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However, we lack research on loneliness in AL. Our objectives were to assess changes in risk\u2010adjusted prevalence of loneliness in AL, and facility\u2010level variations in loneliness before and during the COVID\u201019 pandemic, and facility\u2010level factors associated with AL resident loneliness during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>This population\u2010based, repeated cross\u2010sectional study used Resident Assessment Instrument\u2014Home Care (RAI\u2010HC) data (01\/2017\u201312\/2021) from Alberta, Canada. On a system\u2010level, we estimated quarterly, risk\u2010adjusted loneliness prevalence, and used segmented regressions to assess whether loneliness changed after the start of the pandemic. For risk adjustment, we used resident\u2010covariates known to be associated with loneliness, but out the health system's or AL home's control (e.g., age or cognitive impairment) to enable fair comparisons over time. Linking AL home surveys, collected in COVID\u201019 waves 1 (March\u2013June 2020) and 2 (October 2020\u2013February 2021) to RAI\u2010HC records, we used covariate\u2010adjusted general estimating equations (GEE) to assess AL home factors (e.g., staffing shortages, social distancing measures) associated with resident\u2010level loneliness during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quarterly samples included 2026\u20132721 residents. Loneliness [95% confidence interval] fluctuated between 13.6% [11.5%\u201315.7%], and 16.8% [14.4%\u201319.2%], with no statistically significant increase during the pandemic. Facility\u2010level median [inter\u2010quartile range] loneliness prevalence varied considerably before (14.9% [8.3%\u201321.1%) and during the pandemic (13.5% [6.9%\u201321.3%]). GEEs included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Facility\u2010factors associated with decreased odds of loneliness included: facilitating caregiver involvement (odds ratio\u00a0=\u00a00.531 [95% confidence interval: 0.286\u20130.986]), essential visitor policies (0.672 [0.454\u20130.994]), and video calls with volunteers or religious\/spiritual leaders (0.603 [0.435\u20130.836]). Facilitating outdoor activities\/visits (2.486 [1.561\u20133.961], and providing hallway\u2010based activities (1.645 [1.183\u20132.288]) were associated with increased odds of loneliness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>Loneliness did not change during COVID\u201019 in AL on a health system level, but varied considerably between facilities before and during the pandemic. Modifiable facility\u2010level factors explained variations in loneliness within facilities, suggesting important targets for policies and improvement interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/gps.70093","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T09:46:28Z","timestamp":1748252788000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Facility\u2010Level Variation of Resident Loneliness in Assisted Living and Associated Organizational Context Factors: A\u00a0Repeated Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3465-315X","authenticated-orcid":false,"given":"Matthias","family":"Hoben","sequence":"first","affiliation":[{"name":"School of Health Policy and Management Faculty of Health York University  Toronto Canada"},{"name":"Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana","family":"Dampf","sequence":"additional","affiliation":[{"name":"Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmi","family":"Devkota","sequence":"additional","affiliation":[{"name":"Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Corbett","sequence":"additional","affiliation":[{"name":"Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Hogan","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine Department of Medicine Cumming School of Medicine University of Calgary  Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberlyn M.","family":"McGrail","sequence":"additional","affiliation":[{"name":"Centre for Health Services and Policy Research School of Population and Public Health University of British Columbia  Vancouver Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen J.","family":"Maxwell","sequence":"additional","affiliation":[{"name":"School of Pharmacy University of Waterloo  Waterloo Canada"},{"name":"ICES  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2022.104740"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255088"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa049"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1745691614568352"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2017.07.035"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16842"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2023.1101462"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.12138"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18499"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010021\u201002718\u20105"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182111352"},{"key":"e_1_2_11_13_1","volume-title":"Enabling the Future Provision of Long\u2010Term Care in Canada","author":"Sinha S.","year":"2019"},{"key":"e_1_2_11_14_1","unstructured":"Alberta Health Services. \u201cContinuing Care Home Type B & Type B Secure Space \u201d2024: Alberta Health Services. 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