Aging and Disability Among Hispanics in the United States: Current Knowledge and Future Directions

Racial/Ethnic Differences in Self-Reported Upper Limb Limitations Among U.S. Older Adults

BACKGROUND

The development of disability related to activities of daily living (ADL) is of great concern in the aging population, particularly for Hispanic and Non-Hispanic (NH) Black older adults, where disability prevalence is greater compared to NH Whites. ADL-disability is typically measured across many functional tasks without differentiating upper- versus lower-limb limitations, hindering our understanding of disability burden. Despite the importance of the upper limbs for completing ADL and known age-related declines in function, racial/ethnic differences in upper limb function remain largely unknown.

METHODS

We identified 4 292 NH White, NH Black, and Mexican American older adults (≥65) from the 2011-2018 waves of the National Health and Nutrition Examination Survey (NHANES). We classified participants as having a limitation based on their ability to complete 5 upper-limb tasks (preparing meals, eating, dressing, reaching overhead, and grasping small objects) and compared limitation rates across racial/ethnic groups.

RESULTS

Compared to NH Whites, NH Black older adults had significantly greater odds of reporting difficulties preparing meals (odds ratio [OR]: 1.36, 95% confidence interval [95% CI]: 1.01, 1.86) and dressing (OR: 1.55, 95% CI: 1.19, 2.02), while Mexican Americans had greater difficulty preparing meals (OR: 1.70, 95% CI: 1.12, 2.58), dressing (OR: 1.63, 95% CI: 1.12, 2.36), and grasping small objects (OR: 1.48, 95% CI: 1.06, 2.07).

CONCLUSIONS

Our results demonstrate differences in self-reported upper limb ADL-disability across racial/ethnic groups, particularly for Mexican American older adults. Such findings underscore the need for routine monitoring of upper limb function throughout adulthood to identify limitations and target therapeutic interventions before independence is compromised.

A Scoping Review to Contribute to Knowledge About Culturally Adapting Interventions for Latino Family Caregivers of Persons Living With Dementia

INTRODUCTION

Few interventions have focused on Latino family caregivers to persons with dementia, addressing their unique needs. This review aimed to identify best practices in cultural adaptation to make recommendations for adapting interventions for Latino family caregivers of persons living with dementia.

METHOD

This scoping review was conducted following the Joanna Briggs Institute Scoping Review guidelines, with findings extracted and summarized from 17 studies addressing cultural adaptation.

RESULTS

Frameworks guiding the adaptations were comprehensive, addressing cultural values and traditions and the social context faced by Latino family caregivers. Features of the adaptations included diverse teams of researchers and community members, including Latino family caregivers, to inform the integration of cultural values into the content, mode, and place of intervention delivery.

DISCUSSION

Culturally adapting evidence-based interventions will increase the number of available interventions for Latino family caregivers to persons living with dementia, thus reducing inequities in caregiver support.

Primary care and community partnerships to promote age-friendly care for Hispanic older adults

BACKGROUND

Healthcare and community collaborations have the potential to address health-related social needs. We examined the implementation of an educational initiative and collaborative intervention between a geriatric clinic and Area Agency on Aging (AAA) to enhance age-friendly care for a Hispanic patient population.

METHODS

As part of a Health Resources and Services Administration (HRSA)-funded Geriatric Workforce Enhancement Program, a geriatric clinic partnered with AAA to embed an English- and Spanish-speaking Social Service Coordinator (SSC). The SSC met with patients during new and annual visits or by referral to address What Matters and Mentation in the patient's primary language, provide education, and make social service referrals. Patients aged 60 and older, who received SSC services during a 12-month period, were defined as the intervention group (n = 112). Using a retrospective chart review, we compared them to a non-intervention group (n = 228) that received primary care. We examined available demographic and clinical data within the age-friendly areas of What Matters and Mentation. Measures included cognitive health screenings, advance care planning, patient education, and community referrals.

RESULTS

Most of the intervention groups were eligible for AAA services and had the opportunity for service referrals to address identified needs. A higher proportion of patients within the intervention group completed screenings for cognitive health and advance care planning discussions.

CONCLUSION

Interagency partnerships between ambulatory care settings and community-based organizations have the potential to expand access to linguistically and culturally competent age-friendly primary care for older adults.

Disparities in Stress Exposure and Later-Life Disability

Background and Objectives

Drawing from cumulative inequality theory and the weathering hypothesis, this study examined the relationship between life-course stress exposure (measured cumulatively and by domains) and the onset of disability in later life among White, Black, U.S.-born Hispanic, and foreign-born Hispanic older adults.

