Puerto Rican Elderly Research Articles

AGING IN LATIN AMERICA: HEALTH, DISPARITIES, AND OUTCOMES AMONG OLDER ADULTS

Abstract Older adults in Latin America are living in contexts of high levels of poverty, low education, poor health literacy and reduced healthcare access. This symposium is focused on heath-disparities among older adults living in Brazil, Costa Rica, Mexico, Puerto Rico, and Colombia. The symposium explores connections between aging and health such as longevity, cognition, disability, and wellbeing in the context of Latin America, aiming to shed light on health-related dimensions and disparities among older Latinos. Using data from the Brazilian Longitudinal Study of Aging, Gomes examines the relationship between hearing loss and cognitive decline. Using the longitudinal Puerto Rican Elderly Health Conditions Project and the Puerto Rico Contextual Data Resource, García, examines how the relationships between racial identity, neighborhood-level racial density, and neighborhood-level socioeconomic status are related to the probability of experiencing all-cause mortality among island-dwelling Puerto Ricans. Using four nationally representative surveys of older adults in Latin America, Osuna studies how disability prevalence varies among older adults in Mexico, Costa Rica, Colombia and Brazil. Lastly, Saenz studies evaluates how level of exposure to a major drought Mexico is related with health among older adults, for this study they use data from the Mexican Health and Aging Study. Results underline what populations in Latin American have increased risk of experiencing poorer health outcomes and disparities that may exist. The findings highlight the importance of understanding the conditions under which Latin American older adults are aging and the implications this can have in the future.

RACE, NEIGHBORHOOD DYNAMICS, AND MORTALITY PATTERNS IN OLDER PUERTO RICANS

Abstract This study explores the relationships between race, neighborhoods, and mortality among older Puerto Ricans, drawing upon theoretical frameworks in sociology, gerontology, and public health. We combined data from the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO; 2002-2021) and the Puerto Rico Contextual Data Resource (PR-CDR) to examine how the relationships between racial identity, neighborhood-level racial density, and neighborhood-level socioeconomic status are related to the probability of experiencing all-cause mortality among island-dwelling Puerto Ricans aged 60 and older (n=4,243). Findings show that young-old Black Puerto Ricans residing in high socioeconomic neighborhoods have a lower risk of mortality relative to their same aged Black counterparts residing in low socioeconomic neighborhoods, and White Puerto Ricans who reside in either high or low socioeconomic neighborhoods. However, this mortality advantage diminishes when they reach the age of 75 years and over. We hypothesize that in Puerto Rico, Black communities with access to economic capital are especially beneficial for its residents as they are in spaces where they feel welcomed and are surrounded by amenities that are essential for healthy aging or survival into old age. As Puerto Ricans in these communities age, this advantage may diminish, due to a ceiling effect, meaning that for older Puerto Ricans who survive to age 60 in these communities, there are fewer advantages to accumulate. Our research provides a foundation for informed policy decisions and targeted interventions to promote aging in place in Puerto Rico and offers a framework for understanding similar dynamics in diverse Latin American contexts.

NEIGHBORHOOD SOCIOECONOMIC POSITION, LIVING ARRANGEMENTS, AND CARDIOMETABOLIC DISEASE AMONG OLDER PUERTO RICANS

Abstract Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations such as Puerto Rico. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. Using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03, and II 2006/07), linked with 2000 Census data for neighborhood-level conditions, this study examined the association between neighborhood SEP, living arrangements, and risk of cardiometabolic conditions among island-dwelling Puerto Ricans aged 60 and older, who lived in the same residence across both waves (N=2,769). Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but neighborhood SEP was unrelated to developing cardiometabolic conditions at follow-up. Living without a partner - alone, with children, or with others - was negatively associated with reporting having and developing cardiometabolic conditions relative to living with a partner. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone was associated with lower risk of reporting having one condition, and living with children was associated with lower risk of developing one cardiometabolic condition when living within a socioeconomically advantaged neighborhood. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions.

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007.

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

The neighborhood context and all-cause mortality among older adults in Puerto Rico.

