Race Inequity in School Attendance Across the Jim Crow South and Its Implications for Black-White Disparities in Trajectories of Cognitive Function Among Older Adults.

OBJECTIVES: Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better-funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function. METHODS: We linked historical state-level data on school attendance from the 1919/1920 to 1953/1954 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults older than age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/1920 and completed primary/secondary school by 1953/1954 (n = 4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory. RESULTS: Self-reported years of schooling explained 28%-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41%-55% of the Black-White disparity in these outcomes. DISCUSSION: Our study highlights the importance of using a more refined measure of schooling for understanding the education-cognitive health relationship.

An Evaluation of Dementia Dialogues®: A Program for Informal and Formal Caregivers in North and South Carolina.

In 2019, the University of South Carolina's Office for the Study of Aging (OSA) remodeled the curriculum for the nationally registered Dementia Dialogues® program that delivers high-quality education to formal and informal caregivers of persons who exhibit signs and symptoms of Alzheimer's disease and related dementias (ADRD). This study evaluated new knowledge acquired and program satisfaction by North and South Carolina program participants (N = 235) after completing updated modules. Pre/post module survey data were analyzed using means and percentiles, McNemar's test, and paired t tests. Results demonstrated significant positive increases in caregiver knowledge attainment, with differences in overall knowledge change in specific modules among caregivers and noncaregivers (p < .0001-<.05). Dementia Dialogues® may serve as a useful tool in providing important information that increases caregiver knowledge of persons living with ADRD. Further research is recommended to examine how knowledge improvement translates into caregiving practices.

The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans.

Objectives: We examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences. Methods: The Health and Retirement Study (2006-2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents' first report of resilience. Results: Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life. Discussion: Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. We discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.

Mentorship and Training to Increase Diversity of Researchers and Practitioners in the Field of Aging and Alzheimer's Disease: A Scoping Review of Program Characteristics.

Objectives: Diversity is needed within the aging and Alzheimer's disease and related dementias (ADRD) research and practice workforce to comprehensively address health inequities faced by underrepresented minority (URM) older adults. We conducted a scoping review of training programs designed to diversify the pool of researchers and practitioners in the field of aging and ADRD. Methods: Online database searches yielded 3976 articles published from 1999 to 2019. Fourteen studies met the inclusion criteria. Results: All programs were from the United States and included URM populations. Nine programs included students, one targeted university faculty, and four targeted clinical staff. Only five programs were guided by theory. Discussion: Our review identified URMs' desire for culturally diverse and representative mentorship, the need for career development support at various training stages, and the importance of incorporating theory to program design. It also identified key characteristics for future program development, creation of systematic evaluation standards, and opportunities for promotion.

Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review.

Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.

Early-Life Military Exposures and Functional Impairment Trajectories Among Older Male Veterans: The Buffering Effect of Psychological Resilience.

OBJECTIVES: Drawing on the life course framework and theoretical concept of resilience, we examine the impact of early-life service-related exposures (SREs) on later-life functional impairment trajectories among older U.S. male veterans. We conceptualize resilience as a psychological resource potentially moderating the lasting negative consequences of traumatic military exposures. METHOD: Using the 2013 Veterans Mail Survey linked to the Health and Retirement Study 2006-2014 Leave Behind Questionnaire and RAND Data File (v.N), we estimate latent growth curve models of functional impairment trajectories. RESULTS: SRE to death has a persistent positive effect on functional limitations and activities of daily living limitations. Psychological resilience significantly moderates this association, such that veterans maintaining higher levels of resilience in the face of adverse exposures have considerably less functional impairment over time compared to their counterparts with low levels of resilience. DISCUSSION: Our findings point to the importance of psychological resilience in later life, especially within the realm of traumas occurring in early life. We discuss implications for current military training programs, stressing the importance of research considering individual resources and processes that promote adaptation in the face of adverse life events.

The Impacts of Service Related Exposures on Trajectories of Mental Health Among Aging Veterans.

