Community-dwelling African Americans Research Articles

DISCRIMINATION IS ASSOCIATED WITH HIGHER ODDS OF HOSPITALIZATIONS AMONG OLDER AFRICAN AMERICANS

Abstract Everyday discrimination—experiences of being treated unfairly based on background characteristics like race—is linked to poor physical and mental health throughout the lifespan. Whether more experiences of discrimination are associated with higher likelihood of being hospitalized in older African Americans has not been explored. Hospitalization can represent both poor health and healthcare access. Participants were community-dwelling African Americans from the Rush Memory and Aging Project or Minority Aging Research Study, longitudinal studies of aging (N=301 with at least 12 months linked Medicare fee-for-service claims; mean age 72.5 years (standard deviation [SD]: 5.7), 79% female). Discrimination was assessed using the Detroit Area Study Everyday Discrimination Scale. Hospitalizations (sub-categorized as elective/non-elective, surgical) were quantified using Medicare claims. Mixed-effects ordinal logistic regression models tested associations between baseline discrimination and subsequent odds of hospitalizations per year (0, 1, 2+). The mean baseline discrimination score was 1.7 (SD: 2.2). Over an average 6.5 years (SD: 4.1), 160 participants had at least 1 hospitalization (respectively, 118, 87, and 127 participants had at least 1 nonelective, elective, or surgical hospitalization). Adjusting for age, sex, education, income, depressive symptoms, and medical comorbidity, more experiences of discrimination were associated with higher odds of hospitalization (odds ratio [OR] per point higher on discrimination score=1.12, 95% CI: 1.03-1.22), and higher odds of nonelective (OR=1.12, 95% CI: 1.01-1.24), but not surgical or elective hospitalizations. Drivers of these associations, which may include preventive healthcare avoidance due to discrimination or poor health due to the chronic stress response to discrimination, should be explored.

SELF-PERCEIVED COGNITIVE CHANGES IN OLDER BLACK ADULTS DURING COVID-19

Abstract The COVID-19 pandemic has had myriad effects on health and well-being. Contracting the COVID-19 virus and concerns of social and physical consequences during pandemic-related restrictions have been proven to negatively impact health. To better understand possible effects of COVID-19 on Black community-dwelling older adults’ perceived cognitive changes, we conducted a pilot study with 48 community-dwelling African Americans with measures obtained over 24 months from 10/2020 to 10/2022. Participants were recruited from the Wayne State University Institute of Gerontology Healthier Black Elders Center, and Michigan Alzheimer’s Disease Research Center, and the general Detroit Area (Mage=73.07, Range=65-87 years). The Cognitive Change Index (CCI) was used as a self-report measure of perceived change over the last five years. The COVID Impact Survey (CIS) was used to assess the burden of COVID-19 on daily living. To evaluate emotional-being, the Perceived Stress Scale (PSS responses referred to the last month) and the Geriatric Depression Scale (GDS, within the last week) were administered. Stepwise regression models showed CIS outcome measures did not predict CCI. GDS outcome measures predicted CCI to some degree (R2adj = .15, p = .008), whereas PSS was the strongest predictor (R2adj = .50, p < .001). Results suggest that for older community-dwelling African Americans, past COVID-19 pandemic experiences did not affect their self-evaluated cognitive changes. Higher levels of self-perceived stress within the last month best predicted their subjective cognitive decline. Future research should involve interventions focused on stress reduction, and clinicians should consider stress level when diagnosing cognitive status in older adults.

Cancer Type and Dementia Diagnosis in Community Dwelling African Americans

AbstractBackgroundCancer and dementia have been reported to have an inverse relationship, suggesting those with cancer may have decreased risk of subsequent dementia, and those with dementia may have a decreased risk of subsequent cancer diagnosis (Zablocka, 2021). However, emerging evidence challenges this idea. A paucity of research exists examining these associations in African Americans, who are twice as likely as whites to develop dementia (Barnes, 2022). Our objective was to examine the association between different types of cancer and dementia risk in community dwelling African Americans.MethodsUsing data from the 2011 National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries aged 65 and older, we examined the association between cancer type and dementia diagnosis in community dwelling African Americans (n = 1529). Multinomial logistic regression models examined the association between cancer type and dementia diagnosis, controlling for age, sex, and education, as well as anxiety, depression, diabetes, heart disease, and stroke.ResultsResults showed 2.6% of African Americans reported a kidney disease diagnosis, representing 208,107 older adults. Fully adjusted models revealed that African Americans with kidney cancer are over 5 times as likely to have a dementia diagnosis compared to African Americans without kidney cancer [OR: 5.48, p<0.05 (95% CI: 1.24, 24.20]). Other types of cancer (skin, breast, prostate, bladder, ovarian, colon, and “other”) were not significantly associated with increased odds of dementia diagnosis.ConclusionResults show a strong association between kidney cancer and dementia diagnosis in older African Americans, but not other types of cancer. Further research in this area may elucidate reasons for increased dementia risk in African Americans.

