Subjective cognitive decline and cognitive change among diverse middle-aged and older Hispanic/Latino adults: Results from the Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA).

INTRODUCTION: The potential utility of subjective cognitive decline (SCD) as an early risk marker of Alzheimer's disease and related dementias is under consideration. We examined associations between SCD and cognitive change among middle-aged and older Hispanic/Latino adults living in the United States. METHODS: The short-form Everyday Cognition Scale (ECog-12) was assessed to generate global, executive function, and memory-related SCD scores. We used survey generalized regressions to model the change in learning, memory, verbal fluency, executive function, and global cognitive performance over 7 years as a function of SCD (at Visit 2). RESULTS: The mean age was 56.37 ± 8.10 years at Visit 1 (n = 6225). Higher ECog-12 was associated with greater decline in global cognitive performance (ECog-12 global: B = -0.17, standard error [SE] = 0.02; ECog-12 executive: B = -0.15, SE = 0.02; ECog-12 memory: B = -0.14, SE = 0.02, p's < 0.001). DISCUSSION: These results support the link between subjective reports of cognitive decline and objectively measured 7-year cognitive decline in community-dwelling, middle-aged, and older Hispanic/Latino adults. HIGHLIGHTS: We found that nearly two-thirds of diverse middle-aged and older Hispanics/Latinos reported cognitive concerns in a large and representative population study. Self-reported subjective experiences of cognitive decline reflect objective cognitive decline in US Hispanics/Latinos. The relationship is stronger among men compared to women. The relationship between subjective and objective changes to memory are stronger in those with cognitive concerns, and remain even in cognitively healthy individuals.

Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the second Latinos & Alzheimer's Symposium.

The Alzheimer's Association hosted the second Latinos & Alzheimer's Symposium in May 2021. Due to the COVID-19 pandemic, the meeting was held online over 2 days, with virtual presentations, discussions, mentoring sessions, and posters. The Latino population in the United States is projected to have the steepest increase in Alzheimer's disease (AD) in the next 40 years, compared to other ethnic groups. Latinos have increased risk for AD and other dementias, limited access to quality care, and are severely underrepresented in AD and dementia research and clinical trials. The symposium highlighted developments in AD research with Latino populations, including advances in AD biomarkers, and novel cognitive assessments for Spanish-speaking populations, as well as the need to effectively recruit and retain Latinos in clinical research, and how best to deliver health-care services and to aid caregivers of Latinos living with AD.

Competency-based training for in-home supportive services providers of consumers with ADRD.

The In-Home Supportive Services (IHSS) program in California provides direct care for low-income seniors and people with disabilities. Yet, the vast majority of these workers receive little to no training in caring for consumers, especially those with Alzheimer's disease and related dementias (ADRD). We developed and implemented a competency-based training program for IHSS caregivers who provide care for persons with ADRD. The 10-week, 35-hour program consisted of training modules with topics ranging from roles and rights of the care recipient to assisting with personal hygiene, with a focus on managing ADRD-related behaviors. The in-person training was delivered in English and Spanish to two cohorts of 30 IHSS workers each. Fifty-seven participants completed the training program; the majority in both trainings were female (79%) and self-identified as Latina (70%). There were statistically significant gains post-intervention in overall confidence in caregiving skills and knowledge among all participants.

Overcoming a Bad Day: a Qualitative Look into the Dementia Caregiving Experiences of Mexican-Origin Women in East Los Angeles.

The number of Latinos with Alzheimer's disease (AD) is projected to more than double by 2030. Yet, the current literature is lagging on Alzheimer's caregiving among Latinos. This study explores how Mexican origin women experience dementia caregiving, and the coping strategies they use to manage their caregiving situations. Nine women were identified as caregivers of a family member with AD or dementia from a larger study on caregiving. Interviews with them were collected and subsequently analyzed using a modified grounded theory approach to reduce the data to identify thematic content. All but one participant described caregiving as "tiring," "wearing," or "hard." They reported suffering from stress, insomnia, nervousness, migraines, and/or depression because of their caregiving experiences. Participants engaged in various coping strategies to help combat the perceived negative consequences of their caregiving experiences. The most commonly reported strategies were various forms of distraction, and meditation or prayer. The Mexican origin women in this study experience faced two types of interpersonal challenges related to dementia caregiving: changes in the care receiver's personality and behaviors, and physical care needs. They engaged in various coping to strategies to address the difficulties of their situation. This study provides formative research for identifying research questions and topics of examination in the future.

