Epidemiology of racial differences in decision making among older adults

摘要 正确的决策对于在一生中保持独立和幸福很重要，但 在晚年，当生活中一些最复杂和最有影响力的决定被做出时，这是至关重要的。来自我们的最新工作 小组和其他人的研究表明，决策需要认知、背景和心理社会资源 而且许多老年人--即使是那些没有认知障碍的人--也容易受到糟糕决定的影响 在金融和卫生等关键领域取得进展，并经常成为欺诈的受害者。错误的决定 老龄化预测几种不利的健康后果，包括阿尔茨海默病，轻微事件 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，到目前为止，大多数关于决策的研究都涉及白人参与者。相对较少的是 了解非裔美国人的决策制定，尽管有很好的记录表明 认知、背景(例如，社会经济地位)和心理(例如，心理困扰)资源 影响决策的因素。建立在老龄化和强制性决策的概念模型基础上 初步数据表明种族差异，我们假设种族差异在决策过程中 造成健康结果差异的原因是背景和心理社会因素 不同之处。根据PAR-16-448提交的这项拟议研究的目的是澄清 决策过程中种族差异的决定因素和不良健康后果。这项研究将 利用正在进行的关于非裔美国人的研究的独特资源，少数民族老龄化研究研究， 收集有关决策的多个方面的新的纵向数据(即财务和健康决策 制造、时间折扣、诈骗易感性、诈骗受害)以及相关的背景和心理社会 600名未患痴呆症的老年非裔美国人的因素。这些新收集的数据将与 一项对1100多名白人进行的研究已经提供了相同的纵向决策数据 来自记忆和老龄化项目的支持分析：1)不同种族在决策过程中的差异 非裔美国人和白人在人口统计和认知方面匹配，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，这项研究具有独特的优势，可以有效地确定决定因素和公共健康 种族差异在决策中的影响，并将促进新的治疗方法 不同的老年人之间的独立、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.