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Bayram E, Banks SJ. Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease. Clin Neuropsychol 2024:1-22. [PMID: 38741341 DOI: 10.1080/13854046.2024.2350096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.
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Affiliation(s)
- Ece Bayram
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Sarah J Banks
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
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Mian M, Tahiri J, Eldin R, Altabaa M, Sehar U, Reddy PH. Overlooked Cases of Mild Cognitive Impairment: Implications to Early Alzheimer's Disease. Ageing Res Rev 2024; 98:102335. [PMID: 38744405 DOI: 10.1016/j.arr.2024.102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024]
Abstract
Mild cognitive impairment (MCI) marks the initial phase of memory decline or other cognitive functions like language or spatial perception, while individuals typically retain the capacity to carry out everyday tasks independently. Our comprehensive article investigates the intricate landscape of cognitive disorders, focusing on MCI and Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD). The study aims to understand the signs of MCI, early Alzheimer's disease, and healthy brain aging while assessing factors influencing disease progression, pathology development and susceptibility. A systematic literature review of over 100 articles was conducted, emphasizing MCI, AD and ADRD within the elderly populations. The synthesis of results reveals significant findings regarding ethnicity, gender, lifestyle, comorbidities, and diagnostic tools. Ethnicity was found to influence MCI prevalence, with disparities observed across diverse populations. Gender differences were evident in cognitive performance and decline, highlighting the need for personalized management strategies. Lifestyle factors and comorbidities were identified as crucial influencers of cognitive health. Regarding diagnostic tools, the Montreal Cognitive Assessment (MoCA) emerged as superior to the Mini-Mental State Examination (MMSE) in early MCI detection. Overall, our article provides insights into the multifaceted nature of cognitive disorders, emphasizing the importance of tailored interventions and comprehensive assessment strategies for effective cognitive health management.
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Affiliation(s)
- Maamoon Mian
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, 79430, TX, USA.
| | - Jihane Tahiri
- School of Biology, Texas Tech University, Lubbock, 79430, TX, USA.
| | - Ryan Eldin
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246.
| | - Mohamad Altabaa
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, 79430, TX, USA.
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, 79430, TX, USA.
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, 79430, TX, USA; Nutritional Sciences Department, College Human Sciences, Texas Tech University, Lubbock, TX 79409; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
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Hurd L, Li LYK. "I Want to Grow Older With Dignity": Older LGBTQ+ Canadian Adults' Perceptions and Experiences of Aging. J Appl Gerontol 2024; 43:536-549. [PMID: 38105632 PMCID: PMC10981199 DOI: 10.1177/07334648231219414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
The number of older LGBTQ+ adults is growing worldwide. Yet few studies outside of the United States have examined their experiences of aging. Drawing on the Health Equity Promotion Model and contextualized in Canada's unique socio-political history, our study used multiple, in-depth, qualitative interviews to examine 30 older Canadian LGBTQ+ adults' (aged 65-83) perceptions and experiences of growing older. Our descriptive thematic analysis identified three overarching categories: "Losses," "gains," and "needs." Losses referred to the changes in the participants' health, autonomy, and relationships that had occurred with age. Gains entailed positive later life changes, including increased wisdom, flexibility, and social connections. Finally, needs referred to those things that the participants deemed essential for aging well, namely, inclusive health care, meaningful activities, and supportive networks. We discuss the policy and practice implications of our findings for the fostering of health, well-being, and social inclusion amongst this often-marginalized population.
