A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes

COVID-19 Stress and Cognitive Disparities in Black, MENA, and White Older Adults

BACKGROUND AND OBJECTIVES

Population aging has led to an increased interest in cognitive health and, in particular, the role that stress plays in cognitive disparities. This paper extends previous work by characterizing coronavirus disease 2019 (COVID-19) stress type prevalence and its association with cognitive health in metro-Detroit among Black, Middle Eastern/Arab (MENA), and White older adults.

RESEARCH DESIGN AND METHODS

Data come from a regionally representative sample of adults aged 65+ in metro-Detroit (N = 600; MENA n = 199; Black n = 205; White n = 196). We used generalized linear models to compare groups on sociodemographic, objective stress, and social stress indicators. Multiple group structural equation models evaluated whether COVID-19 stress predicted cognitive health and whether that association varied across racial/ethnic groups.

RESULTS

MENA and Black older adults reported higher levels of objective stress than Whites. There were no racial/ethnic group differences in social stress. More objective stress was associated with better cognitive health, and more social stress was associated with worse cognitive health. The positive effect of objective stress was especially apparent for White older adults.

DISCUSSION AND IMPLICATIONS

Though it appears that minority stress was not exacerbated in the context of pandemic stress, links between greater objective stress and better cognitive health apparent among White older adults were not evident among MENA or Black older adults. Broadening health disparities research by including underrepresented populations allows us to elevate scientific knowledge by clarifying what is universal and what is unique about the stress process.

An exploration of neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older black adults

OBJECTIVES

While existing research has shown that Black adults have worse cognitive functioning than their White counterparts, the psychosocial correlates of cognitive functioning for Black older adults are understudied. The objective of this study was to investigate the relationships among perceived neighborhood characteristics, psychosocial resilience resources, and cognitive functioning among midlife and older Black adults.

METHODS

Data were from 3,191 Black adults ages 51+ in the 2008-2016 waves of the Health and Retirement Study to examine associations among neighborhood characteristics, psychosocial resilience (sense of purpose, mastery, and social support), and cognitive functioning among Black adults. Multilevel linear regression models assessed direct effects of neighborhood characteristics and psychosocial resources on cognitive functioning. We then tested whether psychosocial resources moderated the association between neighborhood characteristics and cognitive functioning.

RESULTS

Mean levels of cognitive functioning, sense of purpose, social support, and mastery were significantly related to neighborhood disorder and discohesion. Regression results showed that levels of neighborhood disorder and high discohesion were significantly associated with cognitive functioning. Sense of purpose was positively associated with cognitive functioning, net of neighborhood characteristics. However, only social support moderated the association between neighborhood discohesion and cognition.

CONCLUSIONS

These findings demonstrate the importance of examining psychosocial and contextual risk and resilience resources among midlife and older Black adults. This work may inform the development of cognitive behavioral interventions aimed at increasing sense of purpose to promote and enhance cognitive resiliency among Black adults. Altogether, this work may have implications for policy aimed at advancing cognitive health equity.

Interactions among neighborhood conditions, sleep quality, and episodic memory across the adult lifespan

OBJECTIVES

On average, adults racialized as non-Hispanic Black and Hispanic sleep more poorly than adults racialized as non-Hispanic White (hereafter, Black, Hispanic, White), but associations between factors that may moderate sleep-memory associations in these groups, such as neighborhood conditions, are unclear. Poorer neighborhood conditions (e.g. lower neighborhood cohesion) may be negatively associated with sleep quality and multiplicatively influence sleep-memory associations. We hypothesized lower ratings of neighborhood conditions would be associated with poorer sleep quality and moderate the association between sleep quality and episodic memory, especially in Black and Hispanic adults, who are disproportionately situated in poor neighborhood conditions.

DESIGN

Seven-hundred-thirty-six adults across the adult lifespan (27-89 years) were recruited from the northern Manhattan community as a part of the Offspring Study of Racial and Ethnic Disparities in Alzheimer's disease. Sleep quality was assessed using a modified version of the Pittsburgh Sleep Quality Index, and episodic memory was evaluated with the Buschke Selective Reminding Test. With multiple regression models, we measured associations between perceived neighborhood conditions and sleep quality and the interaction between sleep quality and neighborhood conditions on episodic memory stratified by racial/ethnic and gender identity groups.

RESULTS

Overall, poorer neighborhood conditions were associated with poorer sleep quality. In Black and Hispanic women, the sleep-memory association was moderated by neighborhood conditions. With more favorable neighborhood conditions, Black women showed an association between higher sleep quality and higher memory performance, and Hispanic women showed a protective effect of neighborhood (higher memory even when sleep quality was poor).

CONCLUSION

Poorer neighborhood experiences may contribute to poorer sleep quality across groups. In Black and Hispanic women, the association between sleep quality and episodic memory performance was dependent upon neighborhood conditions. These findings may inform tailored, structural level sleep interventions, aimed to improve neighborhood experiences and thereby sleep quality and episodic memory.

Habitual behavioural control moderates the relation between daily perceived stress and purging

OBJECTIVE

Evidence suggests that interpersonal stress plays a role in maintaining binge eating and purging (e.g., self-induced vomiting, misuse of laxatives). Stress is especially likely to promote engagement in maladaptive behaviour if the behaviour is habitual; therefore, individuals whose binge eating and/or purging are habitual may be particularly likely to engage in these behaviours in the context of interpersonal stress. We aimed to investigate this hypothesis in a sample of women with binge eating and/or purging using ecological momentary assessment (EMA).

METHOD

Women (N = 81) with binge-eating and/or purging symptoms completed a self-report measure assessing habit strength of binge eating and purging followed by a 14-day EMA protocol assessing daily perceived interpersonal stress and binge-eating and purging episodes.

RESULTS

Habit strength of purging moderated the within-person effect of interpersonal stress on purging frequency, such that higher daily stress was associated with greater same-day purging frequency when purging was more habitual. Contrary to expectations, the interactive effect of habit strength of binge eating and daily interpersonal stress on same-day binge-eating frequency was non-significant.

CONCLUSIONS

Findings suggest that individuals with habitual purging may be vulnerable to engaging in purging when they are experiencing high levels of interpersonal stress.

