Association of Family Support With Lower Modifiable Risk Factors for Dementia Among Cognitively Impaired Older Adults.

OBJECTIVES: Cognitive impairment poses considerable challenges among older adults, with the role of family support becoming increasingly crucial. This study examines the association of children's residential proximity and spousal presence with key modifiable risk factors for dementia in cognitively impaired older adults. METHODS: We analyzed 14,600 individuals (35,165 observations) aged 50 and older with cognitive impairment from the Health and Retirement Study (1995-2018). Family support was categorized by spousal presence and children's residential proximity. Modifiable risk factors, including smoking, depressive symptoms, and social isolation, were assessed. Associations between family support and the modifiable risk factors were determined using mixed-effects logistic regressions. RESULTS: A significant proportion of older adults with cognitive impairment lacked access to family support, with either no spouse (46.9%) or all children living over 10 miles away (25.3%). Those with less available family support, characterized by distant-residing children and the absence of a spouse, had a significantly higher percentage of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the percentage of the risk factors by the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest percentage of the risk factors. These findings were robust to various sensitivity analyses. CONCLUSIONS: Family support from spouses and nearby children serves as a protective factor against modifiable dementia risk factors in cognitively impaired older adults. Policies that strengthen family and social support may benefit this population.

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans.

OBJECTIVES: To examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans. DESIGN AND SETTING: A nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021. PARTICIPANTS: A total of 1,843 U.S. Veterans aged 50 and older (mean age = 67). MEASUREMENTS: PTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories. RESULTS: Most of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period. CONCLUSIONS: Despite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Suicidal Thoughts and Behaviors in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study.

OBJECTIVE: To identify the prevalence and correlates associated with suicidal thoughts and behaviors (STBs) in a nationally representative sample of older (55+) US military veterans. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 3,356; mean age = 70.6). Self-report measures of past-year suicidal ideation (SI), lifetime suicide plan, lifetime suicide attempt(s), and future suicide intent were examined in relation to sociodemographic, neuropsychiatric, trauma, physical health, and protective factors. RESULTS: A total of 6.6% (95% CI = 5.7%-7.8%) of the sample endorsed past-year SI, 4.1% (CI = 3.3%-5.1%) a lifetime suicide plan, 1.8% (CI = 1.4%-2.3%) a lifetime suicide attempt, and 0.9% (CI = 0.5%-1.3%) future suicide intent. Higher levels of loneliness and lower levels of purpose in life were most strongly associated with past-year SI; lifetime history of major depressive disorder with suicide plan and suicide attempt; and frequency of past-year SI and more negative expectations regarding emotional aging with future suicide intent. CONCLUSION: These findings provide the most up-to-date nationally representative prevalence estimates of STBs among older military veterans in the United States. Several modifiable vulnerability factors were found to be associated with suicide risk in older US military veterans, suggesting that these factors may be targets for intervention in this population.

Systemic mRNA Therapy for the Treatment of Fabry Disease: Preclinical Studies in Wild-Type Mice, Fabry Mouse Model, and Wild-Type Non-human Primates.

Fabry disease is an X-linked lysosomal storage disease caused by loss of alpha galactosidase A (α-Gal A) activity and is characterized by progressive accumulation of globotriaosylceramide and its analogs in all cells and tissues. Although enzyme replacement therapy (ERT) is considered standard of care, the long-term effects of ERT on renal and cardiac manifestations remain uncertain and thus novel therapies are desirable. We herein report preclinical studies evaluating systemic messenger RNA (mRNA) encoding human α-Gal A in wild-type (WT) mice, α-Gal A-deficient mice, and WT non-human primates (NHPs). The pharmacokinetics and distribution of h-α-Gal A mRNA encoded protein in WT mice demonstrated prolonged half-lives of α-Gal A in tissues and plasma. Single intravenous administration of h-α-Gal A mRNA to Gla-deficient mice showed dose-dependent protein activity and substrate reduction. Moreover, long duration (up to 6 weeks) of substrate reductions in tissues and plasma were observed after a single injection. Furthermore, repeat i.v. administration of h-α-Gal A mRNA showed a sustained pharmacodynamic response and efficacy in Fabry mice model. Lastly, multiple administrations to non-human primates confirmed safety and translatability. Taken together, these studies across species demonstrate preclinical proof-of-concept of systemic mRNA therapy for the treatment of Fabry disease and this approach may be useful for other lysosomal storage disorders.

