A Comparison of Self-Rated and Objectively Measured Successful Aging Constructs in an Urban Sample of African American Older Adults

Sixty-seven (N = 67) urban African American older adults were divided into successful and nonsuccessful aging groups based on objective MacArthur (i.e., physical and cognitive functioning) and on self-rated health criteria. Only 30% of the sample met objective MacArthur criteria for successful aging compared to 63% who rated themselves as successful. Self-rated successful aging was best predicted by regular exercise, whereas objective successful aging was best predicted by demographic characteristics and cognition. Reading ability mediated the relationship between both education and cognition to objectively defined success. Finally, objective successful aging was related to quantity and quality of education, whereas self-rated successful aging was related to a wider variety of variables. Defining successful aging on objective factors alone may limit our understanding of successful aging in urban African American older adults.     

Understanding Within-Group Variability of Everyday Cognition in Aging Black/African American Adults: A Mimic (Multiple Indicators,Multiple Causes) Model Approach

Background/Study Context: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults.

Methods: Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators.

Results: Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics.

Conclusion: These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.     

Determinants of a sense of mastery in African American and White older adults

OBJECTIVES: This study compares determinants of a sense of mastery in African American and White older adults. METHODS: The association between predictor variables (sociodemographic variables, health conditions, social resources, and religiosity) and feelings of mastery was assessed by using representative community-dwelling samples of 250 African American (mean age = 71.6) and 452 White (mean age = 73.0) older adults. RESULTS: African American older adults had a lower sense of mastery than White older adults. Significant modification by race was found in the associations of age, self-rated health, and religiosity with feelings of mastery. The negative effects of old age and poor health on feelings of mastery were stronger in the White sample, whereas the positive effect of religiosity on feelings of mastery was observed only in the African American sample. DISCUSSION: Although African American older adults had a lower sense of mastery than Whites, their feelings of mastery were less likely to be diminished by old age and poor health and more likely to be enhanced by religiosity. Possible explanations for cross-racial differences are discussed, as are implications.     

A systematic review of diabetes self-care interventions for older,African American,or Latino adults

PURPOSE: This study systematically identified and examined published self-care interventions designed to improve glycemic control or quality of life (QoL) among older, African American, or Latino adults. METHODS: Six electronic databases were searched. Eligible publications were those that described an intervention to change knowledge, beliefs, or behavior among adults with diabetes who were either older than 55 years, African American, or Latino, and that measured the outcomes of glycemic control or QoL. RESULTS: Twelve studies met the inclusion criteria, of which 8 were randomized controlled trials (RCTs). Of the 8 RCTs, improved glycemic control was reported in the intervention arm of 5 RCTs compared with the control arm. Of the 4 RCTs that examined QoL, improved QoL was reported in the intervention arm of 1 study. Characteristics of successful interventions included poor glycemic control at baseline (A1C > 11%), cultural or age-tailoring the intervention, use of group counseling or support, and involvement of spouses and adult children. CONCLUSIONS: Large-scale clinical trials designed according to cultural and age criteria specific for older Latinos and African Americans with diabetes are needed to determine how best to address this growing public health problem.     

APOE epsilon4 as a predictor of subjective quality of life in a biracial older person community sample

The epsilon4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the epsilon4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults. Design: Prospective cohort study. Setting: Community-based sample of older adults in North Carolina (Duke site of the Established Populations for Epidemiologic Studies of the Elderly [Duke EPESE]). Participants: Self-responding genotyped sample members (n = 1,880) of whom 1,254 provided longitudinal data. Measurements: APOE genotype and five newly constructed, reliable, and valid measures of subjective QOL derived from the Duke EPESE questionnaire. The 5 parameters measured were social, economic, mental and physical health, and functional status. Control variables included age, gender, race (African American or White), education and urban/rural residence. Results: Among those with good baseline QOL, there was no significant association between the epsilon4 allele and any of the parameters of subjective QOL in longitudinal analyses. In controlled longitudinal analysis, older age women predicted poorer functional status; being African American, and reporting lower education predicted poorer subjective economic well-being; and being African American predicted better self-assessed mental health. Conclusions: This study is among the first to explore the association of the epsilon4 allele with overall QOL. Considered from a public health perspective, these findings challenge the uncritical assumption that the presence of this susceptibility gene in the population implies an excess burden of poor QOL. The findings do not contradict the previous association of epsilon4 with Alzheimer's disease (AD) and other conditions. Such conditions continue to merit full attention.     

Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors

PURPOSE: This study explored patients' perceptions of barriers to diabetes education among a mostly African American population of adults with diabetes. METHODS: A survey was conducted among 605 new patients attending an urban outpatient diabetes clinic. The questionnaire gathered information on issues patients believed would adversely affect their ability to learn about diabetes. The type and frequency of education barriers were evaluated, and variables associated with reporting an obstacle were analyzed. RESULTS: Average patient age was 50 years, diabetes duration was 5.6 years, body mass index was 32 kg/m2, and hemoglobin A1C was 9.1%. The majority (56%) were women, 89% were African American, and 95% had type 2 diabetes. Most respondents (96%) had received some prior instruction in diabetes care; however, 53% anticipated future difficulties learning about diabetes. The most commonly cited concerns were poor vision (74%) and reading problems (29%). Patients with a perceived barrier to diabetes education were older (P < .001) than were persons without a barrier, and they differed in both employment and educational status (both P < .001). In adjusted analyses, older age, male gender, being disabled, and having an elementary education or less were associated with a significantly increased likelihood of having a barrier to diabetes education, whereas having a college education decreased the odds. Higher hemoglobin A1C levels also tended to be associated with a greater chance of reporting an education barrier (P = .05). CONCLUSIONS: A substantial number of persons anticipated a barrier to diabetes education. Interventions at multiple levels that address the demographic and socioeconomic obstacles to diabetes education are needed to ensure successful self-management training.     

Do racial differences in hypertension persist in successful agers? Findings from the MacArthur Study of Successful Aging

The objective of this study was to determine whether racial differences in hypertension in a random sample of community-dwelling older adults also remained significant in a sample of successful agers. Data for the random sample of community-dwelling older adults came from the Duke University Established Populations for Epidemiologic Studies of the Elderly (4,162 community-dwelling adults age 65 and older) and showed strong racial differences in hypertension. Data for successful agers came from the Duke MacArthur (428 of EPESE respondents in the top 30% in terms of physical, cognitive, and psychosocial performance). The mean of two sitting blood pressure measurements was the dependent variable for both sets of analyses. Independent variables included demographics and health factors. Using logistic regression, odds ratios in the Duke EPESE and Duke MacArthur samples for race were similar (Duke EPESE odds ratio = 1.30; Duke MacArthur odds ratio = 1.29). Sample size differences affected statistical significance. However, race differences in hypertension in older adults appear to be unexplained by socioeconomic status or other usual explanatory variables. Even among successful agers, racial differences in hypertension persist.     

Dimensions of self-report about everyday memory in young and older adults.

This study investigated the relationship between several aspects of memory self-report, objective memory, attitude toward intellectual aging, self-rated health, and self-rated depression in young and older adults. Participants completed a self-report depression scale, and then rated their discomfort with eight categories of everyday forgetting and their attitudes toward intellectual aging. One week later, they rated how frequently they experience the same categories of forgetting, and then completed a battery of objective memory tests analogous to those categories. Ten days later, they rated their willingness to participate in both memory improvement classes and nonmemory classes. Older adults reported significantly more frequent failures but less discomfort with the failures than the young adults. Frequency, discomfort, and self-reported depression were all positively correlated in the older group, but not the young group. Young and old adults were equally positive about participating in memory classes, which both age groups preferred to nonmemory classes; the correlation between willingness to participate in memory classes and objective memory approached significance in the young, but not in the old. Attitude toward intellectual aging was correlated with frequency of and discomfort with forgetting in the older group.     

