Population Science Methods and Approaches to Aging and Alzheimer's Disease and Related Dementias Research E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 390

Veröffentlichungsjahr: 2024

Beschreibung

Gain a thorough understanding of the determinants of health among aging populations, how disparities arise in diverse communities, and what can be done Reducing health disparities among older people is critical to slowing or reversing the individual and societal impacts of aging-related conditions like Alzheimer's and dementia. The field of population science can help us understand disparities and prevent them using community-wide strategies. Population Science Methods and Approaches to Aging and Alzheimer's Disease and Related Dementias Research offers an overview of the population health approach, applying this framework to aging-related conditions and their determinants. By working hand-in-hand with diverse communities to address these conditions we can develop primary and secondary prevention strategies that can increase health equity for all Americans. Included topics range from population health trends and approaches to understanding community and patient engagement to caregiver perspectives and emerging trends. * Learn about the population science approach to understanding aging-related health concerns in diverse communities * See how factors like race, income, sexual orientation, sleep, and community engagement affect Alzheimer's and related dementias * Read about proactive approaches to primary and secondary prevention within aging populations * Discover emerging research and public health initiatives currently underway to promote health equity Students, researchers, and practitioners alike will benefit from this primer on participatory approaches to reducing health disparities. This introduction to the landscape of aging research in the most vulnerable of our communities will facilitate creativity, compassion, and meaningful next steps in biomedical and socioecological research, community support, and clinical care.

Leseprobe

POPULATION SCIENCE METHODS AND APPROACHES TO AGING AND ALZHEIMER’S DISEASE AND RELATED DEMENTIAS RESEARCH

EDITED BY

CHAU TRINH-SHEVRIN

Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data

Names: Trinh-Shevrin, Chau- editor.

Title: Population science methods and approaches to aging and Alzheimer’s disease and related dementias research / edited by Chau Trinh-Shevrin.

Description: Hoboken, NJ : John Wiley & Sons Inc., [2024] | Includes bibliographical references and index.

Identifiers: LCCN 2023026146 (print) | LCCN 2023026147 (ebook) | ISBN 9781394204144 (paperback) | ISBN 9781394204168 (adobe pdf) | ISBN 9781394204151 (epub)

Subjects: LCSH: Aging--Psychological aspects. | Alzheimer’s disease. | Dementia.

Classification: LCC BF724.55.A35 P67 2023 (print) | LCC BF724.55.A35 (ebook) | DDC 155.67--dc23/eng/20230927

LC record available at https://lccn.loc.gov/2023026146

LC ebook record available at https://lccn.loc.gov/2023026147

Cover image: © Irina_QQQ/Shutterstock

Cover design: Thalassa Tam

Set in 10/12pt Times LT Std by Integra Software Services Pvt. Ltd, Pondicherry, India

CONTENTS

Cover

Title Page

Copyright Page

Figures and Tables

Preface

The Editor

The Contributors

Acknowledgments

ONE: OVERVIEW OF POPULATION TRENDS IN AGING AND ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE-RELATED DEMENTIA (AD/ADRD) DISPARITIES

TWO: UNDERSTANDING THE IMPACT OF THE SOCIAL DETERMINANTS OF HEALTH ON COGNITIVE HEALTH AMONG THE AGING POPULATION

THREE: SYSTEMIC RACISM, DISCRIMINATION, AND STIGMA

FOUR: INTERSECTIONAL SYNDEMICS AND AGING AMONG LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER (LGBTQ+) COMMUNITIES

FIVE: COMMUNITY AND PATIENT ENGAGEMENT OF OLDER ADULTS IN AGING AND ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE-RELATED DEMENTIAS RESEARCH

SIX: IMPLEMENTATION SCIENCE APPROACHES TO AGING AND ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASERELATED DEMENTIAS RESEARCH

SEVEN: GROUP MODEL BUILDING TO PROMOTE PUBLIC HEALTH RESEARCH AND ACTION

EIGHT: SLEEP, AGING, AND BRAIN HEALTH

NINE: EMERGING RESEARCH IN AGING AND ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE-RELATED DEMENTIAS

Index

End User License Agreement

List of Tables

CHAPTER 05

TABLE 5.1 Guiding Principles...

TABLE 5.2 Key Considerations...

TABLE 5.3 Roles and...

TABLE 5.4 Strategies to...

CHAPTER 07

TABLE 7.1 Examples of...

CHAPTER 09

TABLE 9.1 Challenges to...

List of Illustrations

CHAPTER 02

FIGURE 2.1 The Five SDOH Domains...

CHAPTER 03

FIGURE 3.1 Conceptual Model of...

CHAPTER 05

FIGURE 5.1 The General Model...

CHAPTER 06

FIGURE 6.1 Implementation...

CHAPTER 07

FIGURE 7.1 Reference Mode...

FIGURE 7.2 CLD for Cognitive...

CHAPTER 08

FIGURE 8.1 Nightly Sleep Cycles...

