Older Blacks Research Articles

Mortality trends for cervical squamous and adenocarcinoma in the United States

In the United States, detection of squamous carcinoma in situ (CIS) by screening has led to reduced rates for invasive squamous carcinoma and lower mortality. Adenocarcinoma in situ (AIS) rates also have increased, but invasive cervical adenocarcinoma rates have not declined similarly. To make inferences about the effectiveness of screening, the authors assessed mortality trends for squamous and adenocarcinoma in relation to incidence of these tumors, incidence of their precursors and survival. Using data from the Surveillance, Epidemiology, and End Results program (SEER), the authors tabulated incidence per 10(5) woman-years for invasive carcinomas (1976-2000) and for CIS and AIS (1976-1995) by age (< 50 years, > or = 50 years) and race (whites, blacks). Cumulative relative survival rates were tabulated for 1976-1995 and mortality rates were estimated for 1986-2000. Among all groups, CIS rates approximately doubled whereas rates for invasive squamous carcinoma declined. Among younger whites, mortality declined from 1.12 to 0.93, and for older whites, mortality decreased from 5.02 to 3.82. Among younger blacks, mortality for squamous carcinoma decreased from 2.69 to 1.96. Among older blacks, the mortality rates declined from 14.88 to 9.15. Although AIS rates have increased dramatically among whites (all ages) and younger blacks, adenocarcinoma incidence and mortality rates have not changed greatly. Survival for patients did not change greatly within these age-race groups. The authors concluded that increases in CIS seemed disproportionately large compared with improvements in mortality rates for squamous carcinoma. Despite increased reporting of AIS, declines in mortality for cervical adenocarcinoma have not been demonstrated conclusively. However, future analyses are required to evaluate these trends more completely.

Exploring Race Differences in a Multidimensional Battery of Prayer Measures among Older Adults

The purpose of this study was to test for race differences in 17 different measures of prayer. These indicators assess five dimensions of prayer: The social context of prayer, the substantive content of prayer, the length of prayer, interpersonal aspects of prayer, and beliefs about how prayer operates. Pervasive race differences emerged in the data. More specifically, data provided by a nationwide sample of older whites and older African Americans suggest that older blacks are more deeply involved than older whites in 16 of the 17 prayer measures. The length of prayer was the only measure where significant race differences failed to emerge.

Social and cultural variables: Individual differences in chronic pain and disease in older blacks: The role of psychosocial factors

Social and cultural variables: Individual differences in chronic pain and disease in older blacks: The role of psychosocial factors

A Preliminary Assessment of Race Differences in the Relationship between Religious Doubt and Depressive Symptoms

The purpose of this study is to test a conceptual model that examines the relationship between religious doubt and depressive symptoms in late life. Data from a nationwide survey of older adults provide support for the following hypotheses that were embedded in this conceptual schemers (1) older people who do not attend church often tend to have more doubts about their faith; (2) older individuals who have doubts about religion will not feel closely connected with others; (3) older people who do not feel a close bond with others will be less likely to forgive people for the things they have done; and (4) older people who are not willing to forgive others will be more likely to experience depressive symptoms. The data further reveal that older blacks are more involved in religion than older whites and that the beneficial impact of religion on depressive symptoms is greater for older African American study participants.

Race, religion, and abstinence from alcohol in late life.

This study aimed to see whether involvement in religion helps explain why older Blacks are more likely to avoid drinking alcohol than older Whites. Interviews were conducted with a nationwide sample of older Whites and older Blacks. Survey items were administered to assess whether study participants consume alcohol, whether they affiliate with fundamentalist congregations, how often they attend religious services, how often they pray privately, and whether they derive a sense of meaning from their faith. The findings reveal that older people who affiliate with fundamentalist churches and who find meaning in religion are more likely to avoid drinking. However, neither church attendance nor private prayer are related to alcohol use. Race differences in the odds of drinking were no longer statistically significant once the religion measures were added to the model. The findings highlight the importance of religion in shaping the health behaviors of older adults.

The HIV epidemic among older men who have sex with men.