Successful aging and well-being: self-rated compared with Rowe and Kahn

PURPOSE: This research evaluates the utility of two different definitions of successful aging in predicting well-being. DESIGN AND METHODS: We assessed the definitions of (a) self-rating and (b) Rowe and Kahn's criteria of absence of disease, disability, and risk factors; maintaining physical and mental functioning; and active engagement with life. We made associations with well-being for each definition using data from 867 Alameda County Study participants aged 65-99 years. RESULTS: The percentage of those rating themselves as aging successfully was 50.3% compared with 18.8% classified according to Rowe and Kahn's criteria. Although absence of chronic conditions and maintaining functioning were positively associated with successful aging for both definitions, many participants with chronic conditions and with functional difficulties still rated themselves as aging successfully; none were so classified according to Rowe and Kahn's criteria. On 14 of 15 measures, self-rated successful aging resulted in sharper contrasts for well-being. IMPLICATIONS: Understanding criteria used by older persons to assess their own successful aging should enhance the conceptualization and measurement of this elusive concept.     

Falls efficacy and self-rated health in older African American adults

Fear of falling and mobility restrictions have a significant negative impact on the quality of life of older adults. Because older African American adults are at increased risk for various modifiable health problems, understanding potential constraints on their overall health and mobility is critical in this population. The current study investigated this issue by analyzing a dataset of 449 older African American adults (mean age = 72.3 years) living in Detroit. We characterized and investigated the relationships among the following falls- and health-related variables: previous falls, falls efficacy, mobility, self-rated health (SRH), and depression and well-being. As a whole, participants reported moderate health and well-being, little depression, few mobility problems (mean = 8.4/40), and very high falls efficacy (mean = 94.9/100) despite the fact that a quarter of the sample experienced a fall within the past year. Correlation results indicated that previous falls, falls efficacy, mobility, SRH and depression and well-being were all inter-related. Regression analyses revealed that higher falls efficacy was more closely associated with better SRH than was having previously fallen. Findings suggest that improving falls efficacy in older African American adults may be beneficial to their mobility and overall health and well-being. Further, by asking a single-item SRH question, clinicians may be able to quickly identify older African American adults who have low falls efficacy and are at high risk for falling.     

Successful aging: perceptions of adults aged between 70 and 101 years

In this research, content analysis was employed to investigate older adults' perceptions of successful aging and the relationship of these perceptions to definitions given in the literature to date. Participants were 18 males and 42 females between the ages of 70 and 101 years. Analyses revealed older adults mentioned only 1 or 2 criteria of successful aging if asked for a definition; however, when prompted, they rated almost all the criteria emerging from the literature as highly important. Participants reported adjusting to the situations they were in by compensating for losses that occurred and selecting activities that best suited their capabilities. Overall, older adults' perceptions of successful aging were similar to aspects identified in the literature. Not all aspects, however, were seen as important by all participants, and only low to moderate correlations were found between some aspects of successful aging.     

Successful aging among the young-old,old-old,and oldest-old Chinese

In this study, successful aging was defined by four dimensions including functional status, affective status, cognitive status, and productive involvement status. This study examined successful aging among Hong Kong Chinese old people in three different age cohorts: young-old, old-old, and oldest-old. The respondents were 1106 people aged 60 years or older from a cross-sectional study of a representative community sample of the elderly population in Hong Kong. We found modest associations between four dimensions of successful aging, indicating the relative independence of these four criteria for successful aging. Using multiple regression models, we found that age, gender, years of education, number of close relatives, frequency of contact with friends, financial strain, number of chronic illnesses, self-rated health, hearing impairment, and life satisfaction were associated with the successful aging indicator.     

Successful Aging: Definitions and Subjective Assessment According to Older Adults

There is no standard method for measuring successful aging or a consensus on its definition. Surveys about successful aging were administered to 53 older adults in New Jersey. Participants defined successful aging as including activity/exercise (56% of responses), physical health (46%), social relationships (41%), and psychological/ cognitive health (33%). Successful aging, as assessed by one question, was positively related to social support, life satisfaction, and subjective health. By understanding more about the concept of aging successfully, researchers can develop interventions to promote successful aging for older adults.     