Guide

Cover

Title Page

Copyright Page

Table of Contents

Figures and Tables

Preface

The Editor

The Contributors

Acknowledgments

Begin Reading

Index

End User License Agreement

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PREFACE

The energy of the mind is the essence of life.

–Aristotle

The way you think, the way you behave, the way you eat, can influence your life by 30 to 50 years.

–Deepak Chopra

Aging begins at birth. Yet most people only begin to recognize and struggle with the aging process when they observe and experience a loss of their own youthful vitality, the breakdown of their bodies, and changes in their appearances. The effects of aging become more apparent to us as we watch our parents and loved ones endure advancing chronic conditions, comorbidities, isolation, and heightened vulnerability. In parallel, we see the reflection of these effects within our neighborhoods, communities, and society at large, producing new challenges for families and caregivers, health care providers, researchers, and policymakers. While national policies and programs, such as Medicare, are pivoting to become more cognizant and inclusive of aging-related conditions and the treatments and support needed by aging Americans and their care partners, there is an urgent need to focus attention and investment on population health approaches to address the unmet needs, sociocultural contexts, and health trajectories of older people.

While a vast array of aging-related conditions can impact the daily activities and well-being of older people, Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are among the most feared of these conditions. These diagnoses portend a complete loss of self, including one’s own identity, purpose, and autonomy as well as one’s loss of self in relation to others. Profound memory loss eats away the connectedness of relationships spanning decades, rendering loved ones strangers – and, at times, strangers to be feared. As AD/ADRD advances, acute fear gives way to chronic anxiety, anger, and withdrawal. Caregivers of people living with AD/ADRD may find the most painful aspects of this process to be observing their loved ones suffer and become mere shells of the people they once were. It is important to distinguish dementia from AD. Dementia is not a specific disease; rather, it is a term that describes a set of symptoms including memory loss and confusion as well as the breakdown of daily life functioning and the ability to communicate and interact with others. AD is the most common cause of dementia, accounting for about 70% of patients diagnosed with dementia. Other forms of dementia include vascular dementia, dementia with Lewy bodies, frontotemporal dementia, Cruetzfeldt-Jakob disease, Huntington’s disease, normal pressure hydrocephalus, and mixed dementia (i.e., a combination of two or more sources of dementia). Typically, this group of diseases is referred to as AD/ADRD. In addition to degenerative diseases, like AD or Parkinson’s disease, other causes of dementia may include chronic drug use, depression, infections, stroke, and vascular disease. For some causes of dementia, there may be treatments to reverse cognitive impairment or slow down the progression of dementia symptoms. AD is a disease of the brain and is progressively degenerative, impairing areas of the brain that include learning, thinking, and bodily functioning and leading to debilitation over time. AD is currently irreversible.

Over the last two decades, there have been increasing and substantial investments in identifying and testing therapeutics to treat and potentially reverse AD. For example, researchers have focused on the role of plaque-forming beta-amyloid in the brain in accelerating AD-associated deterioration, leading to the development of monoclonal antibodies to the immune system to help clear beta-amyloid from the brain. An example of this type of drug is lecanamab (i.e., Lequembi), which received accelerated approval by the United States (US) Federal Drug Administration (FDA) in early 2023; previously, aducanemab (i.e., Aduhelm) was approved in 2021. Evidence from available trials does not yet establish definitively the effectiveness of these drugs in improving cognition (Ackley et al., 2021). Other drugs in development focus on preventing destruction of synapses and halting memory loss (e.g., saracatinib), while still others focus on blocking production of beta-amyloid (i.e., beta- and gamma-secretase inhibitors). None of these currently available therapies, however, has proven beneficial to all of the individuals who have participated in drug trials or to those who have been given these therapies in health care settings, indicating the need for more investment and focused research to better understand the mechanisms and expression of AD.

Increasingly, researchers and advocates are raising attention to the role of prevention and social factors in healthy aging. For example, the role of the microbiome and the significance of the mind–gut relationship have been demonstrated to influence the risk for depression, anxiety, and dementia. What we eat and the health of the microbial environment in our digestive systems are connected to inflammation in our organs, including our brains, and thus impacts the processes for aging and sense of balance and well-being. In addition, social isolation and loneliness can impact risk for depression, cognitive decline, and risk for AD/ADRD. More research is needed to understand how social and environmental determinants impact healthy aging and the role of nutrition and the microbiome on preventing and mediating the risk for dementia.

As research progresses, including more diverse communities in biomedical and community-based research is an urgent imperative. Clinical trials conducted to date have failed to achieve meaningful representation by minoritized and low-income communities, leading to results that are not generalizable to many of the Americans in greatest need of these therapies. Reducing health disparities among older people is critical to slowing or reversing the physical impacts of AD/ADRD and improving the health of older people overall. Toward that end, financial resources and community-engaged strategies are needed to ensure that the promise of biomedical research and clinical trials is available to all. Population health approaches offer ways to work hand-in-hand with diverse communities to address a range of aging-related conditions, including AD/ADRD, and are critical to informing the development of primary and secondary prevention strategies that aim to increase health equity for all Americans.