Research Design and Methods

Cross-sectional and longitudinal models were estimated using nationally representative data from the Health and Retirement Study (N = 11,483). We used logistic regression models to examine associations between stress exposure and Wave 1 disability (i.e., occurrence), and Weibull-accelerated failure-time models to examine the relationship between stress exposure and age of onset of disability 12-14 years later (i.e., incidence). We tested for moderation between stress and disability by race, ethnicity, and Hispanic nativity.

Results

At Wave 1, higher odds of disability occurrence were associated with cumulative stress burden (CSB; odds ratio [OR] = 4.93, 95% confidence interval [CI]: 2.95-8.23). In a model specifying domains of stressors, disability occurrence was associated with childhood financial strain (OR = 1.22, CI: 1.01-1.46), lifetime traumatic events (OR = 1.92, CI: 1.41-2.62), neighborhood disadvantage (OR = 1.32, CI: 1.01-1.73), and major lifetime discrimination (OR = 1.64, CI: 1.12-2.41). Over time, earlier onset of disability was associated with CSB (β = -0.39), childhood traumatic events (β = -0.16), adult financial strain (β = -0.17), everyday discrimination (β = -0.15), and major lifetime discrimination (β = -0.13). The effect of childhood traumatic events on the transition to disability was stronger for U.S.-born Hispanic adults than White adults (occurring 33% earlier).

Discussion and Implications

To reduce racial, ethnic, and nativity disparities in disability, it is important to consider the historical and structural disadvantages associated with stress exposure across the life course. It is also important to acknowledge that nativity influences stratification processes associated with disparities in racial and ethnic health trajectories.

Disability Among Older Immigrants in the United States: Exploring Differences by Region of Origin and Gender

Rapid aging in American society will be disproportionately concentrated among the foreign-born. Immigrants in the United States (U.S.) are a heterogeneous population, yet little is known regarding their differences in disability later in life by region of origin. We use data from the National Health Interview Survey on respondents ages 60+ (n = 313,072) and employ gender-specific logistic models to predict reports of any activity of daily living (ADL) disability. After accounting for socioeconomic factors, compared to their U.S.-born non-Hispanic (NH) White counterparts, the odds of reporting ADL disability were higher among U.S.-born respondents that are Hispanic, NH Black, and NH Multiracial as well as respondents with Mexican, Puerto Rican, Cuban, Russian/former Soviet, Middle Eastern, East Asian, and South Asian origins. Also, Dominican, African, and Southeast Asian women-and European men-reported high odds of ADL disability. Our results highlight heterogeneity in the disability profiles of foreign-born older adults in the U.S..

Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.

Life-space mobility and post-hospitalization outcomes among older Mexican American Medicare beneficiaries

BACKGROUND

Older adults with limited mobility are at an increased risk of adverse health outcomes, an outcome inadequately investigated in older Mexican Americans. We explored whether pre-admission life-space mobility predicts post-hospitalization outcomes among hospitalized Mexican American Medicare beneficiaries.

METHODS

Life-space mobility, using the Life-Space Assessment (LSA), was analyzed using quartiles and 5-point intervals. Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE) Waves 7 and 8 data linked to Medicare claims data, 426 older Mexican Americans with at least 2 months of Medicare coverage who were hospitalized within 2 years of completing the LSA were included. Logistic and Cox Proportional regression analyses estimated the association of pre-admission LSA with post-hospitalization outcomes.

RESULTS

Prior to hospitalization, 85.4% reported limited life-space mobility. Most patients (n = 322, 75.6%) were hospitalized for medical reasons. About 65% were discharged to the community. Pre-admission LSA scores were not associated with community discharge (Odds Ratio [OR] = 1.02, 0.95-1.10). Higher pre-admission LSA scores were associated with 30-day readmission (OR = 1.11, 1.01-1.22). Patients in the highest pre-admission LSA quartile (i.e., greatest life-space mobility) were less likely to die within 2 years after hospital discharge (OR = 0.61, 0.39-0.97) compared to those with lower pre-admission LSA scores.

CONCLUSIONS

Among older Mexican American Medicare beneficiaries, greater pre-admission LSA scores were associated with an increased risk of 30-day readmission and a decreased risk of mortality within 2 years following hospitalization. Future work should further investigate the relationship between LSA and post-hospitalization outcomes in a larger sample of Mexican American older adults.

