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Unintended consequences of COVID-19 social distancing among older adults with kidney disease.
J Gerontol A Biol Sci Med Sci. 2021 Jul 21 [Online ahead of print]JG

Abstract

BACKGROUND

While social distancing policies protect older adults with advanced chronic kidney disease (CKD) from exposure to COVID-19, reduced social interaction may also have unintended consequences.

METHODS

To identify subgroups of patients at risk for unintended health consequences of social distancing, we conducted a cross-sectional analysis of data from a national cohort study of older Veterans with advanced CKD (n=223). Characteristics included activities of daily living (ADLs), instrumental ADLs (IADLs), cognition score, depression score, social support, financial stress, symptom burden, and number of chronic conditions. Unintended consequences of social distancing included restricted Life Space mobility, low willingness for video telehealth, reduced in-person contact with caregivers, and food insecurity. We identified subgroups of patients at risk of unintended consequences using model-based recursive partitioning (MoB).

RESULTS

Participants had a mean age of 77.9 years, 64.6% were white, and 96.9% were male. Overall, 22.4% of participants had restricted Life Space, 33.9% reported low willingness for video telehealth, 19.0% reported reduced caregiver contact, and 3.2% reported food insecurity. For Life Space restriction, four subgroups partitioned (i.e., split) by IADL difficulty, cognition score, and ADL difficulty were identified. The highest rate of restricted Life Space was 54.7% in the subgroup of participants with >3 IADL difficulties For low willingness for telehealth and reduced caregiver contact, separate models identified two subgroups split by cognition score and depression score, respectively.

CONCLUSIONS

Measures of function, cognition, and depressive symptoms may identify older adults with advanced CKD who are at higher risk for unintended health consequences of social distancing.

Authors+Show Affiliations

Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC. Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC. Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC. Department of Medicine, Duke University, Durham, NC.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC.Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System (VAHCS), Durham, NC. Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, NC. Department of Medicine, Duke University, Durham, NC.Department of Medicine, Duke University, Durham, NC.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC. Department of Medicine, Duke University, Durham, NC. Department of Population Health Sciences, Duke University, Durham, NC.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC. Department of Medicine, Duke University, Durham, NC. Department of Population Health Sciences, Duke University, Durham, NC.Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC. Department of Medicine, Duke University, Durham, NC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34286836

Citation

Bowling, C Barrett, et al. "Unintended Consequences of COVID-19 Social Distancing Among Older Adults With Kidney Disease." The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 2021.
Bowling CB, Berkowitz TSZ, Smith B, et al. Unintended consequences of COVID-19 social distancing among older adults with kidney disease. J Gerontol A Biol Sci Med Sci. 2021.
Bowling, C. B., Berkowitz, T. S. Z., Smith, B., Whitson, H. E., DePasquale, N., Wang, V., Maciejewski, M. L., & Olsen, M. (2021). Unintended consequences of COVID-19 social distancing among older adults with kidney disease. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences. https://doi.org/10.1093/gerona/glab211
Bowling CB, et al. Unintended Consequences of COVID-19 Social Distancing Among Older Adults With Kidney Disease. J Gerontol A Biol Sci Med Sci. 2021 Jul 21; PubMed PMID: 34286836.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unintended consequences of COVID-19 social distancing among older adults with kidney disease. AU - Bowling,C Barrett, AU - Berkowitz,Theodore S Z, AU - Smith,Battista, AU - Whitson,Heather E, AU - DePasquale,Nicole, AU - Wang,Virginia, AU - Maciejewski,Matthew L, AU - Olsen,Maren, Y1 - 2021/07/21/ PY - 2021/04/30/received PY - 2021/7/21/entrez PY - 2021/7/22/pubmed PY - 2021/7/22/medline KW - COVID-19 KW - chronic kidney disease KW - older adults JF - The journals of gerontology. Series A, Biological sciences and medical sciences JO - J Gerontol A Biol Sci Med Sci N2 - BACKGROUND: While social distancing policies protect older adults with advanced chronic kidney disease (CKD) from exposure to COVID-19, reduced social interaction may also have unintended consequences. METHODS: To identify subgroups of patients at risk for unintended health consequences of social distancing, we conducted a cross-sectional analysis of data from a national cohort study of older Veterans with advanced CKD (n=223). Characteristics included activities of daily living (ADLs), instrumental ADLs (IADLs), cognition score, depression score, social support, financial stress, symptom burden, and number of chronic conditions. Unintended consequences of social distancing included restricted Life Space mobility, low willingness for video telehealth, reduced in-person contact with caregivers, and food insecurity. We identified subgroups of patients at risk of unintended consequences using model-based recursive partitioning (MoB). RESULTS: Participants had a mean age of 77.9 years, 64.6% were white, and 96.9% were male. Overall, 22.4% of participants had restricted Life Space, 33.9% reported low willingness for video telehealth, 19.0% reported reduced caregiver contact, and 3.2% reported food insecurity. For Life Space restriction, four subgroups partitioned (i.e., split) by IADL difficulty, cognition score, and ADL difficulty were identified. The highest rate of restricted Life Space was 54.7% in the subgroup of participants with >3 IADL difficulties For low willingness for telehealth and reduced caregiver contact, separate models identified two subgroups split by cognition score and depression score, respectively. CONCLUSIONS: Measures of function, cognition, and depressive symptoms may identify older adults with advanced CKD who are at higher risk for unintended health consequences of social distancing. SN - 1758-535X UR - https://www.unboundmedicine.com/medline/citation/34286836/Unintended_consequences_of_COVID-19_social_distancing_among_older_adults_with_kidney_disease. L2 - https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glab211 DB - PRIME DP - Unbound Medicine ER -
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