Dementia Care in Assisted Living

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7. Summary/ Abstract Proposed is an administrative supplement to the grant, Resident-to-Resident Elder Mistreatment (R-REM) Intervention for Dementia Care in Assisted Living. The proposed supplement address Covid-related behavioral and social outcomes both cross-sectionally (n=400) and longitudinally (n=200) by adding a Covid experiences module to an ongoing assessment. The parent study is a cluster randomized trial to evaluate an innovative staff intervention in assisted living residences (ALRs), and addresses the goal of comparing the effectiveness of treatments in managing behavioral disorders in people with Alzheimer’s disease and related disorders (ADRD). The proposed supplement addresses the goal of evaluating how social distancing requirements affect the care and well-being of vulnerable older adults in ALRs, including individuals with mild cognitive impairment and ADRD. Front line staff is ideally suited to inform intervention research and to serve as meaningful collaborators in promoting best practices, including those aimed at keeping residents engaged, such as technological interventions to enhance connections with music, art and social engagement with families. The proposed study addresses the following specific aims: Aim 1 (A1). Describe Covid-related experiences of fear, loneliness, engagement in isolation-mitigating technologies, care satisfaction, and environmental quality. Primary Aim (A2). Examine cross-sectionally and longitudinally the multivariate effects of Covid-related experiences (social isolation, loneliness, fear, stress) of residents on the outcomes of anxiety, depression and behavior, controlling for personal characteristics such as cognition, co-morbidity and physical function. Hypothesis: Covid-related experiences will contribute uniquely to negative outcomes; these effects will be mitigated (mediated) by technological and other interventions to reduce isolation and loneliness. Aim 3 (A3). Evaluate the impact on staff of Covid-related experiences in terms of heightened resident behavioral aggression, staff stress, burden, burnout as well as positive caregiver experiences. Social isolation due to COVID-19 social distancing restrictions in assisted living and other such settings may increase the risk of poor behavioral, cognitive, psychological and health outcomes. Identifying isolation- reducing interventions and examining their potential mediating role in ameliorating adverse outcomes is important, and has implications for future such catastrophic events. The results are likely applicable to the over 1.2 million residents of ALRs, many of whom have significant care needs and dementia-related behaviors. The proposed project is an important step in developing approaches and interventions for ameliorating and preventing social isolation in ALRs. Such interventions have the potential to improve quality of care, enhance resident safety and quality-of-life and reduce behavioral disorder associated with social isolation in general, in future crises, as well as during the current pandemic.