The authors present HIV prevalence and risk behavior data for urban men who have sex with men (MSM) aged 50 years or older. Data are based on a probability sample of MSM conducted in 1997 (n = 2881 total; 507 older MSM) in New York, Los Angeles, Chicago, and San Francisco. The authors determined HIV status through self-report and biologic measures. Risk behavior was assessed through self-report. The authors found that HIV prevalence was 19% (95% CI: 14, 25) for men in their 50s and 3% (95% CI: 1, 10) for men in their 60s. No men in their 70s were HIV-positive. Prevalence was at high levels for older blacks (30%), MSM who are injection drug users (21%), moderately heavy drug users (35%), and less closeted men (21%). High-risk sex between serodiscordant partners was relatively constant (4%-5%) across age groups older than 30 years of age and decreased among MSM in their 70s. Current levels of HIV among older urban MSM in the United States are very high, particularly among those in their 50s. High mortality rates among MSM with AIDS up to 1996 (before highly active antiretroviral therapy [HAART]) would account for the lower levels among men in their 60s and 70s. Because of HAART, we would expect HIV levels to increase in these age groups. Given high levels of risk behavior among MSM through the sixth decade of life, the authors would expect an older MSM epidemic of substantially larger proportion than that observed in the 1980s and 1990s.

Comparison of Mammography Use by Older Black and White Women

To identify differences in the prevalence of ever having had a mammogram and having had a recent mammogram between older black and white women and to compare factors associated with mammography use in older black and white women. Data analysis and comparative study using nationally representative multistage sampling survey. Data were obtained from the 1998 National Health Interview Survey. Four hundred forty-nine black and 3,328 white older women were examined. The outcome variables included never having had a mammogram (yes/no) and not having had a mammogram in the past 3 years (yes/no). The results of chi-square tests showed that older blacks were less likely to have ever had a mammogram than older whites, but there was no difference in having had a recent mammogram between older blacks and whites. After adjusting for other related factors, race was not related to mammography use in older blacks and whites. Health insurance was related to mammography use in older whites but not in older blacks. Family income was associated with never having had a mammogram in older whites but not in older blacks. Older blacks with less than 12 years of education were less likely to have had a mammogram (recently or ever) than older whites with less than 12 years of education. Even though race, per se, was not associated with mammography use in older black and white women, many barriers to mammography use between older black and white women were different or did not have similar effects. To promote mammography use in older black and white women, barriers need to be specifically targeted for each group to enhance the effectiveness of breast cancer screening programs.

Exploring Race Differences in the Relationship between Social Interaction with the Clergy and Feelings of Self-Worth in Late Life

The purpose of this study is to see if em onal support from the clergy and negative interaction with clergy are associated with feelings of self-esteem in late life. A special emphasis is placed on assessing race differences in the relationships among these constructs. Data from a nationwide survey of older whites and older African Americans reveal that emotional support from the clergy tends to bolster the self-esteem of older blacks, but not older whites. The fndings further indicate that negative interaction with a pastor is associated with diminished feelings of selfworth, but race differences failed to emerge in the relationship between these constructs. Instead, unpleasant interation with the cergy was related to lower selfsteem only among older people who did not use religious coping responses to deal with these interpersonal problems.

Exploring Race Differences in a Comprehensive Battery of Church-Based Social Support Measures

The purpose of this study is to see if the social networks maintained by older blacks in the church are more well developed than the church-based social support systems of older whites. Twelve different dimensions of church-based support are evaluated with data from a recent nationwide survey of older whites and older blacks. The findings suggest that mean levels of support are higher for older blacks than older whites on ten of the twelve church-based social support scales. There are two reasons why greater confidence may be placed in these results. First, rigorous analysis of the newly devised church-based support scales reveals that these measures have good psychometric properties. Second, tests for measurement equivalence suggest that it is appropriate to probe for race differences in the church-based support measures because the subjects in both racial groups tend to evaluate the items in the same way (i.e., they mean the same thing to older whites and older blacks).

