Elderly African Americans Research Articles

Acute oral ingestion of alcohol modulates muscle sympathetic neural activity differently in Caucasians and African Americans

Recent studies consistently report that acute alcohol consumption increases muscle sympathetic nerve activity (MSNA) in humans. Despite the increased prevalence of hypertension and alcohol consumption in African Americans (AA), no studies have compared MSNA responses to alcohol consumption in AA and Caucasians (C). We hypothesized that alcohol consumption would increase MSNA in both AA and C, but that sympathoexcitatory responses would be augmented in AA. Five minutes of supine heart rate (HR), blood pressure, MSNA, and forearm blood flow were recorded in 8 AA (age, 23±1 yr) and 8 C (age, 22±1 yr) before and 45 min after consumption of 2.5ml of vodka per kg body mass. Increases in blood alcohol content (BAC) were greater in AA (0.105%) compared to C (0.087%; P<0.05). Alcohol elicited similar increases of HR in AA (62±5 to 70±4 beats/min; p<0.001) and C (62±5 to 68±5 beats/min; p<0.001). Contrary to our initial hypothesis, alcohol consumption increased MSNA in C (14±3 to 27±5 bursts/100 heart beats; P<0.05), but did not alter MSNA in AA (28±7 to 29±6 bursts/100 heart beats). Forearm vascular conductance (FVC) was not altered by alcohol consumption in AA or C. However, when sympathetic vascular transduction was calculated (i.e., FVC/MSNA), alcohol consumption reduced sympathetic vascular transduction in C (2.4±0.4 to 1.1±0.2 units; p<0.01), but not AA (1.3±0.4 to 1.3±0.4 units). These findings suggest acute alcohol consumption influences resting MSNA and MSNA‐vascular coupling differently in AA and C, but it is unclear if the different levels of BAC, and perhaps rates of alcohol metabolism, are contributing to these racial differences.

Cross Cultural Exploration of the Perceived Health Competence Scale

The eight-item Perceived Health Competence Scale (PHCS) is a measure of self-efficacy in general health management that is used to predict health outcomes and behaviors. The PHCS has been shown to be a reliable and valid instrument but has been used in primarily white European Americans. The PHCS is positively correlated to health status and coping abilities. Younger, healthier populations score higher on the PHCS compared to elderly who are managing chronic illness. This study examined the PHCS in three Midwestern samples: African American elders which revealed two separate factors in PHCS; Native Americans who evaluated the PHCS as a single construct; and a Spanish speaking sample. In the latter sample, findings suggest health competence may be a multi-dimensional construct. Further evaluation of the Spanish version of the PHCS and population characteristics are needed to measure health competence beliefs.

The Changing of a Macro System: Finding a Social Role for African American Elderly Males

President Obama on Sunday May 19, 2013 summoned the graduates of historically black Morehouse College to “transform the way we think about manhood,” urging the young men to avoid the temptation to make excuses and to take responsibility for their families and their communities. Delivering a commencement address at the all-male private liberal arts college in Atlanta, Obama spoke in deeply personal terms about the “special obligation” he feels as a black man to help those left behind. “There but for the grace of God, I might be in their shoes,” Obama said. “I might have been in prison. I might have been unemployed. I might not have been able to support a family and that motivates me.

A survey of self-reported skin disease in the elderly African-American population.

In the USA, the geriatric population, almost 12% of which will be comprised of African-Americans, is expected to exceed 88 million by 2050. Data on dermatologic conditions in elderly African-Americans are deficient. This study aimed to identify prevalences of self-reported skin disease and skin-related concerns in elderly African-Americans, and to assess participants' perceptions of skin disease and awareness of skin cancer. Elderly African-Americans were recruited into a cross-sectional study and asked to complete a 17-item questionnaire. A total of 101 participants aged 60-91 years (median age: 71 years) completed the questionnaire. The majority (75.2%) of the subjects were female. The most common self-reported skin diseases were eczema/dermatitis (28.7%), fungal skin infections (16.8%), alopecia (6.9%), viral skin infections (4.9%), and urticaria (4.9%). The most common skin concerns were dry skin/pruritus (40.6%), moles (27.7%), hair loss (25.7%), skin discoloration (20.8%), and wrinkles (15.8%). Overall, 40.6% of participants reported concern about skin cancer, and 75.2% reported examining their skin regularly. However, 34.7% did not believe that people with darker skin types should be concerned about skin cancer. This study provides an important overview of the most common self-reported skin conditions in elderly African-Americans. Substantial age-related differences in the frequencies of skin disorders were apparent. It is important to include the elderly population within campaigns to educate minority group members on skin cancer.