Recent efforts have been made to collect data on neighborhood-level attributes and link them to longitudinal population-based surveys. These linked data have allowed researchers to assess the influence of neighborhood characteristics on the health of older adults in the US. However, these data exclude Puerto Rico. Because of significantly differing historical and political contexts, and widely ranging structural factors between the island and the mainland, it may not be appropriate to apply current knowledge on neighborhood health effects based on studies conducted in the US to Puerto Rico. Thus, we aim to (1) examine the types of neighborhood environments older Puerto Rican adults reside in and (2) explore the association between neighborhood environments and all-cause mortality. We linked data from the 2000 US Census to the longitudinal Puerto Rican Elderly Health Conditions Project (PREHCO) with mortality follow-up through 2021 to examine the effects of the baseline neighborhood environment on all-cause mortality among 3,469 participants. Latent profile analysis, a model-based clustering technique, classified Puerto Rican neighborhoods based on 19 census block group indicators related to the neighborhood constructs of socioeconomic status, household composition, minority status, and housing and transportation. The associations between the latent classes and all-cause mortality were assessed using multilevel mixed-effects parametric survival models with a Weibull distribution. A five-class model was fit on 2,477 census block groups in Puerto Rico with varying patterns of social (dis)advantage. Our results show that older adults residing in neighborhoods classified as Urban High Deprivation and Urban High-Moderate Deprivation in Puerto Rico were at higher risk of death over the 19-year study period relative to the Urban Low Deprivation cluster, controlling for individual-level covariates. Considering Puerto Rico's socio-structural reality, we recommend that policymakers, healthcare providers, and leaders across industries to (1) understand how individual health and mortality is embedded within larger social, cultural, structural, and historical contexts, and (2) make concerted efforts to reach out to residents living in disadvantaged community contexts to understand better what they need to successfully age in place in Puerto Rico.

Healthcare utilization among pre-frail and frail Puerto Ricans.

Frailty is associated with adverse health outcomes and greater healthcare utilization. Less is known about the relationship between frailty and healthcare utilization in Puerto Rico, where high rates of chronic conditions and limited healthcare may put this group at a higher likelihood of using healthcare resources. This study examined the association between pre-frailty and frailty with healthcare utilization at baseline and 4-year follow-up among a cohort of community dwelling Puerto Ricans living on the island. We examined data from 3,040 Puerto Ricans (mean age 70.6 years) from The Puerto Rican Elderly: Health Conditions (PREHCO) study between 2002-2003 and 2006-2007. We used a modified version of the Fried criteria defined as 3 or more of the following: shrinking, weakness, poor energy, slowness, and low physical activity. Pre-frailty was defined as 1-2 components. The number of emergency room visits, hospital stays, and doctor visits within the last year were self-reported. Zero-inflated negative binomial regression models were used for ER visits and hospital stays. Negative binomial models were used for doctor visits. Pre-frailty was associated with a higher rate of doctor visits with a rate ratio of 1.11 (95% CI = 1.01-1.22) at baseline. Frailty was associated with a higher rate of ER visits (1.48, 95% CI = 1.13-1.95), hospital stays (1.69, 95% CI = 1.08-2.65), and doctor visits (1.24, 95% CI = 1.10-1.39) at baseline. Pre-frailty and frailty were not associated with any healthcare outcomes at follow-up. Pre-frailty and frailty are associated with an increased rate of healthcare services cross-sectionally among Puerto Rican adults, which may cause additional burdens on the already pressured healthcare infrastructure on the island.