Gender Differences among Abused Older African Americans and African American Abusers in an Elder Abuse Provider Agency

Objectives of this study were to examine gender differences among mistreated older African Americans and their perpetrators. The analysis was based on substantiated elder abuse cases in Illinois. Gender differences regarding six forms of abuse were examined as were demographic and barrier differences among victims and perpetrators. Overall, older African Americans were more susceptible to financial exploitation and intentional neglect. Other than intentional physical neglect, there were no significant gender differences between male and female victims in their mistreatment (χ 2 = 6.66, p =.010). Both male and female abusers were equally engaged in caring for their aging relatives and more likely to be children of the victims and living with them. Females (75.0%) more than males (67.0%) were abusive to aging relatives. Findings show that older Blacks, especially males, are subject to mistreatment from relatives who may be overwhelmed by caring for them and may benefit from intervention programs.

Medicaid Reimbursement Rates and Access to Nursing Homes

Medicaid reimbursement rates vary widely around the country and at times are just 70 to 80 percent of prevailing private pay rates. These differences may create economic incentives for nursing homes to discriminate against Medicaid applicants. The 1997 National Nursing Home Survey of Current Residents provides the opportunity to develop a ratio of Medicaid to private pay rates for a nationally representative sample of 6,081 residents. Logistic regression modeling shows that even when controlling for sex, race, marital status, and functional level, residents are less likely to be on Medicaid at admission when the ratio is small than when it is close to 1.0. Older Blacks and Hispanics, and older unmarried persons, are more likely to be on Medicaid; therefore, they are more likely to face delay or denial of admission. A possible policy resolution comes from Minnesota, where an equalization law requires nursing home and welfare state officials to work together to set rates, making discriminatory practices against vulnerable groups illegal.

The pattern of expenditure of social pension income of older blacks in rural and urban areas of the Free State, South Africa

A lack of empirical data on the pattern of expenditure of social pension income by black South African beneficiaries prompted an investigation reported in this paper. It was found that although pension sharing is common in multi-generational households, it is not the norm among black pensioners who live alone. Food is the largest single expenditure item, while a relatively small amount of pension money is spent on children and/or grandchildren. Nor does much pension money find its way into the hands of cash loan agents. Little difference was found between the spending patterns of pensioners in rural areas and those in an urban area. It was moreover found that pensioners are less frequently robbed of their pension money than is alleged.

Delivery of preventive services to older black patients using neighborhood health centers.

Older black patients are at risk for underutilization of preventive services. Our objectives were to assess the delivery of five preventive services in Title 330-funded health centers in low income neighborhoods in Cleveland, Ohio, and to determine the association of health system factors and health status with the delivery of these services. A cross-sectional study. Four neighborhood health centers in low income neighborhoods of Cleveland, Ohio. A total of 683 black men and women, aged 70 and older, who regarded the health center as their primary source of outpatient care. Demographic characteristics, independence in basic and instrumental activities of daily living, comorbidity scores, and perceived access were determined by telephone interview. We reviewed charts to determine whether each of five preventive service goals were obtained: influenza vaccination within 1 year; pneumococcal vaccination at any time; mammography within 2 years; Papanicolau screening within 1 year or twice at any time in the past with documentation of normal results; and fecal occult blood testing within 2 years. The defined goals for influenza vaccination, pneumococcal vaccination, mammography, Papanicolau screening, and fecal occult blood testing were achieved for 59%, 64%, 59%, 51%, and 17% of patients, respectively. Influenza and pneumococcal vaccines were obtained more often in persons with greater comorbidity. Mammography and Papanicolau smear were obtained more often in patients without of ADL or IADL impairments. The four clinical sites varied substantially in the delivery of each preventive service. More frequent office visits were associated with greater delivery of all five preventive services. This relationship persisted in multivariable analyses controlling for health status and clinical site. This study shows that Title 330 federally supported neighborhood health center sites providing primary care to older blacks in Cleveland achieved high rates of performance in four of the five recommended preventive services. In addition, preventive services practices were associated with prognostically relevant health status information. The frequency of office visits was related strongly and consistently to the performance of the various preventive services, indicating that more, not fewer, office visits may be necessary to achieve Healthy People 2000 targets. J Am Geriatr Soc 48:124-130, 2000. Key words: preventive services; blacks; access to care; geriatrics; primary care