The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature

OBJECTIVE

Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan.

METHOD

Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin).

RESULTS

A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults.

CONCLUSIONS

Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.

Care Needs and Arrangements of Aging Immigrants in the United States

OBJECTIVES

To examine the need for and arrangements pertaining to personal care assistance among individuals 65 and older, and how life stage at migration impacts nativity differences in aging-related care.

METHODS

Using data from the Survey of Income and Program Participation (2001, 2004, and 2008), I examine the odds of needing care assistance, who provides care assistance, and the duration of time care assistance is needed, comparing U.S.-born individuals to migrants who arrived before age 50 ("earlier-life migrants") and those who arrived after age 50 ("later-life migrants").

RESULTS

While earlier-life migrants showed similar patterns to U.S.-born, later-life migrants showed higher care needs, were more likely to receive care from an adult child, and were particularly likely to need care for longer durations compared to U.S.-born.

DISCUSSION

Aging later-life migrants have strikingly distinct care needs and arrangements, with implications for individual and family well-being, especially considering their barriers to public support.

Arthritis, physical function, and disability among older Mexican Americans over 23 years of follow-up

OBJECTIVE

Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time.

DESIGN

A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility - disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity.

RESULTS

Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09-1.68] and mobility (OR = 1.34, 95% CI = 1.18-1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value < .010).

CONCLUSIONS

Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up.

Cognitive Disability Among Arab Americans by Nativity Status and Arrival Year: Lack of Evidence for the Healthy Migrant Effect

Limited research exists on cognitive disabilities among Arab Americans, especially as it relates to arrival year among the foreign-born. The objectives of this study were to estimate the age- and sex-adjusted prevalence and associations of cognitive disability by (1) nativity status and (2) arrival year (pre-1991, 1991-2000, 2001-2013, and 2014-2018). We analyzed 11 years (2008-2018) of data from the American Community Survey (ACS) Public Use Microdata Samples (weighted n = 264,086; ages ≥ 45 years). Weighted means, percentages, age- and sex-adjusted prevalence estimates, and logistic regression results (crude and adjusted) were calculated. Among all Arab Americans, the age- and sex-adjusted prevalence of cognitive disability was 6.5%. The prevalence was lower for US-born (4.0%) compared to foreign-born (6.0%) (p-value < 0.0001). In logistic regression results, foreign-born Arab Americans were more likely to have a cognitive disability compared to US-born Arab Americans after adjusting for age and sex (OR = 1.41; 95% CI = 1.24, 1.61). Among foreign-born, Arab Americans arriving in 2014 or later had a lower prevalence of cognitive disability (3.4%) compared to all other arrival years at approximately 4.7%. With those arriving prior to 1991 as the reference category, those arriving between 1991 and 2000 were more likely to report a cognitive disability (OR = 1.05; 95% CI = 1.00, 1.08). However, those arriving between 2014 and 2018 were less likely to report a cognitive disability (OR = 0.81; 95% CI = 0.73, 0.88). These findings challenge the universality of the "healthy migrant effect" and highlight the relevance of socioeconomic disparities for Arab American cognitive health.

Functional Limitations and Physical Health in Community-Dwelling Medicare Advantage Beneficiaries: Variation by Race and Hispanic Subgroup

Objectives: The objective is to examine racial and ethnic heterogeneity in older adults' functional limitations and physical health. Methods: Data were from 2011 to 2015 Health Outcomes Survey of Medicare Advantage beneficiaries 65 and older (N = 828,946). Outcomes were Physical Component Summary (PCS) scores and need for assistance with activities of daily living (ADLs). Six non-Hispanic racial groups and five Hispanic subgroups were analyzed. Regression models adjusted for sociodemographic and health characteristics. Results: White and Asian respondents had the lowest unadjusted ADL difficulty rates and highest PCS scores. In adjusted analyses, Cuban respondents had the highest PCS scores and lowest rates of any ADL difficulty; White respondents had the lowest rates of specific ADL difficulties. Native Hawaiian or other Pacific Islander and multiple Hispanic respondents had the highest ADL difficulty rates. Discussion: Both the healthiest and highest need subgroups of Medicare Advantage beneficiaries were Hispanic. Understanding racial and ethnic subgroup differences may help target interventions to prevent or aid with functional limitations.

Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study

Background

Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living.

Objective

This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living.

Methods

This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis.

Results

The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes.

Conclusions

The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder.

