Minority Older Adults Research Articles

Cognitive Trajectories and Associated Social and Behavioral Determinants Among Racial/Ethnic Minority Older Adults in the United States.

Despite higher risks of developing Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) among racial/ethnic minority populations, some maintain good cognition until old age. This study aimed to investigate heterogeneous cognitive trajectories among non-Hispanic Black and Hispanic older adults, examine cognitive impairment prevalence across trajectory classes, and identify associated social and behavioral determinants. Using 11 waves of data from the Health and Retirement Study (1996-2016), 1,322 non-Hispanic Black and 747 Hispanic adults aged 50 + with normal cognition in 1996 were included. Latent class growth modeling and multinomial logistic regressions were performed to examine cognitive trajectories and associated determinants. For both racial/ethnic groups, three trajectory classes were identified: high, medium, and low cognition. In the low cognition class, 87% and 100% of non-Hispanic Black and Hispanic participants developed cognitive impairment. For both racial/ethnic groups, older age and living in rural areas during school time increased the likelihood of being in the low cognition class, while more education was associated with a lower likelihood. Unique risk and protective determinants for non-Hispanic Black and Hispanic participants were also identified. This study reveals the heterogeneity of cognitive trajectories among racial/ethnic minority older adults and various associated social and behavioral determinants. More prevention interventions and accessible, affordable diagnosis and treatment should be provided to older racial/ethnic minorities with these characteristics to reduce disparities. More research is needed to further explore associations between unique determinants and cognition in racial/ethnic minority populations to better inform interventions.

Mental health, fall prevention behaviors, and home environments related to fall experiences among older adults from ethnic groups in rural Northern Thailand

Accidental falls pose significant threats to older adults' health and safety. This study investigates the associations between mental health, fall prevention behaviors, home environments, and yearly falls among older adults of various ethnicities. Conducted in rural ethnic areas of two provinces in northern Thailand, this cross-sectional study utilized multi-stage sampling to survey 462 older adults aged 60 and above, including Mien, Hmong, Karens, and indigenous people. Participants self-reported their history of accidental falls and provided mental health (GHQ-28) data. Univariate logistic regression highlighted associations between falls and mental health problems (OR = 14.87, 95%CI = 7.51–29.43) and the score of fall prevention behaviors (OR = 0.37, 95%CI = 0.31–0.45). Home environment factors, including floor type, floor risk factors, and stair safety features, were significantly related to falls (p < .05). Multivariable analysis identified gender, financial status, underlying disease, vision impairment, mental health problems, and fall prevention behaviors as independent predictors of past-year falls among ethnic older adults (p < .05), explaining 84.7 % of the variation in log odds of falling. This study underscores the heightened fall risks among ethnic minority older adults with mental health issues while emphasizing the protective role of fall prevention behaviors.

Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.

To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization. Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses). Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]). Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol

IntroductionSevere inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality,...

Understanding the implementation and sustainability needs of evidence-based programs for racial and ethnic minoritized older adults in under-resourced communities with limited aging services

BackgroundEvidence-based programs (EBPs) for older adults effectively improve health outcomes. However, there is a limited understanding of the unique needs of service providers as they consider adopting, implementing, and maintaining programs for older minority adults in low-income communities with limited aging services.MethodsWe conducted semi-structured interviews with key informants of community-based organizations (CBOs) to understand implementation and sustainability needs of CBOs within four racial and ethnically diverse Los Angeles County geographic areas. We performed thematic analysis of interview transcripts.ResultsInterviews were conducted with representatives from 25 senior-serving agencies providing aging-related EBPs. CBO representatives reported implementing EBPs in 8 domains: Falls Prevention (68%), Mental Health (64%), Caregiver Health (48%), Chronic Disease Management (48%), Diabetes Management (36%), Arthritis Management (28%), Physical Activity (24%), and Multiple Conditions Management (8%). Themes are presented using the six domains of the Bass and Judge framework for factors impacting successful and sustained EBP implementation. CBOs in low-income and diverse communities described unique challenges with tailoring interventions based on local community context (literacy, language), cultural context, and locally available resources (technology, safe community spaces, transportation) and faced resource-intensive administrative burdens through staff turnover, data collection, sustainable funding, and networking.ConclusionsServing racial and ethnic communities has unique challenges that require tailored approaches and additional resources to ensure equitable access to EBPs for all communities. We describe suggestions for enhancing the effective adoption of EBPs among service agencies in under-resourced and diverse aging communities serving populations with aging-related health disparities.