Intersectional Inequalities in the Transition to Grandparenthood and Cognitive Functioning: A Longitudinal Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy

OBJECTIVES

In aging societies, more people become vulnerable to experiencing cognitive decline. Simultaneously, the role of grandparenthood is central for older adults and their families. Our study investigates inequalities in the level and trajectories of cognitive functioning among older adults, focusing on possible intersectional effects of social determinants and grandparenthood as a life course transition that may contribute to delaying cognitive decline.

METHODS

Using longitudinal data from the Survey of Health, Aging, and Retirement in Europe, we analyzed a sample of 19,953 individuals aged 50-85 without grandchildren at baseline. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy to investigate variation in cognitive functioning across 48 intersectional strata, defined by sex/gender, migration, education, and occupation. We allowed the impact of becoming a grandparent on cognitive functioning trajectories to vary across strata by including random slopes.

RESULTS

Intersectional strata accounted for 17.43% of the overall variance in cognitive functioning, with most of the stratum-level variation explained by additive effects of the stratum-defining characteristics. Transition to grandparenthood was associated with higher cognitive functioning, showing a stronger effect for women. Stratum-level variation in the grandparenthood effect was modest, especially after accounting for interactions between grandparenthood and the stratum-defining variables.

DISCUSSION

This study highlights the importance of social determinants for understanding heterogeneities in older adults' level of cognitive functioning and its association with the transition to grandparenthood. Cumulative disadvantages negatively affect cognitive functioning, hence adopting an intersectional lens is useful to decompose inequalities and derive tailored interventions to promote equal healthy aging.

Network Analysis of the Association between Minority Stress and Activism in LGB People from Poland

(1) Background: This paper presents an analysis of the associations between minority stressors and activism in the population of lesbian, gay, and bisexual individuals in Poland. (2) Methods: The cross-sectional online-based research was conducted among 192 lesbian, gay, and bisexual (LGB) people in two groups: activists (n = 51) and people not engaged in activism (n = 141). Four scales of the Sexual Minority Stress Scale were used: Internalized Homophobia, Expectation of Rejection, Concealment, and Sexual Minority Negative Events Scale. Activism was measured using the Activism Scale and a single item asking about belonging to an activist group. (3) Results: Activists, lesbians, and gays scored significantly higher in the Sexual Minority Negative Events than people not involved in activism and bisexual individuals. Attitude toward LGBT+ activism correlated weakly and positively with Sexual Minority Negative Events and Expectation of Rejection while negatively with Internalized Homophobia. The Network Analysis showed that positive attitudes toward LGBT+ activism, the expectation of rejection, and negative events in minority stress are the most influential variables in the network model, playing a crucial role in the interaction between particular dimensions of minority stress. (4) Conclusions: Prevention and intervention programs should focus on reducing minority stress, especially negative events and rejection, especially among lesbians, gays, and people engaged in LGBT+ activism. The cooperation of politicians, lawyers, social workers, and psychologists is required to decrease homophobia and the stigmatization of people representing sexual and gender minorities.

Loneliness and global cognitive functioning in racially and ethnically diverse US midlife and older adults

Introduction

Few studies have examined the association of loneliness and cognitive functioning in the US. We used two common measures of loneliness and examined their association in a large sample of US Black, Latino, and White adults (ages ≥ 50).

Methods

We analyzed Wave 3 of the National Social Life, Health, and Aging Project (N = 2,757). We examined loneliness using one item from the CES-D and the Felt Loneliness Measure (NFLM); cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA) tool, where higher scores indicated better functioning. We used weighted ordinary least squares regressions to examine the effects of loneliness (CES-D loneliness and NFLM in separate models) on MoCA scores. In exploratory analyses, we examined if these relationships varied by race and ethnicity. We adjusted all models for sociodemographic and other salient factors (e.g., chronic disease, depressive symptoms, living alone).

Results

Mean age was 63.49 years, 52% were female, and 9% were Black and 6% Latino persons. Approximately 54% endorsed feeling lonely on at least one measure; 31% (CES-D) and 46% (NFLM). The relationship between loneliness measures was positive and significant, X 2 (1, N = 2,757) = 435.493 p < 0.001. However, only 40% of lonely individuals were identified as lonely on both assessments. CES-D loneliness was inversely (βˆ = -0.274, p = 0.032) associated with MoCA scores and this association did not vary by race and ethnicity. Greater NFLM loneliness was positively associated (βˆ = 0.445, p < 0.001) with higher MoCA scores for Latino participants only.

Discussion

Loneliness appears to be an important predictor of cognitive functioning. However, the association of loneliness and cognitive functioning varied when using the CES-D loneliness item or the NFLM. Future work is needed to understand how loneliness and its clinically relevant dimensions (social, emotional, existential, chronicity) relate to global and individual cognitive domains. Research is needed with racially and ethnically diverse midlife and older adults, particularly to understand our counterintuitive finding for Latino participants. Finally, findings also support the need for research on interventions to prevent cognitive decline targeting loneliness.

Dyadic loneliness, age, and cognitive functioning among midlife and older Black couples

Objectives: Within marriages, loneliness has been linked with individuals' own and their partners' cognitive health. Yet little research has situated Black older adults within a relational, dyadic context.

Method: This study analyzed longitudinal dyadic data from the Health and Retirement Study (2010-2016; n = 1270 participants from 635 couples) from both partners in opposite-sex midlife and older couples where at least one partner reported being Black or African American.

Results: Results indicated (1) husbands' loneliness was associated with worse cognitive functioning 4 years later for wives who had high baseline cognitive functioning themselves; (2) wives' loneliness was associated with worse cognitive functioning 4 years later only for oldest-old husbands; and (3) wives' cognitive functioning was associated with slower increases to husbands' loneliness 4 years later.

Conclusion: Findings indicate that loneliness has dyadic consequences for cognitive functioning among older Black couples, but that context is crucial for determining who is at greatest risk of harmful repercussions from a partner's loneliness.

Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease

Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.

Racial differences in links between perceived discrimination, depressive symptoms, and ambulatory working memory

OBJECTIVES

Perceived discrimination is associated with racial cognitive health disparities. Links between discrimination and cognitive performance, like working memory, in everyday settings (i.e. ambulatory performance) require investigation. Depressive symptoms may be a mechanism through which discrimination relates to ambulatory working memory.

