Poster Session
Aging in Puerto Rico: An Interdisciplinary Intervention Model for a Better Future View Digital Media
Poster Session Alex Casiano
Recent census data indicates that 25% of the population of Puerto Rico is 65 years of age or older. The massive migration that was accentuated after hurricanes Irma and María in 2017 and the earthquakes of 2020, has had social and emotional consequences in the Puerto Rican family, with older adults being among the most affected. Older adults in Puerto Rico suffer from loneliness, chronic diseases and multimorbidity, conditions of poverty, high rates of depression and mental health disorders, and an increase in cases of suicide – specifically in the group of 85 years or older. Fulfilling its social role and the mission statement of the Inter American University of Puerto Rico of commitment to serving its peoples and communities, the Metropolitan Campus created InterACTIVO, a Center for Supervised Educational and Recreational Activities. InterActivo is not a regular day center. The added value of the program lies in the integration of educational activities offered by faculty and students from academic programs in areas such as music, arts, social work, and education, among others. InterActivo is bridging the gap between theory and practice in these disciplines and offers both faculty and students a chance to contribute to the solution of a real social problem. In this presentation, I will discuss the development and implementation of the service program, as well as the results of the first evaluation. It is hoped that the service model will reduce feelings of isolation and depression among participants as well as increase social participation and connectedness.
It’s Never Too Late: Wealth Accumulation Among Elderly Diabetic Hispanics (Online Only) View Digital Media
Poster Session Mónica García-Pérez
Do health shocks affect Hispanics' wealth more compared to whites? If so, what are the implications and factors components behind these potential differences? Racial and ethnic disparities in health and wealth have regularly been studied separately; we do not yet understand their interrelationships, even though Hispanics have a higher life expectancy than whites or Blacks. Using the RAND-HRS (2010-2018), this research evaluates the longitudinal relationship between health and wealth components among elderly diabetic Hispanics compared to non-Hispanic elderly diabetic populations. It also separates the analysis between US-born Hispanics and immigrant Hispanics. It further uses Census Divisions to account for differences within these Hispanic groups and levels of access to public resources. Preliminary results find a negative relationship between previous newly diagnosed diabetes on net wealth and a decrease of liquid assets for most currently diagnosed diabetes among Hispanics compared to non-Hispanics, with particular attention to immigrant Hispanics in Census Divisions with more barriers to access to public services, and after accounting for several individual and household level factors, and individual-level fixed effects. Given the degenerative health component connected to diabetes and its complications, this paper also looks at the disabilities traditionally associated with diabetic patients with complications. Comparably, a reduction of Fine Motor skills has a contemporary relationship with earnings and debts. Evidence in this paper also shows the importance of early diagnosis and preventive care, which would be translated into access to affordable care for everyone regardless of their background. Some evidence about the take-up rates of public programs among Hispanics (US-born and immigrants) is provided to shed some light on the relevance of access to safety net programs and the risk of extreme poverty in these populations. Overall, this paper contributes to the discussion of the Hispanic Health Paradox and the puzzling result that a longer life expectancy among Hispanics correlates with a higher prevalence rate of chronic conditions among this group. These results also highlight how policies
Underutilization of Respite Care Services: Poor Health Outcomes among Latinx Family Caregivers View Digital Media
Poster Session Babatope Ogunjesa
American Society on Aging stated that Latinx family caregivers have a high cultural commitment (75%) to caregiving which often cause them to disregard their health, thus increasing their risk of poor health outcomes. Studies have underscored adverse health effects of caregiving provision, especially when care recipients have dementia-related conditions. To alleviate the detrimental impact of caregiving, respite care services provide an opportunity for caregivers to have a break from caregiving roles. However, lack of access or underutilization of respite care services remains prevalent among Latinx family caregivers. Objective: Examine health outcomes associated with utilization of respite care services by race/ethnicity. Methods: Using the Long-Term Caregiving survey data conducted by the AP-NORC Center for Public Affairs Research (N=1,024), we conducted logistic regression analysis adjusting for sex and household income relative to the utilization of respite care services by the caregivers of Latinx in contrast to the Whites caregivers. Results: Among caregivers that reported not utilizing respite care services, Latinx were less likely to have “excellent” overall health outcomes than their White counterparts (OR= 0.616, 95% CI: 0.390 - 0.972). African Americans (OR= 0.746, 95% CI: 0.421 - 1.321) and other racial groups had similar results regarding overall health outcomes when compared to the Whites (OR= 0.706, 95% CI: 0.388 - 1.283). No racial disparities relative to the overall health outcomes of caregivers were found among caregivers reporting using respite care services. Additional results include the association between low household income levels and poorer overall health outcomes. Sex showed no significant associations. Conclusion: Lack of utilization of respite care services is adversely affecting the overall health of Latinx family caregivers. Findings support efforts to increase access and utilization of respite care services among Latinx caregivers for health benefits.