These challenges are daunting – but not insurmountable. This Handbook aims to provide a starting point for clinicians and other practitioners eager to take on these challenges in innovative, meaningful ways, particularly in minoritized, limited English proficient, and low-income communities. The topics included here range from population health trends and approaches to understanding community and patient engagement to caregiver perspectives and emerging trends. The Handbook aims to serve as a primer, introducing fundamental aspects of population health and participatory approaches to reducing health disparities and advancing health equity in the context of aging-related research. Our hope is that this introduction to the landscape of aging research in the most vulnerable of our communities will facilitate creativity, compassion, and meaningful next steps in biomedical and socioecological research, community support, and clinical care.

Chau Trinh-Shevrin, DrPHProfessor, Departments of Population Health and Medicine,NYU Grossman School of Medicine

REFERENCES

Ackley, S. F., Zimmerman, S. C., Brenowitz, W. D., Tchetgen Tchetgen, E. J., Gold, A. L., Manly, J. J., Mayeda, E. R., Filshtein, T. J., Power, M. C., Elahi, F. M., Brickman, A. M., & Glymour, M. M. (2021). Effect of reductions in amyloid levels on cognitive change in randomized trials: Instrumental variable meta-analysis.

BMJ (Clinical Research Ed.)

, 372, n156.

https://doi.org/10.1136/bmj.n156

THE EDITOR

CHAU TRINH-SHEVRIN, DrPH is Professor in the Departments of Population Health and Medicine, Vice Chair for Research, Director of the Section for Health Equity, and Institutional Review Board Chair at NYU Grossman School of Medicine. For over 25 years, her research focuses on the rigorous development and evaluation of multilevel strategies to reduce health disparities and advance health equity among low-income and across diverse racial and ethnic groups.

Dr. Trinh-Shevrin is multi-principal investigator (MPI) of a National Institute on Minority Health and Health Disparities (NIMHD) Center of Excellence, the NYU Center for the Study of Asian American Health (CSAAH), and a National Institute on Aging (NIA) Engagement in Longevity and Medicine Research Collaborative. Dr. Trinh-Shevrin also led a Centers for Disease Control and Prevention (CDC) Research Center for over a decade and currently leads a CDC Cancer Prevention and Control Research Network Center. Building on her expertise in community-based participatory research and longstanding relationships with national and local community partners, she is MPI of a National Institutes of Health (NIH) Community Engagement Alliance to End COVID-19 Disparities and associate director of Community Outreach and Engagement for the Perlmutter Cancer Center, a National Cancer Institute-designated Comprehensive Cancer Center.

Dr. Trinh-Shevrin is dedicated to mentoring junior faculty and students in minority and health disparities research. She is involved in many NIH-funded research training and education programs and leads an NIA Academic Leadership Award to support mentored research opportunities in healthy aging and health disparities research.

Dr. Trinh-Shevrin earned her doctorate in public health from the Mailman School of Public Health, Columbia University, and masters in health policy and management at the State University of New York at Albany. She has coauthored more than 150 peer-reviewed publications and is coeditor of three textbooks, Applied Population Health Approaches for Asian American Communities (Jossey-Bass, 2023), Asian American Communities and Health (Jossey-Bass, 2009), and Empowerment and Recovery: Confronting Addiction during Pregnancy with Peer Counseling (Praeger Press, 1998).

THE CONTRIBUTORS

JEANNETTE MICHELE BEASLEY, PhD, MPH, RDN, is an Assistant Professor in the Departments of Nutrition and Food Studies and Medicine at NYU. She trained in biology at the College of William and Mary (BS), nutrition at University of North Carolina-Chapel Hill (MPH, RDN) and epidemiology at the Johns Hopkins Bloomberg School of Public Health (PhD). Her research focuses on understanding the role of nutrition in chronic disease prevention, particularly in furthering the understanding of the role of nutrition in the prevention of cardiovascular disease in diverse populations and refining recommendations regarding the protein needs of older adults. This work has resulted in over 75 peer-reviewed publications and 8 books or book chapters. She has received funding from National Institutes of Health, Centers for Disease Control, and private foundations. She serves as an Associate Editor for BMC Public Health and as a peer reviewer for over 20 other academic journals. She previously held academic appointments at Group Health Research Institute, Fred Hutchinson Cancer Research Center, and Albert Einstein College of Medicine.

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ABRAHAM AIZER BRODY, PhD, RN, FAAN, is the Mathy Mezey Professor of Geriatric Nursing, Professor of Medicine, and Associate Director of the Hartford Institute for Geriatric Nursing at NYU. His work focuses on the intersection of geriatrics, palliative care, quality, and equity. The primary goal of his research, clinical, and policy pursuits is to improve the quality of care for older adults with serious illnesses wherever they reside through the development, testing, and dissemination of real-world, technology, and informatics-supported quality improvement interventions. He is the principal investigator of multiple large-scale pragmatic clinical trials to improve the quality of care and quality of life for persons living with dementia and their care partners living in the community, and leads the Pilot Core for the National Institute on Aging (NIA) IMPACT Collaboratory, which is a collaboration with NIA to move evidence-based practices for persons living with dementia from research to practice. He maintains an active practice on the geriatrics and palliative care consult services at NYU Langone Health.