High Prevalence of Elder Abuse During the COVID-19 Pandemic: Risk and Resilience Factors.

OBJECTIVE: Before the COVID-19 pandemic, elder abuse affected one in 10 American older adults annually. It has been assumed that the pandemic has brought with it a surge in elder abuse due to individuals ordered to stay at home combined with increased interpersonal stressors. However, empirical evidence is lacking. This study aims to estimate the prevalence of, and risk and resilience factors of elder abuse during the pandemic. METHODS: The survey was conducted via two online platforms during April 23 and May 5, 2020, when all states had stay-at-home orders. The final cohort consisted of a sociodemographically diverse sample of 897 older persons in the United States. The prevalence of elder abuse was evaluated by a validated measure previously used in a population-based study of elder abuse. Pandemic-related factors were examined at the community, relational, and individual contexts. We conducted multivariate logistic regression analyses to examine determinants of elder abuse. RESULTS: One in five older persons in the study sample (n = 191; 21.3%) reported elder abuse, an increase of 83.6% from prevalence estimates before the pandemic. In the final models, sense of community emerged as a persistent protective factor for elder abuse (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.85-0.93). At the relational level, physical distancing was associated with reduced risk of elder abuse (OR: 0.94, 95% CI: 0.90-0.98). At the individual level, financial strain was associated with increased risk of abuse (OR: 1.08, 95% CI: 1.02-1.14). CONCLUSION: Health care professionals and policy makers must be prepared to address the increase in elder abuse associated with the evolving pandemic.

Successful Aging in Older US Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study.

OBJECTIVE: To identify the current prevalence, and sociodemographic, military, health, and psychosocial correlates of successful aging in older US veterans. METHODS: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 3,001 US veterans aged greater than or equal to 60 years (mean = 73). Multiple regression and relative importance analyses were conducted to identify key factors associated with successful aging. RESULTS: A total 79% of older veterans rated themselves as aging successfully. Physical and mental health difficulties emerged as the strongest correlates of successful aging (71% variance explained), while psychosocial factors, most notably perceived resilience, purpose in life, and positive expectations about emotional aging, explained 29% of the variance in this outcome. CONCLUSIONS: Nearly 4 of 5 US veterans rate themselves as successful agers. Prevention and treatment efforts designed to mitigate physical and mental health difficulties, and promote protective psychosocial factors may help bolster successful aging in this population.

Protective effects of neighborhood community factors on elder abuse in India.

Elder abuse impacts one in six older persons globally. Most studies of elder abuse have focused on risk factors rather than protective factors, individual-level factors rather than structural factors, and developed countries rather than developing countries where resources are scarce. The current study addressed these gaps by examining whether neighborhood social cohesion and physical order could be such structural-level protective factors for older persons in India. Our cohort consisted of 541 participants aged 60 and over in the pilot wave of the Longitudinal Aging Study in India. We found that older persons with high neighborhood social cohesion were 38% less likely to experience abuse compared to older persons with low cohesion (OR = 0.62, 95% CI = 0.39-0.99). Similarly, participants with high neighborhood physical order were 48% less likely to experience abuse compared to older persons with low physical order (OR = 0.52, 95% CI = 0.32-0.83). Both models adjusted for relevant covariates. Policies supporting greater cohesion and order in communities could reap significant health benefits for older persons.

mRNA Therapy Improves Metabolic and Behavioral Abnormalities in a Murine Model of Citrin Deficiency.

