RACE, PRODUCTIVE ACTIVITIES, AND COGNITIVE FUNCTIONING IN THE HEALTH ABC STUDY

Black-White Differences in Long-Term Services and Supports (LTSS) Deserts: Implications for Unmet Care Needs.

Continuing adult education and training, or lifelong learning, has become increasingly important to fully engage in rapidly changing technology and information-rich societies. However, without motivation to learn (MtL), lifelong learning participation is unlikely to occur. Although previous research has identified lifelong learning gaps by various demographic characteristics, including age, gender, and race/ethnicity, little is known about the intersectionality or differences in MtL across specific sub-groups (e.g., older Black women vs. older Black men) at the national level. The current study analyzed U.S. data from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) to examine MtL at the intersections of age (five 10-year age groups), gender (women vs. men), and race (White vs. Black). The previously established 4-item latent MtL construct was evaluated for twenty sub-groups using the alignment optimization method, which is a machine learning algorithm for latent mean estimation and simultaneous multiple group comparisons. Results showed that the latent MtL construct was validly measured across the sub-groups, and the estimated sub-group means were then used to develop a national MtL profile. Overall, older adults tended to have lower MtL than younger age groups. Notably, compared to than older Black men age 66+ years, older White men aged 55-65 and 66+ years old had lower MtL (latent mean differences of -0.29 and -0.41, respectively, p < .05). Additionally, older Black women had significantly lower MtL than older Black men (latent mean difference = -0.50, p < .05). The national MtL profiles, the intersectionality and policy implications were discussed.

Progression of Physiological Parameters Over Time in Type 1 Diabetes Mellitus Patients in France.

Between the years 1999-2008, a substantial increase in nursing home use occurred among Black and Latinx older adults, while white older adults’ use of nursing homes decreased. These disparate trends suggested potential racial and ethnic disparities in options for preferred long-term services and supports (LTSS) settings. Over the last decade, several initiatives have been put in place to support LTSS needs in the community. However, it is unclear whether Black and Latinx older adults are continuing to use nursing home services at disproportionate rates. We used LTCfocus data for 2011-2017 to explore current trends in nursing home use and access among Black and Latinx older adults in light of these current initiatives. Our findings reveal a continued rise in Black and Latinx older adults’ use of nursing homes while white older adults’ use continues to decline. More notably, there has been a decline in nursing homes servicing these minority groups.

Racial/ethnic disparities in health among older adults are well-documented. More research is needed to clarify the complex and multifactorial mechanisms underlying these associations. This symposium will feature research that employs innovative theoretical and methodological approaches to understand the biopsychosocial mechanisms that underlie racial/ethnic disparities in older adults’ health and determine sources of within-group heterogeneity in minority aging. Dr. Forrester will integrate stress biology and intersectionality to demonstrate the importance of stress and resilience (e.g., John Henryism) with biological aging within Black adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Dr. Brown Hughes will present innovative research using data from the African American United Memory and Aging Project (AA-UMAP) on the importance of Alzheimer’s disease-specific knowledge and perceptions among Black older adults. Dr. Gamaldo will employ a within-race approach to understand how knowledge and perceptions of Alzheimer’s disease and related dementias (ADRD) shape cognitive performance among Black older adults in the AA-UMAP study. Dr. Mitchell will use Health and Retirement Study data to explore the role of midlife stress exposure in accounting for racial disparities in trajectories of cognitive functioning. Drs. Thierry and Farmer will use HRS data to examine how psychosocial resilience (e.g., mastery) affects the relationship between perceived neighborhood conditions (e.g., disorder) and cognition among Black older adults. This work highlights the importance of applying an interdisciplinary lens to move the study of minority aging forward and ultimately, to reduce the unnecessary burden of morbidity and mortality among minoritized groups.