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OMONIGHO MICHAEL BUBU, MD, PhD, MPH, is an Assistant Professor and physician scientist at NYU Grossman School of Medicine, in the Departments of Psychiatry and Population Health, with a programmatic research focus on sleep, aging, and Alzheimer’s disease (AD). Dr. Bubu has graduate, internship, and fellowship-level clinical and research training in neurology, neuro-epidemiology, and public health. His research examines how age-related and age-dependent sleep changes, and vascular risk, impact cognitive decline and AD risk, and how they drive AD-related disparities.

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MIRNOVA E. CEÏDE, MD, MSc, is an Assistant Professor of Geriatric Psychiatry and Geriatrics at the Albert Einstein College of Medicine/Montefiore Medical Center, the Assistant Program Director of the Montefiore Geriatric Psychiatry Fellowship, and Associate Director of Psychiatry at the Montefiore Center for the Aging Brain. She completed her Geriatric Psychiatry Fellowship at SUNY Downstate and joined the Geriatric Psychiatry Division at Montefiore Medical Center in 2013. She has presented at national and international meetings on behavioral risk factors for dementia and models of psychiatric integration in health care. In 2018, she completed the Albert Einstein Clinical Research Training Program and attained a Master of Science in Clinical Research. She completed a Columbia Center for Interdisciplinary Research on Alzheimer’s disease Disparities (CIRAD) Pilot Project Grant to further apathy and cognition in a racially and ethnically diverse clinic population. Most recently, she was awarded a National Institutes of Health Diversity Supplement to study apathy as an early risk factor for dementia in a multicountry cohort of older adults.

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RUIJIA CHEN, ScD, is a social epidemiologist and a postdoctoral scholar in the Department of Epidemiology and Biostatistics at the University of California, San Francisco. She received her Doctor of Science degree in social epidemiology from Harvard University and master’s degree in social policy from the University of Pennsylvania. Her research focuses on applying advanced epidemiologic methods to understand how psychosocial determinants across the life course influence social disparities in late-life cognitive outcomes.

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JOSHUA CHODOSH, MD, MSHS, is Director of the NYU Division of Geriatric Medicine and Palliative Care and the inaugural endowed Michael L. Freedman Professor of Geriatric Research at NYU Grossman School of Medicine. He is also Staff Physician at VA NY Harbor Healthcare System. As Professor of Medicine and Population Health, Dr. Chodosh joined NYU in 2015 after a productive research career at UCLA and the Greater Los Angeles VA. At NYU, he has built the Freedman Research Center on Aging, Technology and Cognitive Health supported by investigators that cross several departments including medicine, population health, surgery, and emergency medicine and multiple institutions across the United States. Dr. Chodosh is PI or MPI of multiple National Institutes of Health R01s and a VA multisite Merit. He is also PI of the Centers for Disease Control and Prevention BOLD Public Health Center of Excellence on Early Detection of Dementia and leads the Outreach, Recruitment, and Engagement Core of the NYU Alzheimer’s Disease Research Center. In 2017, Dr. Chodosh cofounded the NYU Aging Incubator, a University-wide, educational, and research collective serving the larger University community.

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OHSHUE GATANAGA, MPH(c), MSSW(c), is currently a graduate student studying social work and public health at Columbia University. His research focuses on infusing syndemics and intersectionality theories to examine how multiple marginalized identities impact behavioral health and substance use outcomes. In particular, Gatanaga is interested in exploring historically under-researched communities, such as Asian American subgroups and LGBTQ+ communities. Other current and related research projects include partnering on National Institutes of Health grants addressing intersectional stigma among men who have sex with men, the HIV/AIDS intervention BRIDGE (Improving HIV Service Delivery for People who Inject Drugs in Kazakhstan), and gender-based violence studies for Project E-Worth (Multimedia HIV/STI Intervention for Black Drug-Involved women on Probation in New York City). As an aspiring practitioner-scholar, Gatanaga hopes to conduct research at the forefront of clinical implementation. He is currently a member of the New York State Society for Clinical Social Work, the American Public Health Association LGBTQ Health Caucus, and the American Public Health Association Asian and Pacific Islander Caucus for Public Health.

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NISHA GODBOLE, BS, is a third-year medical student at Stony Brook University in New York. She became interested early during her medical education on Aging and Alzheimer’s disease and related dementias. She pursued funded research through the NYU Grossman School of Medicine, Department of Medicine and Engagement and Longevity in Medicine (ELM) research collaborative.

