Delaware is experiencing a significant demographic shift as its older adult population continues to grow. Currently, approximately 18 percent of Delaware residents are age 65 years and older, and projections indicate that more than one in five Delawareans will be over age 65 by 2030. Concurrently, chronic disease prevalence, physical inactivity, cognitive decline, and other aging-related health challenges continue to place increasing demands on healthcare systems, community services, and public health infrastructure. Addressing these complex issues requires coordinated, interdisciplinary approaches that integrate research, education, workforce development, and community engagement. This paper highlights the collective contributions of Delaware's public institutions of higher education in advancing healthy aging initiatives across the state. Programs and activities supported by Delaware State University, Delaware Technical Community College, and the University of Delaware are unique in scope and topic but collectively contribute to research, workforce training, evidence-based program implementation, policy development, and community outreach. Beyond individual programs, this paper emphasizes the value of interdisciplinary partnerships among academic institutions, healthcare organizations, government agencies, and community stakeholders. Such collaborations enhance opportunities for experiential learning, translational research, workforce development, and evaluation of programs that support older adults across rural, suburban, and urban communities. Looking forward, Delaware's higher education institutions are uniquely positioned to strengthen statewide collaboration through shared educational opportunities, aging-focused workforce initiatives, coordinated research efforts, and a proposed statewide aging summit. By leveraging collective expertise and resources of the state's rich academic programs, Delaware can develop a coordinated strategy to promote healthy aging, improve quality of life, and prepare for the needs of its rapidly growing older adult population.
Objective:Falls are a major public health concern among older adults in the United States, and Delaware reflects this growing burden. Fall-related mortality increased steadily from 2012 to 2021, coinciding with a rapidly aging population. Despite the availability of effective evidence-based fall-prevention programs, adoption remains limited among high-risk populations. Grounded in implementation science, this study aimed to identify barriers and facilitators influencing the uptake of fall-prevention interventions among community-dwelling older adults and healthcare providers in Delaware. This project began November 2024 with data collection and analysis concluding March 2026. Methods:A qualitative descriptive, multi-method design was employed including semi-structured interviews with nineteen older adults and focus groups of nine healthcare providers in southcentral Delaware. Interviews and focus groups were audio recorded, transcribed, and analyzed using inductive and deductive coding. Themes were analyzed using Theoretical Domains Framework and Behavior Change Wheel to categorize barriers and facilitators affecting fall prevention participation. Results:Barriers to fall prevention spanned multiple domains, including limited awareness of programs, financial and transportation challenges, provider gatekeeping, time constraints, and inconsistent referral practices. Older adults frequently underestimated their fall risk, underreported falls, and demonstrated low adherence to preventive behaviors, often compounded by social isolation. Facilitators included willingness to adopt prevention strategies, individualized fall action plans, family and social support, use of emergency alert technologies, and strong provider motivation to address fall risk. Conclusion:Gaps in fall prevention reflect implementation challenges rather than a lack of available evidence-based programs. Interconnected behavioral, structural, and system-level barriers influence both older adults and healthcare providers. Coordinated, evidence-informed implementation strategies are needed to expand program reach and improve outcomes for Delaware's growing older adult population. Policy Implications:Standardized fall risk screening, interprofessional referral pathways, and population-specific implementation strategies for Delaware communities may help reduce fall-related morbidity and mortality among the state's rapidly aging population.