Psychosocial factors may contribute to racial disparities in cognitive aging beyond socioeconomic status. Contextual stressors at multiple ecological levels, which may be related to structural racism, disproportionately affect Black older adults in the U.S. and may explain increased dementia risk. This study examined the extent to which interpersonal, community, and societal level stressors independently explained Black-White disparities in memory at baseline and over time. The sample included 16,890 older Black and White adults (Mage=67.98, 22% Black) from the US Health and Retirement Study who completed psychosocial questionnaires and a word list memory task. Interpersonal, community, and societal stressors were operationalized as self-reported everyday discrimination, neighborhood physical disorder, and subjective societal status, respectively. Latent growth curves modeled memory performance over six years. Stressors were modeled simultaneously and allowed to correlate. Covariates included age, sex, education, wealth, and questionnaire year. Compared to White older adults, Black older adults experienced higher discrimination (b = -.004, SE=.001, p&amp;lt;.001), greater neighborhood physical disorder (b = -.012, SE=.002, p&amp;lt;.001), and lower perceived societal status (b = -.003, SE=.001, p=.001), each of which independently mediated the association between Black race and worse initial memory. Together, these stressors explained 11% of the racial disparity in initial memory. There was no racial disparity in memory decline. Individual experiences of stressors across multiple contextual levels contribute to racial disparities in memory, providing evidence that structural racism negatively influences dementia risk among Black older adults. Future research should consider protective factors that buffer against negative impacts of structural racism on health.

Lower 25‐hydroxyvitamin D (25[OH]D) with increasing adiposity has been attributed to decreased sun exposure because of limited mobility and increased vitamin D storage in adipose tissue. However, low 25(OH)D may also lead to increased adiposity via increased PTH, promoting calcium influx into adipocytes and enhancing lipogenesis. Associations between adiposity and 25(OH)D were examined in 2,369 older black and white adults in the Health ABC study (mean age, 74.6 yrs; 50.6% women, 38.3% black). Serum 25(OH)D was measured by DiaSorin RIA. BMI, waist circumference (WC), % body fat by DXA, and visceral (VAT) and subcutaneous (SAT) abdominal fat area by CT were measured at baseline and 4 years later. In whites, BMI (β±SE: − 0.38±0.06), % body fat (−0.20±0.05), WC (−0.11±0.02), VAT (− 0.022±0.004) and SAT (−0.011±0.003) were inversely associated with 25(OH)D at baseline after adjusting for age, gender, education, site, season, height, smoking, alcohol, physical activity, vitamin D intake and vitamin D supplement use (all p&lt;0.0001). In blacks, only WC (−0.05±0.02, p=0.01) and VAT (−0.013±0.004, p=0.002) were associated with 25(OH)D at baseline. Baseline 25(OH)D was not associated with change in total or abdominal adiposity in whites or blacks. In summary, 25(OH)D was inversely associated with baseline adiposity in whites and blacks but not with change in adiposity. Supported by the NIA (R01 AG029364 &amp; K01 AG030506).

The purpose of this study is to examine the relationship between religious meaning and subjective well-being. A major emphasis is placed on assessing race differences in the relationship between these constructs. Interviews were conducted with a nationwide sample of older White and older Black adults. Survey items were administered to assess a sense of meaning in life that is derived specifically from religion. Subjective well-being was measured with indices of life satisfaction, self-esteem, and optimism. The findings suggest that older adults who derive a sense of meaning in life from religion tend to have higher levels of life satisfaction, self-esteem, and optimism. The data further reveal that older Black adults are more likely to find meaning in religion than older White adults. In addition, the relationships among religious meaning, life satisfaction, self-esteem, and optimism tend to be stronger for older African Americans persons than older White persons. Researchers have argued for some time that religion may be an important source of resilience for older Black adults, but it is not clear how these beneficial effects arise. The data from this study suggest that religious meaning may be an important factor.

Chronic stressors, experienced disproportionately by Black older adults, are a risk factor for memory impairment. Racially patterned stress exposure may contribute to higher rates of Alzheimer's disease and related dementias (ADRD) among Black older adults compared with Whites, but less is known about the role of stress appraisal. This study examined whether chronic stress exposure mediates racial disparities in memory and whether stress appraisal moderates these associations. Participants included 16,924 older adults (Mage = 67.39, 21% Black) from the 2010 and 2012 waves of the Health and Retirement Study who completed measures of chronic stress exposure (health, financial, housing, relationships, and caregiving) and appraisal. Latent growth curves modeled longitudinal performance on a word list memory task over 6 years. Black older adults reported greater stress exposure than Whites, and greater stress exposure partially mediated Black-White disparities in initial memory (standardized indirect effect = -0.002, p = .009). However, Black older adults appraised stressors as less upsetting than Whites. While stress appraisal did not moderate links between stress exposure and memory, appraising stressors as less upsetting was independently associated with better initial memory. Thus, Black-White disparities in initial memory was partially offset by Black participants' appraisal of stressors as less upsetting (standardized indirect effect = 0.002, p = .016). Reducing chronic stress exposure may reduce racial disparities in ADRD risk. The counteractive effect of stress appraisal on Black-White disparities in episodic memory highlights resilience factors among Black older adults that should be characterized in future research to move beyond deficit models of ADRD inequality.

