The Center for Disease Control began to assess Perceived Cognitive Impairment in 2009, yet there has been no in-depth study of how perceived decline in thinking or memory skills may be associated to the health and lifestyle of an independent community-dwelling older person. Among urban-dwelling older African Americans who are at elevated risk for cognitive impairment and dementia, we know even less regarding the interaction of these risk factors.
Five hundred and one African American elders (n = 501) between the ages of 55 and 95 with an average age of 70.73 years (SD = 8.6 years) participated in telephone interviews.
Approximately one-third of the elders reported that their memory, thinking skills, or ability to reason was worse than a year ago (n = 150; 29.9%) and 25% of this group (n = 38) reported that this Perceived Cognitive Impairment impacted their daily activities and/or warranted a consultation with their doctor. Bivariate analyses indicated that Perceived Cognitive Impairment was associated with increased health problems, mobility limitations, depressed mood, and lower social functioning.
Elders who reported that cognitive problems impacted their daily functioning reported the greatest health and mental health problems. Perceived Cognitive Impairment is an important health variable with implications for an older adult’s overall health, mobility, and mental health.
African American; mild cognitive impairment; psychological and social aspects of dementia; age associated memory problems; physical health status; functional status
The vascular depression hypothesis posits that cerebrovascular burden contributes to the development of depression symptoms in late life. Building on work that suggests that vascular depression is a prodrome for frailty (Paulson & Lichtenberg, 2011), this paper tests a theoretical framework that vascular depression symptoms are an early marker of a broader pattern of decline characterized by more frailty symptoms and shortened lifespan, and that vascular depression symptoms predict mortality through frailty.
The sample was drawn from the Health and Retirement Study and included 1,361 stroke-free women over the age of 80. Data was included from six biannual waves from 1998 to 2008 (waves 4-9). A vascular depression symptomatology variable was based on CES-D scores and number of cerebrovascular risk factors (hypertension, diabetes, cardiac disease and smoking). Frailty was measured based on wasting, slowness, weakness, fatigue, and falls. Vascular depression and frailty symptoms were modeled using slope and intercept terms. Mortality was modeled using a discrete-time survival term.
The data supported the proposed model (RMSEA=.051; CFI=.971; X2=234.84, p<.001). Higher vascular depression symptom slope and intercept scores significantly predicted higher frailty slope and intercept scores, respectively. Frailty intercept scores significantly predicted mortality. Vascular depression symptoms indirectly predicted mortality through frailty symptoms. A second model testing the competing hypothesis that frailty symptoms lead to vascular depression symptoms and indirectly to mortality was not supported by the data.
Results suggest that vascular depression symptoms are associated with a clinical trajectory that includes greater frailty and shortened remaining lifespan.
Longitudinal modeling; Clinical trajectory; Aging; Mood; Disability
Active engagement in life is a critical factor for successful aging. Research indicates that community engagement is strongly associated with health and well-being in late life. However, less is understood regarding the influence of neighborhood conditions on health and well-being, particularly in older African-American adults. The current study describes a convenience sample of older African Americans (N = 501, mean age = 70.7 [range 55-95] years) living in Detroit. The specific goal is to examine the relationships between their perceptions of neighborhood conditions, level of community engagement, and their health and well-being. Survey findings reveal a sample of highly engaged older African Americans in reasonable health who perceive their neighborhoods favorably. Regression analysis results indicate that community engagement is closely associated with both neighborhood perceptions and well-being in this sample. We propose that community engagement or “participation” mediates the relationship between neighborhood conditions and well-being for older African Americans living in Detroit.
Fear of falling and mobility restrictions have a significant negative impact on the quality of life of older adults. Because older African American adults are at increased risk for various modifiable health problems, understanding potential constraints on their overall health and mobility is critical in this population. The current study investigated this issue by analyzing a dataset of 449 older African American adults (mean age = 72.3 years) living in Detroit. We characterized and investigated the relationships among the following falls- and health-related variables: previous falls, falls efficacy, mobility, self-rated health (SRH), and depression and well-being. As a whole, participants reported moderate health and well-being, little depression, few mobility problems (mean = 8.4/40), and very high falls efficacy (mean = 94.9/100) despite the fact that a quarter of the sample experienced a fall within the past year. Correlation results indicated that previous falls, falls efficacy, mobility, SRH and depression and well-being were all inter-related. Regression analyses revealed that higher falls efficacy was more closely associated with better SRH than was having previously fallen. Findings suggest that improving falls efficacy in older African American adults may be beneficial to their mobility and overall health and well-being. Further, by asking a single-item SRH question, clinicians may be able to quickly identify older African American adults who have low falls efficacy and are at high risk for falling.