Objective:Neighborhood disadvantage has been linked to reduced cognitive performance and cognitive decline among older adults; however, potential moderators of this association, such as loneliness, have not been well studied. Therefore, the objective of the study was to examine associations between neighborhood disadvantage and cognitive function, and whether associations are moderated by self-reported loneliness. Methods:Data were analyzed from the Healthy Heart and Mind Study, a cross-sectional study with data collection ranging from October 2016 to January 2020 in New Castle County, DE and surrounding areas. The analysis included 136 older adults (36% male) with a mean age of 68.04. Neighborhood disadvantage was assessed using the Area Deprivation Index (ADI), which provided state and national rankings of neighborhood deprivation. Cognitive function was assessed with the Verbal Fluency Test (executive function), the Visual Reproductions Test (short- and long-term visuospatial memory), the Logical Memory Test (verbal memory), and Digit Span Forward and Backward (working memory). Loneliness was measured with the UCLA Loneliness Scale. Descriptive statistics were calculated and linear regression analyses were run, adjusted for age, sex, and education. Results:Results showed that higher state and national ADI scores (more disadvantage) were associated with worse short-term visuospatial memory. Loneliness moderated the relationship between national ADI scores and short-term visuospatial memory. Conclusions:Overall, our findings suggest that older adults living in more disadvantaged neighborhoods in and surrounding New Castle County, De may be susceptible to poor visuospatial memory performance, and the relationship may vary based on low or high self-reported loneliness. Policy Implications:Our findings suggest a need to increase exploration of the role of neighborhood factors in older adult cognitive functioning. Health policies focused on ameliorating individual-level risk factors for cognitive dysfunction and decline may need to be expanded to target neighborhood-level factors and the intersection of neighborhood, loneliness, and social ties.
Objective:This study aimed to explore the factors predicting loneliness among older adults attending Delaware senior center programs. Methods:Participants attending Delaware senior centers completed pre-and post-program surveys, including loneliness (UCLA Loneliness Scale), self-rated physical and mental health (SF-12), and demographic items. This study was conducted using data from a state-wide evaluation project of 16 senior centers during the summer of 2024. Results:Participants included 234 older adults (median age = 74.0±8.3 years; 205 female, 27 male). Nearly a third of participants visited the senior center 3 - 4 times in the past week (32.9%) or 1 - 2 times (33.1%). Approximately half of participants reported living with a spouse or another family member (55.6%) and 38.5% reported living alone. Three-quarters of participants identified as white (73.1%), and participants reported average physical and mental health (PH:47.8±8.4; MH:50.9±5.3) via the SF-12. Senior center attendance, pre-program loneliness scores, self-rated mental health, self-rated physical health (B=-0.02, p=0.047), and identifying as white were significant predictors of post-program loneliness in older adults attending senior centers. Estimated marginal effects suggested that more frequent attendance may be associated with lower loneliness amongst individuals with higher baseline loneliness. Conclusion:Our findings suggest that more frequent senior center attendance is associated with lower post-program loneliness and highlight the multifaceted nature of loneliness, including the influence of health and demographic factors. Policy Implications:Resources are needed for senior centers to tailor programs to provide opportunities for social engagement and to increase outreach to older adults at risk for loneliness, as senior centers provide important infrastructure to support healthy aging and mitigate loneliness.
Approximately a third of Delawareans age 65 and older have dementia or mild cognitive impairment. Although a cure remains elusive, there is reason for optimism: disease-modifying treatments are now available, and as many as 45% of dementia cases may be preventable through sustained attention to modifiable risk factors across the lifespan. Most modifiable risk factors are addressed through behavior change, such as nutrition and physical activity, or depend on health behaviors, such as medication adherence or hearing aid use. Large U.S. and international trials of multidomain interventions show that older adults can improve cognitive test scores when they adhere to intervention components. To succeed in real-world settings, however, brain health lifestyle interventions must address patients' capabilities, opportunities, and motivation for behavior change, including through person-centered goals. BrainSpan is a six-session program that educates midlife and older adults about brain health and helps them build motivation and resources to improve brain health behaviors. Since 2023, ten cohorts totaling 158 participants have completed BrainSpan in and around Delaware. This vignette describes BrainSpan's implementation and potential next steps.