Low circulating adropin levels in late-middle aged African Americans with poor cognitive performance

We recently reported accelerated cognitive decline in Europeans aged > 70 years with low circulating adropin levels. Adropin is a small, secreted peptide that is highly expressed in the human nervous system. Expression profiling indicate relationships between adropin expression in the human brain and pathways that affect dementia risk. Moreover, increased adropin expression or treatment using synthetic adropin improves cognition in mouse models of aging. Here we report that low circulating adropin concentrations associate with poor cognition (worst quintile for a composite score derived from the MMSE and semantic fluency test) in late-middle aged community-dwelling African Americans (OR = 0.775, P < 0.05; age range 45–65 y, n = 352). The binomial logistic regression controlled for sex, age, education, cardiometabolic disease risk indicators, and obesity. Previous studies using cultured cells from the brains of human donors suggest high expression in astrocytes. In snRNA-seq data from the middle temporal gyrus (MTG) of human donors, adropin expression is higher in astrocytes relative to other cell types. Adropin expression in all cell-types declines with advance age, but is not affected by dementia status. In cultured human astrocytes, adropin expression also declines with donor age. Additional analysis indicated positive correlations between adropin and transcriptomic signatures of energy metabolism and protein synthesis that are adversely affected by donor age. Adropin expression is also suppressed by pro-inflammatory factors. Collectively, these data indicate low circulating adropin levels are a potential early risk indicator of cognitive impairment. Declining adropin expression in the brain is a plausible link between aging, neuroinflammation, and risk of cognitive decline.

The Fruit and Veggies for Kidney Health Study: A Prospective Randomized Trial

Providing fruits and vegetables (F&Vs) to health care system patients with elevated urine albumin-creatinine ratio (ACR) reduced ACR, slowed chronic kidney disease (CKD) progression and reduced cardiovascular disease (CVD) risk factors in previous studies. This study evaluated a community-based strategy in lower-income populations to identify African Americans with elevated ACR before health care system involvement and sustain them in a 6-month F&V protocol with (F&V+Cook) and without (F&V Only) cooking instructions, with the hypothesis that adjuvant cooking instructions with F&Vs would further reduce ACR. Prospective, randomized, parallel 2-arm design. African American adults with ACR>10mg/g creatinine randomized to 1 of 2 study arms. Two cups/day of F&Vs with or without cooking instructions in participants followed 6 months. Participants sustaining the F&V protocol and between-group indicators of CVD risk, kidney injury, and dietary intake at 6 weeks and 6 months. A total of 142 African American adults (mean age, 57.0 years; ACR, 27.4mg/g; body mass index, 34.4; 24.9% CKD 1; 24.8% CKD 2; 50.4% CKD 3; 55% female) randomized to F&V Only (n=72) or F&V+Cook (n=70), and 71% were retained at 6 months. Participants received 90% of available F&V pick-ups over 6 weeks and 69% over 6 months. In the adjusted model, 6-month ACR was 31% lower for F&V+ Cook than F&V Only (P=0.02). Net 6-week F&V intake significantly increased and biometric variables improved for participants combined into a single group. Small sample size, low-baseline ACR, and potential nonresponse bias for 24-hour dietary recall measure. These data support the feasibility of identifying community-dwelling African Americans with ACR indicating elevated CVD and CKD risk and sustaining a F&V protocol shown to improve kidney outcomes and CVD risk factors and provides preliminary evidence that cooking instructions adjuvant to F&Vs are needed to lower ACR. National Institute on Diabetes, Digestive, and Kidney Diseases grant "Reducing chronic kidney disease burden in an underserved population" (R21DK113440). NCT03832166. African Americans, particularly those in low-income communities, have increased rates of chronic kidney disease (CKD) with worsening outcomes over time. Giving fruits and vegetables to individuals with CKD identified in health care systems was previously shown to reduce kidney damage, measured by urine protein albumin, and slow kidney function decline. We recruited African Americans in low-income communities with increased urine albumin levels. They received fruits and vegetables for 6 months, and we tested whether added cooking instructions further reduced urine albumin levels. Most participants continued to receive fruits and vegetables throughout the 6 months. Those given cooking instructions had lower urine albumin levels after 6 months, indicating decreased kidney damage. Providing cooking instructions with fruits and vegetables appears to lessen kidney damage more than just fruits and vegetables alone.

