GECC - Gateway Exposome Coordinating Center

Community Services Environment

Overview

The Community Services domain focuses on care and support systems, including healthcare, care services, senior services, and emergency preparedness. Research in this domain focuses on developing frameworks and innovative methods for measuring the availability and accessibility of community services, going beyond mere presence to assess their quality, quantity, and access.

Care Services

Medical care services play a critical role in preventing or delaying cognitive decline and dementia by providing treatment for underlying risk factors. Better access to medical care resources such as hospitals, clinics, physicians, and nurses in one’s community may contribute to the early detection and treatment of dementia risks through increased utilization of medical services. Home- and community-based care services are provided by family, home health aides, adult day services, respite care, and post-acute care facilities; access to such services may reduce risks of dementia and promote resilience to cognitive decline.

Civic and Social Services

Social support and engagement promote better cognitive function. Senior and civic services include activities that facilitate social support and engagement, such as community gardening, exercise programs, meal delivery, and financial management. Support provided by these services contributes to lowering dementia risk with cognitive stimulations and to resilience for people with a high risk of dementia while they manage challenges related to functional decline.

Emergency and Safety Services

Safety and emergency services contribute to the surveillance, preparedness, and responsiveness to natural and human-made disasters, such as fire, floods, or infectious disease outbreaks. By alerting about and responding promptly to hazardous environments and incidents, these services may protect people from being exposed to dangerous conditions that may contribute to cognitive decline. The availability of safety and emergency services may help improve the safety of individuals with a high risk of dementia who are more vulnerable to the adverse environment and require additional support.

Community Insights

In the fall of 2024, the GECC hosted a series of town hall meetings with hundreds of unique participants. These meetings yielded critical insights for the Community Services domain, including highlighting key themes and gaps in research.

Key Themes

Care
Promoting healthy behaviors
Basic needs and amenities
Education, knowledge, and awareness

Gaps in Research

Data on care quality
Access to restricted data, such as geographic information
Improved documentation of available data (e.g., periods)

Measures

To address these priorities and facilitate a better understanding of the relationship between the exposome and AD/ADRD outcomes, the Community Services domain will leverage existing measures as well as develop novel measures.

Short-Term Priorities

Complete a care service scoping review, documenting research and gaps on how access to care services may prevent or delay cognitive decline and dementia. Relevant services include medical care, family care, home health aides, adult day services, respite care, and post-acute care facilities.
Develop common methods for measuring care service availability and accessibility (e.g., number of hospitals within a set travel time).
Generate an original dataset of community care services, measuring availability and accessibility using the above methods.
Complete a senior and civic service scoping review, identifying knowledge gaps on how access to services — such as transport programs, community centers, events, and referral services — affects modifiable dementia risk factors.
Review evidence and gaps on safety and emergency services (e.g., fire, ambulance), including response times and outcomes for individuals at high risk of dementia.
Compile existing data and measures on senior/civic and safety/emergency services to better understand national-level coverage.
Complete a systematic review of care service measurement, assessing how accessibility moderates negative health and financial outcomes in late life.

Long-Term Priorities

Complete systematic reviews of senior and civic service measurements as well as safety and emergency service measurements.
Continue to develop the measurement methodology described in Tier 1 to create measures of availability and accessibility to specific community service types.
Update and extend exposome data of community services, specifically adding features to existing community service exposome measures and extend the measured time.
Develop guidelines on measures for each subdomain to promote best practices in research using measures of availability and accessibility to community services.