Citrin deficiency is an autosomal recessive disorder caused by loss-of-function mutations in SLC25A13, encoding the liver-specific mitochondrial aspartate/glutamate transporter. It has a broad spectrum of clinical phenotypes, including life-threatening neurological complications. Conventional protein replacement therapy is not an option for these patients because of drug delivery hurdles, and current gene therapy approaches (e.g., AAV) have been hampered by immunogenicity and genotoxicity. Although dietary approaches have shown some benefits in managing citrin deficiency, the only curative treatment option for these patients is liver transplantation, which is high-risk and associated with long-term complications because of chronic immunosuppression. To develop a new class of therapy for citrin deficiency, codon-optimized mRNA encoding human citrin (hCitrin) was encapsulated in lipid nanoparticles (LNPs). We demonstrate the efficacy of hCitrin-mRNA-LNP therapy in cultured human cells and in a murine model of citrin deficiency that resembles the human condition. Of note, intravenous (i.v.) administration of the hCitrin-mRNA resulted in a significant reduction in (1) hepatic citrulline and blood ammonia levels following oral sucrose challenge and (2) sucrose aversion, hallmarks of hCitrin deficiency. In conclusion, mRNA-LNP therapy could have a significant therapeutic effect on the treatment of citrin deficiency and other mitochondrial enzymopathies with limited treatment options.

Accelerated DNA Methylation Aging in U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study.

OBJECTIVE: The aim of this study was to identify how a broad range of sociodemographic, military, health, and psychosocial factors relate to accelerated DNA methylation aging (Δage) in a large, contemporary, nationally representative sample of male U.S. veterans. METHODS: Data were analyzed from a sample of U.S. male European-American veterans who participated in the National Health and Resilience in Veterans Study (N = 1,135). RESULTS: Psychosocial factors of lifetime trauma burden, child sexual trauma, and negative beliefs about aging were independently associated with Δage. Three health variables-diabetes, hypertension, and body mass index-emerged as additional correlates of Δage. CONCLUSION: Results of the study build on prior work demonstrating associations between accelerated DNA methylation aging and traumatic stress, highlighting a role for child sexual abuse in particular. They further underscore the importance of targeting negative beliefs about aging, which are modifiable, in prevention efforts designed to forestall accelerated DNA methylation aging.

Older Age Associated with Mental Health Resiliency in Sexual Minority US Veterans.

OBJECTIVES: Objectives were to: (a) identify the mental health needs of older and younger sexual minority and heterosexual U.S. veterans and (b) examine whether sexual minority status confers vulnerability or resiliency in older adulthood. Support and trauma exposure were examined as potential mechanisms for age by sexual orientation differences. METHODS: Participants were a nationally representative sample of 3,095 U.S. veterans (ages 21 to 96 years). Measures included demographics, military characteristics, sexual orientation (lesbian, gay, or bisexual; LGB), social support, trauma, and mental health indicators (lifetime and present depression and post-traumatic stress disorder (PTSD); lifetime anxiety and suicidal ideation). RESULTS: Younger LGB veterans were most likely to report lifetime depression and/or PTSD and current depression compared with older LGB and younger and older heterosexual veterans. Older LGB veterans had low levels of mental health problems, but they reported the smallest social support networks. CONCLUSIONS: Older and younger LGB veterans have different mental health challenges. Younger LGB veterans are more vulnerable to mental health problems than their older LGB peers. Older LGB veterans are resilient, but they may be at greater risk of social isolation than their younger LGB peers.

Husbands' and Wives' Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study.

BACKGROUND: When examining older adults' health behaviors and psychological health, it is important to consider the social context. PURPOSE: The purpose of this study was to examine in older adult marriages whether each spouse's physical activity predicted changes in their own (actor effects) and their partner's (partner effects) depressive symptoms. Gender differences were also examined. METHOD: Each spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989-1990), wave 3 (1992-1993), and wave 7 (1996-1997). Dyadic path analyses were performed. RESULTS: Husbands' physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse's depressive symptoms (partner effects). However, husbands' physical activity and depressive symptoms predicted wives' physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity. CONCLUSION: Findings suggest that husbands' physical activity is particularly influential for older married couples' psychological health.

Subliminal strengthening: improving older individuals' physical function over time with an implicit-age-stereotype intervention.

Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age=61-99 years, M=81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time.

From serving in the military to serving loved ones: unique experiences of older veteran caregivers.