Race and Ethnic Variation in Norms of Filial Responsibility among Older Persons

Race and ethnic diversity in attachment to the norms of intergenerational filial responsibility is examined in a sample of older persons drawn from the National Survey of Families and Households (NSFH). The findings show that older Blacks and Hispanics are more likely than older non-Hispanic Whites to agree that each generation should provide coresidence assistance when needed. In terms of attitudes about exchanging financial aid, there tend to be fewer differences between each group. Moreover, in a longitudinal analysis of living arrangements, the impact of race on the likelihood of living with an adult child is reduced to statistical insignificance when variation in commitment to norms governing coresidence is controlled. Key Words: financial assistance, intergenerational relations, living arrangements, minority status, social support. Interest in the family relationships of older minority persons is driven, in part, by the remarkable growth of these populations in American society (e.g., Angel & Hogan, 1992). The non-Hispanic White majority represented nearly 88% of all persons aged 65 years and older in 1990. About 8% of the older population was composed of Blacks, and about 4%, of Hispanics. Yet, by the year 2050, the United States Census Bureau projects that older Blacks and Hispanics combined may account for as much as 26% of all persons over the age of 65 (Treas & Torrecilha, 1995). Improving mortality risk at younger and older ages, younger age distributions, differential fertility, and recent immigration patterns account for much of this relatively rapid increase of minority groups. One reason this growth is important is that some segments of the population of the minority aged appear to experience increased vulnerability with age, compared with their non-Hispanic White counterparts. For instance, older Blacks and Hispanics are disproportionately more likely than older White persons to be poor, to have poorer health, and to experience more functional limitation. Recent evidence shows that older members of minorities are more likely than their majority counterparts to use certain types of formal services (e.g., Mui, Choi, & Monk, 1998), yet Black and Hispanic elders are less likely to rely on institutions for long-term care. Research published in the 1960s and 1970s suggests that minority elders were at least partially sheltered from the worst outcomes of these risks because they were immersed in strong kin support systems-moreso than Whites. In essence, the research tended to suggest that when it came to the family ties of the older minority person, the norms of filial responsibility were stronger for minorities than for Whites. Recent research, however, shows that differences between Blacks and Whites with respect to the actual exchanges of aid and services between family members may not be as significant as once thought (e.g., Silverstein & Waite, 1993). To understand the association between norms of filial responsibility and actual behavior, research is needed that compares attitudes about intergenerational support across racial and ethnic groups, combined with analyses of the impact of these attitudes on behavior. This article addresses the issue by evaluating two specific features of intergenerational filial responsibility: attitudes about coresidence and providing financial assistance in times of need. We also evaluate whether attitudes about intergenerational coresidence are related to actual living arrangements. We explore differences in attitudes about filial responsibility among Whites, Blacks, and Hispanics using the NSFH. THEORY AND LITERATURE REVIEW Given that family members are the preferred first line of defense for older persons who need assistance, it is helpful to know what motivates family members to assist other family members. One motivation is assumed to be related to normatively based attitudes about responsibility, duty, and obligation toward others in the family unit. …

Aging versus disease: the opinions of older black, Hispanic, and non-Hispanic white Americans about the causes and treatment of common medical conditions.

Little is known about how older people interpret disease and how those interpretations might relate to use of medical services. To assess opinions of older subjects about the cause and treatment of common diseases and how they are related to health behaviors. In-home interview of a population-based sample (n = 601) of noninstitutionalized black, Hispanic, and non-Hispanic white American men and women aged 75 and older in Galveston County, Texas. Substantial proportions of the subjects considered heart disease, arthritis, or difficulty sleeping to be a normal part of aging. In multivariate analyses including age, gender, education, marital status, living arrangement, global self-rating of health, and comorbidity, older black subjects were less likely to view heart disease (OR = 0.41; 95% CI, 0.26-0.64), arthritis (OR = 0.48; 95% CI, 0.31-0.73), or sleep problems (OR = 0.50; 95% CI, 0.32-0.77) as a normal part of aging than were non-Hispanic whites. Blacks were more than three times as likely to attribute heart disease to overwork or stress than were non-Hispanic whites. In multivariate analyses, subjects who considered all three of the medical conditions to be a normal part of aging ("fatalistic") were less likely to have received preventive medical services in the previous year (OR = 0.13; 95% CI, 0.02-0.96), and subjects who felt that nothing could be done to treat any of the conditions ("nihilistic") were less likely to have a regular physician (OR = 0.24; 95% CI, 0.08-0.74). Substantial numbers of older subjects are fatalistic about the cause of disease and/or nihilistic about its treatment. These attitudes are associated with decreased utilization of health services. Attempts to improve the health of underserved groups should employ interventions that are sensitive to the health beliefs of the targeted group.