Education Desegregation and Cognitive Change in African American Older Adults.

The present study examined the relationship between desegregated schooling and cognitive change in a sample of 420 community-dwelling African American elders (mean age = 68.6; SD = 9.1). Participants were recruited for the Baltimore Study of Black Aging - Patterns of Cognitive Aging. Cognitive measures from six domains of function were administered at baseline and follow-up 33 months later. Repeated measures multivariate analysis of covariance was conducted; the between subjects factors were schooling type and age cohort, and the within subjects factor was time. Analyses controlled for age, years of education, and sex, and follow-up univariate analyses were used to determine which individual cognitive scores drove the multivariate effects. There were significant multivariate within-group, between-group, and interaction effects (p < .05). Univariate analyses indicated that the desegregated schooling group scored significantly better on Language and Perceptual Speed (p < .01), and the youngest age cohort (50- to 59-year-olds) performed better on measures of Perceptual Speed. There were no significant univariate interactions between schooling group or age cohort and cognitive change over time. Overall, these findings suggest a slight advantage of desegregated schooling for cognitive performance, but no advantage of desegregated schooling on the rate of cognitive change over time in this sample.

Perceptions of Healthy Aging among African-American and Ethiopian Elders

This study explores healthy aging and health promotion preferences, practices and perceptions of African-American and Ethiopian older adults. Participants completed a questionnaire linked to three levels relevant to an ecological framework: individual, interpersonal and community or environmental. Results indicate that the ecological environments of African-Americans and Ethiopian senior were quite different. African-American elders’ conception of healthy aging related to preserving their independence while Ethiopian elders indicated a holistic view that included close ties with extended family members. Both groups reported high levels of spirituality and belief in God. Other similarities and differences are discussed. This study points to the importance of industrialized and developing countries understanding the needs and perfections of elders as they shape flexible and responsive policy and programs for global health promotion.

A-41 * Quality versus Quantity of Education as a Predictor of Cognition in Elderly African American and Caucasian Patients

Objective: Prior research (Manley et al., 2004) has suggested that years of education may not be an adequate predictor of neuropsychological performance especially amongst African Americans. Quality of education, as defined as performance on the Wide Range Achievement Test-3, Reading subtest (WRAT-3), was found in fact to be a better predictor of cognitive functioning in their sample of healthy community dwelling adults. The current study sought to expand on this work by examining this hypothesis in a clinical population using updated measures. Specifically, the current study examined whether educational quality was a better predictor of cognitive performance in a Midwestern clinical sample of elders than educational quantity. Method: Retrospectively, neurocognitive data was gleaned from the files of 60 consecutive African American (mean age = 77.1, SD = 7.2; mean education = 14.7, SD = 3.3) and 60 White (mean age = 79, SD = 6.4; mean education = 13.5, SD = 3.5) patients. Simple regression models determined the relationships among each of five predictor variables (age, sex, years of education, race and WRAT-4 reading) and performance on neuropsychological measures. Results: Significant correlations were documented between WRAT-4 reading and race, (p < .001) and years of education (p < .01). Reading ability significantly predicted performance on neuropsychological measures above and beyond age, gender, and years of education, across racial groups. Conclusion(s): Quality of education was found to be a better predictor of cognition regardless of race. Implications for test interpretation among diverse older adult patients will be discussed.

