Change in modifiable dementia risk factors during COVID-19 lockdown: The experience of over 50s in Tasmania, Australia

The Impact of Pandemic-Related Restrictions on Dementia Risk Factors in Older Adults

Adults aged 65+ are at highest risk for severe COVID-19 outcomes, and prior to the distribution of vaccines in the U.S., were strongly advised to quarantine at home to reduce risk of infection. This study examines how COVID-19 restrictions impacted various dementia risk factors and social determinants of health among older adults. Data came from the Systematic Multi-Domain Alzheimer's Risk Reduction Trial, a randomized controlled trial of a multi-domain intervention in higher-risk older adults (aged 70-89). A questionnaire was administered to participants (n = 156; 90.7% response rate) between May 2020 and March 2021. The data show a significant decline in social activity, physical activity, and mood among respondents. Compared to living with others, living alone was associated with worsened physical activity, diet, and subjective memory/thinking, adjusted for sex and age. These results suggest that the COVID-19 pandemic exacerbated several risk factors for dementia in older adults, particularly in those living alone.

How did COVID-19 restrictions impact alcohol consumption in Australia? A longitudinal study

INTRODUCTION

The state of Victoria experienced more stringent public health measures than other Australian states during the COVID-19 pandemic. This study investigated how these public health measures impacted: (i) total alcohol consumption; (ii) location-specific consumption; and (iii) consumption among different pre-pandemic drinking groups, in Victoria compared to the rest of Australia during the first year of the pandemic.

METHOD

A longitudinal study with six survey waves was conducted between April and December 2020. A total of 775 adults completed data on alcohol use, including detailed consumption location information. Based on their 2019 consumption, participants were classified into low, moderate or high-risk groups. Data were analysed descriptively.

RESULTS

There was no difference in total alcohol consumption from 2019 levels among Victorians and those from the other Australian states when Victoria was the only state in lockdown. Location-specific consumption was relatively similar for Victoria and the rest of Australia, with an increase in home drinking, and a decrease in consumption in someone else's home, licensed premises and public spaces during lockdown compared with 2019. Participants in the high-risk group reported a reduction of two standard drinks per day in November 2020 compared with 2019. In contrast, consumption remained relatively stable for participants in the low and moderate-risk groups once accounting for regression to the mean.

DISCUSSION AND CONCLUSION

Contrary to expectations, restrictions on licensed premises appeared to impact high-risk drinkers more than low and moderate-risk drinkers. Reducing availability of on-premise alcohol may be an effective way to reduce consumption in heavier drinkers.

COVID-19 and working from home-related changes in physical activity in Sydney, Australia

ISSUES ADDRESSED

Evidence on how COVID-19 lockdowns impacted physical activity (PA) is mixed. This study explores changes in PA following initial mobility restrictions, and their subsequent relaxation, in a sample of Sydney (Australia) residents using a natural experiment methodology.

METHODS

Participants' health and travel behaviours were collected pre-pandemic in late 2019 (n = 1937), with follow-up waves during the pandemic in 2020 (n = 1706) and 2021 (n = 1514). Linear mixed-effects models were used to analyse changes in weekly duration of PA between the three waves.

RESULTS

Compared with pre-pandemic, average weekly PA increased in 2021 by 42.6 min total PA (p = .001), 16 min walking PA (p = .02), and 26.4 min moderate-vigorous PA (MVPA) (p = .003). However, average weekly sessions of PA decreased in 2020 and remained lower in 2021. For participants who were sufficiently active in 2019, weekly total PA (-66.3 min) MVPA (-43.8 min) decreased in 2020 compared to pre-pandemic. Conversely, among participants who were insufficiently active in 2019, average weekly PA increased in both 2020 (total PA, +99.1 min; walking PA, +46.4 min; MVPA +52.8 min) and 2021 (total PA, +117.8 min; walking PA, +58.4 min; MVPA +59.2 min), compared to 2019. Participants who did more work from home increased their average weekly total PA in 2021 compared to pre-pandemic (+45.3 min).

CONCLUSION

These findings reveal the complex variability in PA behaviour brought about by the pandemic. SO WHAT?: Strategies to support the population in achieving sufficient PA must focus on maintaining an appetite for PA as we move out of the pandemic and on promoting more frequent PA sessions.

An online, public health framework supporting behaviour change to reduce dementia risk: interim results from the ISLAND study linking ageing and neurodegenerative disease

BACKGROUND

Unmanaged cardiometabolic health, low physical and cognitive activity, poor diet, obesity, smoking and excessive alcohol consumption are modifiable health risk factors for dementia and public health approaches to dementia prevention have been called for. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) is a dementia prevention public health study examining whether improving knowledge about modifiable dementia risk factors supports behaviour changes that reduce future dementia risk.

METHODS

Residents of Tasmania, Australia, aged 50 + years who joined the 10-year ISLAND study were asked to complete annual online surveys about their knowledge, motivations and behaviours related to modifiable dementia risk. ISLAND included two knowledge-based interventions: a personalised Dementia Risk Profile (DRP) report based on survey responses, and the option to do a 4-week Preventing Dementia Massive Open Online Course (PDMOOC). Longitudinal regression models assessed changes in the number and type of risk factors, with effects moderated by exposures to the DRP report and engagement with the PDMOOC. Knowledge and motivational factors related to dementia risk were examined as mediators of risk behaviour change.

