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.

PROJECT NARRATIVE Many older adults living in nursing homes experience loneliness or social isolation. The impact of social isolation on the health and well-being of nursing home residents needs to be better understood. The COVID-19 pandemic restricted visitors to the homes and socializing within nursing homes. This study will examine the extent to which social isolation occurs in nursing homes, how it impacts health and well-being, and what factors may reduce social isolation and increase social connectedness.