EEG asymmetry and cognitive testing in MCI identification

BackgroundFinding the baseline resting-state EEG markers for early identification of cognitive decline can contribute to the identification of individuals at risk of further change. Potential applications include identifying participants for clinical trials, early treatment, and evaluation of treatment, accessible even from a community setting. MethodsAnalyses were completed on a sample of 99 (ages 60–90) consensus-diagnosed, community-dwelling African Americans (58 cognitively typical/HC, and 41 mildly cognitively impaired/MCI), who were recruited from the Michigan Alzheimer's Disease Research Center (MADRC) and the Wayne State University Institute of Gerontology. In addition to neuropsychological testing with CogState and Toolbox computerized batteries, resting-state EEGs (rsEEG, eyes closed) were acquired before and after participants were engaged in a visual motion direction discrimination task. rsEEG frontal alpha asymmetry (FAA) and frontal beta asymmetry (FBA) were calculated. ResultsFAA showed no difference across groups for the pre-task resting state. FBA was significantly different between groups, with more asymmetric frontal beta in MCI. Both physiological indices, however, along with computerized neuropsychological tests were significant predictors in logistic regression classification of MCI vs. control participants. ConclusionrsEEG asymmetries can contribute significantly to successful discrimination of older persons with MCI from those without, over and above cognitive testing, alone.

Correlates of Perceived Stress Among Community-Dwelling Older African Americans Without Dementia

The purpose of this study was to identify correlates of perceived stress among older African Americans without dementia. We grouped correlates into four levels – environmental, sociocultural, behavioral, and biological – guided by the National Institute on Aging’s (NIA) Health Disparities Research Framework. We performed a cross-sectional data analysis with the Minority Aging Research Study using ordinal logistic regression analyses. Participants were 722 African Americans without dementia [mean age = 73.61 years (SD=6.33)]. Correlates from environmental (e.g., larger life space), sociocultural (e.g., larger social network size), behavioral (e.g., more purpose in life), and biological (e.g., higher global cognition) levels were associated with lower odds of having greater levels of perceived stress. Perceived stress was associated with correlates from every level. Future research is needed to examine how changes in these correlates may be related to perceived stress in older African Americans.

The Effect of Vaccines on Older African Americans Emotional Experiences During the COVID-19 Pandemic

The COVID-19 pandemic is an unprecedented health emergency that has forced a change in the daily life of all individuals across the nation for over a year. As vaccinations have begun in Detroit, we examined their effect on older African Americans’ emotional experiences and intent to get vaccinated during the pandemic to help understand how persons make decisions to accept vaccinations. For this study, 194 community-dwelling older African Americans (mean age = 75, age range = 64-94) were recruited from the Wayne State Institute of Gerontology Healthier Black Elders Center and general Detroit area. A telephone survey was administered to assess pandemic experience including demographics, emotional responses (e.g., gratitude, happiness, anger, fear), everyday stressors (e.g., economic problems, reduced privacy), and vaccination attitude (e.g., concern over safety, intent to vaccinate). Of the 194 participants, 149 completed the survey before the first vaccination occurred in the United States on December 15, 2020, and 45 completed the survey after. Participants had not yet been vaccinated, but 67% said they would as soon as available. Participants in the post-vaccination group, as compared to pre-vaccination group, showed increases in stress-related locus of control (p=.03) and reported being more likely to get vaccinated (p=.02). They showed decreased worry about availability of health and safety supplies (p=.01), reduced perceived stress (p=.02), and a decrease in fears of COVID-19 (p=.05) and vaccination safety (p<.001). The current study highlights the effect of vaccinations on the attitudes and emotions experienced by an older minority population living in an urban area.

