Elderly African Americans Research Articles

Self-care production experiences in elderly African Americans with hypertension and cognitive difficulty

The purpose of this qualitative descriptive study was to explore self-care production experiences in older African Americans who, despite some cognitive dysfunction, were able to produce hypertension-related self-care behaviors or blood pressure control successfully. Participants were 10 urban, community-dwelling older African Americans, 60-89 years of age, living in a Midwest region of the United States. A semi-structured interview was conducted in participants homes' using Kvale's "conversational discourse" approach. Oral recordings were transcribed and analyzed for themes and codes. Elders' experiences with the production of self-care were characterized by three themes: preparation, monitoring, and evaluation. Self-care production was found to be cognitively challenging consistent with the finding that 60% of the participants had difficulty with a cognitive task requiring complex cognitive skills. This finding may explain why the production of self-care became a social phenomenon in which elders demonstrated resourcefulness in seeking assistance from surrounding support systems. Nurse practitioners can support better health outcomes in older adults with hypertension by using valid and reliable measures for assessing complex cognitive skills, assessing individuals' progress in self-care production, and identifying individuals' use of social and professional supports to produce self-care.

Perceptions of dental esthetics among older African Americans

Older adults have greater potential for issues with the appearance of their teeth than other age groups. Conditions including missing teeth, fractured or missing restorations, and excessive tooth wear are common and may potentially affect individuals' perceptions of their dental esthetics. These perceptions about dental conditions may be significant because previous research suggests that they may impact elders' quality of life. The purpose of this study was to investigate the esthetic ranking of specific dental conditions by a population of African American elderly, utilizing methods similar to those of an earlier study of older Caucasians. These methods were designed to determine whether specific oral/facial and dental conditions were associated with similar perceptions of esthetics in a series of computer-adjusted images regardless of gender or any other facial characteristics. Our results suggest that, among the conditions studied, perceptions of dental esthetics of elderly African Americans were similar to those of Caucasians.

Incidence and Risk Factors for Cognitive Impairment No Dementia and Mild Cognitive Impairment in African Americans

The aim of this study was to estimate the age-specific incidence of cognitive impairment, no dementia and mild cognitive impairment (CIND/MCI) in a large, community-based sample of older African Americans in Indianapolis, IN. A longitudinal, prospective, 2-stage design was used with follow-up assessments 2 and 5 years after the baseline. A total of 1668 participants completed the 2-year follow-up and a total of 1255 participants completed the 5-year follow-up. The person-years method was used to calculate incidence rates. The age-standardized, annual incidence of CIND/MCI was 4.95% (CI=3.39-6.52) and the subtype of medically unexplained memory loss (single-domain and multidomain amnestic MCI) was 3.67% (CI 2.75-4.48). Rates increased with age (3.43% for participants aged 65 to 74 y, 6.44% from age 75 to 84 y, and 9.62% from age 85+ y), history of head injury [OR 2.37 (CI 1.31-4.29)], and history of depression [OR 2.22 (CI 1.16-4.25)] while increased years of schooling was protective [OR 0.91 (CI 0.85-0.97)]. Rates did not vary substantially by sex. Almost 1 in 20 elderly community-dwelling African Americans, and almost 1 in 10 of the oldest-old (85+ y) developed CIND/MCI each year in this cohort. Risk factors of age and education suggest exposures or mechanisms at both ends of the life span may be important variables in onset of CIND/MCI.

“Peace With My Maker”: Voices of Seriously Ill African American Elders Regarding Advance Care Planning

African Americans participate in advance care planning (ACP) less often and are more likely to opt for life sustaining treatment than non-Hispanic whites. Although prior quantitative and qualitative work has examined the perspectives and attitudes of African Americans, the voices of those who are most likely to confront situations requiring health care decision making—seriously ill African American elders—have not been well depicted. This study utilized literary representations, in the form of found data poetry, to further examine qualitative data from community dwelling, African American elders who were seriously ill. Found data poetry seeks to capture the participant’s voice intact, in an effort to better represent the individual. Reexamining the data yielded 9 found data poems that represented the voice of the participants and expressed strong feelings regarding ACP.