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Affiliation(s)
- Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Lynda Y. K. Li
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Shippee T, Simon Rosser BR, Wright MM, Aumock C, Moone R, Talley KMC, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports. J Appl Gerontol 2024; 43:562-576. [PMID: 37975683 PMCID: PMC10981565 DOI: 10.1177/07334648231213532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Phil Duran
- Aging and Gender Care Access, Saint Paul, MN, USA
| | | | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, MA, USA
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Wolfe HL, Jeon A, Goulet JL, Simpson TL, Eleazer JR, Jasuja GK, Blosnich JR, Kauth MR, Shipherd JC, Littman AJ. Non-affirmation minority stress, internalized transphobia, and subjective cognitive decline among transgender and gender diverse veterans aged 45 years and older. Aging Ment Health 2024:1-7. [PMID: 38567655 DOI: 10.1080/13607863.2024.2335565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To examine the associations of two measures of minority stress, non-affirmation minority stress and internalized transphobia, with subjective cognitive decline (SCD) among transgender and gender diverse (TGD) veterans. METHOD We administered a cross-sectional survey from September 2022 to July 2023 to TGD veterans. The final analytic sample included 3,152 TGD veterans aged ≥45 years. We used a generalized linear model with quasi-Poisson distribution to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) measuring the relationship between non-affirmation minority stress and internalized transphobia and past-year SCD. RESULTS The mean age was 61.3 years (SD = 9.7) and the majority (70%) identified as trans women or women. Overall, 27.2% (n = 857) reported SCD. Adjusted models revealed that TGD veterans who reported experiencing non-affirmation minority stress or internalized transphobia had greater risk of past-year SCD compared to those who did not report either stressor (aPR: 1.09, 95% CI: 1.04-1.15; aPR: 1.19, 95% CI: 1.12-1.27). CONCLUSION Our findings demonstrate that proximal and distal processes of stigma are associated with SCD among TGD veterans and underscore the need for addressing multiple types of discrimination. Above all, these results indicate the lasting sequelae of transphobia and need for systemic changes to prioritize the safety and welfare of TGD people.
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Affiliation(s)
- Hill L Wolfe
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Connecticut, CT, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Section of Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Amy Jeon
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joseph L Goulet
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, Connecticut, CT, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Tracy L Simpson
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jacob R Eleazer
- Department of Psychiatry and Psychology, Mayo Clinic Florida, Jacksonville, FL, USA
- Transgender and Intersex Specialty Care Clinic, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Michael R Kauth
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington, DC, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
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Baril A, Silverman M. "We're still alive, much to everyone's surprise": The experience of trans older adults living with dementia in an ageist, cisgenderist, and cogniticist society. J Aging Stud 2024; 68:101208. [PMID: 38458727 DOI: 10.1016/j.jaging.2024.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 03/10/2024]
Abstract
Trans and non-binary older adults living with dementia experience forms of marginalization, pathologization, and discrimination embedded in epistemic violence that leads them to be mistreated and dismissed as knowledgeable subjects. Based on empirical findings from a Canadian study examining the experiences of trans and non-binary people living with dementia and their carers, we combat this epistemic violence by focusing on the first-hand narratives of this population and their carers. Narrative interviews were conducted with six participants (N = 6): four carers of trans and non-binary adults living with dementia and two trans (binary) people living with dementia. Through a thematic analysis, we examine the unique aspects of living with dementia as a trans or non-binary person. First, the findings show how cogniticism impacts the experience of gender identity and cisgenderism, for example through blocked surgeries, excessive gatekeeping, and not being taken seriously by practitioners. Second, the findings discuss how dementia impacts gender identity and cisgenderism, for example, by increasing the need for formal care that can in turn increase vulnerability to structural violence. Third, the findings illustrate how cisgenderism and gender identity impact the experience of dementia and cogniticism, for example by limiting care options and the ability to advocate for oneself. Fourth, the findings highlight the silo mentality among practitioners, since most of them do not work with an intersectional lens. The article concludes by offering recommendations.
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Affiliation(s)
- Alexandre Baril
- School of Social Work, University of Ottawa, 120 University, Room 12025, Ottawa, Ontario K1N 6N5, Canada.
| | - Marjorie Silverman
- School of Social Work, University of Ottawa, 120 University, Room 12044, Ottawa, Ontario K1N 6N5, Canada.
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Masa R, Inoue M, Prieto L, Baruah D, Nosrat S, Mehak S, Operario D. Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey. J Appl Gerontol 2024; 43:276-286. [PMID: 37801680 PMCID: PMC10809733 DOI: 10.1177/07334648231203838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/08/2023] Open
Abstract
This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50 years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity.
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Affiliation(s)
- Rainier Masa
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Global Social Development Innovations, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Megumi Inoue
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Lucas Prieto
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Dicky Baruah
- School of Social Work, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sarah Nosrat
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Samreen Mehak
- Department of Social Work, George Mason University, Fairfax, VA, USA
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Yang W, Craig SL, Anderson JAE, Ross LE, Muntaner C. Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging. Acta Psychol (Amst) 2024; 242:104117. [PMID: 38134682 DOI: 10.1016/j.actpsy.2023.104117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.
