Physical hardiness and styles of socioemotional functioning in later life

Although the aging literature suggests that there are many paths to later life adjustment, there have been few empirical attempts to identify different patterns of adaptation, or their relation to adaptive outcome. As a way to identify patterns of socioemotional functioning in later life associated with physical hardiness, a cluster analysis was applied to 11 measures of socioemotional functioning in a large sample (N = 1,085) of older adults (65-86 years). Ten subgroups were extracted, with clusters of individuals being primarily defined by social network variables, religious characteristics, and emotion profiles. Groups were then compared on a measure of physical hardiness. Patterns of adaptation characterized by high levels of negative emotions tended to represent less hardy adaptation, although there were nonetheless some patterns of noteworthy exception. In contrast, however, patterns of adaptation characterized by religiosity were typically associated with greater hardiness. Finally, physical hardiness was not exclusively the province of individuals exhibiting close social networks, with some groups high in connectedness being less likely to report high hardiness.     

Sex and age cohort differences in patterns of socioemotional functioning in older adults and their links to physical resilience

Although the aging process brings with it some common challenges to older men and women, there has been little attention to gender differences in patterns of socioemotional functioning or their links to adaptive outcome. In this paper we examine patterns of socioemotional functioning among 687 “younger” (65–73 years) and 426 “older” (74–86 years) men and women, describe sex differences in these patterns, and examine whether the same patterns are linked to physical resilience in the same ways across groups. Cluster analysis was applied to 11 measures of socioemotional functioning with ten qualitatively different patterns emerging. As expected, men and women from our two age groups were not equally distributed across the patterns. As expected, older men more frequently manifested patterns of adaptation characterized by inhibited emotion but, together with younger men, were less likely to be represented in patterns characterized by stress-buffering friend support networks. The patterns also showed predictable links to a measure of physical resiliency, which was predicted by participant sex, and both sex and age interacted with cluster membership in predicting resiliency. Taken together, these data underscore the complexity of adaptation to later life among men and women and highlight the possibility that the existence of particular patterns of later life adaptation may have differing late life consequences for older men and women. Implications for the continued study of sex differences in adaptation to later life and directions for future research are given. Nathan S. Consedine has a faculty appointment in the Psychology Department at Long Island University and is deputy director of the Intercultural Institute on Human Development and Aging. His research training centered on evolutionary functionalism and its applications to personality and goal striving. He has since turned the ideas developed during this time to the lifespan developmental consideration of emotions, emotion regulation, and adaptive outcomes among diverse ethnic groups. She is a Fellow of the American Psychological Association, the Gerontological Society of America, and the International Society of Research on Emotion. She is also the founding director of the Intercultural Institute on Human Development and Aging. The Institute is devoted to research, training, and consultation on the role of culture in health and human development. Yulia S. Krivoshekova is a research associate and project coordinator at the Intercultural Institute on Human Development and Aging and is currently in her fifth year of clinical training in the Psychology Department at Long Island University (Brooklyn). Her research is focused on the cognitive and health-related consequences of self-disclosure processes, with an emphasis on developmental differences and cultural variation.     

Not quite color blind: ethnic and gender differences in attitudes toward older people among college students

Attitudes toward older people can influence how they are treated and their cognitive and physical health. The populations of the United States and many other countries have become more ethnically diverse, and are aging. Yet little research examines how ethnic diversity affects attitudes toward older people. Our study addresses this research gap. Using the Aging Semantic Differential, 592 university students expressed their attitudes toward older African-American, Hispanic, and White women and men. Repeated measures analysis of variance examined attitude differences by participant ethnicity and gender, and by the ethnicity and gender of evaluated individuals. Both African-American and White students had more positive attitudes toward older women and men of their own ethnic group. Participants had more positive attitudes toward older women than they did toward older men. Findings suggest in-group favoritism, and the usefulness of training those in service industries and public service to treat older individuals equitably.     

