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.

Stories after disaster survival: Preparing, heeding warnings, and self-reliance.

OBJECTIVE: The purpose of the study was to examine the content of stories told by people personally impacted by disasters. DESIGN: Semistructured, qualitative interviews. SETTING: Northwest part of a mid-south state. PARTICIPANTS: Fourteen disaster survivors who were recruited through their attendance at an emergency preparedness-related fair. MAIN OUTCOME MEASURES: Interview schedule based on previous research using the family resilience framework. RESULTS: Three themes emerged: prior emergency preparation, heeding warnings of impending disaster, and rural self-reliance. CONCLUSIONS: Participants had made prior emergency preparedness plans, but their personal experiences led to them adjusting their plans, or making more relevant plans for future disasters. Participants expressed the importance of sharing their experiences with family and community members, expressing hope that others would learn, vicariously rather than first-hand, from their experiences.

Emergency Preparedness of Persons Over 50 Years Old: Further Results From the Health and Retirement Study.

OBJECTIVE: This article conceptualized emergency preparedness as a complex, multidimensional construct and empirically examined an array of sociodemographic, motivation, and barrier variables as predictors of levels of emergency preparedness. METHODS: The authors used the 2010 wave of the Health and Retirement Study's emergency preparedness module to focus on persons 50 years old and older in the United States by use of logistic regression models and reconsidered a previous analysis. RESULTS: The models demonstrated 3 key findings: (1) a lack of preparedness is widespread across virtually all sociodemographic variables and regions of the country; (2) an authoritative voice, in the role of health care personnel, was a strong predictor of preparedness; and (3) previous experience in helping others in a disaster predisposes individuals to be better prepared. Analyses also suggest the need for caution in creating simple summative indexes and the need for further research into appropriate measures of preparedness. CONCLUSION: This population of older persons was generally not well prepared for emergencies, and this lack of preparedness was widespread across social, demographic, and economic groups in the United States. Findings with implications for policy and outreach include the importance of health care providers discussing preparedness and the use of experienced peers for outreach. (Disaster Med Public Health Preparedness. 2017;11:80-89).

Depressive symptoms of caregiving women in midlife: the role of physical health.

This research examined the relationships between providing assistance to aging family members, caregivers' age, caregivers' perceptions of their physical health, and caregivers' depressive symptoms. Several alternative hypotheses were examined. Longitudinal data from 1,898 women from the 1992 and 2000 waves of the Health and Retirement Study (HRS) were used. Results indicate a reciprocal relationship between depression and physical health. These processes were examined using a path analysis. Although the evidence only supported one of the hypotheses, this study clearly demonstrated the importance of physical health for the psychological well-being of women in midlife.

Life course transitions and depressive symptoms among women in midlife.

This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature.