Life Course Center for the Demography and Economics of Aging (LCC)

2023. Jiao Yu. Neighborhood Characteristics and Cognitive Health among Black and White Older Adults: The Mediation Role of Allostatic Load .

This pilot project aims to generate preliminary data to understand how place-based chronic stressors get under the skin to produce racial disparities in cognitive impairment. One indicator of physiological dysregulation that has received increasing attention is allostatic load (AL). Guided by the “weathering” hypothesis and the stress process theory, this study will develop longitudinal measures of physiological dysregulation (AL) from the Health and Retirement Survey (HRS, 2006–2016). Through linking the HRS to the National Neighborhood Data Archive (NaNDA), it will also investigate the extent to which AL, as an indicator of physiological response to stress, explains neighborhood-driven racial disparities in later life cognitive health. The project has two aims: (1) Develop a longitudinal measure of allostatic load with a range of biomarkers and examine disparities in the allostatic load trajectories by race, gender, education, and their intersections. (2) Identify racial differences in the relationship between neighborhood characteristics (neighborhood disorder and neighborhood cohesion) and cognitive health trajectories among black and white older adults aged 65 years and older.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2023. Michael Esposito and Jessica Finlay. Place-Based Determinants of Cognitive Aging Across the Life Course.

While disparities in Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) are well documented, the underlying causal process explaining how and why these inequalities arise is less clear. Evidence suggests that potentially-modifiable individual factors, such as social isolation and physical inactivity, can significantly reduce one’s dementia risk. Much less attention, however, focuses on the upstream, contextual factors that structure people’s access to these risk factors and behaviors. Neighborhood amenities that facilitate socialization, learning, healthy eating, and physical activity may slow rates of cognitive decline, while exposure to highways and polluting sites may increase risk for AD/ADRD. Drs. Finlay and Esposito developed a novel concept of Cognability to identify how neighborhood built and social environments structure opportunities and barriers for later-life cognitive health. This proposal aims to extend Cognability to identify how the accumulation of neighborhood exposures over the adult life course may modify cognitive aging trajectories.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms, Later Life-Course Population Trends in Context

2023. Naomi Thyden. Japanese American Health by Generational Status and Exposure to Structural Racism.

Although Asian American interest groups have worked against health disparities in their communities for decades, there are now broader calls for more data about Asian Americans, including data disaggregated by ethnicity. At the same time, structural racism has become accepted as a driving force of racial health disparities. There is a long history of discriminatory policies against Asian Americans, and specifically against Japanese Americans. Most notably, the incarceration of Japanese and Japanese Americans during World War II is a racial trauma whose health effects have been insufficiently documented. The effects of indiscriminate incarceration of Japanese residents have implications for today’s federal policies, which include ethnic-based detention centers and blurred lines between criminal and immigration law – termed “crimmigration.” Because Japanese Americans have been in the U.S. since the 1890s, their experiences can offer insights into the long-term effects of being a minoritized immigrant group in the U.S. In this project we aim to (1) understand differences in self-reported discrimination and well-being among Japanese Americans by internment status and how many generations their family lived in the U.S. and (2) investigate social, demographic, and socioeconomic characteristics of Japanese American internees before incarceration.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2023. Shekinah Fashaw-Walters and Quinton Cotton. Qualitative Research to Quantify Exposures to Racism among Older Adults.

The overall objective of this pilot project is to identify through qualitative inquiry the elements of racism across the life course that affect healthy aging and healthcare experiences for Black older adults. Black older adults have worse health outcomes and poorer access to high-quality healthcare services as compared to their white counterparts. Emerging evidence documents the role of community and social factors (i.e., racism, segregation, structural poverty) in healthy aging processes and access to healthcare. However, little is known about the specific impacts of exposure to racism over the life course on healthy aging. Our work will explore and elucidate how multiple systems and institutions of structural discrimination (including within healthcare) can lead to widened racial inequities in healthy aging. Furthermore, we will explore how factors of resistance and resilience (e.g., familial and cultural factors) moderate the impact of racism on healthy aging. We will sample Black older adults ages 50 and above in the Midwest (Minneapolis, Minnesota) and anticipate reaching data saturation with 24 participants.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2022. Cindy Vang. Discrimination and Resilience on Health Across the Lifespan: A Mixed-Methods Study of Asian and Asian American Older Adults.

