Intersectional Approaches to Minority Aging Research

Re-thinking the Concept of Cultural Competency in Nursing Care of Older Adults

The influx of migrants to Canada has resulted in a shift in the country's demographic landscape. Individuals often interpret and approach health and wellness through the lens of their cultural heritage, which has led to stereotyping behaviors and discriminatory practices, exacerbating the notion of "Othering". Immigrant older adults are likely to experience discrimination in a more dreadful way in the form of societal isolation and marginalization due to the collective systems of power such as ageism, ableism, and racism. This paper results from continuous thought-provoking discussions initiated by the first author (AM) in her doctoral program at the University of Western Ontario for the Philosophy of Nursing Science course, taught and facilitated by the second author (SM). After studying the course materials on "revolutionary science" and reflection on the process of paradigm shift introduced by Thomas Khun and engaging in critical discussions on a range of relevant philosophical concepts such as bio-power, othering, silencing and ignorance, marginalization, oppression, neoliberalism, health equity, and social justice, we have been prompted to rethink the concept of cultural competence in nursing education and healthcare practices, particularly in the context of nursing care of older adults. Therefore, in this paper, we will critique the concept of cultural competency in the context of an anti-racist and anti-oppressive lens and suggest a pivotal response to move towards an inquiry-driven approach based on cultural humility and respect in the nursing care of older adults.

The Relationship Between Race and Obesity Among Non-Hispanic White and Non-Hispanic Black Men by Education Level

Prior disparities in obesity research emphasize socioeconomic status as a potential driver of White-Black differences in obesity prevalence, but there is a paucity of research examining the influence of education on the observed racial difference among men. The objective of this study was to determine whether the relationship between race and obesity varies by education level among Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) men. We used 1999 to 2016 National Health and Nutrition Examination Survey data consisting of a sample of 13,583 men (9,459 NHW and 4,124 NHB). Race and Ethnicity were determined by self-reports of whether they were Hispanic or not and their racial group. Education was based on self-reporting of the highest grade level or level of school completed and categorized as: less than high school, high school diploma or General Equivalency Diploma, some college or associate degree, and college degree or above. Thirty-four percent of the men were obese (body mass index [BMI] > 30 kg/m2); a higher proportion of NHB men reported being obese than NHW men (36.0%, n = 1,508, vs. 33.8%, n = 3,140; p = .049). Adjusting for age, marital status, income, insurance status, smoking status, drinking status, self-rated health, physical inactivity, and the number of chronic conditions, NHB men with a college degree or above had a higher prevalence of obesity (prevalence ratio: 1.21, confidence interval [1.06, 1.39]) than NHW men. Findings suggest that among college-educated NHW and NHB men, there is a relationship between race/ethnicity and obesity prevalence.

Mental health outcomes and loneliness in older transgender individuals receiving long-term gender-affirming hormone therapy compared with older cisgender individuals

OBJECTIVES

Many older adults experience mental health challenges and loneliness which negatively affect other health aspects. This data is largely lacking in older transgender adults. This study aimed to determine differences in depressive symptoms, anxiety and loneliness between older transgender individuals receiving gender-affirming hormone therapy (GHT), and cisgender (non-transgender) individuals, and to assess the contribution of financial, psychological, somatic, and social-contact related factors.

DESIGN

Cross-sectional.

SETTING

Gender identity clinic; general population.

PARTICIPANTS

Seventy-two transgender women and 39 transgender men (56-84 y) receiving GHT for ≥ 10 y, age-matched 1:3 with cisgender women and men from the general population.

MEASUREMENTS

Depressive symptoms, anxiety and loneliness were assessed with questionnaires. Differences were compared using linear regression analyses with log-transformed variables, and back-transformed for presentation. Additionally, models were adjusted for financial, psychological, somatic and social-contact related factors.

RESULTS

Transgender women scored higher than cisgender women and cisgender men, respectively, on depressive symptoms (1.92, 95 % confidence interval (CI) 1.52-2.42; 2.66, CI 2.11-3.37), anxiety (1.43, CI 1.17-1.75; 1.89, CI 1.54-2.32) and loneliness (2.42, CI 1.96-2.97; 2.32, CI 1.92-2.82). Transgender men scored higher than cisgender men on depressive symptoms (2.10, CI 1.50-2.94), anxiety (1.67, CI 1.27-2.19) and loneliness (1.50, CI 1.16-1.93), and higher than cisgender women on loneliness (1.57, CI 1.20-2.05). These differences were largely explained by differences in financial, psychological, somatic and social-contact related factors.

CONCLUSIONS

Mental health outcomes and loneliness are compromised in older transgender individuals compared to cisgender individuals, particularly in transgender women. The socio-economic, psychological and somatic risk factors identified warrant further research and awareness.

Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States

OBJECTIVES

To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status.

METHODS

Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics.

RESULTS

Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier.

DISCUSSION

Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.

Interpersonal discrimination and depressive symptoms among older Black and African American adults

To examine the association between recent experiences of discrimination and depressive symptom presentation and severity among a U.S. sample of older Black and African American adults. A cross-sectional survey of 124 Black and African American adults aged 50 and older in the United States was conducted assessing interpersonal discrimination and depressive symptoms. The Perceived Ethnic Discrimination Questionnaire assessed four forms of interpersonal discrimination. A measure of heightened vigilance to bias assessed anticipatory coping with discrimination experiences. Past-month affective and somatic symptoms of depression were assessed using the Depressive and Somatic Symptoms Scale. All forms of interpersonal racial discrimination were positively associated with greater affective symptom severity. Being avoided, devalued, and threatened or actively physically harmed were associated with greater somatic symptom severity. Vigilant coping was positively associated with affective symptom severity but not somatic symptom severity. Racial discrimination is linked to depression severity among older Black and African American and varies by symptom. This study helps inform work on processes linking discrimination with poorer psychological outcomes and will allow for more effective interventions and prevention efforts that are tailored to older minority populations.

[Suicide and medical practices: Assessing the way of life among Colombian coffee-growing rural men in mental health care]

The aim was to understand the way of life and self-care practices in mental health among adult male farmers living in a municipality in the Risaralda department, located in the coffee axis of Colombia, marked by a high incidence of suicides. An ethnographic study was conducted between March and December 2021, employing a combination of methods including interviews, participant observation, document review, and field diaries. Economic and social aspects undergoing transformations were identified, impacting gender roles, family dynamics, and caregiving possibilities for these men. By observing how men discuss their suffering and the resources available to address it, it can be concluded that mental health practices function more as self-care resources, while health services often provide symptom-based care, neglecting attentive listening. These findings are valuable for shaping services and life care strategies that align with the conditions of rural men in Colombia.

Emotion Regulation in Couples Across Adulthood

Intimate relationships are hotbeds of emotion. This article presents key findings and current directions in research on couples' emotion regulation across adulthood as a critical context in which older adults not only maintain functioning but may also outshine younger adults. First, I introduce key concepts, defining qualities (i.e., dynamic, coregulatory, bidirectional, bivalent), and measures (i.e., self-report versus performance-based) of couples' emotion regulation. Second, I highlight a socioemotional turn in our understanding of adult development with the advent of socioemotional selectivity theory. Third, I offer a life-span developmental perspective on emotion regulation in couples (i.e., across infancy, adolescence and young adulthood, midlife, and late life). Finally, I present the idea that emotion regulation may shift from "me to us" across adulthood and discuss how emotion regulation in couples may become more important, better, and increasingly consequential (e.g., for relationship outcomes, well-being, and health) with age. Ideas for future research are then discussed.