Assigning Lifetime Occupation Domains for Older Mexicans: MHAS-O*NET Linkage Protocol View Digital Media
Poster Session Chih-Ying Li, Mariela Gutierrez
Longitudinal studies have documented declines in the prevalence of dementia in high-income countries. Such declines have been associated with increases in educational attainment and proper chronic disease management across successive generations of old adults. Most evidence about cognitive reserve and preserving cognitive function through mental engagement comes from high-income or developed countries. Similar research using longitudinal data in Low-Middle-Income countries (LMIC) can provide insights on factors potentially mediating cognitive declines of older adults from understudied groups. In LMICs with large informal labor markets, older adults with jobs in the informal sector may be able to stay mentally engaged longer over their life compared to high-income or developed countries. To investigate if this assumption holds true, we proposed to develop a cognitive index to examine cognitively stimulating activities based on occupations, and evaluate if cognitive demands associated with higher levels of cognitive functioning in later life. We identified 130 unique occupation codes from 2012 Mexican Health Aging Study (MHAS) and selected one to four cases per code for a total of 440 observations as a representative sub-sample for matching. Three raters with graduate degrees independently selected corresponding Occupational Information Network (O*NET) occupation codes with 130 MHAS occupation codes. The matching is guided by MHAS occupation descriptions, MHAS open-ended questions and O*NET job descriptions. We used Delphi method to achieve matching agreements. Each successful 1:1 matching requires at least two raters came out with the same codes or reaches a consensus after a group discussion. We generated the end product of 1:1 matching between MHAS and O*NET occupation codes. We will use this 1:1 matching between MHAS and O*NET to develop our occupation-based cognitive demand index and further use this index to examine longitudinal cognitive change in MHAS.
Childhood Health as a Determinant of Cognitive Health in Adulthood: Results from the Mexican Health and Aging Study View Digital Media
Poster Session Lesley Guarena
Objective: Early childhood factors such as education and socioeconomic status are known to influence cognitive outcomes later in adulthood. Childhood health may be especially important late life cognition in low and middle income countries (LMIC’s) where childhood health conditions are more common. In this study, we analyzed the effects of early childhood health on cognitive status of older adults using a nationally representative Mexican sample. Methods: We used data from the 2012 Mexican Health and Aging Study (MHAS) (N=14,575; age: M=64.34; 58% female; education: M=5.65). To assess childhood health, participants were asked if before age 10, they had ever been diagnosed with a chronic health condition including typhoid fever, a serious blow to head, tuberculosis, rheumatic fever, polio, and other (hypertension, diabetes, cancer, respiratory illness, heart attack, or stroke). Participants underwent a comprehensive cognitive battery, from which scores were used to assess dementia. Results: Adjusting for sex, age and education, logistic regression models on dementia revealed that a serious blow to the head before age 10 was associated with higher odds of dementia (OR=1.7, p<0.001). Similarly, participants with other chronic childhood health conditions (hypertension, diabetes, cancer, respiratory illness, heart attack or stroke) were more likely to have dementia later in life (OR=1.5, p<0.001). All other childhood health conditions assessed (typhoid fever, tuberculosis, rheumatic fever, and polio) were not significantly associated with odds of dementia later in life (ps>.05). Conclusions: Adverse childhood health conditions including blows to the head and hypertension, diabetes, cancer, respiratory illness, heart attack or stroke were associated with greater odds of dementia later in life. Patient life childhood health conditions should be better understood as risk factors of late life dementia.
