Pain and incident cognitive impairment in very old Mexican American adults.

BACKGROUND: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. METHODS: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). RESULTS: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. CONCLUSIONS: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.

Diabetes Complications and Pain Among Mexican Americans Aged 80 and Older.

Background and Objectives: Diabetes is common among Hispanic older adults; however, the association between diabetic complications and pain has not been widely studied in this population. Our objective was to examine the association between diabetes complications and pain over 6 years among Mexican Americans aged 80 years and older. Research Design and Methods: We used data from Waves 7 to 9 (2010-2016) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (n = 853). Participants were categorized as having no diabetes, diabetes without complications, and diabetes with complications. Pain was defined as reporting pain when standing or walking (pain on weight-bearing) and having pain that limited daily activities (pain interference). We used generalized estimating equations to estimate the odds of pain over 6 years as a function of diabetes status controlling for socioeconomic and health characteristics. Results: At baseline, the mean age was 85.7 (standard deviation = 3.9) years, 65.2% female, 68.5% had no diabetes, 14.7% had diabetes without complications, and 16.9% had diabetes with complications. Those with diabetes without complications had lower odds of reporting pain on weight-bearing and pain interference, compared to those with no diabetes. Among those reporting diabetes (n = 269), those with complications had higher odds of pain on weight-bearing and pain interference, compared to those without complications. Those with both micro and macro complications had over 2 times the odds of pain, compared to those having no complications. Discussion and Implications: The lower burden of pain in those with diabetes but no complications may reflect optimal management of diabetes. Routine screening and treatment of pain in patients with diabetes complications can mitigate excess disability and increase the quality of life for patients with diabetes.

The impact of insomnia symptoms on obesity among Mexicans aged 50 and older.

OBJECTIVE: To examine the association between insomnia and obesity in Mexican adults aged 50 and older. MATERIALS AND METHODS: We used data from the Mexican Health and Aging Study (2015-2018). Self-reported insomnia was measured using the modified insomnia severity index with scores ranging from zero to six. Obesity was categorized using body mass index (BMI ≥ 30 kg/m2). We used generalized estimating equations to assess the association between insomnia and obesity over three years. RESULTS: Insomnia was associated with obesity (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.01,1.11), among those with no obesity at baseline. Among those with obesity, insomnia was not associated with changes in BMI. Lastly, obesity was not associated with changes in insomnia symptoms. CONCLUSION: This work highlights the association between insomnia and obesity among older Mexican adults and demonstrates the importance of further studies on the effects of insomnia within this population.

Social and Leisure Activities Predict Transitions in Cognitive Functioning in Older Mexican Adults: A Latent Transition Analysis of the Mexican Health and Aging Study.

OBJECTIVES: Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incidence of transitions between these states, and investigate how social and leisure activities were associated with state transitions over a 6-year period in Mexican adults aged 60 and older. METHODS: We performed latent transition analyses to identify distinct cognitive statuses in the 2012 and 2018 waves of the Mexican Health and Aging Study (N = 9,091). We examined the transition probabilities between these states and their associations with social and leisure activities. RESULTS: We identified 4 cognitive statuses at baseline: normal cognition (43%), temporal disorientation (30%), perceptual-motor function impairment (7%), and learning and memory impairment (20%). Various social and leisure activities were associated with reduced odds of death and disadvantageous cognitive transitions, as well as increased odds of beneficial transitions. DISCUSSION: Mapping the effects of popular social and leisure activities onto common patterns in cognitive functioning may inform the development of more enjoyable and effective health-protective behavioral interventions.

Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage.

OBJECTIVES: Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico. METHODS: Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression. RESULTS: Among those in the lowest quartile of expected cognition, a more internal LOC (ß = 0.32 [men] and ß = 0.44 [women]) and conscientious personality (ß = 0.39 [men] and ß = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender. DISCUSSION: Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.

Perceptions of Research Participation among a Sample of Florida Residents Aged 50 and Over Reporting Dementia.

