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Wong R, Grullon JR. Interaction effect of race-ethnicity and dementia on COVID-19 diagnosis among a national US older adult sample. BJPsych Open 2024; 10:e63. [PMID: 38482681 PMCID: PMC10951841 DOI: 10.1192/bjo.2024.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/09/2024] [Accepted: 01/30/2024] [Indexed: 03/22/2024] Open
Abstract
Older racial and ethnic minorities and older adults with dementia have an elevated COVID-19 risk, warranting research into the intersection between these two high-risk groups. We examined whether race-ethnicity moderates the association between dementia and COVID-19 diagnosis. Data were retrieved for 3189 respondents from a nationally representative prospective cohort sample of US older adults aged 65+ years. We analysed the effects of the interaction between race-ethnicity and dementia on COVID-19 diagnosis, after adjusting for sociodemographic factors, health and COVID-19 mitigation behaviours. The odds of COVID-19 diagnosis were significantly lower for Black older adults with dementia (adjusted odds ratio [aOR] = 0.07, 95% CI = 0.01-0.78, P = 0.03). In addition, dementia increased the odds of COVID-19 diagnosis among Hispanic older adults (aOR = 1.59, 95% CI = 0.12-21.29, P = 0.72), although this increase was not statistically significant. The interaction between race-ethnicity and dementia should be considered when assessing COVID-19 risk among older adults. Future research is needed to examine pathways through which dementia may interact with race and ethnicity to influence COVID-19 risk.
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Affiliation(s)
- Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA; and Department of Geriatrics, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Jason Rafael Grullon
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, New York, USA
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Wong R, Lovier MA. Racial and ethnic disparities in COVID-19 diagnosis and adherence to mitigation behaviours in a national United States older adult sample. Epidemiol Infect 2023; 151:e175. [PMID: 37799056 PMCID: PMC10600897 DOI: 10.1017/s0950268823001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
Older adults and people of colour are vulnerable to the COVID-19 pandemic, and mitigation behaviours reduce COVID-19 infection. We examined racial and ethnic differences in COVID-19 diagnosis and adherence to COVID-19 mitigation behaviours among U.S. older adults. Data were retrieved from the National Health and Aging Trends Study, a nationally representative prospective cohort with 3257 U.S. Medicare beneficiaries aged 65+. COVID-19 variables were collected in 2020; all other data in 2019. Odds of COVID-19 diagnosis and adherence to mitigation behaviours (handwashing, masking, social distancing) were analysed using logistic regression. Compared to White older adults, only Hispanic respondents had 2.7 times significantly higher odds of COVID-19 after adjusting for sociodemographics, health, and mitigation behaviours (aOR = 2.71, 95% CI = 1.20-6.12). Black older adults had 7.9 times significantly higher odds of masking (aOR = 7.94, 95% CI = 2.33-27.04) and 2.3 times higher odds of social distancing (aOR = 2.33, 95% CI = 1.28-4.24), after adjusting for sociodemographics and health. Among all racial and ethnic groups, only Hispanic older adults had a significantly elevated COVID-19 diagnosis. Despite higher adherence to COVID-19 mitigation behaviours among racial and ethnic minorities, especially Black older adults, odds of COVID-19 remained elevated. Research is needed to explore potential mechanisms for higher odds of COVID-19 among minority older adults.