This project will investigate discrimination, resilience, mental health, and cognitive health across the life course for Asian and Asian American (AAA) older adults using an exploratory sequential mixed methods approach. We will (1) characterize the levels of discrimination, resilience, cognitive health, and mental health of AAA older adults across the life course and (2) provide the context of overcoming discrimination experienced by AAA older adults across the life course.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2022. Elizabeth Wrigley-Field. Infectious Disease Exposures in Early Childhood Among Contemporary Old-Age White and African American Cohorts.

It is well established that early-life infectious disease exposures can be harmful to long-term health. These exposures changed dramatically in the United States during the first half of the twentieth century—and thus, during the critical childhood periods of the cohorts that recently reached, are now reaching, or will soon reach the ages when most deaths happen. Yet we have little systematic information about what this childhood infectious disease exposure burden actually looked like across and within birth cohorts, including its variation by race and place. This project will create a new dataset that will generate a far more comprehensive description of these infectious environments than has ever been previously available and will set up future research into the consequences of those environments for aging trajectories.

Priority Research Areas: Later-Life Course Population Trends in Context

2022. Frank Heiland. Perceived Workplace Age Discrimination and Racial/Ethnic Disparities in Cognitive Functioning among Older Workers.

This pilot project will explore the role of perceived workplace ageism in racial/ethnic disparities in cognitive functioning among older workers approaching retirement age. We will examine the differences in cognitive performance between older workers who identify as non-Hispanic white, non-Hispanic Black, Indigenous, and (other) people of color (BIPOC) and Hispanic. Our first goal is to assess the significance, magnitude, and direction of the relationship between perceived workplace ageism and cognitive functioning among older workers. The second and related goal is to investigate whether perceived workplace ageism moderates the relationship between paid work and cognitive health in later life, for example, by increasing the risk of early withdrawal from the labor force or unemployment among older workers.

Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

2022. Renada Goldberg. Work Precarity and the Aging Workforce: Trends in Health Disparity Among Older Service Sector Workers.

The main objective of this study is to measure the mechanisms by which work precarity contributes to disability and negative health outcomes for older non-college-educated workers in the service sector, measuring racial-ethnic differences in the experience of work precarity. We have three aims: (1) Establish levels of work precarity based on a variety of measures, including wages, hours, work/family conflicts, period of unemployment, or access to health insurance, among older non-college workers (age 50+) in health care, retail, and food service;  (2)  Measure the degree to which the level of work precarity predicts disability and negative health outcomes over time among older non-college workers (age 50+) in health care, retail, and food service; and (3) Measure whether there are differences in levels of work precarity and disability across racial-ethnic groups of older non-college workers (age 50+) in healthcare, retail, and food service.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2022. Theresa Andrasfay. Disparities in Inflammation at Older Ages: Exploring the Role of Occupation.

The objective of this project is to determine which occupational characteristics impact inflammation at midlife and how these are implicated in socioeconomic inequality in midlife inflammation. Because inflammation is a risk factor for many health outcomes—e.g., disability, pain, chronic conditions—and is important for the overall aging process, the results will help clarify the role of work as a social determinant of health and quality of life at older ages and identify potentially modifiable occupational risk factors.

Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

2021. Colleen Peterson. Comparing the Utility of Subjective and Objective Measures of Older Adult Health and Physical Functioning to Predict Long-Term Driving Difficulty and Driving Cessation.