OBJECTIVE: We examined whether older caregiving veterans differ from noncaregiving veterans in terms of health and psychosocial factors and how these factors and caregiving aspects (i.e., hours, relationship type) relate to caregiving strain and reward. We also evaluated two hypotheses: (1) combat exposure provides protection from emotional caregiving strain, and (2) grandparenting is particularly rewarding. METHODS: We used a cross-sectional web survey of a nationally representative sample of older veterans in the United States. Data were drawn from the National Health and Resilience in Veterans Study, and participants were 2,025 U.S. veterans aged 60 or older (mean: 71.0; SD: 7.1; range: 60-96). Participants completed measures of caregiving status, sociodemographic characteristics, combat exposure, physical and mental health, cognitive status, and psychosocial characteristics. Caregivers reported caregiving hours, caregiving type, emotional and physical strain, and reward. RESULTS: A total of 20.4% of U.S. older veterans are caregivers. As predicted, among the veteran caregivers, (1) combat exposure was associated with less emotional caregiving strain (odds ratio [OR]: 0.57), and (2) grandparenting was associated with increased perception of caregiving reward (OR: 5.28). Resilience was negatively associated with physical strain, whereas depressive symptoms were associated with greater emotional strain; gratitude, happiness, and social support were additionally associated with greater reward. Caregivers were more likely to be married and highly educated than noncaregivers but did not differ with respect to health or psychosocial characteristics. CONCLUSION: One in five older U.S. veterans is a caregiver. Older veterans' combat exposure may decrease the emotional demands of caregiving, and grandparenting is perceived as particularly rewarding. Results suggest that older veterans are an important caregiving resource that deserves tailored resources.

Association between experiencing low healthcare quality and developing dementia.

BACKGROUND: Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older. METHODS: Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors. RESULTS: Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk. CONCLUSIONS: As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

Beneficial Effect of Societal Factors on APOE-ε2 and ε4 Carriers' Brain Health: A Systematic Review.

BACKGROUND: Apolipoprotein-E (APOE) ε4 and ε2 are the most prevalent risk-increasing and risk-reducing genetic predictors of Alzheimer's disease, respectively. However, the extent to which societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on brain health has not yet been examined systematically. METHODS: To fill this gap, we conducted a systematic review searching for studies in MEDLINE, Embase, PsycINFO, and Scopus until June 2023, that included: (a) 1 of 5 social determinants of health (SDH) identified by Healthy People 2030, (b) APOE-ε2 or APOE-ε4 allele carriers, (c) cognitive or brain-biomarker outcomes, and (d) studies with an analysis of how APOE-ε2 and/ or APOE-ε4 carriers differ on outcomes when exposed to SDH. RESULTS: From 14 076 articles retrieved, 124 met the inclusion criteria. In most of the studies, exposure to favorable SDH reduced APOE-ε4's detrimental effect and enhanced APOE-ε2's beneficial effect on cognitive and brain-biomarker outcomes (cognition: 70.5%, n: 74/105; brain-biomarkers: 71.4%, n: 20/28). A similar pattern of results emerged in each of the 5 Healthy People 2030 SDH categories, where finishing high school, having resources to satisfy basic needs, less air pollution, less negative external stimuli that can generate stress (eg, negative age stereotypes), and exposure to multiple favorable SDH were associated with better cognitive and brain health among APOE-ε4 and APOE-ε2 carriers. CONCLUSIONS: Societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on cognitive outcomes. This suggests that plans to reduce dementia should include community-level policies promoting favorable SDH.

A psychological predictor of elders' driving performance: social-comparisons on the road.

Older individuals often believe they can drive better than their contemporaries. This belief is an example of downward social-comparisons; they can be self-enhancing tools that lead to beneficial outcomes. As predicted, we found that drivers who engaged in downward social-comparisons were significantly less likely to have adverse driving events over time, after controlling for relevant factors (p = .02). This effect was particularly strong among women, who tend to experience more negative driving stereotypes (p = .01). The study was based on 897 interviews of 117 elder drivers, aged 70-89 years, over 2 years. Our findings suggest that interventions to reduce adverse driving events among elders could benefit from including a psychological component.

Societal impact on older persons' chronic pain: Roles of age stereotypes, age attribution, and age discrimination.