As the population ages, the prevalence of dementia will increase. More research is needed; however, low rates of research participation, especially by older adults, hinder progress. Data came from HealthStreet, a University of Florida community engagement program in which community health workers assess community members for their health conditions. Adults 50 and over were included in these analyses; their perceptions of health research studies were assessed. Our sample had an average age of 60.5 years and 4.3% reported dementia (n = 4,881). Overall, older adults reported a high willingness to participate in research. Individuals who reported dementia had 0.64 times the odds of reporting willingness to participate in a research study that required an overnight stay, compared to those who did not report dementia (95% CI: 0.45-0.89). We report on willingness to participate in research in a more granular basis than has been previously done. Community members reporting dementia, compared to those without, were as or more likely to desire future participation in health research. However, barriers to participation remain and must be addressed.

Increasing Pain Interference Is Associated With Cognitive Decline Over Four Years Among Older Puerto Rican Adults.

BACKGROUND: Pain is associated with cognitive decline among older adults, but few studies have investigated bidirectional associations between pain and cognitive decline, especially in older Hispanic populations. Our objective was to assess the bidirectional association between pain interference and cognitive performance in a sample of older Puerto Rican adults. METHODS: Data came from baseline and 4-year follow-up of the Puerto Rican Elderly: Health Conditions Study, a longitudinal representative study of Puerto Rican older adults aged 60 and older. Pain and cognitive performance were assessed at each wave. A pain interference variable was created using the sum of pain status (yes/no) and pain interference (yes/no; range 0-2). Global cognitive performance was assessed with the Mini-Mental Cabán. We tested bidirectional associations using a path model with concurrent and cross-lagged paths between pain and cognitive performance, adjusting for sociodemographic and health factors (n = 2 349). RESULTS: Baseline pain interference was not associated with baseline cognitive performance (p = .636) or with cognitive performance at follow-up (p = .594). However, increased pain interference at follow-up was associated with greater cognitive decline at follow-up (ß = -0.07, standard error [SE] = 0.02, p = .003). Greater baseline cognitive performance was associated with lower pain interference at follow-up (ß = -0.07, SE = 0.02, p = .007). CONCLUSIONS: These findings highlight the importance of worsening pain interference as a potentially modifiable risk factor for cognitive decline, as pain treatment options exist. Additionally, better baseline cognitive performance may be a protective factor for pain, providing further evidence of the dynamic relationship between pain and cognitive performance.

The pain and depressive symptoms cascade: A bidirectional analysis of the Mexican Health and Aging Study 2012-2015.

OBJECTIVES: The association of pain and depression has not been evaluated in low- and middle-income countries, which have a disproportionate burden of pain compared to high-income countries. METHODS: Using data from the Mexican Health and Aging Study (baseline, 2012; follow-up, 2015), we examined the bidirectional relationship between pain and depressive symptoms and identified shared predictors among community-dwelling participants ≥60 years (n = 7237). Multivariable logistic regressions models evaluated the association between (1) baseline pain and incident elevated depressive symptoms and (2) baseline depressive symptoms and incident pain, adjusting for demographic, socioeconomic, and health-related factors. Models included inverse probability weights and evaluated interactions by gender. RESULTS: Participants (55.0% women) were on average 69.1 years old. Over half reported no pain (60.7%) and low/no depressive symptoms (67.9%) in 2012, of which, 20.2% reported elevated depressive symptoms and 25.3% self-reported pain in 2015. Baseline pain was associated with higher odds of incident elevated depressive symptoms (aOR 1.65; 95% CI, 1.41-1.93). Baseline elevated depressive symptoms were associated with higher odds of developing pain (aOR 1.57; 95% CI, 1.32-1.87). Age, gender, self-rated health, and activity of daily living limitations were shared risk factors for pain and elevated depressive symptomatology onset. Although the incidence of elevated depressive symptoms and pain was higher in women, there were no statistically significant interactions. CONCLUSIONS: Older adults with pain or depression may be at risk for developing the other. These shared predictors could help identify patients in clinical settings, where pain and depression are often overlooked, reducing the cascading risk of this comorbidity.

Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective.

Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.

