Elderly American Indians Research Articles

T54 - Prescribed Opioids and Neurocognitive Status Among Elderly American Indians: Data From the Strong Heart Study

T54 - Prescribed Opioids and Neurocognitive Status Among Elderly American Indians: Data From the Strong Heart Study

APOE genotype, brain imaging, and neuropsychological testing markers of Alzheimer’s disease: Data from the Strong Heart Study

AbstractBackgroundCarrying an APOE ε4 allele increases risk for Alzheimer’s disease and related dementias. However, risk effects and prevalence of risk alleles are not consistent across races/ethnicities. Prevalence of cognitive impairment or dementia and attributable risk from APOE ε4 genotype are unknown in American Indians (AI). This project evaluated associations of APOE genotype with cranial imaging and cognitive testing markers of vascular and Alzheimer’s dementias in a large, prospective, population‐based cohort of AI.MethodThe Strong Heart Study recruited 4,549 AI aged 45‐75 from 13 tribal communities across 3 major geographic regions in 1989‐1991. In 2010‐2013, all eligible surviving participants, then aged 65‐95, underwent cognitive examination including 3MS, WAIS, COWA, and CVLT‐II long delay free recall and cranial magnetic resonance imaging (MRI). APOE was genotyped from blood using ABI PRISM Linkage Mapping and DNA sequencing.ResultMost participants carried either 3.3 (73%) or 4.3 genotypes (23%). Clinical risk factors for dementia were prevalent, including high body mass index (mean>30), hypertension (80%), diabetes (48%), high LDL (39‐44%), chronic kidney disease (27%), and prior stroke (8‐9%). APOE ε4 carriers did not differ from non‐carriers in clinical factors, with the exception of serum LDL (103.9 mg/dL vs 96.7 mg/dL, P=0.015). Findings from MRI were also similar between genotypes, including presence of infarcts or hemorrhages, brain volume, and grade (0‐9) for white matter hyperintensities, sulcal widening, and ventricle enlargement. APOE ε4 carriers had marginally more WMH volume than non‐carriers. Cognitive examination scores were also similar, including Modified Mini Mental Status Examination (3MSE), Weschler Adult Intelligence Scale coding test (WAIS), Controlled Oral Word Association test (COWA), California Verbal Learning Test long delay free recall (CVLT).ConclusionDespite evidence for higher risk of Alzheimer’s and related dementias from presence of APOE ε4 allele among individuals from other populations, our study found little evidence of such an effect in elderly AIs. These findings raise intriguing questions about the presence of as‐yet‐unknown protective factors. Limitations of this study include cross‐sectional analyses and possibility of selective survival before the MRI examination. Future research should directly examine whether longitudinal changes in cognition and brain structure are associated with APOE genotype.

Cognitive Correlates of MRI-defined Cerebral Vascular Injury and Atrophy in Elderly American Indians: The Strong Heart Study.

American Indians experience substantial health disparities relative to the US population, including vascular brain aging. Poorer cognitive test performance has been associated with cranial magnetic resonance imaging findings in aging community populations, but no study has investigated these associations in elderly American Indians. We examined 786 American Indians aged 64 years and older from the Cerebrovascular Disease and its Consequences in American Indians study (2010-2013). Cranial magnetic resonance images were scored for cortical and subcortical infarcts, hemorrhages, severity of white matter disease, sulcal widening, ventricle enlargement, and volumetric estimates for white matter hyperintensities (WMHs), hippocampus, and brain. Participants completed demographic, medical history, and neuropsychological assessments including testing for general cognitive functioning, verbal learning and memory, processing speed, phonemic fluency, and executive function. Processing speed was independently associated with the presence of any infarcts, white matter disease, and hippocampal and brain volumes, independent of socioeconomic, language, education, and clinical factors. Other significant associations included general cognitive functioning with hippocampal volume. Nonsignificant, marginal associations included general cognition with WMH and brain volume; verbal memory with hippocampal volume; verbal fluency and executive function with brain volume; and processing speed with ventricle enlargement. Brain-cognition associations found in this study of elderly American Indians are similar to those found in other racial/ethnic populations, with processing speed comprising an especially strong correlate of cerebrovascular disease. These findings may assist future efforts to define opportunities for disease prevention, to conduct research on diagnostic and normative standards, and to guide clinical evaluation of this underserved and overburdened population.

