Elderly Hispanics Research Articles

236 Association Between Gait Limitation and Alzheimer’s Disease: Comparison among Elderly in Puerto Rico and Mainland U.S.

OBJECTIVES/GOALS: In 2022, 116,000 Puerto Ricans were estimated to be affected by Alzheimer’s disease (AD). Gait limitation (GL) has been associated with different stages of AD. We study the GL-AD association in two elderly populations: Hispanics residing in PR and Americans in the mainland U.S., and identify the effects, and social determinants of health. METHODS/STUDY POPULATION: We propose a cross-sectional study involving data analysis from elderly (>65 years) Hispanics in PR and Americans in the U.S. Data will come from the National Alzheimer Coordinating Center (NACC) and a cohort of AD in PR. Our analysis will consider gait parameters, cognitive performance assessments, and AD stage (mild, moderate, and severe) as determined by the Alzheimer’s Association. We will examine social determinants of health and their association with GL and cognitive performance by AD. RESULTS/ANTICIPATED RESULTS: Our analysis will evaluate data about GL and AD stages to 1) investigate the association between GL and the distinct stages of AD and 2) evaluate the effects of social determinants of health in the association between GL and AD. We seek to profoundly understand how these factors interact within elderly populations. This exploration encompasses a diverse demographic, including elderly individuals in the U.S. and PR. We seek to identify disparities in social determinants among elderly individuals experiencing GL and AD by comparing PR and US populations. Through this association analysis, our study aspires to offer insight into the connections between GL and AD while considering the effects of social determinants of health in diverse populations. DISCUSSION/SIGNIFICANCE: The prevalence of AD is higher among Hispanic populations (e.g., Puerto Ricans) in the USA when compared to other ethnic groups. Experiencing GL may affect their daily lives, leading to exacerbating AD stages. The findings from this study will contribute to possible interventions to improve their GL and AD progression.

Preventing Falls in Community-Dwelling Hispanic Elderly Using an Evidenced-Based Fall Prevention Toolkit

Preventing Falls in Community-Dwelling Hispanic Elderly Using an Evidenced-Based Fall Prevention Toolkit

Abstract 16794: Trends and Predictors of In-Hospital Mortality in Elderly STEMI Patients With Cancer - 2016-2019

Introduction: As cancer survivors have imported survival rates, they are more likely to develop cardiovascular diseases (CV), identifying elderly cancer patients who are at high risk of mortality with the development of ST-segment elevation myocardial infarction (STEMI) becomes important. Methods: Using 2016-19 National Inpatient Sample, we identified elderly (>65 years) cancer patients with STEMI admissions and were analysed for demographic and clinic risk factors of all-cause mortality (ACM). Results: Of 13470 selected STEMI admissions with cancer patients, decreased cohort had higher rates of females (41.8 vs 33.8%, p<0.001), blacks & Asian/Pacific Islanders (8.1 vs 0.6%; 3.1 vs 2.5%; p=0.035), patients from lower income quartile (29.5 vs 25.2%, p<0.001), with severe renal failure (2.4 vs 1.6%, p<0.001) vs. those who survived. STEMI-cancer patients with hypertension, hyperlipidemia, smoker status, obesity, prior MI, and prior PCI/CABG had steady trends in ACM with DM interestingly showing improving trends in mortality (24% vs 18.1%) from 2016-19. Multivariate regression also did not reveal the worse impact of traditional cardiovascular risk factors on ACM. Conclusions: We identified elderly Hispanics being the only predictor of all-cause mortality in elderly cancer patients that develop STEMI.