Narratives for Resilience: Two Case Studies of Institutionalized Elders in Mexico View Digital Media
Poster Session T.L. Brink
Narratives are the stories we tell ourselves (and others) in order to understand and justify what we think, feel, and do (Brink & Karalun, 2022). Some narratives are dead-ends that leave the individual stuck in a role of victim, while other narratives promote willpower, wisdom and resilience. The goal of cognitive psychotherapy is to change dysfunctional narratives to healthy ones. Narratives are an important factor in maintaining mental health even in later life, and even with the onset of dementia (Buggins, Clarke, Wolverson, 2021; Clark, Burbank, Greene, Riebe, 2018; Li, 2022). Two case studies are presented of residents of a Mexican geriatric hospital and how their unique narratives supported either victimhood (Mrs. A) or resilience (Mr. B).
Acculturation, Social Determinants of Health, and Cognitive Performance of Latinx Older Adults View Digital Media
Poster Session Rifat Binte Alam
The Hispanic/Latinx community in the U.S. is very diverse based on their acculturation levels and present differences in cognitive performance (CP). However, social determinants related to the CP differences across acculturation levels are understudied. This study examines the effects of sociodemographic and socially patterned health behaviors as social determinants of Latinx differences in CP among older adults. Participants included 616 Latinx individuals from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 2011-2014 [Mage= 67.15 years]. CP was assessed with Digit Symbol Substitution Test. Approximately 48% of the Latinx participants were from Mexico and were grouped by language as a measure of acculturation (only/mostly Spanish (low acculturated), Spanish and English/bilingual, only/mostly English (high acculturated)). Adjusted linear regression evaluated the link among acculturation levels and sociodemographic and health behavioral factors with CP. Three models were created for adjusted linear regression. Model 1 examined the association between acculturation and CP controlled for- age, sex, country of origin, citizenship status and marital status. Results indicated poorer CP among only/mostly Spanish-speakers and bilinguals compared to only/mostly English-speakers (p<.001). To create Model 2, sociodemographic factors were introduced in Model 1 and lower education, lower income, and no housing ownership were found significantly associated with poorer CP. β-estimate of CP of both only/mostly Spanish-speakers and bilinguals decreased (from -14.17 to -6.94 and -8.52 to - 3.33, respectively) compared to only/mostly English-speakers but remained only significant for only/mostly Spanish-speakers (p<.001). Model 3 examined if Latinx within-group differences can be further explained by differences in physical activity, smoking, alcohol use and BMI. Although none of these health behaviors were found significantly associated, β-estimate of CP further decreased (-6.94 to -6.03) among only/mostly Spanish-speakers (p<.001). In conclusion, the difference in CP among the low acculturated Latinx compared to the high acculturated subgroup was partly mediated by sociodemographic inequalities.
