This proposal is responsive to PAR-19-373 and the National Institute on Aging Strategic Plan Goals B and C.
Social connectedness, the relationship people have with others, contributes to thriving in nursing homes.
Loneliness is prevalent in nursing homes, and more so in residents with Alzheimer’s disease and related
dementias (ADRD). In the community, loneliness spreads through a contagious process. Nursing homes provide
congregate living for older adults where such spread of loneliness has not been studied. The proposed R01
explores the longitudinal evolution of lack of social connectedness throughout the nursing home stay, describes
the interdependence of social isolation and lack of social connectedness within congregate living environments,
and identify individual and contextual factors that exacerbate or attenuate its spread. Understanding who is at
risk for lack of social connectedness and the health consequences of “being alone in a crowd” will inform
interventions to address this important determinant of health and well-being in nursing home residents. The
importance of this R01 is underscored by the impact of the COVID-19 pandemic on nursing home residents.
Necessary policies introduced unprecedented social disruption to nursing homes (e.g., no visitors, residents
restricted to their rooms), coupled with devastating COVID-19 illnesses and deaths leaving no resident, loved
one, or nursing home staff unaffected. The horrific COVID-19 “natural experiment” allows the study of the
downstream ripple effects of the policies to contain COVID-19 in nursing homes on social isolation and
connectedness. The proposed R01 builds from our novel NIH-funded work to develop and test indices of social
connectedness and social isolation using the Minimum Data Set 3.0 (MDS). We leverage an in-house
longitudinal national MDS-based data source (2011-2018, extended to 2021) which includes area-based and
facility characteristics, COVID-19 related data (e.g., policies, cases, deaths), and Medicare eligibility and claims
data. These data enable the evaluation of deaths, hospitalizations and other validated outcomes. Our specific
aims are to: 1) Extend our social connectedness/isolation MDS measure development and testing to residents
without ADRD; 2) Evaluate the “natural course” of social connectedness in nursing homes and identify individual
and contextual factors that modulate its spread; 3) Quantify the effect of social connectedness and isolation on
health outcomes and evaluate factors that moderate its impact; 4) Estimate the impact of the pandemic on the
lack of social connectedness in nursing home residents and the corresponding ripple effects of lack of social
connectedness on resident health and well-being; 5) Identify characteristics of nursing homes that altered the
impact of COVID-19 on the lack of social connectedness and its associated health effects among residents. The
project develops a knowledge base regarding the broader impact of social isolation and COVID-19 on outcomes
in nursing homes. The research will inform policies for the care of a rapidly growing segment of an aging society
and guidance nursing home pandemic preparedness.