Age-related Changes of the Corneal Endothelium in the Hispanic Elderly Population

Purpose: To assess the corneal endothelial morphometry in healthy elderly Hispanic eyes. Methods: A retrospective, cross-sectional, observational, descriptive, and analytical study was designed to assess the central region of the corneal endothelium by specular microscopy. A total of 241 eyes from 125 patients were studied. All eyes included were from healthy patients 65 or older (mean: 74.56± 6.74), without ocular disease or surgeries. Results: The mean cell density (MCD) was 2198.92±493.43 cells/mm2. 125 (51.87%) eyes had polymegethism, with a mean coefficient of variation (CV) of 42.89 ± 9.16%. 148 (61.41%) eyes presented pleomorphism, with an average of 46.25 ± 7.13% hexagonal cells. The mean corneal thickness was 527.55±28.37 μm. A statistically significant difference between age groups was found for MCD and pachymetry (P<0.05). 41 eyes (17.01%) had cornea guttata. Conclusion: This study suggests that the elderly Hispanic population has a high prevalence of polymegethism, pleomorphism, and guttata. Surprisingly, the oldest age group (>85) had an above-average MCD, with lower rates of polymegethism and pleomorphism. Trial Registration Number: #ARCC/ECH2019 Date of Registration: October 18, 2019

Air Pollution and Traffic Noise Interact to Affect Cognitive Health in Elderly Hispanics

Air Pollution and Traffic Noise Interact to Affect Cognitive Health in Elderly Hispanics

A prospective cross-sectional study of tuberculosis in elderly Hispanics reveals that BCG vaccination at birth is protective whereas diabetes is not a risk factor.

BackgroundAging increases the risk of tuberculosis (TB) and its adverse outcomes, but most studies are based on secondary analyses, and few are in Hispanics. Diabetes is a risk factor for TB in adults, but its contribution in the elderly is unknown. We aimed to identify the role of diabetes and other risk factors for TB in elderly Hispanics.MethodsCross-sectional study among newly-diagnosed TB patients, recent contacts (ReC), or community controls (CoC) totaling 646 participants, including 183 elderly (>60 years; 43 TB, 80 ReC, 60 CoC) and 463 adults (18 to 50 years; 80 TB, 301 ReC and 82 CoC). Host characteristics associated with TB and latent Mycobacterium tuberculosis infection (LTBI) were identified in the elderly by univariable and confirmed by multivariable logistic regression.ResultsLTBI was more prevalent among the elderly CoC (55% vs. 23.2% in adults; p<0.001), but not in ReC (elderly 71.3% vs. adult 63.8%); p = 0.213). Risk factors for TB in the elderly included male sex (adj-OR 4.33, 95% CI 1.76, 10.65), smoking (adj-OR 2.55, 95% CI 1.01, 6.45) and low BMI (adj-OR 12.34, 95% CI 4.44, 34.33). Unexpectedly, type 2 diabetes was not associated with TB despite its high prevalence (adj-OR 0.38, 95% CI 0.06, 2.38), and BCG vaccination at birth was protective (adj-OR 0.16, 95% CI 0.06, 0.45).ConclusionsWe report novel distinctions in TB risk factors in the elderly vs. adults, notably in diabetes and BCG vaccination at birth. Further studies are warranted to address disparities in this vulnerable, understudied population.

Apolipoprotein ɛ4 Affects Multiple Domains of Neuropsychological Functioning in a Sample of Elderly Hispanics

Apolipoprotein ɛ4 allele (APOEɛ4) is the strongest genetic risk factor for sporadic Alzheimer's disease (AD), but inconsistencies have arisen in studies with Hispanics. The objective of this study was to explore APOEɛ4 expression and cognitive function in a sample of Panamanian older adults, including healthy controls, mild cognitive impairment, and AD. Participants with at least one copy of APOEɛ4 had a significantly lower performance in global cognition, verbal memory, executive functions, visuospatial abilities, regardless of diagnosis. The present study contributes to the understanding of the association of APOEɛ4 and impairment in specific cognitive domains in elderly Hispanics.

Cultural factors related to neuropsychological performance and brain atrophy among Hispanic older adults with amnestic Mild Cognitive Impairment (aMCI): A pilot study