SOCIAL SUPPORT AND LONELINESS AS DETERMINANTS OF THE ONSET OF DISABILITY AMONG PUERTO RICAN OLDER ADULTS

Abstract Background The effect of loneliness and social support on health is poorly understood among older Puerto Ricans. As family size continues to decrease in Puerto Rico due to out-migration, a higher number of older adults have fewer family members to rely on, which may lead to detrimental health outcomes.Method: Using both waves (2002-03 and 2006-07) of the Puerto Rican Elderly: Health Conditions database, we examined the association between social support, living alone, and incident disability among a sample of older adults over 60 years of age residing in Puerto Rico. Disability was defined as the occurrence of difficulties with Activities of Daily Living (ADLs). Results 13.4% of older adults in our sample developed some form of disability. Older adults who developed a disability indicated receiving higher levels of social support (2.04 vs. 1.64) and loneliness (30.7% vs. 22.8%). Using multivariate logistic regression, we found that receiving social support increased the odds of developing a disability by 17% (OR: 1.17; CI: 1.02 – 1.35). Older adults who live alone had 58% higher odds of developing a disability (OR: 1.58; CI: 1.01 – 2.46). Conclusion The presence of social support and loneliness was correlated with a population prone to developing disabilities. Our findings concur with the well-established literature on psychosocial determinants in late life. However, this study represents the first attempt to understand psychosocial measures and disability in Puerto Rico. Public health organizations and healthcare systems must develop new societal mechanisms of support for older adults at risk of developing disabilities.

THE NEIGHBORHOOD CONTEXT AND ALL-CAUSE MORTALITY AMONG OLDER ADULTS IN PUERTO RICO

Abstract The neighborhood contexts in which older adults live are increasingly being recognized for their role in influencing disease processes and risk of death among the U.S. population. However, few studies have focused on neighborhood impacts among older populations residing in Puerto Rico– a U.S. territory –who are especially vulnerable to the effects of the environment as they “age in place” in the context of a budget crisis, the great recession, the debt crisis, and Hurricanes Irma and María. The combination of these events can obstruct access to neighborhood resources, services, and contexts considered necessary for promoting healthy aging. Thus, it is warranted to understand the effects of place on mortality in Puerto Rico, whose social and economic contexts differ from the U.S. and are more similar to that of other Latin American and Hispanic-Caribbean countries. We used 2000 U.S. Census data at the block-group level linked to the 2002 Puerto Rican Elderly Health Conditions Project with mortality follow-up to 2021 to examine neighborhood characteristics that are conceptualized as influencing mortality (e.g., residents without a high school degree; households receiving public assistance income; residents living below the poverty level; unemployed residents; residential stability; age structure). Multilevel mixed-effects parametric survival models with a Weibull distribution were estimated. Overall, results show that neighborhood socioeconomic disadvantage is associated with an increased risk of mortality among older Puerto Ricans. This suggests that older Puerto Ricans clustered in disadvantaged communities are more likely to experience a cumulative burden of social disadvantages that adversely impacts their longevity.

THE NEIGHBORHOOD CONTEXT AND ALL-CAUSE MORTALITY AMONG OLDER ADULTS IN PUERTO RICO

Abstract The neighborhood contexts in which older adults live are increasingly being recognized for their role in influencing disease processes and risk of death among the U.S. population. However, few studies have focused on neighborhood impacts among older populations residing in Puerto Rico– a U.S. territory –who are especially vulnerable to the effects of the environment as they “age in place” in the context of a budget crisis, the great recession, the debt crisis, and Hurricanes Irma and María. The combination of these events can obstruct access to neighborhood resources, services, and contexts considered necessary for promoting healthy aging. Thus, it is warranted to understand the effects of place on mortality in Puerto Rico, whose social and economic contexts differ from the U.S. and are more similar to that of other Latin American and Hispanic-Caribbean countries. We used 2000 U.S. Census data at the block-group level linked to the 2002 Puerto Rican Elderly Health Conditions Project with mortality follow-up to 2021 to examine neighborhood characteristics that are conceptualized as influencing mortality (e.g., residents without a high school degree; households receiving public assistance income; residents living below the poverty level; unemployed residents; residential stability; age structure). Multilevel mixed-effects parametric survival models with a Weibull distribution were estimated. Overall, results show that neighborhood socioeconomic disadvantage is associated with an increased risk of mortality among older Puerto Ricans. This suggests that older Puerto Ricans clustered in disadvantaged communities are more likely to experience a cumulative burden of social disadvantages that adversely impacts their longevity.