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LU HU, PhD, is a behavioral scientist and an Assistant Professor in the Department of Population Health at NYU Langone Health. Her research primarily focuses on developing and testing innovative, sustainable, and scalable technology-based interventions to increase access to care and reduce health disparities in underserved populations with chronic conditions.

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TERRY T-K HUANG, PhD, MPH, MBA, is Professor and Chair of the Department of Health Policy and Management, Director of the Center for Systems and Community Design, and Co-Director of the NYU-CUNY Prevention Research Center (Centers for Disease Control and Prevention-designated) at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH). In addition to his academic research endeavors, Dr. Huang founded a public health entrepreneurship platform, Firefly Innovations (www.firefly-innovations.com), at the CUNY SPH and leads a new angel portfolio fund, COREangels Health Equity & Mental Wellbeing. He received the United States Department of Health and Human Services Secretary’s Innovation Award in 2010 and the National Institutes of Health Director’s Award in 2011. In addition, he received the National Cancer Institute Award of Merit in 2012. Dr. Huang holds a PhD in Preventive Medicine and an MPH from the University of Southern California, an MBA from IE Business School (Madrid, Spain), and a BA in Psychology from McGill University (Montreal, Canada).

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JAY M. IYER, AB(c), is a sophomore at Harvard College concentrating in Molecular and Cellular Biology and Statistics. He is a researcher in the Department of Stem Cell and Regenerative Biology at Harvard University, investigating the potentially selective distribution of specific ribosomal proteins in neuronal subtypes and their respective subcellular compartments. Furthermore, he is a researcher in the Department of Neurology at Massachusetts General Hospital, where he analyzes data from clinical cohorts to discover predictors of Parkinson’s Disease and Progressive Supranuclear Palsy (PSP) progression. Iyer also leads his nonprofit organization, MIND Relief, which provides support to patients and families with rare neurodegenerative diseases such as PSP. He further serves as the director of Harvard College Alzheimer’s Buddies, where he assists individuals with Alzheimer’s disease and related dementias.

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KALISHA BONDS JOHNSON, PhD, RN, PMHNP-BC, is an Assistant Professor at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta, Georgia and a Psychiatric Mental Health Nurse Practitioner at Emory University’s Integrated Memory Care, a primary care clinic tailored to the care of persons living with dementia. She graduated from The University of Tennessee at Martin with a Bachelor of Science in Nursing in 2007. In 2012, she graduated with a Master of Science in Nursing from Vanderbilt University, specializing as a Family Psychiatric Mental Health Nurse Practitioner. In 2019, Dr. Bonds Johnson graduated with a PhD from Oregon Health & Science University. Most recently, she completed her postdoctoral training at Emory University from 2019 to 2021. Dr. Bonds Johnson’s research focuses on improving the quality of life of African American persons living with dementia and their family care partners. Specifically, this research focuses on the creation of culturally tailored interventions to improve the decision-making processes of adult daughters navigating the health care system for a parent living with dementia while considering individual, family, community, and societal factors.

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LISA A. JUCKETT, PhD, OTR/L, is an Assistant Professor of Occupational Therapy at The Ohio State University. Her research centers on bridging the gap between empirical discoveries and the use of these discoveries in real-world practice settings. Heavily informed by the field of implementation science, Dr. Juckett’s research examines the factors and strategies that influence evidence-based practice uptake, primarily in organizations that serve the older adult population. Specifically, Dr. Juckett’s work aims to develop and test implementation strategies that support the use of evidence-based practices in the contexts of (a) stroke rehabilitation and (b) home- and community-based service systems. Active involvement of community and clinical partners is a hallmark characteristic of Dr. Juckett’s research, resulting in several collaborations with entities that provide immensely valuable health and human services to the older adult community.

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AISHA T. LANGFORD, PhD, MPH, is an Assistant Professor in the Department of Population Health NYU Grossman School of Medicine. Under NYU Langone Health’s Clinical and Translational Science Institute, she co-directs the Recruitment and Retention Core (RRC). In her role as RRC co-director, Dr. Langford advises study teams across the medical school on recruitment feasibility and ways to maximize participant retention, covering all stages of clinical trial and health research study design. A large proportion of these consultations include ways to enhance inclusion of women, racial/ethnic minorities, and adults aged 65 and older in clinical research. Dr. Langford advocates that researchers should ensure that all eligible patients are invited to participate in clinical trials and that underrepresented populations in research have equitable access to research opportunities, which often means addressing the logistical and communication barriers that may hinder participation. Dr. Langford earned her BA in English from the University of Virginia, MPH in Behavioral Science from Saint Louis University, and PhD in Health Behavior and Health Education from the University of Michigan.