Montreal Cognitive Assessment Memory Index Score (MOCA-MIS) as an Indicator of Cognitive Decline (Online Only) View Digital Media
Poster Session Dulce Espino, Najla Mariel Ruiz Ortiz
The Montreal Cognitive Assessment (MoCA) is a screening tool highly sensitive to cognitive impairment in the elderly population. It evaluates multiple domains including the delayed memory, which allows calculate a Memory Index Score (MoCA-MIS), that may be a valuable tool to differentiate amnesic mild cognitive impairment from normal cognition in the elderly. The objective of this investigation was to analyze the relationship between the total scores for the MoCA (MoCA-TS) and the MoCA-MIS in Mexican elderly adults with cognitive impairment. Data of 58 subjects, 40 women and 18 men, were analyzed with a mean age of 75.7 (DE=7.5) and a mean education of 8 years (DE=5). The assessment tools were the MoCA, and additionally the Geriatric depression scale (GDS), and the General anxiety disorder 7 (GAD-7). The MoCA-TS correlated significantly with the MoCA-MIS (r= 0.663, p<0.01), indicating that the lower the MoCA-TS, the lower the MoCA-MIS. Age was significantly correlated with the MoCA-TS (r= -0.670, p<0.01), showing that age is a predictor of MoCA performance and level of impairment. No significant correlation was found between the total scores of the GDS and GAD-7 with the MoCA-TS, MoCA-MIS, or age. The results indicate that the MoCA-MIS could be taken as an indicator of possible cognitive decline in patients who, due to other factors, don’t reflect it in the total scores, guiding professionals to carry out a further evaluation. Although high levels of depression and anxiety have been associated with greater cognitive impairment in elderly people, in clinical practice the qualitative observations do not always correlate with the quantitative results of the tests used, this could be due to an incorrect administration of the instruments or poor comprehension by patients.
The Contribution of Acculturation, Native Cultural Resources, and Loneliness to Cognitive Impairment in older Hispanic Immigrants View Digital Media
Poster Session Jeung Hyun Kim
My study ascertains to what extent acculturation and native cultural values and resources shape how loneliness and cognitive outcomes of cultural adjustment develop in older Mexican American immigrants. The current study employs a sociocultural approach to discover how individual and community influences, such as practices of familism and neighborhood engagement, can shape older immigrants’ health outcomes. It introduces typological analyses to build a multicultural model of immigrant wellbeing. This study uses data from the Hispanic Established Population for the Epidemiological Study of the Elderly (wave 7), a survey of older Mexican Americans in the southwestern U.S. Among over 400 older Mexican immigrants, the current study focuses on vulnerabilities in the health outcomes of later-life immigrants who tend to be poorly acculturated and isolated. [Analysis in progress] Results are expected to show that the lack of native cultural resources, in conjunction with low acculturation, is likely to be associated with greater loneliness, which can also be a mediator of cognitive impairment. Among older immigrants, those who arrived in the U.S. at an earlier age are better adjusted in the mainstream society and less likely to suffer from loneliness and cognitive impairment compared to those who arrived at later-life. Discussion centers on how acculturation emerges under different native cultural contexts and how various cultural readjustment processes can create diverse pathways to older immigrants’ psychological and cognitive health outcomes. The proposed study advances our theoretical understanding of the significance of native cultural resources on wellbeing among the poorly acculturated and has policy implications in terms of the development of culturally sensitive intervention programs to promote wellbeing of the Mexican older immigrants.
Addressing the Need for Alzheimer’s Disease Tracking in Mexico’s Emergency Medical Services System View Digital Media
Poster Session Esmeralda Melgoza
Background: On November 2014, Mexican President Enrique Peña Nieto announced the establishment of a single national emergency number with the purpose of standardizing the collection of emergency medical service (EMS) data, reducing response times, and improving quality of care (CNSP, 2016). From 2014 to 2016, the Mexican Executive Cabinet’s Secretariat of Public Security (SESNSP) was tasked with creating a standardized data dictionary, and establishing protocols to triage EMS calls (CNIE, 2017). The data dictionary was developed to include the most common types of emergencies affecting the Mexican population (CNI, 2022). This is the first study to examine the collection of Alzheimer’s disease data in Mexico’s EMS system. Alzheimer’s disease is a leading cause of morbidity and mortality in Mexico, especially among persons aged 65 years and older (IHME, 2019). Tracking the use of EMS by persons with Alzheimer’s disease is an important first step in examining the medical care received by this population in the prehospital care setting. Methods: In this study, we analyzed the Mexican EMS data dictionary to check for inclusion of dementia-related conditions, including Alzheimer’s disease. Results: The data dictionary included 7 types of calls (medical, civil protection, security, public services, inadmissible, assistance, and other services), and 282 pre-determined emergency codes. Of the 282 pre-determined emergency codes, 60 were medical codes. The 60 medical emergency codes were organized into three main categories: accidents, trauma, and clinical. Dementia-related conditions, including Alzheimer’s disease, were not included as pre-determined emergency codes in Mexico’s EMS data dictionary. Conclusion: Future versions of Mexico’s EMS data dictionary should include codes for dementia-related conditions, including Alzheimer’s disease. The collection of EMS data for persons with Alzheimer’s disease is the first step in ensuring that this population receives the best quality of care regardless of their entry point into Mexico’s healthcare system.