An Interdisciplinary Outreach Model of African American Recruitment for Alzheimer's Disease Research

The African American Outreach Satellite (Satellite) provides educational outreach to facilitate African American recruitment for longitudinal studies at the Washington University Alzheimer's Disease Research Center (ADRC). This descriptive article characterizes the Satellite's recruitment methods, plan for community engagement, results of recruitment efforts, and potential for replication. The Satellite developed a comprehensive outreach and recruitment plan that identifies and addresses barriers to research participation. The Satellite conducts community outreach and recruitment programs and training for health care providers. Enrollment of cognitively healthy and mildly demented African Americans for participation in all ADRC studies increased following implementation of the recruitment plan. Current African American participation rates for ADRC studies include 39% for lumbar puncture, 43% for positron emission tomography with Pittsburgh Compound-B, 52% for magnetic resonance imaging, 95% for apolipoprotein E genotype testing, and 100% for clinical and cognitive assessment. The Satellite reduces barriers to research participation, encourages retention through sustained interactions with participants and their families, and develops lasting partnerships with community organizations and health professionals who care for African American elders.

Barriers to treatment and culturally endorsed coping strategies among depressed African-American older adults

Objective: Older adults are particularly vulnerable to the effects of depression, however, they are less likely to seek and engage in mental health treatment. African-American older adults are even less likely than their White counterparts to seek and engage in mental health treatment. This qualitative study examined the experience of being depressed among African-American elders and their perceptions of barriers confronted when contemplating seeking mental health services. In addition, we examined how coping strategies are utilized by African-American elders who choose not to seek professional mental health services. Method: A total of 37 interviews were conducted with African-American elders endorsing at least mild symptoms of depression. Interviews were audiotaped and subsequently transcribed. Content analysis was utilized to analyze the qualitative data. Results: Thematic analysis of the interviews with African-American older adults is presented within three areas: (1) Beliefs about Depression Among Older African-Americans; (2) Barriers to Seeking Treatment for Older African-Americans; and (3) Cultural Coping Strategies for Depressed African-American Older Adults. Conclusion: Older African-Americans in this study identified a number of experiences living in the Black community that impacted their treatment seeking attitudes and behaviors, which led to identification and utilization of more culturally endorsed coping strategies to deal with their depression. Findings from this study provide a greater understanding of the stigma associated with having a mental illness and its influence on attitudes toward mental health services.

Context and culture: African-American elders’ experiences of depression

The word “depression” is used in many forums, such as clinically or colloquially. Our study explored how the word is used culturally and experientially in a particular group of individuals. In this article, we examine the meaning of depression to a sample of 60 African-American men and women with varying levels of health and functional status. We presented the word depression in our interview questionnaire but did not pre-define the word, nor did anyone in the sample ask us to define it. A key finding of this article is that the way in which persons construct an experience of depression, their expression of it, and their perception of an appropriate resolution emerges from their belief system. Our data offered a window into the internal world of elders, particularly the cultural and religious beliefs and traditions that shaped their processes of defining, interpreting, and resolving depression. For this group, resolving depression meshed with the spiritual adaptive strategies, such as reliance on God, community, self, and others, that they used throughout life to deal with negative circumstances.

Gender Differences in Colonoscopy Outcomes in Elderly African Americans

Gender Differences in Colonoscopy Outcomes in Elderly African Americans

Impact of Co-morbidities on Colorectal Cancer Screening Decision in Elderly African Americans and Hispanics

Impact of Co-morbidities on Colorectal Cancer Screening Decision in Elderly African Americans and Hispanics

Effects of Massage Therapy on African Americans with Type 2 Diabetes Mellitus: A Pilot Study