METHOD

Discrimination, retrospective and momentary depressive symptoms/mood, and aggregated and momentary working memory performance among older Black and White adults were examined within the Einstein Aging Study.

RESULTS

Racially stratified analyses revealed that discrimination did not relate to Black or White adults' ambulatory working memory. Among Black adults, however, more frequent discrimination was associated with greater retrospectively reported depressive symptoms, which related to more working memory errors across two weeks (indirect effect p < 0.05). This path was not significant among White adults. Links between discrimination and momentary working memory were not explained by momentary reports of depressed mood for Black or White adults.

CONCLUSION

Depressive symptoms may play an important role in the link between discrimination and ambulatory working memory among Black adults across extended measurements, but not at the momentary level. Future research should address ambulatory cognition and momentary reports of discrimination and depression to better understand how to minimize cognitive health disparities associated with discrimination.

Neighborhood disadvantage is associated with working memory and hippocampal volumes among older adults

It is not well understood how neighborhood disadvantage is associated with specific domains of cognitive function and underlying brain health within older adults. Thus, the objective was to examine associations between neighborhood disadvantage, brain health, and cognitive performance, and examine whether associations were more pronounced among women. The study included 136 older adults who underwent cognitive testing and MRI. Neighborhood disadvantage was characterized using the Area Deprivation Index (ADI). Descriptive statistics, bivariate correlations, and multiple regressions were run. Multiple regressions, adjusted for age, sex, education, and depression, showed that higher ADI state rankings (greater disadvantage) were associated with poorer working memory performance (p < .01) and lower hippocampal volumes (p < .01), but not total, frontal, and white matter lesion volumes, nor visual and verbal memory performance. There were no significant sex interactions. Findings suggest that greater neighborhood disadvantage may play a role in working memory and underlying brain structure.

A Scoping Review of Neighborhoods and Cognitive Health Disparities Among US Midlife and Older Adults

Objectives: The neighborhood environment may be an important determinant of racial/ethnic disparities in cognitive function. To understand how neighborhoods are linked to cognition across racial/ethnic groups, this scoping review organizes research investigating relationships between multiple neighborhood domains and cognitive function in diverse samples of US midlife and older adults. Methods: PubMed/MEDLINE, Web of Science, and CAHL were used to extract quantitative disparities-focused studies (n = 17) that included US adults ages 50+, racial/ethnic minoritized populations, cognitive dependent variable(s), and neighborhood-level independent variable(s) published from January 2010 to October 2021. Results: Studies demonstrate variation within and between racial/ethnic groups in how neighborhood factors are associated with cognition. Economically and socially advantaged neighborhoods were associated with better cognition. Findings were mixed for built and neighborhood composition measures. Discussion: More research with greater racial/ethnic representation is needed to disentangle which aspects of the neighborhood are most salient for specific cognitive function domains across diverse populations.

Whose Signals Are Being Amplified? Toward a More Equitable Clinical Psychophysiology

Research using psychophysiological methods holds great promise for refining clinical assessment, identifying risk factors, and informing treatment. Unfortunately, unique methodological features of existing approaches limit inclusive research participation and, consequently, generalizability. This brief overview and commentary provides a snapshot of the current state of representation in clinical psychophysiology, with a focus on the forms and consequences of ongoing exclusion of Black participants. We illustrate issues of inequity and exclusion that are unique to clinical psychophysiology, considering intersections among social constructions of Blackness and biased design of current technology used to measure electroencephalography, skin conductance, and other signals. We then highlight work by groups dedicated to quantifying and addressing these limitations. We discuss the need for reflection and input from a wider variety of stakeholders to develop and refine new technologies, given the risk of further widening disparities. Finally, we provide broad recommendations for clinical psychophysiology research.

Managing Complexity: Black Older Adults With Multimorbidity

BACKGROUND AND OBJECTIVES

Black older adults have higher rates of multimorbidity and receive less effective multimorbidity support than their white counterparts. Yet little is known about the experiences of Black older adults with multimorbidity that may be at the heart of those disparities and which are central to interventions and improving care for this population. In this study, we aimed to conceptualize the multimorbidity management (MM) experience for Black older adults.

RESEARCH DESIGN AND METHODS

As part of a larger study on Black older adults' multimorbidity and physician empathy, we conducted in-depth qualitative interviews with 30 Black older adults living in a large midwestern city in the United States aged 65 years and older with self-reported multimorbidity. We used grounded theory analysis to distill findings into a core conceptual category as well as component domains and dimensions.

RESULTS

"Managing complexity" emerged as the core category to describe MM in our sample. Managing complexity included domains of "social context," "daily logistics," "care time," and "care roles."

DISCUSSION AND IMPLICATIONS

We discuss how managing complexity is distinct from patient complexity and how it is related to cumulative inequality and precarity. Study findings have potential implications for intervention around provider education and empathy as well as for enabling agency of Black older adults with MM.

Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans

Background

Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer's disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD).

Objective

The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD.

Methods

Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents' neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD.

Results

We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (β=0.046, p = 0.031, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD.

Conclusions

Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer's disease.

Which variables moderate the relationship between depressive symptoms and global neurocognition across adulthood?

The current study examined moderators of the relationship between depressive symptoms and global neurocognition in a large non-clinical community-dwelling sample spanning adulthood. Participants comprised 5,430 individuals between the ages of 18-99 years drawn from the Virginia Cognitive Aging Project. Depressive symptoms were measured via the Center for Epidemiologic Studies-Depression scale and neurocognition was operationalized as a composite variable comprising episodic memory, spatial visualization, processing speed, and reasoning tasks. Moderator variables included physical activity, cognitive activity, education, emotional stability, and openness. Hierarchical regressions were used to examine the influence of depressive symptoms and the moderators on neurocognition. Depressive symptoms significantly predicted neurocognition. Cognitive activity, years of education, and emotional stability moderated the depression-neurocognition relationship by buffering the impact of depressive symptoms on neurocognition. Cognitive activity engagement and level of education may function as a protective influence on those with higher levels of depressive symptoms, while emotional stability may be protective for individuals with lower levels of depressive symptoms. No differences in moderation were found across three age groups representing younger, middle, and older adults. Post-hoc analyses showed years of education and openness as moderators in a subsample excluding individuals with potentially clinically meaningful levels of depressive symptoms.

