The Digital Divide Exacerbates Disparities in Latinx Recruitment for Alzheimer’s Disease and Related Dementias Online Education During COVID-19

A Latent Class Analysis of Personal Coping Resources and Depressive Symptoms Among Middle-Aged and Older Latinx Adults

Objectives: To identify coping profiles and evaluate their implications for depressive symptoms among Latinx adults. Methods: Data come from a community-dwelling sample of Latinx adults ages 45+ in Florida (N = 461). Latent class analysis was used to identify profiles of personal coping resources based on patterns across spirituality (spiritual coping, divine fate), ethnic identity (centrality, connectedness), and personal control (mastery, self-esteem). Multivariable linear regression assessed differences in depressive symptoms across coping resource classes. Results: Four coping resource profiles were identified: (1) low resources overall, yet high spiritual coping; (2) high spirituality and personal control; (3) high spirituality and ethnic identity; and (4) high resources overall. Members of Class 4 had significantly fewer depressive symptoms than members of Class 1 and Class 3, controlling for sociodemographic characteristics, p < .001. Discussion: Results elucidate nuances in personal coping resources among aging Latinx adults, identify under-resourced groups, and suggest that resource profiles characterized by few personal coping resources are linked with more depressive symptoms. Findings clarify the underpinnings of the latent coping construct and have implications for mental health promotion interventions among aging Latinx adults.

Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States

OBJECTIVES

To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status.

METHODS

Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics.

RESULTS

Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier.

DISCUSSION

Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.

Alzheimer's Centers in US Hospitals: Enough to Adequately Address Dementia Care Nationwide?

OBJECTIVES

To investigate the availability of Alzheimer's Centers (ACs) in US hospitals.

METHODS

Utilizing the American Hospital Association Annual Survey, Area Health Resource File, and US Census (n = 3251), we employed multivariable logistic regression to examine hospital, county, and regional predictors of AC availability.

RESULTS

Large hospitals (>399 beds) had approximately 14 times higher odds of having an AC than small hospitals (<50 beds; OR = 14.0; 95% CI = 6.44 - 30.46). Counties with a higher proportion of Latino residents, relative to non-Latino Whites, had lower odds of having an AC (OR = .05; 95% CI = .01 - .41). Northeastern (OR = 1.92; 95% CI = 1.15 - 3.22) and Midwestern (OR = 2.12; 95% CI = 1.34 - 3.37) hospitals had higher odds of having an AC than Southern hospitals.

DISCUSSION

To address dementia needs and disparities, investment in a national infrastructure is critical.

Recruiting Socially Disconnected Latinos Caring for a Person with Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic: Lessons Learned

OBJECTIVES

The purpose of this article is to present conceptual and methodological challenges to recruitment strategies in enrolling socially disconnected middle-aged and older Latino caregivers of a loved one with Alzheimer's disease and related dementias (ADRD).

METHODS

Middle-aged and older Latino ADRD caregivers were recruited into two early stage, intervention development studies during the COVID-19 pandemic via online or in-person methods. Recruitment criteria included Latino ADRD caregivers over the age of 40 reporting elevated loneliness on the UCLA 3-item Loneliness Scale (LS) during screening.

RESULTS

Middle-aged, Latino caregivers were recruited predominantly from online methods whereas older caregivers were mostly recruited from in-person methods. We report challenges identifying socially disconnected Latino caregivers using the UCLA 3-item LS.

CONCLUSIONS

Our findings support previously reported disparities in recruitment by age and language and suggest further methodological considerations to assess social disconnection among Latino caregivers. We discuss recommendations to overcome these challenges in future research.

CLINICAL IMPLICATIONS

Socially disconnected Latino ADRD caregivers have an elevated risk for poor mental health outcomes. Successful recruitment of this population in clinical research will ensure the development of targeted and culturally sensitive interventions to improve the mental health and overall well-being of this marginalized group.