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MATTHEW LEE, DrPH, MPH, is an Assistant Professor in the Section for Health Equity and the Center for the Study of Asian American Health within the Department of Population Health at NYU Grossman School of Medicine. Dr. Lee earned their doctorate in Sociomedical Sciences from the Columbia University Mailman School of Public Health and was also a Robert Wood Johnson Foundation Health Policy Research Scholar. As a community-engaged implementation scientist and critical health equity researcher, Dr. Lee’s research applies participatory approaches and mixed methods to examine the reach and impact of policies and evidence-based interventions within structurally underserved communities. Broadly, Dr. Lee is focused on improving the equitable implementation and sustainability of policies and programs to eliminate health disparities and advance health justice.

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SAHNAH LIM, PhD, MPH, MIA, is an Assistant Professor who is leading the Gender Equity scientific track and Mental Health scientific track at NYU Grossman School of Medicine’s Department of Population Health’s Section for Health Equity. As a health equity researcher, Dr. Lim conducts applied, community-engaged studies that seek to address gender-related health issues among hard-to-reach populations such as sex workers and immigrant survivors of gender-based violence. Her research uses intersectionality and syndemics frameworks to understand how multiple marginalization impacts mental and sexual health outcomes.

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DAVID W. LOUNSBURY, PhD, is Associate Professor in the Department of Epidemiology & Population Health and Associate Director of Patient-Centered Outcomes Research Training at the Albert Einstein College of Medicine, New York, USA. His domestic and international research is directed toward implementation of evidence-based, community-facing health services for prevention and treatment of chronic health conditions (cancer, diabetes/obesity, HIV/AIDS, opioid use disorder, depression, and dementia) in medically underserved populations. He applies ecologically grounded social science methodologies, such as action research and system dynamics modeling, as a means of participatory problem-solving to address complex multilevel problems in health care delivery. Dr. Lounsbury is also a Faculty Fellow with the Center for Systems & Community Design (City University of New York, Graduate School of Public Health & Health Policy) and currently serves as Co-Chair of the System Dynamics Society’s Psychology and Human Behavior Special Interest Group.

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DEBORAH K. MIN, MPH, is a Senior Project Coordinator at the NYU Center for the Study of Asian American Health (CSAAH) based in the Department of Population Health’s Section for Health Equity at NYU Grossman School of Medicine. She is also a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health within the Health Equity and Social Justice track. Her research interests include community-driven and culturally tailored projects that confront health disparities and advance health equity within and across Asian American communities. She received her BA in Psychology at Wheaton College (IL) and MPH from Columbia University’s Mailman School of Public Health, Department of Sociomedical Sciences with a concentration in Child, Youth, and Family Health.

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SUPRIYA MISRA, ScD, is currently an Assistant Professor in the Department of Public Health at San Francisco State University and a Faculty Scholar in the Health Equity Institute at San Francisco State University. Her research focuses on mental health inequities among socially marginalized communities, particularly racial and ethnic minority groups. She uses mixed methods to understand the roles of racism, stigma, and trauma on the onset and experience of mental distress and to promote dignity and justice for those living with mental illness. Dr. Misra completed her BA and MA in Psychology at Stanford University, her ScD in Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, and a Provost’s Postdoctoral Fellowship at NYU. She also worked for several years in nonprofit management to develop and implement evidence-based health education resources.

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KOMAL PATEL MURALI, PhD, RN, ACNP-BC, is an Assistant Professor at NYU Rory Meyers College of Nursing. Her primary program of research focuses on improving end-of-life and hospice care transitions for seriously ill persons living with dementia in the home health care setting. Additionally, Dr. Murali aims to develop care coordination interventions to facilitate equitable hospice use among racially and ethnically diverse persons living with dementia. As a nurse scientist and board-certified acute care nurse practitioner with a background in critical care, Dr. Murali is also passionate about end-of-life decision making and palliative care integration in the intensive care unit.

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BETH PRUSACZYK, MSW, PhD, is an Assistant Professor at the Institute for Informatics and in General Medical Sciences at Washington University School of Medicine in St. Louis. Her research focuses on improving health care and social services for older adults living in rural areas, especially vulnerable older adults such as those with dementia or low income, by understanding how to better implement existing research findings into practice and policy. Her work also focuses on how network science and health information technology can both inform and speed this implementation process. Dr. Prusaczyk received her PhD and MSW from the Brown School of Social Work at Washington University in St. Louis and completed her postdoctoral training at Vanderbilt University Medical Center. She also served as a 2018–2019 Health and Aging Policy Fellow, working in the United States Senate on the Special Committee on Aging. She has her undergraduate degree in journalism from Webster University and worked as a journalist prior to her career in research.

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STUART F. QUAN, MD, is a Senior Physician in the Division of Sleep and Circadian Disorders at Brigham and Women’s Hospital and the Gerald E. McGinnis Professor of Sleep Medicine at Harvard Medical School. In addition, he is Professor Emeritus of Medicine at the University of Arizona where he was Chief of Pulmonary and Critical Care Medicine, Associate Head of the Department of Medicine, Program Director of the GCRC, and Director of the Sleep Disorders Center. He also is an adjunct faculty member in the Arizona State University College of Nursing and Health Innovation. Dr. Quan is the Field Editor of Frontiers in Sleep, was the founding editor of the Journal of Clinical Sleep Medicine, and has served as President of the American Academy of Sleep Medicine. His current research activities focus on the epidemiology of sleep and sleep and circadian disorders. He has written over 400 publications in scientific journals and books, and has authored a number of educational products for the general public.