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Affiliation(s)
- Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Margaret Anne Lovier
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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Iyer SS, Ngo V, Humber MB, Chen P, Pallaki M, Dolinar T, Brodrick MFB, Gould CE, Trivedi RB. Caregiver Experience of Tele-dementia Care for Older Veterans. J Gen Intern Med 2023; 38:2960-2969. [PMID: 37131102 PMCID: PMC10153773 DOI: 10.1007/s11606-023-08188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/22/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND For the 5 million persons living with dementia (PLWD) in the USA, telemedicine may improve access to specialty care from their homes. OBJECTIVE To elicit informal caregiver perceptions of tele-dementia care provided during COVID-19. DESIGN Qualitative, observational study using grounded theory. PARTICIPANTS Informal caregivers aged 18 + who cared for an older adult who received tele-dementia services at two major VA healthcare systems participated in 30-60-min semi-structured telephone interviews. INTERVENTIONS Interviews were designed using Fortney's Access to Care model. MAIN MEASURES Thirty caregivers (mean age = 67, SD = 12, 87% women) were interviewed. KEY RESULTS Five major themes were (1) Tele-dementia care avoids routine disruption and pre-visit stress; (2) Transportation barriers to in-person visits include not only travel logistics but navigating the sequelae of dementia and comorbid medical conditions. These include cognitive, behavioral, physical, and emotional challenges such as balance issues, incontinence, and agitation in traffic; (3) Tele-dementia care saves time and money and improves access to specialists; (4) Tele-dementia facilitated communication between caregiver and provider without hindering communication between PLWD and provider; and (5) Caregivers described ideal future dementia care as a combination of virtual and in-person modalities with in-home help, financial and medical support, and dementia-sensitive caregiver access. Caregivers interviewed saved 2.6 h ± 1.5 h (range: 0.5 to 6 h) of travel time. Multiple caregivers described disruption of routines as difficult in PLWD and appreciated the limited preparation and immediate return to routine post telemedicine visit as positives. CONCLUSIONS Caregivers found tele-dementia care convenient, comfortable, stress reducing, timesaving, and highly satisfactory. Caregivers would prefer a combination of in-person and telemedicine visits, with an opportunity to communicate with providers privately. This intervention prioritizes care for older Veterans with dementia who have high care needs and are at higher risk for hospitalization than their same age counterparts without dementia.
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Affiliation(s)
- Sowmya S Iyer
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
- Division of Primary Care and Population Health, Geriatrics Section, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Victoria Ngo
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Health Services Research & Development, U.S. Department of Veteran Affairs, Palo Alto, CA, USA
- Department of Health Policy, Freeman Spogli Institute & Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marika Blair Humber
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Peijun Chen
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Muralidhar Pallaki
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Teresa Dolinar
- Geriatric Research, Education, and Clinical Center, VA Northeast Ohio Health Care System, Cleveland, OH, USA
| | | | - Christine E Gould
- Geriatric Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ranak B Trivedi
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Public Mental Health and Population Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, San Francisco, CA, USA
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Lee JJ, Kim N, Park MK, Ji H, Kim GS. The association between depression and non-compliance with COVID-19 preventive behaviors in South Korean older adults stratified by sex. Int J Geriatr Psychiatry 2023; 38:e5949. [PMID: 37303124 DOI: 10.1002/gps.5949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study evaluated the association between depression and non-compliance with COVID-19 preventive behaviors among community-dwelling South Korean older adults. METHODS We utilized the 2020 Korean Community Health Survey-a community-based nationwide survey. A score of 10 points or higher on the Patient Health Questionnaire-9 was defined as depression. Non-compliance with COVID-19 preventive behaviors was assessed on the following three behaviors: washing hands, wearing masks, and watching distance. We also included socio-demographic characteristics, health behaviors, and COVID-19-related characteristics as covariates. Multiple logistic regression analyses were performed, and all statistical analyses were stratified by sex. RESULTS The 70,693 participants included 29,736 men and 40,957 women. Notably, 2.3% of men and 4.2% of women had depression. Non-compliance with washing hands was significantly higher in men than women (1.3% vs. 0.9%), whereas no significant differences were observed in wearing masks and watching distance. The adjusted logistic regression analysis showed that depression was positively associated with non-compliance with washing hands and watching distance in both sexes. The association between depression and non-compliance with wearing masks was significant only in women. CONCLUSIONS There was an association between depression and non-compliance with COVID-19 preventive behaviors in South Korean older adults. This signifies that health providers need to reduce depression to improve compliance with preventive behaviors in older adults.