Objectives This study examined the association of cultural factors and literacy to neuropsychological performance and measures of regional brain atrophy among Hispanic elders diagnosed with amnestic Mild Cognitive Impairment (aMCI). Method Acculturation and literacy levels were measured among 45 subjects tested in Spanish; their primary language. Scores for measures of memory, executive functioning, and verbal fluency, as well as volumetric analysis of MRI scans of left hemisphere structures commonly affected by Alzheimer’s disease (AD) were examined. Linear regression models were employed to examine the association of acculturation and literacy to neuropsychological performance and MRI measures. Results After controlling for age, higher literacy levels were associated with better performance on phonemic verbal fluency (r = 0.300, p < .05), while higher levels of acculturation to the U.S. was associated with poorer performance on category verbal fluency (r = 0.300, p < .05). There was a significant inverse relationship after controlling for age between literacy and the left entorhinal cortex (r = –0.455, p < .05), left precuneus (r = –0.457, p < .05), and left posterior cingulate (r = –0.415, p < .05). Conclusions Results of the current pilot study indicate that high acculturation to the U.S. among aMCI immigrants from Latin-American countries may hinder performance on verbal learning measures when they are administered in one’s primary language. Moreover, in this cohort, a higher literacy level, which is indicative of greater cognitive reserve, was associated with better performance in language measures, but with greater atrophy in brain regions susceptible to neurodegenerative disease. These preliminary findings should be further examined among larger cohorts and using more diverse measures, which capture other cultural constructs.

SURVIVAL ANALYSIS AMONG VERY OLD MEXICAN AMERICAN: THE IMPORTANCE OF IMMIGRATION

The older Hispanic population is growing rapidly in the United States. Research consistently shows a survival advantage among Hispanics, despite a worse risk profile (i.e. Hispanic Paradox). The goal of this study was to confirm this survival advantage among very old Mexican Americans (75+) and to test the impact of immigration status on mortality risk. We used data from the 1993–1994 Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), which was linked to follow up vital status in 2016. We used Cox proportional hazards models to estimate risk of death for those born in the US (vs. foreign-born), while controlling for demographics and health conditions. The sample (n=1,108) was a majority female (59%), non-married (58%), and had an average education of 3.33 years. The average age was 80.91 (range 75–105). The multivariate Cox regression model showed that US-born Hispanic elders had 26% higher odds of death compared to foreign born (p-value =.00015). The models controlled for demographics and health conditions. While being female was a significant direct predictor of survival, the immigration effect did not differ by gender. These results confirm that a significant factor influencing survival among very older Mexican Americans is immigration status. This suggests that the healthy immigrant effect maintains even in old age. Policy and practice implications will be discussed.

Do accountable care organizations affect race mediated differences in cancer screening?

131 Background: Accountable care organizations (ACO) reflect a payment innovation aimed to orient incentives to improve quality and reduce waste. The objective of this study was to determine whether ACO enrollment affects racial disparities in cancer screening, and to characterize the impact on the appropriateness of prostate cancer screening in minority populations. Methods: We built a cohort of Medicare beneficiaries from 2007 to 2013 were comprising a cohort of 11,087,056 person-years among ACO beneficiaries and 37,187,979 person-years among non-ACO beneficiaries. A difference-in-difference-in-differences (DDD) approach was utilized to identify the effect of ACO enrollment on cancer screening in racial/ethnic minorities relative to non-Hispanic whites. We then characterized differences in screening appropriateness after ACO enrollment using age (65-74 vs. 75+) and predicted survival (top vs. bottom quartile). Results: ACO enrollment was associated with approximately a 5% reduction in prostate cancer overscreening for white beneficiaries, namely among the elderly and those with unfavorable predicted survival. Compared to white men in the lowest quartile of predicted survival, Asian and Hispanic men with similarly low survival had a 4.8% and 13.0% relative increase in prostate cancer screening associated with ACO enrollment (DDD p = 0.015, p = 0.011, respectively). Prostate cancer overscreening was common among Asian men, with 46% of elderly Asian men attributed to an ACO undergoing cancer screening compared to 28% of elderly white men. Furthermore, ACO enrollment was associated with a 2.7% increase in screening relative to whites (DDD p = 0.0005). Compared to white beneficiaries, black men had consistently lower rates of prostate cancer screening. ACO enrollment did not narrow the disparity of prostate cancer screening between healthier (DDD p = 0.75) or younger (DDD p = 0.27) black and white beneficiaries. Conclusions: This study provides evidence of ACO-mediated increases in low-value screening for prostate cancer among sick and elderly Hispanics and Asians. Furthermore, ACO enrollment did not narrow known disparities in high-value prostate cancer screening among healthier and younger black men.

Physical activity modifies the influence of apolipoprotein E ε4 allele and type 2 diabetes on dementia and cognitive impairment among older Mexican Americans

IntroductionThe etiologies of dementia are complex and influenced by genetic and environmental factors including medical conditions. MethodsWe used Cox regression model to estimate the individual and joint effects of physical activity (PA), apolipoprotein E (APOE) ε4, and diabetes status on risk of dementia and cognitive impairment without dementia (CIND) among 1438 cognitively intact Mexican American elderly who were followed up to 10 years. ResultsThe risk of developing dementia/CIND was increased more than threefold in APOE ε4 carriers or diabetics with low levels of PA compared with ε4 noncarriers or nondiabetics who engaged in high PA (ε4: hazard ratio [HR] = 3.44, 95% confidence interval [CI] = 1.85–6.39; diabetes: HR = 3.11, 95% CI = 1.87–5.18); the presence of all three risk factors increased risk by nearly 10-fold (HR = 9.49, 95% CI = 3.57–25.3). DiscussionPA in elderly Hispanics protects strongly against the onset of dementia/CIND, especially in APOE ε4 carriers and those who have diabetes.

Light and Moderate to Vigorous Physical Activity Correlates with Physical Fitness in Hispanic Elders

Recent evidence suggests that light activity (LA) as well as moderate to vigorous physical activity (MVPA) are associated with reduced mortality from all causes. Physical fitness (PFit) is also associated with better health maintenance and functionality, particularly among elders. However, the association between LA and PFit components has not been explored in this population. PURPOSE: To evaluate the association between PFit and LA, LA to MVPA (LMVPA), and MVPA in a group of Hispanic elders in Puerto Rico. METHODS: Sixty-two elders (24 females, 38 males; mean age = 76.4±8.4 yrs) completed a battery of PFit testing (sit and reach for flexibility, hand dynamometer and arm curls in 30 sec. for muscle strength and resistance, distance in 6 min for cardiorespiratory fitness, and foot up and go for agility), and wore an ActiGraph accelerometer (GT3X+) attached to a waist band during 7 consecutive days. Wilcoxon rank-sum tests were conducted to detect differences by sex, and spearman correlations to determine associations between PFit, LA, MVPA, and LMVPA. RESULTS: PFit and physical activity variables were not different between females and males; but some differences were detected in some anthropometric variables (WHR; 0.96±0.07 vs. 0.91±0.07, and muscle resistance = 18.3±3.3 vs. 15.4±4.9, respectively, P<0.05). LA (27.7±11.5 hr/day), MVPA (59.7±118.0 min/week) and LMVPA (28.7±12.3 hr/day) correlated with cardiorespiratory fitness (0.30, 0.31, 0.28; respectively, P<0.03); time in agility test (-0.38, -0.27, -0.35; respectively, P<0.04), and muscle strength (0.29, 0.26, 0.28; respectively, P<0.05). Flexibility correlated only with LA and LMVPA (0.30, 0.29; respectively, P<0.04). CONCLUSION: Our results suggest that LA as well as LMVPA positively influence cardiorespiratory fitness, agility, muscle strength and flexibility components of PFit in Hispanic elders. Therefore, LA could be integrated in physical activity recommendations for this population.

Chronic Pain and Psychological Distress Among Older Adults: A National Longitudinal Study.

This research examines whether unobserved time-stable influences confound the association between chronic pain and psychological distress in older adults as well as how race and ethnicity combine with subjective social status (SSS) to modify the association. In a nationally representative longitudinal survey, holistically controlling for unobserved time-stable influences using fixed-effects models substantially reduces the pain-depression relationship and eliminates the overall pain-anxiety relationship. The association with depression is stronger for Black and Hispanic elders, illustrating a process of double-jeopardy. Black elders with severe pain experience lower anxiety, as do Black elders with moderate pain and low SSS, which we suggest may be due to the enervating effects of undermanaged pain. Black elders at high SSS experience greater anxiety with moderate pain. This research suggests that undermanagement of chronic pain among racial and ethnic minorities differentiates the association between pain and distress in late life and especially creates stronger associations with depression.

