Medical and Social Determinants of Brain Health and Dementia in a Multicultural Community Cohort of Older Adults

2021 ◽  
pp. 1-14
Author(s):  
James E. Galvin ◽  
Stephanie Chrisphonte ◽  
Lun-Ching Chang
Keyword(s):  
Older Adults ◽  
Health Disparities ◽  
African Americans ◽  
Health Outcomes ◽  
Sex Education ◽  
Screening Program ◽  
Healthcare Services ◽  
Social Dimension ◽  
Medical Comorbidities ◽  
Race Ethnicity

Background: Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer’s disease and related disorders (ADRD) health disparities. Objective: Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program. Methods: We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes. Results: African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants. Conclusion: SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes.

scholarly journals Insights Gained From Developing Academic-Community Partnerships for Minority Aging, Community-Engaged Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 844-844
Author(s):  
Ronica Rooks ◽  
Peter Lichtenberg
Keyword(s):  
Older Adults ◽  
African Americans ◽  
Health Outcomes ◽  
Community Advisory Board ◽  
Health Clinic ◽  
Dementia Patient ◽  
Community Engaged Research ◽  
Academic Partnerships ◽  
Older African Americans ◽  
Minority Aging

Abstract Increasingly community-engaged research, characterized by collaborations between researchers and community partners, is recognized as an important part of translating research into improved health outcomes and reduced health disparities for community participants. Training community participants to engage in some or all aspects of this research, particularly focusing on racial and ethnic minority older adults, highlights the need to understand its opportunities and challenges. With this symposium we will discuss and reflect on community-engaged and community-based participatory research approaches to community-academic partnerships with minority older adults. The first presentation addresses recruitment, retention, and training of a community advisory board of older African Americans in Michigan. The second presentation addresses a health education outreach and engagement program to improve health outcomes among older African Americans in California. The third presentation combines community engagement with survey design methods for research with older Native Hawaiian and Pacific Islander adults to improve data collection and health outcomes in this U.S. population. The final presentation examines partnerships between a hospital memory clinic, meal delivery service, research university, and low-income health clinic to improve caregiver and dementia patient outcomes for minority older adults. The symposium discussant will address opportunities, challenges, and implications of community-academic partnerships promoting minority aging.

scholarly journals SOCIODEMOGRAPHIC AND HEALTH DISPARITIES IN USE OF PREVENTIVE HEALTHCARE SERVICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S873-S873
Author(s):  
Terese Sara Hoej Joergensen ◽  
Heather Allore ◽  
Corey Nagel ◽  
Ana R Quiñones
Keyword(s):  
Older Adults ◽  
Influenza Vaccination ◽  
Educational Level ◽  
Health Indicators ◽  
Healthcare Services ◽  
Geographical Region ◽  
Preventive Healthcare ◽  
Dementia Diagnosis ◽  
The Us ◽  
Race Ethnicity

Abstract Introduction: Older adults experience multiple health problems necessitating medical care. However, studies have shown that healthcare is not equally accessible for older adults in the US. In 2011, Medicare introduced Annual Wellness Visits to improve access to preventive healthcare including influenza vaccination. Objectives: Ascertain whether sociodemographic factors, multimorbidity, and other health indicators pose a barrier for older adults to access Annual Wellness Visits and influenza vaccination. Methods: We analyzed data from the 2012 and 2014 waves of the Health and Retirement Study linked with Medicare records. 4,858 older adults aged 65+ years were included in Conditional Random Forests to identify the most important predictors of Annual Wellness Visits and influenza vaccination during this two-year period. The predictors included: age, sex, race/ethnicity, partnered, geographical region, wealth, educational level, Medicaid coverage, body mass index, activities and instrumental activities of daily living, proxy interview, cognitive impairment, dementia diagnosis, and multimorbidity. Results: In total, 1,142 (23.6%) older adults had an Annual Wellness Visit and 3,316 (68.4%) older adults received an influenza vaccination. 11.9% were non-Hispanic black, 6.3% were Hispanic, with a median of 6 chronic conditions and 16.9% had dementia. The most important predictors of Annual Wellness Visits were region, wealth, dementia diagnosis, and race/ethnicity. The most important predictors of influenza vaccination were multimorbidity, race/ethnicity, educational level, and wealth. Conclusion: The importance of geographical region for Annual Wellness Visits suggests that the service has not been adopted equally throughout the US, whereas multimorbidity is the most important factor for receiving influenza vaccination.