RESULTS

Data collected between October 2019 and October 2022 (n = 3038, av. 63.7 years, 71.6% female) showed the mean number of modifiable dementia risk factors per participant (range 0 to 9) reduced from 2.17 (SD 1.24) to 1.66 (SD 1.11). This change was associated with the number of exposures to the DRP report (p = .042) and was stronger for PDMOOC participants (p = .001). The interaction between DRP and PDMOOC exposures yielded a significant improvement in risk scores (p = .004). The effect of PDMOOC engagement on behaviour change was partly mediated by increased knowledge (12%, p = .013). Self-efficacy enhanced the effect of knowledge on behaviour change, while perceived susceptibility to dementia mitigated this relationship.

CONCLUSIONS

The ISLAND framework and interventions, a personalised DRP report and the four-week PDMOOC, work independently and synergistically to increase dementia risk knowledge and stimulate health behaviour change for dementia risk reduction. ISLAND offers a feasible and scalable public health approach for redressing the rising prevalence of dementia.

Older adults' perspectives towards optimizing lifestyle behaviors and strategies to support healthy brain ageing during COVID-19 restrictions

Introduction

It is unknown how the impact of COVID-19 restrictions has affected brain healthy behaviors that contribute to dementia risk reduction in older adults. Our aim was to explore perspectives of older adults on lifestyle behaviors that support positive brain health and dementia risk reduction during and following COVID-19 restrictions.

Methods

Community-dwelling older Australians (N = 159) during June to October 2021 (the second wave of COVID-19 restrictions) who had taken part in a pre-post dementia risk reduction intervention program were invited to discuss the impact of COVID-19 on their lifestyle behaviors. Semi-structured interviews explored individual's adaptability to pandemic restrictions, intended behavior changes following restrictions easing, and feedback on the effectiveness of ongoing intervention programs for sustaining brain health. Thematic data analysis was performed using a deductive approach.

Results

Participants had an average age of 73.1 years (SD = 5.6; range: 65-90), majority were female (74.7%), lived in a major city (82.2%) and mean 9.5 years (SD = 1.7) of education. Older adults' views about lifestyle prevention strategies during the pandemic were both positive (e.g., more spare time and adaptive leisure activities) and negative (e.g., social isolation, lack of motivation, adverse emotions). Participants highlighted a continuous conscious effort to adapt certain brain healthy behaviors despite the persistence of adverse impacts of COVID-19 restrictions. Participants also expressed the intention and desire to revert to their previous lifestyle before the COVID-19 pandemic or a sense of the 'new normal'.

Conclusion

This formative research will inform future interventions targeting dementia risk reduction to consider the immediate and lasting effects of COVID-19 restrictions on older adult's lifestyle behavior.

The Drivers of Conversations About Dementia Risk Reduction: A Qualitative Study

Dementia prevention is an area of health where public knowledge remains limited. A growing number of education initiatives are attempting to rectify this, but they tend to reach audiences of limited size and diversity, limiting intervention-associated health equity. However, initiative participants tend to discuss these initiatives and the information they contain with members of their social network, increasing the number and diversity of people receiving dementia risk reduction information. In this qualitative study, we sought to understand the drivers of this information sharing. We interviewed 39 people from Tasmania, Australia who completed the Preventing Dementia Massive Open Online Course in May 2020. We identified themes from responses to semi-structured interview questions using reflexive thematic analysis. We identified three key drivers of information sharing: participants' personal course experiences; participants finding information sharing opportunities with people they expected to be receptive; and conversation partners' responses to conversation topics. These drivers aligned with existing communication theories, with dementia-related stigma effecting both actual and perceived conversation partner receptivity. Understanding the drivers of information sharing may allow information about dementia risk reduction, and other preventative health behaviors, to be presented in ways that facilitate information diffusion, increasing equity in preventative health education.

Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study

Background

Up to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed.

Objective

We aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels.

Methods

The Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time.

Results

In the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing.

Conclusions

Recruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context.

International Registered Report Identifier (IRRID)

DERR1-10.2196/34688

Changes in Physical Activity Patterns Due to the Covid-19 Pandemic: A Systematic Review and Meta-Analysis

With the outbreak of the Corona Virus Disease 19 (Covid-19) in late 2019, governments increasingly imposed containment strategies, including social distancing as well as restricted population movement, potentially having negative impacts on mental and physical health. A growing number of studies have examined the impact of the pandemic on different facets of physical activity (PA); an overview combining these (mixed) results, however, is missing. Thus, the objective of this systematic review and meta-analysis was to investigate whether and to which extent PA changed from before to during the Covid-19 pandemic, taking age, gender, and measurement method into account. The literature search was conducted using PubMed, Web of Science, and Scopus. Results of the main characteristics were descriptively synthesized and analyzed in a meta-analysis quantifying effects of the pandemic on PA divided by age groups, with additional subgroup analyses of the characteristics age, gender, and measurement method being narratively synthesized. Overall, 57 studies with a total sample size of 119,094 participants (N between 10 and 60,560 subjects) from 14 countries worldwide with participants aged between four and 93 years were included. Thirty-two studies revealed a significant decline in PA, whereas only five studies found a significant increase in PA during the Covid-19 pandemic. Fourteen studies revealed mixed results. PA decreased in all age groups, independent of gender. Most self-reported and all device-based measurement methods showed a reduction in PA. However, effects were not found to be significant in all age groups. Nevertheless, the declining trend should be noted and governments should strive to enable PA within periods of pandemic restrictions, or promote alternatives such as digital training to avoid negative health consequences within the population.