APOE ε4 and the risk for Alzheimer disease and cognitive decline in African Americans and Yoruba

There is little information on the association of the APOEe4 allele and AD risk in African populations. In previous analyses from the Indianapolis-Ibadan dementia project, we have reported that APOE ε4 increased the risk for Alzheimer's disease (AD) in African Americans but not in Yoruba. This study represents a replication of this earlier work using enriched cohorts and extending the analysis to include cognitive decline. In this longitudinal study of two community dwelling cohorts of elderly Yoruba and African Americans, APOE genotyping was conducted from blood samples taken on or before 2001 (1,871 African Americans & 2,200 Yoruba). Mean follow up time was 8.5 years for African Americans and 8.8 years for Yoruba. The effects of heterozygosity or homozygosity of ε4 and of the possession of e4 on time to incident AD and on cognitive decline were determined using Cox's proportional hazards regression and mixed effects models. After adjusting for covariates, one or two copies of the APOE ε4 allele were significant risk factors for incident AD (p < 0.0001) and cognitive decline in the African-American population (p < 0001). In the Yoruba, only homozygosity for APOE ε4 was a significant risk factor for AD (p = 0.0002) but not for cognitive decline (p = 0.2346), however, possession of an e4 allele was significant for both incident AD (p = 0.0489) and cognitive decline (p = 0.0425). In this large longitudinal comparative study, APOE ε4 had a significant, but weaker, effect on incident AD and on cognitive decline in Yoruba than in African Americans. The reasons for these differences remain unclear.

Cardiorespiratory fitness in older adult women: relationships with serum 25-hydroxyvitamin D

Previous studies suggest that circulating 25(OH)D may favorably influence cardiorespiratory fitness and fat oxidation. However, these relationships have not been examined in older adult women of different ethnic groups. The objectives of this study were to determine whether serum 25(OH)D is related to cardiovascular fitness (VO2max) in sedentary women ages ≥60 years and to determine whether these associations differ between African Americans (AA) and European Americans (EA). A secondary aim was to determine whether serum 25(OH)D is correlated with respiratory quotient (RQ) during submaximal exercise. This cross-sectional analysis included 67 AA and EA women ages 60-74 years. VO2max was measured by a modified Bruce graded treadmill protocol, and measurements were adjusted for percent fat and lean body mass assessed by air displacement plethysmography. Indirect calorimetry was used to measure RQ at rest and during four submaximal exercise tests. Fasting blood samples were obtained to quantify serum 25(OH)D. Serum 25(OH)D was associated with VO2max (ml/kg LBM/min) independent of percent body fat (r = 0.316, p = 0.010). However, subgroup analysis revealed that this relationship was specific to AA (r = 0.727, p = 0.005 for AA; r = 0.064, p = 0.643 for EA). In all subjects combined, 25(OH)D was inversely correlated (p < 0.01) with all measures of submaximal RQ. Higher serum 25(OH)D was associated with greater cardiorespiratory fitness in older adult AA women. Among both AA and EA, inverse associations between serum 25(OH)D and RQ suggest that women with higher levels of circulating vitamin D also demonstrated greater fat oxidation during submaximal exercise.

Colonic Volvulus in the United States

Colonic volvulus is a rare entity associated with high mortality rates. Most studies come from areas of high endemicity and are limited by small numbers. No studies have investigated trends, outcomes, and predictors of mortality at the national level. The Nationwide Inpatient Sample 2002-2010 was retrospectively reviewed for colonic volvulus cases admitted emergently. Patients' demographics, hospital factors, and outcomes of the different procedures were analyzed. The LASSO algorithm for logistic regression was used to build a predictive model for mortality in cases of sigmoid (SV) and cecal volvulus (CV) taking into account preoperative and operative variables. An estimated 3,351,152 cases of bowel obstruction were admitted in the United States over the study period. Colonic volvulus was found to be the cause in 63,749 cases (1.90%). The incidence of CV increased by 5.53% per year whereas the incidence of SV remained stable. SV was more common in elderly males (aged 70 years), African Americans, and patients with diabetes and neuropsychiatric disorders. In contrast, CV was more common in younger females. Nonsurgical decompression alone was used in 17% of cases. Among cases managed surgically, resective procedures were performed in 89% of cases, whereas operative detorsion with or without fixation procedures remained uncommon. Mortality rates were 9.44% for SV, 6.64% for CV, 17% for synchronous CV and SV, and 18% for transverse colon volvulus. The LASSO algorithm identified bowel gangrene and peritonitis, coagulopathy, age, the use of stoma, and chronic kidney disease as strong predictors of mortality. Colonic volvulus is a rare cause of bowel obstruction in the United States and is associated with high mortality rates. CV and SV affect different populations and the incidence of CV is on the rise. The presence of bowel gangrene and coagulopathy strongly predicts mortality, suggesting that prompt diagnosis and management are essential.