The chloroplast NADPH thioredoxin reductase C, NTRC, controls non-photochemical quenching of light energy and photosynthetic electron transport in Arabidopsis.

High irradiances may lead to photooxidative stress in plants, and non-photochemical quenching (NPQ) contributes to protection against excess excitation. One of the NPQ mechanisms, qE, involves thermal dissipation of the light energy captured. Importantly, plants need to tune down qE under light-limiting conditions for efficient utilization of the available quanta. Considering the possible redox control of responses to excess light implying enzymes, such as thioredoxins, we have studied the role of the NADPH thioredoxin reductase C (NTRC). Whereas Arabidopsis thaliana plants lacking NTRC tolerate high light intensities, these plants display drastically elevated qE, have larger trans-thylakoid ΔpH and have 10-fold higher zeaxanthin levels under low and medium light intensities, leading to extremely low linear electron transport rates. To test the impact of the high qE on plant growth, we generated an ntrc-psbs double-knockout mutant, which is devoid of qE. This double mutant grows faster than the ntrc mutant and has a higher chlorophyll content. The photosystem II activity is partially restored in the ntrc-psbs mutant, and linear electron transport rates under low and medium light intensities are twice as high as compared with plants lacking ntrc alone. These data uncover a new role for NTRC in the control of photosynthetic yield.

Assessing the connection between health and education: identifying potential leverage points for public health to improve school attendance.

OBJECTIVES: We examined multiple variables influencing school truancy to identify potential leverage points to improve school attendance. METHODS: A cross-sectional observational design was used to analyze inner-city data collected in Los Angeles County, California, during 2010 to 2011. We constructed an ordinal logistic regression model with cluster robust standard errors to examine the association between truancy and various covariates. RESULTS: The sample was predominantly Hispanic (84.3%). Multivariable analysis revealed greater truancy among students (1) with mild (adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI] = 1.22, 2.01) and severe (AOR = 1.80; 95% CI = 1.04, 3.13) depression (referent: no depression), (2) whose parents were neglectful (AOR = 2.21; 95% CI = 1.21, 4.03) or indulgent (AOR = 1.71; 95% CI = 1.04, 2.82; referent: authoritative parents), (3) who perceived less support from classes, teachers, and other students regarding college preparation (AOR = 0.87; 95% CI = 0.81, 0.95), (4) who had low grade point averages (AOR = 2.34; 95% CI = 1.49, 4.38), and (5) who reported using alcohol (AOR = 3.47; 95% CI = 2.34, 5.14) or marijuana (AOR = 1.59; 95% CI = 1.06, 2.38) during the past month. CONCLUSIONS: Study findings suggest depression, substance use, and parental engagement as potential leverage points for public health to intervene to improve school attendance.

Association of anxiety and depressive symptoms with C-reactive protein in diverse Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

BACKGROUND: High sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation that has been associated with persistent depressive symptoms. Depression and anxiety are frequently associated with a chronic inflammatory state, yet the nature of this relationship has not been rigorously examined in diverse Hispanic/Latino populations. We aimed to study the association of anxiety and depressive symptoms as well as comorbid presentations, with circulating high sensitivity C-reactive protein (hsCRP) levels in a large Latino cohort of diverse heritages. We hypothesized a significant positive associations of both anxiety and depressive symptoms and hsCRP levels and potential variations among the heritage groups. METHODS: Depressive symptoms and anxiety were measured by the Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. Serum hsCRP (hsCRP) levels of 15,448 participants (age 18 to 75 years; 52.3% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were measured and categorized based on the established cardiovascular disease (CVD) risk reference values (< 1mg/L, low; 1-<3 mg/L, intermediate; ≥ 3mg/L, high). RESULTS: Mean CES-D, STAI scores, and hsCRP levels were 7.0 (SD = 5.9), 17.0 (SD = 5.7), and 3.84 (SD = 7.85), respectively. Generalized linear modeling, adjusted for sociodemographic characteristics revealed significant associations between depression (exp(ß) = 1.12; p<0.01) and anxiety symptoms (exp(ß) = 1.10; p<0.05) with continuous hsCRP levels. For categorical values of hsCRP, one SD increase in CES-D and STAI scores was associated with a 10% and 8% increase in the RRRs of high vs. low hsCRP, respectively. However, these relationships between CES-D or STAI and hsCRP were no longer statistically significant after adjustment for CVD risk factors and medications. CONCLUSION: We found modest associations between anxiety and depressive symptoms and systemic inflammation measured by hsCRP among diverse Hispanics/Latinos that did not appreciably differ between heritage groups.