The Burden of having to Wonder: Hospice Caregiving Experiences of LGBTQ+ Cancer Family Caregivers

BACKGROUND AND OBJECTIVES

LGBTQ+ people are more likely to be caregivers for family and friends with life-limiting illnesses than non-LGBTQ+ people. LGBTQ+ caregivers may also experience stigma, bias, and discrimination, in addition to caregiving stress. Yet few studies have elicited LGBTQ+ family caregivers' perspectives on their end-of-life (EOL) experiences of home hospice.

RESEARCH DESIGN AND METHODS

We conducted semi-structured interviews with LGBTQ+ family caregivers of home hospice patients (N = 20). Following an interpretive descriptive approach, interview data were audio recorded, transcribed, and iteratively coded, and themes were developed and synthesized.

RESULTS

The burden of having to wonder expressed caregivers' uncertainty and concern about whether their negative experiences were common to all EOL caregivers or stemmed from cultural stigma and provider bias. Participants described how invisibility vs. risks of disclosure, anticipatory anxiety, perceived microaggressions, and protective vigilance increased stress and complicated caregiver-provider communication. Navigating EOL universalities vs. minority realities depicted underlying tensions between commonly assumed universalities of EOL caregiving and LGBTQ+-specific experiences. Providers' discomfort, awkward communication, lack of access to culturally competent EOL support resources, and broader structural and cultural discrimination eroded their sense of connectedness and safety. Together, these themes characterized the impact of minority stress at EOL.

DISCUSSION AND IMPLICATIONS

Our findings suggest that LGBTQ+ hospice caregivers are at risk for minority stress in addition to more common sources of EOL caregiving pressures and thus have specific support and communication needs. Providers must understand this to deliver effective EOL care for all families.

Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S

Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998-2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress-an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent's death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.

Employment of trauma informed principles in the Palabras Fuertes project: Implications for narrative research with older Latinx communities

In the US, there is a growing number of older Latinx communities. Qualitative approaches such as narrative inquiry may be fruitful endeavors to elucidate their lived experiences. However, older Latinx communities, including sexual minorities, are disproportionately exposed to social, health, and historical challenges that may result in exposure to potentially traumatic events (e.g. discrimination, illness, grief, etc.). The recognition of high rates of exposure to potentially traumatic events among participants has led to the recommended adoption of Trauma Informed (TI) principles for use in non-trauma specific research. At present, there are limited examples and discussions about the implementation of TI principles in qualitative research and our literature review yielded no discussion of the use of TI principles in narrative inquiry or with older Latinx communities. In this manuscript, we advocate for the adoption of TI principles when engaging in narrative inquiry with older Latinx adults. Second, we discuss examples of TI guided practices we employed while conducting the Palabras Fuertes study of life history narratives with older Latino immigrant gay men living in New York City. Finally, based on these experiences, we provide recommendations for incorporating TI into future narrative research with older Latinx communities.

Examining Racial/Ethnic Disparities in Coping and Stress Within an Environmental Riskscape

Existing research on racial/ethnic differences in stress and coping is limited by small samples, single-item measures, and lack of inclusion of Mexican Americans. We address these gaps by analyzing data from the Texas City Stress and Health Study, a cross-sectional sample of Black (N = 257), White (N = 304), US-born (N = 689), and foreign-born (N = 749) Mexican Americans residing in proximity to a petrochemical complex. We compared active and avoidant coping by race/ethnicity and explored multivariable associations between coping and perceived stress. Black and foreign-born Mexican American respondents had the highest stressor exposure yet displayed different patterns of coping and perceived stress patterns. Active coping may be particularly effective for African Americans but may not offset extreme stress disparities. For Mexican Americans, the lack of association between coping and stress underscores the need for more work focused on the culturally diverse coping experiences.

Cultural Consensus Modeling to identify culturally relevant reasons for and against suicide among Black adolescents

INTRODUCTION

The development of evidence-based treatments relies on accurate theoretical frameworks sensitive to the lived realities of the populations from which they are derived. Yet, the perspectives of Black youth are vastly underrepresented in extant theories of suicidal behavior. Cultural Consensus Modeling provides an evidence-based approach for developing a culturally informed understanding of suicide risk among Black youth.

METHOD

Participants were 50 Black adolescents (Mage  = 16.20 years; 76.0% male) who completed Phase 1 of a Cultural Consensus Modeling study. Participants freely listed reasons for suicide and reasons for living among similar peer Black youth. Responses were synthesized and coded for major themes.

RESULTS

The most common reasons for suicide were racism (40%), depression (32%), poverty (26%), and bullying (22%). The most common reasons for living were family (58%), having a purpose or goals (36%), friends (30%), and hope for a better future (26%).

CONCLUSION

Responses highlighted issues of racism and social justice, depression, and poverty, as well as the protective role of relationships, living for the future, and contributing to Black empowerment. Future research should utilize Cultural Consensus Modeling to elevate the voices of Black youth, improving extant theories of suicide, and identifying unique mechanisms or opportunities for prevention.

Intersectional inequalities in the transition to grandparenthood and cognitive functioning: A longitudinal Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA)

Objectives

With aging societies, more people become vulnerable to experiencing cognitive decline. While normal aging is associated with a deterioration in certain cognitive abilities, little is known about how social determinants intersect to create late-life cognitive functioning inequalities. Simultaneously, the role of grandparenthood is central for older adults and their families. There are indications that social determinants intersect to modulate the effect of the transition to grandparenthood, but further evidence is needed. Our study investigates the relation of transition to grandparenthood with cognitive functioning and explores differences across intersectional strata.

Methods

Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe, we analyzed a sample of 19,953 individuals aged 50-85 without grandchildren at the baseline. We applied Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy to investigate cognitive functioning differences across 48 intersectional strata, defined by sex/gender, migration, education, and occupation. We allowed the impact of becoming a grandparent to vary across strata by including random slopes.

Results

Intersectional strata accounted for 17.43% of the overall variance in cognitive functioning, with most of the stratum-level variation explained by additive effects of the stratum-defining characteristics. Transition to grandparenthood was associated with higher cognitive functioning, with a stronger effect for women. Stratum-level variation in the grandparenthood effect was modest.

Discussion

This study highlights the importance of social determinants for understanding heterogeneities in the association of transition to grandparenthood with cognitive functioning. Adopting an intersectional lens is useful to decompose inequalities and derive tailored interventions to promote equal healthy aging.

