ENHANCE: Developing a Clinical Geography Tool to Intervene in Cognitive Decline through Neighborhood Design
Dementia is frequent and burdensome among aging Americans. Environmental factors may significantly increase the risk of, or buffer against, age-related cognitive decline, yet strategies to improve cognitive health outcomes to date largely overlook the role of neighborhoods. Residence in socioeconomically advantaged neighborhoods may promote cognitive function and/or buffer against cognitive decline in part through greater density of physical resources (e.g., recreational centers, gyms, parks, walking paths) and social resources (e.g., libraries, community centers, coffee shops) that promote physical activity, facilitate mental stimulation, and encourage social engagement. This project proposes to develop a new niche of clinical geography by translating geographical knowledge into a tool designed to facilitate place-based interventions that improve the health and independence of aging individuals. First, the project aims to identify built and social environmental factors linked to changes in cognitive function over time based on secondary data analysis of a national, racially diverse, population-based sample. The dataset includes multiple measures of cognitive function and geographic coordinates of residential locations for over 30,000 aging Americans tracked annually since 2003. Interpretations of generalized linear mixed models will focus on identifying built and social environmental factors relevant to cognitive decline. Second, the project aims to translate this knowledge into a place-based diagnostic tool: Environmental Neighborhood Health Assessment to Nurture Cognitive Enhancement (ENHANCE). A community advisory board (CAB) will be formed to develop ENHANCE through input from diverse stakeholders including urban planners, health researchers, gerontologists and geriatricians, dementia-friendly community advocates, community service providers, and older adults. The CAB will review how multi-scalar environmental factors may impact cognitive function, develop the diagnostic tool, and refine ENHANCE based upon preliminary feasibility testing. The F32 fellowship will facilitate Dr. Finlay's career development and future as an independent translational health researcher. It complements and extends her methodological and substantive expertise in health geography and environmental gerontology through mentored training in five new areas: 1) quantitative data analysis; 2) cognitive function; 3) clinical experience with older people of varying levels of physical and cognitive function; 4) tailored design of environmental audit tools for intervention studies; and 5) NIH grant skills. The interdisciplinary and supportive training environment at the University of Michigan provides a foundation for Dr. Finlay to pursue translational research throughout her career. The long-term research objective is to develop a new concept of `cognability? (a measure of how supportive a community environment is to cognitive functioning) with a reliable and efficient instrument to evaluate relevant macro and micro environmental conditions. Resulting tailored, place-specific interventions are intended to help aging individuals reduce risk of dementia, live independently longer, and lessen the need for long-term care.
National Institute on Aging
Funding Period: 2/1/2020 to 1/31/2022