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Affiliation(s)
- Wook Yang
- Rongxiang Xu College of Health and Human Services, California State University Los Angeles, 5151 State University Drive, Los Angeles, CA 90032, USA
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario M5S 1V4, Canada
| | - John A E Anderson
- Department of Cognitive Science, Carleton University, 2202A Dunton Tower, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada
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Morgan E, Dyar C, Rose K. Dissecting sexual minority subgroup differences in the association between depression, anxiety, and cognitive difficulties. PLoS One 2024; 19:e0295821. [PMID: 38170685 PMCID: PMC10763951 DOI: 10.1371/journal.pone.0295821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION A growing body of research has demonstrated extensive mental health disparities affecting sexual minority populations, yet little research has assessed how these disparities may affect cognitive functioning among subgroups of sexual minorities. METHODS Data come from the 2021 National Health Information Survey (NHIS). Survey-weighted linear regression analyses were used to assess self-reported measures of cognition, stratified by subgroups sexual identity. In particular, we focused on the association between symptoms of depression or anxiety and each of the measures of cognition, adjusting for demographic covariates. RESULTS Among 31,994 NHIS participants in the 2021 survey, 5,658 (17.7%) reported at least some difficulty in remembering or concentrating. Basic demographic differences existed when assessing any cognitive difficulty, particularly for bisexual participants (aOR = 2.73; 95% CI: 2.07, 3.60) and participants identifying as a different identity (aOR = 4.22; 95% CI: 2.72, 6.56). Depression was significantly associated with cognitive difficulty with the largest relationship observed among gay/lesbian participants (aOR = 1.39; 95% CI: 1.29, 1.49). The association between anxiety and cognitive difficulty was smallest among bisexuals (aOR = 1.13; 95% CI: 1.08, 1.18) and relatively consistent across other subgroups: heterosexuals (aOR = 1.23; 95% CI: 1.22, 1.24), gay/lesbians (aOR = 1.27; 95% CI: 1.19, 1.36), and those with a different identity (aOR = 1.22; 95% CI: 1.10, 1.35). CONCLUSION There is a clear set of health disparities between sexual minority subgroups and heterosexuals across all cognitive difficulties. Future research should focus on developing a better understanding of differences in cognition based on sexual minority status while also working to ascertain how disparities vary among sexual minorities.
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Affiliation(s)
- Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
- College of Public Health, The Ohio State University, Columbus, OH, United States of America
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
| | - Karen Rose
- College of Nursing, The Ohio State University, Columbus, OH, United States of America
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Xu Y, Wang Y, Chen Y, Zhang Y, Tong L, He Y, Fang J, Li R, Zhang X, Jin L. The Relationship Between Adverse Childhood Experiences and Subjective Cognitive Decline Based on Sexual Orientation. Clin Gerontol 2023:1-9. [PMID: 37955228 DOI: 10.1080/07317115.2023.2282484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Research indicates adverse childhood experiences (ACEs) were associated with subjective cognitive decline (SCD), with higher ACEs reported by sexual minoritized individuals (i.e. lesbian, gay, and bisexual; LGB). This study aimed to explore the relationships between ACEs and SCD based on sexual orientation in middle-aged and older adults. METHODS The study included 76,592 participants from the 2019-2020 Behavioral Risk Factor Surveillance Survey (BRFSS). Multivariate logistic regressions analyzed ACEs status, score, and type associations with SCD. RESULTS 2.18% of the participants identified as sexual minoritized individuals. More sexual minoritized individuals reported SCD compared to heterosexual individuals (10.70% for heterosexuals; 17.27% for sexual minoritized individuals). Positive association between SCD and ACEs status (OR = 2.18, 95%CI: 1.09-4.40) was identified among sexual minoritized individuals. CONCLUSIONS The association between ACEs and SCD was strong in both heterosexual and sexual minoritized populations. Given the higher experience of ACEs among sexual minoritized adults, the subsequent frequency of SCD among these adults also may be higher. CLINICAL IMPLICATIONS Sexual minoritized older adults may have a history of numerous ACEs, which could contribute to a greater burden of SCD. Clinicians and other stakeholders may wish to consider relationships between ACEs and SCD based on sexual orientation.