Terminally Ill African American Elders’ Access to and Use of Hospice Care

The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care.

Perceived Cognitive Impairment among African American elders: health and functional impairments in daily life

Objectives: 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.Method: 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.Results: 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.Conclusion: 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.

Mitochondrial DNA sequence associations with dementia and amyloid-β in elderly African Americans

Mitochondrial dysfunction occurs early in the course of several neurodegenerative diseases, and is potentially related to increased oxidative damage and amyloid-β (Aβ) formation in Alzheimer's disease. The goals of this study were to assess mtDNA sequence associations with dementia risk, 10-year cognitive change, and markers of oxidative stress and Aβ among 1089 African-Americans in the population-based Health, Aging, and Body Composition Study. Participants were free of dementia at baseline, and incidence was determined in 187 (18%) cases over 10 to 12 follow-up years. Haplogroup L1 participants were at increased risk for developing dementia (odds ratio = 1.88, 95% confidence interval = 1.23–2.88, p = 0.004), lower plasma Aβ42 levels (p = 0.03), and greater 10-year decline on the Digit Symbol Substitution Test (p = 0.04) when compared with common haplogroup L3. The p.V193I, ND2 substitution was associated with significantly higher Aβ42 levels (p = 0.0012), and this association was present in haplogroup L3 (p = 0.018) but not L1 (p = 0.90) participants. All associations were independent of potential confounders, including APOEε4 status and nuclear genetic ancestry. Identification of mtDNA sequence variation associated with dementia risk and cognitive decline may contribute to the development of new treatment targets and diagnostic tests that identify responders to interventions targeting mitochondria.

Homocysteine levels and dementia risk in Yoruba and African Americans

High levels of homocysteine have been associated with increased risk for dementia although results have been inconsistent. There are no reported studies from the developing world including Africa. In this longitudinal study of two community-dwelling cohorts of elderly Yoruba and African Americans, levels of homocysteine, vitamin B12 and folate were measured from blood samples taken in 2001. These levels were compared in two groups, participants who developed incident dementia in the follow-up until 2009 (59 Yoruba and 101 African Americans) and participants who were diagnosed as cognitively normal or in the good performance category at their last follow-up (760 Yoruba and 811 African Americans). Homocysteine levels were divided into quartiles for each site. After adjusting for age, education, possession of ApoE, smoking, and time of enrollment the higher quartiles of homocysteine were associated with a non-significant increase in dementia risk in the Yoruba (homocysteine quartile 4 vs. 1 OR: 2.19, 95% CI 0.95-5.07, p = 0.066). For the African Americans, there was a similar but non-significant relationship between higher homocysteine levels and dementia risk. There were no significant relationships between levels of vitamin B12 and folate and incident dementia in either site although folate levels were lower and vitamin B12 levers were higher in the Yoruba than in the African Americans. Increased homocysteine levels were associated with a similar but non-significant increase in dementia risk for both Yoruba and African Americans despite significant differences in folate levels between the two sites.

Mind-Body Techniques, Race-Ethnicity, and Depression among Urban Senior Center Participants

As the older adult population grows and becomes more diverse, more of its members are turning to complementary and alternative medicine (CAM). There are mixed findings regarding racial and ethnic differences in the use of CAM. This article explores racial and ethnic differences in use of a category of CAM known as mind-body techniques (MBT) among senior center participants with symptoms of depression. It also examines the relationship between use of MBT and depression severity. A cross-sectional survey was conducted with a representative sample of senior center participants in New York City, from which a subsample of those with depressive symptoms was drawn. Racial and ethnic differences in MBT use were identified, as was a significant negative relationship between MBT use and depression severity. African American elders were more likely to have used MBT than other racial or ethnic groups. When controlling for race or ethnicity, health status, and barriers to medical care, predictors of depression severity included health status, experiencing barriers to medical care, and Hispanic identity. Findings suggest that being female or younger is associated with a higher likelihood of using CAM. Contrary to some prior research, education level was not associated with use of MBT.