Vascular Risk Factors and Findings on Brain MRI of Elderly Adult American Indians: The Strong Heart Study

Background: Clinical stroke is prevalent in American Indians, but the risk factors for cerebrovascular pathology have not been well-studied in this population. The purpose of this study was to correlate abnormalities on brain magnetic resonance imaging (MRI) with clinical risk factors in a cohort of elderly American Indians. Methods: Brain MRI scans from 789 participants of the Strong Heart Study were analyzed for infarcts, hemorrhage, white matter disease, and measures of cerebral atrophy including ventricular and sulcal grade and total brain volume. Clinical risk factors included measures of hypertension, diabetes, and high levels of low-density lipoprotein (LDL) cholesterol. Regression models adjusted for potential confounders were used to estimate associations between risk factors and brain MRI outcomes. Results: ­Hypertension was associated with the presence of infarcts (p = 0.001), ventricle enlargement (p = 0.01), and increased white matter hyperintensity volume (p = 0.01). Diabetes was associated with increased prevalence of cerebral atrophy (p < 0.001), ventricular enlargement (p = 0.001), and sulcal widening (p = 0.001). High LDL was not significantly associated with any of the measured cranial imaging outcomes. Conclusions: This study found risk factors for cerebrovascular disease in American Indians similar to those seen in other populations and provides additional evidence for the important roles of hypertension and diabetes in promoting cerebral infarcts and brain atrophy, respectively.

Low-level inorganic arsenic exposure and neuropsychological functioning in American Indian elders

BackgroundInorganic arsenic at high and prolonged doses is highly neurotoxic. Few studies have evaluated whether long-term, low-level arsenic exposure is associated with neuropsychological functioning in adults. ObjectivesTo investigate the association between long-term, low-level inorganic arsenic exposure and neuropsychological functioning among American Indians aged 64–95. MethodsWe assessed 928 participants in the Strong Heart Study by using data on arsenic species in urine samples collected at baseline (1989–1991) and results of standardized tests of global cognition, executive functioning, verbal learning and memory, fine motor functioning, and speed of mental processing administered during comprehensive follow-up evaluations in 2009–2013. We calculated the difference in neuropsychological functioning for a 10% increase in urinary arsenic with adjustment for sex, age, education, and study site. ResultsThe sum of inorganic and methylated arsenic species (∑As) in urine was associated with limited fine motor functioning and processing speed. A 10% increase in ∑As was associated with a .10 (95% CI −.20, −.01) decrease on the Finger Tapping Test for the dominant hand and a .13 decrease (95% CI −.21, −.04) for the non-dominant hand. Similarly, a 10% increase in ∑As was associated with a .15 (95% CI −.29, .00) decrease on the Wechsler Adult Intelligence Scale–Fourth Edition Coding Subtest. ∑As was not associated with other neuropsychological functions. ConclusionsFindings indicate an adverse association between increased urinary arsenic fine motor functioning and processing speed, but not with other neuropsychological functioning, among elderly American Indians.

Findings of Vascular Brain Injury and Structural Loss from Cranial Magnetic Resonance Imaging in Elderly American Indians: The Strong Heart Study

Background: The Cerebrovascular Disease and its Consequences in American Indians study conducted cranial MRI examination of surviving participants of the Strong Heart Study, a longitudinal cohort of elderly American Indians. Methods: Of the 1,033 recruited participants, some were unable to complete the MRI (n = 22), some scans were unusable due to participant motion or technical errors (n = 13), and one community withdrew consent after data collection (n = 209), leaving 789 interpretable MRI scan images. Six image sequences were obtained in contiguous slices on 1.5T scanners. Neuroradiologists graded white matter hyperintensities (WMH), sulci, and ventricles on a 0- to 9-point scale, and recorded the presence of infarcts and hemorrhages. Intracranial, brain, hippocampal, and WMH volumes were estimated by automated image processing. Results: The median scores for graded measures were 2 (WMH) and 3 (sulci, ventricles). About one-third of participants had lacunar (20%) or other infarcts (13%); few had hemorrhages (5.7%). Findings of cortical atrophy were also prevalent. Statistical analyses indicated significant associations between older age and findings of vascular injury and atrophy; male gender was associated with findings of cortical atrophy. Conclusions: Vascular brain injury is the likely explanation in this elderly American Indian population for brain infarcts, hemorrhages, WMH grade, and WMH volume. Although vascular brain injury may play a role in other findings, independent degenerative other disease processes may underlie abnormal sulcal widening, ventricular enlargement, hippocampal volume, and total brain volume. Further examination of risk factors and outcomes with these findings may expand the understanding of neurological conditions in this understudied population.

