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

项目摘要/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 在接下来的30年里，这一数字将增加一倍以上。同时，患有阿尔茨海默氏症的IOA人数 疾病和相关痴呆症(ADRDS)也将增加。我们对认知健康的有限了解 IOAS的减少代表着健康公平的危机。这项拟议的研究不仅旨在为这一问题提供新的线索， 而且还促进将IOAS公平地纳入认知健康研究、政策和干预。这 拟议的研究是由一个概念模型指导的，该概念模型将这些风险因素整合到一个压力框架中； 少数民族压力与认知模型。这一模型假设，暴露在较高水平的心理社会压力中 个人形式(如感知到的种族主义)和系统性歧视(如教育质量低， 贫穷)增加一个人对慢性健康状况的易感性和晚年认知障碍的风险 通过恒定负荷的累积。这项研究将这一模型扩展到IOAS，这是一个也 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 各州。这项建议旨在通过使用限制性健康和退休研究来解决这些知识差距 (小时)数据，以调查在过去10年(2008-2018年)内，未充分研究的一组内部审计机构的表现如何 认知健康领域。这项拟议研究的具体目的是：1)纵向调查 土著、黑人、西班牙裔和白人老年人认知健康的差异；2)确定 心理社会因素如何与土著、黑人、西班牙裔和 以及3)确定行为、身体压力因素如何与总的 土著、黑人、西班牙裔和白人老年人的认知轨迹。我假设除了 认知障碍的其他风险因素(如低教育水平、低社会经济地位、酗酒和吸烟、 身体不活动、高不平衡负荷)感觉到的歧视水平越高，就越低 总体总认知轨迹和更早开始的下降。使用来自Health And的受限数据 退休研究的核心样本和2008-2016年的离职调查问卷，这项拟议的研究将 调查总认知功能(TICS-M)的变化。要做到这一点，整个认知功能 轨迹将与社会人口信息(年龄、性别、种族/族裔)相适应，然后首先进行修改 先是心理社会因素，然后是身体和行为因素。这些关系将使用以下几种方法进行评估 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 似然估计。这项拟议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.