Multimorbidity Is Associated With Pain Over 6 Years Among Community-Dwelling Mexican Americans Aged 80 and Older.

Introduction: Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is associated with decreased quality of life, greater disability, and increased mortality. Yet, the association of multimorbidity with pain, another significant contributor to decreased quality of life, has not been widely studied. This is especially understudied among very old (aged ≥ 80) Mexican Americans, a fast-growing segment of the United States (US) population. Objective: To assess the association of multimorbidity with pain in very old Mexican Americans, over six years of follow-up. Methods: We used data from Waves 7 (2010/2011) to 9 (2015/2016) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly, a longitudinal study of older Mexican Americans residing in the Southwestern US. Multimorbidity was defined as reporting two or more chronic health conditions. Pain was defined as (1) pain on weight-bearing, (2) pain in back, hips, knees, ankles/feet, legs, entire body, or two or more locations, and (3) pain that limits daily activities. We use generalized estimation equations to estimate the odds ratio of pain as a function of multimorbidity over 6 years. Results: At baseline (n = 841), 77.3% of participants had multimorbidity. Those with multimorbidity had greater odds [2.27, 95% confidence interval (CI): 1.74, 2.95] of reporting pain on weight-bearing over time, compared to those without multimorbidity. Also, those with multimorbidity had 2.12 times the odds of reporting pain that limited their daily activities (95% CI: 1.61, 2.78) compared to those without multimorbidity. Lastly, those with multimorbidity had higher odds of reporting pain in their back, knee, ankles/feet, legs, hips, entire body, or two or more locations, compared to those without multimorbidity. Conclusions: Those with multimorbidity consistently had higher odds of all types of pain, highlighting the need for early management of pain among those with multiple chronic conditions and complex health needs. This is especially important among very old Mexican Americans, who have a high burden of chronic health conditions.

Gender differences in activity-limiting pain trajectories over a 17-year period in the Mexican Health and Aging Study.

ABSTRACT: Pain increases with age, disproportionately affects women, and is a major contributor to decreased quality of life. Because pain is dynamic, trajectories are important to consider. Few studies have examined longitudinal trajectories of pain, by gender, in Mexico. We used data from 5 waves (over 2001-2018) of the Mexican Health and Aging Study, a nationally representative sample of Mexicans aged 50 years and older. Pain was categorized as self-reported frequent pain that makes it difficult to do usual activities. Latent class mixture models were used to create pain trajectories (n = 9824). The sample was majority female (56.15%), with a mean age of 61.72 years. We identified 2 pain trajectories: low-stable (81.88%) and moderate-increasing (18.12%). Women had 1.75 times the odds of being in the moderate-increasing group compared with men (95% confidence interval= 1.41, 2.17). In addition, having zero years of education was associated with higher odds of being in the moderate-increasing group, compared with having any years of education. Fair/poor self-rated health, obesity, arthritis, elevated depressive symptoms, and falls were positively associated with pain for both trajectory groups. Being married was positively associated with pain in the low-stable group. Insurance status was negatively associated with pain in the low-stable group, but positively associated with pain in the moderate-increasing group. We identified 2 trajectories of activity-limiting pain, among older Mexican adults (50+) over 17 years of follow-up. Understanding gender differences in pain trajectories in later life and the factors associated with trajectory development is crucial to improve quality of life, especially in vulnerable populations.

Effects of diabetes and obesity on cognitive impairment and mortality in older mexicans.