INFLUENCE OF AGE AND RACE ON THE TIME TO FIRST ACUTE REJECTION IN CADAVERIC RENAL TRANSPLANT (CRT) RECIPIENTS IN THE MYCOPHENOLATE MOFETIL (MMF) ERA

561 An increased incidence of acute rejection in young CRT recipients, especially those that are black, has been described in previous studies. This clinical finding, however, has not been cited for patients who have received MMF as part of their primary immunosuppression. This was a retrospective review of 247 consecutive CRT recipients transplanted at a single center between 6/29/95 and 10/15/98. The influence of age and race on the time to first acute rejection was compared using Kaplan-Meier curves and the log rank test. Cox proportional hazard models were used to adjust for potential confounders. Patients were divided into those aged <50 or ≥50. There were 58 younger whites, 70 older whites, 71 younger blacks, and 49 older blacks. In the overall analysis, there was a significantly higher incidence of first biopsy proven rejection in the recipients aged <50 compared to recipients aged ≥50 (38.6% vs. 19.7%, P=0.002). These findings were also significant when looking at the first 3, 6 and 12 months post-transplant. When analyzing age as a continuous variable, the incidence of first acute rejection was inversely related to recipient age, with younger patients rejecting earlier post-transplant (P=0.03). There was no difference in acute rejections when comparing whites to blacks, however, the difference in rejection rates noted for age was more pronounced in blacks. Younger black recipients had the highest incidence of first acute rejection (P=0.002, RR=4.05) relative to older black recipients who had the lowest incidence of acute rejection. There was no significant difference between older blacks and all whites regardless of age as a variable. After adjusting for sex, race, degree of HLA mismatch, discharge serum creatinine (≤2.2 or >2.2 mg/dl), the use of induction with either OKT3 or antilymphocyte globulin and the type of calcineurin inhibitor in the regression model, age <50 or ≥50 remained a significant predictor of time to first acute rejection (P=0.008, RR=0.49). In the MMF era, younger black recipients (<50) have the highest incidence of first acute rejection.

Etiologic models for incident periodontal attachment loss in older adults.

Etiologic factors for incident periodontal attachment loss (ALOSS) have not been conclusively identified. The purpose of this study was to develop etiologic models for ALOSS in older adults. Data on 697 older blacks and whites were obtained from 5 sequential examinations over 7 years in the Piedmont 65+ dental study, a complex random sample of older adults in North Carolina. Multivariable Poisson regression models were fit for average number of ALOSS events per person or site month at risk. In models for whites, molar sites, sites with adjacent caries, sites in persons who had: Porphyromonas gingivalis (P.g.) at least 2% of total microbial count (TMC), never had a dental checkup, more depression symptoms, fewer than 12 years of education, higher BANA score, or smoked, had significantly higher rates of ALOSS. In a separate model for blacks, interproximal and molar sites, sites in blacks who had: P.g. at least 2% of TMC, higher BANA score, never had a dental checkup, lower socioeconomic status (SES), or smoked, had significantly higher rates of ALOSS. These results confirm a multifactorial etiology for ALOSS in older adults and indicate that interventions aimed at infection, smoking, and preventive dental care utilization, may be most useful.

Racial differences in functional status among elderly U.S. migrants from the south

This study describes patterns of functional status among older blacks and whites by their history of birth in and migration out of the South. We used multivariate regression to analyze data on functional status of US-born non-Hispanic blacks ( N=1868) and whites ( N=13 469) age 60 years or above. In general, the functional status of blacks who were born in the South and migrated was similar to that of blacks born outside the South and better than those born in the South who did not migrate. Whites who migrated from the South had functional status similar to those who did not migrate and worse than those born outside of the South. Socioeconomic status did not explain differences by race and migration history. These results differ sharply from mortality studies, which have found a consistent pattern of high mortality among black migrants from the South. Differences among race groups by migration history vary across health measures. Selective migration and selective survival may account for the complex patterns of racial differences in geographic distributions of function and health.

