Epidemiology of racial differences in decision making among older adults

摘要

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.