Effects of COVID‐19 on cognition of older African Americans

BackgroundThe Covid‐19 pandemic, with its diverse effects (e.g., on quality of life, health and illness, physical and psychological well‐being, social and economic life), has also been suggested to effect cognitive functioning. To better understand the possible effect of the COVID‐19 pandemic, we examined cognitive functioning of older African Americans.MethodStudy included 164 community‐dwelling older African Americans (mean age= 75.6, range=64‐94) recruited from the Wayne State Institute of Gerontology Healthier Black Elders Center and general Detroit area. Responses were gathered over the phone between 7/28/2020 to 1/14/2021. Change in cognitive functioning was evaluated with the newly developed Cognitive Change Questionnaire (CCQ) in which participants self‐evaluated their cognition related to daily activities (e.g., memorizing, paying attention, task switching) on a 5‐point scale (1–Much easier, 3–No difference, to 5–Much harder), comparing it to the pre‐pandemic time. In addition, all participants received the TICSm phone‐based cognitive screen. Responses to COVID‐19 were measured on these scales: positive emotions (e.g., gratitude, happiness), negative emotion (e.g., anger, fear), unmet needs (e.g., food, medical care), and personal issues (e.g., economic problems, reduced privacy).ResultFindings showed that 106 (65%) participants did not report any COVID‐19 related cognitive changes, 7 (4%) indicated improved cognitive functioning, and 50 (31%) indicated that their cognitive functioning was worse as compared to pre‐COVID‐19 times. Average CCQ scale score (range 8‐40) was 26.86. CCQ scale showed good psychometric properties (Cronbach alpha=.84). Significant correlations were obtained between CCQ and TICSm subscales: r=–.16 (p=.05) with total score, r=–.19 (p=.01) with immediate recall, and r=–.24 (p=.002) with delayed recall. Stepwise regression analysis showed that COVID‐19 related responses explained 24% of variability on CCQ: participants reported greater cognitive decline if they expressed greater level of negative emotions (21% explained variance) and higher anxiety (3% explained variance).ConclusionThese results demonstrate that a sizeable percentage of older community‐dwelling African Americans do self‐report cognitive decline following COVID‐19, associated with increased presence of negative emotions and anxiety. The possibility of altered cognitive function should be considered not only for quality‐of‐care issues, but also when recruiting for research trials during and after the pandemic.

Can Social Connections Improve Dementia Knowledge Among Homebound Community-Dwelling Older African Americans?

Despite the clear and compelling association between social connections and well-being, the underlying mechanisms that help stave off adverse health impacts are not well understood, particularly among older adults in disadvantaged groups. Social relationships in older age may be instrumental for exchanging and gaining knowledge that further influence health and help increase awareness about misconceptions and lifestyle behaviors known to delay or reduce cognitive decline. This study used cross-sectional survey data from 147(aged 58-90 years; 75% female) low-income African American homebound community dwellers to investigate heterogeneity in dementia literacy profiles and its association with social connectedness. Eleven items (false=0, true=1, don’t know=2) from a validated instrument were used to measure dementia literacy (DL). The Lubben’s social network scale was used for a social connectedness construct. We employed a 2-stage latent class modeling approach to examine heterogeneity in DL and estimate the regressions among the derived classes and the predictors (social connectedness, education level and age). A 3-class model produced a reasonable fit and classification (entropy=0.852) of “dementia literacy patterns” labeled as (high-literacy:37%), moderate-literacy:45.2%), low-literacy:17.8%)). Social connectedness was highly predictive of class membership. A high level of social relationships increased the probability of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class (OR=2.189, p=0.016). For a unit increase in social connectedness, the odds of being in the “high-dementia-literacy” class compared to the “low-dementia-literacy” class increased by a factor of 2.2. Tailored and focused interventions to reduce social disconnectedness may also help increase dementia awareness and reduce barriers to early diagnosis.