Demographic and Health Characteristics of Older Latino Birth Cohorts in the Health and Retirement Study

OBJECTIVES

Latinos are the fastest aging racial/ethnic minority group in the United States. One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos.

METHODS

We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of five entry birth cohorts of older Latinos aged 51-56 years (n = 2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the HRS birth cohorts.

RESULTS

Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity.

DISCUSSION

Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population.

Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study

BACKGROUND

Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE

We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS

We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS

After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION

Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

The Influence of Race and Gender on Receiving Assistance with Daily Activities among Older Americans

Background and Objectives

Nearly 8.2 million community-dwelling, older Medicare beneficiaries receive support from long-term services and supports (LTSS) with routine daily activities. Prior work demonstrates disability-related disparities; however, it is unclear whether these patterns persist among LTSS recipients and across specific sets of activities. We examine race and gender differences in receiving help with self-care (e.g., eating), mobility (e.g., getting around the house), and household (e.g., shopping) activities in a nationally representative sample of community-dwelling Medicare beneficiaries receiving LTSS.

Research Design and Methods

Cross-sectional analysis of 1,808 White and Black older adults receiving assistance with routine daily activities in the 2015 National Health and Aging Trends Study. Bivariate statistics were used to describe the sample and provide comparisons of characteristics by race and gender. Logistic regression models examined race and gender differences in receiving assistance with self-care, mobility, and household activities after adjusting for sociodemographic and health characteristics.

Results

Race and gender differences were observed across all sociodemographic and health characteristics, as well as for all forms of assistance. Relative to White men, Black men had lower odds of receiving help with self-care activities. White and black women had higher odds and Black men had lower odds of getting help with mobility activities than White men. Black men and White and Black women all had higher odds of receiving assistance with household tasks compared to White men.

Discussion and Implications

Our findings indicate that, despite prior evidence of disability-related disparities, the receipt of help with self-care, mobility, and household activities varies by race and gender. Findings reveal several target areas for future research. Future work should examine the role of cultural and social preferences for care, as well as the appropriateness of help, as evidenced by health service use and changes in quality of life.

Aging into disadvantage: Disability crossover among Mexican immigrants in America

The "Hispanic paradox" refers to the accepted finding that Mexican immigrants have lower mortality compared to the US-born population, despite having lower levels of income, educational attainment, and health insurance coverage. However, Mexican immigrants' mortality advantage is not matched by lower disability rates, particularly later in the life course. Past studies have identified a crossover in disability rates for Mexican immigrants using age-specific disability rates but confound the effects of aging and duration of residence. By using the synthetic cohort method, I extend prior work on the disability crossover by tracing immigrant cohorts across the life course and disentangling newly arrived immigrants from those already established in the U.S. I use American Community Survey (ACS) 2015-2019 data to test whether the acculturation or cumulative disadvantage hypotheses account for the disability crossover. I find that, contrary to the expected finding of a socioeconomic health gradient in disability rates, Mexican immigrants' high disability rates converge regardless of education level or immigrant cohort. In addition, Mexican female immigrants are doubly disadvantaged, living in a protracted period of disability compared to males of the same education level. My findings support the negative health acculturation hypothesis as the dominant pathway for Mexican immigrants' later-life disability trajectories and consequently the explanation behind the disability crossover.

Indicators of poor mental health and stressors during the COVID-19 pandemic, by disability status: A cross-sectional analysis

BACKGROUND

Evidence from previous public health emergencies indicates that adults with disabilities have higher risk for morbidity (physical and mental) and mortality than adults without disabilities.

OBJECTIVE

To provide estimates of mental health indicators and stressors for US adults by disability status during April and May 2020, shortly following the emergence of the COVID-19 pandemic.

METHODS

We analyzed data from Porter Novelli View 360 opt-in Internet panel survey conducted during the weeks of April 20th and May 18th^, 2020 among 1004 English-speaking adults aged ≥18 years without and with disabilities (serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living). Weighted logistic regression was used to test for significant differences between calculated prevalence estimates at the P ≤ .05 level.

RESULTS

One in four adults reported any disability. Adults with any disability were significantly more likely than adults without disability to report current depressive symptoms, frequent mental distress, suicidal ideation, and COVID-19-related initiated or increased substance use (all p values < .0001). Adults with disabilities also reported significantly higher levels of stressors, such as access to health care services (p < .0001), difficulty caring for their own (or another's) chronic condition (p < .0001), emotional or physical abuse from others (p < .001), and not having enough food (p < .01).