RATIONALE: In view of the severity and prevalence of chronic pain, combined with the limited success of long-term treatments, there is the need for a more expansive understanding of its etiology. We therefore investigated over time three societal-based potential determinants of chronic pain that were previously unexamined in this connection: negative age stereotypes, age attribution, and age discrimination. METHODS: The cohort consisted of 1373 Americans aged 55 and older, who participated in four waves of the National Health and Resilience in Veterans Study, spanning seven years. RESULTS: Consistent with the hypotheses, negative age stereotypes as well as age discrimination predicted chronic pain, and age attribution acted as a mediator between the negative age stereotypes and chronic pain. In a subset of participants who were free of chronic pain at baseline, those who had assimilated negative age stereotypes were 32% more likely to develop chronic pain in the next seven years than those who had assimilated positive age stereotypes. CONCLUSION: Our finding that the three societal-based and modifiable predictors contributed to chronic pain refutes the widely held belief that chronic pain experienced in later life is entirely and inevitably a consequence of aging.

Children's Residential Proximity, Spousal Presence and Modifiable Risk Factors for Dementia among Older Adults with Cognitive Impairment.

Background: Cognitive impairment in older adults poses considerable challenges, and the role of family support becomes increasingly crucial. This study aims to examine the impact of children's residential proximity and spousal presence on the key modifiable risk factors for dementia among older adults with cognitive impairment. Methods: Utilizing the Health and Retirement Study (HRS) data from 1995 to 2018, we analyzed 14,731 participants (35,840 person-waves) aged 50 and older with cognitive impairment. Family support was characterized based on the presence of a spouse and residential proximity to children. Smoking, depressive symptoms and social isolation were included as the key modifiable risk factors for dementia identified in later life. Using mixed-effects logistic regressions, associations between access to family support and the modifiable risk factors were determined, adjusting for various socio-demographic and health-related factors. Results: Significant associations were found between access to family support and modifiable risk factors for dementia. Cognitively impaired older adults with less available family support, characterized by distant-residing children and the absence of a spouse, had significantly higher risks of smoking, depressive symptoms, and social isolation. Moreover, we revealed a consistent gradient in the prevalence of the risk factors based on the degree of family support. Relative to older adults with a spouse and co-resident children, those without a spouse and with all children residing further than 10 miles displayed the highest risks of smoking, depressive symptoms, and social isolation. Conclusion: Access to family support, particularly from spouses and proximate children, plays a protective role against key modifiable risk factors for dementia in older adults with cognitive impairment. The findings highlight the need for bolstering family and social support systems to enhance the well-being of this vulnerable population.

Implicit and Explicit Dehumanization of Older Family Members: Novel Determinants of Elder Abuse Proclivity.

Elder abuse affects one in six older persons globally. Three limitations impede progress in prevention: most research is victim- rather than perpetrator-based; the reliance on explicit, self-reported factors; and failure to account for psychological factors, such as dehumanization, that motivate abuse. The current study addressed these gaps by examining whether implicit and explicit dehumanization of t could explain elder abuse proclivity. In a web-based survey of 585 family caregivers of older persons, dehumanization was found to be prevalent with 51% of the caregivers implicitly and 31% explicitly dehumanizing older persons. As predicted, implicit and explicit dehumanization contributed to elder abuse proclivity (OR = 1.23, 95% CI = 1.02-1.50, p = .03) and (OR = 1.26, 95% CI = 1.05-1.51, p = .01), respectively, after adjusting for relevant covariates including caregiver burden, and caregivers' and care-recipients' health. Developing caregiver-based interventions to humanize older persons may complement ongoing efforts in reducing elder abuse.

Health advantages of ethnic density for African American and Mexican American elderly individuals.

Research suggests that greater ethnic density correlates with worse health among African Americans but better health among Hispanic Americans. These conflicting patterns may arise from Hispanic American samples being older than African American samples. We found that among 2367 Mexican American and 2790 African American participants older than 65 years, ethnic density predicted lower rates of cardiovascular disease and cancer, adjusting for covariates, showing that the health benefits of ethnic density apply to both minority communities.