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Affiliation(s)
- Yan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yana Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Li Tong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Jiaxin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Runhong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinyao Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Fredriksen-Goldsen K, Petros R, Jung HH, Kim HJ. Sexual Minority Disparities in Subjective Cognitive Impairment: Do They Persist After Accounting for Psychological Distress? J Aging Health 2023; 35:727-735. [PMID: 36843284 PMCID: PMC10680409 DOI: 10.1177/08982643231156286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Objectives: Sexual minority older adults are a health disparate group with disproportionate rates of subjective cognitive impairment (SCI) and psychological distress. This study estimated risks of SCI by sexual orientation and gender, accounting for variations in psychological distress. Methods: We aggregated National Health Interview Survey data (2013-2018) of adults aged 45 and older and implemented logistic regressions of SCI indicators on sexual orientation and psychological distress, adjusting for covariates. Results: Sexual minority adults showed higher likelihoods of SCI in terms of status, severity, frequency, extent, and activity limitations than heterosexuals, even after controlling for psychological distress. SCI risk was significantly higher among sexual minority vs. heterosexual women, with no significant difference among men. Conclusions: Public health initiatives should address this health disparity in SCI and support informal care networks for sexual minorities. Future research is needed that further investigates SCI at-risk groups, with attention to sexual minority women.
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Affiliation(s)
| | - Ryan Petros
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hailey H Jung
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
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Sassatelli EH. A Call to Action: Improving Support for Sexual and Gender Minority Dementia Caregivers. J Gerontol Nurs 2023; 49:3-6. [PMID: 37523336 DOI: 10.3928/00989134-20230706-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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14
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Rosser BRS, Shippee T, Wright MM, Aumock C, Moone R, Talley KM, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. "Going Back in the Closet": Addressing Discrimination Against Sexual and Gender Minority Residents in Long-Term Services and Supports by Providing Culturally Responsive Care. J Aging Soc Policy 2023:1-13. [PMID: 37348486 PMCID: PMC10739643 DOI: 10.1080/08959420.2023.2226300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/27/2022] [Indexed: 06/24/2023]
Abstract
Sexual and gender minority (SGM) older adults face discrimination in long-term services and supports (LTSS). Yet, SGM older adults use LTSS disproportionately higher relative to their non-SGM counterparts. The discrimination is compounded by existing disparities, resulting in worse health outcomes and well-being for SGM older adults. Guided by socioecological model, we posit that training LTSS staff in SGM responsive care and implementing SGM anti-discrimination policies will be needed to improve care. Considering accessibility and turnover challenges, training should be online, interactive, and easily accessible. Studies that assess interventions for SGM responsive care are needed to guide policy and practice.
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Affiliation(s)
- B. R. Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tetyana Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Morgan M. Wright
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cailynn Aumock
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rajean Moone
- Long Term Care Administration Program, College of Continuing and Professional Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristine M.C. Talley
- Adult and Gerontological Health Cooperative, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | | | - Carrie Henning-Smith
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Jason D. Flatt
- Department of Social and Behavior Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV
| | - Jaime Slaughter-Acey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel Greenwald
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Teresa McCarthy
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael W. Ross
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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15
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Cicero EC, Lett E, Flatt JD, Benson GP, Epps F. Transgender Adults From Minoritized Ethnoracial Groups in the U.S. Report Greater Subjective Cognitive Decline. J Gerontol B Psychol Sci Soc Sci 2023; 78:1051-1059. [PMID: 36688593 PMCID: PMC10214655 DOI: 10.1093/geronb/gbad012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Investigate subjective cognitive decline (SCD) among 4 study groups consisting of cisgender and transgender adults who are from minoritized ethnoracial groups (i.e., minoritized ethnoracial transgender, minoritized ethnoracial cisgender) and White cisgender and transgender adults aged 45+ (i.e., White transgender, White cisgender) to determine the odds of SCD by group and to test for group differences. METHODS Data from the 2015-2020 Behavioral Risk Factor Surveillance System were used in a modified case-control approach to perform an intercategorical intersectional study. Each transgender participant was matched to 2 cisgender men and 2 cisgender women, on state, ethnoracial identity, and age. Multivariable logistic regressions modeled SCD odds by group and post hoc contrasts estimated pairwise odds ratios comparing the SCD odds for each combination of groups. RESULTS SCD prevalence was highest among minoritized ethnoracial transgender (21.6%), followed by White transgender (15.0%), minoritized ethnoracial cisgender (12.0%), and White cisgender (9.0%). After accounting for age, education, and survey year, the odds of SCD were higher in minoritized ethnoracial transgender when compared to White cisgender (adjusted odds ratio [aOR] = 2.51, 95% confidence interval [CI]: 1.59-3.96) and minoritized ethnoracial cisgender (aOR = 1.89, 95% CI: 1.16-3.09). The odds of SCD were higher in White transgender compared to White cisgender (aOR = 1.66, 95% CI: 1.20-2.30). DISCUSSION When considering the intersection of transgender and ethnoracial identities, we found that transgender adults from minoritized ethnoracial groups reported higher odds of SCD when compared to cisgender adults from minoritized ethnoracial groups. Additional studies are needed to understand the relationship between racialized and gendered inequities in cognitive impairment and how specific mechanisms of systemic transphobia and racism may contribute to this inequity.