Aims: African American (AA) subjects with type 2 diabetes mellitus were studied to determine effects of Massage Therapy/Acupressure (MTA) on vital signs (VS): blood pressure (BP), heart rate (HR), blood flow (BF), skin temperature (TEMP), O2 saturation (O2); well-being (WB); glycosylated hemoglobin (A1c), cortisol, and insulin. Method: Eleven AA ages 45 to 72, (8 female/3 males) were subjects. VS were obtained before and after each of 20, 60-minute MTA sessions. BF was measured with a Pulsed Doppler and decibel meter. Blood collections (n = 9) and Well-Being-22 Questionnaires [(WBQ-22) n = 11] were completed at baseline and following the 20th massage. MTA involved acupressure on spine-T-8/T-9, Urinary Bladder-UB17/UB23/U2, Stomach-ST2, Kidney-K5, Renal-R3; and Effleurage-gliding/stroking, Petrissage-kneading, Tapotement-cupping/hacking/pinching of extremities, and back/torso and Vibration Friction-neck. Hand pressure provided massage to the pancreas. VS were analyzed with General Estimation Equations, and Wilcoxon Sign Tests evaluated WBQ-22/blood work. Results: Pre/Post MTA BF increased with sessions (p = .001). Immediately following a MTA session, BP (systolic) increased while HR and TEMP decreased. Over-time MTA therapy led to significant increases in HR and BF, while TEMP decreased. No significant changes in cortisol, A1c, or insulin were noted. WBQ-22 parameters improved insignificantly; +Energy, +Positive WB, and +Total WB. Anxiety/Depression decrease. 19.5%/13.8%, respectively. Conclusions: Immediate effects of MTA were increased BP (systolic) and lower HR and TEMP. Long-term effects were higher resting HR and increased BF, while TEMP significantly decreased. MTA was feasible, well received and could have potential health benefits. Randomized controlled studies are needed to thoroughly explore this therapy as a useful adjunct to conventional allopathic care.

Perceptions, Knowledge, Incentives, and Barriers of Brain Donation Among African American Elders Enrolled in an Alzheimer's Research Program

To learn about African American older adults' knowledge and perceptions of brain donation, factors that relate to participating or not participating in a brain donation research program, and methods to increase African American brain donation commitment rates in the context of an Alzheimer's disease (AD) research program. African American older adults (n = 15) from the Boston University Alzheimer's Disease Core Center participant research registry enrolled in 1 of 2 focus groups of 90 min about brain donation. Seven participants were selected for a third follow-up focus group. Focus group transcripts were analyzed using consensual qualitative research methods, and 8 overarching themes emerged: (a) perceptions of and misconceptions about brain donation procedures, (b) racial minorities in medical research, (c) racial disparities and discrimination in medical settings, (d) influence of religion and spirituality, (e) family perceptions of and involvement in donation, (f) family history of disease and desire to find a cure, (g) prior exposure to medical and research settings, and (h) culturally sensitive approaches to brain donation. Culturally relevant educational protocols need to be created for use with African American older adults. These protocols should include information about brain donation procedures, rates of AD among Black elders, and potential benefits of donation to Black communities; inclusion of religious figures, family, and peers in donation education and decisions; and methods to address mistrust, including cultural competence trainings for staff.

Recruitment of African Americans and Asian Americans With Late-Life Depression and Mild Cognitive Impairment

The purpose of this study was to compare the relative effectiveness of several different strategies for recruiting elderly Asians, African Americans, and whites to participate in mental health research. A total of 35 African American, 24 Asian American, and 215 white participants were phone screened for potential enrollment into a University of California, San Francisco, Department of Psychiatry treatment outcome study for older adults (aged 60 years and older) with major depression and mild cognitive impairment. The methods by which participants were recruited were recorded, coded into composite categories, and statistically analyzed to determine whether certain recruitment strategies were disproportionately effective for recruiting participants from the three racial groups. Fisher's exact test analyses revealed that Asians and African Americans were significantly less likely than whites to be recruited through mental health-based methods, and African Americans were significantly more likely than whites and Asians to be recruited through referrals rather than solicitations. Logistic regression, which controlled for potential confounds, largely supported these findings. Findings suggest that the recruitment of elderly African or Asian Americans into mental health treatment outcome research can be facilitated by a flexible consumer-oriented strategy that integrates multiple recruitment methods. Establishing study credibility through nonmental health media and professional referral sources may be especially effective in engaging the participation of elderly Asian Americans; and cultivating ongoing relationships with key gatekeepers, who can observe benefits to the community, may be particularly effective in recruiting elderly African Americans.

