Healthy Aging in Rural Communities

By Genevieve Wanucha

About 1 million of the 8 million residents of Washington State live in rural areas. While rural communities often provide social and environmental benefits, rural residents often have lower access to healthcare, especially for specialty care. According to the U.S. Health Resources and Services Administration, 65% of rural areas have a shortage of primary care physicians. Other rural health obstacles include high rates of poverty, lower levels of education, and the lack of public transportation.

“When it comes to health care, and specifically neurology care, there’s a substantial lack of providers, resources, and capacity,” says Justin B. Miller, PhD, ABPP, Professor of Neurology at UW Medicine and Co-Lead of the Clinical Core at the UW Alzheimer’s Disease Research Center. As a neuropsychologist, he has a clinical focus on aging and dementia, and understanding risk for neurodegenerative disease in older adults. “This shortage creates substantial disparities in health and health care that I don’t think are being addressed.”

Research using medical claims data suggests that individuals living in rural areas have a higher risk of Alzheimer’s disease and other forms of dementia, but it is unclear why. “We don’t know a lot about how the aging process differs between rural and urban-dwelling adults,” says Miller. One reason is that rural residents are underrepresented in Alzheimer’s research.

In 2025, Miller launched the UW Northwest Rural Brain Health Initiative to study aging in rural communities to better understand brain health and dementia risk. For this project, he aimed to knock down common barriers to participation in research for rural residents. These barriers may include challenges in traveling to an urban center, the time required, and uncertainty about the benefits of engaging in a research study.

Over the past year, the UW Northwest Rural Brain Health Initiative has partnered with Mason Health in Shelton, Washington, to conduct a local brain health study and bring in needed clinical services and resources. Miller and program manager Nam Phuong Nguyen, PhD, work on-site at Mason General Hospital to carry out the study.

The Northwest Rural Brain Health Initiative is a two-part process in which Miller’s team collects blood to look at various biomarkers of brain health, and measures of memory and thinking skills, as well as life history, from rural-dwelling adults aged 50 and older. In return, participants can receive a copy of their clinical labs, as well as a cognitive health assessment and information on whether their cognitive abilities are expected for their age or indicate something out of the ordinary. Participants can also have this clinical information sent to their doctor.

“I’m reminded every time we meet with a participant in Shelton that we are having an immense impact in the community,” said Nam Phuong Nguyen. “We are providing resources for cognitive and memory care that can be very difficult for rural communities to access, leading to health disparities that negatively affect many families. I have met so many rural-dwelling participants who are concerned about their neurological health but have felt ignored and disadvantaged by the current health care system, and this is the motivating factor behind our mission.”

Miller’s current work builds on previous rural brain health research at the Cleveland Clinic’s Lou Ruvo Center for Brain Health, where he worked for almost 11 years before moving to the University of Washington. His preliminary findings suggest that some people in rural communities demonstrate better memory than urban dwellers with matching clinical characteristics. Benefits of living in a rural community include greater social connectedness, more green space and recreational opportunities, and lower pollution levels.

“One of my leading hypotheses is that, for some individuals, living and aging in a rural community will increase disease risk,” said Miller. “But for others, it will foster resilience.”

Now, with the Northwest Rural Brain Health Initiative, Miller is working to understand the relative influences of personal, social, economic, and environmental factors on brain health outcomes in rural communities. This knowledge could help researchers develop risk profiles for use in preventive medicine.

But Miller’s ultimate goal comes from his clinical experience with individuals living with memory loss or with worries about their cognitive health. “I hope that people can receive the highest quality care regardless of where they live.” •

 

For more information or to register for the study, call 206-744-6280 or email brainhealth@uw.edu.