Having a Say Matters: The Association Between Home Health Aides' Voice and Job Satisfaction.

Purpose: Despite a rapidly growing need for home health aides (HHAs), turnover rates are high. While this is driven in large part by the demanding nature of their work and low wages, another factor may be that HHAs are often not considered part of the medical team which can leave them feeling unheard by other healthcare professionals. We sought to determine whether this concept, or HHAs' perceived voice, was associated with job satisfaction. Methods and Design: This cross-sectional survey of English- and Spanish-speaking HHAs caring for adults with heart failure (HF) was conducted from June 2020 to July 2021 in New York, NY in partnership with a labor management fund of a large healthcare union that provides benefits and training to HHAs. Voice was assessed with a validated 5-item scale (total score range 5 to 25). Job Satisfaction was assessed with the 5-item Work Domain Satisfaction Scale (total score range 5 to 35). Multivariable linear regression analysis was used to examine the association between voice and job satisfaction. Results: A total of 413 HHAs employed by 56 unique home care agencies completed the survey; they had a mean age of 48 years, 97.6% were female, 60.2% were Hispanic, and they worked as HHAs for a median of 10 years (IQR, 5, 17). They had a median Voice score of 18 (IQR 15-20) and mean job satisfaction score of 26.4 (SD 5.6). Higher levels of voice (1.75 [0.46-3.04]) were associated with greater job satisfaction (p=0.008). When adjusting for Race/Ethnicity, HF training, and HF knowledge, the association between Voice and job satisfaction remained significant ((1.77 [0.40-3.13]). Conclusion: HHAs with a voice in the care of their patients experienced greater job satisfaction. Voice may be an important target for interventions aiming to improve HHAs' retention in the field.

A Tribute to the Contributions of Dr. Steven P. Wallace to Aging Research.

The articles published in this special issue of the Journal of Aging and Health are written by students, mentees, colleagues, and friends of Steven P. Wallace, PhD. They exemplify the broad and wide reach he had in the aging field, and his deep interest in the economic, health, and overall well-being of diverse older adults. All the articles touch upon key aspects of older adulthood that Dr. Wallace was a champion of: social determinants of health, immigrant health, and health equity.

Evaluating Interorganizational Collaborations: Lessons Learned from Five California Geriatric Workforce Enhancement Programs.

BACKGROUND: Five Geriatric Workforce Enhancement Programs (GWEPs) in California, funded for 4 years, worked collaboratively across different organizations to provide education on aging issues and/or training to enhance services for older adults. OBJECTIVES: To investigate characteristics of the collaborations that were associated with perceptions and experiences of success for participating organizations. METHODS: A survey distributed to 37 organizations participating in 5 GWEPs measured the correlation of resources and dimensions of collaboration with perceived sense of success of the collaborations. Interviews with 30 representatives of the participating organizations collected information about perceived barriers, impact, and satisfaction with the collaborations. RESULTS: Overall perceptions of interorganizational collaboration success were associated with provision of physical resources and four key measures of collaboration (governance, administration, mutuality, and norms/trust). Barriers to success were described in terms of organization functioning and resources. Strong communication appeared as a facilitator of success, and reciprocity was described as a key experience of satisfaction. CONCLUSIONS: This study highlights the positive effects of shared goals, the experience of reciprocity, and communication during interorganizational collaborations. It also notes the negative effects of having inadequate resources and organizational dysfunction.

Understanding the context and appreciating the complexity of evaluating the Diversity Program Consortium.

The National Institutes of Health (NIH) made a sizeable investment in developing a scientific approach to understanding how to best increase diversity in the NIH-funded workforce by fostering inclusive excellence at a national scale through the Diversity Program Consortium (DPC). This chapter provides an overview of the context in which the consortium-wide evaluation study has taken place to provide readers with an understanding of its level of complexity. This evaluation effort is the first large-scale, national, systemic, longitudinal evaluation of harmonized interventions focused on undergraduate biomedical research training programs in the history of the NIH and the National Institute of General Medical Sciences.