SOCIAL SUPPORT AND LONELINESS AS DETERMINANTS OF THE ONSET OF DISABILITY AMONG PUERTO RICAN OLDER ADULTS

Abstract Background The effect of loneliness and social support on health is poorly understood among older Puerto Ricans. As family size continues to decrease in Puerto Rico due to out-migration, a higher number of older adults have fewer family members to rely on, which may lead to detrimental health outcomes.Method: Using both waves (2002-03 and 2006-07) of the Puerto Rican Elderly: Health Conditions database, we examined the association between social support, living alone, and incident disability among a sample of older adults over 60 years of age residing in Puerto Rico. Disability was defined as the occurrence of difficulties with Activities of Daily Living (ADLs). Results 13.4% of older adults in our sample developed some form of disability. Older adults who developed a disability indicated receiving higher levels of social support (2.04 vs. 1.64) and loneliness (30.7% vs. 22.8%). Using multivariate logistic regression, we found that receiving social support increased the odds of developing a disability by 17% (OR: 1.17; CI: 1.02 – 1.35). Older adults who live alone had 58% higher odds of developing a disability (OR: 1.58; CI: 1.01 – 2.46). Conclusion The presence of social support and loneliness was correlated with a population prone to developing disabilities. Our findings concur with the well-established literature on psychosocial determinants in late life. However, this study represents the first attempt to understand psychosocial measures and disability in Puerto Rico. Public health organizations and healthcare systems must develop new societal mechanisms of support for older adults at risk of developing disabilities.

Increasing Pain Interference Is Associated With Cognitive Decline Over Four Years Among Older Puerto Rican Adults.

Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults. Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. Apain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0-2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n=2349). Baseline pain interference was not associated with baseline cognitive performance (p=.636) or with cognitive performance at follow-up (p=.594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (β=-0.07, standard error [SE]=0.02, p=.003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (β=-0.07, SE=0.02, p=.007). These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance.

20th Century Puerto Rico and Later-Life Health: The Association Between Multigenerational Education and Chronic Conditions in Island-Dwelling Older Adults.

Previous research on the association between education and older adult health in the U.S. has not included Puerto Rico. We investigated the effects of multigenerational educational attainment and chronic conditions among older Puerto Ricans residing on the archipelago's main island. Data were from the longitudinal Puerto Rican Elderly Health Conditions Project. Generalized Poisson regression models were used to examine if multigenerational educational attainment was associated with chronic disease. Findings show that parental educational attainment was associated with fewer chronic conditions among females at baseline but not at follow-up, suggesting that the effects of parental education on health over time are less pronounced. For males, educational attainment across the three generations was not significantly associated with chronic disease at baseline or follow-up. Multigenerational education is an important determinant of older adult health that continues to be relevant in Puerto Rico and the Latin American and Hispanic-Caribbean region.

Living Arrangements and Intergenerational Support in Puerto Rico: Are Fathers Disadvantaged?

To examine how intergenerational support varies by parents' living arrangements and whether there are gender differences in received support in Puerto Rico. Data come from the 2006-2007 Puerto Rican Elderly and Health Conditions Project, a representative longitudinal study of adults aged 60 and older in Puerto Rico (n = 2,288). We examined the association between parents' living arrangements (alone, with spouse/partner only, with children) and their receipt of functional (help with errands/housework/transport) and health (help when sick) support from children, and whether parents' gender moderates the association. Intergenerational coresidence was associated with higher odds of receiving functional and health support than living alone. Women were more likely than men to receive both forms of support. Parents' gender significantly moderated the association between living arrangements and receiving health support-men living with their partners were less likely to receive health support from children than women in similar living arrangements. These associations persisted when analyses were restricted to those with disability. Our findings suggest that parents' receipt of support from children is conditioned upon their living arrangement and gender, even when their functional health is jeopardized. We discuss these results in relation to the heterogeneous influence of living arrangements for older adults' support needs and provide suggestions for policy and directions for future research in rapidly aging Puerto Rico.

