Megan E. O’Connell’s research while affiliated with University of Saskatchewan and other places

Background During the COVID-19 pandemic, olderadult-focused community organizations played an essential role in supporting the wellbeing of older adults. Supporting older adults during this time required extensive modifications to existing programming but their adaptations during the COVID-19 pandemic are not well documented. The purpose of this study was to understand how older adult-focused community organizations adopted virtual delivery formats during the COVID-19 pandemic and their perspectives of the barriers and facilitators for organizations and older adults. Methods To understand the changes that were made, we conducted a qualitative environmental scan of community-based services across British Columbia. Online searches were complemented by snowball sampling and key informant interviews. We identified 90 older adult-serving community organizations and interviewed 26. We used reflexive thematic analysis to understand the main strategies. Results These community organizations described barriers related to older adults’ wellbeing, information technology proficiency, and personal/organizational losses related to changes in program structure. Facilitators for virtual activities and events included inter- and intra-organizational collaboration, intrinsic qualities of program design, physical resources to supporting virtual programming, and availability of technological resources. Organizations described meeting the challenge by increasing the ‘depth’ and ‘breadth’ of their reach. Conclusion Older adult-focused community organizations recognized the critical role they played for older adults and adapted their resources to meet those needs. Informational technology was quickly and effectively leveraged to promote social interaction for older adults when physical distancing was required during the COVID-19 pandemic. Barriers related to cost, time, and ultimately older adults’ interest in a virtual delivery format were critical limitations. Graphical Abstract

Objectives: We evaluated the association between two measures of social connection prior to COVID-19-social isolation and functional social support-and loneliness during the pandemic. Method: The study was a retrospective longitudinal analysis of 20,129 middle-aged and older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). We drew upon two waves of CLSA data spanning three years and the supplemental COVID-19 Questionnaire Study of eight months to conduct our analysis. Results: Social isolation prior to COVID-19 was associated with loneliness during COVID-19 only among persons who were lonely before the pandemic (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.02, 1.35). Higher functional social support prior to COVID-19 was inversely associated with loneliness during the pandemic, when adjusting for pre-COVID-19 loneliness (aOR: 0.37; 95%CI: 0.34, 0.41) and when assessing incident loneliness during the pandemic (adjusted relative risk: 0.59; 95% CI: 0.55, 0.63). Conclusion: Policies are needed to identify people who are both socially isolated and lonely, and provide them with functional social support, to prevent worsening loneliness during public health crises.

Background We sought to compare whether quality of life (QOL) in patients with subjective cognitive impairment (SCI) who performed normally on a neuropsychological battery significantly differed from those diagnosed with mild cognitive impairment (MCI), Alzheimer’s disease (AD) or non-Alzheimer’s dementia (non-AD) at initial assessment in a Rural and Remote Memory Clinic (RRMC). Methods 610 patients referred to our RRMC between 2004 and 2019 were included in this study. We compared self-reported and caregiver-reported patient QOL scores in those with SCI ( n = 166) to those diagnosed with MCI ( n = 98), AD ( n = 228) and non-AD ( n = 118). Results Patients with SCI self-reported significantly lower QOL compared to patients with AD. Interestingly, the reverse was seen in caregivers: SCI caregivers rated patient QOL higher than AD caregivers. Patients with SCI also reported lower QOL than patients with MCI. SCI caregivers reported higher patient QOL than their non-AD counterparts. Caregiver-rated patient QOL was higher in those with MCI compared to AD. Patients with MCI self-reported higher QOL scores compared to patients with non-AD dementias. Similarly, MCI caregivers reported higher patient QOL than non-AD caregivers. No other comparisons were statistically significant. Conclusion Although they lacked clinically significant cognitive deficits, patients with SCI self-reported significantly lower QOL than patients with MCI and AD. Conversely, caregiver-reported patient QOL was higher for patients with SCI than for patients with AD and non-AD. This shows that SCI seriously impacts QOL. More research is needed on how we can better support patients with SCI to improve their QOL.

Background Remote diagnostic assessment of cognitively impaired individuals offers numerous potential benefits including increased access to care. However, remote cognitive and behavioral assessment also has limitations, and may not be appropriate for certain patients. Currently, evidence‐based guidance on virtual assessment readiness is lacking. Our goal was to develop a clinical decision‐making tool that outlines an approach to determining a patient’s suitability for undergoing remote cognitive and behavioral diagnostic assessment by identifying ‘red flags’ for remote assessment. To address this goal, a multidisciplinary workgroup was convened under the auspices of the Canadian Consortium on Neurodegeneration in Aging (CCNA). This workgroup was composed of experts in remote assessment and included behavioral neurologists, neuropsychiatrists, neuropsychologists, social workers, geriatricians, persons with lived experience and family medicine specialists. Methods The Delphi process is an iterative, systematic, group consensus method, used here to determine the features of the patient, caregiver, clinician and context/situation, or ‘red flags’, indicating that a remote cognitive diagnostic assessment should be avoided. The process consisted of anonymized data collection in three rounds among the multidisciplinary expert workgroup, culminating in two rounds of iterative scoring of potential red flags based on three quality indicators that assessed a potential red flag’s effectiveness, reproducibility, and efficiency. Red flags that received an overall mean score above the pre‐determined consensus threshold on the final round were included in the final clinical decision‐making tool. Result In the first round, 11 respondents, with an average of 12.4 years of clinical experience, generated 67 unique potential red flags. In the second and third rounds, 8 and 9 respondents, respectively, scored the flags on the three quality indicators. Applying consensus criteria yielded 14 red flags that achieved consensus. Conclusion To enhance the translation and implementation of these findings, we developed a clinical decision‐making tool and infographic describing the final set of red flags in collaboration with the CCNA knowledge translation team. This infographic is designed to help clinicians determine a patient’s readiness to undergo remote cognitive assessment. This study directly impacts the clinical care of cognitively impaired individuals by providing clinical decision‐making guidance on a patient’s suitability for remote neurobehavioral assessment.