Consistent growth in the number of older adults in the United States has led many health systems to evaluate their capacity for supporting an aging population. Delaware needs to identify priorities and action areas to support the state's increasingly older population. Using publicly available data from national surveillance systems and state reports, this analytic essay compared demographic aging trends, age-related chronic disease prevalence, and public health infrastructure across Delaware, Maryland, Pennsylvania, Rhode Island, and Vermont. These states were chosen given their similar geographical location or population size. Between 2015 and 2024, the proportion of Delaware residents aged 60 years and older grew from 23.7 percent to 29.3 percent, placing Delaware as second among comparison states in the proportion of older adults. Relative to the comparison states, Delaware had the highest proportion of older adults moving into the state, with 18.8 percent of adults aged 60 years and older relocating from another state in 2024. In 2024, Delaware had the highest prevalence of several age-related health conditions, including diabetes (13.3%), stroke (3.5%), arthritis (26.2%), and neurological difficulties (15.8%). Delaware had the highest disparities relative to the comparison states on measures of economic hardship, food instability, and uninsured populations. Despite these demographic, economic, and disease trends, Delaware had the second-lowest geriatric healthcare workforce capacity, reporting 39.3 geriatricians and nurse practitioners per 100,000 adults aged 65 years and older in 2025, compared with 74.1 in Rhode Island. These findings suggest that Delaware's aging population is growing rapidly, and that the state may be facing substantial preparedness gaps related to meeting the needs of older Delawareans. Strategic investments in workforce development, economic supports, community-based services, healthcare access, and dementia preparedness will be critical to ensuring Delaware is prepared to meet the evolving needs of its growing older adult population.
Ageism and ageist attitudes and behaviors have a negative impact on the well-being of older adults in Delaware, the fifth oldest state in the country. An integrated, cross-sector public health agenda that addresses both the achievements and challenges of growing older is essential to ensure that Delawareans can age with the highest quality of life possible. Rethinking how we age and valuing longevity can make Delaware, the First State, First in Aging.
Despite treating tens of millions of Americans affected by substance use disorder, most clinicians receive little formal training on SUD. The gap leaves providers underprepared and patients feeling unwelcome, creating a cycle of avoidance that contributes to low treatment uptake and preventable overdose deaths. This piece argues that stigma and knowledge deficits, not lack of empathy, drive that breakdown. Drawing on direct experience piloting Shatterproof's Provider's Pathway training with psychiatry residents, the author shows how targeted education on non-judgmental communication, FDA-approved treatments, and screening tools can shift provider confidence and patient trust. The training is relevant beyond addiction specialists, extending to primary care, emergency medicine, and other settings where SUD routinely surfaces. Provider's Pathway is offered as one concrete, scalable intervention in a system that has consistently asked clinicians to do more with less.
Objective:. More than two million older adults are homebound and five million need help leaving their homes. They often experience social isolation, food insecurity, and lack of connection to community resources. Affordable, adaptable, comprehensive home-based services for those aging in place are lacking. This study examined the benefits of an intergenerational home-based service-learning program on goal attainment in 1) social support, 2) home safety and cleanliness, 3) access to community resources, 4) food access, and 5) improving physical health. Methods:. 201 homebound and near-homebound older adults enrolled in Lori's Hands in Newark, DE; Baltimore, MD; and Metro Detroit, MI were surveyed between December 2021 and May 2026. Descriptive and chi-square analyses were conducted to examine changes in domain-specific subjective assessment of goal attainment over time. Results:Findings indicated that 83% of clients reported positive changes in at least one of the five target service areas over six or more months of participation in the program. The majority of participants reported 1) home safety and cleanliness and 2) social support as their most important goals. Results from the chi-square test indicated statistically significant differences in goal attainment for all five service areas. Conclusions:Results from this study suggest that intergenerational in-home support services can improve social support, home safety and cleanliness, physical activity, food access and nutrition, and access to community resources for homebound older adults, thereby supporting aging in place and reducing the load on informal caregivers. Policy Implications:. Policies and practice can support a pipeline of health professionals through innovative service-learning models to benefit older adults, caregivers, students, and the broader community.