546 Association of personality traits with napping behaviors in older adults

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A215-A215
Author(s):  
Yuqi Shen ◽  
Darlynn Rojo-Wissar ◽  
Katherine Duggan ◽  
Brant Hasler ◽  
Adam Spira
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Sex Education ◽  
Personality Dimensions ◽  
Older Adulthood ◽  
Lower Odds ◽  
Personality Differences ◽  
Nationally Representative ◽  
Nighttime Sleep ◽  
Representative Cohort

Abstract Introduction Greater neuroticism and lower conscientiousness are linked to poorer nighttime sleep among older adults, but little is known about the association between personality and daytime sleep. Napping increases in older adulthood, and napping has been linked to health outcomes, including cognitive impairment. Thus, it is important to extend personality and sleep research to investigate napping behavior. We examined the association between personality and napping in a nationally representative cohort of older adults. Methods We studied 742 adults aged ≥65 years from the National Health and Aging Trends Study (NHATS) who completed the sleep and personality modules in NHATS rounds 3 or 4 (2013–2014). Personality dimensions (neuroticism, extraversion, openness, agreeableness, conscientiousness) were assessed by the Midlife Development Inventory Personality Scales. Participants reported nap frequency over the past month (most days or everyday [nappers-frequent]; some days [nappers-infrequent]; rarely/never [non-nappers]); napping intention (intentional/unintentional); and average nap duration (coded as ≤40 minutes [short]; and >40 minutes [long], consistent with previous studies). Personality dimensions were included together in all models. Model 1 adjusted for age, sex, education, and BMI, and Model 2 further adjusted for anxiety and depression, comorbidities, sleep medications, and nighttime sleep duration. Only nappers were included in models with nap frequency, intention, or duration as outcomes (n=387). Results There were no personality differences between nappers and non-nappers. Among nappers, however, higher neuroticism was associated with lower odds of frequent naps (OR=0.73, 95% CI: 0.55,0.97), and higher agreeableness was associated with greater odds of unintentional napping (OR=1.95, 95% CI:1.12, 3.41) and lower odds of long nap duration (OR=0.54, 95% CI:0.33, 0.90) in Model 1. Associations remained in Model 2. Higher neuroticism was also associated with greater odds of long nap duration in Model 1 (OR=1.40, 95% CI:1.03, 1.91), but not after further adjustment in Model 2. Conclusion This is, to our knowledge, the first study examining the association between personality and daytime napping behaviors among a large sample of older adults, extending the literature on personality and nighttime sleep in this population. Because napping behaviors are associated with health outcomes, personality may be an important factor to consider in interventions addressing napping. Support (if any) NIH grant 5T32MH014592-39

scholarly journals Challenges and Insights: Psychosocial Stressors, Physiology, and Health Disparities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 572-573
Author(s):  
Julie Ober Allen ◽  
Briana Mezuk
Keyword(s):  
Older Adults ◽  
Health Disparities ◽  
Health Outcomes ◽  
Acute Stress ◽  
Adult Population ◽  
Premature Aging ◽  
Cardiometabolic Health ◽  
Cortisol Reactivity ◽  
Complex Relationships ◽  
Older Adult Population

Abstract The persistence of health disparities demonstrates the need for more comprehensive research to better understand key methodological approaches and intervention leverage points among the complex relationships between psychosocial, environmental, and biological factors influencing patterns of health among older adults. Growing empirical evidence implicates differential exposure to chronic stressors that are rooted in the social environment and related social inequities in premature aging and development of chronic diseases among socially marginalized groups. This, in turn, leads to health disparities within the older adult population. Mechanisms linking stressors and health, however, remain poorly understood. This symposium assembles research examining challenges associated with measuring exposure to stressors, relationships between stressors and health outcomes, and the insight provided by stress-based frameworks for understanding mechanisms of health disparities. Allen and colleagues use comprehensive measures of exposure to stressors to identify stressor characteristics most closely associated with diurnal cortisol dysregulation and Black-White disparities, which are risk factors for adverse cardiometabolic health outcomes. Kalesnikava and colleagues will introduce methods for exploring relationships between self-reported stress and another cortisol stress biomarker—cortisol reactivity to an acute stress event. Byrd and colleagues round out the symposium with a presentation on the directionality of relationships between perceived stress and depressive symptoms contributing to health disparities among Blacks. Discussant Jackson will explore implications of these studies for more nuanced research related to mechanisms of health disparities and for more targeted approaches to the prevention of health disparities among older adults.

scholarly journals A Narrative Review of Mental Illness Stigma Reduction Interventions Among African Americans in The United States

2021 ◽  
Vol 5 (2) ◽  
pp. 20-31
Author(s):  
Kevin J. Rivera ◽  
Jenny Y. Zhang ◽  
David C. Mohr ◽  
Annie B. Wescott ◽  
Aderonke Bamgbose Pederson
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Disparities ◽  
African Americans ◽  
Health Outcomes ◽  
The United States ◽  
Mental Illness Stigma ◽  
Current Evidence ◽  
Stigma Reduction ◽  
Review Team