Abstract 50: Persistent Racial/Ethnic Disparities Despite Declining Rates of Ischemic Stroke Hospitalizations Among Medicare Beneficiaries, 2001-2013

Background: Stroke hospitalizations in the US have declined over the last decade, but little is known about whether decreases are similar across racial/ethnic groups. We compared ischemic stroke hospitalization rates and geographic patterns across the US from 2001-2013 for elderly Hispanics, Blacks, Whites, and those of other race/ethnicity. Methods: Ischemic stroke hospitalizations (ICD-9 primary discharge codes 433, 434, 436) were identified among Medicare fee-for-service beneficiaries aged ≥65y in 2001-2003 and 2011-2013. National annualized rates for each period were calculated per 100,000 person-years (PY). A spatial mixed model with a Poisson link function and adjustment for age and sex was fit to calculate and map county-specific risk-standardized stroke hospitalization rates for each racial/ethnic group. Results: National annualized stroke hospitalization rates decreased by 15% between 2001-2003 and 2011-2013 (1298/100,000 PY to 1103/100,000 PY). County-level risk-standardized hospitalization rates varied across the US and among the four racial/ethnic groups (figure). Regardless of time period, Blacks had the highest rates, followed by Whites, Hispanics, and other races. The absolute and relative declines in risk-standardized hospitalization rates were smallest for Hispanics (173/100,000 PY; 15%) and Blacks (196/100,000 PY; 12%) compared to Whites (243/100,000 PY; 19%) and other races (273/100,000 PY; 33%). Conclusions: Although national hospitalization rates for ischemic stroke among those aged ≥65y decreased between 2001 and 2013, the decline varied by race/ethnicity, with persistent disparities between groups. Despite the declines in US stroke hospitalizations, these racial/ethnic differences call for greater prioritization of prevention intervention programs to reduce stroke disparities. AHA/ASA efforts to expand stroke systems of care also need to address these disparities.

A-36Differences in Neuropsychological Performance in the Diagnosis of Alzheimer's Disease Among Non-Hispanic and Hispanic Elderly

A-36Differences in Neuropsychological Performance in the Diagnosis of Alzheimer's Disease Among Non-Hispanic and Hispanic Elderly

Serum-based protein profiles of Alzheimer's disease and mild cognitive impairment in elderly Hispanics.

To describe the biomarker profiles in elderly Panamanians diagnosed with Alzheimer's disease (AD), mild cognitive impairment (MCI) or no impairment using serum-based biomarkers. Twenty-four proteins were analyzed using an electrochemiluminescence-based multiplex biomarker assay platform. A biomarker profile was generated using random forest analyses. Two proteins differed among groups: IL-18 and T-lymphocyte-secreted protein I-309. The AD profile was highly accurate and independent of age, gender, education and Apolipoprotein E ε4 status. AD and MCI profiles had substantial overlap among the top markers, suggesting common functions in AD and MCI but differences in their relative importance. Our results underscore the potential influence of genetic and environmental differences within Hispanic populations on the proteomic profile of AD.

Analysis of overall survival in a large multiethnic cohort reveals absolute neutrophil count of 1,100 as a novel prognostic cutoff in African Americans.

Although absolute neutrophil counts (ANC) below 1.5x103/uL are used to define neutropenia as a marker of increased susceptibility to infections, their relationship with survival has not been examined. Since low counts trigger extensive investigations, determining prognostic cutoffs especially for different ethnicities and races is critical.A multiethnic cohort of 27,760 subjects, 65 years old and above, was utilized to evaluate the association of neutropenia with overall survival in different ethnicities and races.The mean ANC was 4.6±1.51x103/uL in non-Hispanic whites, 3.6±1.57x103/uL in non-Hispanic blacks and 4.3±1.54x103/uL in Hispanics (p<0.001). An ANC below 1.5x103/uL was associated with significantly shorter overall survival among whites (HR 1.74; 95% CI 1.18 - 2.58; p<0.001), but not in blacks (HR 0.89; 95% CI 0.86 - 1.17; p=0.40) or Hispanics (HR 1.04; 95% CI 0.76 - 1.46; p=0.82), after adjustment for age, sex, comorbidities, anemia and thrombocytopenia. Using Cox regression multivariable models, an ANC below 1.1x103/uL in blacks was found to be associated with increased mortality (HR 1.86; 95%CI 1.21 - 2.87; p<0.01). We found no association between neutropenia and mortality at any ANC cutoff in elderly Hispanics. In conclusion, neutropenia was found to be an independent prognostic variable in the elderly, when determined in race-specific manner. Most importantly, a cutoff of 1.1x103 neutrophils/uL may be a more prognostically relevant marker in elderly blacks and could serve as a novel threshold for further evaluation and intervention in this population.

