The New Age of Aging
Public Health + Community on the Journey of Growing Older
Dr. Naoko Muramatsu remembers the moment it clicked. She was working on a study involving home care aides and older adults, many of whom were homebound and need help with daily tasks. The program focused on physical activity, something Muramatsu knew had strong public health benefits. But what surprised her was how participants responded.
“They’d say, ‘Oh, I can’t remember things, but I really enjoy this program,’” she recalls. “It’s not just cognitive declines that determine people’s well-being. It’s how we deal with it.”
That insight now drives her work as co-director of the Center for Health in Cognitive Aging (CHECA) at the University of Illinois Chicago. CHECA, founded in 2023, is part of a national network of 10 resource centers for aging research, called RCMARs, focused on behavioral and social research on aging, health disparities in older adults, and Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD).
Aging Alone
Globally, people are increasingly living alone and dying alone.
Muramatsu has witnessed firsthand the impact of social isolation and loneliness on older adults from a global perspective. She studies global aging and care systems in the U.S. and Japan, where her 91-year-old mother is aging in a robust long-term care system. Japan started universal long-term care insurance in 2000. Individuals begin paying into the system at age 40, and then, at 65, based on an individual’s needs, they are entitled to care at home, in the community, or in facilities. Muramatsu believes these supports make a marked difference.
“You may fall at home and people may not realize for the next two or three days or even for a week,” Muramatsu explains. “Aging and dying alone is a growing societal concern which has major implications for mental, physical, and cognitive health in older adults and caregivers.”
In the U.S., this trend is especially true among marginalized populations.
Dr. Nathaniel M. Tran, Assistant Professor at UIC’s School of Public Health, has been studying how sexual orientation intersects with aging and cognitive decline. In their landmark study Aging in Isolation, Tran found that sexual minority adults—those identifying as lesbian, gay, bisexual, or queer—are significantly more likely to experience subjective cognitive decline (SCD) than their heterosexual peers. And among those with cognitive impairments, sexual minority adults are less likely to receive help with daily tasks like cooking, managing medications, or paying bills.
The disparities are especially stark for sexual minority women. Tran’s research shows 17% experience cognitive decline compared to 11% of heterosexual women, and 52% report giving up on daily activities due to memory loss compared to 43% of heterosexual women. Yet 28% of sexual minority women receive no social support for these impairments compared to 12% of heterosexual women.
“When memory problems or difficulty concentrating make everyday tasks dangerous or impossible, too many older adults are left to navigate these challenges completely alone,” Tran explains. “It’s alarming.”
Chronic Disease and the Aging Experience
Muramatsu points out that while people are living longer, it is unclear whether they are living healthier lives.
Chronic diseases like heart disease, diabetes, and stroke are increasing and closely tied to cognitive health. A stroke, for example, can be the result of lifelong poor cardiovascular health and can trigger rapid cognitive decline. Mental health and cognitive health are deeply intertwined, too. Depression, for example, can mimic or mask dementia symptoms, making diagnosis and treatment more complex.
Tran’s research in the U.S. South adds another layer to the conversation. In a longitudinal study of approximately 1,000 LGBTQ+ adults aged 50 to 76, Tran found that only one-third received affirming care from healthcare providers. The rest experienced neutral or discriminatory care—and those differences mattered.
LGBTQ+ adults who received non-affirming care were up to 17% less likely to access preventive services like flu shots, HIV tests, and cancer screenings.
When people don’t get care that respects their identity and needs, they often skip doctor visits. Missing routine screenings and vaccines can lead to serious health problems like diabetes and heart disease. These illnesses speed up physical decline, limit independence, and raise the risk of memory loss and dementia, making healthy aging much harder.
“Health is not only the absence of disease,” Muramatsu says. “It’s how we deal with it, and how we promote well-being even in the presence of illness.”
The Role of Public Health
Both Muramatsu and Tran agree aging is not just a medical issue–it’s a public health imperative.
“Aging is an integral part of public health,” Muramatsu says. “It’s not just about older people’s problems. It’s about all of us.”
And public health is the natural choice to convene researchers to address aging, as the discipline already works across medicine, policy, and social sciences to improve population health. Professionals trained in public health bring skills in collaboration, data analysis, and systems-level thinking, all of which make them exceptionally equipped to bridge disciplines and create new solutions for healthy aging.
The CHECA, led by Muramatsu and her team, aims to develop these unique skillsets in early-career faculty members to tackle aging from various angles. The Center builds and enriches research and mentoring infrastructure at UIC. Annually, CHECA welcomes researchers from various disciplines, colleges, and units at UIC, including public health and other health science colleges, economics, and engineering. These early-career scientists work together and with their mentoring teams to cross-fertilize ideas and methods from population science and intervention studies. Early cohorts have already begun investigating how everything from environmental contaminants to reduction in antipsychotic use in nursing homes to transnationalism can impact cognitive decline and aging.
And CHECA takes this interdisciplinary collaboration a step further by also creating mentoring infrastructure within the center.
“We’re supporting early-career scientists and their pilot projects that explore behavioral and social pathways to Alzheimer’s Disease and Related Dementia, which involve biobehavioral, psychological, and societal factors such as caregiving, social norms, and healthcare systems,” Muramatsu explains. “These relationships are how interdisciplinary research begins: with people.”
Existing public health strategies, too, offer hope. Physical activity, for instance, is one of the most powerful tools for preventing and managing chronic disease and poor aging. This is one area Muramatsu has chosen to focus her own research. She works with home care aides or family members who care for older people and bring physical activity programs into their homes.
And cognizant of the social determinants of health, Muramatsu recognizes that individuals aging in resource-deprived areas face challenges in accessing physical activity programs, particularly if they are homebound. Interestingly, her research results have shown that even low-resource, home-based exercise programs can have a big impact on well-being.
Muramatsu emphasizes that public health must focus not just on preventing disease, but also on helping those with reduced cognition or health issues mitigate further decline.
Her number one piece of advice: “It’s never too late to start,” she says. “Older adults can build muscle and improve function.”
A Call to Action
As the global population grows older, the challenges of cognitive decline, chronic disease, and social isolation require a public health approach grounded in health, collaboration, and innovation. From addressing disparities among marginalized communities to creating systems that support dignity and independence, emerging research reminds us that aging is not a niche issue but a universal journey.