Qigong Exercise in Frailty, Psychological Health, and Spiritual Well-Being of Middle-Aged and Older Blacks

Interventions are needed to address the frailty and psychological health in middle-aged and older African Americans. Qigong, a traditional medicine exercise, consists of gentle body movements, breathing exercise, and meditation. The benefits of Qigong exercise have been widely reported in Asian adults but there have been no known studies testing Qigong exercise in the African American population. The purpose of this pilot study was to evaluate the potential benefits of an 8-week Qigong exercise in physical and functional ability, balance, frailty, depression and anxiety, and spiritual well-being in community-dwelling middle-aged African Americans using a single group design. Fifteen African Americans aged 45 to 85 years were recruited to receive Qigong exercise over 16 bi-weekly, one-hour sessions. The Layers Module that unfolds the complex multidimensional benefits of Qigong exercise on physical, mental, and spiritual dimensions was used to guide the outcome measures. Data were collected at baseline and 14 days post intervention. Results showed positive trends in repeat chair stands, physical function, and spiritual well-being (p<0.05) with effect sizes ranging from 0.45 to 0.87. Despite no significance, over 52% of the participants showed improved depression scores, fast gait speed, and standing balance than baseline. Nearly 42% demonstrated some levels of frailty improvement than the baseline. No adverse events related to Qigong exercise intervention was reported. Qigong exercise is a potentially promising intervention which needs further testing in a randomized clinical trial.

Older African Americans’ Perspectives on Exposure to Structural Discrimination Across Contexts and the Life Course

This presentation reports on findings from the first phase of a mixed methods study aimed at developing an instrument to assess older African Americans’ exposure to structural racial discrimination. We conducted semi-structured interviews with older African Americans about their perspectives on and exposure to structural discrimination. Participants (n=20) were community-dwelling African Americans aged fifty and older in Baltimore, MD. Participants described exposure to structural discrimination that had accumulated across the life course and across the contexts of education, employment, healthcare services, criminal justice system, neighborhood factors, media and marketing of unhealthy products, environmental toxin exposures, and income, credit and wealth. In the next phase of the study, we will incorporate these findings into the development of instrument items. Developing and testing a tool to assess exposure to discrimination beyond the interpersonal level is an important step in identifying solutions to mitigate the contribute of discrimination to racial health disparities.

The Association of ARMC5 with the Renin-Angiotensin-Aldosterone System, Blood Pressure, and Glycemia in African Americans.

Armadillo repeat containing 5 (ARMC5) on chromosome 16 is an adrenal gland tumor suppressor gene associated with primary aldosteronism, especially among African Americans (AAs). We examined the association of ARMC5 variants with aldosterone, plasma renin activity (PRA), blood pressure, glucose, and glycosylated hemoglobin A1c (HbA1c) in community-dwelling AAs. The Jackson Heart Study is a prospective cardiovascular cohort study in AAs with baseline data collection from 2000 to 2004. Kernel machine method was used to perform a single joint test to analyze for an overall association between the phenotypes of interest (aldosterone, PRA, systolic and diastolic blood pressure [SBP, DBP], glucose, and HbA1c) and the ARMC5 single nucleotide variants (SNVs) adjusted for age, sex, BMI, and medications; followed by Baysian Lasso methodology to identify sets of SNVs in terms of associated haplotypes with specific phenotypes. Among 3223 participants (62% female; mean age 55.6 (SD ± 12.8) years), the average SBP and DBP were 127 and 76 mmHg, respectively. The average fasting plasma glucose and HbA1c were 101 mg/dL and 6.0%, respectively. ARMC5 variants were associated with all 6 phenotypes. Haplotype TCGCC (ch16:31476015-31476093) was negatively associated, whereas haplotype CCCCTTGCG (ch16:31477195-31477460) was positively associated with SBP, DBP, and glucose. Haplotypes GGACG (ch16:31477790-31478013) and ACGCG (ch16:31477834-31478113) were negatively associated with aldosterone and positively associated with HbA1c and glucose, respectively. Haplotype GCGCGAGC (ch16:31471193-ch16:31473597(rs114871627) was positively associated with PRA and negatively associated with HbA1c. ARMC5 variants are associated with aldosterone, PRA, blood pressure, fasting glucose, and HbA1c in community-dwelling AAs, suggesting that germline mutations in ARMC5 may underlie cardiometabolic disease in AAs.

The Role of County Characteristics in Mental Health Service Use by Older African Americans.