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REBECCA ROBBINS, MMSci, PhD, is an Instructor in Medicine at Harvard Medical School and an Associate Scientist at the Brigham and Women’s Hospital. In her research, Dr. Robbins designs and evaluates novel interventions to improve sleep and sleep disorders among underserved communities. She has published more than 60 scientific articles. Dr. Robbins has held teaching positions at the Weill Cornell Medical College in Doha, Qatar and at Harvard College.

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NASIM S. SABOUNCHI, PhD, MSc, is an Associate Professor at the City University of New York (CUNY) Graduate School of Public Health and Health Policy where she is also affiliated with the Center for Systems and Community Design (CSCD). She is an industrial and systems engineer, and a systems scientist in the field of public health and health care and recipient of the Systems Science Scholarship, Academy of Health – Robert Wood Johnson Foundation. Her research interest involves adopting tools including systems science methodologies, systems engineering and data analytics to model complex systems and problems pertaining to health outcomes at both the individual and population levels. Dr. Sabounchi contributes to the advancement of system dynamics modeling and computer simulation for studying complex health and social systems, and leads various projects in the domain of public health and health policy analysis including those that focus on the opioid epidemic, obesity, infectious disease, enhancing access to care for socio-economically disadvantaged populations, antibiotic resistance, Lyme Disease, and epidemics.

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RACHEL SACKS, MPH, is an independent public health consultant specializing in scientific and technical writing. Prior to establishing her consulting business in 2006, she served in managerial positions with nonprofit organizations, a university-based research center, and a public health department in Bangkok, Thailand; Mumbai, India; and New York City, USA. She received her bachelor’s degree at Tufts University in International Relations and French and her master’s degree in public health at Yale University School of Medicine in the Division of International Health.

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TINA R. SADARANGANI, PhD, RN, ANP-BC, GNP-BC, is a National Institutes of Health-funded Principal Investigator and board-certified primary care nurse practitioner. She is cross-appointed as an Assistant Professor at NYU Grossman School of Medicine’s Department of Population Health. Her program of research is underscored by a profound commitment to advancing the health of minoritized older adults by leveraging the strengths of community-based adult day health care centers to target health disparities. In the last three years, she has expanded her program of research to focus on identifying and addressing the health care needs of cognitively impaired older immigrants, by using the adult day health center as a platform for the delivery of culturally and linguistically congruent care. Her on-going collaborations with the California Association of Adult Day Services, as well as other community-based organizations, have demonstrated that integrating adult day centers into the health care continuum contributes to reductions in avoidable health care utilization. Dr. Sadarangani’s latest work focuses on improving communication between adult day centers and primary care providers using low-cost mobile technology. She recently received a K23 Career Development Award from the National Institute on Aging (NIA) as well as an R21 from NIA.

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SCOTT E. SHERMAN, MD, MPH, is a Professor of Population Health, Medicine and Psychiatry at NYU Grossman School of Medicine. He received his MD from NYU School of Medicine and completed an MPH in Epidemiology/Biostatistics at Boston University School of Public Health. He is a practicing physician in internal medicine and geriatrics and sees patients at the Veterans Health Administration (VA) in New York. His research studies have focused on how to redesign health care systems to better help people quit smoking. Dr. Sherman is particularly focused on population health studies, examining the effectiveness of interventions in routine practice, as well as how to disseminate and implement them. He helped start and co-leads the NYU Clinical and Translational Science Institute Recruitment and Retention Core, which focuses on increasing recruitment into federal research, particularly recruiting groups that are underrepresented in clinical research. Dr. Sherman has over 225 peer-reviewed publications in scientific journals and is currently leading 7 large grants, with funding from the National Institutes of Health, the VA, and foundations.

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RACHEL L. THOMPSON, MS, is a PhD student studying Environmental and Planetary Health Sciences at the City University of New York (CUNY) Graduate School of Public Health and Health Policy (New York, NY) where she also works as a research associate at the CUNY Center for Systems and Community Design (CSCD). Thompson holds a Master of Science degree from Grand Valley State University (Grand Rapids, MI) in biostatistics and has several years of experience in public health and basic sciences research. Over the course of her academic and professional career, she has contributed to a variety of research projects spanning a range of public health and health policy domains, including social determinants of health, substance use, environmental health, and infectious disease. Thompson’s research interests center on using system dynamics and geospatial modeling techniques to study complex health and socio-ecological systems. Her current research contributes to National Institutes of Health-funded projects using group model building and system dynamics modeling to design and evaluate evidence-based practices for opioid overdose prevention and treatment for opioid use disorder.