Older adults; African Americans; Falls efficacy; Mobility; Health
Sustainability is important if community health organizations are to be effective in collaborating to achieve long term health goals. We present a multi-method set of longitudinal analyses examining structural markers applied to a group of organizations brought together to reduce cancer disparities among older African American adults. At the overall network level, sustainability was seen in the growth of outgoing connections and multiplexity. Results of hierarchical clustering analyses identified distinct patterns of collaborative activation over time at the relationship level. Growth modeling indicated the effects of continuing network membership and participation in collaborative events on several structural markers of sustainability. Results of these analyses provide longitudinal indicators for how collaborations among partner organizations impacted their likelihood of continuing in the community network program. The strategy presented here introduces novel methods to assist with planning and evaluation of future community based public health endeavors.
Community; Networks; Partnerships; Sustainability; Hierarchical cluster analysis; Growth modeling
Frailty is a common geriatric disorder associated with ADL impairment, hospitalization, and death. Phenomenological evidence suggests that late-life depression (Katz, 2004), particularly vascular depression, may be a risk factor for frailty. This study tests that hypothesis.
We identified a sample of stroke-free women over the age of 80 from the Health and Retirement Survey. The sample included 984 respondents in 2000 (incidence sample). Of these, 459 were non-frail at baseline and still alive in 2004 (prevalence sample). Frail respondents experienced at least three of the following: wasting, exhaustion, weakness, slowness, and falls. Vascular depression was represented using two dummy variables. The first represented respondents with either high CVB (at least two cerebrovascular risk factors) or probable depression (score ≥ 3 on the 8-item CES-D), and the second represented respondents with both high CVB and probable depression.
At baseline, the prevalence of frailty was 31.5%. Over 4 years the incidence of frailty was 31.8%. After controlling for age, education, ADL and IADL disability, arthritis, pulmonary disorders, cancer, and self-rated health, respondents with either high CVB or probable depression were more likely to be frail at baseline, and those with both were at even higher risk. Of those who were not frail at the 2000 wave, respondents who reported both high CVB and probable depression were more likely to become frail by 2004.
These findings suggest that vascular depression is a prodrome for frailty.
Frailty; Vascular Depression; Older Women
Financial exploitation, and particularly thefts and scams, are increasing at an alarming rate. In this study we (a) determined the national prevalence of older adults who report having been a victim of fraud, (b) created a population-based model for the prediction of fraud, and (c) examined how fraud is experienced by the most psychologically vulnerable older adults. The older adults studied were 4,400 participants in a Health and Retirement Study substudy, the 2008 Leave Behind Questionnaire. The prevalence of fraud across the previous 5 years was 4.5%. Among measures collected in 2002, age, education, and depression were significant predictors of fraud. Financial satisfaction and social-needs fulfillment were measured in 2008 and were significantly related to fraud above and beyond the 2002 predictors. Using depression and social-needs fulfillment to determine the most psychologically vulnerable older adults, we found that fraud prevalence was three times higher (14%) among those with the highest depression and the lowest social-needs fulfillment than among the rest of the sample (4.1%; χ2 = 20.49; p < .001). Clinical gerontologists and other professionals in the field need to be aware of their psychologically vulnerable clients heightened exposure to financial fraud.
financial exploitation; psychological vulnerability; scams
Hypertension disproportionately affects all African-Americans and lack of adequate blood pressure control could contribute to cognitive decline among older adult African-Americans. Cognitive difficulties might impair the self-management ability of these individuals, further limiting their blood pressure control. The purpose of this study, therefore, was to determine the personal characteristics that were associated with cognitive difficulties in order to identify older adults who needed environmental supports to enhance their self-management capabilities. A sample of 102 African-Americans from 60 to 89 years of age with diagnosed hypertension was recruited. Forty-nine percent (n = 50) of the sample had cognitive impairments that could hinder hypertension self-management. Depressive symptoms were also associated with a decrease in cognitive function (i.e., orientation and complex cognitive skills), as well as being negatively associated with social support. These findings support the need for nurses to assess personal characteristics in order to plan self-management strategies that help clients compensate for cognitive deficits.