Mild Cognitive Impairment, Incidence, Progression, and Reversion: Findings from a Community-Based Cohort of Elderly African Americans

To examine the long-term outcomes of community-based elderly African Americans by following their transitions from normal cognition to mild cognitive impairment (MCI) to dementia. Participants were from the community-based Indianapolis Dementia Project. A total of 4,104 African Americans were enrolled in 1992 or 2001 and followed until 2009 with regularly scheduled evaluation of cognitive assessment. A two-stage sampling was used at each evaluation to select individuals for extensive clinical assessment following the results of Stage 1 cognitive testing. Age- and gender-specific incidence, progression, and reversion rates for MCI were derived using the person-year method in a dynamic cohort and predicted probabilities from weighted multinomial logistic models of transitional probabilities among normal cognition, MCI, and dementia. Annual overall incidence rate for MCI was 5.6% (95% confidence interval [CI]: 4.6%-6.6%). Annual progression rate from MCI to dementia was 5.9% (95% CI: 5.3%-6.5%), and annual reversion rate from MCI to normal was 18.6% (95% CI: 16.7%-20.4%). Both MCI incidence rates and MCI to dementia progression rates increased with age, whereas reversion rates from MCI to normal decreased with age. MCI progression to dementia was much more frequent in the older age groups than in younger participants where reversion to normal cognition is more common. Future research is needed to determine factors related to the heterogeneous outcomes in MCI individuals.

Producing Africa at the New Orleans Jazz &amp; Heritage Festival

Producing Africa at the New Orleans Jazz &amp; Heritage Festival

A Heavenly Collaboration: Social Workers and Churches Working to Increase Advance Directive Completion among African American Elderly

The Patient Self-Determination Act (PSDA) was enacted in 1990 as a guarantee to patients that their wishes surrounding end-of-life care would be honored if they expressed verbally or through advance directives the desired level of care they wished to receive at the end of life. Research shows that African Americans have the lowest percentage of advance directives completed among the major racial groups in the United States despite the PSDA's purpose. African American elderly rely on community supports such as social workers and the church to meet physical and spiritual needs. However, these two entities have yet to collaborate to eradicate the dismal percentages of completed advance directives among African American elderly. This article explores how the religious community and social workers can work toward educating this population on the importance of advance directives and empowering them to take the necessary steps at completion if they choose to do so.

PMH42 - Health care and social service use and cost in depressed african american elders: Results from the beat the blues randomized clinical trial

PMH42 - Health care and social service use and cost in depressed african american elders: Results from the beat the blues randomized clinical trial

Relationship between arterial stiffness and cerebral vascular reactivity in college‐aged african americans

African Americans (AA) have increased risk for cardio and cerebral vascular disease relative to Caucasians (CA). While is it generally accepted that arteries become stiffer at a younger age in AA; less is known regarding cerebral vascular function/reactivity (CVMR) to hypercapnia in AAs. Furthermore, to our knowledge, little is known regarding the relationship between arterial stiffness and CVMR, particularly in young healthy adults. We tested the hypothesis that AAs have elevated arterial stiffness and reduced CVMR during hypercapnia relative to CAs. Furthermore, we hypothesized that there would be a negative relationship between arterial stiffness and CVMR. In 7 AA and 13 CA subjects central arterial stiffness was indexed from carotid‐femoral pulse wave velocity (PWV). CVMR was assessed by the cerebral vascular conductance (CVC) response to rebreathing induced hypercapnia. PWV was elevated in the AAs (AA: 564±54 cm/ms vs. CA: 482±73 cm/ms; P=0.02). CVMR was also significantly reduced during hypercapnic rebreathing in the AAs (AA: 2.7±1.0 %/Torr vs. CA: 4.0±1.1 %/Torr; P=0.01). When data from all subjects was included there was a negative relationship between PWV and CVMR such those with elevated stiffness had an attenuated increase in CVC during hypercapnia (P=0.04). These data indicate that AAs have impaired cerebral vascular responses to hypercapnia and that this might be related to stiffer arteries.