Effects of Loneliness and Social Isolation on Cognitive Health: Latest Perspectives and Future Directions

Abstract Loneliness and social isolation as antecedents of cognitive decline have received substantial attention in recent research. This symposium addresses this year’s conference theme of aging in the “new normal”. The COVID-19 pandemic has highlighted the negative impacts of loneliness and social isolation on older adults’ health and wellbeing. This symposium includes studies that shed light on the relationships between loneliness, social isolation and cognitive health using a multidisciplinary approach, and provide recommendations and future directions for advancing this research area. The first presentation examines cardiovascular biomarkers as potential mechanisms that mediate the longitudinal relationship between loneliness and cognitive decline with the HRS dataset. The second presentation examines several social isolation indicators and their effects on cognitive decline in a Canadian longitudinal study. Using the US ADRC longitudinal study of aging, the third study shows the effect of loneliness on cognitive health in older adults pre- and post-onset of the COVID-19 pandemic. The symposium concludes with a literature review of the different measures employed to operationalize the constructs of loneliness, isolation, which resulted in heterogeneous study findings on their influences on the risk of developing dementia. This review calls for consistent measures to produce comparable evidence on the health consequences of loneliness and isolation. In all, this symposium reports and reviews the latest evidence on the association between social isolation, loneliness and cognitive health amidst the ongoing COVID-19 pandemic. It also echoes the conference theme of transforming disruption to opportunities in aging health service and research.

Deerfield, Illinois, United States,3. Walgreens,Deerfield,Illinois,United States The COVID-19 pandemic and Black Lives Matter movement brought increased recognition to the need for health equity.Diabetes, the 7th leading cause of death, is one of many conditions where health inequities are evident.A higher percentage of Black (11.7%) and Hispanic (12.5%)U.S. adults are diagnosed with diabetes compared to non-Hispanic Whites (7.5%).To address this health inequity, a nationwide pharmacy chain implemented telephonic 'Advanced Care' (AC) outreach for patients with diabetes.During the AC call, pharmacists used motivational interviewing techniques to counsel patients on the importance of closing gaps in care and reducing barriers to medication adherence.Gaps included timely A1C testing, exams (eye, foot, kidney), immunizations (influenza, pneumonia, Hepatitis B), and recommendation of additional therapies for patients with multiple chronic conditions (ACE/ARB, statins).Medication fill gaps were compared between the Intervention period (8/1/20-1/31/-21) and a pre-intervention period (2/1/20-7/31/20).The AC pilot occurred in 8 Chicago Walgreens locations that primarily serve Black and Hispanic patients.Eight control stores were matched on census block-level household income and race/ethnicity, patient volume, and insurance mix.A pre/ post-test vs. control difference-in-difference (DID) analysis was conducted to compare on-time refill rates.Of the 1,009 older patients (age≥50) called, 59.9% were reached.The DID analysis showed that patients in pilot stores had improved pre-post on-time refill rates compared to controls (p<0.0001).Diabetes self-management is key to reducing diabetes-related complications.Early findings from this pilot demonstrate that the Walgreens AC intervention improves medication adherence -an important step toward improving health equity.
tested using a path model with concurrent and cross-lagged paths between cognition and IADL difficulty adjusting for covariates.Lower baseline cognition related to more baseline IADL difficulty (B=-0.08,SE=0.02, p<.001).Cognitive decline at follow-up related to greater IADL difficulty at follow-up (B=-0.06,SE=0.02, p=.012).Looking at cross-lagged associations, greater baseline IADL difficulty associated with more cognitive decline at follow-up (B=-0.10,SE=0.04, p=.012).However, baseline cognition was not significantly associated with change in IADL difficulty at follow-up (B=-0.003,SE=0.02, p=.869).Findings support the growing body of literature that IADL difficulties can predict future cognitive decline in samples of community-dwelling older adults.More research into both functional and cognitive decline in Latinx samples will provide a more generalizable view of aging.

POPULATION AGING AND MULTICULTURAL DIVERSITY IN THE UNITED STATES: IMPLICATIONS FOR OLDER CONSUMERS' NEEDS AND EXPECTATIONS
Julie Miller, 1 Taylor Patskanick, 2 Lisa D'Ambrosio, 3 and Joseph Coughlin, 1 1.MIT,Cambridge,Massachusetts,United States,2. MIT,Somerville,Massachusetts,United States,3. Massachusetts Institute of Technology,Cambridge,Massachusetts,United States Looking ahead to 2030 and beyond, the United States will be both older and more multicultural than presently.To explore the impacts and characteristics of an increasingly diverse population beginning to age, the MIT AgeLab conducted online focus groups in August 2020 (n=92) with ethnically diverse participants ages 40-69 on topics related to household composition, use of technology and digital engagement.Regarding household composition, Black and Latinx participants were more likely to report living with grandchild(ren), and Asian, Latinx, and White participants were more likely to report living with a parent(s) or parent(s)-in-law.Latinx participants often described ways in which caregiving for aging parents was a cultural value, but many participants who had raised children in the United States but who were not born in the United States themselves described cultural gaps in family attitudes that had sometimes widened across the generations.While all participants were using some technology, due to the coronavirus pandemic, digital tools were being used more widely than ever before.Racial/ethnic identity groups were more similar than different in terms of their responses to questions around consumer digital engagement.There were notable differences in overall trust in technology across racial/ethnic groups, with Asian participants reporting the highest average overall level of trust in technology and Multiracial participants reporting the lowest.Looking ahead, the intersection of aging and growing racial/ethnic diversity in the United States will yield a wider array of consumer needs and expectations.