The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: A prospective cohort study

BackgroundThis study aims to understand the mechanisms contributing to the elevated risk of depression among sexual minority older adults compared to heterosexuals. Specifically, the role of loneliness as a potential mediator is investigated to inform targeted interventions for preventing depression in sexual minority populations. MethodsData from the English Longitudinal Study of Ageing, focusing on adults aged over 50, were analysed. Sexual orientation (sexual minority or heterosexual) and loneliness scores (UCLA scale) were assessed at wave six (2010−2011), while depressive symptoms (CESD) were assessed at wave seven (2013–14). Linear regression models and mediation analyses, using g-computation formula and adjusted for confounders, were conducted. ResultsThe sample included 6794 participants, with 478 (7.0 %) identifying as sexual minorities. After adjustments, sexual minorities scored higher on depressive symptoms at wave seven (mean difference): 0.23, 95 % CI 0.07 to 0.39) and loneliness at wave six (MD: 0.27, 95 % CI 0.08 to 0.46). Loneliness was positively associated with depressive symptoms (coefficient: 0.27, 95 % CI 0.26 to 0.29). In mediation analyses, loneliness explained 15 % of the association between sexual orientation and subsequent depressive symptoms. LimitationsThe dataset used sexual behaviour rather than desire and identity, potentially skewing representation of sexual minorities. Additionally, transgender older adults were not included due to limited gender diversity reported within the ELSA dataset. ConclusionsLoneliness appears to be a significant modifiable mechanism contributing to the heightened risk of depressive symptoms in sexual minority older adults compared with their heterosexual counterparts.

An Exploration on the Reverberations of Health-Related Social Needs on Loneliness Among Minority Older Adults

An Exploration on the Reverberations of Health-Related Social Needs on Loneliness Among Minority Older Adults

Hearing loss and cognitive decline: Prioritizing equity in a world in which hearing health matters.

Alzheimer's disease and related dementias (ADRDs) and age-related hearing loss are the intersection of two major public health challenges. With age as the primary risk factor for both disease processes, the burden of ADRDs and age-related hearing loss is growing, and each field maintains significant barriers to broadscale identification and management that is affordable and accessible. With the disproportionate burden of ADRDs among racial and ethnic minority older adults and existing disparities within hearing care, both areas face challenges in achieving equitable access and outcomes across diverse populations. The publication of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial in July 2023 marked a significant moment in the fields of brain and hearing health. The ACHIEVE trial was the first randomized controlled trial to examine whether providing hearing intervention, specifically provision of hearing aids, compared to an education control, would reduce cognitive changes over 3 years. The participants most at risk for cognitive decline, with lower education, lower income, more likely to identify as Black, and have more cardiovascular risk factors, were the participants who benefited most from the hearing intervention and are also the least likely to be represented in research and the least likely to obtain hearing care. With growing evidence of the interconnection between cognitive and sensory health, we have an opportunity to prioritize equity, from purposeful inclusion of diverse participants in trials to influencing the emerging market of over-the-counter hearing aids to supporting expanded models of hearing care that reach those who have traditionally gone unserved. No longer can hearing go unrecognized by clinicians, researchers, and advocates for brain health. At the same time, the fields of brain and hearing health must center equity if we are going to meet the needs of diverse older adults in a world in which hearing health matters.

Supplemental Material for Mental Health of Gender Minority Older Adults in the United States: A Systematic Review

Supplemental Material for Mental Health of Gender Minority Older Adults in the United States: A Systematic Review

Mental health of gender minority older adults in the United States: A systematic review.

Mental health of gender minority older adults in the United States: A systematic review.