African-Americans; cognition; hypertension; self-management
Use of normative data stratified by education may result in misclassification of African American older adults because reading ability, an estimate of educational attainment, is lower than reported years of education for some African American elders. This study examined the contribution of reading ability versus education to neuropsychological test performance in 86 community-dwelling African American elders ages 56–91 with 8–18 years of education. Hierarchical multiple regression analyses revealed that reading ability, but not education, was significantly associated with performances on the Trail Making Test, Controlled Oral Word Association Test, Animal Naming, Digit Span, and the Stroop test. Reading ability was not significantly related to performances on measures of memory. Medium to large effect sizes (Cohen's d = 0.58–1.41) were found when comparing mean performances on neuropsychological measures in groups with low versus high reading scores. Results indicate that reading ability contributes beyond educational attainment to performances on some neuropsychological measures among African American elders. These findings have implications for reducing misclassification among minority populations through the use of appropriate normative data.
Assessment; Elderly; Geriatrics; Aging; Norms; Normative studies
Purpose: Effective strategies to recruit minority elders into health research (e.g., through churches, partnering with community gatekeepers) often involve nonrandom sampling methods. The current study has two aims: (a) to examine some new practices in recruitment of African American elders and (b) to determine the similarities and differences of the volunteers in the Healthier Black Elders (HBE) Participant Resource Pool (PRP), with a population-based community sample from the Detroit Health Needs Assessment (Chapleski, E. E. (2002). Facing the future: City of Detroit needs assessment). Detroit, MI: Wayne State University. Design and Methods: A community-based participatory research approach was used to establish the HBE as an educational and support program in Detroit and to use HBE to launch a research participant registry of older Black adults. Data were drawn from a community-based telephone survey of 723 older African American elders aged 60 years and older recruited into the PRP registry. Results: PRP participants had some differences from those in the Detroit Health Needs Assessment. These included that older women had a significantly higher participatory rate compared with their male counterparts. African American women in the PRP reported a modestly healthier life with less disability compared with their Detroit Health Needs Assessment counterparts, whereas for men, it was the reverse for chronic diseases. The PRP was able to attract a significantly higher percentage of older old compared with the population=based survey. Implications: Study findings suggest that the HBE approach of recruiting African American elders in health research appears effective and to have some unique strengths.
African American elders; Recruitment and retention; Community-Based participatory research
Purpose of the study: An emerging strategy for increasing public participation in health research is volunteer registries. Using a community-based participatory research framework, we describe recruitment processes and outcomes in building a research volunteer registry of older urban African Americans. The specific research question examined retrospectively was: How does a community outreach partnership between older residents and academic researchers of the Healthier Black Elders Center facilitate recruitment of older urban African Americans for a research volunteer registry? Design and Methods: We adapted program evaluation methods, specifically, the logic model, for clarifying how community outreach health education activities supported development of a research volunteer registry of older urban African Americans. Results: Paralleling the 7 years in which an annual health reception was held, enrollees in a research volunteer registry increased from 102 to 1,273 enrollees. Implications: Targeted outreach to underrepresented groups to build a registry of volunteers for health research may be a promising strategy for addressing recruitment disparities in African Americans’ research participation.
Process evaluation; Logic model; Minority; Participatory research; Underrepresented groups
Mentoring junior faculty in geropsychology is becoming more critical due to the paucity of geropsychologists and the financial and talent costs experienced by universities of faculty turnover. This paper presents the unique aspects of mentoring junior faculty as opposed to mentoring of graduate students or interns, and examines some of the author's personal core values in mentoring that have been applied to over 50 junior faculty members. The author presents the RESPECT model as away to view the important and varied tasks involved in successful mentoring of junior geropsychology faculty. The model identifies the mentee as the leader in the mentee-mentor faculty relationship and examines the types of empowerment, support, protection and planning that goes into mentoring. The model, in addition, discusses the personal and emotional relationship the mentee-mentor has and the role of mentor in handling disappointment and assisting the mentee in negotiating conflict.