A call to address structural barriers to Hispanic/Latino representation in clinical trials on Alzheimer's disease and related dementias: A micro-meso-macro perspective

Introduction

This perspective paper addresses the US Hispanic/Latino (herein, Latino) experience with regards to a significant public health concern-the underrepresentation of Latino persons in Alzheimer's disease and related dementias (AD/ADRD) clinical trials. Latino individuals are at increased risk for AD/ADRD, experience higher disease burden, and low receipt of care and services. We present a novel theoretical framework-the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment-which considers multi-level barriers and their impact on Latino trial recruitment.

Methods

Based on a review of the peer-reviewed literature and our lived experience with the Latino community, we drew from our interdisciplinary expertise in health equity and disparities research, Latino studies, social work, nursing, political economy, medicine, public health, and clinical AD/ADRD trials. We discuss factors likely to impede or accelerate Latino representation, and end with a call for action and recommendations for a bold path forward.

Results

In the 200+ clinical trials conducted with over 70,000 US Americans, Latino participants comprise a fraction of AD/ADRD trial samples. Efforts to recruit Latino participants typically address individual- and family-level factors (micro-level) such as language, cultural beliefs, knowledge of aging and memory loss, limited awareness of research, and logistical considerations. Scientific efforts to understand recruitment barriers largely remain at this level, resulting in diminished attention to upstream institutional- and policy-level barriers, where decisions around scientific policies and funding allocations are ultimately made. These structural barriers are comprised of inadequacies or misalignments in trial budgets, study protocols, workforce competencies, healthcare-related barriers, criteria for reviewing and approving clinical trial funding, criteria for disseminating findings, etiological focus and social determinants of health, among others.

Conclusion

Future scientific work should apply and test the Micro-Meso-Macro Framework for Diversifying AD/ADRD Trial Recruitment to examine structural recruitment barriers for historically underrepresented groups in AD/ADRD research and care.

Intersectional Approaches to Minority Aging Research

Purpose of Review

Growing racial/ethnic diversity among America's older adults necessitates additional research specifically focused on health and well-being among aging minoritized populations. Although Black and Latinx adults in the USA tend to face worse health outcomes as they age, substantial evidence points to unexpected health patterns (e.g., the race paradox in mental health, the Latino health paradox) that challenge our understanding of health and aging among these populations. In this review, we demonstrate the value of intersectionality theory for clarifying these health patterns and highlight the ways that intersectionality has been applied to minority aging research. To advance the field, we also make several recommendations for incorporating intersectional approaches in future scholarship on minority aging.

Recent Findings

Scholars have applied intersectional approaches to health and aging to unravel how social statuses and social conditions, such as race, ethnicity, gender, nativity, incarceration history, geographic region, and age, produce distinct shared experiences that shape health trajectories through multiple mechanisms.

Summary

We highlight common intersectional approaches used in minority aging research and underscore the value of this perspective for elucidating the complex, and often unexpected, health patterns of aging minoritized populations. We identify several key lessons and propose recommendations to advance scholarship on minority aging.

Loneliness Exacerbates the Association Between Bodily Pain and Depressive Symptoms Among Middle-Aged and Older Latinx Adults

Objectives: To investigate the associations between three bodily pain dimensions (intensity, frequency, severity) and depressive symptoms among middle-aged and older Latinxs ages 40-94 and to determine whether loneliness conditioned the pain-depressive symptoms associations. Methods: Data are from a community-based study of community-dwelling residents in Florida (N = 527). Multivariable linear regression models assessed the impact of each pain dimension on depressive symptoms, controlling for sociodemographic factors. Interactions determined whether loneliness moderated the pain-depressive symptoms relationships. Results: Each pain dimension was positively associated with depressive symptoms (p < .01). Loneliness modified the impact of pain frequency and pain severity on depressive symptoms. Those with moderate and high loneliness levels experienced an amplified pain-depressive symptoms association. Discussion: Findings underscore the synergistic effects of pain and loneliness in exacerbating depressive symptomatology among middle-aged and older Latinx adults. Loneliness is an important point of intervention to improve mental health among aging Latinxs.