This study explored self-reported changes in caregiving intensity (CI) and caregiver burden (CB) among informal caregivers due to the COVID-19 pandemic overall and by gender. Informal caregivers for someone age 50+ completed a survey via Amazon’s MTurk in June 2020. Participants reported changes in CI and CB due to COVID-19 and provided demographic information. Multinomial logistic regression models assessed changes in CI and CB attributed to the COVID-19 pandemic overall and by gender. The sample ( n = 835) was 68.5% male and had an average age of 34 years ( SD 9.8); 55.7% had increased CI, and 53.1% had increased CB attributed to the pandemic. Increased CB due to COVID-19 was associated with increased CI (OR 5.67, 95% CI 3.92–8.00). Male caregivers with decreased CI due to COVID-19 were nearly seven times as likely as those with no change in CI to have reduced CB due to COVID-19 (OR 6.91, 95% CI 3.29–14.52). Women with decreased CI due to COVID-19 were over eight times as likely to have reduced CB due to COVID (OR 8.30, 95% CI 2.66–25.91). Results indicate that many caregivers experienced increases in CI and CB since the start of the COVID-19 pandemic, and that these changes are complex and vary by gender.

Background Informal caregivers providing unpaid assistance may be vulnerable to changes in health behaviors due to modifications in caregiving during the COVID-19 pandemic. Therefore, this cross-sectional study explored self-reported changes in physical activity (PA), sedentary behavior, and screen time among informal caregivers providing care for older adults aged 50+ during the pandemic. Methods Study participants were recruited via Amazon’s Mechanical Turk and reported their perceived changes (increased a lot, increased a little, remained the same, decreased a little, decreased a lot) in moderate-intensity PA (MPA), vigorous-intensity PA (VPA), sedentary behavior, and screen time (weekday and weekend) during the pandemic. For analytic purposes, response categories were categorized into three-level ordinal variables—increased (increased a lot, increased a little), no change (remained the same), decreased (decreased a little, decreased a lot). Multinomial logistic regression models assessed the likelihood of changes (vs. no change) in  MPA,  VPA, sedentary behavior, and screen time (weekday, weekend) based on caregiving and demographic characteristics. Results In total, 2574 individuals accessed the study link, 464 of whom did not meet eligibility requirements. In addition, people who completed 80% or less of the survey (n = 1171) and/or duplicate IP addresse (n = 104) were excluded, resulting in an analytic sample of n = 835. The sample was 69% male, had a mean age of 34 (SD = 9.7), and 48% reported increased VPA, while 55% reported increased MPA. The majority also reported increased sedentary behavior, as well as increased screen time. Respondents living with their care recipient were more likely to report increased weekday screen time (Odds Ratio [OR] = 1.55, 95% CI 1.11–2.16) and sedentary behavior (OR = 1.80, 95% CI 1.28–2.53) than respondents not living with the care recipient. Those living with their care recipient were also more likely to reported increased MPA (OR = 1.64, 95% CI 1.16–2.32), and VPA (OR = 1.53, 95% CI 1.09–2.15), but also more likely to report a decrease in VPA (OR = 1.75, 95% CI 1.14–2.70). Conclusion The majority of respondents reported that their MPA, VPA PA, sedentary behavior, and screen time had changed during the pandemic. Living with the care recipient was associated with both positive and negative changes in behavior. Future research can explore factors associated with these reported changes in behavior.

The objective of this exploratory study was to explore potential associations between changes to caregiver burden (CB) due to the COVID-19 pandemic and rural-urban status using a nationally representative sample of 761 informal caregivers. Tertiles of two measures of rural-urban status were used: Rural-Urban Commuting Areas (RUCAs) and population density. Bivariate and multivariable binary and ordinal logistic regression were used to asses study objectives. Using RUCAs, rural informal caregivers were more than twice as likely as urban informal caregivers to report a substantial increase in CB due to COVID-19 (OR 2.27, 95% CI [1.28–4.02]). Similar results were observed for population density tertiles (OR 2.20, 95% CI [1.22–3.96]). Having a COVID-19 diagnosis was also significantly associated with increased CB. Understanding and addressing the root causes of rural-urban disparities in CB among informal caregivers is critical to improving caregiver health and maintaining this critical component of the healthcare system.

