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

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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.