Aging in Place Before and After the COVID-19 Pandemic Onset: A Study of Neighborhoods and Cognitive Health Among Older Americans

摘要 虽然大多数患有阿尔茨海默病和阿尔茨海默病相关痴呆症的美国人 (AD/ADRD）独立生活，他们发展和导航认知衰退的邻里环境 和损伤都被忽视了生活在有社交机会的社区（例如，咖啡 商店、老年中心），智力刺激（例如，博物馆、图书馆）和体育活动（例如，公园， 可步行的街道）可以减缓认知能力下降的速度，并降低AD/ADRD的风险。然而，随着 新冠肺炎大流行，许多社区资源是社会化，刺激， 和活动都是封闭或严格限制的。避免拥挤的地方，隔离，限制旅行，以及永久性的 企业倒闭可能会对认知障碍和AD/ADRD风险产生深远的影响， 日常生活的中断;对心理健康的影响;以及社交、智力和身体机会的丧失 活动这项研究解决了一个关键的知识差距，在社区背景的认知下降之前， 以及大流行病爆发后。这是为数不多的利用定性和定量数据的研究之一， 美国健康与退休研究（HRS），针对51岁以上的美国成年人。目标1（K99阶段：2021- 23)识别与大流行爆发前HRS中的认知轨迹相关的邻域特征。 目标2（R 00阶段：2023-25）采用先进的混合方法方法和新型HRS实验模块 调查COVID-19的集体创伤如何从根本上改变了社区景观， 老地方的方式。这将告知目标3分析（R 00阶段：2024-26）的重点，以确定 社区特征与老年人认知障碍的风险和弹性相关， 2020年3月大流行爆发。调查结果将为“认知”的新概念提供证据， 一种理论方法来表明一个地理区域对老年居民认知健康的支持程度 通过特定的社区资源和设施。K99/R 00奖学金将促进芬利博士的职业生涯 作为一名成功的独立健康研究人员的发展和未来。它扩展了她在环境保护方面的专业知识， 老年学、混合方法和认知功能，在纵向分析中进行高级培训;认知 衰退、损伤和AD/ADRD;以及老年人中的急性疾病。强大的跨学科指导 密歇根大学的团队和出色的支持性培训环境为博士提供了基础。 芬利填补了一个重要的科学利基对邻里脆弱性和恢复能力的认知下降， AD/ADRD。她有一个独特的Vantage，以推进研究AD/ADRD的社会决定因素，确定 影响健康和福祉的社区特征，并为公共卫生政策和卫生服务提供信息。她 长期目标是建立一个由R 01资助的混合方法研究项目，为社区提供信息 干预措施和社区服务，以支持老年人的需求，健康和福祉。

ABSTRACT Although the majority of Americans with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD) live independently, the neighborhood contexts in which they develop and navigate cognitive decline and impairment are largely ignored. Living in neighborhoods with opportunities for social interaction (e.g., coffee shops, senior centers), intellectual stimulation (e.g., museums, libraries) and physical activity (e.g., parks, walkable streets) may slow rates of cognitive decline and reduce risk for AD/ADRD. However, with the onset of the COVID-19 pandemic, many neighborhood resources that are critical sources of socialization, stimulation, and activity are closed or tightly restricted. Avoiding crowded places, isolating, limiting travel, and permanent business closures likely have profound consequences for cognitive impairment and AD/ADRD risk due to disruptions in daily life; impacts on mental health; and loss of opportunities for social, intellectual, and physical activities. This research addresses a critical knowledge gap on neighborhood contexts of cognitive decline before and after the pandemic onset. It is one of few studies to utilize both qualitative and quantitative data from the nationally-representative Health and Retirement Study (HRS) of US adults aged 51+. Aim 1 (K99 phase: 2021- 23) identifies neighborhood features associated with cognitive trajectories in the HRS before the pandemic onset. Aim 2 (R00 phase: 2023-25) uses an advanced mixed-methods approach and novel HRS experimental module to investigate how the collective trauma of COVID-19 has fundamentally changed neighborhood landscapes and ways of aging in place. This will inform where to focus Aim 3 analyses (R00 phase: 2024-26) to identify which neighborhood features are associated with risk and resiliency for cognitive impairment among older adults after the March 2020 pandemic onset. Findings will build evidence for a new concept of `cognability', an innovative theoretical approach to indicate how supportive a geographic area is to cognitive health for aging residents through specific neighborhood resources and amenities. The K99/R00 fellowship will facilitate Dr. Finlay's career development and future as a successful independent health researcher. It extends her expertise in environmental gerontology, mixed-methods, and cognitive function with advanced training in longitudinal analysis; cognitive decline, impairment, and AD/ADRD; and acute illness among aging adults. A strong interdisciplinary mentorship team and outstanding supportive training environment at the University of Michigan provide a foundation for Dr. Finlay to fill an important scientific niche on neighborhood vulnerability and resilience for cognitive decline and AD/ADRD. She has a unique vantage point to advance research on social determinants of AD/ADRD, identify neighborhood features that affect health and well-being, and inform public health policy and health services. Her long-term goal is to establish an R01-funded, mixed-methods research program that informs neighborhood interventions and community services to support the needs, health, and well-being of older adults aging in place.