BackgroundMiddle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US.MethodsWe use longitudinal data from the Health and Retirement Study (HRS 1992–2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers.ResultsThe percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19–0.99) and Latino (OR = 0.26, 95% CI: 0.11–0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05–6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes.ConclusionsA large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.

The COVID-19 pandemic has disproportionately impacted older Black Americans. Given that assistance networks play a crucial role in older adults' ability to respond to challenges, we sought to investigate whether older adults' assistance network size changed during the COVID-19 pandemic and differed by race. We analyzed data from the 2018-2020 rounds of the U.S. National Health and Aging Trends Study for Black and White adults aged 70 and older receiving help in the community or residential care settings. We used ordinary least squares regression to compare changes in assistance network size in the 2 years pre-COVID-19 (2018-2019, N = 3438) to changes in size at the onset of COVID-19 (2019-2020, N = 3185). Black older adults had larger assistance networks with a greater number of family helpers before and during the pandemic compared to their White counterparts. Assistance network size for older adults increased before but not during the pandemic mostly due to declines in unpaid nonrelative helpers and lack of increase in paid helpers. These effects did not differ by race. Black and White older adults experienced similarly sized reductions in their assistance networks as a consequence of the COVID-19 pandemic. Future research should investigate the relationship between these network changes and the unmet needs of older adults.

Objective:Non-Hispanic Black older adults experience a disproportionate burden of Alzheimer’s Disease and related dementias (ADRD) risk compared to non-Hispanic White older adults. It is necessary to identify mechanisms that may be contributing to inequities in cognitive aging. Psychosocial stressors that disproportionately affect Black adults (e.g., discrimination) have the potential to impact brain health through stress pathways. The brain’s white matter, which appears to be particularly important for ADRD risk among Black older adults, may be uniquely vulnerable to stress-related physiological dysfunction. To further understand whether and how discrimination can affect ADRD risk, this study aimed to examine associations between multiple forms of racial discrimination and white matter integrity, operationalized through diffusion tensor imaging.Participants and Methods:Cross-sectional data were obtained from 190 non-Hispanic Black residents aged 65+ without dementia in northern Manhattan. Racial discrimination was self-reported using the Everyday Discrimination and Major Experiences of Lifetime Discrimination scales. Example items from the Everyday Discrimination Scale include: “You are treated with less respect than other people”; “You are called names or insulted.” Example items from the Major Experiences of Lifetime Discrimination Scale include: “At any time in your life, have you ever been unfairly fired from a job?”; “Have you ever been unfairly denied a bank loan?” Racial discrimination was operationalized as experiences attributed to “race” or “skin color.” White matter integrity was assessed using fractional anisotropy (FA) via diffusion tensor imaging. Multivariable regression models evaluated the unique effects of everyday and major experiences of lifetime racial discrimination on mean FA in the whole brain and specific regions. Initial models controlled for age, sex/gender, intracranial volume, and white matter hyperintensities. Subsequent models additionally controlled for socioeconomic and health factors to consider potential confounders or mediators of the relationship between discrimination and white matter integrity.Results:Major experiences of lifetime discrimination were negatively associated with mean FA within the left cingulum cingulate gyrus and the right inferior fronto-occipital fasciculus. These associations persisted when controlling for additional covariates (i.e., education, depression, and cardiovascular diseases). In contrast, major experiences of lifetime discrimination were positively associated with mean FA within the right superior longitudinal fasciculus (temporal part). This association was attenuated when controlling for additional covariates. Everyday racial discrimination was not associated with mean FA in any regions.Conclusions:These results extend prior work linking racial discrimination to brain health and provide evidence for both risk and resilience among Black older adults. Major experiences of lifetime racial discrimination, a proxy for institutional racism, may have a stronger effect on white matter integrity than everyday racial discrimination, a proxy for interpersonal racism. Educational opportunities and cardiovascular risk factors may represent mediators between racial discrimination and white matter integrity. White matter integrity within specific brain regions may be a mechanism through which racially patterned social stressors contribute to racial disparities in ADRD. Future research should characterize within-group heterogeneity in order to identify factors that promote resilience among Black older adults.