Cranial Magnetic Resonance Imaging in Elderly American Indians: Design, Methods, and Implementation of the Cerebrovascular Disease and Its Consequences in American Indians Study

The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study recruited surviving members of a 20-year, longitudinal, population-based cohort of American Indians focused on cardiovascular disease, its risk factors, and its consequences. The goal of the CDCAI Study is to characterize the burden, risk factors, and manifestations of vascular brain injury identified on cranial MRI. The CDCAI Study investigators enrolled 1,033 participants aged 60 and older from 11 American Indian communities and tribes in the Northern Plains, Southern Plains, and Southwestern United States. In addition to cranial MRI performed according to standardized protocols, participants underwent extensive medical interview, clinical examination, neurocognitive testing, physical function evaluation, electrocardiogram, and provided blood and urine specimens. Participants also self-administered questionnaires covering demographics, quality of life, and medical history. This report describes the design, implementation, and some of the unique challenges of this study and data collection.

2009 American Anthropological Association Meeting, New Orleans, LA, Session on Culture, Health and Aging in Native North American Communities

Introduction: Wayne WarryMarie’s Story Of Aging Well: Toward New Perspectives on the Experience Of Aging For Aboriginal Seniors in CanadaSyvia Abonyi Marie Favel, Ile a la CrosseMistreatment and the Meaning of Respect for Native EldersLori L. Jervis William Sconzert HallForgetting and Forgotten: Dementia in Aboriginal SeniorsKristen Jacklin and Wayne WarryUnderstanding Aging: Culture, Cognitive Health and Contemporary Aboriginal People’s Experience with DementiaJessica PacePerspectives on Brain Autopsy, Diabetic Amputation, and End-of-Life Issues among Elderly American Indian People Neil Henderson, L. Carson Henderson, Ryan Blanton and Steven GomezDiscussion: Robert C. Harman and Wayne Warry

Prescriptions for Potentially Inappropriate Medications Among Elderly American Indian Medicare Beneficiaries

Prescriptions for Potentially Inappropriate Medications Among Elderly American Indian Medicare Beneficiaries

Disparities and Chronic Health Care Needs for Elderly American Indians Living on or near a Reservation

The American Indian tribal nations and communities have long experienced health status worse than that of other Americans. Although major gains in reducing health disparities were made during the last half of the twentieth century, most gains stopped by the mid-1980s. Consequently, health disparities continue to exist with marked variation across Indian Health Service (IHS) areas and within tribes. This is especially concerning for low-income, elderly members of the American Indian community. Addressing chronic diseases in elderly American Indian communities will help us reach the Healthy People 2010: Understanding and Improving Heath goals of improving the quality of life and increasing the life expectancy of American Indians.1 In an effort to reduce these existing health disparities, it is important to understand the major illnesses affecting the American Indian community and address mechanisms to address the illnesses within the American Indian community. This is a review of the literature about the major illnesses found among elderly American Indians living on or near a reservation. Four sources, including CINAHL, Google Scholar, MEDLINE, and PsycInfo, were used to review the literature regarding elderly American Indians living on or near a reservation for the three leading causes of death (heart disease, cancer, and diabetes) and suggested recommendations for health intervention programs in these disease areas.

How Elders Guided the Evolution of the Modern Human Brain, Social Behavior, and Culture

To prepare for writing this article, we reviewed many academic tomes, from anthropology to zoology, and perused many decades’ worth of ethnographic studies of American Indian elders and elders from other groups around the world. We wanted not only to describe elderly American Indians but also to build the argument that elders are of critical importance for American Indian families and communities and have been of critical importance for tens of thousands of years. We wanted to construct the fundamental argument that in virtually all species with large brains and long childhoods, elders are of critical importance. This is as true in caribou as it is in humans; it is as true in American Indians as it is in whites, African Americans, and Asians. It is true because elders are the holders of ancient wisdom about the conduct and management of social behavior and about strategies for protecting the vulnerable from the problems that consistently arise in anyone’s life. In reviewing the literature, it was a bit startling to move from the period that encompassed the late 1800s to the 1940s. This literature includes strong and clear descriptions of the important role of American Indian elders, the wisdom of their words, and the respect that their position held; hundreds of detailed descriptions of the importance of the elders and their

