Weathering the Storm of Cognitive Inequities: Testing the Minority Stress and Cognition Model with Indigenous Older Adults

经受认知不平等的风暴：用土著老年人测试少数民族压力和认知模型

• 批准号: 10510949
• 负责人: Timothy Clifford Whetung
• 金额: $ 6.78万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2024-06-03
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10510949
• 关键词: Address; Age; Aging; Alaska Native; Alcohol consumption; Alzheimer' s disease related dementia; Award; Behavioral; Black Populations; Black race; Canada; Chippewa; Chronic; Chronic stress; Cognition; Cognitive; Data; Development; Discrimination; Education; Educational Background; Elderly; Ethnic Origin; Exposure to; Family; Future; Gender; General Population; Gerontology; Government; Grant; Growth; Health; Health and Retirement Study; Hispanic; Impaired cognition; Indigenous; Individual; Infant Mortality; Institutional Racism; Intervention; Knowledge; Life Expectancy; Light; Link; Long-Term Care; Longitudinal Studies; Measures; Mental Health; Modeling; Native Americans; Native-Born; Neurobehavioral Manifestations; Ontario; Participant; Pathway interactions; Persons; Physiological; Policies; Population; Poverty; Predisposition; Prevention; Psychological Stress; Psychosocial Factor; Psychosocial Stress; Public Health; Questionnaires; Race; Reporting; Research; Reservations; Resources; Risk; Risk Factors; Rural; Sampling; Social Environment; Statistical Methods; Strategic Planning; Stress; Testing; Tribes; Underrepresented Populations; United States; United States National Institutes of Health; Weather; Work; allostatic load; care costs; care systems; career; cigarette smoking; cognitive function; dementia risk; early onset; experience; health care availability; health data; health equity; health inequalities; improved; indigenous community; innovation; low socioeconomic status; member; minority stress; mortality; novel; people of color; perceived discrimination; physical conditioning; physical inactivity; protective factors; psychosocial; racism; sociodemographics; statistics; systematic review; tribal health

Project Summary/Abstract The number of Indigenous older adults (IOAs) in the United States, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with Alzheimer’s Disease and Related Dementias (ADRDs) will also increase. Our limited knowledge about the cognitive health of IOAs represents a crisis of health equity. This proposed study aims to not only shed new light on this issue, but also to promote the equitable inclusion of IOAs in cognitive health research, policy, and intervention. This proposed study is guided by a conceptual model that integrates these risk factors into a stress framework; the Minority Stress and Cognition Model. This model posits that exposure to higher levels of psychosocial stress in the form of individual (e.g. perceived racism) and systematic discrimination (e.g. low quality of education, poverty) increase one’s susceptibility to chronic health conditions and the risk of cognitive impairment in later life via an accumulation of allostatic load. This study extends this model to IOAs, a population of color that also experienced systemic racism, poor educational quality, poverty, health inequities, and racism in the United States. This proposal aims to address these knowledge gaps by using restricted Health and Retirement Study (HRS) data to investigate how an understudied group of IOAs fared over a 10-year period (2008-2018) in the domain of cognitive health. The specific aims of this proposed study are: 1) To investigate longitudinal differences in cognitive health between Indigenous, Black, Hispanic, and White older adults; 2) To determine how psychosocial factors are associated with total cognition trajectories among Indigenous, Black, Hispanic, and White older adults; and 3) To determine how behavioral, and physical stress factors are associated with total cognition trajectories among Indigenous, Black, Hispanic, and White older adults. I hypothesize that alongside other risk factors for cognitive impairment (e.g. low levels of education, low SES, alcohol and cigarette use, physical inactivity, high allostatic loads) higher levels of perceived discrimination will be associated with lower overall total cognition trajectories and earlier onset of decline. Using restricted data from the Health and Retirement Study Core sample and the 2008-2016 Leave-Behind Questionnaire, this proposed study will investigate the change on a measure of total cognitive function (TICS-M). To do this, total cognitive function trajectories will be fitted with sociodemographic information (age, gender, race/ethnicity) and then modified first by psychosocial and then by physical, and behavioral factors. These relationships will be assessed using several statistical methods: 1) descriptive statistics, 2) t-test and chi-squared statistics, 3) correlation coefficients, and 4) mixed effect growth curve models. Missing data treatment will be conducted using Full Information Maximum Likelihood estimation. This proposed study has important implications for stress and cognition models, the health equity of Indigenous older adults, and future preventative research. This proposal is responsive to PAR-19-394: Aging Research Dissertation Awards to Increase Diversity.

项目概要/摘要 美国原住民老年人 (IOA) 的数量，此处定义为美洲原住民和阿拉斯加人 未来 30 年，本地人的数量将增加一倍以上。与此同时，患有阿尔茨海默病的 IOA 数量 疾病及相关痴呆症（ADRD）也会增加。我们对认知健康的了解有限 IOA 代表了健康公平危机。这项拟议的研究不仅旨在为这个问题提供新的线索， 还促进 IOA 公平地纳入认知健康研究、政策和干预。这 拟议的研究以概念模型为指导，将这些风险因素整合到压力框架中；这 少数民族压力和认知模型。该模型假设，暴露于较高水平的心理社会压力 个人形式（例如，感知到的种族主义）和系统性歧视（例如，教育质量低、 贫困）增加人们对慢性健康问题的易感性以及晚年认知障碍的风险 通过非稳态负荷的积累。这项研究将这个模型扩展到 IOA，这是一个有色人种，也 在美国经历了系统性种族主义、教育质量差、贫困、健康不平等和种族主义 国家。该提案旨在通过使用有限的健康和退休研究来解决这些知识差距 (HRS) 数据来调查一组 IOA 在 10 年期间（2008-2018）的表现如何 认知健康领域。本研究的具体目标是： 1) 纵向研究 原住民、黑人、西班牙裔和白人老年人之间认知健康的差异； 2）确定 心理社会因素如何与原住民、黑人、西班牙裔和黑人的总体认知轨迹相关 白人老年人； 3) 确定行为和身体压力因素与总压力之间的关系 原住民、黑人、西班牙裔和白人老年人的认知轨迹。我假设旁边 认知障碍的其他危险因素（例如教育水平低、社会经济地位低、酗酒和吸烟、 体力不活动、高动态负荷）感知歧视水平越高，与较低水平相关。 总体认知轨迹和衰退开始较早。使用来自健康和 退休研究核心样本和 2008-2016 年留守调查问卷，本拟议研究将 研究总体认知功能（TICS-M）测量的变化。要做到这一点，总认知功能 轨迹将配备社会人口统计信息（年龄、性别、种族/民族），然后首先进行修改 首先是心理社会因素，然后是身体和行为因素。这些关系将使用多种方式进行评估 统计方法：1) 描述性统计，2) t 检验和卡方统计，3) 相关系数，4) 混合效应增长曲线模型。将使用全信息最大值进行缺失数据处理 可能性估计。这项拟议的研究对压力和认知模型、健康具有重要意义 土著老年人的公平性和未来的预防性研究。该提案响应 PAR-19-394： 老龄化研究论文奖以增加多样性。