Childhood food insufficiency and adulthood cardiometabolic health conditions among a population-based sample of older adults in Puerto Rico

Childhood food insufficiency negatively influences physical and psychosocial health in children, but less is known about long-term health implications. This study aimed to elucidate the association of childhood food insufficiency with older adulthood cardiometabolic conditions. We conducted cross-sectional analyses using data from the Puerto Rican Elderly: Health Conditions Project (n = 2712), a population-based sample of elderly adults (>60 y) living in Puerto Rico. Childhood food insufficiency was ascertained with a proxy question on childhood economic hardships that prevented eating. Participants self-reported hypertension, diabetes, and cardiovascular disease (CVD; including heart attack, heart disease, or stroke). Obesity was assessed as body mass index using measured height and weight. Multivariable-adjusted, sex-stratified, complex survey logistic regression models tested associations of childhood food insufficiency with each condition, number of cardiometabolic conditions (0–6), and age of onset. Nearly a third (29.4%) of the sample reported childhood food insufficiency; 68.7% reported hypertension, 29.6% reported type 2 diabetes, 34.2% reported CVD, 29.9% were categorized with obesity, and 55.4% had two or more cardiometabolic conditions. In men, but not women, childhood food insufficiency was associated with higher odds of hypertension (Odds Ratio (OR) (95% Confidence Intervals (CI)): 1.7 (1.1, 2.7)), CVD (1.7 (1.1, 2.6)), and having two (1.9 (1.0, 3.4) or three to four (2.3 (1.2, 4.4)) cardiometabolic conditions. Childhood food insufficiency was marginally associated with higher odds of early age of onset of CVD among men (2.2 (1.0, 4.7)). Childhood food insufficiency may increase the likelihood of having cardiometabolic conditions in Puerto Rican older men. Programs that enable access to sufficient, healthy food in childhood may help prevent eventual cardiovascular-related diseases.

Risk Factors for Cognitive Decline in Older Adults in Puerto Rico: Assessing Bias From Sample Attrition

Many risk factors for cognitive decline are associated with mortality and are common among older adults who cannot complete a survey interview. Our objective was to compare analyses of risk factors for cognitive decline among older adults in Puerto Rico with and without accounting for sample attrition. Data came from the Puerto Rican Elderly: Health Conditions Study. Our sample included 3,437 participants interviewed in 2002/03. Cognitive function was measured using the Mini-Mental Caban (MMC). The outcome was the change in MMC score between 2002/03 and 2006/07. Logistic regression was used to estimate inverse probability weights for being interviewed in 2006/07 (n=3,028) and completing the MMC at follow-up (n=2,601). Linear regression models were used to assess the association between stroke, hypertension, diabetes, smoking status, and cognitive decline with and without the IPWs. In the unweighted analysis, stroke was associated with a significantly greater decline in cognition (b=-0.62, standard error [SE]=0.30, p=0.04). Hypertension (b=-0.02, SE=0.12, p=0.84), diabetes (b=-0.22, SE=0.13, p=0.10) and being a current (b=0.05, SE=0.22, p=0.84) or former smoker (b=0.05, SE=0.14, 0.74) were not associated with cognitive decline in the unweighted analysis. The results were similar when including the IPW for mortality (stroke b=-0.63; hypertension b=-0.03; diabetes: b=-0.20; current smoker: b=0.08; former smoker: b=0.07) and having completed the MMC at follow-up (stroke b=-0.58; hypertension b=-0.03; diabetes: b=-0.20; current smoker: b=0.03; former smoker: b=0.09). These findings indicate that stroke is a risk factor for cognitive decline among older Puerto Rican adults even after accounting for selective attrition.

Instrumental Activities of Daily Living Difficulties Predict Cognitive Decline in Older Puerto Rican Adults

Given the hypothesized bidirectional association between functional and cognitive decline, further characterization of the temporal association between the two is needed, especially in Latinx samples as they are the most rapidly growing demographic in the United States and at greater risk for Alzheimer’s disease. This study assessed bidirectional associations between instrumental activities of daily living (IADL) difficulty and cognition in older Puerto Rican adults. Participants included 2,840 community-dwelling adults (60+ years) without cognitive impairment who completed baseline and a four-year follow-up in the Puerto Rican Elderly: Health Conditions (PREHCO) project. At each wave, cognition (using the Mini-Mental Cabán) and self-reported IADL difficulty (a sum score of 10 everyday tasks) were measured. Covariates included age, gender, education, comorbidities, and depressive symptoms. Bidirectional associations were tested using a path model with concurrent and cross-lagged paths between cognition and IADL difficulty adjusting for covariates. Lower baseline cognition related to more baseline IADL difficulty (B=-0.08, SE=0.02, p<.001). Cognitive decline at follow-up related to greater IADL difficulty at follow-up (B=-0.06, SE=0.02, p=.012). Looking at cross-lagged associations, greater baseline IADL difficulty associated with more cognitive decline at follow-up (B=-0.10, SE=0.04, p=.012). However, baseline cognition was not significantly associated with change in IADL difficulty at follow-up (B=-0.003, SE=0.02, p=.869). Findings support the growing body of literature that IADL difficulties can predict future cognitive decline in samples of community-dwelling older adults. More research into both functional and cognitive decline in Latinx samples will provide a more generalizable view of aging.

