COVID-19-Related Changes in Assistance Networks for U.S. Older Adults With and Without Dementia

Changes in Long-term Services and Supports Among Adults With and Without Dementia During the First Year of the COVID-19 Pandemic

Background and Objectives

This study draws upon local coronavirus disease 2019 (COVID-19) mortality rates as a proxy for pandemic severity to determine if the COVID-19 pandemic disrupted long-term services and supports (LTSS) for adults with dementia, relative to adults with care needs unrelated to dementia.

Research Design and Methods

We used the Health and Retirement Study to estimate associations between local COVID-19 mortality rates from March 2020 through April 2021 and LTSS outcomes (receiving paid and unpaid help, monthly hours of paid and unpaid help, number of paid and unpaid helpers, living in a residential care setting, or living with adult children). We compared 2 groups of adults ages 51 and older: those with dementia (n = 522) and those without dementia but having difficulty with at least one activity of daily living (n = 2,036).

Results

We found that higher local COVID-19 mortality rates were associated with a reduction in paid care and living in residential care settings for both groups of adults with care needs. In addition, higher local COVID-19 mortality rates were associated with a greater likelihood of living with adult children among those without dementia and greater hours of unpaid help among those with dementia.

Discussion and Implications

Although we did not find differences in disruptions of LTSS between persons with and without dementia, observed declines in paid LTSS and increases in unpaid care in the first year of the pandemic may nevertheless have different implications for persons with dementia. Future research should investigate if COVID-19 related disruptions in LTSS led to differential changes in health and unmet needs among adults with dementia, increased strain for their caregivers, and the equitable availability of high-quality paid care.

Perceived loss of support to community caregivers during the COVID-19 pandemic in the United States

Coronavirus disease (COVID-19) had a negative impact on the health and well-being of community caregivers. Few studies examine the pandemic's negative impact on the availability of social networks of caregivers. This article uses data collected during COVID-19 before vaccination to examine caregivers' reports of perceived lost and reduced network support. We assessed the personal networks of a nationally representative sample of 2214 community caregivers in the United States. We analyzed associations between caregiving factors and caregivers' perceptions of lost and reduced network support. Changes in care recipient living circumstances during COVID-19, longer-term caregiving, care recipient hearing/vision/mobility problems, caregiver travel/socializing restrictions, caregiver race/ethnicity, caregiver income, caregiver age, network connectivity, family relationships, and network members' age were associated with perceived lost/reduced support during the pandemic. Findings provide insights for the development of social network interventions to support caregivers and help them cultivate support networks resilient to public health crises.

Changes in late-life assistance networks for Black and White older adults during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has disproportionately impacted older Black Americans. Given that assistance networks play a crucial role in older adults' ability to respond to challenges, we sought to investigate whether older adults' assistance network size changed during the COVID-19 pandemic and differed by race.

METHODS

We analyzed data from the 2018-2020 rounds of the U.S. National Health and Aging Trends Study for Black and White adults aged 70 and older receiving help in the community or residential care settings. We used ordinary least squares regression to compare changes in assistance network size in the 2 years pre-COVID-19 (2018-2019, N = 3438) to changes in size at the onset of COVID-19 (2019-2020, N = 3185).

RESULTS

Black older adults had larger assistance networks with a greater number of family helpers before and during the pandemic compared to their White counterparts. Assistance network size for older adults increased before but not during the pandemic mostly due to declines in unpaid nonrelative helpers and lack of increase in paid helpers. These effects did not differ by race.

CONCLUSIONS

Black and White older adults experienced similarly sized reductions in their assistance networks as a consequence of the COVID-19 pandemic. Future research should investigate the relationship between these network changes and the unmet needs of older adults.