BACKGROUND: Diabetes is a risk factor for dementia and mortality, while obesity later in life is associated with a reduced risk. Their co-occurrence, diabesity, is common, but its association with dementia and mortality is unclear. METHODS: Using data from the Mexican Health and Aging Study, we used multinomial logistic regression to examine the associations of diabetes and body mass index (BMI), and diabesity, in 2012, with cognitive impairment and mortality in 2018, among participants aged ≥60 years with normal cognition at baseline (n = 7,885). RESULTS: Diabetes was associated with cognitive impairment, compared to not having diabetes (RRR=1.83, 95% CI=1.48-2.26). BMI was not associated with cognitive impairment. Regarding mortality, diabetes was associated with an increased risk (RRR=2.28, 95% CI=1.98-2.63) and being overweight or having obesity was associated with a reduced risk (RRR=0.74, 95% CI=0.65-0.86; RRR=0.79, 95% CI= 0.66-0.95). When BMI and diabetes were combined, having diabetes only (RRR=2.01, 95% CI=1.40-2.87), being overweight with diabetes (RRR=1.42, 95% CI=1.02-1.97) or having diabesity (RRR=1.50, 95% CI=1.08-2.06) were associated with cognitive impairment, compared to having a normal BMI without diabetes. Diabetes, regardless of BMI, was associated with an increased risk of mortality, while being overweight or having obesity was associated with a reduced risk of mortality. CONCLUSIONS: With the increase in the prevalence of obesity and diabetes among Mexicans, it is important to understand how these conditions and their co-occurrence impact cognitive impairment and mortality. Among older Mexicans, diabesity is associated with 6-year mortality and cognitive impairment onset, likely driven by the effect of diabetes.

Trends in the Use of Benzodiazepines, Z-Hypnotics, and Serotonergic Drugs Among US Women and Men Before and During the COVID-19 Pandemic.

Importance: The ongoing COVID-19 pandemic and associated mitigation measures have disrupted access to psychiatric medications, particularly for women. Objective: To assess the sex differences in trends in the prescribing of benzodiazepines, Z-hypnotics and serotonergic (selective serotonin reuptake inhibitors [SSRIs] and serotonin and norepinephrine reuptake inhibitors [SNRIs]), which are commonly prescribed for anxiety, insomnia, and depression. Design, Setting, and Participants: This cohort study used data from Clinformatics Data Mart, one of the largest commercial health insurance databases in the US. Enrollees 18 years or older were required to have complete enrollment in a given month during our study period, January 1, 2018, to March 31, 2021, to be included for that month. Main Outcomes and Measures: Prescription of a benzodiazepine, Z-hypnotic, or SSRI or SNRI. For each month, the percentage of patients with benzodiazepine, Z-hypnotic, or SSRI or SNRI prescriptions by sex was calculated. Results: The records of 17 255 033 adults (mean [SD] age, 51.7 [19.5] years; 51.3% female) were examined in 2018, 17 340 731 adults (mean [SD] age, 52.5 [19.7] years; 51.6% female) in 2019, 16 916 910 adults (mean [SD] age, 53.7 [19.8] years; 51.9% female) in 2020, and 15 135 998 adults (mean [SD] age, 56.2 [19.8] years; 52.5% female) in 2021. Compared with men, women had a higher rate of prescriptions for all 3 drugs classes and had larger changes in prescription rates over time. Benzodiazepine prescribing decreased from January 2018 (women: 5.61%; 95% CI, 5.60%-5.63%; men: 3.03%; 95% CI, 3.02%-3.04%) to March 2021 (women: 4.91%; 95% CI, 4.90%-4.93%; men: 2.66%; 95% CI, 2.65%-2.67%), except for a slight increase in April 2020 among women. Z-hypnotic prescribing increased from January 2020 for women (1.39%; 95% CI, 1.38%-1.40%) and February 2020 for men (0.97%; 95% CI, 0.96%-0.98%) to October 2020 (women: 1.46%; 95% CI, 1.46%-1.47%; men: 1.00%; 95% CI, 0.99%-1.01%). Prescribing of SSRIs and SNRIs increased from January 2018 (women: 12.77%; 95% CI; 12.75%-12.80%; men: 5.56%; 95% CI, 5.44%-5.58%) to April 2020 for men (6.73%; 95% CI, 6.71%-6.75%) and October 2020 for women (15.18%; 95% CI, 15.16%-15.21%). Conclusions and Relevance: In this cohort study, coinciding with the COVID-19 pandemic onset was an increase in Z-hypnotic as well as SSRI and SNRI prescriptions in both men and women along with an increase in benzodiazepine prescriptions in women, findings that suggest a substantial mental health impact of COVID-19-associated mitigation measures.

