A Mixed-methods Approach to Understand the Interplays of Social and Physical Environments, Loneliness, and Cognition among Older People with HIV - PROJECT SUMMARY There is a rapid growth in the graying of HIV population in the United States who are at increased risk for cognitive impairment. Loneliness is a risk factor for cognitive deficits, and older people with HIV report significant loneliness. Despite the well-established associations between loneliness and cognition, the findings specific to older people with HIV only have implications for overall cognition and are cross-sectional in nature, limiting the understanding of the longitudinal effects of loneliness on cognition and on specific cognitive domains over time. The ecological theory of aging posits that an individual's well-being and health as one grows older are shaped by the interplay and dynamic exchange of person- and environment-level factors. As such, social and physical environments have the potential to affect and mutually reinforce loneliness and exacerbate downstream cognitive health, yet it has not been empirically studied. My long-term career goal is to enhance overall health and well-being of the aging HIV population by identifying and intervening on modifiable factors across multiple levels of influence. Building on my prior cross-sectional research on social isolation and loneliness in older people with HIV, the proposed mixed methods research will uncover the influences of social/physical environment-level factors on, and elicit perspectives to add rich description to, the relationship between loneliness and cognition in older PWH. I will leverage the unique strengths of an ongoing prospective R01 study that examines multiple indices of social connections on HIV control and is nested within the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study. Guided by multidisciplinary mentors with complementary and synergistic expertise, I will pursue the following research aims: among older people with HIV (≥50 years old), 1) determine the longitudinal patterns of loneliness and cognition over time; 2) identify social and physical environment-level factors related to loneliness and cognition; and 3) elicit perspectives of how person- and social/physical environment-level factors affect cognitive health and how narratives of loneliness subgroups vary. Complementing this research, a detailed training plan will include 1) the science of cognition within the context of HIV and aging; 2) assessment of social and structural level factors ; 3) longitudinal data analytic skills; and 4) mixed-methods and community-engaged research. The protected time afforded by K01 will equip me with the necessary skills to launch an independent research career that incorporates socio-structural determinants into the study of HIV and aging. Findings will provide critical insights into understanding the complex, multifactorial contributors to the link between loneliness and cognitive health in older people aging with HIV. The results will inform subsequent R-level grants toward expanding and translating the findings to stakeholder groups and, ultimately, developing effective strategies that seek to improve the health and well-being of older PWH.
