Social Connectedness and Social Isolation in Nursing Home Residents

该提案是对PAR-19-373和国家老龄战略计划目标B和C的响应。 社会联系，即人们与他人的关系，有助于养老院的兴旺发展。 孤独感在疗养院很普遍，在患有阿尔茨海默病和相关疾病的居民中更是如此 痴呆(ADRD)。在社区中，孤独是通过传染的过程传播的。养老院提供 聚集在一起为老年人生活，而这种孤独的传播还没有研究过。建议的R01 探索在养老院住宿期间缺乏社交联系的纵向演变，描述 社会孤立的相互依赖和聚集生活环境中社会联系的缺乏， 并确定加剧或减弱其传播的个人和背景因素。了解谁在 缺乏社会联系的风险和“独自一人在人群中”的健康后果将 旨在解决养老院居民健康和幸福感这一重要决定因素的干预措施。这个 新冠肺炎大流行对养老院居民的影响突显了R01的重要性。 必要的政策给养老院带来了前所未有的社会混乱(例如，没有访客、居民 受限于他们的房间)，再加上毁灭性的新冠肺炎疾病和死亡，没有留下任何居民，爱 一，或养老院工作人员不受影响。令人毛骨悚然的新冠肺炎“自然实验”让人们得以研究 养老院遏制新冠肺炎政策对社会孤立和贫困的下游涟漪效应 连通性。建议的R01建立在我们由NIH资助的新工作的基础上，以开发和测试社会 使用最小数据集3.0(MDS)的连接性和社交隔离。我们利用内部的 基于MDS的纵向国家数据源(2011-2018年，延长至2021年)，包括基于区域的和 设施特征、新冠肺炎相关数据(例如，保单、病例、死亡人数)以及联邦医疗保险资格和索赔 数据。这些数据能够评估死亡、住院和其他经过验证的结果。我们的特定 目标是：1)将我们的社会联系/隔离MDS措施的开发和测试扩展到居民 在没有ADRD的情况下；2)评估养老院的社会联系的自然过程，并确定个人 以及调节其传播的背景因素；3)量化社会联系和孤立对 健康结果和评估减缓其影响的因素；4)估计大流行对 养老院居民缺乏社会联系及其相应的连锁反应 连通性对居民健康和福祉的影响；5)确定疗养院改变 新冠肺炎对居民缺乏社会联系的影响及其相关的健康影响。这个 该项目开发了一个关于社会孤立和新冠肺炎对结果的更广泛影响的知识库 在疗养院。这项研究将为照顾老龄化社会快速增长部分的政策提供参考 和指导疗养院预防大流行的工作。

This proposal is responsive to PAR-19-373 and the National Institute on Aging Strategic Plan Goals B and C. Social connectedness, the relationship people have with others, contributes to thriving in nursing homes. Loneliness is prevalent in nursing homes, and more so in residents with Alzheimer’s disease and related dementias (ADRD). In the community, loneliness spreads through a contagious process. Nursing homes provide congregate living for older adults where such spread of loneliness has not been studied. The proposed R01 explores the longitudinal evolution of lack of social connectedness throughout the nursing home stay, describes the interdependence of social isolation and lack of social connectedness within congregate living environments, and identify individual and contextual factors that exacerbate or attenuate its spread. Understanding who is at risk for lack of social connectedness and the health consequences of “being alone in a crowd” will inform interventions to address this important determinant of health and well-being in nursing home residents. The importance of this R01 is underscored by the impact of the COVID-19 pandemic on nursing home residents. Necessary policies introduced unprecedented social disruption to nursing homes (e.g., no visitors, residents restricted to their rooms), coupled with devastating COVID-19 illnesses and deaths leaving no resident, loved one, or nursing home staff unaffected. The horrific COVID-19 “natural experiment” allows the study of the downstream ripple effects of the policies to contain COVID-19 in nursing homes on social isolation and connectedness. The proposed R01 builds from our novel NIH-funded work to develop and test indices of social connectedness and social isolation using the Minimum Data Set 3.0 (MDS). We leverage an in-house longitudinal national MDS-based data source (2011-2018, extended to 2021) which includes area-based and facility characteristics, COVID-19 related data (e.g., policies, cases, deaths), and Medicare eligibility and claims data. These data enable the evaluation of deaths, hospitalizations and other validated outcomes. Our specific aims are to: 1) Extend our social connectedness/isolation MDS measure development and testing to residents without ADRD; 2) Evaluate the “natural course” of social connectedness in nursing homes and identify individual and contextual factors that modulate its spread; 3) Quantify the effect of social connectedness and isolation on health outcomes and evaluate factors that moderate its impact; 4) Estimate the impact of the pandemic on the lack of social connectedness in nursing home residents and the corresponding ripple effects of lack of social connectedness on resident health and well-being; 5) Identify characteristics of nursing homes that altered the impact of COVID-19 on the lack of social connectedness and its associated health effects among residents. The project develops a knowledge base regarding the broader impact of social isolation and COVID-19 on outcomes in nursing homes. The research will inform policies for the care of a rapidly growing segment of an aging society and guidance nursing home pandemic preparedness.