EFFECTS OF LONELINESS AND SOCIAL ISOLATION ON COGNITIVE HEALTH: LATEST PERSPECTIVES AND FUTURE DIRECTIONS
Chair: Ted Ng Co-Chair: Kexin Yu Discussant: James Lubben Loneliness and social isolation as antecedents of cognitive decline have received substantial attention in recent research.This symposium addresses this year's conference theme of aging in the "new normal".The COVID-19 pandemic has highlighted the negative impacts of loneliness and social isolation on older adults' health and wellbeing.This symposium includes studies that shed light on the relationships between loneliness, social isolation and cognitive health using a multidisciplinary approach, and provide recommendations and future directions for advancing this research area.The first presentation examines cardiovascular biomarkers as potential mechanisms that mediate the longitudinal relationship between loneliness and cognitive decline with the HRS dataset.The second presentation examines several social isolation indicators and their effects on cognitive decline in a Canadian longitudinal study.Using the US ADRC longitudinal study of aging, the third study shows the effect of loneliness on cognitive health in older adults pre-and post-onset of the COVID-19 pandemic.The symposium concludes with a literature review of the different measures employed to operationalize the constructs of loneliness, isolation, which resulted in heterogeneous study findings on their influences on the risk of developing dementia.This review calls for consistent measures to produce comparable evidence on the health consequences of loneliness and isolation.In all, this symposium reports and reviews the latest evidence on the association between social isolation, loneliness and cognitive health amidst the ongoing COVID-19 pandemic.It also echoes the conference theme of transforming disruption to opportunities in aging health service and research.

BIOLOGICAL PATHWAYS UNDERLYING THE LONGITUDINAL ASSOCIATION BETWEEN LONELINESS AND COGNITIVE DECLINE
Kexin Yu, 1 and Ted Ng, 2 1. USC, LA, California, United States, 2. ASU , Phoenix, Arizona, United States Loneliness has been recognized as a risk factor for cognitive decline (CD) in older adults.However, how loneliness "gets under the skin" to influence CD has been conceptually proposed but rarely empirically examined.The purpose of this study is to investigate whether cardiovascular and kidney biomarkers mediate the longitudinal association between loneliness and CD.We used the cross-lagged panel model (CLPM) to examine the hypothesized relationships with 2006, 2010 and 2014 waves of data from the Health and Retirement Study (HRS).Loneliness is measured with 3-item UCLA loneliness scale.Cognitive health was assessed using the total cognition score.Biomarkers considered including HbA1C, total cholesterol, HDL cholesterol, CRP, and Cystatin C.Among all five biomarkers examined, HbA1c significantly mediated the longitudinal association between loneliness and CD.The other biomarkers examined did not mediate the relationship between loneliness and CD.The study findings show loneliness might affect CD through elevating HbA1C levels.

A PUBLIC HEALTH ANALYSIS OF THE RELATIONSHIP BETWEEN LONELINESS, ISOLATION, AND DEMENTIA
Christina Victor, Brunel University London, Uxbridge, England, United Kingdom Loneliness and isolation are now characterised as major public health problems largely because of reported associations with negative health outcomes including dementia.We adopt a public health perspective and review the relationship between loneliness/isolation and dementia focussing on how these concepts are defined, measured, and reported.We identified community based longitudinal studies which measured loneliness/isolation at baseline and dementia at follow up (minimum 12 months) published up to February 2021.We identified 12 papers for loneliness and 15 for isolation which demonstrated substantial heterogeneity in how exposure (loneliness/ isolation) and outcome (dementia) were measured and reported.For example, dementia was measured in 5 different ways: death, hospitalisation, clinical diagnosis, dementia screening tools or cognitive function.Evidence to support a relationship between loneliness/isolation and dementia is inconclusive largely because of this methodological heterogeneity.Using consistent exposure and outcome measures is a prerequisite for determining the health consequences of loneliness and isolation.Social isolation is an emerging public health concern with an emphasis on its potential preventive impact on cognitive impairment.We hypothesize that change in social isolation is associated with cognitive decline over two years.Latent

THE RELATIONSHIP BETWEEN LONELINESS AND THE COVID-19 PANDEMIC ON COGNITION AND WELL-BEING IN OLDER ADULTS
Elizabeth Rhodus, 1 Justin Barber, 1 Allison Gibson, 2 Shoshana Bardach, 3 Kelly Parsons, 1 Julia Johnson, 1 and Gregory Jicha, 1 1.University of Kentucky, Lexington, Kentucky, United States, 2. University of Kentucky, University of Kentucky, Kentucky, United States, 3. Dartmouth University, Dartmouth University, New Hampshire, United States Social distancing is necessary to limit the spread of Covid-19.However, many older adults are predisposed to isolation and loneliness despite calls to socially distance.The current study examined loneliness during Covid-19 in relation to cognition and wellbeing in older adults.Data were extracted from a U.S. ADRC longitudinal study of aging database.Cognition was assessed using the NACC UDS 3.0 battery.Measures of well-being include: Short Form Health Survey, Subjective Memory Assessment, and Geriatric Depression Scale.Measurement of loneliness was selected from the NIH ADRC Covid-19 questionnaire.Data were from 115 older adults with normal cognition or MCI with a visit ≤18 months before research stoppage in March 2020 and after resumption in late-June 2020.Cognition and wellbeing are compared before and after onset of pandemic.Isolation due to Covid-19 may have long-term implications.Results of this study will highlight the need for acute assessments and psychosocial interventions.