Older African Americans may underutilize mental health services, although they experience mental health problems at rates comparable with those of whites. Untreated mental disorders contribute to increased risk of morbidity and mortality and decreased quality of life, and therefore, understanding the factors that influence racial disparities in service use is critical. This study examined whether county characteristics were associated with mental health service use by older African Americans after the analyses adjusted for individual characteristics. This study combined individual-level data from the 2008-2012 Medical Expenditure Panel Survey with county-level data for 2008-2012 from the 2013-2014 Area Health Resources Files and county-level data from the 2008-2012 Chronic Conditions Report of the Chronic Conditions Data Warehouse for 1,567 community-dwelling African Americans ages 60 and older. Multilevel logistic regressions were used to examine the role of county characteristics on mental health services use with adjustment for individual-level risk factors. At the county level, individuals living in a county with a higher proportion of African Americans were less likely to use mental health services. At the individual level, higher income and mental health status were associated with mental health service utilization. Among older African Americans, the racial composition of one's county of residence played a role in mental health service use, indicating the need for future research focusing on the relationship between an area's racial composition and mental health service use. Programs may be able to ameliorate racial disparities in mental health care by targeting areas with a higher percentage of African Americans.

EXPLORING THE WITHIN-PERSON COUPLING RELATIONSHIP BETWEEN BLOOD PRESSURE AND COGNITION IN OLDER AFRICAN AMERICANS

We examined the within-person relationship between systolic blood pressure (SBP) and cognition and whether this association is moderated by hypertension status and stress level. Analysis was conducted on 50 (39 women and 11 men) community-dwelling African Americans ranging in age from 50 to 80 years (M = 65.40, SD = 8.53). Participants’ blood pressure and cognition (i.e., executive function, memory, perceptual speed, inductive reasoning, constructional praxis, and language) was assessed on 8 different occasions over a 2-week time period. Stress was measured at baseline using the Elderly Life Stress Inventory. Findings show on days systolic blood pressure increased above an individual’s average level, their memory performance also tended to improve on that day. A significant 3-way interaction was further observed; such that on occasions when an individual’s systolic blood pressure was above his or her personal average, their executive functioning performance (i.e., Letter Fluency test) was significantly better, particularly for participants who on average had a high SBP (or were hypertensive) and reported a history of high stress. These results suggest that higher levels of blood pressure are related to better cognitive performance among middle age to older African Americans. These counterintuitive findings may be attributed to the inclusion of a selective sample of resilient African Americans who have survived despite having adverse health conditions. This association may also arise from stress induced high effort coping, which is needed to perform well on cognitive tasks but also increases blood pressure.

Pain Intensity among Community-Dwelling African American Older Adults in an Economically Disadvantaged Area of Los Angeles: Social, Behavioral, and Health Determinants.

Background. Although social, behavioral, and health factors influence prevalence and intensity of pain, very few studies have investigated correlates of pain among economically disadvantaged older African American (AA) adults. Objective. This study explored social, behavioral, and health correlates of pain intensity among community-dwelling AA older adults in an economically disadvantaged area of Los Angeles. Methods. A cross-sectional study on 740 AA older adults (age ≥ 55 years) was conducted in South Los Angeles between 2015 and 2018. Exploratory variables were age, gender, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, pain-related chronic medical conditions (CMCs), and depressive symptoms. Dependent variable was pain intensity. Linear regression was used for data analysis. Results. Age, financial difficulties, living alone, smoking, pain-related chronic medical conditions, and depressive symptoms were associated with pain intensity. Individuals with lower age, higher financial difficulties, those who lived alone, those with a higher number of pain-related chronic medical conditions, more depressive symptoms, and nonsmokers reported more pain intensity. Gender, educational attainment, marital status, and drinking were not associated with pain intensity. Conclusion. The results may help with the health promotion of economically disadvantaged AA older adults in urban areas.

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

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

The Use of Prayer During Life-Threatening Illness: A Connectedness to God, Inner-Self, and Others.

To explore how prayers were used as expressions of spirituality among community-dwelling African Americans in response to life-threatening illness. Fifty-eight older African American adults residing in the Southeastern US participated in a qualitative descriptive study. Through prayers, participants requested the strength to endure, protection, healing and expressed gratitude. Prayers were expressions of spirituality through dimensions of connectedness: transpersonally to God or the unseen; intrapersonally to one's inner-self; and, interpersonally to others. Prayers are an important aspect of spirituality and the mental health of older African Americans particularly during serious, life-threatening illness. An understanding of the ways in which prayers are used might enhance the cultural relevance of mental health interventions in this population.

Detection of Mild Cognitive Impairment Among Community-Dwelling African Americans Using the Montreal Cognitive Assessment.