This article offers insights into an innovative community-based organization improving the health of individuals residing in Delaware, with a focus on older adults and rural populations. We profile Milford Wellness Village (MWV), an integrated health and social services campus hosting over 30 service providers and offering a suite of interventions that help residents to age in place, address chronic conditions, and reduce overall health care costs. Specifically, MWV's adaptive reuse of community facilities, establishment of an integrated continuum of care, and adoption of value-based payment approaches make it a unique entity worthy of ongoing study. As communities across the country wrestle with how to address public health concerns, improve service delivery, and enhance outcomes for vulnerable populations, innovative models like MWV can serve as a blueprint. Adoption of value-based payment is a growing priority for stakeholders across the health care system who are seeking ways to reform traditional approaches to reimbursement to address cost growth while ensuring access to high-quality care. For many providers and payers, the path forward has been challenging, but examples of successful models offer important lessons for national efforts.
Objective:To determine whether fecal incontinence is associated with cardiovascular, pulmonary, and kidney disease, individually and in combination, and with all-cause mortality among community-dwelling US adults. Methods:Nationally representative cohort study using the National Health and Nutrition Examination Survey (NHANES) 2005-2010 with linkage to the National Death Index through December 31, 2019. The analytic cohort comprised 14,731 adults aged 20 years or older, with 14,718 eligible for mortality analysis. Fecal incontinence, defined as accidental leakage of mucus, liquid stool, or solid stool during the prior 30 days. A composite cardiopulmonary-kidney (CPK) burden was calculated as the count of three affected systems: cardiovascular disease (self-report), pulmonary disease (current asthma, emphysema, or chronic bronchitis), and kidney disease markers (estimated glomerular filtration rate <60 mL/min/1.73 m², urine albumin-creatinine ratio ≥30 mg/g, or self-reported kidney disease). Multisystem CPK burden was defined as ≥2 affected systems. Survey-weighted prevalence ratios (PRs) for each cardiopulmonary-kidney outcome from modified Poisson regression and hazard ratios (HRs) for all-cause mortality from Cox proportional hazards models, with sequential adjustment for sociodemographic, cardiometabolic, and shared functional/mood/urinary factors. Results:Among 14,731 adults (weighted mean age 46.8 years; 51.2% women), the weighted prevalence of fecal incontinence was 8.4% (95% CI, 7.8%-9.0%). Adults with fecal incontinence were nearly a decade older than those without (mean age 55.6 vs 46.0 years) and had higher prevalences of urinary incontinence (62.0% vs 32.6%), depressive symptoms (17.4% vs 6.2%), and functional limitation (30.3% vs 13.8%) (all P<.001). After full adjustment, fecal incontinence remained associated with kidney disease markers (PR, 1.16; 95% CI, 1.02-1.32) and with simultaneous involvement of all three CPK systems (PR, 2.38; 95% CI, 1.47-3.86). During follow-up, 2,395 deaths occurred. Crude mortality was 80.8 per 1,000 person-years among adults with both fecal incontinence and multisystem CPK burden, versus 10.6 in adults with neither. After adjustment, multisystem CPK burden alone (HR, 1.80; 95% CI, 1.58-2.04) and combined fecal incontinence plus burden (HR, 2.14; 95% CI, 1.66-2.77) predicted mortality. Fecal incontinence alone did not (HR, 1.06; 95% CI, 0.87-1.28). With multisystem CPK burden as the reference, the combined group did not demonstrate a statistically significant mortality increment (HR, 1.19; 95% CI, 0.92-1.54; P=.18). Conclusions and Relevance:Fecal incontinence in US adults is associated with disproportionate cardiopulmonary-kidney disease, functional impairment, and mortality, but the association with mortality was related to multisystem disease rather than to bowel symptoms themselves. Disclosure of fecal incontinence is a low-cost clinical signal that warrants integrated systemic assessment, including routine kidney function testing, rather than purely anorectal evaluation.
