Older African Americans Research Articles

Risk factors for second primary breast cancer by laterality, age, and race and ethnicity.

Epidemiologic studies of risk factors for second primary breast cancer (SBC) have been conducted primarily in non-Hispanic White (NHW) women. A racially- and ethnically-diverse population-based pooled cohort of 9,639 women with first primary stage I-III invasive breast cancer (FBC) was linked with the California Cancer Registry; 618 contralateral SBC (CSBC) and 278 ipsilateral SBC (ISBC), diagnosed >6 months after FBC, were identified. Using Fine and Gray models accounting for competing risks, we assessed associations of CSBC and ISBC risk with FBC clinical characteristics and epidemiologic factors. In younger women (FBC at age <50 years), higher CSBC risk was associated with ER/PR-negative FBC [hazard ratio (HR)=1.68], breast cancer family history (HR = 2.20), and nulliparity (HR = 1.37). In older women (FBC at age ≥50 years), higher risk was associated with breast cancer family history (HR = 1.32), premenopausal status (HR = 1.49), overweight (HR = 1.39), and higher alcohol consumption (HR = 1.34). For ISBC, higher risk was associated with married status (HR = 1.94) in younger women, and overweight (HR = 1.60) among older women. For CSBC, HR estimates were generally similar across racial and ethnic groups. Even after adjustment for these risk factors, compared with NHW women, risk remained elevated for CSBC in younger African American, Asian American, and Hispanic women, and for ISBC in older African American and Hispanic women with ER/PR-positive FBC. Our findings support genetic risk evaluation, enhanced screening, and lifestyle changes in women at higher risk of SBC. Additional risk factors must contribute to the unequal burden of SBC across racial and ethnic groups.

The Effects of APOE Alleles, Cognitive Activities, and Social Activities on Cognitive Decline in African Americans.

Older African Americans are among the fastest growing populations, yet are underrepresented in studies examining risk factors related to decline. The present study examines whether biological factors (APOE alleles) interact with behavioral factors including cognitive activities (e.g., reading, playing games) and social activities (e.g., participating in social groups) to predict cognitive decline in African Americans. 734 African American adults from the Minority Aging Research Study (MARS), aged 65 and older (with no known dementia at the time of enrollment) underwent annual cognitive testing for up to 10 years. At baseline, APOE status was determined and participants reported their frequency of participation in social and cognitive activities. Structural equation modelling was used to examine the effects of APOE, cognitive activities, and social activities on cognitive decline, and their interaction effects over a ten-year period. The number of APOE alleles had an effect on cognitive decline, such that a greater number of APOE4 alleles was associated with greater cognitive decline, whereas a greater number of APOE2 alleles was associated with less cognitive decline. Cognitive and social activities did not interact with APOE count to predict cognitive decline, however, APOE4 and social activities had additive, independent effects on cognitive decline. Results replicate prior findings linking APOE4 to cognitive decline and highlight the importance of APOE2 and social activities in delaying cognitive decline in African Americans.

Combined Diabetes Education/Skills Training and Social Needs Resolution Intervention for Older African Americans with Poorly Controlled Type 2 Diabetes (DM Social Needs): Study Protocol for a Randomized Controlled Trial.

Approximately 11.3% of the US population has diabetes. The burden of diabetes is higher in older adults and African Americans (AAs), such that 40% of adults aged 50 years and older have diabetes; African Americans are 60% more likely to be diagnosed with diabetes compared to non-Hispanic Whites (NHWs). Structural racism has resulted in fewer economic and educational opportunities for AAs, higher social risks, and unmet basic needs, which result in financial instability, housing instability, food insecurity, and a lack of transportation compared to NHWs. The presence of these unmet basic needs is a driver of poor adherence to diabetes self-management in older AAs. To test the preliminary efficacy of a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, while also addressing and resolving the unmet social needs of older AAs with poorly controlled type 2 diabetes mellitus (T2DM). The primary hypothesis is that older AAs with T2DM randomized to the DM Social Needs intervention will have significantly lower hemoglobin A1C (HbA1C), blood pressure, and LDL levels compared to the usual care arm at 6 months post randomization. This is a three-year prospective, randomized clinical trial that will enroll 100 AAs aged 50 and older with type 2 diabetes (T2DM) and HbA1C ≥ 8% into one of the following two groups: (1) a nurse case-manager, telephone-delivered intervention that provides foundational diabetes self-management education and skills training, but also addresses and resolves unmet social needs; or (2) an enhanced usual care group that will receive mailed diabetes education materials. Participants will be followed for 6 months to determine the effect of the intervention on HbA1C, blood pressure, and low-density lipoprotein (LDL) cholesterol levels. Baseline characteristics will be presented by study group, and within- and between-group changes in primary outcomes from baseline to 6 months will be reported. The results from this study will provide insights into the efficacy of a combined diabetes education and skills training and social needs resolution intervention for older African Americans with poorly controlled type 2 diabetes and will inform strategies to improve diabetes outcomes for this vulnerable population.

