A Mixed-methods Approach to Understand the Interplays of Social and Physical Environments, Loneliness, and Cognition among Older People with HIV
Funded Grant
Overview
Affiliation
View All
Overview
description
PROJECT SUMMARY There is rapid growth in the aging HIV population in the United States, who are at increased risk for cognitive impairment. Loneliness is a risk factor for cognitive deficits, and older people with HIV (PWH) report significant loneliness. Despite well-established associations between loneliness and cognition, findings specific to older PWH address only overall cognition and are cross-sectional, limiting understanding of longitudinal effects on specific cognitive domains over time. The ecological theory of aging posits that well-being is shaped by the dynamic interplay of individual- and environment-level factors; social and physical environments may therefore mutually reinforce loneliness and exacerbate cognitive health, yet this has not been empirically studied. My long-term goal is to enhance health and well-being of the aging HIV population by identifying and intervening on modifiable, multilevel factors. Building on prior cross-sectional work, this proposed mixed-methods study will examine how specific, measurable social (including community integration, social support, social isolation) and physical environment-level factors (geocoded data informing area deprivation, neighborhood-level resources, greenspace) influence the relationship between loneliness and cognition in older PWH, and will elicit qualitative perspectives to add rich description to these associations by leveraging an ongoing prospective R01 nested within the MACS/WIHS Combined Cohort Study. Guided by multidisciplinary mentors with complementary and synergistic expertise, I will pursue the following research aims among older people with HIV (≥50 years old): 1) determine the longitudinal patterns of loneliness (measured by De Jong Gierveld Scale) and cognitive performance across specific domains over time; 2) identify social and physical environment-level factors related to loneliness and cognition; and 3) elicit perspectives of how individual- and social/physical environment-level factors affect cognitive health and how narratives of loneliness vary. Complementing this research, a detailed training plan will include 1) the science of cognition within the context of HIV and aging; 2) measurement and analysis of social and physical environmental factors that influence health ; 3) longitudinal data analytic skills; and 4) mixed-methods and community-engaged research. The protected time afforded by K01 will equip me to launch an independent research career incorporating measurable social and environmental determinants into the study of HIV and aging, informing subsequent R-level grants and ultimately strategies to improve health and well-being of older PWH.
