COVID-19 Supplement to LitCog IV: Health Literacy and Cognitive Function Among Older Adults

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We are seeking a supplement to our ongoing study (‘LitCog’; R01AG030611) in order to conduct two parallel, complementary investigations of the longer-term impact of COVID-19 on older adults’ lifestyle behaviors, psychological & physical function, socioeconomic circumstances, healthcare use, access & adherence to treatment, and health outcomes. First, we will extend our current inquiries to now determine whether LitCog participants with cognitive impairment are experiencing greater challenges in accessing care and managing personal health due to COVID-19 compared to cognitively ‘normal’ adults. Such a natural experiment is possible with LitCog; since 2007 we have tracked declines in cognition, as well as onset of cognitive impairment, and the resulting impact on self-management of chronic conditions among diverse, community dwelling, older adults. We will leverage our recent renewal award, with data capture from active patients (N=776), involved caregivers (N=100), electronic health (EHR) and pharmacy records, and add 5 telephone interviews conducted every 4 months to address the following primary aim: Aim 1 Investigate whether poorer cognitive function or MCI prior to the COVID-19 outbreak is associated with inadequate use of healthcare services and/or poorer health status. Second, we will also extend our LitCog-linked, Chicago COVID-19 Comorbidities (C3) cohort study. In March 2020, as cases of COVID-19 were emerging in Chicago, our team rapidly responded by launching a survey to understand how older adults with chronic conditions, at greater risk for COVID-19 complications, were responding and taking action (or not) to prevent infection and disease spread. LitCog participants (n=153), as well as patients enrolled in four other active studies (N=673) with uniform data collection for a large set of patient factors and similar access to EHR and pharmacy records were recruited. Interviews were conducted during Chicago’s COVID-19 outbreak phase (March 13-20), rapid acceleration phase (March 27-April 3), and apex phase (May 1-19). Our findings revealed many high risk adults lacked critical knowledge of COVID-19 symptoms and ways to prevent harm, did not feel susceptible to the virus, felt unprepared for the outbreak, were not social distancing or ensuring they had adequate supplies of prescribed medications. Disparities were revealed; black adults, those living below poverty level, with low health literacy and poorer cognition were less prepared. Moving forward, the C3 cohort will also be followed as the LitCog cohort in Aim 1, allowing us to combine both cohorts and more directly investigate the longer-term impact of stress due to COVID-19 on the health and behaviors of adults with chronic conditions. Our secondary aim is to: Aim 2 Examine adults’ perceived stress from COVID-19 and its associations with lifestyle & self- management behaviors, healthcare use, patient-reported and clinical outcomes over time.