Among African Americans, the chronicity and severity of mental illness correlates with worse health outcomes and widens health disparities. Stigma related to mental illness compounds mental health disparities by creating barriers to help-seeking behavior. We examine the current tools designed to reduce mental illness stigma and promote improved mental health outcomes among African Americans. The authors reviewed the current evidence in the literature for such stigma reduction interventions. The review team developed a focused search across four databases: PubMed, Embase, Scopus, and APA PsycINFO. Initial searches identified 120 articles, from which six studies were included as reporting on mental illness stigma reduction interventions among African Americans. We describe these four quantitative and two qualitative studies. There have been various interventions used among African Americans to reduce mental illness stigma, and the level of efficacy and effectiveness is not well studied. Our review demonstrated a need for more robust studies to yield strong evidence on effectiveness among stigma reduction interventions in this target population. The evidence does support tailoring intervention studies to this population. Effectively engaging and partnering with key stakeholders, including schools, community organizations, and faith-based institutions enhances the acceptance and delivery of stigma reduction interventions.

scholarly journals Socioeconomic Status, Ecologically Assessed Social Activities, and Daily Cortisol Among Older Urban African Americans

2019 ◽  
Vol 32 (7-8) ◽  
pp. 830-840
Author(s):  
Samuele Zilioli ◽  
Heather Fritz ◽  
Wassim Tarraf ◽  
Susan A. Lawrence ◽  
Malcolm P. Cutchin
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
African American ◽  
Health Disparities ◽  
African Americans ◽  
Relative Frequency ◽  
Community Dwelling ◽  
Endocrine Function ◽  
Social Activities ◽  
African American Adults

Objectives: Higher socioeconomic status (SES) individuals report more social activities than their lower SES counterparts. Yet, SES and racial health disparities are often confounded. Here, we tested whether the frequency of engagement in social activities contributed to the association between SES and daily cortisol secretion among urban African American older adults. Methods: Ninety-two community-dwelling African Americans aged 55 years and older reported what they were doing at regular intervals across the day on an Android smartphone for seven consecutive days. They also provided four saliva samples at four time points a day during the same period. Results: Higher SES older adults engaged in proportionally more social activities than their lower SES counterparts. A greater relative frequency of weekly social activities was associated with a steeper diurnal cortisol decline. Higher SES was indirectly linked to a steeper cortisol decline via increased relative frequency of weekly social activities. Discussion: Our findings suggest that engagement in weekly social activities represents a behavioral intermediary for SES health disparities in endocrine function among older urban African American adults.

scholarly journals Bridging Health Disparity Gaps through the Use of Medical Legal Partnerships in Patient Care: A Systematic Review

2017 ◽  
Vol 45 (2) ◽  
pp. 260-273 ◽  
Author(s):  
Omar Martinez ◽  
Jeffrey Boles ◽  
Miguel Muñoz-Laboy ◽  
Ethan C. Levine ◽  
Chukwuemeka Ayamele ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Disparities ◽  
Health Outcomes ◽  
Healthcare Services ◽  
Long Term Effects ◽  
Environmental Threats ◽  
Patient Health ◽  
Medical Teams ◽  
Meta Analyses ◽  
The Impact

Over the past two decades, we have seen an increase in the use of medical-legal partnerships (MLPs) in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs to address legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities.

scholarly journals Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Tegan J. Reeves ◽  
Taylor J. Mathis ◽  
Hailey E. Bauer ◽  
Melissa M. Hudson ◽  
Leslie L. Robison ◽  
...  
Keyword(s):  
Health Disparities ◽  
Health Outcomes ◽  
Childhood Cancer ◽  
Ethnic Disparities ◽  
Childhood Cancer Survivors ◽  
Individual Level ◽  
Family Level ◽  
Race Ethnicity ◽  
Racial Ethnic ◽  
Neighborhood Level

The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

Mechanisms of Black–White disparities in health among older adults: Examining discrimination and personality

2019 ◽  
pp. 135910531986018 ◽  
Author(s):  
Juliette McClendon ◽  
Ryan Bogdan ◽  
Joshua J Jackson ◽  
Thomas F Oltmanns
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Health Disparities ◽  
Health Outcomes ◽  
Personality Traits ◽  
Personality Factors ◽  
Physical And Mental Health ◽  
Black And White ◽  
Behavioral Sequelae ◽  
And Gender

We tested whether personality traits help explain the association between discrimination and racial health disparities in a sample of 1033 Black and White older adults. Participants completed measures of discrimination, personality, and self-reported physical and mental health. Elevated discrimination among Black participants was indirectly linked to worse physical and mental health outcomes through elevated neuroticism and lower agreeableness, controlling income, education, and gender. The specific facets of depression, impulsiveness, and trust were the most robust intervening personality factors. Interventions that target cognitive, emotional, and behavioral sequelae of discrimination may lessen its impact on health disparities.

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