Cognitive and Functional Improvement via Novel Skill Learning for Low-Income Minoritized Middle-Aged and Older Adults

Prior research has demonstrated beneficial outcomes for learning new skills in older adulthood, including increased cognitive and functional abilities, which help prevent age-related declines and foster healthy aging. However, these studies largely have included participants not typically considered at risk for cognitive and functional decline (i.e., White, highly educated, higher income). Cognitive and functional disparities exist among minoritized racial and ethnic individuals, particularly Black and Latinx populations, because of a lifetime of inequalities associated with low socioeconomic status, low education, and discrimination. This theoretical paper proposes a potential pathway in which such disparities could be mitigated by increasing cognitive and functional abilities via novel skill learning in these at-risk populations in middle and later life to prevent decline. We also discuss indirect barriers (e.g., financial and health issues), direct barriers (e.g., limited learning opportunities), and motivational barriers (e.g., self-beliefs, values) that these adults may encounter. We further highlight that addressing these barriers to novel skill learning by providing appropriate resources is necessary to maximize the feasibility and potential effectiveness of this pathway. Lastly, we encourage future research to test this pathway and help inform policymakers and existing learning programs to implement better ways of promoting lifelong learning in an inclusive and equitable manner to prevent decline.

Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline

OBJECTIVES

Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences.

METHODS

Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups.

RESULTS

SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30).

DISCUSSION

When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.

Racial and Ethnic Differences in Health-Related Quality of Life for Individuals With Parkinson Disease Across Centers of Excellence

BACKGROUND AND OBJECTIVES

Racial and ethnic minorities have been underrepresented in Parkinson disease (PD) research, limiting our understanding of treatments and outcomes across all non-White groups. The goal of this research is to investigate variability in health-related quality of life (HRQoL) and other outcomes in patients with PD across different races and ethnicities.

METHODS

This was a retrospective, cross-sectional and longitudinal, cohort study of individuals evaluated at PD Centers of Excellence. A multivariable regression analysis adjusted for sex, age, disease duration, Hoehn and Yahr (H&Y) stage, comorbidities, and cognitive score was used to investigate differences between racial and ethnic groups. A multivariable regression with skewed-t errors was performed to assess the individual contribution of each variable to the association of 39-item PD Questionnaire (PDQ-39) with race and ethnicity.

RESULTS

A total of 8,514 participants had at least 1 recorded visit. Most of them (90.2%) self-identified as White (n = 7,687), followed by 5.81% Hispanic (n = 495), 2% Asians (n = 170), and 1.9% African American (n = 162). After adjustment, total PDQ-39 scores were significantly higher (worse) in African Americans (28.56), Hispanics (26.62), and Asians (25.43) when compared with those in White patients (22.73, p < 0.001). This difference was also significant in most PDQ-39 subscales. In the longitudinal analysis, the inclusion of cognitive scores significantly decreased the strength of association of the PDQ-39 and race/ethnicity for minority groups. A mediation analysis demonstrated that cognition partially mediated the association between race/ethnicity and PDQ-39 scores (proportion mediated 0.251, p < 0.001).

DISCUSSION

There were differences in PD outcomes across racial and ethnic groups, even after adjustment for sex, disease duration, HY stage, age, and some comorbid conditions. Most notably, there was worse HRQoL among non-White patients when compared with White patients, which was partially explained by cognitive scores. The underlying reason for these differences needs to be a focus of future research.

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States

PURPOSE

This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders.

METHOD

We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine.

RESULTS

The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes.

CONCLUSION

Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Design of the think PHRESH longitudinal cohort study: Neighborhood disadvantage, cognitive aging, and alzheimer's disease risk in disinvested, black neighborhoods

BACKGROUND

Black Americans have disproportionately higher rates and earlier onset of Alzheimer's disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying the risks, may contribute to elevated ADRD risk in Black Americans.

METHODS

The Think PHRESH study builds on existing, community-based research infrastructure, from the ongoing Pittsburgh Hill/Homewood Research on Neighborhood Change and Health (PHRESH) studies, to examine the contributions of dynamic neighborhood socioeconomic conditions across the lifecourse to cognitive outcomes in mid- and late-life adults living in two historically disinvested, predominantly Black communities (anticipated n = 1133). This longitudinal, mixed-methods study rests on the premise that neighborhood racial segregation and subsequent disinvestment contributes to poor cognitive outcomes via factors including (a) low access to educational opportunities and (b) high exposure to race- and socioeconomically-relevant stressors, such as discrimination, trauma, and adverse childhood events. In turn, these cumulative exposures foster psychological vigilance in residents, leading to cardiometabolic dysregulation and sleep disruption, which may mediate associations between neighborhood disadvantage and ADRD risk. This premise recognizes the importance of potential protective factors that may promote cognitive health, including neighborhood social cohesion, safety, and satisfaction. The proposed study will leverage our existing longitudinal data on risk/protective factors and biobehavioral mediators and will include: (1) up to three waves of cognitive assessments in participants ages 50 years + and one assessment in participants ages 35-49 years; clinical adjudication of ADRD will be completed in participants who are 50+, (2) extensive surveys of risk and protective factors, (3) two assessments of blood pressure and objectively measured sleep, (4) a comprehensive assessment of life and residential history; and (5) two rounds of in-depth qualitative interviews to reveal lifecourse opportunities and barriers experienced by Black Americans in achieving optimal cognitive health in late life.

DISCUSSION

Understanding how structural racism has influenced the lived experience of Black Americans, including dynamic changes in neighborhood conditions over time, is critical to inform multi-level intervention and policy efforts to reduce pervasive racial and socioeconomic disparities in ADRD.

Discrimination and Education Quality Moderate the Association of Sleep With Cognitive Function in Older Black Adults: Results From the Einstein Aging Study

OBJECTIVES

Heterogeneity among Black adults' experiences of discrimination and education quality independently influence cognitive function and sleep, and may also influence the extent to which sleep is related to cognitive function. We investigated the effect of discrimination on the relationship between objective sleep characteristics and cognitive function in older Black adults with varying education quality.