MEDSReM©: A technology innovation to improve hypertension medication adherence for older adults – learning the needs of Latino communities in the Americas View Digital Media
Poster Session Renato F. L. Azevedo
Hypertension is the most prevalent treatable risk factor for cardiovascular diseases. Nevertheless, it is the leading cause of death and disability in the Americas. Although hypertension medications are highly effective in controlling blood pressure and preventing deleterious effects on the heart, kidneys, eyes, and brain, adherence to hypertension medications is low at only around 50%. Technology interventions may provide easy access to effective and sustained strategies to improve hypertension medication adherence as increasing numbers of older adults and Latinos are using smartphones. Medication Education, Decision Support, Reminding, and Monitoring System (MEDSReM©) is a theory-based, integrated digital therapeutic system comprising a mobile app and a companion website that supports hypertension medication adherence and blood pressure management for older adults. An interdisciplinary team representing pharmacy, nursing, cognitive aging, community health, gerontechnology, human factors, and health technology collaborated to develop the MEDSReM© system. For broader reach and impact, we need to understand the user needs of diverse populations in the Americas, to develop and customize effective health technology interventions for older adults in Latino communities. In Latin America and the Caribbean regions, only 35% of women and 23% of men with hypertension diagnosis have controlled blood pressure. Moreover, in the U.S. disparities in healthcare are often stem from limited English proficiency, socioeconomic, and cultural barriers in Latinos receiving care in the U.S. With an estimated 85% of Latino adults using the internet and smartphones, health technology solutions may overcome identified barriers including providing health communications in Spanish. By learning the needs of the Latino communities in the Americas, and their motivators and barriers to adopt health technologies to manage hypertension, we can advance the design of MEDSReM© to incorporate Spanish and culturally competent features on adherence and blood pressure management and test new functionalities.
Designing a Videoconferencing Platform to Support Social Engagement for Older Adults View Digital Media
Poster Session George Mois
Loneliness is a societal challenge that affects older adults’ wellbeing and quality of life. Furthermore, the social and physiological effects of aging can further disturb the ability to maintain, support, and make social relationships. With an increasing older adult population, many communities across the world are often unprepared to meet the diverse social needs of older adults. Leveraging existing tools and developing new resources to meet the social needs of individuals aging in Mexico and Latino Communities in the United States, is essential in supporting resiliency across the aging process. Communication technology, more specifically videoconferencing, creates new opportunities to facilitate social engagement. However, market ready videoconferencing platforms are often not designed to meet the needs and preferences of an older adult user. Furthermore, videoconferencing technologies are merely tools and not solutions to the experience of loneliness. Understanding how to leverage videoconferencing to deliver social engagement interventions is an essential step towards bridging the resource gap. Our interdisciplinary team has developed a web-based videoconferencing platform called OneClick.chat to support and meet the needs of older adults, both with and without mild cognitive impairment. The OneClick.chat platform is optimized to minimize usability challenges (e.g., system requirements) and enhance ease of use (e.g., user interface). We are currently testing an intervention that leverages OneClick.chat to facilitate opportunities for social engagement through fun and engaging online social events. The intervention uses OneClick.chat to organize (e.g., event registration and reminders) and implement (e.g., event hosting) the online social events. Through our research we aim to understand the potential of OneClick.chat to serve as a tool to deliver social engagement interventions and to support and meet the diverse needs of older adults. We will provide an overview of the platform and its potential for broader use with the goal of exploring opportunities for collaboration.