Applying the theoretical domains framework to identify determinants to mental healthcare use among older African Americans with type 2 diabetes: a qualitative study

ObjectivesThere is a paucity of research focused on enhancing access to mental healthcare for older African Americans with type 2 diabetes (T2D), who may be at risk for or living...

"I Have Come Because I See You Care About Me": Recruiting Older Black Americans for Genomic Research.

The lack of diversity in genomic studies is a disparity that influences our understanding of human genomic variation and threatens equity in the benefits of precision medicine. Given our current genomic research with Black older adults, we conducted a qualitative study to elucidate participants' knowledge, attitudes, and beliefs about genomic research and research participation and what factors contribute to their willingness to participate and to gain insights into barriers that researchers may have in recruiting Black Americans. We conducted semistructured interviews (N=16) with previous genomic research participants, and an inductive thematic approach was used to code and interpret the data. The mean age was 70, 82% reported <$15,000 annual income, and 100% participated in genomic research. The results note that genomic research is poorly understood despite participation in prior genomic studies, and cultural beliefs about health and managing health impact an individual's research participation. Although not all participants identified with historical distrust, those who did report health system distrust also contributed distrust in research. Relationship building facilitates research participation, especially when perceived as personally relevant and meaningful. Participant incentives and convenience to engage in the study are less important if the personal benefits or relevance of the research are clear. Our results provide new context into the importance of relationship building and research literacy and highlight new considerations for engaging racially diverse populations in research.

Exploring Correlates of Resource Insecurity Among Older Black or African Americans with HIV in Ohio.

Resource insecurity is a social determinant of health that can impact people with HIV (PWH), in particular older African Americans (AA) or blacks with HIV. The purpose of this study was to identify resource insecurities among older Blacks or AA PWH specifically related to food and housing. Secondary focus was to find associations between resource insecurity and substance use history, stigma, and various forms of discrimination. Eligible participants (N = 52) of this cross-sectional study were 50years old or older, identified as Black or AA, diagnosed with HIV, and living in Ohio. Food insecurity was assessed using the Household Food Insecurity Access Scale and housing insecurity was defined as not having stable housing. Resource insecurity was categorized into food and housing secure, food or housing insecure, and food and housing insecure. Almost half (48.1%) of participants reported housing insecurity, with approximately 58.0% experiencing food insecurity, and 38.5% facing both. Current substance use, particularly opiates, showed significant association with resource insecurity (OR = 5.54; 95% CI = 1.91-17.30). Moreover, experiences of everyday (OR = 1.19; 95% CI = 1.10-1.30) or major forms (OR = 1.75; 95% CI = 1.33-2.39) of discrimination, as well as HIV stigma (OR = 1.24; 95% CI = 1.01-1.55), were also linked to increased odds of resource insecurity among participants. Findings highlight how social factors contribute to resource insecurity among older AA PWH. Understanding the factors offers insight for targeted intervention in the fight against HIV transmission.

In Their Words: African American and Latine Immigrant Older Adults (Re)Define Civic Participation.