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Affiliation(s)
- Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Applied Transgender Studies, Chicago, Illinois, USA
| | - Jason D Flatt
- School of Public Health, Department of Social and Behavioral Health Program, University of Nevada, Las Vegas, Nevada, USA
| | - G Perusi Benson
- Department of Psychology, North Carolina State University, Raleigh, North Carolina, USA
| | - Fayron Epps
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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16
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Franco-Rocha OY, Wheldon CW, Trainum K, Kesler SR, Henneghan AM. Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review. Eur J Oncol Nurs 2023; 64:102343. [PMID: 37290162 DOI: 10.1016/j.ejon.2023.102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/07/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors. METHODS We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools. RESULTS The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes. CONCLUSIONS SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.
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Affiliation(s)
- Oscar Y Franco-Rocha
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Christopher W Wheldon
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B, Moore Ave., Ritter Hall Annex 9th Floor, Room 955, Philadelphia, PA, 19122, USA.
| | - Katie Trainum
- School of Nursing, University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Shelli R Kesler
- School of Nursing, Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
| | - Ashley M Henneghan
- School of Nursing, Department of Oncology, Dell Medical School, The University of Texas at Austin, 1710 Red River St, Austin, TX, 78712, USA.
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Scorza FA, de Almeida ACG, Fiorini AC, Scorza CA, Finsterer J. Parkinson's disease in LGBT+ older adults: The unexplored connection. Clinics (Sao Paulo) 2023; 78:100196. [PMID: 37137182 PMCID: PMC10176155 DOI: 10.1016/j.clinsp.2023.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Affiliation(s)
- Fulvio A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil.
| | - Antonio-Carlos G de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Laboratório de Neurociência Experimental e Computacional, Departamento de Engenharia de Biossistemas, Universidade Federal de São João del-Rei (UFSJ), São João Del-Rei, MG, Brazil
| | - Ana C Fiorini
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Departamento de Fonoaudiologia, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Programa de Estudos Pós-Graduado em Fonoaudiologia, Pontifícia Universidade Católica de São Paulo (PUC-SP), São Paulo, SP, Brazil
| | - Carla A Scorza
- Disciplina de Neurociência, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | - Josef Finsterer
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil; Neurology & Neurophysiology Center, Vienna, Austria
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Fredriksen-Goldsen K, Teri L, Kim HJ, La Fazia D, McKenzie G, Petros R, Jung HH, Jones BR, Brown C, Emlet CA. Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners. Contemp Clin Trials 2023; 128:107143. [PMID: 36893987 PMCID: PMC10639124 DOI: 10.1016/j.cct.2023.107143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.
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Affiliation(s)
| | - Linda Teri
- University of Washington, School of Nursing, Box 357260, Seattle, WA 98195, USA.
