Epidemiology of racial differences in decision making among older adults

摘要 健全的决策对于在整个生命周期中保持独立和幸福很重要， 关键是在老年，当一些生活中最复杂和最有影响力的决定。我们最近的工作 小组和其他人已经表明，决策需要认知，背景和心理社会资源 许多老年人--即使是那些没有认知障碍的人--也容易做出错误的决定 在金融和卫生等关键领域，他们经常成为欺诈的受害者。糟糕的决定 衰老预示着几种不利的健康结果，包括阿尔茨海默病， 认知障碍和死亡率，并构成重大的公共卫生和经济挑战。重要的是， 然而，迄今为止，大多数关于决策的研究都涉及白色参与者。之甚少 众所周知，非裔美国人的决策，尽管有充分的记录种族差异， 认知的，上下文的（例如，社会经济地位）和社会心理（例如，心理困扰）资源 影响决策。基于我们的老龄化决策概念模型， 初步数据表明种族差异，我们假设种族差异在决策中 导致健康结果的差异，环境和心理社会因素是造成这些差异的原因。 差异为响应PAR-16-448而提交的拟议研究的目标是阐明 决定因素和不利的健康后果的种族差异的决策。本研究将 利用正在进行的非裔美国人研究的独特资源，少数民族老龄化研究， 为了收集关于决策的多个方面的新的纵向数据（即，财务和健康决策 制作，时间折扣，诈骗易感性，欺诈受害）和相关的背景和心理社会 600名无痴呆症的老年非裔美国人。这些新收集的数据将与 相同的纵向决策数据已经从正在进行的1,100多名白人的研究中获得 从记忆和衰老项目，以支持分析：1）种族差异的决策， 非裔美国人和白人在人口统计学和认知方面相匹配，2）背景和心理社会 驱动他们的因素，以及3）决策中的种族差异在多大程度上有助于 健康方面的差距。因此，这项研究是唯一准备有效地确定决定因素和公共卫生 种族差异对决策的影响，并将促进新的治疗方法， 不同老年人的独立、健康和福祉。

ABSTRACT Sound decision making is important for maintaining independence and well-being across the lifespan but is critical in old age, when some of life’s most complex and impactful decisions are made. Recent work from our group and others has shown that decision making requires cognitive, contextual and psychosocial resources and that many older persons—even those without cognitive impairment—are vulnerable to poor decision making in key domains such as finance and health and frequently become victims of fraud. Poor decision making in aging predicts several adverse health outcomes including Alzheimer’s disease, incident mild cognitive impairment and mortality and poses a major public health and economic challenge. Importantly, however, most of the research on decision making to date has involved White participants. Relatively little is known about decision making among African Americans, despite well documented racial differences in the cognitive, contextual (e.g., socioeconomic status) and psychosocial (e.g., psychological distress) resources that influence decision making. Building on our conceptual model of decision making in aging and compelling preliminary data that suggest racial differences, we hypothesize that racial differences in decision making contribute to disparities in health outcomes and that contextual and psychosocial factors account for these differences. The goal of the proposed study, submitted in response to PAR-16-448, is to elucidate the determinants and adverse health consequences of racial differences in decision making. This study will leverage the unique resources of an ongoing study of African Americans, the Minority Aging Research Study, to collect new longitudinal data on multiple aspects of decision making (i.e., financial and health decision making, temporal discounting, scam susceptibility, fraud victimization) and related contextual and psychosocial factors in 600 older African Americans without dementia. These newly collected data will be linked with identical longitudinal decision making data already available from an ongoing study of more than 1,100 Whites from the Memory and Aging Project to support analyses of: 1) racial differences in decision making among African Americans and Whites matched on demographics and cognition, 2) the contextual and psychosocial factors that drive them, and 3) the degree to which racial differences in decision making contribute to disparities in health. Thus, this study is uniquely poised to efficiently identify the determinants and public health impact of racial differences in decision making and will facilitate new therapeutic approaches to promote independence, health and well-being among diverse older persons.