Climate

The climate domain considers the impacts of a wide range of relevant hazards on healthy aging, including rising outdoor temperatures and risks posed by smoke from wildfires, flooding, episodes of extreme heat, and other extreme weather events. This is an important area of focus since the climate is rapidly changing and weather events have been associated with higher rates of death and healthcare utilization among the general population, but especially those with dementia. Older adults with poorer cognition are particularly vulnerable to extreme weather events and stressors since they are often less mobile, are on a fixed income, may be taking medications that interfere with thermoregulation, and have chronic diseases. Climate hazards can vary dramatically across individuals for reasons including age, occupation, and living conditions. Therefore, activities focused on climate change mitigation, adaptation, and resilience can profoundly impact the health of people with cognitive declines and dementia. The Climate domain is led by Dr. Gregory Wellenius (Boston University).

Physical Environment

The natural and built environment where we live, work, exercise, and socialize can have important influences on health. Some features of the physical environment can be harmful to health like air pollution and noise. Yet, other aspects like visibility of trees and lakes or access to transportation, parks, benches, restrooms, and safe communities can improve health. Since much of the physical environment can be modified, this is a critical area of importance to reduce the risks of dementia or improve the well-being of those with dementia. The Physical Environment domain is co-led by Dr. Jeffrey Brook (University of Toronto) and Dr. Michael Brauer (University of British Columbia).

Social Environment

The social environment includes a person’s workplace, neighborhood, society, and groups to which they belong. It can be characterized by how people relate to each other and the structures of the community. Features of social processes include things like social connections, support networks, and trust among people. Structural features refer to aspects of a place like racial segregation of where people live, housing affordability, and the overall wealth of a neighborhood. Many of these factors are linked to health conditions associated with dementia like hypertension and cardiovascular diseases, but more research is needed to understand how they affect brain health. The Social Environment domain is led by Dr. Maggie Hicken (University of Michigan).

Policy Environment

The policy domain covers a broad scope of government policies that influence key determinants of AD/ADRD outcomes throughout life. This may include public health policies targeting dementia prevention (e.g., tobacco and alcohol control policies, nutritional labelling and food policies, urban design and walkability policies); health and long-term care policies (e.g., home-based care programs, institutional long-term care, caregiving support policies, end-of-life and palliative care policies); physical environmental policy (e.g., air quality and pollution control, noise pollution reduction, access to green spaces), and social policies (e.g., education policy, employment and workplace policies, social inclusion policies, income security and protection). Given this wide range of influential policies, variations across jurisdictions and time periods serve as natural experiments, allowing researchers to study how different policies affect AD/ADRD risk factors, and ultimately informing more targeted and effective interventions. To make progress in this domain, the GECC focuses on three main aims: reaching consensus on key policies affecting AD/ADRD outcomes, developing standardized methods for policy data collection, and creating robust analytical approaches to examine policy variations across temporal and spatial dimensions. The Policy Environment domain is led by Prof. Mauricio Avendano (University of Lausanne).

Community Services Environment

The community services domain focuses on care and support systems, including healthcare, long-term care, senior services, and emergency preparedness. These services significantly influence AD/ADRD risks, care, and resilience for individuals and populations, while also moderating the impacts of other domains. Research in this domain focuses on developing frameworks and innovative methods for measuring the availability and accessibility of diverse services, going beyond mere presence to assess their quality, quantity, and access. This comprehensive approach aims to deepen our understanding of how community services impact AD/ADRD outcomes, providing crucial insights for developing effective interventions to mitigate disparities and improve quality of care. The Community Services Environment domain is co-led by Dr. HwaJung Choi (University of Michigan) and Mr. David Van Riper (University of Minnesota).

Life Experiences

The life experiences domain explores how a range of experiences – from well-studied categories like education and caregiving, to less-studied aspects such as migration, stress and day-to-day experiences – shape health and well-being across the lifespan and relate to AD/ADRD outcomes. Primarily focused on individual and family level experiences, this domain employs novel approaches to understanding these occurrences across space and time. For example, time-related research in this domain examines how the cumulative effects of life experiences differ from isolated risk factors, takes into account how certain experiences have different impacts over time, and considers how the duration of an important life experience or when it occurs in the life course changes its import. This domain also intersects with the social environment, policy landscape, and community services domains to provide a holistic understanding of how various life experiences influence health and wellbeing as individuals and populations age. The Life Experiences domain is co-led by Dr. Sarah Flood (University of Minnesota) and Dr. Shrikanth Narayanan (University of Southern California).

Methods

The methods core tackles cross-domain methodological challenges focused on measuring exposures and their associations with AD/ADRD outcomes. Topics of interest to the methods group include methods and approaches for summarizing and analyzing high-dimensional and complex exposome data, including index construction methods, the application of mixture methods to jointly model combinations of exposures, and the use of machine learning methods to capture complex interplay between different exposome components. The group will also tackle challenges related to consideration of life course data on exposures from birth and early childhood to late life, developing and discussing common approaches to understand and evaluate sensitive periods and cumulative exposures across time. Additionally, the methods core will consider topics focused on minimizing bias in causal analyses of the exposome and AD/ADRD outcomes, including the incorporation and consideration of measurement error, selection bias in studies of older adults, and evidence triangulation and synthesis. By tackling high-priority challenges relevant to multiple domains, the methods core will provide crucial insights to guide measure construction and subsequent analytic projects across the coordinating center. The methods core is led by Dr. Emma Nichols (University of Southern California).

Dissemination

The dissemination team leverages and expands an existing network of outreach partners to distribute GECC-developed resources to a diverse array of AD/ADRD stakeholders. Collaborating with different domains, the team will produce, publish, and publicize materials like research briefs, infographics, and lay summaries of GECC activities. These resources will be crafted for clarity and accessibility, catering to the needs of both policymakers and researchers in adjacent disciplines. The dissemination core is co-led by Dr. Lorna Thorpe (NYU Grossman School of Medicine) and Dr. Marc Gourevitch (NYU Grossman School of Medicine).