At‐homeness: A novel psycho‐socio‐environmental construct for an eMental Health controlled trial to prevent loneliness and cognitive decline among older adults with multimorbidity

Abstract

AbstractBackgroundApproximately two‐thirds of older adults’ experience multimorbidity in Canada and the US. Challenges of symptoms management and reduced mobility often coincide with late‐life depression which is associated with a 2 to 5‐fold increased dementia risk. Loneliness and depression are connected in the prodromal phases. Loneliness is distinct from social isolation and has direct neurological impact on the brain (Cacioppo et al., 2014). Yet, recent umbrella review of RCTs on loneliness reported “limited effects” (Jarvis et al., 2020). Following recommendations for theory‐based non‐pharmacological interventions (Sikkes et al., 2020), this paper develops a novel construct as an antidote to loneliness for eMental Health intervention among MMOA.MethodFindings from three sequential studies were combined to examine the preventive potential of a measurable construct. (1) Systematic review identified 28 studies on the experiences people living with dementia in the community. Comparative synthesis was conducted ethnographic data (e.g., in‐depth interviews) since Chaudhury (2001). (2) Primary qualitative data were extracted to generate items for a preliminary scale. Factor analysis was conducted to examine construct validity. (3) An index was constructed using comprehensive data from the Canadian Longitudinal Study on Aging (CLSA). Path analysis was conducted to examine direct and indirect effects on loneliness, depression, and cognition, controlling for baseline. Social environment (e.g., social support) was included for comparison.Result(1) Understanding behavioral symptoms as non‐verbal expressions and employing Deweyan person‐place integration, at‐homeness emerged as a psychological construct that could address prodromal loneliness. (2) Factor analysis (n=212) reduced 28 items to 20 items (α=.920) At‐homeness includes three factors: identity‐stability(α=.886), social experiences (α=.887), self‐expression (α=.767)(SRMR=.075). Convergent validity with neighborhood factors was found (B=.43, p<.001). (3) Measures of housing, neighborhood, and life satisfaction were used. Path analysis (n=15,087) showed good model fit indexes (TLI=.989; CFI=.999; RMSEA=.026; SRMR=.006). At‐homeness (B=‐.20, p<.001) rivals the effect of social environment (B=‐.19, p<.001) on loneliness. Structural equation modelling showed that, together, at‐homeness and loneliness have as much effect on cognition as depression.ConclusionAt‐homeness is a promising novel psycho‐socio‐environmental construct to reduce loneliness and cognitive decline among MMOA. Its factors may be influenced through customized activity suggestions. A pilot study is underway.