Beyond p Values: A Qualitative Evaluation of the Aging Mastery Program Implementation in Los Angeles County.

BACKGROUND: The National Council on Aging's Aging Mastery Program (AMP) aims to help older adults implement health behavior and lifestyle changes to promote healthy aging. The purpose of this community-partnered evaluation was to assess the effectiveness of the implementation in Los Angeles, and understand participant outcomes beyond the findings of a randomized waitlist controlled trial. OBJECTIVES: The purpose of this qualitative process evaluation was to deepen our understanding of participant outcomes and potential site-level implementation issues with the randomized waitlist controlled trial, as participant and site lead satisfaction ratings were very high. METHODS: After the intervention was completed, interviews were conducted with site directors to understand potential challenges or barriers in the implementation of AMP, participant feedback were reviewed for common themes, and focus groups were conducted to elicit additional insight feedback. RESULTS: Analysis of interviews with site directors revealed that the study design was characterized by its complexity, but that the overall AMP program was very compatible with the sites' goals and met the needs of the participants. The participants reported greater interest in nutrition and healthy eating, the importance of exercise and 'preparing' for important life decisions, which were not captured through the measures used in the waitlist controlled trial. CONCLUSIONS: Future evaluations of the AMP should continue the use of mixed methods evaluation designs in order to understand both the quantitative and qualitative outcomes of the program, and consider including measures of other constructs, such as socialization, that have been identified by the participants.

The Impact of COVID-19 on Diverse Older Adults and Health Equity in the United States.

Older adults are most at risk of negative COVID-19 outcomes and consequences. This study applies the World Health Organization's Health Inequity Causal Model to identify different factors that may be driving the higher observed hospitalizations and deaths among older adults of color compared to non-Latinx Whites in the United States. We used multiple data sets, including the US Census American Community Survey and PULSE COVID data, along with published reports, to understand the social context of older adults, including income distributions by race and ethnicity, household composition and potential COVID-19 exposure to older adults by working family members. Our findings point to multiple social determinants of health, beyond individual health risks, which may explain why older adults of color are the most at risk of negative COVID-19 outcomes and consequences. Current health policies do not adequately address disproportionate impact; some even worsen it. This manuscript provides new data and analysis to support the call for equity-focused solutions to this pandemic and health in general in the future, focusing on meeting the needs of our most vulnerable communities.

Mentoring Experiences and Publication Productivity among Early Career Biomedical Investigators and Trainees.

Objective: To identify which mentoring domains influence publication productivity among early career researchers and trainees and whether publication productivity differs between underrepresented minority (URM) and well-represented groups (WRGs). The mentoring aspects that promote publication productivity remain unclear. Advancing health equity requires a diverse workforce, yet URM trainees are less likely to publish and URM investigators are less likely to obtain federal research grants, relative to WRG counterparts. Methods: A mentoring-focused online follow-up survey was administered to respondents of the NRMN Annual Survey who self-identified as mentees. Publications were identified from a public database and validated with participant CV data. Bivariate and multivariate analyses tested the associations of publication productivity with mentoring domains. Results: URM investigators and trainees had fewer publications (M = 7.3) than their WRG counterparts (M = 13.8). Controlling for career stage and social characteristics, those who worked on funded projects, and received grant-writing or research mentorship, had a higher probability of any publications. Controlling for URM status, gender, and career stage, mentorship on grant-writing and funding was positively associated with publication count (IRR=1.72). Holding career stage, gender, and mentoring experiences constant, WRG investigators and trainees had more publications than their URM counterparts (IRR=1.66). Conclusions: Grant-writing mentorship is particularly important for publication productivity. Future research should investigate whether grant-writing mentorship differentially impacts URM and WRG investigators and should investigate how and why grant-writing mentorship fosters increased publication productivity.

Dementia and Falls Management in Underserved Populations: The Cognition and Mobility Care Management Program.

BACKGROUND/OBJECTIVES: Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk. DESIGN: Observation, baseline and 1 year after intervention. SETTING: Community-based primary care county clinics in inland southern California. PARTICIPANTS: A total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period. INTERVENTION: A nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers. MEASUREMENTS: Process outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program. RESULTS: Medical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (meanage = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others. CONCLUSION: A primary care-based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers.

Interventions to Optimize Mentoring Relationships for Diverse Biomedical Researchers.

