Recognizing Structural and Social Determinants of Health in the Diagnosis and Care of Dementia.

Structural and social determinants of health are environmental conditions that affect individuals' health and functioning across the life course. These determinants are salient factors at the apex of individual psychology, community variables, and larger sociological factors, exerting prominent effects on individuals' wellbeing. The National Institute on Aging seeks to understand their influence on aging and Alzheimer's disease. We propose that the benefits of doing so may reach beyond knowledge of disease mechanisms - it may also improve clinical outcomes. We describe efforts introducing structural and social determinants of health data into the national network of Alzheimer's disease research centers. We report results of pilot testing 225 structural and social determinants of health items at the University of Pennsylvania's center among 135 cognitively unimpaired research participants. We summarize item and instrument completion rates, participant feedback, and survey adjustments. We describe the initiative, potential for its impact, pilot testing results, and future directions.