METHOD

Cross-sectional analyses include Black participants in the Einstein Aging Study (N = 104, mean age = 77.2 years, 21% males). Sleep measures were calculated from wrist actigraphy (15.4 ± 1.3 days). Mean ambulatory cognitive function (i.e., spatial working memory, processing speed/visual attention, and short-term memory binding) was assessed with validated smartphone-based cognitive tests (6 daily). A modified Williams Everyday Discrimination Scale measured discriminatory experiences. Linear regression, stratified by reading literacy (an indicator of education quality), was conducted to investigate whether discrimination moderated associations between sleep and ambulatory cognitive function for individuals with varying reading literacy levels. Models controlled for age, income, sleep-disordered breathing, and sex assigned at birth.

RESULTS

Higher reading literacy was associated with better cognitive performance. For participants with both lower reading literacy and more discriminatory experiences, longer mean sleep time was associated with slower processing speed, and lower sleep quality was associated with worse working memory. Later sleep midpoint and longer nighttime sleep were associated with worse spatial working memory for participants with low reading literacy, independent of their discriminatory experiences.

DISCUSSION

Sociocultural factors (i.e., discrimination and education quality) can further explain the association between sleep and cognitive functioning and cognitive impairment risk among older Black adults.

Theory Integration for Examining Health Care Discrimination among Minoritized Older Adults with Chronic Illness

Prevalence of chronic illnesses, including type 2 diabetes (T2DM), is increasing disproportionately among Latinx adults in the United States. Health care inequities such as health care discrimination contribute to the disparities in this population. Academic and clinical nurses must address health care discrimination from a strong theoretical framework. In this article, we integrate the minority stress theory and ecosocial theory of disease distribution to offer a whole-person model that identifies the concepts most relevant to Latinx older adults who function at multiple levels of intersectionality. This paper uses T2DM as an exemplar of chronic illness. The integrated model depicts possible pathways of physiological and psychological embodiment of lived experiences of minoritized older persons managing chronic illness who are living in a society deeply embedded with structural racism and oppression. This model may guide future research aimed at elucidating the social and structural determinants that impact health-related outcomes among Latinx older adults.

Testing the Reserve Capacity Model: Does Race Moderate the Relationship Between Negative Emotions and Neurocognition?

OBJECTIVE

To test whether race moderates the relationship between negative emotions and neurocognition by applying the reserve capacity model within a large sample that spans adulthood.

METHOD

The study sample (N = 1,020) consisted of community-dwelling adults between 18 and 84 years of age who were drawn from the Virginia Cognitive Aging Project. Demographic variables were used to match a sample of Black participants to a sample of White participants. Race was examined as a moderator of the relationship between negative emotions (i.e., depressive symptoms, trait anxiety, and the negative affect subscale from the Positive and Negative Affect Schedule) and neurocognitive variables (episodic memory, reasoning, spatial visualization, and processing speed) with multiple-group structural equation modeling.

RESULTS

After accounting for sociodemographic variables, depressive symptoms were negatively associated with processing speed in both groups, and with worse reasoning in the White subsample. Negative affect was associated with lower reasoning performance in both groups and with lower spatial visualization in the White subsample. Trait anxiety was not significantly associated with the neurocognitive constructs in either group. Multigroup structural equation models showed that the magnitudes of the associations were not different between the Black and White subsamples. Thus, race did not moderate the relationships between depressive symptoms, trait anxiety, and negative affect with neurocognition.

CONCLUSIONS

Negative emotions are associated with lower performance on different neurocognitive tasks, but race does not moderate these relationships. Future research should examine perceived discrimination or other psychosocial variables when examining the relationships among negative emotions and neurocognition.

Changes in executive function in the Canadian longitudinal study on aging over 3-years: A focus on social determinants of health

Maintaining executive functions, including planning, inhibition, and decision-making skills, is important for autonomy and activities of daily living. There is a growing body of evidence linking social determinants and cognitive aging, but less is known about the potential role of social determinants in changes in executive functioning over time. Using data from the Canadian Longitudinal Study on Aging (CLSA), a large cohort of mid-aged and older adults, we examined changes in executive function over a 3-year period. Specifically, we focused on the role of social determinants (i.e., social positioning, social support, education) in explaining these changes. Executive function was measured at baseline and follow-up 3 years later using the Mental Alteration Test (MAT). We computed a reliable change index (RCI) and used a multiple linear regression model to examine the associations between known correlates and change in executive function over the 3-year period (n = 29,344). Older age, higher household income, and greater educational attainment predicted declines in executive function. Health factors (e.g., depression symptoms, physical activity levels) and many social determinants (sexual orientation, gender identity, race, and perceived social standing) were not associated with change in executive function. These results suggest that social determinants of health may be related to initial differences in cognitive functioning (i.e., cross-sectional differences) rather than more rapid cognitive aging.

Social determinants of memory change: A three-year follow-up of the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Changes in memory can interfere with activities of daily living and may be indicative of serious health concerns such as mild cognitive impairment or dementia. Risk factors for cognitive decline and dementia have been shown to cluster around inequalities, suggesting that minority groups may be at an increased risk for cognitive decline. We sought to clarify the relationship between social determinants and change in memory function over a 3-year follow-up period, after accounting for demographic and health variables.

METHODS

We used baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CLSA). Our primary analysis consisted of a multivariable linear regression model (n = 30,475). Demographic, health, education and occupation, social support, social identity, and social positioning variables (predictors) were measured at baseline. We computed a reliable change index (outcome) using the Rey Auditory Verbal Learning Test (RAVLT).

RESULTS

Older age and some health considerations (e.g., higher body mass index, low hearing) were associated with a greater decline in memory over the three-year period. In contrast, some physical activity and better self-rated general health were associated with improvements in memory. Having a hobby and better perceived social standing were associated with greater memory improvement. Social identities who experience minority stress (sexual orientation, gender identity, and race) did not predict change in memory.

DISCUSSION

Altogether, these results contribute to a growing body of evidence that points to older members of minoritized communities exhibiting initial differences in cognitive functioning (i.e., cross-sectional differences) but not more rapid cognitive aging.

Cognitive Aging in Same- and Different-Sex Relationships: Comparing Age of Diagnosis and Rate of Cognitive Decline in the Health and Retirement Study

INTRODUCTION

The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer's disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs).

METHODS

The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998-2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender.

RESULTS

Participants in SSRs reported dementia diagnoses (β = -12.346; p = 0.001), crossed the threshold into CIND (β = -8.815; p < 0.001) and possible dementia (β = -13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (β = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (β = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women.