A Multi-Level Model for Improving Immunization Rates in the United States: Where are the Gaps and Opportunities for Individual, Household and Neighborhood-Level Data?

s / Annals of Epidemiology 25 (2015) 702e719 711 positive indirect effects (p<.05) of perceived discrimination on unhealthy days through perceived stress, sleep disturbances, and self-reported medical conditions (model fit: RMSEA 0.048; CFI .99; TLI; .96; Chisquare/DF 1⁄4 104.4/10). Conclusion: Future research and community health promotion programs should address the experiences of discrimination as this may help improve physical and mental health outcomes among racial minorities. P36. Health Disparities and Barriers to Healthcare Access and Utilization in Elderly Hispanic Diabetics Shweta Shah MHA, Suzzane Boyd PhD. University of North Carolina at Charlotte Purpose: Hispanics have a higher risk of developing diabetes mellitus and its complications than other ethnic groups. This study focused on the role of three social determinants, policy recommendations, and a culturally competent model for diabetes management in elderly Hispanics. Methods: The electronic databases Medline, PubMed, ScienceDirect, and ERIC were systematically searched from 1984 to 2014.

Preliminary Detection of Relations Among Dynamic Processes With Two-Occasion Data

Most novel analytic methods for longitudinal data are applicable to studies spanning three time-points of data at a minimum, whereas methods for two-occasion data have garnered comparatively little attention. Here, we address this limitation by introducing the two-wave latent change score (2W-LCS) model, a technique appropriate for preliminary detection of relations among dynamic processes with two-occasion data. The 2W-LCS model is well suited for the investigation of hypotheses in which changes in a construct are posited as predictors of changes in another construct. In an empirical illustration using data of elderly Hispanics from the Health and Retirement Study, we demonstrate how the 2W-LCS model provides the best match to theories rooted in changes, and highlight the advantages of this approach over other modeling alternatives (i.e., Little, Preacher, Selig, & Card, 2007; Selig & Preacher, 2009).

Nursing Home Admissions Among Medicaid HCBS Enrollees

Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity in a retrospective cohort of Medicare and Medicaid dually eligible individuals who enrolled in Medicaid HCBS programs. We analyzed the 2006 Medicaid Analytic eXtract personal summary files from 19 states, and linked these data to nursing home Minimum Data Sets and other files. We used multivariable competing risk proportional hazard models to estimate 2-year risks of short-term and long-term nursing home admissions for black and Hispanic HCBS enrollees, compared with white enrollees. We also compared racial/ethnic differences in physical and cognitive impairments at the time of nursing home admissions. Among 93,508 older (65 y and above) and new HCBS users, the 2-year long-term nursing home admission rates were 10.16% for blacks [n=18,000; hazard ratio (HR)=0.80, P<0.001 in multivariable regression] and 5.59% for Hispanics (n=13,786; HR=0.49, P<0.001), compared with 12.27% for whites. The 2-year short-term nursing home admission rates were 11.99% for blacks (HR=0.84, P<0.001 in multivariable regression) and 9.29% for Hispanics (HR=0.62, P<0.001), compared with 13.40% for whites. Black and Hispanic elders were more impaired than whites in physical and cognitive functions at both short-term and long-term nursing home admissions. Among dual-eligible older HCBS recipients, blacks and Hispanics tended to stay longer in their communities until a nursing home admission, and upon admission, are more impaired both physically and cognitively. These differences may suggest continued racial/ethnic disparities in access to nursing homes in addition to cultural differences in long-term care preferences.