Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

GENERIC AND TAILORED INTERVENTIONS FOR COMMUNITY OLDER ADULTS WITH CHRONIC COGNITIVE COMMUNICATION DISORDERS

Many Community-Dwelling Older Adults (CDOA) live with debilitating chronic cognitive and communication disorders including Aphasia, Mild Cognitive Impairment, and Traumatic Brain Injury, and no longer receive healthcare services. This portion of the symposium will discuss why engaging CDOA and their caregivers with developing and selecting interventions for their cognitive communication disorders is important. Further, we discuss a community-based approach to make generic as well as tailored speech-language pathology services available to CDOA free of charge. The process of developing and using a multi-stakeholder advisory board of clinicians, researchers, CDOA, as well as a diverse advisory board of caregivers will be described, and challenges will be discussed. Further, we will present and discuss some relevant data.

INTEGRATING RESEARCH, TEACHING, AND SERVICE: AN INTERGENERATIONAL BONDING PROGRAM AT THE UNIVERSITY OF NEBRASKA

To establish an Intergenerational Bonding (IGB) program that pairs undergraduate students at the University of Nebraska at Kearney with older adults of this rural community, we first tested acceptability and feasibility of such a program. We surveyed both groups to identify their interest level in IGB and identify their common interests in activities. Older adults residing in independent dwellings, assisted living homes, and nursing homes and members of community groups were invited to participate in the survey. However, the response rate was low. Given the restrictions of the pandemic, accessing community older adults was challenging. Internet access was low, which made virtual and digital participation modalities impossible; recruitment from assisted living facilities was not successful; and, establishing collaboration with nursing homes was not easy despite initial interest. Building trust and working with community activity group facilitators was ultimately beneficial in recruiting older adults. Collaboration with community-based organizations facilitated the study.

COVID-19 and the Vulnerabilities of Community-Dwelling Other Adults: Findings From a Statewide Survey of Home-Delivered Meals Recipients*

COVID-19’s impact on community-dwelling older adults, especially those in rural and underserved areas, as well as those who are homebound, is of interest to policy makers and clinicians, now and in the future. This study aims to examine the consequences of the COVID-19 pandemic on community-dwelling older adults with the greatest social and economic needs residing in a mostly rural state. Using a self-administered survey, we collected data from 1852 home-delivered meal recipients, age 60 years and older, served by Nebraska’s eight Area Agencies on Aging. Results highlight three areas of importance: social connections, healthcare access and utilization, and technology. We found that while most older adults maintained social interaction, despite the restrictions imposed by the pandemic, feelings of loneliness persisted or even increased, with 35% of respondents feeling lonelier because of the pandemic. Our findings further reveal that 42% of older adults skipped or postponed healthcare visits during the pandemic, although the majority expressed interest in using telehealth. Finally, the rural‐urban divide was evident in our data, with less than one-half of respondents (45%) having access to reliable internet. Suggestions on how to prepare the most vulnerable people for similar crises are included.

Intergeneration Bonding: An Acceptability and Feasibility Study

Social isolation and loneliness are detrimental risk factors to older adult’s physical and psychological well-being and quality of life. Given the current situation of the COVID-19 pandemic, social isolation has risen. Social isolation affects younger adults as well and may increase the chances of depression and anxiety. In this study, we tested the acceptability and feasibility of an Intergenerational Bonding (IGB) Program with older and younger adults. Participants include students aged 19-29 at the University of Nebraska at Kearney and older adults above the age of 60 residing in the community. First, we surveyed younger and older adults to determine their interest level in participating in an IGB Program. Both groups of participants rated their interest in different activities. The most popular activities among both groups included engaging in conversations, board games, and an exchange of skills. Neither of the groups was in favor of participating in free housing opportunities or sports-related activities. Response rates were high in young adults but low in older adults, due to lack of trust. Then, in a pilot study, we measured the feasibility and acceptability of the IGB Program. Older adults residing in independent dwellings, assisted living environments, nursing homes and members of community groups were invited to participate in the intergenerational program. Response rates of older adults were low. Further, establishing collaboration with institutions such as nursing homes was not easy despite initial interest. Building trust and working with community activity group facilitators would be beneficial in recruiting older adults.