Developing and evaluating a mindfulness-based finger/hand exercise intervention for ethnically diverse older adults with and without disabilities: A feasibility study

Few exercise interventions target ethnic minority older adults, especially those with disability. We evaluated feasibility of newly-developed finger/hand exercises to promote health in ethnically diverse older adults with/without disability. We conducted 10-minute video exercises daily, supervised by research assistants. The feasibility, evaluated via three studies, focused on recruitment, intervention fidelity, safety, outcome assessment, and acceptability. Studies varied in design and delivery methods, being conducted across settings (senior centers, apartments). We enrolled 101 Chinese older adults (mean age = 72) without disability in Study 1, and 15 older Africans/Hispanics with disability (mean age = 70) in Studies 2 and 3. Intervention, either in-person or online, was implementable and acceptable with high fidelity. Attendance was satisfactory (79.6%, 74.2%, 76.7%) and attrition was low (12%, 0%, 0%). Outcome measures data was ascertained. No adverse events were observed. Preliminary findings indicate feasibility, acceptability, and safety of the simple finger/hand exercise for diverse older adults.

Resilience of racial and ethnic minority older adults during the COVID-19 pandemic: The role of a prior disability prevention intervention.

Older adults from racially and ethnically diverse backgrounds and with preexisting mental illness have been disproportionately vulnerable to severe illness, disability, and death due to the adverse impacts of the COVID-19 pandemic. This study used a sample of older adults (60 +; N = 307) from a randomized clinical trial (Positive Minds-Strong Bodies [PMSB]) conducted between May 25, 2015, and March 5, 2019. Participants were recontacted to assess symptoms of anxiety, depression, general distress, and physical functioning during the COVID-19 pandemic between March 2, 2021, and July 18, 2022 (62.7% recontacting rate excluding ineligible participants; N = 165). We estimated an analysis of covariance model to evaluate whether or not prior differences between the PMSB intervention and enhanced usual care (EUC) groups continued to be observed at the COVID-19 follow-up. Results showed that, compared to EUC, participants who received the PMSB intervention reported fewer depression symptoms (Geriatric Depression Scale-15 scores) and greater physical functioning (Late-Life Functioning and Disability Instrument scores) at the COVID-19 follow-up. No significant differences were observed between the PMSB intervention and EUC groups on anxiety symptoms (Generalized Anxiety Disorder-7 scores) during the pandemic. Last, findings suggested that the lower depression symptoms and greater physical functioning observed after treatment completion were sustained, though not further improved, over time. These findings provide evidence that the PMSB intervention is a powerful intervention to promote resilience and prevent disability associated with major life stressors, such as the COVID-19 pandemic. Future research is needed to examine the underlying mechanisms of psychosocial and exercise training interventions that lead to lasting resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The (un)caring experienced by racialized and/or ethnoculturally diverse residents in supportive living: a qualitative study

BackgroundRacialized and/or ethnocultural minority older adults in supportive living settings may not have access to appropriate services and activities. Most supportive living facilities are mainstream (not specific to one group); however, culturally specific facilities are purpose-built to accommodate older adults from a particular group. Our objective was to describe the perspectives of diverse participants about access to culturally appropriate care, accessible services, and social and recreation activities in culturally specific and mainstream (non-specific) supportive living facilities.MethodsWe conducted semi-structured interviews with 21 people (11 staff, 8 family members, 2 residents) from 7 supportive living homes (2 culturally specific and 5 mainstream) in Alberta, Canada. We used a rapid qualitative inquiry approach to structure the data collection and analysis.ResultsStaff and family members described challenges in accessing culturally appropriate care in mainstream facilities. Family members expressed guilt and shame when their relative moved to supportive living, and they specifically described long waitlists for beds in culturally specific homes. Once in the facility, language barriers contributed to quality of care issues (e.g., delayed assessments) and challenges accessing recreation and social activities in both mainstream and culturally specific homes. Mainstream facilities often did not have appropriate food options and had limited supports for religious practices. Residents who had better English language proficiency had an easier transition to supportive living.ConclusionsRacialized and/or ethnoculturally diverse residents in mainstream supportive living facilities did not receive culturally appropriate care. Creating standalone facilities for every cultural group is not feasible; therefore, we must improve the care in mainstream facilities, including recruiting more diverse staff and integrating a wider range of recreation and religious services and food options.

Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S.

Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults. Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors. 28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only. There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

“WE DON’T AGE ALONE; WE AGE AS A COMMUNITY”: BARRIERS AND ENABLERS OF AGING WELL IN BLACK/AFRICAN AMERICAN OLDER ADULTS

Abstract Eurocentric understandings of successful aging privilege optimal physical and cognitive health, absence of disease and disability, and active social engagement in later life. This marginalizes the experiences of diverse older adults who may live with chronic conditions but maintain a good quality of life, supported by factors such as spirituality, resilience, and close familial ties. Further, this approach is myopic because it fails to capture social determinants of health (SDOH) that influence the aging process over time. The Perceptions of Aging Well in Diverse Older Adults study is a 5-year series that seeks to identify: 1) micro-, meso- and macro-level factors that shape aging well in racial/ethnic minority older adults, and 2) strategies to support aging well in racial/ethnic minority older adults. This presentation highlights preliminary findings from a sub-study with Black/African American participants. In-depth, semi-structured interviews were conducted with 23 community-dwelling Black/African American adults age 50+ (14 females, 9 males; mean age = 71.2 years). Thematic analysis of the interview data showed that neighborhood safety, food insecurity, pharmacy deserts, adverse childhood experiences, structural racism, and everyday micro-aggressions shaped perceptions of aging well in powerful ways. Strong kinship bonds and a desire to leave a legacy of resilience and empowerment for younger generations motivated participants to engage in prosocial activities such as volunteering in local church communities. These findings suggest that along with addressing key SDOH, fostering generativity through teaching and mentoring, creative arts, and taking on community leadership roles may enhance subjective well-being in Black/African American older adults.

RESPONSE AND RETENTION OF AN ONLINE RESEARCH REGISTRY: ADAPTATIONS MADE FOR RECRUITING ASIAN AMERICANS

Abstract Challenges in recruiting research volunteers, especially racial/ethnic minority older adults, have been documented as one of the most significant obstacles to developing effective treatments for Alzheimer’s Disease and Related Dementia (ADRD). To address the need for recruitment and raise awareness about ADRD research, the Layton Aging and Alzheimer’s Disease Research Center built the online dementia research registry, Alzheimer’s Comprehensive Treatment Network of Oregon and Washington (ACTNOW). Individuals aged 18 and above are eligible to join, and prospective participants self-initiated enrollment into the registry. As of March 2023, there are 497 participants (mean age 63.9, 71.6% female, 74% had bachelor’s or above degree, 12% residing in a rural area) registered in ACTNOW, with an average follow-up period of 1.8 years (SD=1.2, Max=5). To date, 20 research projects have used ACTNOW for their recruitment, and 93% of registry volunteers have been referred to at least one requesting study. The current ACTNOW participants are predominantly non-Hispanic White (92.4%). We will describe ACTNOW’s infrastructure expansion to improve the registry’s capacity for engaging and recruiting older Asian American adults with limited English proficiency. We tested the feasibility of using translated informed consent forms and questionnaires, reconciling data collected in different languages with existing data structures, and the effectiveness of community outreach sessions. Developing the capacity to recruit underrepresented populations for future ADRD research projects can be critical to addressing health disparities in dementia awareness, prevention, diagnosis, and care. Standardizing communications with all registry stakeholders, both researchers and volunteers, helps engagement and accurate recruitment efforts.

COGNITIVE IMPAIRMENT AMONG OLDER ADULTS WITH INTERSECTING SEXUAL, GENDER, RACIAL, AND ETHNIC MINORITY IDENTITIES

Abstract Emerging research shows Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience higher prevalence of cognitive impairment when compared to their heterosexual and cisgender peers of a similar age. The same is true for racial and ethnic minority older adults when compared to their White counterparts. Little is known about the cognitive health of older adults with intersecting sexual, gender, racial, and ethnic minority identities, highlighting a critical gap in gerontological research that requires further investigation. This study utilizes four time-point data from the first longitudinal study of a racially and ethnically diverse sample of LGBTQ older adults. Multilevel mixed models accounting for intersecting sexual, gender, racial, and ethnic identities were applied to examine subgroup differences in cognitive impairment as well as risk and protective factors after controlling for confounding factors. Black and Hispanic LGBTQ minority older adults (b=5.20, p&amp;lt;.01; b=4.05, p&amp;lt;.01) experience higher levels of cognitive impairment over time when compared to their White LGBTQ peers. Day-to-day discrimination targeting the confluence of sexual/gender and racial/ethnic minority status (b=2.78, p&amp;lt;.05) was positively associated with higher cognitive impairment. Community engagement (b=-.46, p&amp;lt;.05) was negatively associated with cognitive impairment regardless of race and ethnicity whereas network size was exclusively negatively associated with cognitive impairment for Black LGBTQ older adults. The overall findings demonstrate racial and ethnic differences in cognitive impairment among LGBTQ older adults and illuminate the importance of culturally tailored interventions that account for intersectionality, social connectivity, and discrimination to promote cognitive health for specific subgroups.

