Social, Digital and Community Capital Facilitated COVID-19 Pandemic Resilience in a Qualitative Survey of Older Adults With Mild Cognitive Concerns

The COVID-19 pandemic negatively affected known dementia risk factors and cognition in older adults. Our objective was to explore how older adults with cognitive concerns (ie, MCI or SCD) were able, or not able to engage in lifestyle activities associated with dementia prevention and maintain their wellbeing. We invited adults with mild cognitive concerns without dementia, aged ≥60 years participating in a randomised controlled trial of a psychosocial, secondary dementia prevention intervention, to complete a semi-structured survey, regarding how the pandemic impacted their lifestyle and wellbeing in areas relevant to dementia risk: social connections, activities, diet, mental and physical health, community and family support. Data was collected between October 2020 and December 2022; we inductively coded responses using manifest content analysis. 551/748 trial participants completed the survey. Most (n = 530, 96%) described pandemic-related lifestyle or wellbeing changes; two thirds (n = 369/545, 67.7%) reported less activities. A quarter (n = 145, 26.8%) identified no change in social connections, with others reporting less in-person meetings (n = 139, 25.7%) or speaking to less people (n = 99; 18.2%); a minority engaged in compensatory online activities (n = 31, 5.7%) and online (n = 63, 11.6%) or phone (n = 90, 16.6%) social contact. Relatively few reported weight gain (n = 22, 4.0%); two-thirds reported no change in their diet (n = 360, 66.1%). Modes of support changed, with reliance on food parcels, online services and shopping by neighbours. Over half reported (almost exclusively negative) mental health pandemic-related changes (n = 307, 56.9%), including depression, stress, fear and loneliness; many reported declines in physical health (n = 153, 28.1%) and/or fitness (n = 70, 12.8%). Stoical accounts of adaptation and resilience, enabled by technology and community support predominated, but were not possible for all. Creating communities where cognitively frail people are more digitally and socially connected will support resilience of this group and contribute to dementia prevention, now and in any future pandemic. Trial registration- ISRCTN17325135