Experiencing discrimination may be a risk factor for cardiovascular disease (CVD), which disproportionately impacts Black adults in the United States. With the few prospective, time-varying investigations, evidence of everyday discrimination impacting incident CVD is sparse, especially among older Black adults. This study examined the association between everyday discrimination and incident CVD across a 12-year period using a nationally representative population of older Black adults from the Health and Retirement Study. Weighted Cox proportional hazards regression estimated the association between everyday discrimination (measured on a continuous scale) and incident CVD. Supplemental analyses examined the association between everyday discrimination and incident CVD among those who experienced racial versus nonracial discrimination. Covariates included sociodemographic characteristics, health behaviors, and CVD risk factors. At baseline, participants (N=988) were 65years old on average and 57.3% were female. During the 12-year period, 16.3% of participants developed CVD. Each increase in everyday discrimination was associated with a higher incidence of CVD in fully adjusted models (adjusted hazard ratio, 1.28; 95% CI, 1.03-1.59). Older Black adults who experience frequent everyday discrimination may be at higher risk of developing CVD. Clinical and nonclinical interventions assessing and addressing experiences of discrimination may help in CVD prevention efforts among Black adults.

This study examines factors contributing to racial differences in domain-specific life satisfaction. Our study offers a major contribution to prior research that has tended to pay greater attention to psychological well-being outcomes such as life satisfaction which do not directly pertain to material circumstances of older adults. Those studies generally report better life satisfaction and fewer depressive symptoms among Black older adults than their White counterparts. Our study is based on 409 randomly selected older adults from Cleveland (mean age 79 and 25% African American). We considered socioeconomic status, stressors such as recent negative life events and coping resources such as religiosity to understand their impact on domain specific life- satisfaction (e.g., satisfaction with neighborhood, housing, and standard of living). Our ordinary least squares regression estimates suggest that, on average, Black older adults reported lower levels of domain-specific life satisfaction (b=-0.81, p&amp;lt; 0.01) compared to their White counterparts, despite having stronger social support and being more religious. Even though social support and religiosity did not contribute to racial differences in domain specific life satisfaction, the inclusion of education, income, and recent negative life events fully explain such differences. Findings indicate that interrelated factors such as socioeconomic disadvantage and greater life adversities such as negative life events contribute to lower domain life satisfaction among Black older adults. This finding highlights the need for further exploration of factors shaping material-related well-being outcomes for Black older adults. Our study informs future policies addressing racial well-being inequities.

BackgroundApproximately 25% of adults 65+ are socially isolated. Social isolation (i.e., loneliness), or the perceived absence of an available and acceptable social network, may be associated with increased cognitive decline. However, there is a limited understanding of how social isolation influences cognitive decline and if this relationship differs as a function of race.MethodsA total of 3,082 participants (n = 1943 Whites, n = 1139 Blacks) with 20,882 follow‐ups over 10 years were included from the RUSH database. Participants completed the De Jong Gierveld Loneliness Scale and were identified as having either high or low loneliness using a median split of perceived social isolation. Participants were then divided into one of four groups based on race (White vs Black) and loneliness (High vs Low): 1) White‐High (n = 1030), 2) White‐Low (n = 913), 3) Black‐High (n = 493), 4) Black‐Low (n = 646). Linear mixed‐effects models examined group differences in cognitive change over time (global cognition, episodic memory, semantic memory, visuospatial ability, and working memory).ResultsWhite adults with high loneliness exhibited increased rates of cognitive change compared to low and high loneliness Black adults in all domains (p&lt;.01). Compared to White adults with low loneliness, Whites with high loneliness exhibited increased decline in all domains except processing speed and visuospatial ability (p&lt;.001). Black adults with high loneliness exhibited increased decline compared to Black adults with low loneliness in all domains (p&lt;.01).ConclusionOur study reveals a robust association between loneliness and cognitive decline in older adults, with White individuals experiencing a more pronounced impact than their Black counterparts. These findings underscore the need for targeted interventions to address loneliness, particularly among White older adults, to mitigate cognitive decline and promote healthy aging.