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

Lisa Ann Wiese, C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA.
Allison Gibson, University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA.
Marc Aaron Guest, Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
Amy R. Nelson, Frederick P. Whiddon College of Medicine, Department of Physiology & Cell Biology, University of South Alabama, Mobile, Alabama, USA.
Raven Weaver, Department of Human Development, Washington State University, Pullman, Washington, USA.
Aditi Gupta, Division of Nephrology and Hypertension, Department of Internal Medicine, Neurology, Alzheimer's Disease Research Center, University of Kansas, Kansas City, Kansas, USA.
Owen Carmichael, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Jordan P. Lewis, Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, Minnesota, USA.
Allison Lindauer, Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.
Samantha Loi, Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Rachel Peterson, University of Montana School of Public and Community Health Sciences, Missoula, Montana, USA.
Kylie Radford, School of Psychology, University of New South Wales, Sydney, Australia.
Elizabeth K. Rhodus, University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA.
Christina G. Wong, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.
Megan Zuelsdorff, School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Ladan Ghazi Saidi, Department of Communication Disorders, Center for Brain Biology and Behavior (CB3), University of Nebraska at Kearney, and Lincoln, Nebraska, USA.
Esmeralda Valdivieso-Mora, Department of Psychology and Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador, El Salvador.
Sanne Franzen, Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Caitlin N. Pope, Department of Health, Behavior, & Society, University of Kentucky, Lexington, Kentucky, USA.
Timothy S. Killian, Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas, USA.
Hom L. Shrestha, School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Ontario, Canada.
Patricia C. Heyn, Center for Optimal Aging, Department of Physical Therapy, Marymount University, Arlington, Virginia, USA.
Ted Kheng Ng, Department of Psychology, Arizona State University, Phoenix, Arizona, USA.
Beth Prusaczyk, Institute for Informatics (I2), Center for Population Health Informatics at I2, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
Samantha John, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA.
Ambar Kulshreshtha, Department of Family and Preventive Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Julia L. Sheffler, Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA.
Lilah Besser, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA.
Valerie Daniel, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA.
Magdalena I. Tolea, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA.
Justin Miller, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.
Christine Musyimi, Africa Mental Health Research and Training Foundation, Nairobi, Kenya.

Document Type

Journal Article

Publication Date

5-23-2023

Journal

Alzheimer's & dementia : the journal of the Alzheimer's Association

DOI

10.1002/alz.13104

Keywords

community engagement; community-based action; facilitators and barriers to ADRD diagnosis and treatment; global disparities; health disparities; location dynamics; modifiable ADRD risk factors; rural; rural culture; under-represented; underserved

Abstract

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.

Department

Clinical Research and Leadership

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