Albuminuria Within the “Normal” Range and Risk of Cardiovascular Disease and Death in American Indians: The Strong Heart Study

"Normal" albuminuria has been defined as urinary albumin-creatinine ratio (UACR) less than 30 mg/g (3.4 mg/mmol). Whether higher UACR within this range independently predicts cardiovascular disease (CVD) and CVD death is uncertain. A total of 3,000 participants aged 45 to 74 years with a UACR less than 30 mg/g and free of CVD at the baseline examination of the Strong Heart Study (SHS) were evaluated. Survival time was calculated from the baseline examination to the first nonfatal CVD, fatal CVD, or December 31, 2002. During follow-up (average, 10.4 years), 383 incident nonfatal CVD and 145 fatal CVD cases were ascertained. After adjustment for conventional CVD risk factors, participants with a UACR in the third (UACR >or= 5.4 to <10.2 mg/g [>or=0.6 to <1.1 mg/mmol] in men, >or=7.6 to <12.9 mg/g [>or=0.9 to <1.4 mg/mmol] in women) and the fourth (UACR >or=10.2 to <30 mg/g in men, >or=12.9 to <30 mg/g in women) quartiles had 41% and 72% greater risks of all CVD events and 118% and 199% greater risks of CVD mortality than those in the lowest quartile (UACR < 2.7 mg/g [<0.3 mg/mmol] in men, <4.3 mg/g [<0.5 mg/mmol] in women), respectively. In subgroup analysis, these associations were more pronounced in persons with diabetes. In the SHS cohort of middle-aged to elderly American Indians, albuminuria levels less than the traditional cutoff value predict CVD. Our findings agree with a growing number of studies questioning the concept that UACR less than 30 mg/g is normal.

Not traditional, not assimilated: elderly American Indians and the notion of 'cohort'.

In this article, a Native Americanist anthropologist whose research focuses on elders, and a gerontologist who specializes in American Indians, draw on their respective studies--the former primarily quantitative and the latter primarily qualitative--to illuminate the nature of ethnic identity among American Indian elderly. The regional focus is the Upper Great Lakes (primarily Michigan) and the tribal/cultural group under consideration is the Anishinaabeg (Chippewa, Ottawa, Potawatomi). The analysis is centered on a key concept--cohort--considered by the authors to be crucial to the understanding of American Indian elderly. In addition to integrating quantitative and qualitative findings, an historical framework is utilized to assist in interpreting the results. It is suggested that Anishinaabe elders, despite some superficial appearances to the contrary, are by no means fully assimilated into mainstream American culture; their ethnic identity is not necessarily stereotypically 'traditional,' but it is nonetheless quintessentially American Indian. Researchers will be better able to appreciate such subtleties by taking into consideration the ways in which various stages in the life course intersect with specific historical periods (cohort), as well as by drawing on both qualitative and quantitative studies in pursuing their investigations.

Health Care of American Indian Elderly: Determinants of the Perceived Difficulty Obtaining Access to Health Care

This study examines the perceived areas of difficulty in obtaining access to health care and the factors influencing that difficulty among elderly American Indians in a rural environment. One hundred thirty-seven elderly Indians in the Ponca and Pawnee tribes of Oklahoma were interviewed. Four major difficulties are reported: a long waiting period at Indian health centers, difficulty in making appointments to see physicians, language and cultural barriers to communication with the health care providers, and lack of available transportation. The long waiting period is the most serious problem, and lack of transportation is the least serious. The results of probit analysis show that physical health, automobile ownership, education, employment, and the presence of an informal caregiver are related to difficulty obtaining access to health care. Ways to minimize this difficulty are discussed.

