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: 10663384
• 负责人: Timothy Clifford Whetung
• 金额: $ 6.16万
• 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/10663384
• 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; Disparity; Education; Educational Status; Elderly; Equity; Ethnic Origin; Exposure to; Family; Future; Gender; General Population; Gerontology; Government; Grant; Growth; Health; Health and Retirement Study; Hispanic; Impaired cognition; Indigenous; Individual; Inequity; Infant Mortality; Institutional Racism; Intervention; Knowledge; Life Expectancy; Link; Long-Term Care; Longitudinal Studies; Maximum Likelihood Estimate; 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.

项目摘要/摘要 美国的土著老年人（IOA）的数量，在这里定义为美国原住民和阿拉斯加 当地人将在未来30年内翻一番。同时，与阿尔茨海默氏症同住的IOA数量 疾病和相关痴呆症（ADRDS）也将增加。我们对认知健康的了解有限 IOAS代表了卫生公平的危机。这项拟议的研究旨在不仅对这个问题开发新的启示， 而且还为了促进IOA在认知健康研究，政策和干预中的公平包含。这 拟议的研究是由将这些风险因素整合到压力框架中的概念模型的指导。这 少数族裔压力和认知模型。该模型认为，暴露于更高水平的社会心理压力 个人（例如，种族主义）和系统歧视的形式（例如，教育质量低， 贫困）增加了一个人对慢性健康状况的敏感性和后来的认知障碍风险 通过累积同性载荷负载。这项研究将该模型扩展到IOA，这是一种颜色种群 曼联经历了系统性的种族主义，教育质量差，贫困，健康不平等和种族主义 国家。该建议旨在通过使用受限的健康和退休研究来解决这些知识差距 （HRS）数据研究如何在10年（2008-2018）中了解一个理解的IOA群体。 认知健康领域。这项拟议的研究的具体目的是：1）研究纵向 土著，黑人，西班牙裔和白人老年人的认知健康差异； 2）确定 社会心理因素与土著，黑人，西班牙裔和 白人老年人； 3）确定行为和身体压力因素与总数如何相关 土著，黑人，西班牙裔和白人老年人之间的认知轨迹。我假设 认知障碍的其他危险因素（例如，低水平的教育水平，低SES，酒精和香烟， 身体不活跃，高静态负荷）较高的感知歧视将与较低的歧视有关 总体认知轨迹和早期下降开始。使用来自健康的限制数据， 退休研究核心样本和2008 - 2016年保留调查表，这项拟议的研究将 研究总认知功能（TICS-M）的量度变化。为此，总认知功能 轨迹将配备社会人口统计学信息（年龄，性别，种族/种族），然后首先修改 通过社会心理，然后是身体和行为因素。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）相关系数和4） 混合效应生长曲线模型。缺少数据处理将使用最大信息进行 可能性估计。这项拟议的研究对压力和认知模型具有重要意义 土著老年人和未来预防研究的公平性。该提议对19-394套第19-394页的反应： 衰老研究论文奖励以增加多样性。