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Affiliation(s)
- Jae Jun Lee
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea
| | - Min Kyung Park
- Department of Nursing, Graduate School of Yonsei University, Seoul, Republic of Korea
| | - Hyunju Ji
- Division of Nursing, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Gwang Suk Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Smadi M, Kaburis M, Schnapper Y, Reina G, Molero P, Molendijk ML. SARS-CoV-2 susceptibility and COVID-19 illness course and outcome in people with pre-existing neurodegenerative disorders: systematic review with frequentist and Bayesian meta-analyses. Br J Psychiatry 2023:1-14. [PMID: 37183681 DOI: 10.1192/bjp.2023.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND People with neurodegenerative disease and mild cognitive impairment (MCI) may have an elevated risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and may be disproportionally affected by coronavirus disease 2019 (COVID-19) once infected. AIMS To review all eligible studies and quantify the strength of associations between various pre-existing neurodegenerative disorders and both SARS-CoV-2 susceptibility and COVID-19 illness course and outcome. METHOD Pre-registered systematic review with frequentist and Bayesian meta-analyses. Systematic searches were executed in PubMed, Web of Science and preprint servers. The final search date was 9 January 2023. Odds ratios (ORs) were used as measures of effect. RESULTS In total, 136 primary studies (total sample size n = 97 643 494), reporting on 268 effect-size estimates, met the inclusion criteria. The odds for a positive SARS-CoV-2 test result were increased for people with pre-existing dementia (OR = 1.83, 95% CI 1.16-2.87), Alzheimer's disease (OR = 2.86, 95% CI 1.44-5.66) and Parkinson's disease (OR = 1.65, 95% CI 1.34-2.04). People with pre-existing dementia were more likely to experience a relatively severe COVID-19 course, once infected (OR = 1.43, 95% CI 1.00-2.03). People with pre-existing dementia or Alzheimer's disease were at increased risk for COVID-19-related hospital admission (pooled OR range: 1.60-3.72). Intensive care unit admission rates were relatively low for people with dementia (OR = 0.54, 95% CI 0.40-0.74). All neurodegenerative disorders, including MCI, were at higher risk for COVID-19-related mortality (pooled OR range: 1.56-2.27). CONCLUSIONS Our findings confirm that, in general, people with neurodegenerative disease and MCI are at a disproportionally high risk of contracting COVID-19 and have a poor outcome once infected.
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Affiliation(s)
- Muhannad Smadi
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Melina Kaburis
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Youval Schnapper
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Gabriel Reina
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; and Clínica Universidad de Navarra, Department of Microbiology, Pamplona, Spain
| | - Patricio Molero
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain; and Clínica Universidad de Navarra, Department of Psychiatry and Medical Psychology, Pamplona, Spain
| | - Marc L Molendijk
- Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands; and Leiden Institute for Brain and Cognition, Leiden University Medical Centre, Leiden, The Netherlands
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Sloane R, Pieper CF, Faldowski R, Wixted D, Neighbors CE, Woods CW, Kristin Newby L. COVID-19 Infection Risk Among Previously Uninfected Adults: Development of a Prognostic Model. Health Serv Res Manag Epidemiol 2023; 10:23333928231154336. [PMID: 37006334 PMCID: PMC10052611 DOI: 10.1177/23333928231154336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/14/2023] [Indexed: 03/29/2023] Open
Abstract
Background Few models exist that incorporate measures from an array of individual characteristics to predict the risk of COVID-19 infection in the general population. The aim was to develop a prognostic model for COVID-19 using readily obtainable clinical variables. Methods Over 74 weeks surveys were periodically administered to a cohort of 1381 participants previously uninfected with COVID-19 (June 2020 to December 2021). Candidate predictors of incident infection during follow-up included demographics, living situation, financial status, physical activity, health conditions, flu vaccination history, COVID-19 vaccine intention, work/employment status, and use of COVID-19 mitigation behaviors. The final logistic regression model was created using a penalized regression method known as the least absolute shrinkage and selection operator. Model performance was assessed by discrimination and calibration. Internal validation was performed via bootstrapping, and results were adjusted for overoptimism. Results Of the 1381 participants, 154 (11.2%) had an incident COVID-19 infection during the follow-up period. The final model included six variables: health insurance, race, household size, and the frequency of practicing three mitigation behavior (working at home, avoiding high-risk situations, and using facemasks). The c-statistic of the final model was 0.631 (0.617 after bootstrapped optimism-correction). A calibration plot suggested that with this sample the model shows modest concordance with incident infection at the lowest risk. Conclusion This prognostic model can help identify which community-dwelling older adults are at the highest risk for incident COVID-19 infection and may inform medical provider counseling of their patients about the risk of incident COVID-19 infection.