This study investigated whether symptoms of depression and cognitive dysfunction predicted all-cause mortality in long-term care (LTC) residents at 12 months after admission. Participants were 171 adults with a mean age of 77 in an urban LTC setting (51% African American and 49% European American). The Geriatric Depression Scale and the Dementia Rating Scale, Second Edition (DRS–2), were administered upon admission, and demographic variables and the Charlson Comorbidity Index were also recorded. Cox regression analyses found that increased depressive symptoms, lower performance on the DRS–2, and European American ethnicity were significant predictors of all-cause mortality. The overall results suggest that the combination of cognitive dysfunction and depressive symptoms can increase the chances of 12-month, all-cause mortality in LTC settings.
all-cause mortality; cognition; depression; African American; long-term care
The objective of this evaluation study was to assess the effect of academic detailing (AcD) as a strategy to increase early detection of dementia in primary care practice and to improve support and management of Alzheimer’s disease and other dementia disorders by increasing communication and referrals to local community agencies. As designed for dementia education, AcD consisted of 15-minute educational sessions delivered in primary care practice offices. Twenty-nine visits were conducted by trained teams comprised of a physician and representatives of the Alzheimer’s Association (AA) and Area Agency on Aging (AAA). A key outcome of the visits was increased knowledge of the specific programs and services available. In all, 77.4% rated the visit very effective, and follow-up evaluation suggests visits led to an increase in referral to these agencies (55%) and potentially enhanced early detection of dementia by physicians as measured by 35% making changes in the way they identify at-risk patients.
dementia; academic detailing; physician education; older adults
Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.
African American; education; cognition; construct validity; successful aging
The present research investigates differences between primary informal caregivers who were in the care recipient’s immediate family (adult children or spouses) versus those primary caregivers who were outside the immediate family. Measurement occurred at the time of admission of the care recipient to an urban nursing home. We hypothesized that immediate family caregivers would report greater behavioral disturbance among care recipients and increased caregiver depression and stress. Data were collected from 115 consecutive caregiver-elder dyads at nursing home intake. Non-immediate family caregivers comprised 43% of the sample. Consistent with our hypotheses, immediate family caregivers reported significantly greater caregiver depression and caregiver stress. Immediate family care recipients demonstrated greater behavioral disturbance. Implications for policy and caregiver interventions are discussed.
caregiver; family status; nursing home; obligation
Based in successful aging theory and terminal cognitive drop research, this paper investigates cerebrovascular burden (CVB), depressive symptoms, and cognitive decline as threats to longevity. A subsample of stroke-free women over the age of 80 was identified in the Health and Retirement Survey (years 2000–2008). Mortality at 2, 6, and 8 year intervals was predicted using CVB (diabetes, heart disease, hypertension), depressive symptoms (Center for Epidemiological Studies Depression Scale), and cognitive decline (decline of 1 standard deviation or more on the 35-point Telephone Interview for Cognitive Status over 2 years). At most waves (2002, 2004, and 2006) mortality was predicted by CVB, depressive symptoms, and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8 years. Older women with the greatest longevity had low CVB, robust cognitive functioning, and few depression symptoms, supporting successful aging theory and terminal cognitive drop.
An older adult's ability to perform physical tasks is predictive of disability onset and is associated with declines in cognition. Risk factors for physical performance declines among African Americans, a group with the highest rates of disability, remain understudied. This study sought to identify demographic, health, and cognitive factors associated with lower-extremity physical performance in a sample of 106 African American women ages 56 to 91. After controlling for global cognitive functioning (Mini Mental State Exam), physical performance was associated with executive functioning (Stroop Color/Word), but not visuospatial construction (WASI Block Design) or processing speed (Trail Making Test, Part A). Executive functioning remained associated with physical performance after entry of demographic variables, exercise, depression, disease burden, and body mass index (BMI). Age, and BMI were also significant in this model. Executive functioning, age and BMI are associated with lower-extremity physical performance among older African American women.
The purpose of this study was to examine the relationships among parental stress, health (defined as level of systolic and diastolic blood pressure and body mass index), childcare characteristics, and social support. The study used a correlational research design and the setting was the metropolitan Detroit area. The sample consisted of 120 hypertensive African American parents and grandparents who reported caring for 1 to 9 children living in the household. Several variables (average diastolic blood pressure, number of children/grandchildren in home, child/grandchild is physically/mentally disabled, ability to decrease stress) were statistically significant predictors of parental stress. These results indicate that the multiple demands of parenting may become a barrier to making life-style changes for parents and grandparents diagnosed with hypertension. Nursing implications of the findings are discussed.
