Social Isolation and Loneliness due to COVID-19: Effect on Cognitive, Physical, and Mental Health in Older Adults in the SAGES Study

PROJECT SUMMARY/ABSTRACTWith the arrival of the SARS-CoV-2 virus and associated Coronavirus Disease 19 (COVID-19) to the U.S. inMarch 2020 came an extraordinary shift in daily living. Social distancing (SD) and sheltering in place (SIP),while essential in the fight against COVID-19, have created unique challenges for the health and well-being ofolder adults, and in particular those with mild cognitive impairment (MCI) and Alzheimer's disease and relateddementia (ADRD). Decreased socialization for many community-dwelling older adults has led to increasedfeelings of isolation and loneliness, both of which has been shown in numerous studies to lead to adverseoutcomes. For this supplement application, "Social Isolation and Loneliness due to COVID-19: Effect onCognitive, Physical, and Mental Health in Older Adults in the SAGES Study, we propose two related sub-projects: Sub-Project 1 will examine the effects of COVID-19 related loneliness on cognitive, physical, andmental health in the Successful Aging After Elective Surgery (SAGES I) Study (NIA grant P01 AG031720, PIInouye), an ongoing prospective cohort study of 315 older adults with an average age of 84 years old, whohave been followed after elective major non-cardiac surgery with serial cognitive, physical and functionalmeasures. We will use this well-characterized cohort to (1) Examine potential predictors of loneliness resultingfrom social distancing, (2) Examine the effect of loneliness on cognitive function in persons with and withoutMCI or ADRD, and (3) Examine the effect of loneliness on physical and mental health in persons with andwithout MCI or ADRD. We hypothesize that the SIP order due to the SARS-CoV-2 pandemic will increaseloneliness in older adults, and for those with pre-existing MCI and ADRD, loneliness will be associated withgreater declines in cognitive, physical and mental health compared to those without MCI and ADRD. Inaddition to their established annual visit, all SAGES follow-up participants will undergo extra telephoneinterviews for this project, two at the start of the study and two 6 months later. The interview will includemeasures of loneliness, social network size, social and physical activities, technology use, pre-existingcognitive and functional or mobility impairment, cognition, anxiety, depression, and COVID-19 infection orexposure. Hospitalizations, medical visits, falls, nursing home placement, new prescription medication use, anddeath will be determined. Sub-Project 2 will allow us to convert study procedures to remote assessmentsduring the time of COVID-19; and to harmonize and validate the SAGES neuropsychological assessmentadministered via telephone, videoconferencing, and in-person modes. This study will generate statisticallycomparable scores across our approaches to examine cognitive trajectories over time. Significance: This studywill allow us to evaluate the effect of COVID-19 related loneliness on cognitive, physical, and mental health inolder adults and in those with MCI or ADRD. Moreover, this study will allow us to adapt our study proceduresto remote during COVID-19 and to cross-validate our remote assessment with phone and in-person modes.