CONCLUSION

Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories' claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.

Racism, xenophobia, and discrimination: mapping pathways to health outcomes

Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.

Opportunities to Discuss Diversity-Related Topics in Neuroscience Courses

Diversity is a foundational topic in psychology, and APA recommends that diversity is covered across the psychology curriculum. Neuroscience courses face challenges with incorporating diversity-related topics owing to the historical lack of neuroscience research that focuses on diversity and the restricted range of diversity-related topics that neuroscience is typically associated with (i.e., health and disability status). This may limit students' learning of neuroscience's contributions towards understanding diversity. We review some specific examples of diversity-related topics that can be incorporated into neuroscience courses. These examples have been selected to include topics across the three major content domains of neuroscience (cellular/molecular, neuroanatomy/systems, and cognitive/behavioral), as well as across multiple diversity-related topics. Neuroscience instructors can use these examples to incorporate greater coverage of diversity-related topics within their courses and/or as points of inspiration for their own curricular additions. Providing systematic coverage of diversity-related topics in neuroscience courses highlights the ways neuroscience advances our understanding of human diversity and contributes to the educational objectives of psychology and neuroscience programs.

Older immigrant Latino gay men and childhood sexual abuse: Findings from the Palabras Fuertes project

Childhood Sexual Abuse (CSA) and maltreatment have long-term negative impacts on survivors, including older adults. Yet, limited qualitative examinations of how these experiences impact the lives of older adults exists and even fewer among older Latino gay men. We drew data from life-history narratives the first author conducted with five Spanish speaking older Latino gay men in New York City. Our analyses were guided by an Ecological Model, a Suffering lens, and our clinical social work experience with older adults, sexual minorities and people of color. All participants reported sexual experiences prior to the age of 15 and possible emotional and physical maltreatment. Yet, not all participants perceived these experiences as abuse. Our findings indicate how cultural, linguistic and contextual factors may affect disclosure and coping. Despite the fact that CSA and maltreatment occurred decades ago, these early experiences affected long-term psychosocial functioning. Our findings support a need for future research and clinical practice that considers the subjective perceptions of childhood sexual experiences and maltreatment and how these relate to psychosocial functioning in Latino gay men during older adulthood.

The Death of a Child and Parents' Psychological Distress in Mid to Later Life: Racial/Ethnic Differences in Exposure and Vulnerability

OBJECTIVES

This study considered whether experiencing the death of a child is associated with subsequent psychological distress in older populations, as well as variation in both exposure and vulnerability to the death of a child among Black, Hispanic, and White older parents.

METHODS

We used multilevel models to link the death of a child with subsequent distress for 9,763 non-Hispanic White, 2,496 non-Hispanic Black, 1,014 foreign-born Hispanic, and 712 U.S.-born Hispanic parents from the Health and Retirement Study, 2006-2016.

RESULTS

The death of a child is associated with increased psychological distress in mid to later life for Black, White, and Hispanic parents, with greater vulnerability for foreign-born Hispanic parents. Notably, Black and U.S.-born Hispanic parents are disadvantaged because of the additive effects of their greater exposure to bereavement and their higher distress levels regardless of bereavement status. These effects persist net of additional stressors associated with race/ethnicity.

DISCUSSION

The death of a child is a traumatic life course event associated with lasting psychological distress for aging parents. Black and U.S.-born Hispanic parents are disadvantaged in that they are more likely than White parents to experience the death of a child, and foreign-born Hispanic parents may be disadvantaged by greater vulnerability to distress following child death.

Growth Mindset Predicts Cognitive Gains in an Older Adult Multi-Skill Learning Intervention

Growth mindset (belief in the malleability of intelligence) is a unique predictor of young learners' increased motivation and learning, and may have broader implications for cognitive functioning. Its role in learning in older adulthood is unclear. As part of a larger longitudinal study, we examined growth mindset and cognitive functioning in older adults engaged in a 3-month multi-skill learning intervention that included growth mindset discussions. Before, during, and after the intervention, participants reported on their growth mindset beliefs and completed a cognitive battery. Study 1 indicated that intervention participants, but not control participants, increased their growth mindset during the intervention. Study 2 replicated these results and found that older adults with higher preexisting growth mindsets showed larger cognitive gains at posttest compared to those with lower preexisting growth mindsets. Our findings highlight the potential role of growth mindset in supporting positive learning cycles for cognitive gains in older adulthood.

They Cannot, They Will Not, or We Are Asking the Wrong Questions: Re-examining Age-Related Decline in Social Cognition

Social cognition is critical for successfully navigating social relationships. Current evidence suggests that older adults exhibit poorer performance in several core social-cognitive domains compared to younger adults. Neurocognitive decline is commonly discussed as one of the key arbiters of age-related decline in social-cognitive abilities. While evidence supports this notion, age effects are likely attributable to multiple factors. This paper aims to recontextualize past evidence by focusing issues of motivation, task design, and representative samples. In light of these issues, we identify directions for future research to aide our understanding of social-cognitive aging.

A Landscape of Subjective and Objective Stress in African-American Dementia Family Caregivers

Stress is a significant part of daily life, and systemic social inequities, such as racism and discrimination, are well-established contributors of chronic stress for African Americans. Added exposure to the stress of caregiving may exacerbate adverse health outcomes. This secondary analysis describes subjective and objective stress in African American family caregivers, and relationships of subjective and objective stress to health outcomes. Baseline data from 142 African American dementia family caregivers from the "Great Village" study were described using means and frequencies; regression models and Pearson's correlation were used to examine associations between demographics, social determinants of health, and health outcomes. Mixed models were used to examine change and change variation in cortisol. Most caregivers had moderate degrees of stress. Stress was associated with sleep disruption and depressive symptoms, and discrimination appeared to be an independent contributor to depressive symptoms. This work provides a foundation for interpreting subjective and objective indicators of stress to tailor existing multicomponent interventions.

Prospective Associations between Physical Activity and Memory in the Canadian Longitudinal Study on Aging: Examining Social Determinants

Objectives

To examine associations between physical activity (PA) and prospectively assessed memory in a cohort of cognitively healthy adults, after accounting for understudied social determinants.