The articles in this special issue provide insights from a variety of mentoring interventions that were implemented across the NIH Diversity Program Consortium (DPC). Many of the articles highlight examples of how the Entering Mentoring and Entering Research curricular materials, available through the National Research Mentoring Network (NRMN), were adapted and implemented for research mentors and research trainees at Building Infrastructure Leading to Diversity (BUILD) institutions. Other articles report the outcomes of programs developed and offered more broadly by the NRMN. This overview provides background information on NIH DPC-wide efforts and the Entering Mentoring and Entering Research curricula.

Burden and Bad Days Among Mexican-Origin Women Caregivers.

OBJECTIVES: This article examines the construct of burden and the use of coping strategies among Mexican-origin caregivers of older adults. METHODS: In-depth semistructured interviews were conducted with 44 Mexican-origin women caregivers living in the East Los Angeles area. Audio files were transcribed and analyzed in Atlas.ti V7.1.8. Data were analyzed using a grounded theory approach. RESULTS: Caregivers did not typically talk about caregiving as a burden per se; they used other terms for burden that resonated with their experiences. Caregivers viewed caregiving difficulty in physical and emotional terms as it related to specific caregiving circumstances and situations. Caregivers used a variety of coping strategies to get through bad days, including reframing stressful situations to make sense of their circumstances. DISCUSSION: Findings shed light on the mixed results found in the literature on Latino caregiving burden. Results suggest that Mexican-origin women caregivers have a more nuanced experience of caregiving burden than has been found in prior literature. Results also suggest research using traditional measures of burden may not fully capture situational and cultural distinctions to the extent Mexican-origin caregivers ascribe other language to represent difficult caregiving experiences.

Characterization and Processing of Table Olives: A Special Issue.

Table olives are recognized as an essential component of the Mediterranean diet, having been explicitly included in the second level of its nutritional pyramid as an aperitif or culinary ingredient, with a recommended daily consumption of one to two portions (15-30 g). Producers demand innovative techniques improving the performance and industrial sustainability, as well as the development of new products that respond efficiently to increasingly demanding consumers. The purpose of this special issue was to publish high-quality papers with the aim to cover the state-of-the-art, recent progress and perspectives related to characterization and processing of table olives. Two reviews offer an overview about the processing and storage effects on the nutritional and sensory properties of table olives, as well as the main technologies used for olive fermentation, and the role of lactic acid bacteria and yeasts characterizing this niche during the fermentation. A total of 10 research papers cover a broad range of aspects such as characterization of their chemical composition, bioavailability, advances in the processing technology, chemical and microbiological changes, optimized use of starter cultures for the improvement of the different fermentative processes, and new strategies to reduce sodium and additives to stabilize the organoleptic properties and avoid defects.

Community-Partnered Evaluation of the Aging Mastery Program in Los Angeles Area Senior Centers.

Background. The National Council on Aging's Aging Mastery Program (AMP) aims to help older adults implement health behavior and lifestyle changes to promote healthy aging and social engagement. The purpose of the present community-partnered evaluation was to test the effectiveness of AMP implementation in Los Angeles County to improve participants' quality of life, global physical and mental health, and patient activation. Method. A modified randomized wait-list controlled trial design was used to examine experimental, quasi-experimental, and dose-response evidence in five senior centers. Participants completed questionnaires at baseline and after the 10-week intervention, self-reporting their overall quality of life, physical health, mental health, and patient activation. Results. Experimental, intention-to-treat analyses found AMP assignment did not affect any measured outcomes (n = 71). Quasi-experimental, "as treated" analyses (n = 106) controlling for study site and sociodemographic characteristics indicated that participants who attended AMP reported more positive changes in global mental health than the control group. Attending AMP was not associated with changes in quality of life, physical health, or patient activation. Dose-response analyses among AMP participants who attended at least one class (n = 75) found that attending more classes was not significantly associated with greater improvements in mental health. Conclusions. Experimental, intention-to-treat analyses did not support effectiveness of AMP on quality of life, physical or mental health, or patient activation; quasi-experimental analyses found attending AMP was associated with improvements in mental health. Recruitment challenges and participants' nonadherence with condition assignment decreased our ability to detect effects. https://clinicaltrials.gov/ct2/show/NCT03342729?term=Aging+Mastery+Program&rank=1 .