Measurement of Cognitive Function in Older Adults with Sensory Loss

ABSTRACT This urgent competing revision of NIA R21AG060243 is in response to NOT-AG-20-022 and aims to examine 2019 coronavirus (COVID-19) clinical outcomes and the impact of the COVID-19 pandemic on healthcare utilization for older adults with disabilities, including those with sensory impairments and Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD). While data indicate that COVID-19 has disproportionately affected nursing home populations, urgent questions remain about how COVID-19 has impacted healthcare outcomes and utilization for older adults with disabilities, leaving an urgent, yet unaddressed, gap in response efforts. This work is an extension of the parent project that focuses on assessing ADRD and sensory impairments among older adults and leverages a unique data resource linking electronic health record (EHR) information from Johns Hopkins Medical Institute Emergency Department (ED) patients (across 5 locations in the Baltimore/Washington, DC area) to data from the Johns Hopkins COVID-19 Precision Medicine Analytics Platform Registry (JH-CROWN). Aim 1 will test our hypotheses that patients with disabilities are more likely to have severe COVID-19 disease, assessed using scores on the World Health Organization (WHO) COVID-19 disease severity scale, and compare COVID-19 outcomes between patients with disability who are 65 years and older to patients under 65 years. Secondary outcomes will include hospital admission and in-hospital mortality, as well as examine COVID-19 outcomes by gender, race, and disability type. Aim 2 will investigate the impact of the COVID-19 pandemic on health care utilization by patient disability status and age, and testing hypotheses that: (1) ED visit rates (non-COVID related) are lower among patients with disabilities during the COVID-19 pandemic [Jan 1, 2020 to Dec 31, 2020]; (2) preventable hospitalization rates, determined using AHRQ metrics, are higher among patients with disabilities during the pandemic; and (3) ED visit rates are lower and preventable hospitalization rates are higher during the pandemic [Jan 1 to Dec 31, 2020] then in the year prior among patients with disabilities. Analyses will examine potential interactions between age and disability status and compare results across health-adjusted strata. This work fills an urgent gap in the COVID-19 response, as there remains limited data on the healthcare implications of the pandemic for older adults with disabilities.