Loss of Autonomy: Likely Dementia and Living Arrangement Transitions Among Mexicans and Mexican Americans

BACKGROUND AND OBJECTIVES

To examine the role of probable dementia on changes in living arrangements and mortality among very old Mexicans and Mexican Americans in 2 different nations.

RESEARCH DESIGN AND METHODS

We employ the Hispanic Established Population for the Epidemiologic Study of the Elderly and the Mexican Health and Aging Study, 2 comparable longitudinal data sets, to identify predictors of changes in living arrangements using multinomial logistic regression, controlling for cognitive status, demographic characteristics, and resources.

RESULTS

In Mexico, women with dementia who lived alone at baseline were more likely to become part of an extended family household than men with similar levels of cognitive impairment. A similar pattern emerges for the oldest Mexican-American women. Spousal loss increases the likelihood of living alone for women in the United States regardless of dementia. Although dementia elevates the risk of mortality for men living alone in the United States, in both countries, women in their 90s who lived alone with dementia had a lower risk of mortality relative to men.

DISCUSSION AND IMPLICATIONS

Longer life spans increase the risk of living alone with dementia in both countries, especially for women. Older individuals in both countries face financial hardships. Mexicans have limited formal options in dementia care. Mexican Americans with dementia continue to live alone despite low income although, unlike the Mexicans, they have access to Medicaid long-term care. For Mexico and the United States, the growing number of older individuals with dementia represents a growing public health concern.

Incorporating Intersectionality as a Framework for Equity-Minded Tobacco Control Research: A Call for Collective Action Toward a Paradigm Shift

INTRODUCTION

To eliminate tobacco-related disparities, tobacco control research would benefit from a paradigm shift. Intersectionality, a framework pioneered by Kimberlé Crenshaw in late 1980s, has the potential to improve our understanding of why and how certain social groups are disproportionately harmed by commercial tobacco use, and improve our ability to address persistent tobacco-related health disparities.

AIMS AND METHODS

In this commentary, we outline the rationale and recommendations for incorporating intersectionality into equity-minded tobacco control research. These recommendations arose from intersectionality webinars organized by the Health Disparities (now Health Equity) Network of the Society for Research on Nicotine & Tobacco (SRNT) in 2019 and 2020.

RESULTS

Specifically, we propose that eliminating tobacco-related disparities through intersectionality-informed research requires a multilevel, multipronged approach. We summarize priority actions for the tobacco control research field to achieve health equity through the intersectionality framework including acknowledging that structural factors, racism and power dynamics shape lived experiences, integrating critical theoretical frameworks and intersectionality scholarship into research questions, and embracing collaborative community-based approaches at every level of the research process.

CONCLUSIONS

Through these actions, our field can take concrete steps to fundamentally improve our approach to conducting research to achieve health equity.

IMPLICATIONS

Intersectionality is a valuable tool to align our field with our pursuit of health equity. The recommendations aim to improve methods of equity-focused tobacco control, prompt ongoing dialogue on the utility of this tool, and shift paradigms in how the research process is conducted at every level among stakeholders, including researchers, journal editors and reviewers, funders, practitioners, and policy makers.

Spousal Education and Cognitive Functioning in Later Life

OBJECTIVES

Numerous studies have documented the relationship between education and cognitive functioning at the individual level. Yet few studies have examined whether a spouse's education spills over to influence the other spouse's cognitive functioning. This study, therefore, investigates the association between spousal education and cognitive functioning, the pathways that may account for this association, and gender differences in this association.

METHOD

Growth curve models were analyzed by using longitudinal couple data from the Health and Retirement Study (N = 5,846 individuals).

RESULTS

More years of spousal education are associated with higher level of cognitive functioning at age 65 (γ000 = 0.0532, 95% confidence interval [CI] = 0.0163-0.0901) and slower decline in cognitive functioning in later adulthood (γ100 = 0.0054, 95% CI = 0.0026-0.0082). The positive association between spousal education and the level of cognitive functioning at age 65 is fully explained by economic resources. The association of spousal education with the rate of change in cognitive functioning decreases but remains significant after controlling for economic resources and health behaviors (γ100 = 0.0043, 95% CI = 0.0014-0.0072). The association between spousal education and cognitive functioning is similar for men and women.

DISCUSSION

Findings suggest that more years of spousal education may slow decline in cognitive functioning for men and women in later life.