CONCLUSIONS

The disproportionately high levels of poor mental health indicators among adults with disabilities as compared to those without highlight the importance of delivering timely mental health screening and treatment/intervention during and after the COVID-19 pandemic to persons with disabilities.

Nativity, Family, Disability: Results from the Hispanic Established Populations for the Epidemiologic Study of the Elderly

Objectives

ativity and family support may influence attitudes and behaviors that delay or accelerate the disability process in older adults. The objectives of this study were twofold: 1) to evaluate nativity and migration cohort differences in trajectories of disability (assessed by activities of daily living [ADL]) among older Mexican Americans; and 2) to determine the role of objectively measured family support in the association between nativity, migration cohort, and disability changes over time.

Methods

This is a longitudinal study with up to 18 years follow-up (1993-2011) using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (N=2,785, mean age =72.4 years). Disability was assessed using self-reported limitations in activities of daily living (ADL). Nativity and migration cohort were self-reported. Family support was assessed by marital status and the number of their children participants saw each month. Linear growth curve models evaluated the trajectory of ADL disability over 18 years and assessed variations by nativity status, migration cohort and family support.

Results

Foreign-born respondents who migrated before age 20 had more starting ADL limitations (β= .36, P<.001) and accumulated disability faster (β=.04, P<.01) compared with their US-born counterparts. In contrast, foreign-born respondents who migrated at later ages showed disability trajectories similar to US-born respondents. Married respondents had a lower level of disability (β= -.14, P<.01) and a lower rate of accumulation over time (β= -.02, P=.001) compared with participants who were not married.

Discussion

Mexican Americans who migrate at younger ages may experience greater disability over time; however, family support may help mitigate the accumulation of disability among older Mexican Americans.

Disability, food insecurity by nativity, citizenship, and duration

Prior research examines the prevalence of either disability or food insecurity among immigrants. We examine whether the presence of a disability operates as a stronger predictor of food insecurity among prime-aged immigrants relative to the US-born. Probit models estimate the relationship of disability with food insecurity among immigrants and distinguish by duration of US residence and citizenship status using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2014. Descriptively, food insecurity was highest among non-citizen immigrants with longer durations of US residence, compared to non-citizen immigrants with shorter durations and naturalized immigrants. Multivariate results suggest that among Hispanics, the association between disability and food insecurity was stronger among immigrants compared to US-born adults; the disability-food insecurity association varied by an immigrant's duration of US residence and citizenship status. The results emphasize the importance of disaggregating by citizenship status and duration of US residence.

Effectiveness of a Disability Preventive Intervention for Minority and Immigrant Elders: The Positive Minds-Strong Bodies Randomized Clinical Trial

OBJECTIVE

To test the acceptability and effectiveness of a disability prevention intervention, Positive Minds-Strong Bodies (PMSB), offered by paraprofessionals to mostly immigrant elders in four languages.

DESIGN

Randomized trial of 307 participants, equally randomized into intervention or enhanced usual care.

SETTING

Community-based organizations in Massachusetts, New York, Florida, and Puerto Rico serving minority elders. Data collected at baseline, 2, 6, and 12 months, between May 2015 and March 2019.

PARTICIPANTS

English-, Spanish-, Mandarin-, or Cantonese-speaking adults, age 60+, not seeking disability prevention services, but eligible per elevated mood symptoms and minor to moderate physical dysfunction.

INTERVENTIONS

Ten individual sessions of cognitive behavioral therapy (PM) concurrently offered with 36 group sessions of strengthening exercise training (SB) over 6 months compared to enhanced usual care.

MEASUREMENTS

Acceptability defined as satisfaction and attendance to >50% of sessions. Effectiveness determined by changes in mood symptoms (HSCL-25 and GAD-7), functional performance (SPPB), self-reported disability (LLFDI), and disability days (WHODAS 2.0).

RESULTS

Around 77.6% of intervention participants attended over half of PM Sessions; 53.4% attended over half of SB sessions. Intent-to-treat analyses at 6 months showed significant intervention effects: improved functioning per SPPB and LLFDI, and lowered mood symptoms per HSCL-25. Intent-to-treat analyses at 12 months showed that effects remained significant for LLFDI and HSCL-25, and disability days (per WHODAS 2.0) significantly decreased 6-month after the intervention.

CONCLUSIONS

PMSB offered by paraprofessionals in community-based organizations demonstrates good acceptability and seems to improve functioning, with a compliance-benefit effect showing compliance as an important determinant of the intervention response.