Older adults' civic participation has received considerable attention. However, this literature has understudied the experiences of civic participation among minoritized ethnoracial older adults. Particularly absent from this literature is the contextualization of civic participation as it exists within cultural and historical structures of inequality that influence how these populations understand, participate, and experience civic life. A phenomenological design was used to explore civic participation through participants' experiences and unique perspectives. Thirty-four in-depth, semistructured interviews were conducted with Latine immigrant and Black older adults (ages 60+) living in New Jersey and New York City. A conceptual content analysis was used to identify how older Black and Latine immigrant adults define civic participation for themselves. This study presents 3 new definitions of civic participation, that are derived directly from participants' conceptualization and applied across the lived experiences. Definitions present civic participation as the responsibility of community belonging; as a religious/spiritual practice; and as a way of life. These definitions provide new perspectives by which to study civic participation and challenge current framing of helper and needy, altruism, the voluntary nature of participation, and the separation between social, political, and spiritual participation. Findings from this study contribute to expanding gerontology's ontological imagination of how civic participation is experienced and conceptualized among older Latine immigrants and Black adults. The expertise shared by older African Americans and Latine immigrants lends us important perspectives to develop a critical theoretical framework by which scholars can more accurately study civic participation among this diverse population.

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia

BackgroundWith an increasing proportion of older adults and the associated risk of Alzheimer’s Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.MethodsThis paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.DiscussionThis study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.Trial registrationClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Working Through It: Lifetime Experiences of Employment Discrimination Among Older Black Americans and Implications for Labor Force Participation, Job Dissatisfaction, and Mental Health in Older Adulthood.

To examine lifetime experiences of employment discrimination and their association with Black older adults' employment status and well-being. We use data from the Health and Retirement Study's leave-behind questionnaire to characterize lifetime experiences of being unfairly fired, not hired, or not promoted among Black older adults (N = 2948) and test associations with labor force status at age 62, job satisfaction among those working, and depressive symptoms. Employment discrimination was commonly reported by Black older adults, especially among men and those with college educations. Employment discrimination was not associated with employment status at age 62 but was associated with job dissatisfaction (OR = 2.00, p = .001) and depressive symptoms (Beta = 0.34, p < .001). Findings suggest a negative association between employment discrimination at any point in the life course and Black older adults' well-being. Employment discrimination is an obstacle to healthy aging, yet improved discrimination survey items are needed to fully capture its impact on Black Americans.

Exploring how military culture shapes veterans' perception of aortic aneurysm repair: A qualitative study.

Veterans represent a distinct cultural group whose perceptions of illness and treatment are influenced by military culture. The study explores how prior military service shapes Veterans' assumptions and behaviors in the setting of aneurysm repair surgery. We conducted content and thematic analysis of a case series of 10 transcripts from telephone interviews with older (76.7 ± 4.3 years) African American and White male Veterans now residing in the Southern U.S. who underwent open or endovascular aneurysm surgery at Veterans Affairs Medical Centers or university affiliates between 2004 and2019. Throughout the continuum of care, Veterans described deferring to authority and not questioning provider's decisions ["I just can't make a judgment on that, because I'm not a doctor"]. Veterans valued commitment and articulated pride in keeping logistically challenging surveillance appointments [I always took them very seriously. . . If I'm scheduled for something by the doctor, I always make it."]. The routine structure of VA care aligned with Veterans military experiences, facilitating compliance with doctor's orders. However, procedural deviations in VA care were disconcerting for patients ["They haven't reached out to me in at least three years, since my surgery; I was being seen once a year and then all of a sudden, they just quit."]. While Veterans praised VA care, they exhibited sensitivity to signs of untoward treatment from clinical and support staff "…my surgeon, he never talked to me before, nor after, no anytime…I thought that maybe that wasn't right". Military culture embodies rank, order, and respect, and remains a source of strength and stability for Veterans in their medical care late in life. Cultural competency about how military service has shaped Veterans' expectations can enhance providers' awareness of patients' military mindsets and inform surgeons' efforts to engage Veterans in shared decision making.

The African American Dementia and Aging Project (AADAPt): An Oregon-based Longitudinal Study.

The vast majority of studies on aging, cognition, and dementia focus on non-Hispanic white subjects. This paper adds to the extant literature by providing insight into the African American aging experience. Here we describe the study design and baseline characteristics of the African American Dementia and Aging Project (AADAPt) study, which is exploring aging and cognition in African American older adults in Oregon. African American older adults (n=177) participated in AADAPt, a longitudinal study that collected data on cognitive, physical, and social functioning in annual visits since 2000. AADAPt participants had risk factors for developing dementia in future, such as hypertension and hyperlipidemia, but also reported protective factors such as high social engagement. The AADAPt project offers new insights into aging in older African Americans that includes data on cognition, social engagement, and physical health, which are crucial for understanding the experience of under-represented groups and making future studies more inclusive. These findings reflect a window of time for a geographically-focused cohort, and the lessons learned from this study likely have broader implications for shaping the health of these older African American adults. Keywords: African American, Dementia, Observational Study.