Cognitive reserve and depression predict subjective reports of successful aging

BackgroundWith graying of western societies, successful aging is a hotly debated topic. Attaining successful aging brings benefits not only at the individual level, but also to society. To better understand successful aging, we conducted a study of older adults in the Republic of Slovenia.MethodsWe recruited 213 community-dwelling adults, age 65 years and older, who responded to the Successful Aging Inventory (SAI), Purpose of Life Questionnaire (PIL), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), Cognitive Reserve Index, Functional Activities Questionnaire (FAQ), and Multiple Abilities Self-Report Questionnaire (MASQ).ResultsResponses to all scales were significantly correlated, which was taken into account when identifying covariates of latent successful aging in a structural equation model. Successful aging, as evaluated by the combination questionnaire responses, was most strongly associated with depression and marginally associated with cognitive reserve. Self-rated functional and cognitive capacities did not significantly explain individual differences in successful aging.DiscussionIn our study of community-dwelling, older Slovenes, self-rated depression emerged as a strong correlate of successful aging and, to a lesser degree, cognitive reserve. Future studies of interventions that aim to promote successful aging should consider the role of depression and cognitive reserve in the older adult’s experience of aging.     

Memory complaint as a predictor of cognitive decline: a comparison of African American and White elders

Of a representative, racially mixed community sample of older adults in North Carolina, 59% of Whites and 49% of African Americans reported worsening memory. The complaint about memory was positively correlated with age, depressive symptomatology, and physical function but not with level of cognitive function as measured by the Short Portable Mental Status Questionnaire (SPMSQ) at baseline. In a controlled analysis of longitudinal data, initial SPMSQ score, age, African American race, lower education, depressive symptomatology, and physical deficits at baseline, but not memory complaint, predicted a decline in cognitive function as measured by the SPMSQ 3 years later. Whereas African Americans were less likely to complain of deterioration in memory, actual decline as measured by the SPMSQ was greater for African Americans than for Whites.     

Prevalence and severity of urinary incontinence in older African American and Caucasian women.

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services. METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups. RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women. CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.     

Modifiable Factors on Use of Adaptive Strategies Among Functionally Vulnerable Older Persons

Providing adaptive strategies to offset functional limitation is common therapeutic practice with frail older adults in home care or rehabilitation. This study examines modifiable factors that influence the use of two types of adaptive strategies, environmental (assistive technology, home modifications) and behavioral (energy conservation, performance techniques). The sample included 154 functionally vulnerable elders, aged 70 years or older, who participated in a randomized trial that was implemented to improve daily function. Strategy use scores reflected the percentage of strategies utilized of those introduced in intervention. Hierarchical regression analyses revealed that a person’s enhanced readiness to change predicted environmental strategy use, whereas living alone and a person’s desire to learn new mobility skills predicted behavioral strategy use. Higher education was associated with behavioral strategy use for Whites but not for non-Whites, most of whom were African American. Other participant demographic and health related characteristics were not predictive of either strategy type. Findings show that predictors differ for each type of adaptive strategy, suggesting that training for use be tailored to strategy type and individual characteristics.     

Self-rated current and future health independently predict subsequent mortality in an aging population