ImportanceThe study results suggest that delirium is the most common postoperative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.ObjectiveTo examine the patterns and pace of cognitive decline up to 72 months (6 years) in a cohort of older adults following delirium.Design, Setting, and ParticipantsThis was a prospective, observational cohort study with long-term follow-up including 560 community-dwelling older adults (older than 70 years) in the ongoing Successful Aging after Elective Surgery study that began in 2010. The data were analyzed from 2021 to 2022.ExposureDevelopment of incident delirium following major elective surgery.Main Outcomes and MeasuresDelirium was assessed daily during hospitalization using the Confusion Assessment Method, which was supplemented with medical record review. Cognitive performance using a comprehensive battery of neuropsychological tests was assessed preoperatively and across multiple points postoperatively to 72 months of follow-up. We evaluated longitudinal cognitive change using a composite measure of neuropsychological performance called the general cognitive performance (GCP), which is scaled so that 10 points on the GCP is equivalent to 1 population SD. Retest effects were adjusted using cognitive test results in a nonsurgical comparison group.ResultsThe 560 participants (326 women [58%]; mean [SD] age, 76.7 [5.2] years) provided a total of 2637 person-years of follow-up. One hundred thirty-four participants (24%) developed postoperative delirium. Cognitive change following surgery was complex: we found evidence for differences in acute, post–short-term, intermediate, and longer-term change from the time of surgery that were associated with the development of postoperative delirium. Long-term cognitive change, which was adjusted for practice and recovery effects, occurred at a pace of about −1.0 GCP units (95% CI, −1.1 to −0.9) per year (about 0.10 population SD units per year). Participants with delirium showed significantly faster long-term cognitive change with an additional −0.4 GCP units (95% CI, −0.1 to −0.7) or −1.4 units per year (about 0.14 population SD units per year).Conclusions and RelevanceThis cohort study found that delirium was associated with a 40% acceleration in the slope of cognitive decline out to 72 months following elective surgery. Because this is an observational study, we cannot be sure whether delirium directly causes subsequent cognitive decline, or whether patients with preclinical brain disease are more likely to develop delirium. Future research is needed to understand the causal pathway between delirium and cognitive decline.

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Objective: To develop and test the validity of program outcome evaluation instruments for cooking, eating, and playing together for obesity prevention during iCook 4-H. Design: Instrument development for both youth and adults through pre-post testing of items newly constructed and compiled to address key curriculum constructs. Testing occurred throughout program intervention and dissemination to determine dimensionality, internal consistency and test-retest reliability, and validity. Setting: A 5-state out-of-school program in cooperative extension and other community sites. Participants: Youths aged 9−10 years; adults were main food preparers; the first phase involved 214 dyads and the second phase, 74 dyads. Main Outcome Measure(s): Youth measures were cooking skills, culinary self-efficacy, physical activity, and openness to new foods. Adult measures were cooking together, physical activity, and eating together. Analysis: Exploratory factor analysis to determine initial scale structure and confirmatory factor analysis to confirm factor structures. Longitudinal invariance tests to see whether the factor structure held over time. Test-retest reliability was determined by Pearson r and internal consistency was determined by coefficient V and Cronbach a. Validity testing was determined by Pearson r correlations. Results: Youth cooking skills, openness to new foods, and adult eating together and cooking together showed strong evidence for dimensionality, reliability, and validity. Youth physical activity and adult physical activity measures showed strong evidence for dimensionality and validity but not reliability. The youth culinary selfefficacy measure showed strong evidence for reliability and validity but weaker evidence for dimensionality. Conclusions and Implications: Program outcome evaluation instruments for youths and adults were developed and tested to accompany the iCook 4-H curriculum. Program leaders, stakeholders, and administrators may monitor outcomes within and across programs and generate consistent reporting.

The COVID-19 pandemic has had a dramatic impact on global economies and societies. Although social distancing policies are needed to contain the spread and impact of COVID-19, they also impose a psychological and economic burden on people who are already experiencing increased distress such as caregivers. Yet, few measures have been developed and validated to measure the psychosocial impact of COVID-19. Utilizing item response theory (IRT), the purpose of this study was to develop and psychometrically validate a measure of psychosocial functioning—the Psychosocial Functioning during COVID-19 (PFC-19) Questionnaire—to assess changes in social interaction, mental health, health behavior, and global functioning among a sample of informal caregivers during the COVID-19 pandemic. The analytic sample ( n = 733) was recruited from Amazon Mechanic Turk (MTurk) (69% male, 55% white). Results suggest a two-factor measure, assessing global functioning (14 items) and affective response (8 items), with strong evidence for reliability, validity, and dimensionality. Future research should replicate this factor structure in other samples.