Gender Differences in Neuropsychiatric Symptoms Among Community-Dwelling Mexican Americans Aged 80 and Older.

Background and ObjectivesTo assess gender differences in prevalence of neuropsychiatric symptoms (NPS) among community-dwelling Mexican Americans ≥80 years. Research Design and Methods: Using data from Wave 7 (2010-2011) of the Hispanic Established Population for the Epidemiological Study of the Elderly, we analyzed the NPS of 914 participants as determined by the Neuropsychiatric Inventory (NPI) with assessments conducted by their caregivers. Multivariate logistic regression models were used to test the association of individual NPS with gender, adjusting for relevant characteristics. Results: The average age of our sample was 86.1 years, and 65.3% were women. Over 60% of participants had at least one informant/caregiver reported NPS. After adjustment, women had lower odds than men of agitation/aggression but higher odds of dysphoria/depression and anxiety. Discussion: Recognizing gender differences in NPS phenotype could help guide development of culturally appropriate NPS screening and treatment programs.

Willingness to Participate in Health Research Among Community-Dwelling Middle-Aged and Older Adults: Does Race/Ethnicity Matter?

INTRODUCTION: Older adults, including racial and ethnic minorities, are underrepresented in research. As the US population ages, the number of older racial and ethnic minority individuals will increase. Including these individuals in research is an important step towards reducing health disparities. METHODS: We used data from HealthStreet, a University of Florida community engagement program which uses community health workers to assess the health of the community, to assess willingness to participate in different types of health research by race/ethnicity. Descriptive statistics and logistic regression models were used to assess willingness to participate among adults aged 50 and older, by race/ethnicity (n = 4694). RESULTS: Our sample was 42.0% non-Hispanic White, 52.8% non-Hispanic Black, and 5.2% Hispanic. Non-Hispanic White participants reported more past research participation than non-Hispanic Black and Hispanic participants (28.7% vs. 19.0% and 19.2%, respectively). Compared with non-Hispanic White participants, non-Hispanic Black participants were less willing to participate in most types of studies, while Hispanic participants were less willing to participate in studies that might be seen as invasive (required blood sample, genetic sample, or participants to take medicine, or use of medical equipment). CONCLUSIONS: Our study provides investigators with a general profile of research preferences by race/ethnicity; compared with non-Hispanic White individuals, non-Hispanic Black individuals are less willing to participate in most studies, while Hispanic individuals are less willing to participate in studies that may be seen as invasive or demanding. It is imperative to include diverse older adults in health research. By tailoring research based on preferences we can improve recruitment in underrepresented populations.

Is "Busy" Always Better? Time-Use Activities and Depressive Symptoms Among Older Mexican Adults.

BACKGROUND AND OBJECTIVES: Depression among older Mexican adults is underrecognized and of increasing concern due to its association with comorbidities including cognitive and functional impairments. Prior studies have found an association between low involvement levels in social activities and depression. We aimed to examine the association of time-use activities and depressive symptomatology by sex. RESEARCH DESIGN AND METHODS: We used data from the 2012 and 2015 waves of the Mexican Health and Aging Study. Participants aged 60 and older who had low or no depressive symptoms in 2012 were included in these analyses (N = 4,309). Factor analysis was used to group activities and logistic regression models were used to assess the association of baseline time use with depressive symptomatology in 2015. RESULTS: Among those with low or no depressive symptomatology in 2012, 21.0% reported elevated symptoms (5+) in 2015. Those with elevated depressive symptoms were more likely to be women, older, lower educated, and with at least one activity of daily living limitation. Four time-use domains emerged from the factor analysis including hobbies and indoor activities, volunteering, caregiving, and working. The hobbies and indoor activities domain was associated with lower odds of elevated symptoms for men and women (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.61-0.96; and OR: 0.75, 95% CI: 0.61-0.91, respectively). Additionally, the volunteer and community activities domain was associated with lower odds of depressive symptoms for women (OR: 0.72, 95% CI: 0.58-0.89) and men (OR: 0.77, 95% CI: 0.60-0.99). DISCUSSION AND IMPLICATIONS: Understanding how older Mexicans distribute their time among different activities and its associations with depressive symptoms can help guide policy and sex-specific interventions for psychological well-being. Certain domains had lower odds for elevated depressive symptomatology; future work should examine this association in other countries as well as the context of the built environment.