Aging is a universal experience, yet public health systems have historically approached it as a specialized issue rather than a population-wide priority. As the proportion of older adults increases, particularly in states like Delaware, the implications for health systems, infrastructure, and community design are profound. This commentary examines the 2024 National Plan on Aging and its relevance to Delaware's rapidly aging population. With more than one in five residents already age 65 or older and continued growth projected over the next decade, Delaware faces both challenges and opportunities. This paper argues for a multisector public health framework that integrates health care, housing, transportation, and community systems.
Objective:To examine whether prefrontal cortex activation measured by functional near‑infrared spectroscopy (fNIRS) during the St. Louis University Mental Status (SLUMS) exam differs by cognitive status and whether relative neural efficiency (RNE) can serve as a physiological marker of cognitive impairment. Methods:This exploratory study was conducted in 2024 at a senior center in a small Mid‑Atlantic U.S. city. Thirteen community‑dwelling adults aged 65-85 years completed the SLUMS while wearing an fNIRS sensor positioned over the prefrontal cortex. Participants were classified as having normal cognition (NOR), mild cognitive disorder (MCD), or dementia (DEM) based on SLUMS scores. ΔHbO served as the indicator of cognitive effort, and RNE was calculated by combining normalized SLUMS performance and oxygenation values. Group differences were tested using ANOVA with confirmatory nonparametric analyses. Results:RNE differed significantly among groups (F₂,₁₀ = 5.26, p = 0.0275). Post‑hoc comparisons showed lower RNE in the DEM group compared with the NOR group (p = 0.0224). Confirmatory Kruskal‑Wallis testing supported these findings (p = 0.0287), with a significant DEM-NOR difference on Dunn's test (p = 0.0311). Descriptive hemodynamic patterns indicated higher ΔHbO and ΔHbR variability in the DEM group across SLUMS question blocks. Conclusions:Older adults with dementia demonstrated reduced neural efficiency during SLUMS administration, suggesting greater cognitive effort relative to performance. These preliminary findings indicate that SLUMS items impose different cognitive workloads depending on impairment level. Policy Implications:Integrating physiological markers such as neural efficiency into cognitive screening may enhance early identification of impairment, support more targeted referral pathways, and inform public health planning for Delaware's aging population.
Introduction:Prematurity remains a significant cause of infant and childhood morbidity and mortality. Infants who are exclusively breastfed during the first 6 months of life have improved outcomes. A majority of premature infants are discharged home on formula. Neonatal Intensive Care Unit (NICU) design may influence parental involvement and, in turn, affect breast milk utilization. This study assesses breast milk utilization at discharge, before, and after transitioning from a traditional open-bay NICU to a private, single-family room (SFR) NICU. Methods:This is a retrospective observational study of infants born at <32 weeks gestation admitted to a level III NICU before and after a transition from a traditional open-bay to a SFR NICU. Infants who received care in both NICU environments were excluded. The primary outcome was breast milk utilization at discharge. Standard descriptive statistics were used. Results:A total of 276 infants were included in the analysis. Demographic and clinical variables did not differ except for increased socioeconomic disadvantage and eligibility for donor breast milk. There was a significant increase in overall breast milk utilization (p=.04) but not maternal breast milk (p=0.61) in the SFR. Infants admitted to the traditional open-bay unit were younger at first oral feeding attempt (34.2 weeks (2.9)) compared to infants in the SFR room (35.2 weeks (2.4), p=0.007). Conclusion:Transition from a traditional open-bay model to a single-family room (SFR) model affected the time of oral feeding initiation but did not significantly impact breast milk exposure, breastfeeding attempts, or parental involvement in feeding. Breastfeeding outcomes may be more strongly influenced by clinical practices and support systems rather than by the physical environment. Understanding the impact of the NICU environment on feeding practices can inform institutional policies aimed at optimizing breast milk utilization.