Students’ perspective on higher educators: interpersonal relationship matters

Students’ perspective on the higher educators’ performance matters because the ultimate goal of teaching is education quality and students’ satisfaction. Student evaluations are important to university professors to improve their teaching quality and in many cases, secure their promotion and tenureship. Excellent teaching does not have a universal definition, and students often have different perspectives on effective and excellent teaching. In this study, we examined the factors contributing to excellent teaching as rated by students on the website ratemyprofessors.com, a popular website among students to rate their educators voluntarily. The information from this website can be valuable, despite all the critics it has received, given that students provide feedback on a volunteer basis to help their peers with selecting the best class. The website provides a forum for opinions that are not influenced by fear of possible consequences, such as a low grade or tension with faculty. Our study results show that the five top characteristics that are important to students include being caring, respectful, inspirational, as well as giving good feedback, and delivering “amazing” lectures. Further data analysis shows that subject content, in terms of manageable workload, reasonable content difficulty, and grading, can influence students' ratings. The findings indicate that students value interpersonal relationships and cherish individualized feedback and receiving personal support.

Loneliness among Rural and Underserved Older Adults During the COVID-19 Pandemic

During the COVID-19 pandemic, older adults are among the most vulnerable populations to the medical complications of COVID-19; however, they are also deeply affected by the unintended consequences of social distancing and sheltering in place. Social distancing effectively mitigates the spread of COVID-19, but this practice can also lead to social isolation and loneliness. Drawing on a sample of adults age 60 or older receiving Meals on Wheels/Grab and Go Meals in the state of Nebraska, this study investigates loneliness among rural and underserved older adults during the COVID-19 pandemic. Surveys were distributed to 3725 meal recipients across Nebraska’s eight Area Agencies on Aging in July 2020 (response rate = 50%), and a stratified random subsample was selected for preliminary analysis (N = 240). Logistic regression models were used to estimate the effects of COVID-19 and its associated safety precautions on loneliness. The findings reveal that 1 in 10 older adults have not left their home in over a month, and 38 percent feel lonelier due to the impact of COVID-19. Older adults who engaged in more community activities before the pandemic, reported leaving their home less, and experienced a longer absence of social interaction since the pandemic all had significantly increased odds of feeling lonelier in the COVID-19 era. Longer duration of sheltering in place was marginally associated with increased loneliness. The findings from this study show the consequences of social distancing on rural and underserved older adults, which calls for coordinated intervention.

BILINGUAL SPEAKERS POSTPONE SYMPTOMS OF COGNITIVE DEFICIT IN PARKINSON’S DISEASE

Maintaining cognitive abilities despite healthy aging, neurodegeneration or acute damage is known as cognitive reserve (Stern, 2002; Stern, et. al., 2018). There is evidence for a higher cognitive reserve in bilingual speakers (Kavé, et. al., 2008), mainly due to their improved executive functioning and attention. Thus, I hypothesized that patients with Parkinson’s disease would manifest PD related cognitive symptoms later than monolinguals as a result of better compensation. The aim of this study is to explore how bilingualism affects cognitive abilities in PD patients with cognitive deficit. QPN publicly available database was used to analyze the data on PD patients with (PD-CD) and without (PD) cognitive deficit and their demographic information including the number of spoken languages. Monolingual PD and PD-CD patients were compared to their bi- and multilingual peers on their age of on-set of their cognitive decline as well as descriptive demographic information. The results showed that PD-CD patients who speak more than one language manifest symptoms of cognitive impairment at least three years later than their monolingual peers. These results bring evidence that life-long bilingualism contributes to a stronger cognitive reserve and better compensation in case of a neurodegenerative disorder such as PD.

Functional connectivity changes in second language vocabulary learning

Functional connectivity changes in the language network (Price, 2010), and in a control network involved in second language (L2) processing (Abutalebi & Green, 2007) were examined in a group of Persian (L1) speakers learning French (L2) words. Measures of network integration that characterize the global integrative state of a network (Marrelec, Bellec et al., 2008) were gathered, in the shallow and consolidation phases of L2 vocabulary learning. Functional connectivity remained unchanged across learning phases for L1, whereas total, between- and within-network integration levels decreased as proficiency for L2 increased. The results of this study provide the first functional connectivity evidence regarding the dynamic role of the language processing and cognitive control networks in L2 learning (Abutalebi, Cappa, & Perani, 2005; Altarriba & Heredia, 2008; Leonard et al., 2011; Parker-Jones et al., 2011). Thus, increased proficiency results in a higher degree of automaticity and lower cognitive effort (Segalowitz & Hulstijn, 2005).