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BEI WU, PhD, is Vice Dean for Research and Dean’s Professor in Global Health at the NYU Rory Meyers College of Nursing. Dr. Wu is currently leading several National Institutes of Health-funded projects including a clinical trial to improve oral health for persons with cognitive impairment. She co-leads the Rutgers-NYU Center for Asian Health Promotion and Equity. Through this center, she leads a 5-year intervention study that focuses on supporting Chinese and Korean dementia caregivers. Dr. Wu is a Principal Investigator of the National Institute on Aging-funded Asian Resource Center for Minority Aging. Her extensive publications cover a wide range of areas on aging and health, with a particular focus on risk factors related to cognitive impairment, dementia caregiving, and geriatric oral health. Dr. Wu is a fellow of the Gerontological Society of America and the New York Academy of Medicine. She is also an Honorary Fellow of the American Academy of Nursing.

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JIAQI YANG, BS, currently is a master’s student at the Johns Hopkins Bloomberg School of Public Health, pursuing a degree in Cardiovascular and Clinical Epidemiology. She received her bachelor’s degree in Nutrition and Dietetics at NYU. Yang’s research mainly examines how healthy dietary patterns influence chronic disease risk, particularly focusing on cardiovascular disease and cognitive decline in elderly populations.

ACKNOWLEDGMENTS

This book was supported in part by the National Institute on Aging (NIA) Award Number K07AG068186, the National Institutes of Health (NIH) National Institute on Minority Health and Health Disparities (NIMHD) Award Number U54MD000538, and the Centers for Disease Control and Prevention (CDC) Award Number CDC NU58DP006911. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NIMHD, or CDC.

CHAPTEROVERVIEW OF POPULATION TRENDS IN AGING AND ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE-RELATED DEMENTIA (AD/ADRD) DISPARITIES

CHAU TRINH-SHEVRIN, TINA R. SADARANGANI, RACHEL SACKS, DEBORAH K. MIN

LEARNING OBJECTIVES

By the end of this chapter, readers will be able to:

Describe demographic changes occurring among the United States (US) population as a whole and among the subpopulation of older adults.

Articulate ways in which health disparities uniquely impact racial and ethnic minoritized, low income, and other vulnerable older adults.

Identify key health issues affecting older adults in the US.

INTRODUCTION

This chapter describes demographic trends and health issues impacting the health of older people in the United States (US) and identifies unique challenges and concerns related to healthy aging among racial and ethnic minoritized populations, including disproportionate incidence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). As the aging population becomes more diverse, the National Institute on Aging (National Institute on Aging, 2019) and the US Department of Health and Human Services have called for strategies that focus on improving the health of older people in diverse populations and specifically improving health outcomes for racial and ethnic minoritized populations by addressing factors that underpin disparities, such as access to care (United States Department of Health and Human Services, 2019). Summarizing these issues in a concise manner is difficult because of manifold demographic, cultural, and societal changes impacting the rapidly growing and diversifying population of older Americans. This chapter aims to present an overview and introduction to this shifting landscape, offering a foundation upon which more detailed discussions of these various issues will be constructed in the chapters that follow.

DEMOGRAPHIC TRENDS

As a whole, the US population is growing older (US Census Bureau, 2020). Longer lifespans and aging baby boomers – that is, the generation born between 1946 and 1964 – are the two key drivers of this growth contributing to an increase in the national median age from 37.2 years in 2010 to 38.4 years in 2019. Regional differences in the aging population are notable, with over half of states having a median age older than 38.4 years, including all 9 states of the Northeast region, 11 states in the South, 6 in the Midwest, and 3 in the West. In Maine, Florida, West Virginia, and Vermont, one in five people were aged 65 or older in 2019. It is estimated that by 2030, older adults will comprise 20% of the US population overall, representing an increase of 22% from 2014 (Matthews et al., 2019).

Importantly, racial and ethnic minoritized populations are aging at a faster rate than the non-Hispanic White (White) population (CDC, 2020). In 2020, only 10% of racial and ethnic minoritized groups were aged 65 or older, whereas 21% of non-Hispanic White (White) people were older adults (Administration for Community Living, 2022). Of the total population of older Americans (aged 65 or older), 77% was White alone, 9% was Black (Black) alone, 5% was Asian American alone, 0.6% was American Indian or Alaska Native (AI/AN), and 0.1% was Native Hawaiian or Pacific Islander (NH/PI). Eight percent identified as Hispanic (Latine) of any race and 6% as two or more racial or ethnic groups (ACL, 2022). In contrast to these relatively small proportions, some estimates predict that by 2060, among people aged 65 or older, racial and ethnic minoritized adults will represent 45% of the population (Matthews et al., 2019). The Latine population is expected to increase by 391%, the AI/AN population by 274%, the combined Asian American and NH/PI populations by 270%, and the Black population by 172%. In comparison, the White population is predicted to increase by only 75%.

As the US population ages and diversifies, the health care system will face growing challenges related to paying for and delivering care to older Americans. Overall, health care spending is projected to increase by 25% by 2030, from $555 billion to $903 billion (CDC,