Hypertension is associated with reduced resting-state medial temporal lobe dynamic network flexibility in older African Americans.

Hypertension disproportionately affects African Americans and is a risk factor for Alzheimer's disease (AD). We investigated the relationship of blood pressure (BP) with medial temporal lobe (MTL) dynamic network flexibility (a novel AD biomarker) and cognitive generalization in older African Americans. In a cross-sectional study, 37 normotensive (systolic BP <130 mmHg, 82.5% F, 64.4 ± 4.9 years; 14.3 ± 2.1 years of education) versus 79 hypertensive (systolic BP ≥130 mmHg, 79.5% F, 66.8 ± 4.1 years; 14.0 ± 0.2 years of education) participants were enrolled. All participants completed a 10-min resting-state functional magnetic resonance imaging scan to assess MTL dynamic network flexibility and two generalization tasks to assess cognition. Anthropometrics and aerobic fitness (via 6-min walk test) were also determined. There was no difference in BMI (29.7 ± 6.4 vs. 31.9 ± 6.3 kg/m2, p = 0.083) or aerobic fitness (15.5 ± 2.6 vs. 15.1 ± 2.6 mL/kg/min; p = 0.445) between normotensive and hypertensive groups. However, normotensive participants had higher MTL dynamic network flexibility compared to hypertensive participants (0.42 ± 0.23 vs. 0.32 ± 0.25 mL, p = 0.040), and this was associated with higher mean arterial blood pressure (r = -0.21, p = 0.036). Therefore, hypertensive older African Americans demonstrated lower MTL dynamic network flexibility compared to their normotensive counterparts independent of BMI and aerobic fitness. Further studies are required to determine how blood pressure mediates AD risk in African Americans.

Influence of Obesity on the Relationship of Cardiometabolic Risks Factors With Cardiovascular Disease in Older African and European Americans.

This study evaluated the impact of obesity on cardiometabolic risk factors (CRF) interrelationships and predictive efficiency of CVD development in older African (AA) and European Americans (EA). A comparative research design evaluated CRF risk profile differences between participant groups. Seven neighborhoods in a southern US city. A sample of 179 older AA (n = 128) and EA (n = 51) adults. Non-fasting blood samples were evaluated for lipids and lipoproteins, glycosylated hemoglobin, systolic -(SBP) and diastolic blood pressure (DBP), body mass index (BMI), body fat percentage (BF%) and physical function. Data were analysis with descriptive statistics, t-tests, and correlations. AA were heavier than EA although all had above average age-appropriate fitness. Means and relationships between CRF and other variables were different (P < .05) based on race. Both AA (41.3 + 5.8) and EA (38.6 + 6.4) BF% were CRF risks. Holding BMI constant, CRF were generally not related, and the relationships were different for AA and EA. AA had a range of 13.0 to 27.2% more favorable values for cholesterol, HDL-C, and triglyceride. EA had favorable A1c (EA 5.8 vs AA 6.2%) values. A limitation of this report is the small sample size. Although further research is warranted, these findings suggest population specific CRF selections would improve CVD prediction in AA.

Everyday Discrimination Is Associated With Higher Odds of Hospitalizations Among Older African Americans.

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 odds of being hospitalized in older African Americans has not been explored. Community-dwelling participants from 3 longitudinal cohort studies (N = 446, age 65+ years) with discrimination scores and ≥12 months of linked Medicare claims were included. Hospitalizations were identified using Medicare fee-for-service claims, available for an average of 6.2 (SD: 3.7) years of follow-up after baseline. In mixed-effects ordinal logistic regression models (outcomes of 0, 1, or 2+ hospitalizations per year) adjusted for age, sex, education, and income, higher discrimination was associated with higher odds of total annual hospitalizations (odds ratio [OR] per point higher = 1.09, 95% confidence intervals [95% CI]: 1.02-1.17). Results were similar when accounting for depressive symptoms. Higher exposure to everyday discrimination is associated with higher odds of hospitalization among older African Americans. Mechanisms underlying associations should be explored further to understand how hospitalizations may be reduced in older African Americans.