Color disparities in cognitive aging among Puerto Ricans on the archipelago

This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.

Pain associates with subjective memory problems and cognition in older Puerto Rican adults

ABSTRACT This study examined whether pain is associated with subjective memory problems or cognition in Puerto Rican older adults. Participants came from the Puerto Rican Elderly Health Conditions (PREHCO) study, aged 60 and over (n = 2,144). Analyses examined concurrent and longitudinal associations of pain with subjective memory problems and cognition using a cognitive screener. Overall, participants with pain were more likely to report concurrent subjective memory problems than those without pain. Older adults with pain also exhibited slightly lower concurrent cognition. Novel pain was associated with cognitive decline and greater likelihood of incident subjective memory problems at follow-up. Persistent pain was only related to incident subjective memory problems at follow-up. Pain is associated with cognitive decline and subjective memory problems in older Puerto Ricans. Future studies should implement more in-depth neuropsychological assessments and examine the potential role of barriers to pain management in this population.

Quality of Education and Late-Life Cognitive Function in a Population-Based Sample From Puerto Rico.

Background and ObjectivesWe examined quality of education, literacy, and years of education in relation to late-life cognitive function and decline in older Puerto Ricans.Research Design and MethodsOur sample consisted of 3,385 community-dwelling adults aged 60 years and older from the Puerto Rican Elderly: Health Conditions study. Quality of education was based on principal component analysis of variables gathered from Department of Education and Census reports. Literacy (yes/no) and years of education were self-reported. Cognitive function was assessed in participants’ homes at baseline and 4 years later using a previously validated Spanish-language 20-point global screening measure for dementia, the minimental Cabán. Regression models were adjusted for sociodemographic and life course covariates.ResultsQuality of education was positively correlated with both educational attainment and cognitive performance. Independent of years of education, literacy, childhood economic hardship, and adult economic hardship, compared to participants in the lowest quartile of education quality, those in the highest quartile had significantly better baseline cognitive performance (β = 0.09, p < .001). Quality of education did not consistently show an association with change in cognitive function over 4 years. Literacy and greater educational attainment were each independently associated with better cognitive function at baseline and less cognitive decline.Discussion and ImplicationsQuality of education, literacy, and years of education, while interrelated, also show independent associations with cognitive functioning in older Puerto Ricans. The downstream factors of literacy and years of education were more closely related to age-related cognitive decline than quality of education.

Job Strain and Late-Life Cognition: Findings From the Puerto Rican Elderly Health Conditions Study.

Objectives: We examined associations between job strain and cognitive aging in a sample of older Puerto Ricans. Methods: Members of the Puerto Rican Elderly: Health Conditions study, aged 60-100years at baseline, participated. Job strain indicators were quantified from O*NET (n = 1632) and a matrix of Job Content Questionnaire scores (JCQ; n = 1467). Global cognition was assessed twice across 4years. Results: Controlling for age, sex, depressive symptoms, financial problems, hypertension, diabetes, childhood economic hardship, low job control and high job strain were consistently associated with greater cognitive decline. Adding education attenuated these associations. High education strengthened the JCQ job control-cognitive change link. Discussion: Low job control and high job strain may accelerate cognitive aging in this population. However, it may be more difficult to disentangle the intersecting roles of education and job strain in cognitive aging among older Puerto Ricans relative to older adults from contiguous United States or Europe.