An unintended side-effect of the COVID-19 pandemic has been changes in lifestyle factors which impact middle-aged and older adult cognition – including changes in 24-hour behaviours (i.e., physical activity, sedentary behaviour, and sleep). In a longitudinal analysis of the Canadian Longitudinal Study on Aging (CLSA) tracking cohort, we explored age- and sex-differences in the effects of the COVID-19 pandemic on cognition and 24-hour behaviours, and whether pandemic-related changes in 24-hour behaviours and cognition are associated. We included cognitively healthy participants at baseline (2012-2105), follow-up 1 (FU1; 2015-2018), and follow-up 2 (FU2; 2018-2021), with complete neuropsychological testing data (N=11,355). Cognition and 24-hour behaviours were indexed at each timepoint. Participants were categorized into pre-pandemic (N=6,174) and post-pandemic (N=5,181) cohorts based on whether FU2 assessments occurred before or after COVID-19 pandemic onset (March 11th, 2020). We examined time x cohort changes in cognition and 24-hour behaviours from FU1 to FU2, and if changes in 24-hour behaviours from FU1 to FU2 were associated with changes in cognition. All models were allowed to vary by age and sex. Our results indicated that post-pandemic cohort males and females aged 65+ years had significantly worse cognition and poorer 24-hour behaviours from FU1 to FU2 than their peers in the pre-pandemic cohort (p’s< 0.05). However, changes in 24-hour behaviours from FU1 to FU2 were unassociated with changes in cognition, irrespective of age or sex. Our results highlight that the pandemic negatively impacted 24-hour behaviours and cognition in older adults – although these effects may be unassociated with each other.

Objective Technology can be combined with psychological interventions to support older adults with memory concerns. Using a bi-phasic design, cognitive rehabilitation (CR) was integrated with off-the-shelf technology and delivered to two people with cognitive impairment, and one care partner. Method Pre- and post-intervention assessments were completed for all participants. Individuals with memory problems received pre- and post-intervention remote neuropsychological assessment (i.e., Rey auditory verbal learning test; mental alternations test; animal fluency), and the hospital anxiety and depression scale (HADS). The care partner completed the HADS, Zarit burden interview, and neuropsychiatric inventory questionnaire. Change metrics incorporated reliable change indices where possible. Goals were tracked using the Canadian occupation performance measure; these data were analyzed through visual inspection. A research journal (used to document intervention process) was analyzed thematically. Results Results cautiously suggested our integration was feasible and acceptable across several technologies and varying goals. Across participants, significant changes in goal progress suggested the integration of technology with CR successfully facilitated goal performance and satisfaction. The research journal underscored the importance of a visual component, intervention flexibility, and a strong therapeutic alliance in integrating technology and CR. Conclusions CR and technology present a promising avenue for supporting people living with cognitive impairment. Further exploration of technology and CR with a range of etiologies and target goals is warranted.

The Canadian Consortium on Neurodegeneration in Aging (CCNA) was created by the Canadian federal government through its health research funding agency, the Canadian Institutes for Health Research (CIHR), in 2014, as a response to the G7 initiative to fight dementia. Two five-year funding cycles (2014–2019; 2019–2024) have occurred following peer review, and a third cycle (Phase 3) has just begun. A unique construct was mandated, consisting of 20 national teams in Phase I and 19 teams in Phase II (with research topics spanning from basic to clinical science to health resource systems) along with cross-cutting programs to support them. Responding to the needs of researchers within the CCNA teams, a unique sample of 1173 deeply phenotyped patients with various forms of dementia was accrued and studied over eight years (COMPASS-ND). In the second phase of funding (2019–2024), a national dementia prevention program (CAN-THUMBS UP) was set up. In a short time, this prevention program became a member of the World Wide FINGERS prevention consortium. In this article, the challenges, successes, and impacts of CCNA in Canada and internationally are discussed. Short-term deliverables have occurred, along with considerable promise of impacts in the longer term. The creation of synergy, networking, capacity building, engagement of people with lived experience, and economies of scale have contributed to the considerable success of CCNA by all measures. CCNA is evidence that an organized “centrally-organized” approach to dementia research can catalyze important progress nationally and yield significant and measurable results.