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

项目概要/摘要 美国土著老年人（IOA）的数量，这里定义为美洲原住民和阿拉斯加州 在未来30年内，土著人口将增加一倍以上。同时，患有阿尔茨海默病的IOA人数 疾病和相关痴呆症（ADRD）也会增加。我们对认知健康的有限知识 IOAs的出现代表了卫生公平性的危机。这项拟议中的研究不仅旨在阐明这一问题， 同时也要促进IOA在认知健康研究、政策和干预中的公平纳入。这 拟议的研究是由一个概念模型，将这些风险因素整合到一个压力框架; 少数民族的压力和认知模式。这个模型假设，暴露于更高水平的心理社会压力， 个人歧视（如被认为是种族主义）和系统性歧视（如教育质量低， 贫困）增加了一个人对慢性健康状况的易感性和晚年认知障碍的风险 通过非稳态负荷的积累。这项研究将这一模型扩展到IOA，一个有色人种群体， 经历了系统性的种族主义，教育质量差，贫困，健康不平等，种族主义在美国 States.本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，以调查一组未充分研究的IOA在10年期间（2008-2018年）的表现， 认知健康领域。本研究的具体目的是：1）调查纵向 土著、黑人、西班牙裔和白色老年人之间认知健康的差异; 2）确定 社会心理因素如何与土著、黑人、西班牙裔和 白色老年人;和3）确定行为和身体压力因素如何与总的 土著、黑人、西班牙裔和白色老年人的认知轨迹。我假设除了 认知障碍的其他风险因素（例如，教育水平低，SES低，饮酒和吸烟， 身体不活动，高非稳态负荷）较高水平的感知歧视将与较低的 总体认知轨迹和早期衰退。使用来自卫生部和 退休研究核心样本和2008-2016年遗留问卷，这项拟议的研究将 研究总认知功能测量（TICS-M）的变化。为了做到这一点， 轨迹将与社会人口统计信息（年龄、性别、种族/民族）拟合，然后首先进行修改 先是社会心理因素，然后是生理因素和行为因素。这些关系将使用几个 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缺失数据处理将使用最大完整信息进行 可能的估计。这项拟议中的研究对压力和认知模型，健康， 土著老年人的平等，以及未来的预防性研究。本提案响应PAR-19-394： 老龄化研究论文奖，以增加多样性。

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.