To establish a cut score for the Montreal Cognitive Assessment (MoCA) that distinguishes mild cognitive impairment (MCI) from normal cognition (NC) in a community-based African American (AA) sample. A total of 135 AA participants, from a larger aging study, diagnosed MCI (n = 90) or NC (n = 45) via consensus diagnosis using clinical history, Clinical Dementia Rating score, and comprehensive neuropsychological testing. Logistic regression models utilized sex, education, age, and MoCA score to predict MCI versus NC. Receiver operating characteristic (ROC) curve analysis determined a cut score to distinguish MCI from NC based on optimal sensitivity, specificity, diagnostic accuracy, and greatest perpendicular distance above the identity line. ROC results were compared with previously published MoCA cut scores. The MCI group was slightly older (MMCI = 64.76[5.87], MNC = 62.33[6.76]; p = .033) and less educated (MMCI = 13.07[2.37], MNC = 14.36[2.51]; p = .004) and had lower MoCA scores (MMCI=21.26[3.85], MNC = 25.47[2.13]; p < .001) than the NC group. Demographics were non-significant in regression models. The area under the curve (AUC) was significant (MoCA = .83, p < .01) and an optimal cut score of <24 maximized sensitivity (72%), specificity (84%), and provided 76% diagnostic accuracy. In comparison, the traditional cut score of <26 had higher sensitivity (84%), similar accuracy (76%), but much lower specificity (58%). This study provides a MoCA cut score to help differentiate persons with MCI from NC in a community-dwelling AA sample. A cut score of <24 reduces the likelihood of misclassifying normal AA individuals as impaired than the traditional cut score. This study underscores the importance of culturally appropriate norms to optimize the utility of commonly used cognitive screening measures.

Restrictive Spirometry Pattern, Cardiac Structure and Function, and Incident Heart Failure in African Americans. The Jackson Heart Study.

Although chronic obstructive pulmonary disease has been related to heart failure, the relationship between the restrictive spirometry pattern (forced vital capacity [FVC] < 80% predicted with preserved forced expiratory volume in 1 second [FEV1]/FVC ratio) and heart failure is poorly understood. To determine whether having a restrictive spirometry pattern is associated with incident heart failure hospitalization. Community-dwelling African Americans from the Jackson Heart Study (total n = 5,306; analyzed n = 4,210 with spirometry and heart failure outcome data) were grouped by restrictive spirometry (FEV1/FVC ≥ 0.70, FVC < 80%; n = 840), airflow obstruction (FEV1/FVC < 0.70; n = 341), and normal spirometry (FEV1/FVC ≥ 0.70, FVC ≥ 80%; n = 3,029) at the time of baseline examination in 2000-2004. We assessed relationships of echocardiographic parameters and biomarkers with spirometry patterns using regression models. Incident heart failure was defined as an adjudicated hospitalization for heart failure after January 1, 2005 in subjects with no self-reported heart failure history. We used multivariable-adjusted Poisson regression models and Cox proportional hazards models, with death treated as a competing risk in the Cox models, to test associations between spirometry patterns and incident heart failure. We also modeled the association of FVC% predicted with heart failure hospitalization risk using a restricted cubic spline after excluding subjects with airflow obstruction. At the time of baseline spirometry, participants with restrictive spirometry had a median age of 57.2 years (interquartile range, 47.8-64.1); 38.1% were male. Compared with normal spirometry, restrictive spirometry was associated with a higher transmitral early (E) wave velocity to atrial (A) wave velocity ratio, higher pulmonary artery systolic pressure, and higher endothelin levels. After a median follow-up time of 8.0 years, 8.0% of subjects with restrictive spirometry (n = 67) had developed incident heart failure, compared with 3.8% of those with normal spirometry (n = 115) and 10.6% of those with airflow obstruction (n = 36). After risk adjustment, both a restrictive pattern (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.1-2.0) and airflow obstruction (HR, 1.7; 95% CI, 1.1-2.5) were associated with increased rates of incident heart failure hospitalization compared with normal spirometry. Using flexible modeling, the lowest hazards of heart failure hospitalization were observed around FVC 90-100%, with lower FVC% values associated with an increased incidence of heart failure. Both a restrictive pattern on spirometry and airflow obstruction identify African Americans with impaired lung health at risk for heart failure.