PRESIDENTIAL SYMPOSIUM: IMPACT OF DISCRIMINATORY POLICIES ON LGBTQ+ OLDER ADULTS’ HEALTH AND WELL-BEING AND HOW TO COMBAT THEM

Abstract Despite some advances in LGBTQ+ rights over the past few decades, many states lack legal protections against discrimination based on sexual orientation or gender identity, and the current political climate raises concerns about future challenges to LGBTQ+ rights. This symposium explores the implications of discriminatory policies on the health, housing, and economic well-being of LGBTQ+ older adults, and solutions for promoting empowerment, equity, and inclusion throughout the care continuum, from long-term services and supports to end-of-life care. The first presentation describes a complex paradox in which sexual and gender minority (SGM) older adults avoid formal services due to fear of discrimination and poor treatment despite significant health disparities and a lack of informal support, discusses opportunities to improve access and health through education and awareness, and elucidates implications for policy and research. The second presentation describes geographic variations in access to, and receipt of gender-affirming surgery among transgender and gender-diverse Medicare beneficiaries using national Medicare data and discusses policy implications. The third paper focuses the role of spirituality and faith in the lives of LGBTQ+ older adults and reports findings from a mixed-methods study on how involvement in faith communities shape their end-of-life care perceptions and preparation. The fourth presentation describes barriers and facilitators to communicating with SGM hospice patients and caregivers about their sexual orientation and gender identity and recommendations for developing communication training to promote authentic end-of-life care for this population. Karen Frederickson-Goldsen as discussant will provide policy and practice implications of these important works.

LGBTQ AGING PARADOX: NEEDING WHILE AVOIDING LONG-TERM SERVICES AND SUPPORTS

Abstract A growing body of literature recognizes the significant health disparities experienced by sexual and gender minority (SGM) older adults including higher rates of chronic conditions, mental illness, and disabilities in comparison to their peers. Simultaneously SGM older adults are more likely to age alone and not have a friend or family caregiver to provide support. At the same time SGM older adults express hesitation and fear in accessing formal long term services and supports (LTSS). One study of trans older adults noted that suicide was a preferred option to a nursing home. This paper will outline a complex paradox: Many SGM older adults (1) experience significant health disparities which may require additional support; (2) lack informal support thus needing to rely on formal LTSS; and (3) avoid formal services due in large part to fear of discrimination and poor treatment. Opportunities to mitigate the paradox through education and awareness as well as implications for policy and research will be discussed.

THE EFFECT OF CHRONIC CONDITIONS ON DEPRESSIVE SYMPTOMS IS MODERATED BY SEXUAL MINORITY STATUS

Abstract It is important to examine disparities in the effects of physical health on depression among sexual minority (SM) older adults. We examined whether the effects of chronic conditions (CCs) and self-rated health (SRH) on depressive symptoms were moderated by sexual orientation among 3,741 adults aged 50+ (SM = 216) who participated in the 2016 wave of the Health and Retirement Study (HRS) and responded to the recently added sexual orientation item. Structural equation modeling was used to model the effects of SRH and CCs on depressive symptoms, while controlling for participant sex, age, years of education, net-worth, and race/ethnicity. Greater numbers of CCs were associated with greater depressive symptoms (b= .24, SE = .04, p &amp;lt;.001), whereas better SRH was associated with fewer depressive symptoms (b = -.60, SE = .05, p &amp;lt;.001). The direct effect of SM on depressive symptoms was significant, b = 1.14, SE = .48, p =.02, indicating greater depressive symptoms among SM adults. The interaction between SM and SRH on depressive symptoms was significant (b = -.39, SE = .17, p = .02). The same effect was seen for CCs (b = -.32, SE = .15, p = .04). Simple slopes revealed that for heterosexual older adults, greater CCs were associated with greater depressive symptoms (b = .27, SE = .04, p &amp;lt;.001), however this association was not significant for SM older adults (b = -.05, SE = .16, p = .75). Future research should examine health disparities among SMs in relation to mental health.