Race Differences in Filial Responsibility Expectations among Older Parents

Gary R. Lee Bowling Green State University Chuck W. Peek University of Florida* Raymond T. Coward University of New Hampshire** This study examines race differences in extent to which older parents believe that parents are entitled to support from their children. Bivariate analyses show that Blacks have higher filial responsibility expectations than do Whites, and difference is only marginally attenuated by controls for sociodemographic and other factors. The results provide tentative evidence of a difference between Blacks and Whites, which is consistent with differences in observed levels of support from children and other descendants. In addition, neither higher expectations for assistance from children nor higher levels of actual assistance appear to deter parents in need front utilizing formal service providers. Key Words: aging, filial responsibility, intergenerational relations, race. A long tradition in social sciences argues that Blacks have larger and more active support networks than do Whites and that kin play a stronger role in these networks among Blacks (Burton et al., 1995; Gibson, 1982; Gibson & Jackson, 1987: Hayes & Mindel, 1973; Jayakody, Chatters, & Taylor, 1993; McAdoo, 1978, 1980; Miller, McFall, & Campbell, 1994; Miner, 1995; Stack, 1974; Staples & Mirande, 1980; Thornton, White-Means, & Choi, 1993). Pyke and Bengtson (1996) categorize family types into individualist (emphasizing self-sufficiency and voluntary nature of kin relations) and collectivist (emphasizing familistic norms and responsibilities). They suggest that collectivism is associated with working-class and ethnic families, and individualism, with White middle class (p. 382). Black culture frequently is presumed to emphasize informal support systems more than White culture, in part because formal institutions viewed by Whites as supportive (e.g., police, government, education) may be seen as exploitive by Blacks (Hayes & Mindel, 1973; Miner, 1995; Seelbach, 1981). Thus, it has been suggested that Blacks may feel a aversion to formal services (Miner, 1995; Morrison, 1983) or at least be less dependent on formal services because of their stronger informal networks (Litwak, 1985; Watson, 1990). Stack's (1974) study of survival strategies in a Black community showed how kin and others band together to share resources in face of poverty and discrimination and how culture values this sharing. (See also Johnson, 1995; Willie, 1988.) Recent research, however, has provided equivocal support for this position (Bengtson, Rosenthal, & Burton, 1996; Hofferth, 1984; Hogan, Hao, & Parish, 1990). A number of studies have found either that there are no race differences in informal social support or that Whites receive slightly more support than Blacks (Belgrave & Bradsher, 1994; Burton et al., 1995; Miller et al., 1994). Miner (1995) did find that older Blacks received somewhat more assistance from kin than older Whites, but Blacks also made greater use of formal services. And Silverstein and Waite (1993) demonstrated that most race differences in provision and receipt of social support across life cycle favored Whites, except among older Black women, who were more likely to receive instrumental support from their networks than were their White counterparts. We concur with Silverstein and Waite (1993) that the findings of high rates of support within social networks of Blacks often rest on a weak empirical base (pp. S212-S213). In addition, there is little direct evidence of cultural difference on which many arguments for stronger informal networks among Blacks rely (McAdoo, 1978; Miner, 1995; Morrison, 1983; Mutran, 1985; Stack, 1974; Taylor, Chatters, Tucker, & Lewis, 1990). Bengtson et al. (1996) identify the view of pervasive strength in extended kin networks of minority elders (p. …

CONTEXTUALIZING SOCIAL SUPPORT AND HEALTH IN OLD AGE:RECONSIDERING CULTURE AND GENDER

In this paper we develop a conceptual model of the cultural context within which gender and social support affect health among the elderly. We argue that given the highly contextualized and subjective nature of social support, observed associations between social contacts and health cannot be explained using simple survey probes concerning contacts during some period. The research employs two large surveys of older blacks and Hispanics to illustrate the speculative nature of any explanation of the association among various social contacts, disability, and death that are based only on responses to questions concerning the presence or absence of specific contacts. We end with a call for an extension of what is currently common practice in the study of social support and health to include greater attention to the subjective nature of social support and a greater appreciation of the cultural and social contexts within which social support operates to influence the health of older men and women.