Lessons Learned Regarding Recruitment to the National African American Alzheimer Disease Health Literacy Program

It has been shown that patients with poor health literacy generally do not fare as well from a health perspective because they lack understanding of health information and are unaware of the steps involved in preventative health care. There are also unique issues with regard to the recruitment of minority participants into research. The National African American Alzheimer Disease Health Literacy Program was a research project whose purpose was to increase the health literacy of African American adults by providing objective scientific and educational information to the African American community of patients, families, and caregivers about dementia and Alzheimer disease. The target audience was the African American communities of Chicago, Cleveland, Indianapolis, Los Angeles, Newark, and Washington D.C. Reaching into these communities for participants was challenging for a variety of reasons and provided insight into potential strategies for working with the population of elderly African Americans. This article discusses the successes and challenges of the work conducted in Indianapolis.

VACCINATING FREEDOM: SMALLPOX PREVENTION AND THE DISCOURSES OF AFRICAN AMERICAN CITIZENSHIP IN ANTEBELLUM PHILADELPHIA

For historians of African American public health, the U.S. presidential election was a landmark event--not only because it produced the nation's first African American commander-in-chief, but also because unprecedented numbers of elderly African Americans received flu shots in the process. Considered wary of vaccination due to a long collective history of medical exploitation and neglect, African Americans have long ranked among those U.S. citizens least likely to avail themselves of preventive vaccines, resulting in low vaccination rates among black children, adults, and senior citizens alike. (1) Governmental and private agencies have devoted vast resources to correcting this disparity, encouraging many innovative outreach programs. (2) Among the most striking is Vote and Vax, the Sickness Prevention Achieved through Regional Collaboration (SPARC) initiative that worked with community groups to bring influenza vaccination to polling places in 2008. Launched in 1996 and expanded in 2006 with support from the Robert Wood Johnson Foundation, Vote and provides convenient polling-place vaccination to the elderly, who comprise the largest numbers of both registered U.S. voters and influenza fatalities. (3) Through such outreach, the program melds the civic responsibilities of the franchise with those long associated with vaccination. (4) Almost a year before the 4 November election, the Robert Wood Johnson Foundation announced that Vote and Vax 2008 would offer free influenza vaccination at 250 sites in thirty-five states and Washington, DC, on election day. (5) Some observers, noting that analysts expected Barack Obama's candidacy to increase African American voter participation exponentially, predicted a concomitant spike in the number of black elders consenting to polling-place vaccination. (6) Post-election reports vindicated these forecasts, as analysts concluded that Vote and had immunized record numbers of African American senior citizens during the election. (7) If, as some researchers have argued, racial disparities in willingness to be vaccinated vary according to the characteristics of the vaccination program, then Barack Obama's presidential bid appears to have provided some African Americans with increased incentive for polling-place vaccination. (8) With Vote and pledged to participate in the approaching midterm elections of November 2010, this is an opportune moment to consider the historical antecedents of the presidential election's marriage of vaccination and African American political concerns. (9) Because effective vaccination campaigns encourage prevention among individuals in order to guard against the spread of disease within the larger population, they have traditionally appealed to civic duty in ways that blend politics and medical science. (10) Nonetheless, much of the press coverage of Vote and Vax 2008 presupposed that the program's juxtaposition of vaccination and African Americans' national political interests was without precedent. (11) However, reporting of much older provenance, specifically that of the abolitionist and African American press that comprised black print culture in the United States in the four decades preceding the Civil War, presented smallpox vaccination as an integral part of African Americans' understanding of civic and political involvement. Within this antebellum print culture, vaccination featured in free, northern African Americans' efforts to demonstrate that both they and their enslaved brethren in the South were fit for freedom, that is, possessed of the mental and physical soundness and commitment to civic engagement that qualified them for full citizenship rights. More importantly, this print culture promoted vaccination in order to encourage behaviors consistent with citizenship, including intellectual advancement and civic responsibility, among its African American readership. This essay explores vaccination's role in this discursive citizenship ideal by focusing upon the experience of black Philadelphians, who comprised the largest African American community in the North in the antebellum period. …