Objectives: Drawing on life-course perspective and cumulative advantage theory, we examined whether service related exposures (SREs)-combat and exposure to death-have lasting impacts on depressive symptom and psychiatric problem trajectories of aging veterans. Methods: The Health and Retirement Study and linked 2013 Veterans Mail Survey were used to examine SREs and mental health among older veterans between 2002 and 2012 (N = 1,662). Latent growth curves were used to measure how individuals vary from average mental health trajectories based on SREs and other important covariates. Results: Exposure to death had a significant and lasting effect on depressive symptoms for veterans in late life but was reduced to nonsignificance when physical health trajectories were included. Combat and exposure to death had independent and robust impacts on psychiatric problems, which were robust in final models. Discussion: SREs presented varied and significant impacts, suggesting that combat does not work alone in driving poor mental health trajectories, and that exposure to death is a more robust risk marker for later outcomes.

Adjustment to Widowhood and Loneliness Among Older Men: The Influence of Military Service.

Background and Objectives: Men are at higher risk of experiencing poorer adjustment to widowhood compared to women, a transition that is associated with increased loneliness. Military service may play an important role in how men process widowhood, particularly among current cohorts of older men. The present study explores whether military experiences relate to better adjustment to widowhood, that is, reduction of loneliness associated with widowhood for men. We examine (a) whether military experience, especially exposure to death, shapes changes in loneliness following widowhood relative to those without military experience, and (b) if any observed benefits of military experience are explained by greater social engagement. Research Design and Methods: We use the Health and Retirement Study and linked Veterans Mail Survey to address respondents while they are continuously married (T1) and at widowhood four years later (T2) using Ordinary Least Squares (OLS) regression. To address our hypotheses, we examine whether military experience without exposure to death, and/or military experience with exposure to death moderates the overall negative effect of widowhood for loneliness relative to civilians. Results: There is a significantly lower level of loneliness among veterans with exposure to death relative to civilians who become widowed; however, veterans without exposure to death remain similar to civilian widowers. Social engagement does not explain the benefits associated with military exposures for widowers. Discussion and Implications: Although exposure to death early in life is traumatic, our research suggests that such adversity within the specific context of the military may help enhance resilience during the transition to widowhood.

Race Differences in ADL Disability Decline 1984-2004: Evidence From the National Long-Term Care Survey.

OBJECTIVE: Disability declined in lower levels of impairment during the late 20th century. However, it is unclear whether ADL disability also declined, or whether it did so across race. In this study, we examine cohorts entering later life between 1984 and 1999, by race, to understand changing ADL disability. METHOD: We used latent class methods to model trajectories of ADL disability and subsequent mortality in the National Long-Term Care Survey among cohorts entering older adulthood (ages 65-69) between 1984 and 1999. We examined patterns by race, focusing on chronic condition profiles. RESULTS: White cohorts experienced consistent declines in ADL disability but Blacks saw little improvement with some evidence for increased disability. Stroke, diabetes, and heart attack were predominant in predicting disability among Blacks. DISCUSSION: Declining disability trends were only observed consistently among Whites, suggesting previous and future disability trends and their underlying causes should be examined by race.

Service-Related Exposures and Physical Health Trajectories Among Aging Veteran Men.

PURPOSE OF THE STUDY: We examined the association of military service-related exposures (SREs) with physical health trajectories to establish whether combat and other hazards have lasting connections to health in later life. We also examined potential confounders and mechanisms to further understand the associations. DESIGN AND METHODS: We used the 2013 HRS Veterans Mail Survey linked to the longitudinal Health and Retirement Study (HRS) to examine military service experiences and health over a decade (2000-2010) among veteran men. We employed latent class analysis to disaggregate trajectories of health in later life. RESULTS: Most veteran men experienced good health over the decade. Although we found a connection between combat and later health, it was driven primarily by hazardous or traumatic exposures. Service-related disability, current health behaviors, and mental health were not likely explanations for these associations. IMPLICATIONS: The measurement of service experiences is primary in understanding health implications of military service and projecting the health service needs of aging veterans. SREs are varied and complex and have differential connections to health. These connections remain unexplained by current behaviors and mental health, suggesting the need to examine earlier life course pathways and mechanisms.