Major electrocardiographic abnormalities among American Indians aged 45 to 74 years (the strong heart study)

As part of the Strong Heart Study assessment of prevalent cardiovascular disease in middle-aged to elderly American Indians, the prevalence of major Minnesota code electrocardiographic (ECG) abnormalities was assessed in 4,531 participants aged 45 to 74 years (59% women) in selected tribal communities in Arizona, South and North Dakota, and Oklahoma. The overall prevalence of major ECG abnormalities was lowest in Arizona participants, (e.g., definite ECG myocardial infarction in 0.3% vs 1.8% in the other centers), although nearly two thirds of them had diabetes. One or more major ECG abnormality occurred in progressively more women (10.4% to 21.2%) and men (13.3% to 32%) (both p < 0.0001) from 45- to 54- to 55- to 64- and 65- to 74year age groups, with the latter prevalence rates exceeding those in predominately white age peers in the Cardiovascular Health Study. Diabetes in women, but not in men, and hypertension in both genders showed positive associations with prevalence rates of major ECG abnormalities compatible with coronary artery disease or hypertensive cardiac hypertrophy. Hypercholesterolemia was not associated with ECG abnormalities except for definite myocardial infarction in women. In conclusion, major ECG abnormalities are common in middleaged to elderly American Indians, consistent with recent documentation of higher cardiovascular mortality in this population than in similar-aged U.S. whites.

American Indian Elder Abuse:

This paper presents an overview of factors that put elderly American Indians at risk for domestic abuse and neglect. Protective factors that contribute to family and tribal resiliency are also discussed. Although little is known about elder abuse among Indians, it is possible that older individuals both on and off the reservation are more at risk today than ever before. On the other hand, non-Indians can learn much from Indian people about building and maintaining family and cultural strenghts that may reduce or prevent mistreatment of the elderly and other famly members.

A Model for Assessing Rehabilitation Needs of the Elderly American Indians Who Are Visually Impaired and Living on Reservations

The purpose of the article is to present a research model for assessing rehabilitation needs of elderly American Indians who are visually impaired or blind and living on reservations. The article describes the research design, methodology, andfindings of a recent study which assessed the rehabilitation needs of the elderly American Indians who were visually impaired or blind and living on the Hualapai reservation in Arizona. The article includes a review of literature as regards the elderly American Indians in order to emphasize the need/or assessing rehabilitation needs of those who are visually impaired or blind among them.

Nutrient Intake of Urban Elderly American Indians

To provide nutrition programming for the local American Indian Council preliminary food intake data was collected. Twenty urban elderly American Indians consented to provide three day dietary records and seventeen provided demographic information. Additionally, twenty elderly non-American Indians provided dietary records for comparison purposes. Results of the nutrient analysis indicated nutrient intakes similar to the general elderly population with total food energy, vitamin A, and calcium intakes below recommendations for both groups. The elderly American Indians consumed significantly greater amounts of total food enregy, protein, fat, and niacin than the non=Indians. This difference was likely due to the inclusion of traditional food in the American Indians' diets. Recommendations are made for the focus of nutrition education with this group.

Life satisfaction of the elderly American Indian

This study examined the life satisfaction of 58 elderly American Indians and its relationship to selected external and internal environmental factors. Elderly Indians were 51–85 years of age and resided on two midwestern reservations. Data were collected through use of the Life Satisfaction Index Z-scale (LSI-Z), the Oars Multi-dimensional Functional Assessment Questionnaire (OARS) and a semi-structured interview schedule. Findings indicated that life satisfaction tended to be high. Six internal environmental variables explained 40% of the variance in life satisfaction scores. A higher correlation was found between self-perception of life satisfaction and mental health than objective ratings on these two variables. This study suggests that variables associated with the internal environment may be useful as indicators of life satisfaction in elderly reservation American Indians and that subjective measures of life satisfaction may be more predictive of mental health than objective measures.

Impact of mental disorders upon elderly American Indians as reflected in visits to ambulatory care facilities.

In order to assess the impact of mental health problems among elderly American Indians, a study was conducted on the utilization patterns of ambulatory care facilities by various age groups of Indians. Since most health care of Indians is rendered by the Indian Health Service (IHS), data obtained from IHS computer centers provided a reasonable index of disease patterns. Because the elderly have constituted such a small fraction of the Indian population, they have not heretofore received significant attention. However, their problems are rapidly increasing. By adjusting the frequency of visits according to population, an estimate of visit "rates" was made. These rates showed one visit for every 10 persons in the 0-44 age group, one for every 5 persons in the 45-54 age group, but only one visit for every 25 persons in the 65+ age group. Most of the visits by older Indians concerned "social" problems rather than "mental" disorders as such. These data provided information that should prove especially helpful in the design of social and health programs for elderly Indians.