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

摘要 尽管大多数患有阿尔茨海默病和阿尔茨海默病相关痴呆的美国人 (AD/ADRD)独立生活，即他们发展和应对认知衰退的社区环境 而损害在很大程度上被忽视了。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、 步行街道)可能会减缓认知衰退的速度，降低AD/ADRD的风险。然而，随着 新冠肺炎大流行，许多邻里资源是社会化、刺激、 和活动被关闭或严格限制。避免拥挤的地方，与世隔绝，限制旅行，并永久 由于以下原因，企业关闭可能会对认知障碍和AD/ADRD风险产生深远影响 日常生活的中断；对心理健康的影响；失去社交、智力和身体上的机会 活动。这项研究解决了之前认知下降的邻里环境中的关键知识差距 以及在大流行爆发之后。这是为数不多的利用定性和定量数据的研究之一 对51岁美国成年人进行的具有全国代表性的健康和退休研究(HRS)。目标1(K99阶段：2021年- 23)识别与大流行爆发前HRS中的认知轨迹相关联的邻里特征。 目标2(R00阶段：2023-25)采用先进的混合方法和新颖的HRS实验模块 调查新冠肺炎的集体创伤如何从根本上改变附近的景观和 就地老化的方法。这将告知目标3分析的重点在哪里(R00阶段：2024-26)，以确定哪些 社区特征与老年人认知障碍的风险和恢复力相关 2020年3月大流行爆发。研究结果将为“认知能力”的新概念提供证据，这是一种创新的 表明地理区域对老年居民认知健康的支持程度的理论方法 通过特定的社区资源和便利设施。K99/R00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。它扩展了她在环境方面的专业知识 老年学，混合方法，经过高级纵向分析训练的认知功能；认知 衰弱、损害和AD/ADRD；以及老年人的急性疾病。强大的跨学科导师关系 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。 Finlay将填补关于社区认知下降的脆弱性和恢复力的重要科学空白 AD/ADRD。她在推进AD/ADRD社会决定因素的研究方面具有独特的优势， 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R01资助的混合方法研究计划，向邻居提供信息 干预和社区服务，以支持老龄化老年人的需求、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.