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Jain S, Bey GS, Forrester SN, Rahman-Filipiak A, Thompson Gonzalez N, Petrovsky DV, Kritchevsky SB, Brinkley TE. Aging, Race, and Health Disparities: Recommendations From the Research Centers Collaborative Network. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae028. [PMID: 38442186 PMCID: PMC11101762 DOI: 10.1093/geronb/gbae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 03/07/2024] Open
Abstract
Racial disparities in adverse health outcomes with aging have been well described. Yet, much of the research focuses on racial comparisons, with relatively less attention to the identification of underlying mechanisms. To address these gaps, the Research Centers Collaborative Network held a workshop on aging, race, and health disparities to identify research priorities and inform the investigation, implementation, and dissemination of strategies to mitigate disparities in healthy aging. This article provides a summary of the key recommendations and highlights the need for research that builds a strong evidence base with both clinical and policy implications. Successful execution of these recommendations will require a concerted effort to increase participation of underrepresented groups in research through community engagement and partnerships. In addition, resources to support and promote the training and development of health disparities researchers will be critical in making health equity a shared responsibility for all major stakeholders.
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Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ganga S Bey
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah N Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Annalise Rahman-Filipiak
- Department of Psychiatry—Neuropsychology Section, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Thompson Gonzalez
- Department of Integrative Anthropological Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Tina E Brinkley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Griffin CP, Bowen JR, Walker MM, Lynam J, Paul CL. Understanding the value of brain donation for research to donors, next-of-kin and clinicians: A systematic review. PLoS One 2023; 18:e0295438. [PMID: 38117774 PMCID: PMC10732432 DOI: 10.1371/journal.pone.0295438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
PURPOSE Post-mortem brain donation affords the opportunity to characterise disease by exploring global neuropathological changes. Such opportunities are essential to progress knowledge of CNS tumours such as Glioblastoma. A comprehensive understanding of the experience of consenting to brain donation is crucial to maximising consent rates while providing patient-centred care. This review aimed to synthesise the reported facilitators and barriers according to potential donors, next-of-kin (NOK) and clinician respondents. DESIGN Database searches included Embase, Medline, PsycINFO, Psychology and Behavioural Science and Scopus. Search terms focused on motivations, attitudes and psychosocial experiences of brain donation. Exclusions included organ transplantation and brain death. All studies were assessed for quality and validity using tools from the Joanna Briggs Institute. To determine perceptions of benefit and harm, a method guided by the thematic analysis of Braun and Clarke was employed to reflexively assess and identify common themes and experiences. RESULTS 40 studies (15 qualitative, 25 quantitative) were included involving participants with paediatric cancer, neurodegenerative and psychological diseases. Perceptions of benefit included benefit to future generations, aiding scientific research, avoidance of waste, improved treatments and the belief that donation will bring consolation or aid in the grieving process. Perceptions of harm included a perceived conflict with religious beliefs, disfigurement to the donor, emotional distress at the time of autopsy and discord or objections within the family. CONCLUSION Brain donation can afford a sense of purpose, meaning and empowerment for donors and their loved ones. Careful strategies are required to mitigate or reduce potential harms during the consent process.
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Affiliation(s)
- Cassandra P. Griffin
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Jenna R. Bowen
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Marjorie M. Walker
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
| | - James Lynam
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Department of Medical Oncology, Calvary Mater, Newcastle, NSW, Australia
| | - Christine L. Paul
- College of Health, Medicine and Wellbeing University of Newcastle, Tamworth, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
- Priority Research Centre Cancer Research, Innovation and Translation, University of Newcastle, Callaghan, Australia
- Priority Research Centre Health Behaviour, University of Newcastle, Callaghan, Australia
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Gamboa CJ, Julion WA, Fogg L, Bounds DT, Sumo J, Barnes LL. Perceptions of Caring Recruitment Among Older Adults: African Americans and Non-Latinx Whites. Nurs Res 2023; 72:114-122. [PMID: 36598918 PMCID: PMC9991987 DOI: 10.1097/nnr.