The proposed exploratory study will identify the simplest and most predictive measures of driving difficulty and driving cessation by identifying relationships between several self-reported subjective and objective physical health measures and long-term incidence of driving difficulty and driving cessation. Limited research has evaluated both objective and subjective mental and physical health indicators to predict only older adult driving cessation over shorter follow-up periods. The more long-range prediction capacity a tool for driving cessation has, the more potential it has for reducing negative older adult health outcomes by linking them earlier to interventions that might delay driving cessation (e.g., rehabilitation to reduce physical difficulties) or support its successful transition (e.g., community-based transportation resources). The proposed study will identify simple, long-range predictors of both driving difficulty and driving cessation to inform evidence-based clinical practice and research.

Priority Research Areas: Later Life-Course Population Level Trends in Context

2021. Hannah Neprash. Primary Care Exam Length and Potentially Inappropriate Prescribing among Older Adults.

This project will use a database of national electronic health record (EHR) data from athenahealth, Inc., a large health information technology company, to test for a relationship between exam length and PIP. This database contains detailed information on more than 40 million primary care visits for adults aged 65 and older, including exam length and medications ordered by the clinician during each visit. To quantify exam length, we will use methods developed and deployed by study team members. To define and quantify PIP, we will rely on the 2019 American Geriatric Society Beers Criteria for potentially inappropriate medication use in older adults. This proposed work will contribute much-needed evidence on possible age-related disparities in time use in the form of interaction times between older Americans and their physicians and how that relates to the quality of care that older adults receive. Time use studies typically focus on paid work or family relationships, not community relationships, and yet time spent in medical care is arguably key to healthy aging. We will also promote understanding about how race and gender in combination with being over 65 shape exam times and their health impacts.

Priority Research Areas: Interrelationships of Work, Family, Community Participation, and Health

2021. Janette Dill. Measuring the supply and turnover of direct care workers in long-term services and supports (LTSS) in the care of adults with AD/ADRD.

The long-term goals of this project are to assess the supply of the LTSS direct care workforce needed to support the growing demand for AD/ADRD care and to measure the extent to which compensation and resource-related constraints contribute to high turnover and instability in the LTSS direct care workforce. This pilot study will conduct preliminary analyses toward these goals, leading to a rigorous study that will use robust, nationally-representative datasets to measure the supply of the LTSS direct care workforce relative to the AD/ADRD population in local labor markets, identifying areas with relative shortages of this critical workforce. This will be the first study to provide crucial national and regional rates of employer and industry turnover among LTSS direct care workers, including turnover rates across LTSS sectors.

2021. Tom VanHuevelen and Jane VanHuevelen. Intergenerational Health Socialization in Rural America.

The goal of the proposed study is to investigate health socialization occurring within families that impacts health knowledge, beliefs, and behaviors throughout the life course. We focus on health socialization between retirement aged residents between 65 and 90 of rural areas and their adult children. We seek to identify key factors in the socialization process that influence adoption of health promoting behaviors among retirement-aged rural residents. Because health socialization is necessarily relational, we propose a data collection process that will capture the interconnected nature of health behavior and health socialization.

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms and Later-Life Course Population Trends in Context

2021. Wei Duan-Porter. Racial and Ethnic Disparities in Risk for Cognitive Decline and Dementia among Veterans with PTSD.

Our long-term goal is to address the negative effects of PTSD on cognitive functioning over the life-course, focusing on racial and ethnic minorities. We will meet this objective by building on our prior work with a national cohort of racially and ethnically diverse veterans in VA care who had PTSD and no diagnosis of dementia in 2009 (n=7645). The proposed pilot work will identify surviving respondents and evaluate potentially higher mortality among minority (vs. White) participants. We will update VA data on medical conditions, health care utilization, and participants’ addresses. To examine community-level markers of socioeconomic disadvantage, we will link publicly available Census data on several key measures (e.g., proportion unemployed and proportion of households below the poverty line) using participants’ home zip codes. We will also evaluate the feasibility of recruiting minority participants for cognitive assessments by telephone (using the modified Telephone Interview for Cognitive Status [TICS-M] and telephone-modified Mini-Mental Status Exam [T-3MS]).