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Affiliation(s)
- Richard Sloane
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
- Richard Sloane, Center for the Study of Aging and Human Development, Box 3003, Duke University Medical Center, Durham, NC 27710, USA.
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Richard Faldowski
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Douglas Wixted
- Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
| | - Coralei E Neighbors
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
| | - Christopher W Woods
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina, USA
- Departments of Medicine and Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - L Kristin Newby
- Duke Clinical and Translational Science Institute, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Schrack JA, Corkum AE, Freedman VA. COVID-19 pandemic experiences of older adults with dementia in community and residential care settings: Results from a US national survey. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12382. [PMID: 36582364 PMCID: PMC9791074 DOI: 10.1002/dad2.12382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/27/2022]
Abstract
Introduction Investigations into consequences of the US COVID-19 pandemic for older adults with dementia have been limited. Methods We used the National Health and Aging Trends Study to examine self-reported COVID-19 infection; measures taken to limit its spread; social, behavioral, and emotional responses to the pandemic; and changes in health-care use and provider communication. We compared adults aged ≥70 with and without dementia in community and residential care settings. Results In residential care settings, infection was substantially higher and social contact less common for those with dementia. In community and residential care settings, those with dementia had 2 to 3 times the odds of reporting sleeping more often. In residential care settings, those with dementia were less likely to put off care and more likely to start telehealth. Discussion Findings highlight the disproportionate social and behavioral consequences of the COVID-19 pandemic for those living with dementia, particularly in residential care settings. HIGHLIGHTS Data are from the nationally representative National Health and Aging Trends Study.COVID-19 infection was higher in residential care settings for those with dementia.Social contact was less common for those with dementia in residential care.Pandemic-related coping behaviors differed by dementia and residential status.In residential care, those with dementia were less likely to delay health care.
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Affiliation(s)
- Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA,Center on Aging and HealthJohns Hopkins University and Medical InstitutionsBaltimoreMarylandUSA
| | - Abigail E. Corkum
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA,University of Maryland School of MedicineBaltimoreMarylandUSA
| | - Vicki A. Freedman
- Institute for Social ResearchUniversity of MichiganAnn ArborMichiganUSA
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COVID-19 Risk Factors and Predictors for Handwashing, Masking, and Social Distancing Among a National Prospective Cohort of U.S. Older Adults. Public Health 2022; 211:164-170. [PMID: 36152400 PMCID: PMC9385770 DOI: 10.1016/j.puhe.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
Objectives Older adults have a disproportionately higher COVID-19 risk; however, there is limited research investigating adherence to the major COVID-19 mitigation behaviors (handwashing, masking, social distancing) for older populations. We examined COVID-19 risk factors and predictors for adherence to COVID-19 mitigation behaviors among a national sample of US older adults. Study design Data were retrieved for 3257 respondents from a nationally representative prospective sample of US Medicare beneficiaries aged ≥65 years. COVID-19 variables were collected in 2020, whereas all other data were collected in 2019. Methods We used multiple logistic regression to analyze COVID-19 risk factors and predictors for handwashing, masking, and social distancing to minimize COVID-19 spread. All models applied survey sampling weights. Results Factors significantly associated with increased odds of COVID-19 diagnosis among US older adults were Hispanic ethnicity (adjusted odds ratio [aOR] = 2.83, P = .01), income (aOR = 0.71, P = .04), residential care or nursing home (aOR = 2.62, P = .01), and generalized anxiety disorder (aOR = 2.38, P = .04). We identified multiple factors significantly associated with adherence to handwashing, masking, and social distancing. Most notably, older males had a significantly lower odds of practicing all three COVID-19 mitigation behaviors, and Black older adults had a significantly higher odds of masking (aOR = 7.94, P < .001) and social distancing (aOR = 2.33, P = .01). Conclusions When prioritizing COVID-19 prevention efforts for older adults, risk factors that should be considered are race and ethnicity, income, residential setting, and anxiety. To effectively mitigate COVID-19 disease spread, public health professionals must also recognize sociodemographic and health factors may influence whether older adults adhere to handwashing, masking, and social distancing.
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