Gender differences in diversion among non-medical users of prescription opioids and sedatives.

BACKGROUND: Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion. OBJECTIVE: To examine gender differences in diversion of prescription opioids and sedatives among non-medical prescription opioid and sedative polysubstance users. We hypothesize that men will be more likely than women to engage in incoming diversion. METHODS: Data from the Prescription Drug Abuse, Misuse, and Dependence Study, a cross-sectional study focused on prescription drug users, were analyzed. Non-medical use was defined as use of a drug that was not prescribed or use in a way other than prescribed. Individuals who reported past 12-month non-medical opioid and sedative use were included; diversion was defined as incoming (obtaining drugs from a source other than a health professional) and outgoing (giving away/selling/trading prescription drugs). RESULTS: Among the 198 polysubstance users, 41.4% were female. Men were 2.85 times as likely as women to report incoming diversion (95% CI: 1.21-6.72). Women were more likely to obtain opioids from a healthcare professional; men were more likely to obtain sedatives from a roommate, coworker, or friend. Over half of men and women reported outgoing diversion opioids or sedatives. CONCLUSION: Drug diversion highlights an important point of intervention. Current prevention efforts that target prescribers should be expanded to include users and diversion activities; these interventions should be gender-specific.

Racial and Ethnic Differences in Alzheimer's Disease Knowledge Among Community-Dwelling Middle-Aged and Older Adults in Florida.

Objective: To compare Alzheimer's disease (AD) knowledge by race and ethnicity in a community sample of middle-aged and older adults aged 50 and over in Florida. Method: Data from HealthStreet, a University of Florida community engagement program, which uses community health workers to assess the health conditions, concerns, and knowledge of community members, was used (n = 842). A multivariate regression model was used to quantify differences in AD knowledge by race and ethnicity. Results: Older age and recruitment from Miami were associated with higher AD knowledge while being non-Hispanic Black, reporting male sex, having less than high school diploma, and reporting food insecurity were associated with lower AD knowledge. Discussion: Hispanics had comparable AD knowledge to non-Hispanic Whites and more knowledge than non-Hispanic Blacks after adjusting for other factors that could differentiate these groups. Almost half of the participants did not know hypertension is a risk factor for AD, highlighting a point of intervention.

Discriminative Ability of Montreal Cognitive Assessment Subtests and Items in Racial and Ethnic Minority Groups.

INTRODUCTION: The Montreal Cognitive Assessment (MoCA) is a popular screening tool for Mild Cognitive Impairment (MCI). The psychometric properties of the MoCA have not been widely examined in minority groups. We aimed to analyze the discriminate ability of subtests and items by race and ethnicity given gold-standard clinical diagnosis of cognitive status. METHODS: We analyzed data from the National Alzheimer Coordinating Center Uniform Data Set March 2018 data freeze. Stepwise regression was used to determine which subtests predicted cognitive status (normal cognition, MCI, or dementia), by race/ethnicity. Item discrimination and difficulty was calculated by race/ethnicity and cognitive status. RESULTS: In our sample (n=3895), with an average age of 69.7, 80.7% were non-Hispanic white, 15.0% were non-Hispanic black, and 4.2% were Hispanic. Among non-Hispanic whites all subtests, education, and age predicted clinician diagnosis, while visuospatial/executive, attention, language, delayed recall, and orientation subtests were predictive among non-Hispanic blacks and visuospatial/executive, delayed recall, and orientation subtests and education were predictive among Hispanics. Item discrimination and difficulty varied by race/ethnicity and cognitive status. CONCLUSIONS: By understanding the psychometric properties of MoCA subtests, we can focus on subtests that have higher discrimination and more diagnostic utility. Subtests should be further evaluated for use in screening of minority individuals.