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND African Americans (AAs) are underrepresented in health-related research studies. Few studies have investigated how behaviors of study recruiters affect recruitment of older AAs versus non-Latinx Whites (NLWs). OBJECTIVES The aim of this study was to explore whether caring behaviors influence AA and NLW older adults' decision to participate in hypothetical, high-commitment, health-related research studies and differences in participants' enrollment decisions by race. METHODS Using a descriptive, cross-sectional study design, guided by Kristen Swanson's middle-range theory of caring, a research-savvy sample of 60 AA and 60 NLW adults (age > 65 years) were randomly assigned one of two written vignettes. The concept of caring behaviors was manipulated and illustrated in a hypothetical recruitment scenario. A participant feedback survey was used to assess (a) participants' perceptions of caring and uncaring behaviors exhibited by the fictitious research recruiter, (b) differences in their willingness to participate based on vignette type, and (c) participants' judgment of the research recruiter as being caring or uncaring. A chi-square test assessed the association among categorical variables (caring behavior and participants' race). RESULTS Participants who received the vignette with the high caring recruiter were more than twice as likely to agree to participate in the study than those who received the vignette with the low caring recruiter. AA and NLW participants did not differ in their likelihood to agree to participate. Participants who received the caring vignette and judged the recruiter as caring were 5 times as likely to agree to participate in the high-commitment study than those who received the uncaring vignette ( p < .001). Associations did not vary by race. DISCUSSION This experimental study of equally recruited older adults from an existing longitudinal study revealed that caring behaviors in recruitment strategies are associated with an increased likelihood of participation in high-commitment research with older adults. The research-savvy AA participants were just as likely to participate in the hypothetical high-commitment research as their NLW peers when the fictional research recruiter was perceived as having caring behaviors. When targeting specific populations, it is essential to employ nuanced recruitment approaches where the study recruiters are attuned to caring behaviors.
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Affiliation(s)
- Charlene J. Gamboa
- Rush University Medical Center, Rush Alzheimer’s Disease Center, Office of Research Affairs, Chicago, IL
| | | | - Louis Fogg
- Rush University, College of Nursing, Chicago, IL
| | - Dawn T. Bounds
- The University of California, Irvine, Sue, and Bill Gross School of Nursing, Irvine, CA
| | - Jen’nea Sumo
- Rush University, College of Nursing, Chicago, IL
| | - Lisa L. Barnes
- Rush University, Rush Alzheimer’s Disease Center, Chicago, IL
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Glover CM, Arfanakis K, Aggarwal NT, Bennett DA, Marquez DX, Barnes LL. A Qualitative Examination of Knowledge, Experiences, and Considerations of PET Brain Scan Participation Among Older Black and Latino Adults. J Alzheimers Dis 2023; 91:961-976. [PMID: 36530086 DOI: 10.3233/jad-220861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Biological biomarkers yielded from positron emission tomography (PET) brain scans serve as a pathway to understanding Alzheimer's disease pathology. PET brain scan data remain limited for populations traditionally under-included in aging research. OBJECTIVE The purpose of this qualitative study was to examine participant-identified barriers to PET brain scan consent and characterize participant-informed elements of educational materials needed to facilitate PET brain scan participation among older Black and Latino adults. METHODS Participants (N = 31) were older adults (mean age = 71 years) who self-identified as either non-Latino Black (n = 15) or Latino (n = 16). Each participant took part in a one-time, in-depth individual interview. Researchers analyzed data guided by a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. RESULTS Four overarching themes emerged across all participants: 1) knowledge limitations; 2) requirements for consent; 3) motivators for participation; and 4) social networks. Within the four themes, there were differences based on participant ethnoracial group. For example, for Theme Three, older Black adults indicated that they would expect compensation for PET brain scan participation. Conversely, older Latinos stated that they would appreciate, but not anticipate, a financial incentive. All participants stressed the importance of written educational materials with subsequent verbal discussions with studystaff. CONCLUSION Findings inform the development and implementation of scientifically-relevant and culturally-cognizant engagement approaches, educational materials, and recruitment strategies to increase PET brain scan participation by diverse older adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, USA.,Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Neelum T Aggarwal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
| | - David X Marquez
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Kinesiology and Nutrition, University of Illinois - Chicago, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, USA.,Department of Neurological Sciences, Rush Medical College, Chicago, IL, USA
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Marrie RA, Kosowan L, Cutter GR, Fox RJ, Salter A. Attitudes of people with multiple sclerosis toward brain donation. Front Neurol 2023; 14:1115303. [PMID: 36779059 PMCID: PMC9909011 DOI: 10.3389/fneur.2023.1115303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Research directly examining brain tissue has played an important role in understanding the pathology and pathogenesis of multiple sclerosis (MS) and other diseases of the central nervous system. Such research relies heavily on donations of post-mortem brain tissue yet little is known about the attitudes of people with multiple sclerosis (MS) about brain donation. We aimed to assess the attitudes of people with MS toward brain donation, their preferences related to discussions of brain donation, and factors associated with attitudes toward brain donation including sociodemographic and clinical characteristics, health literacy and religiosity. Methods In a cross-sectional study, we surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding their attitudes toward brain donation, reasons for participating or not participating in brain donation, and related communication preferences. We used multivariable logistic regression analyses to test factors associated with attitudes regarding brain donation. Results Most of the 4,520 participants were women (80.8%), self-identified as white (88.1%), with a post-secondary education, functional health literacy and moderate-severe disability. Sixty-two percent of participants would consider brain donation. Factors associated with considering brain donation included female gender, having a post-secondary education, being physically active, having moderate-severe disability and more comorbidities, and alcohol intake. Seventy-five percent of participants indicated that they preferred to receive information regarding brain donations from physicians. Conclusion Two-thirds of people with MS would consider brain donation. People with MS desire to hear about brain donation from their health care providers rather than other sources.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada,*Correspondence: Ruth Ann Marrie ✉
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Gary R. Cutter
- Department of Biostatistics, University of Alabama in Birmingham, Birmingham, AL, United States
| | - Robert J. Fox
- Mellen Center for Multiple Sclerosis, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Amber Salter
- Department of Neurology, UT Southwestern, Dallas, TX, United States
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Alzheimer disease in African American individuals: increased incidence or not enough data? Nat Rev Neurol 2021; 18:56-62. [PMID: 34873310 PMCID: PMC8647782 DOI: 10.1038/s41582-021-00589-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/13/2022]
Abstract
Research on racial differences in Alzheimer disease (AD) dementia has increased in recent years. Older African American individuals bear a disproportionate burden of AD and cognitive impairment compared with non-Latino white individuals. Tremendous progress has been made over the past two decades in our understanding of the neurobiological substrates of AD. However, owing to well-documented challenges of study participant recruitment and a persistent lack of biological data in the African American population, knowledge of the drivers of these racial disparities has lagged behind. Therapeutic targets and effective interventions for AD are increasingly sought, but without a better understanding of the disease in African American individuals, any identified treatments and/or cures will evade this rapidly growing at-risk population. In this Perspective, I introduce three key obstacles to progress in understanding racial differences in AD: uncertainty about diagnostic criteria, disparate cross-sectional and longitudinal findings; and a dearth of neuropathological data. I also highlight evidence-informed strategies to move the field forward. In this Perspective, Barnes introduces three key obstacles to progress in our understanding of racial differences in Alzheimer disease and highlights evidence-informed strategies that can move the field forward.
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Glover CM, Shah RC, Bennett DA, Wilson RS, Barnes LL. Perceived Impediments to Completed Brain Autopsies Among Diverse Older Adults Who Have Signed a Uniform Anatomical Gift Act for Brain Donation for Clinical Research. Ethn Dis 2020; 30:709-718. [PMID: 33250618 DOI: 10.18865/ed.30.s2.709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A small number of older adults in the United States who agree to brain donation for clinical research belong to diverse racial, ethnic, and economic groups. Those who agree, however, are less likely to have completed brain autopsies compared with older non-Latino Whites of higher socioeconomic status. As such, our understanding of Alzheimer's disease and related dementias remains limited in these underrepresented and understudied populations. Here, we examine perceived impediments to completed brain autopsies among diverse older adults who have agreed to brain donation for clinical research. Methods Participants (N=22) were older adults (mean age=77 years) who self-identified as African American (n=8), Latino (n=6), or White of lower income (n=8). All participants had previously agreed to brain donation via the Uniform Anatomical Gift Act. Each participant took part in a one-time, semi-structured focus group. Data were analyzed using a Grounded Theory Approach with both Open Coding and Constant Comparative Coding. Results Perceived impediments to completed brain autopsies varied by group. Older African Americans and older Latinos expressed concern about a lack of follow-through by family members regarding their brain donation wishes. Older Whites of lower income indicated that their own uncertainty surrounding the processes of brain donation and brain autopsy might serve as an impediment. Discussion Diverse older adults expressed different perceived impediments to having brain autopsies completed upon their death. Continuous education for diverse older adults and their family members regarding brain donation for clinical research, including clear guidelines and processes, may facilitate completed brain autopsies among diverse older adults.
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Affiliation(s)
- Crystal M Glover
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Family Medicine, Rush University Medical Center, Chicago, IL
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL.,Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
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Bennett DA, Knopman DS. Extending Alzheimer disease biomarker studies into the Hispanic community. Neurology 2020; 95:665-666. [DOI: 10.1212/wnl.0000000000010714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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