Exploring the Interconnections Between Hypertension and Depression, and Cognitive Function Among Hispanics
Poster Session Mariola Acosta
Objectives: Cardiovascular risk factors and depression increase with age and are related with poorer cognitive performance, cognitive decline, and increased risk for mild cognitive impairment and dementia. Appropriate control of hypertension and depression treatment can potentially stave off the onset of cognitive deficits and improve quality of life. However, increasing evidence links negative affective states to compromised physical health and depression may relate with poorer adherence to medical and lifestyle interventions to manage chronic conditions. This study aims to investigate the effects of hypertension and depression on cognition among Hispanics, and whether hypertension and depression have an additive or interactive effect on cognitive function. Method: Data come from the 2018 RAND Health and Retirement Study. We included Hispanics age 50 and older (n= 3, 224). Hypertension is measured as doctor diagnosed high blood pressure. Depression is ascertained using the 8-item Center for Epidemiologic Studies Depression Scale (CES-D). Cognition is assessed by the tests from the Mini-Mental Status Examination (MMSE) included in the HRS. We conducted linear regressions to model associations between hypertension, depression, and cognition and to test whether depression moderates the effect of hypertension on cognition adjusting for education, gender, age, and nativity. Results: The regression model showed a negative association between hypertension, depression and cognition. This negative association suggests that Hispanics with greater cognitive scores were less likely to have hypertension or be depressed. However, a significant moderating effect of hypertension on cognition with the presence of depression was not supported. Conclusion: Findings suggest a negative association between hypertension and depression on cognition among Hispanics. However, our results did not support our hypothesis that depression would modify the association between hypertension and cognition. In addition to current mental health status, researchers should consider an individual’s history of depression, evaluate all cognitive domains, and include other modifiable risk factors.
Cognitive Life Expectancy by Educational Attainment in Mexican Adults aged 60 and Older View Digital Media
Poster Session Jose Cabrero Castro
Background Cognitive impairment is associated with decreased life expectancy. Among socioeconomic factors, low education has been related to cognitive impairment and mortality. The objective of this study is to estimate cognitively healthy life expectancy (CHLE), life expectancy with cognitive impairment (CILE), and life expectancy with dementia (DLE), in Mexican adults aged 60 and older stratified by educational attainment. Methods Data came from Waves 1 (2001) to 5 (2018) of the Mexican Health and Aging Study. The final sample included all individuals aged 60 and older who were interviewed between 2001 and 2018 (n=15,284). Educational attainment was categorized as no formal education (n=3,642), incomplete elementary (n=5,073), complete elementary (n=3,078), middle school (n=1,102), medium-superior (high school, technical school, teaching school; n=1,438), and superior (professional or graduate degree; n=951). Participants were classified as cognitively healthy, cognitively impaired, and dementia. Life expectancy was estimated using a multistate life table analysis. Results Total life expectancy by educational attainment was 22.7 years (no formal education), 22.6 years (incomplete elementary), 22.9 (complete elementary), 23.6 (middle school), 24.7 years (medium-superior), and 24.4 years (superior). CHLE ranged from 17.6 years for individuals with no formal education to 23 years for individuals with a medium-superior level of education. CILE and DLE decreased with greater educational attainment. The largest changes in CILE were between individuals with no formal education (2.3 years), incomplete elementary (1.4 years), middle school (0.9 years), and medium-superior (0.5 years). Dementia life expectancy ranged from 2.8 years for individuals with formal education to 0.9 years for those with a superior level of education. Conclusion Older adults in Mexico with higher education live more years cognitively healthy and fewer years with cognitive impairment and dementia. Future research should assess the role of occupation and other factors related to educational attainment in late-life cognitive reserve.