Priority Research Areas: Life-Course Dynamics as Disparity Mechanisms

2020. Carrie Henning-Smith and Julia Drew. Rural-Urban Differences In 5-Year Mortality Among Older Adults In The United States: The Role Of Socio-Demographic And Health Characteristics, Living Arrangements, And Spousal Mortality.

This project will investigate rural-urban differences in five-year mortality among older adults and variation in mortality risk by individual socio-demographic and health characteristics, living arrangements, and spousal mortality. This demographic research will produce new knowledge about the large number of older adults living in rural areas and deepen our understanding of mortality risks in urban versus rural areas.

Priority Research Areas: Determinants of Health, Well-Being and Longevity, Later life-course population trends in context

2020. Evan Roberts and Anna Prizment. Do Grandparents Moderate The Association Between Early Life Conditions and Health At Older Ages?.

Grandparents can be a crucial source of material and social assistance to families and make a significant difference to early-life environments. Because early-life social environments and experiences have an important impact on the life course and aging trajectories, the availability and role of grandparents potentially shapes the aging pattern of subsequent generations. We will expand understanding of how grandparents influence the aging and mortality of their grandchildren by creating a dataset of women observed in childhood in the 1920s, for whom we can objectively measure the presence, proximity, and socio-economic status of grandparents and track health and mortality in recent years. Using these data, we will examine whether the proximity and resources of grandparents during childhood moderates the association between early-life social and economic conditions, and health outcomes at older ages.

Priority Research Areas: Determinants of Health, Well-Being and Longevity, Later life- course population trends in context

2020. Lynn Blewett. The Budgetary Impact Of Assisted Living Availability On State Medicaid Spending On LTSS.

This project will document and evaluate Medicaid financing of assisted living services in Minnesota. We have three aims: (1) conduct a preliminary scan of state Medicaid financial support for care in Assisted Facilities; (2) operationalize an assisted living support variable to include in our Minnesota LTSS Projection Model; and (3) provide baseline data on Medicaid coverage of home care services in assisted living facilities. We will develop an initial financial projection model that assesses the impact of the availability of Assisted Living facilities on use and costs of Medicaid spending on LTSS. The model will include both supply information on number and type of Assisted Living, Nursing Facilities, and waivered services as well as demand based on current projections of Minnesota’s aging population and need for LTSS currently available in Minnesota’s LTSS Projection Model.

2020. Rachel Hardeman and Samuel L. Myers, Jr. The Paradox of Racial Disparities in Alzheimer’s Disease.

This research seeks to resolve a paradox that drives misunderstandings of the impact of Alzheimer’s on African American and white populations. Although research on the diagnosis of Alzheimer’s and other forms of dementia indicates a much higher incidence among African Americans than whites, mortality rates indicate the opposite. The proposed pilot study tests two competing hypotheses for the divergence in the racial gaps in the recorded diagnoses of Alzheimer’s disease and related disorders vs official mortality statistics. The first hypothesis is that there is a pattern of misdiagnosis of African American patients with cognitive deficits possibly due to lower quality medical care or lack of access to expensive modern screening technologies that minimize misdiagnoses. The second hypothesis is that there is a statistical anomaly arising from the fact that relatively few deaths result in autopsies, the definitive assessment of the presence of Alzheimer’s disease.

2020. Sarah Flood, Jesse Berman, Kathryn Grace, and David Van Riper. The Impacts of Extreme Weather on Older Adults’ Time Use.

This project seeks to understand how older adults’ daily lives are affected by extreme weather and to explore demographic variation in the impact of such events. This project promises to advance our understanding of the effects of different types of extreme weather on daily lived experiences and well-being and speaks directly to NIA’s current “heightened interest in research to understand how extreme weather and disaster events impact older adults” (NIH PAR-19-250). Using novel data linkage, the research team will provide a population-based understanding of older adults’ time allocation and well-being on days when they experience extreme weather events.