Food Insecurity Among Aging SNAP Participants and Eligible Nonparticipants in Two Predominantly Low-Income Black Neighborhoods: Implications for SNAP Enrollment and Outreach for Older Adults

BackgroundThe Supplemental Nutrition Assistance Program (SNAP) plays a critical role in alleviating poverty and food insecurity. Despite these benefits, many older Americans who are eligible for SNAP do not participate in the program. Few studies have explored household factors and food insecurity outcomes associated with nonparticipation among older Black Americans. ObjectivesThe study aim was to explore changes in food insecurity and related financial hardship outcomes between 2020 and 2021 among SNAP participants, eligible nonparticipants, and ineligible nonparticipants; compare reasons for not participating in SNAP; and to compare household factors associated with SNAP nonparticipation. MethodsLongitudinal design examining data from 2020 and 2021 to assess changes in food insecurity over the course of the coronavirus disease 2019 pandemic. Participants/settingParticipants were 528 adults (aged 30 to 97 years) in households randomly selected from a listing of all residential addresses in two predominantly Black neighborhoods with lower incomes in Pittsburgh, PA, and surveyed between March to May 2020 and May to December 2021. Main outcome measuresFood security was measured using the validated 6-item US Department of Agriculture Adult Food Security Survey Module. Statistical analyses performedFindings are based on a descriptive analysis of food security and related indicators. Statistical testing was performed to assess differences between SNAP participation status and individual characteristics, food security, and financial hardship using Wald F test for continuous measures and Pearson χ2 test for categorical measures. A multivariable linear model was used to assess the association of SNAP participation and eligibility status with change in food insecurity. ResultsIn cross-sectional analyses of 2021 data, no differences were observed between SNAP participants and eligible nonparticipants for food insecurity, food bank use, mean weekly food spending per person, and difficulty paying for basics. However, with respect to changes in food insecurity over the course of the pandemic, SNAP participants experienced a greater improvement in mean food security scores between 2020 and 2021 (–0.52 reduction in mean food insecurity score or a 16% improvement in food security; P ≤ 0.05) relative to SNAP-eligible nonparticipants. Perceived ineligibility (71.3%) and perceived lack of need (23%) were the most common reasons for not participating in SNAP. ConclusionsMore than one-third of SNAP participants and eligible nonparticipants experienced food insecurity and financial hardship. However, there were differences in the changes in food insecurity between these groups.

An Examination of Factors Contributing to Overall Life Satisfaction Among Older Black and White Americans: Findings from the 2020 Health and Retirement Study

An Examination of Factors Contributing to Overall Life Satisfaction Among Older Black and White Americans: Findings from the 2020 Health and Retirement Study

“NO FEAR, ALL FAITH”: RELIGIOUS COPING AND COVID-19 VACCINE HESITANCY AMONG OLDER AFRICAN AMERICANS

Abstract While COVID-19 had a devasting impact on many groups across the globe, older African Americans were especially affected by the disproportionate rates of morbidity and mortality associated with the virus. Faced with “double jeopardy” - the nature of being both old and Black - older African Americans were at an increased risk of COVID-19-related infection and death due to their age and factors associated with ethnicity (e.g., access to resources, distrust of healthcare). These risks led many health professionals to prioritize COVID-19 vaccine uptake for older African Americans. However, historically and contemporaneously, African Americans report some of the highest levels of vaccine hesitancy in comparison to other ethnic groups. Many older African Americans use religious coping as a source to alleviate the stress of health threats. Yet, the novelty of COVID-19 contributed to a limited understanding of how and why vaccine hesitant older African Americans used religious coping in response to the pandemic. The present study gathered qualitative data from 22 vaccine hesitant older African Americans to describe the role of religious coping in vaccine hesitancy. Data were analyzed using thematic analysis and inductive coding methods. Analyses identified several salient themes relative to religious coping and COVID-19 vaccine hesitancy, including (1) No Fear, All Faith, (2) Prayer Protects my Peace, and 3) My Faith Justifies my Hesitance. As vaccine uptake remains important for both older adults and African Americans, implications from this study highlight important considerations for navigating the nexus of religion and health with highly religious populations.

