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

基本信息

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
项目类别：
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&apos 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

项目摘要

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.

项目概要/摘要美国原住民老年人 (IOA) 的数量，此处定义为美洲原住民和阿拉斯加人与此同时，患有阿尔茨海默氏症的 IOA 人数将在未来 30 年增加一倍以上。我们对认知健康的有限了解也会增加。 IOA 代表了健康公平的危机。这项拟议的研究不仅旨在为这个问题提供新的见解，还促进 IOA 公平地纳入认知健康研究、政策和干预。拟议的研究以概念模型为指导，将这些风险因素整合到压力框架中；少数群体压力和认知模型假设暴露于较高水平的心理社会压力。个人形式（例如，感知到的种族主义）和系统性歧视（例如，教育质量低、贫困）增加一个人对慢性健康问题的易感性以及晚年认知障碍的风险这项研究将这个模型扩展到 IOA，即一种颜色群体。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该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) 数据来调查一组 IOA 在 10 年期间（2008-2018）的表现如何这项研究的具体目标是：1）纵向调查。土著、黑人、西班牙裔和白人老年人之间认知健康的差异 2) 确定心理社会因素如何与原住民、黑人、西班牙裔和黑人的总体认知轨迹相关白人老年人；3) 确定行为和身体压力因素与总压力之间的关系原住民、黑人、西班牙裔和白人老年人的认知轨迹。认知障碍的其他危险因素（例如教育水平低、社会经济地位低、酗酒和吸烟、体力不活动、高动态负荷）感知歧视水平越高，与较低水平相关。总体认知轨迹和早期下降使用来自健康和卫生部门的有限数据。退休研究核心样本和 2008-2016 年留守调查问卷，本拟议研究将研究总体认知功能（TICS-M）测量的变化。轨迹将配备社会人口统计信息（年龄、性别、种族/民族），然后首先进行修改将通过心理社会因素，然后通过身体和行为因素来评估这些关系。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进行缺失数据处理。这项拟议的研究对压力和认知模型、健康具有重要意义。土著平等老年人和未来的预防性研究该提案响应 PAR-19-394：老龄化研究论文奖以增加多样性。