Factor Structure of Cognitive Ability Measures in Older African Americans

This study examined the fluid-crystallized distinction of cognitive abilities in African Americans. We analyzed the factorial invariance of a battery of cognitive ability measures in a sample of 197 community-dwelling African American elders. Specifically, factorial invariance was tested in groups of African American elders differing in age (50-61 years, 62-79 years) and education (low, high). Using a partial invariance approach, if non-invariance was found between two groups, we explored the specific model parameters that contributed to the overall lack of invariance. The results indicated that the factor structure was confirmed in the sample as a whole. Evidence of strict invariance was found between age groups. However, a lack of invariance of specific factor loadings, intercepts, and uniqueness terms was found between education groups. The importance of highlighting idiosyncrasies in cognitive performance among African Americans is shown using a within group variation approach.

Mental Health Treatment Seeking Among Older Adults With Depression: The Impact of Stigma and Race

Stigma associated with mental illness continues to be a significant barrier to help seeking, leading to negative attitudes about mental health treatment and deterring individuals who need services from seeking care. This study examined the impact of public stigma (negative attitudes held by the public) and internalized stigma (negative attitudes held by stigmatized individuals about themselves) on racial differences in treatment-seeking attitudes and behaviors among older adults with depression. Random digit dialing was utilized to identify a representative sample of 248 African American and white older adults (older than 60 years) with depression (symptoms assessed by the Patient Health Questionnaire-9). Telephone-based surveys were conducted to assess their treatment-seeking attitudes and behaviors and the factors that impacted these behaviors. Depressed older adult participants endorsed a high level of public stigma and were not likely to be currently engaged in or did they intend to seek mental health treatment. Results also suggested that African American older adults were more likely to internalize stigma and endorsed less positive attitudes toward seeking mental health treatment than their white counterparts. Multiple regression analysis indicated that internalized stigma partially mediated the relationship between race and attitudes toward treatment. Stigma associated with having a mental illness has a negative influence on attitudes and intentions toward seeking mental health services among older adults with depression, particularly African American elders. Interventions to target internalized stigma are needed to help engage this population in psychosocial mental health treatments.

Influence of Culture and Discrimination on Care-Seeking Behavior of Elderly African Americans: A Qualitative Study

In this study, the influence of culture and discrimination on care-seeking behavior of elderly African Americans was explored. This was a qualitative phenomenological study that involved in-depth interviews with 15 African American men and women aged 60 and older in Alabama. The sample size of 15 was adequate for the phenomenological method of this study. While this was a small exploratory study and was not intended for any generalizations, it did provide a unique opportunity to hear the voices, the concerns, and the stories of elderly African Americans, which have often been overlooked in the literature. The following themes emerged from the analysis of data: (1) perception of health as ability to be active, (2) reluctance toward prescription medicine use, (3) lack of trust in doctors, (4) avoidance of bad news, (5) race of doctors, (6) use of home remedies, and (7) importance of God and spirituality on health, illness, and healing.