Methods

We used data from the Canadian Longitudinal Study on Aging (CLSA). PA (exposure) and memory (outcome) were assessed using validated measures in 2013–2015 and 2015–2018, respectively. Respondents reported their daily number of hours spent engaging in five different PAs. We conducted multiple imputation and used linear regression (n = 41,394), adjusting for five categories of covariates: demographics, sensory health characteristics, health behaviors, health status, and social determinants (sex/gender, education, income, social support, perceived social standing, race, and sexual orientation).

Results

In crude models, nearly every intensity and duration of PA was associated with better memory. In fully adjusted models, protective associations were attenuated; however, some associations held: all durations of walking, most durations of light activities, moderate activities for ≥1 hour, and strenuous activities for 1 to <2 hours.

Discussion

Some forms of PA may be associated with better memory. The benefits of higher intensity PA may only be realized after social determinants are addressed.

Racial Disparities in Cognitive Function Among Middle-Aged and Older Adults: The Roles of Cumulative Stress Exposures Across the Life Course

BACKGROUND

Racial disparities in cognitive function are well documented, but factors driving these disparities remain underexplored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black-White disparities in executive function and episodic memory in middle-aged and older adults.

METHOD

Data were drawn from the 2004-2006 wave of the Midlife Development in the United States Study (MIDUS 2) and the MIDUS Refresher study (N = 5,947; 5,262 White and 685 Black). Cumulative stress exposures were assessed by 10 stressor domains (ie, childhood stress, stressful life events in adulthood, financial stress, work psychological stress, work physical stress, work-family conflicts, neighborhood disorder, relationship stress, perceived inequality, and perceived discrimination). Cognitive function was assessed using the Brief Test of Adult Cognition by Telephone. Marginal structural models were used to quantify the proportion of the effect of race/ethnicity status on cognitive function mediated through cumulative stress exposures.

RESULTS

After adjusting for age, sex, and sample, on average, Black participants had lower levels of executive function (difference: -0.83 SD units, 95% CI: -0.91, -0.75) and episodic memory (difference: -0.53 SD units, 95% CI: -0.60, -0.45) scores than White participants. Cumulative stress exposures accounted for 8.4% of the disparity in executive function and 13.2% of the disparity in episodic memory.

CONCLUSIONS

Cumulative stress exposures across the life course explained modest proportions of Black-White disparities in cognitive function in this large cross-sectional study.

Immune markers are associated with cognitive performance in a multiethnic cohort: The Northern Manhattan Study

OBJECTIVE

To determine whether immune protein panels add significant information to correlates of cognition.

BACKGROUND

Immune mechanisms in vascular cognitive aging are incompletely characterized.

DESIGN/METHODS

A subsample of the prospective Northern Manhattan Study underwent detailed neuropsychological testing. Cognitive scores were converted into Z-scores and categorized into four domains (memory, language, processing speed, and executive function) based on factor analysis. Blood samples were analyzed using a 60-plex immunoassay. We used least absolute shrinkage and selection operator (LASSO) procedures to select markers and their interactions independently associated with cognitive scores. Linear regression models assessed cross-sectional associations of known correlates of cognition with cognitive scores, and assessed model fit before and after addition of LASSO-selected immune markers.

RESULTS

Among 1179 participants (mean age 70 ± 8.9 years, 60% women, 68% Hispanic), inclusion of LASSO-selected immune markers improved model fit above age, education, and other risk factors (p for likelihood ratio test < 0.005 for all domains). C-C Motif Chemokine Ligand 11 (CCL 11, eotaxin), C-X-C Motif Chemokine Ligand 9 (CXCL9), hepatocyte growth factor (HGF), and serpin E1 (plasminogen activator inhibitor-1) were associated with each of the domains and with overall cognitive function. Immune marker effects were comparable to conventional risk factors: for executive function, each standard deviation (SD) increase in CCL11 was associated with an effect equivalent to aging three years; for memory, HGF had twice the effect of aging.

CONCLUSIONS

Immune markers associate with cognitive function in a multi-ethnic cohort. Further work is needed to validate these findings and determine optimal treatment targets.

Perceived Discrimination and Symptoms of Cognitive Dysfuntion Among Middle-Age and Older Persons Living With HIV in China: A Multicenter Cross-Sectional Study of the Mediating Role of Mental Health Symptoms and Social Isolation

ABSTRACT

Perceived discrimination is associated with symptoms of cognitive dysfunction (SOCD) among middle-age and older persons living with HIV (PLWH). We aimed to explore how the association between perceived discrimination and SOCD was mediated by mental health symptoms and social isolation. The sample included 321 PLWH, ages 45 years and older, for a multicenter cross-sectional study. Structural equation modeling showed an acceptable model fit and a significant total indirect effect between perceived discrimination and SOCD. All three indirect effect pathways were significant, suggesting that perceived discrimination could influence SOCD through mental health symptoms, through social isolation, or through mental health symptoms and then social isolation. Our study demonstrates that perceived discrimination is a concern for the management of cognitive function among middle-age and older PLWH. Both mental health symptoms and social isolation are critical elements in the design and evaluation of interventions for promoting cognitive health.

Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach

OBJECTIVES

Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years.

METHODS

Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing).

RESULTS

Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function.

DISCUSSION

These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.

Life Course Stressors and Functional Limitations in Later Life among White, Black, and Hispanic Adults: Deleterious, Hardening, or Benign?

OBJECTIVES

Although striking racial and ethnic disparities in health are manifest during later life, they may be rooted in early-life exposures. Drawing from cumulative inequality theory, we investigate whether life course stressors are associated with risk of later life functional limitations and whether this relationship differs by race and ethnicity.

METHODS

We utilize longitudinal data from the Health and Retirement Study to test whether child and adult stressors predict trajectories of the occurrence and severity of functional limitations among a diverse sample of older adults.

RESULTS

Child and adult stressors are associated with greater occurrence and severity of functional limitations during later life. Mediation analyses reveal the indirect influence of child stressors via adult stressors on occurrence and severity of functional limitations; however, the indirect effects are slightly stronger for Black and Hispanic adults than their White counterparts.

DISCUSSION

Child stressors, in and of themselves, do not increase functional limitations among Black and Hispanic people but are associated with greater adult stress exposure, predisposing them to more functional limitations. Results suggest that childhood stressors are associated with distinct social pathways to functional limitations among Black, White, and Hispanic older adults.