Disease Containment Measures Among Older Adults During the Covid-19 Pandemia

Study Overview
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Brief Summary
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This study will examine which impact lockdown strategies intending to prevent the spread of COVID-19 had on people with cognitive impairment and dementia. Comprehensive data from two large health studies in Norway, conducted before and after the COVID-19 outbreak, will be linked with health register data on the use of health care services and medication. Further, it will be conducted a survey addressing questions on social isolation and use of communicative technology, from March 2020 to January 2021. The knowledge gained from this study can improve the health care system's ability to respond more adequately to pandemics and other unforeseen events, so that the negative consequences for older adults with dementia and cognitive impairment can be reduced.

Detailed Description
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Introduction: To prevent the spread of COVID-19 societies around the world have implemented various levels of lockdown strategies. Norway locked down major parts of the society from March 2020. Specifically, this meant that public services were closed (e.g. most in-home healthcare services, day care centres, group exercise/gyms and services that offer physiotherapy, medical and psychological consultation). For people with cognitive impairment and dementia, social distancing and self-isolation may have limited the use of normal strategies (e.g., distraction, stimulation, and social interaction) that are routinely adopted to manage some of the dementia symptoms, such as neuropsychiatric symptoms. A lack of daily routines may change the clinical conditions of patients with dementia. Worsening of preexisting and/or the onset of new neuropsychiatric symptoms may occur, in addition to a possible decline of cognitive and functional capacities Aim: The overarching aim of this project is to provide decision makers with vital information to improve the healthcare of people with dementia and cognitive impairment in the context of an epidemic. Method: We will use four data sources:1) The fourth wave of the Trøndelag Health study (HUNT, HUNT4 70+), 2) Three national health registries (The Norwegian Patient Registry (NPR), the Norwegian Registry for Primary Health Care (NRPHC) and the Norwegian Prescription Database (NorPD)), 3) A postal questionnaire concerning social isolation during the COVID-19 epidemic, and 4) The Ageing in Trøndelag study (AiT), which is a follow-up of the HUNT4 70+ study. With this linkage of cohort data and national health registry data, we can identify factors that may make people with cognitive impairment and dementia vulnerable to loss of healthcare services because of COVID-19 and subsequently to negative health consequences.

Official Title
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The Impact of the COVID-19 Epidemic on the Health of Older Adults

Conditions
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Dementia, Cognitive Impairment, Depression, Anxiety, Loneliness

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Inhabitants living in the designated areas Exclusion Criteria: None

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Inhabitants in Nord-Trøndelag 70 years of age and older<br>All inhabitants in Nord-Trøndelag 70 years of age and older, who participated in the HUNT4 70+-study, between 2017 and 2019. | |
| Inhabitants in one area in Trondheim, 70 years of age and older<br>All inhabitants one area in Trondheim, 70 years of age and older, who participated in the HUNT4 70+-study, between 2017 and 2019. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Use of Health care services | Information from the Norwegian Patient Registry (NPR) and the Norwegian Registry for Primary Health Care (NRPHC) | The participants' use of health care services from the period 2017-2019 | 
| Use of Health care services | Information from the Norwegian Patient Registry (NPR) and the Norwegian Registry for Primary Health Care (NRPHC) | The participants' use of health care services in 2020 | 
| Use of Health care services | Information from the Norwegian Patient Registry (NPR) and the Norwegian Registry for Primary Health Care (NRPHC) | The participants' use of health care services from the period 2021-2022 | 
| Use of psychotropic medications | Information from the Norwegian Prescription Database (NorPD) | The participants' use of psychotropic medication from the period 2017-2019 | 
| Use of psychotropic medications | Information from the Norwegian Prescription Database (NorPD) | The participants' use of psychotropic medication in 2020 | 
| Use of psychotropic medications | Information from the Norwegian Prescription Database (NorPD) | The participants' use of psychotropic medication from the period 2021-2022 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Montreal Cognitive Assessment scale | Tests cognitive function in the domain's memory, visuospatial and executive functions, attention, concentration, language and orientation. Scores from 0 - 30 where 30 indicates best function. impairment or dementia, and questions on subjective memory decline | The participants were assessed when attending the HUNT4 70+-study, and will be assessed with the same measures in the followup study in 2021/2022 | 
| CERAD Ten-words test | Tests immediate and delayed memory. Scores from 0 - 30 in immediate memory and 0-10 in delayed recall, higher scores indicates better function. | The participants were assessed when attending the HUNT4 70+-study, and will be assessed with the same measures in the followup study in 2021/2022 | 
| Incidence of dementia diagnosis | Two clinical and scientific experts will independently set at diagnosis of cognitive impairment or dementia based on all available information applying standard diagnostic criteria DSM-5 | The participants were assessed when attending the HUNT4 70+-study, and will be assessed with the same measures in the followup study in 2021/2022 | 
| Incidence of mild cognitive impairment | Two clinical and scientific experts will independently set at diagnosis of cognitive impairment or dementia based on all available information applying standard diagnostic criteria DSM-5 | The participants were assessed when attending the HUNT4 70+-study, and will be assessed with the same measures in the followup study in 2021/2022 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Dementia, Pandemic, Health care services, Population study, Older adults, Depression