BACKGROUND: Self-rated current health is an independent, robust predictor of subsequent mortality in older adults. Investigators hypothesize that individuals likely take into account their future health when reporting their current health. However, few have measured and examined self-rated future health in relation to mortality. METHODS: We investigate the effect of three self-rated health measures on 10-year mortality in 2091 men and women in an aging cohort: (i) self-rated current health, (ii) self-rated future health (1 year in the future), and (iii) a combined measure of current and future health. Vital status at follow-up year 10 was the outcome. We used data from SPPARCS (Study of Physical Performance and Age-Related Changes in Sonomans), a population-based, census-sampled, study of the epidemiology of aging, health, and functioning. RESULTS: Compared to those reporting their future health as better/same, participants reporting their future health as worse or unknown (don't know) experienced elevated 10-year mortality (adjusted rate ratio [RR]=1.6, 95% confidence interval [CI], 1.2-2.1, p=.01), after adjustment for self-rated current health and other relevant covariates. The combined measure of current and future health also contributed important information. Compared to the referent (the best combination, current health excellent/good and future health better/same), participants reporting the worst combination, fair/poor current health and worse/unknown future health, experienced the highest 10-year mortality in the cohort (adjusted RR=3.2, 95% CI, 2.2-4.7, p=.00). CONCLUSIONS: Self-rated future health is an independent, robust predictor of mortality. It is as predictive of subsequent mortality in older adults as the standard measure of self-rated current health. Furthermore, a measure that combines self-reports of current health with future health was most useful in the identification of older adults with the highest mortality rates. Thus, the combined measure of current and future health may be most useful in practice, in distinguishing the differential mortality rates among persons reporting fair or poor self-rated current overall health.     

Receipt of influenza and pneumonia vaccinations: the dual disparity of rural minorities

OBJECTIVES: To examine the receipt of age‐appropriate influenza and pneumococcal polysaccharide vaccinations (PPV), with particular attention to rural minority persons. DESIGN: Data were drawn from the 2005 Behavioral Risk Factor Surveillance System. The dependent variables were self‐reported receipt of annual influenza immunizations in adults aged 50 and older (n=177,417) or lifetime pneumococcal immunizations in adults aged 65 and older (n=81,762). The main independent variables were residence and race. MEASUREMENTS: All data are self‐reported. Multivariate analysis controlled for selected personal and county‐level characteristics. Analyses were conducted in 2009/10. RESULTS: Forty‐two percent of adults aged 50 and older reported an influenza vaccination; 31.1% of rural African Americans reported an influenza vaccination, and 64.6% reported a PPV. White and African‐American rural residents reported lower vaccination rates. Adjusted analysis indicated an interaction between race and rurality. White rural residents were more likely to be vaccinated than other whites, whereas rural African Americans were less likely to be vaccinated than urban African Americans. CONCLUSION: This study confirms previous findings while finding an interactive effect between rurality and race. The results indicated the importance of provider availability to delivery. Alternative delivery methods may be an effective solution to improve delivery rates.     

Identifying older Chinese immigrants at high risk for osteoporosis

BACKGROUND: Data about whether Asian Americans are a high-risk or a low-risk group for osteoporosis are limited and inconsistent. Few previous studies have recognized that the heterogeneity of the Asian American population, with respect to both nativity (foreign- vs U.S.-born) and ethnicity, may be related to osteoporosis risk. OBJECTIVE: To assess whether older foreign-born Chinese Americans living in an urban ethnic enclave are at high risk of osteoporosis and to refer participants at high risk for follow-up care. DESIGN: Cross-sectional survey and osteoporosis screening, undertaken as a collaborative project by the Chinese American Service League and researchers at the University of Chicago. SETTING: Chicago's Chinatown. PARTICIPANTS: Four hundred sixty-nine immigrant Chinese American men and women aged 50 and older. MEASUREMENTS AND MAIN RESULTS: Chinese Americans in this urban setting are generally recent immigrants from south China with limited education and resources: mean age at immigration was 54, 56% had primary only or no education, and 57% reported "fair" or "poor" self-rated health. Eighteen percent are uninsured and 55% receive Medicaid. Bone mineral density (BMD) of the calcaneus was estimated using quantitative ultrasound. Immigrant Chinese women in the study had lower average BMD than reference data for white women or U.S.-born Asian Americans. BMD for immigrant Chinese men in the study was similar to white men at ages 50 to 69, and lower at older ages. Low body mass index, low educational attainment and older age at immigration were all associated with lower BMD. CONCLUSIONS: Foreign-born Chinese Americans may be a high-risk group for osteoporosis.