The uncharted waters of emotion: Ethnicity, trait emotion and emotion expression in older adults

Emotions are central to contemporary theories of health, and a growingbody of psychological research has shown emotion and emotion regulatorystyles to be predictive of health outcomes. Yet despite these clear links andthe fact that patterns of emotion and expression are partially a product ofculture, there is a meager literature on the emotional characteristics ofdifferent ethnic groups. Even where ethnicity has been investigated inemotions research, it has typically been operationalized in such a way thatwithin-group differences are obscured with most individuals assigned tobroad ethnic categories, such as non-Hispanic White, or Black. In thepresent study we draw on data from a multi-ethnic sample of 755community-dwelling older adults to parse a picture of the emotionalcharacteristics of three of the largest and most culturally distinct ethnicgroups in the Northeastern United States: African Americans, West Indians (Jamaicans), andEastern Slavs (Russians and Ukrainians) from the former Soviet Republic,as well as a comparison group of US-born European Americans. Aspredicted, there were striking differences in nine of 10 trait emotions aswell as in levels of emotion expressed during conflict. The findings arediscussed in terms of emotion socialization and implications for predictionand intervention in psychosocial models of emotions, emotion regulation,and health in older ethnic populations.     

Social conditions and distress in elderly persons: findings from the MacArthur Studies of Successful Aging

The purpose of this study was to determine separate and joint associations of race/ethnicity and socioeconomic status (SES) with psychological distress among older high-functioning adults and to examine 2 psychosocial resources that may explain these associations. Participants were 70-79-year-old individuals (n = 1,189) participating in the MacArthur Studies of Successful Aging program, a 3-site study of community-dwelling men and women. Participants represented the top third of their peers in terms of functional ability in 1988. Additive and interactive models were used to examine cross-sectional associations among race/ethnicity, SES, and distress. Although decreases in distress generally occur with aging, findings suggest that social structural factors can influence distress even among elderly people. Blacks were less distressed than Whites when SES was controlled. There was a gradient between education and distress among Whites but not among Blacks. Measures of social support and control did not mediate effects of race/ethnicity on distress. These results differ from those of previous studies and indicate that age and functional status should be considered in examinations of relationships among race/ethnicity, SES, and distress.     

Ethnic variation in the impact of negative affect and emotion inhibition on the health of older adults

The relations between patterns of emotional experience, emotion inhibition, and physical health have been little studied in older adults or ethnically diverse samples. Testing hypotheses derived from work on younger adults, the authors examined the relations between negative affect and emotion inhibition and that of illness (hypertension, respiratory disease, arthritis, and sleep disorder) in a sample (N = 1,118) of community-dwelling older adults from four ethnic groups: U.S.-born African Americans, African Caribbeans, U.S.-born European Americans, and Eastern European immigrants. Participants completed measures of stress, lifestyle risk factors, health, social support, trait negative emotion, and emotion inhibition. As expected, the interaction of ethnicity with emotion inhibition, and, to a lesser extent, negative affect, was significantly related to illness, even when other known risk factors were controlled for. However, the relations among these variables were complex, and the patterns did not hold for all types of illness or operate in the same direction across ethnic groups. Implications for emotion-health relationships in ethnically diverse samples are discussed.     

Religious and spiritual involvement among older african americans, Caribbean blacks, and non-Hispanic whites: findings from the national survey of american life

OBJECTIVES: The purpose of this study was to examine similarities and differences in religious involvement among three groups of older adults-African Americans, Caribbean Blacks, and non-Hispanic Whites. METHODS: We used data from the National Survey of American Life, a nationally representative household study of African Americans and Caribbean Blacks with a national sample of non-Hispanic Whites who reside in areas (census tracks and block groups) at least 10% African American. We examined demographic correlates of 16 measures of organizational, nonorganizational, subjective religiosity, as well as religious coping and spirituality. RESULTS: The findings indicated that older African Americans and Caribbean Blacks reported higher levels of religious participation, religious coping, and spirituality than older Whites. We observed few significant differences between older African Americans and older Caribbean Blacks. Gender, age, marital status, income, education, marital status, and region all exhibited significant influences on religious participation and spirituality. DISCUSSION: Racial groups within the older population present distinctive profiles of religious participation and spirituality. The demographic correlates of religious involvement and spirituality are consistent across a variety of diverse dimensions and measures.     

Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

BACKGROUND AND AIMS: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. METHODS: We used the S?o Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and comorbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. RESULTS: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/ Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32-3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41-2.38 in women; OR= 3.42; 95% CI 2.41-4.86 in men). CONCLUSIONS: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.     

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.     

Ethnically diverse older adults' beliefs about staying mentally sharp

This study examined diverse older adults' (n = 396, ages 50+) views about how to stay mentally sharp. We conducted 42 focus groups in four languages at nine United States locations using a standardized discussion guide and methods. The groups represented African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos, and Vietnamese Americans. All groups mentioned benefits of social interaction. All groups, especially Chinese and African Americans, mentioned benefits of community engagement. Participants in all groups expressed their belief that mental stimulation, particularly reading, promoted cognitive health; African Americans and Whites were especially likely to say that mental exercises (e.g.; puzzles) were useful. Results suggest opportunities for education about potential cognitive health benefits of being socially connected through senior center activities and volunteer programs.     

Hospice usage by minorities in the last year of life: results from the National Mortality Followback Survey

OBJECTIVES: To examine racial/ethnic variations in rates of hospice use in a national cohort and to identify individual characteristics associated with hospice use. DESIGN: Secondary analysis of the 1993 National Mortality Followback Survey (NMFS), a nationally obtained sample using death certificates and interviews with relatives (proxy respondents) to provide mortality, social, and economic data and information about healthcare utilization in the last year of life for 23,000 deceased individuals. SETTING: Hospice care. PARTICIPANTS: Individuals aged 15 and older who died in 1993. Subjects were included in this analysis if they died of nontraumatic causes (N = 11,291). MEASUREMENTS: Hospice use was dichotomized by proxy responses indicating use or nonuse of home or inpatient hospice services. The percentage of individuals using hospice services in the last year of life was calculated. RESULTS: Unadjusted bivariate results found that African Americans were less likely to use hospice than whites (odds ratio (OR) = 0.59; P <.001) and that those without a living will (LW) (OR = 0.23; P <.001) and without a cancer diagnosis (OR = 0.28; P <.001) were less likely to use hospice. The negative relationship between African Americans and hospice use was unaffected when controlled for sex, education, marital status, existence of a LW, income, and access to health care. Logistic models revealed that presence of a LW diminished the negative relationship between African Americans and hospice use, but the latter remained significant (OR = 0.83; P =.033). A subanalysis of subjects aged 55 and older showed a significant interaction between access to care and race/ethnicity with respect to hospice use (P =.044). Inclusion of income in this multivariable logistic model attenuated the relationship between African-American race/ethnicity and hospice use (OR = 0.77), and the difference between whites and African Americans became only marginally statistically significant (P =.060). CONCLUSION: In the 1993 NMFS, hospice use was negatively associated with African-American race/ethnicity independent of income and access to healthcare. The relationship is not independent of age, insurance type, or history of stroke. For subjects aged 55 and older, access to healthcare may be an important confounder of the negative relationship between African-American race/ethnicity and hospice use. Consistent with previous studies, this analysis found that African Americans were less likely to use LWs than whites. The reduced importance of African-American race/ethnicity on hospice use with the inclusion of presence of a LW in logistic models suggests that similar cultural processes may shape differences between African Americans and whites in advance care planning and hospice use.     

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.     

Social and Religious Support on Treatment Adherence Among HIV/AIDS Patients by Race/Ethnicity

Abstract

Using data from the second follow-up of the HIV Cost and Services Utilization Study (HCSUS), we investigated the influence of social and religious support variables on treatment adherence for Whites, African American and Hispanic HIV patients. Study results show differential effects of social, religious support and background variables on treatment adherence. In general, for Whites, background variables such as educational levels and age were found to be significant variables affecting treatment adherence, in addition to some religious support variables. On the other hand, for African Americans and Hispanics, religious and social support variables were influential. Results also suggest that strategies to improve treatment adherence may vary for different race/ethnic groups. The study highlights the importance of working with and involving religious organizations in an effort to increase adherence and support to HIV-infected members, particularly among African Americans and Hispanic communities.     