894 Outcome Analysis of Colonoscopy in Elderly African American, Hispanic and Asian Americans Above Age 85

894 Outcome Analysis of Colonoscopy in Elderly African American, Hispanic and Asian Americans Above Age 85

Detectable Changes in Physical Performance Measures in Elderly African Americans

African American older adults have higher rates of self-reported disability and lower physical performance scores compared with white older adults. Measures of physical performance are used to predict future morbidity and to determine the effect of exercise. Characteristics of performance measures are not known for African American older adults. The purpose of this study was to estimate the standard error of measurement (SEM) and minimal detectable change (MDC) for the Short Physical Performance Battery (SPPB), Timed "Up & Go" Test (TUG) time, free gait speed, fast gait speed, and Six-Minute Walk Test (6MWT) distance in frail African American adults. This observational measurement study used a test-retest design. Individuals were tested 2 times over a 1-week period. Demographic data collected included height, weight, number of medications, assistive device use, and Mini-Mental Status Examination (MMSE) scores. Participants then completed the 5 physical performance tests. Fifty-two participants (mean age=78 years) completed the study. The average MMSE score was 25 points, and the average body mass index was 29.4 kg/m(2). On average, participants took 7 medications, and the majority used assistive devices. Intraclass correlation coefficients (ICC [2,1]) were greater than .90, except for the SPPB score (ICC=.81). The SEMs were 1.2 points for the SPPB, 1.7 seconds for the TUG, 0.08 m/s for free gait speed, 0.09 m/s for fast gait speed, and 28 m for 6MWT distance. The MDC values were 2.9 points for the SPPB, 4 seconds for the TUG, 0.19 m/s for free gait speed, 0.21 m/s for fast gait speed, and 65 m for 6MWT distance. The entire sample was from an urban area. The SEMs were similar to previously reported values and can be used when working with African American and white older adults. Estimates of MDC were calculated to assist in clinical interpretation.

Abstract 2807: The relationship between age and efficiency of cervical cancer screening using population-based surveillance

Abstract Data for in situ cervical carcinomas are not routinely collected by U.S. tumor registries. Some experts suggest that comparing preinvasive and invasive cervical cancers (ICC) rates may represent our best population-based appraisal of screening strategies. From 1991-1997, a total of 5,921 women diagnosed with in situ or ICC were reported to the Markey Cancer Registry in Lexington, Kentucky, a population-based registry. Maximum-likelihood Poisson regression analyses were used to estimate the incidence rate of in situ and ICC (per 100,000), summarized over age-and race-specific groups for each of seven years, 1991 to 1997. U.S. Census age and race data for 1990 were used to estimate denominators for two race groups: African American (AA) and all others (white). Incidence rates and rate ratios are reported. A total of 4,290 and 1,631 were diagnosed with in situ and ICC in the study period. While more than 80% of cases among women <30 years of age were diagnosed as in situ lesions, only about half of cases diagnosed among 50-54 year-olds were identified at a preinvasive stage. For women >65 years, only 42% (+4%) of tumors were diagnosed as in situ lesions. Specifically, among 20-39 year olds, AA were less likely than white women to be diagnosed with in situ carcinoma (p<0.05), while after age 60, they were more likely than whites to be similarly diagnosed (p<0.05). White women 20-49 years were 1.4-23.8 times more likely to be diagnosed with in situ carcinoma than ICC; however, AA ages 25-34 were 1.4-1.6 times more likely to show in situ disease. Whites >55 were less likely to be diagnosed with in situ disease than ICC. While year of diagnosis was significant in the analyses, relationships between age and diagnostic stage persisted across each of 7 years examined. These data suggest that Pap test most efficiently identifies treatable, high-grade precancerous lesions among women younger than 50 years. HPV infection prevalence varies by age, but not race, while ICC disproportionately affects women of color, especially as they age. Several factors may explain these findings. Screening may be performed less often overall or more inconsistently among older women and among AA. Also, if screening in the population decreases with advancing age, symptomatic older women with higher likelihood of malignancy will be over-represented in the data. Directly tailoring screening programs to recruit and retain non- and under-screened women and women with medical record evidence of poorly triaged Pap test abnormalities may improve detection of cervical cancers at a preinvasive stage, where there is a very high likelihood of survival. We believe that these findings are consistent with those of others, and together they suggest our best public health strategy may be to actively recruit middle-age and older women into cervical cancer screening programs who have undergone Pap test screening fewer than three times in a ten year period. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2807.