Because stress is a major factor in hypertension, research on parenting stressors and lifestyle behaviors of grandparents with hypertension is important. This study describes urban African Americans caring for grandchildren and examines effects of perceived parenting stress-ors on hypertension self-management. Hypertensive African American grandparents (N = 49) residing in a large Midwestern city participated in the study. Structured interviews collected descriptive data and the Index of Parental Attitudes (IPA). Participants’ ages ranged from 30 to 82 years, were mostly female (77%), and had from 1 to 6 grandchildren. Participants were sedentary (51%), cigarette smokers (47%), and obese (67%). Mean systolic blood pressure was 157 and mean diastolic blood pressure was 89. IPA scores averaged 12.7, with scores ≥ 30, indicating high levels of parental stress. Some participants (8.4%) had clinically stressful relationships with their grandchildren. The correlation between blood pressure and parental stress was not statistically significant, with a significant negative correlation found between participants’ ages and diastolic blood pressure. The correlation between the number of hours spent caregiving and age produced a statistically significant relationship.
Parental stress; hypertension; grandparent(s); urban; African American
African Americans are at greater risk for hypertension than are other ethnic groups. This study examined relationships among hypertension, stress, and depression among 120 urban African American parents and grandparents. This study is a secondary analysis of a larger nurse-managed randomized clinical trial testing the effectiveness of a telemonitoring intervention. Baseline data used in analyses, with the exception of medication compliance, were collected at 3 months' follow-up. Health indicators, perceived stress, and social support were examined to determine their relationship with depressive symptoms. A total of 48% of the variance in depressive symptomology was explained by perceived stress and support. Health indicators including average systolic blood pressure explained 21% of the variance in depressive symptomology. The regression analysis using average diastolic blood pressure explained 26% of the variance in depressive symptomology. Based on study results, African Americans should be assessed for perceived stress and social support to alleviate depressive symptomology.
Executive dysfunction is correlated with disability in tasks of daily living. Less is known about the relationship between cognition, particularly executive dysfunction, and physical performance. This study investigated how executive ability, measured by the Trail Making Test, Part B (TMT-B), Controlled Oral Word Association test (COWA) and Animal Naming (AN), related to completion of physical tasks on the Short Physical Performance Battery (SPPB). The sample included 68 urban-dwelling Black adults ages 59–95. AN and TMT-B accounted for 6.2% and 7.1% of the variance, respectively, in SPPB total score after controlling for general cognitive functioning (Mini Mental Status Exam) and demographics. COWA and the MMSE did not obtain significance. Only the TMT-B remained significant after accounting for illness burden. Findings suggest that executive ability is related to physical performance in older urban Black adults more than general cognitive functioning. This relationship is attenuated by illness burden.
Disability; Executive function; Short Physical Performance Battery; Cognition; Older adults
Normative neuropsychological data for U.S. racial/ethnic minorities is limited. Extant norms are based on small, regional groups that may not be nationally representative. The objectives of this study were to 1) provide norms for a modified Symbol Digit Modalities Test (M-SDMT) based on a nationally representative sample of African Americans, Caribbean Blacks and non-Latino Whites (NLW) living in areas with large populations of Blacks, and 2) determine significant correlates of M-SDMT performance. The M-SDMT was administered to a subset of respondents from the National Survey of American Life in standard, face-to-face interviews. M-SDMT performance was influenced by race/ethnicity, age, education, and gender. African Americans and NLW groups had similar M-SDMT performances, which differed from Caribbean Blacks. The Black ethnic differences in M-SDMT were not explained by the sociodemographic factors considered in this study. Unlike previous work, this study supports the consideration of Black ethnicity when evaluating Black neuropsychological test performance.
African Americans; Caribbean Blacks; Blacks; Neuropsychological Tests
BACKGROUND: African Americans have a higher incidence and prevalence of Alzheimer's disease (AD) than whites but have been underrepresented in clinical trials, including studies of cholinesterase inhibitors. PURPOSE: The purpose of this 12-week, open-label study was to evaluate the efficacy and safety of donepezil in African Americans with mild-to-moderate AD. METHODS: Efficacy was assessed via the Mini-Mental State Examination (MMSE), Clinician's Interview-Based Impression of Change-Plus interview with the patient and caregiver (CIBIC-Plus) and Fuld Object Memory Evaluation (FOME), a measure that has been validated for use with elderly African Americans. RESULTS: Significant improvements were observed in cognition (MMSE), global function (CIBIC-Plus) and memory (all four subscales of the FOME). Donepezil was well tolerated; 51% of patients experienced adverse events, most commonly diarrhea (5.6%), hypertension (5.6%) and urinary tract infection (4.8%). CONCLUSIONS: These results suggest that donepezil is effective and safe in treating African Americans with mild-to-moderate AD, and support the value of FOME in assessing efficacy in AD trials in diverse populations.