Cognitive abilities: use of family data as a control to assess sex and age differences in two ethnic groups.

Four cognitive factors were extracted from test data obtained on 997 families (3,268 individuals) in Hawaii. Factor loading profiles for the two largest ethnic groups (Caucasians and Japanese) are nearly identical, as are profiles for three different age groups. Age curves are presented for factor scores and for four specific cognitive tests. The younger respondents on the age curves are biological offspring of older respondents represented on the same curves, facilitating an unusual control for between-family variance. When the data were stratified by ethnicity, differential rates of cognitive development were indicated.     

Barriers to eligibility and enrollment among older women in a clinical trial on osteoporosis: effects of ethnicity and SES

OBJECTIVES: The study examined whether ethnicity or socioeconomic status influenced a group's ability to meet eligibility criteria and willingness to enroll. METHOD: The eligibility and enrollment status of 904 women aged 65 years and older who responded to recruitment efforts of an estrogen and osteoporosis clinical trial were analyzed. RESULTS: Among women screened, 59% were White, 27% African Americans, and 14% Hispanics; average age was 75 years; 57.6% were eligible, of which 32% enrolled. High-income area residents were more likely to be eligible than low-income residents. African Americans were less likely to be eligible for medical reasons than non-African Americans. Eligible Hispanics were more likely to be enrolled than non-Hispanics. African Americans were equally willing to enroll as Whites. Minority residents of low-income areas were more likely to enroll than minority residents of high-income areas. DISCUSSION: Recruitment efforts should address barriers to eligibility and barriers to willingness to enroll.     

Willingness to participate in clinical treatment research among older African Americans and Whites

PURPOSE: Using a health services utilization conceptual framework, the purpose of this analysis was to examine race differences in factors predictive of the behavioral intention of older persons to participate in a clinical treatment trial should they have a diagnosis of cancer. In addition, the analysis sought to determine if older African Americans were less likely than Whites to express willingness to participate, given knowledge of the Tuskegee syphilis study and greater fatalistic cancer beliefs. DESIGN AND METHODS: Data were drawn from a community-based telephone survey of 216 African Americans and 222 Whites, 50 years of age and older. RESULTS: Findings show that willingness to participate was significantly higher among males, persons of younger age, higher incomes, and with nonfatalistic cancer beliefs. Race differences were only apparent for the two significant interactions of race with age and high income. Neither knowledge of the Tuskegee study nor fatalistic cancer beliefs were more important for African Americans than for Whites. IMPLICATIONS: Study findings suggest that recruitment strategies need to be tailored to racial differences in factors affecting willingness to participate, particularly those related to age and income level.     

Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey

BACKGROUND: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. METHODS: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. RESULTS: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. CONCLUSIONS: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.     

Racial and ethnic differences in use of assistive devices for mobility: effect modification by age

Purpose: The authors investigated the extent to which differences in mobility device use existed by race/ethnicity and whether the effects were modified by age. Method: Using Phase II of the National Health Interview Survey on Disability, the authors identified 7,148 mobility-impaired adults. Logistic regression models provided estimates of race/ethnicity, adjusting for predictors of device use. Results: Blacks were 1.2 times as likely as non-Hispanic Whites (95% CI: 1.0-1.4) to use devices. Hispanics were 0.78 times less likely to use devices as were non-Hispanic Whites (95% CI 0.65-0.96). Differences were attenuated by age, with a 40% increased likelihood of use attributable to being Black and aged 45 to 75, a 30% increased likelihood attributable to being Hispanic and aged 65 to 75, and a 130% increased likelihood attributable to being Hispanic and older than 75. Conclusion: Disentangling the observed patterns in mobility device use will provide direction for development of interventions to promote assistive device use.