Social Connectedness and Social Isolation in Nursing Home Residents

本提案是对PAR-19-373和国家老龄问题研究所战略计划目标B和C的回应。 社会联系，人们与他人的关系，有助于在养老院蓬勃发展。 孤独症在养老院很普遍，在患有阿尔茨海默病和相关疾病的居民中更是如此。 痴呆症（ADRD）。在社区中，孤独通过一种传染性的过程传播。养老院提供 老年人的集体生活，这种孤独感的传播还没有被研究过。建议的R 01 探讨了缺乏社会联系的整个养老院住宿的纵向演变，描述 在集体生活环境中，社会孤立和缺乏社会联系的相互依赖， 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“在人群中独处”的健康后果将告知 干预措施，以解决这一重要的决定因素的健康和福祉的养老院居民。的 COVID-19疫情对疗养院居民的影响凸显了R 01的重要性。 必要的政策给养老院带来了前所未有的社会破坏（例如，禁止访客和居民 限制在他们的房间），再加上毁灭性的COVID-19疾病和死亡，没有居民，爱 一个，或养老院工作人员不受影响。可怕的COVID-19“自然实验”允许研究 护理院遏制COVID-19政策对社会隔离的下游涟漪反应， 连通性拟议的R 01建立在我们的新NIH资助的工作，以开发和测试社会指标， 使用最小数据集3.0（MDS）的连通性和社会隔离。我们利用内部 基于MDS的纵向国家数据源（2011-2018年，延长至2021年），其中包括基于地区的 设施特征，COVID-19相关数据（例如，政策、病例、死亡）以及Medicare资格和索赔 数据这些数据可以评估死亡、住院和其他经验证的结果。我们的具体 目标是：1）将我们的社会联系/隔离MDS措施开发和测试扩展到居民 无ADRD; 2）评估养老院社会联系的“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 4）评估大流行对健康的影响，并评估减轻其影响的因素; 养老院居民缺乏社会联系以及缺乏社会联系的相应涟漪反应 居民健康和福祉的连通性; 5）确定养老院的特点，改变了 COVID-19对居民缺乏社会联系及其相关健康影响的影响。的 项目开发了一个关于社会隔离和COVID-19对结果的更广泛影响的知识库 在疗养院。这项研究将为老龄化社会中快速增长的部分的护理政策提供信息 并指导疗养院做好大流行病的准备。

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.