A CONTENT ANALYSIS OF NATIONAL AFRICAN AMERICAN REPARATION COMMISSION’S REPARATIONS PLAN FOR OLDER BLACK AMERICANS

Abstract This policy content analysis critically examined the National African American Reparations Commission’s (NAARC) 10-Point Plan for Reparations. As the first comprehensive plan for reparations, the latest revision has gained attention for its potential to rectify socioeconomic inequality. However, the degree to which the plan addresses the nuanced challenges faced by older Black Americans (e.g., higher rates of poverty) is unclear. Therefore, the objectives of this analysis were to: a.) assess the plan’s potential to reduce inequality among older Black Americans, and b.) evaluate its capacity to address inequality over the life course and subsequent generations. Before the qualitative analysis began, a coding scheme was developed surrounding cumulative disadvantage theory. For example, codes addressing economic disparities, healthcare barriers, and intergenerational wealth transfer were developed. From there, the 12-page document was deductively coded by the author using this scheme. The findings suggest that the NAARC’s 2023 revision is considerably comprehensive, providing strategies to address socioeconomic inequality on structural levels (e.g., funds for entrepreneurial development, criminal justice reform). Even so, the plan needs work to fully address the needs of today’s older Black adults. To maximize the plan’s impact on older Black Americans, the NAARC could incorporate long-term care provisions, family-centered support systems, and long-term services and supports. This analysis has significant implications for the NAARC’s plan and continued fight for reparations. To maximize its impact on older Black Americans and promote intergenerational equity, policymakers should consider inclusive provisions for a demographic most directly haunted by the legacies of slavery and Jim Crow.

INCARCERATION HISTORY AND ITS ASSOCIATION WITH COGNITION AND ISOLATION AMONG OLDER BLACK AMERICANS

Abstract Incarceration is a risk factor for adverse health and disproportionately affects Black Americans. Little is known about its implications for later life functioning. This study investigated the associations between incarceration and social isolation and cognition among older Black Americans. Sample included African American and Caribbean Black respondents aged 50+ from the National Survey of American Life, 2001-2003 (N=1,561; 12.6% with incarceration history). Lifetime incarceration history (yes/no) was defined as having been in jail, prison, or juvenile detention. Continuous cognitive score was measured using the WHO Disability Assessment Schedule-II, with higher scores indicating higher cognitive difficulty. Binary isolation was assessed by combining two indicators of frequency of contact and feelings of closeness, for friends and family, using a 4-point Likert scale. Multivariable weighted linear and logistic regressions were fit for the associations between cognitive score and social isolation, respectively. All models adjusted for age, sex, ethnicity, poverty, education, marital status, and drug use; model for cognition further adjusted for mental health and traumatic experiences and models for isolation further adjusted for discrimination. Moderation by nativity (U.S. versus foreign born) was assessed using interaction. History of incarceration was associated with worse cognition (β = 0.09, 95% CI: -1.48, 1.66) and higher odds of social isolation for frequency (AOR: 1.48 95% CI: 0.89, 2.46) and closeness (AOR: 1.05, 95% CI: 0.52, 2.15). Results not moderated by nativity. Findings suggest contexts surrounding incarceration, like social supports, may be important engagement points for successful transitions and promotion of psychological and cognitive health in this population.

INTERROGATING AGEISM

Abstract This paper identifies and addresses a puzzle within the conceptualization of ageism. According to the Reframing Aging Initiative, “Ageism refers to stereotypes, prejudice, and discrimination directed toward people on the basis of age”; these adversely affect older people’s lives in daily lives, including in employment and healthcare. Yet, unlike other marginalized groups, like people of color and women, older people are not underrepresented in powerful positions nor are they worse off. Indeed, they tend to fare better than the population overall: the mean age of US CEOs is 59 years; US Representatives and Senators are 58.4 and 64.3, respectively. Older Americans are more likely to be homeowners and less likely to be unemployed or food-insecure than the overall population. This paper considers several possible explanations. First, unlike racism or sexism, ageism may not be structural, but personal: present in individuals’ attitudes and interactions, but without population-level effects, codification, or institutionalization. Second, ageism may only hold intersectionally, becoming operational under conditions of structural oppression like racism and sexism. For example, while older US whites have less risk of food insecurity than younger whites, older Black Americans are at greater risk than younger Blacks. Finally, ageism may be mitigated by selective mortality: while older people face ageism daily, not everyone reaches older age. Wealthier people and whites are more likely to live to older age; older people’s greater power and welfare reflect their earlier status. Each option presents benefits and drawbacks; together they allow us to address those whom ageism most harms.