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - David La Fazia
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3076, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, USA.
| | - Ryan Petros
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Hailey H Jung
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Brittany R Jones
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Char Brown
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Charles A Emlet
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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May JT, Harris ML. Health Experiences of Sexual and Gender Minority People Living With Dementia and Their Care Partners: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e44918. [PMID: 36757411 PMCID: PMC10131999 DOI: 10.2196/44918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND People living with dementia and their care partners who identify as a sexual and gender minority (SGM) often experience specific health inequities and disparities due to discrimination related to age, cognitive impairment, and being SGM. OBJECTIVE The purpose of this scoping review is to identify, explore, and synthesize the state of the science regarding the health and health care experiences of SGM people living with dementia and their care partners. This review also aims to identify gaps in research and set forth key recommendations to improve the health and health care experiences of SGM people living with dementia and their care partners by advancing health equity through research, policy, and practice. METHODS The protocol follows the guidelines set forth by Joanna Briggs Institute protocol for scoping reviews. Steps of this framework that will be followed include (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consultation. This scoping review will explore several electronic databases, including MEDLINE, Embase, CINAHL, AgeLine, PsychINFO, and Scopus. Health librarians will conduct the initial search for articles that are in English, include people living with dementia who identify as SGM, SGM people living with dementia and their care partners, or SGM care partners caring for people with dementia. Studies must be peer reviewed and focus on the phenomenon of interest, which is the health and health care experiences of participants. Covidence will be used to review abstracts and full-text articles and to screen articles. After the search has been completed, 2 independent reviewers will screen article titles and abstracts to identify eligibility. Discrepancies will be discussed and decided upon by the 2 reviewers. Relevant studies will be collected, and data will be extracted and charted to summarize key findings. Key findings will be presented to a community stakeholder group of SGM care partners and people living with dementia, and a listening session will be convened. RESULTS This scoping review will identify the state of the science of health and health care experiences of people living with dementia and their care partners who identify as SGM. We will identify gaps and provide recommendations to inform future research, policy, and practice to improve health and health care experiences of SGM people living with dementia and their care partners. CONCLUSIONS Little is known about people living with dementia and their care partners who identify as SGM. This scoping review will be one of the first to identify the health and health care experiences of people living with dementia and their care partners who identify as SGM. The results of this review will be used to guide future interventions and to inform future policy and practice to improve health care and reduce health disparities in this population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/44918.
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Affiliation(s)
- Jennifer T May
- School of Nursing, Duke University, Durham, NC, United States
| | - Melissa Louise Harris
- School of Nursing, Duke University, Durham, NC, United States.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, United States
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21
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Nelson CL, Wardecker BM, Andel R. Sexual Orientation and Gender Identity-Related State-Level Policies and Perceived Health Among Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the United States. J Aging Health 2023; 35:155-167. [PMID: 35857422 DOI: 10.1177/08982643221116762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectivesWe examined the associations between state-level policies and the health of lesbian, gay, bisexual, and transgender (LGBT) older adults. Methods: Using data from the 2018-2020 Behavioral Risk Factor Surveillance System surveys, we assessed physical and mental health by the tally of points for enacted LGBT-related policies (Low= <0-49.9% of possible points, High= 50-100% of possible points) in 10,032 sexual minority (i.e., lesbian, gay, and bisexual) and 1,072 transgender (non-sexual minority) adults aged 50 and older from 41 states. Results: Sexual minority adults in low tally states had greater odds of reporting fair or poor general health and 14 or more days of poor physical health in the past 30 days. Transgender participants in low tally states also had greater odds of reporting fair or poor general health. Discussion: Lesbian, gay, bisexual, and transgender adults have significantly greater risk of poor health if they live in a state with fewer LGBT anti-discriminatory policies enacted.
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Affiliation(s)
- Christi L Nelson
- School of Aging Studies, 7831University of South Florida, Tampa, FL, USA
| | - Britney M Wardecker
- Ross and Carol Nese College of Nursing, 8082The Pennsylvania State University, University Park, PA, USA
| | - Ross Andel
- School of Aging Studies, 7831University of South Florida, Tampa, FL, USA.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
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22
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Correro AN, Gauthreaux K, Perales-Puchalt J, Chen YC, Chan KC, Kukull WA, Flatt JD. Cognitive Aging with Dementia, Mild Cognitive Impairment, or No Impairment: A Comparison of Same- and Mixed-Sex Couples. J Alzheimers Dis 2023; 92:109-128. [PMID: 36710669 PMCID: PMC10029351 DOI: 10.3233/jad-220309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Lesbian and gay older adults have health disparities that are risk factors for Alzheimer's disease, yet little is known about the neurocognitive aging of sexual minority groups. OBJECTIVE To explore cross-sectional and longitudinal dementia outcomes for adults in same-sex relationships (SSR) and those in mixed-sex relationships (MSR). METHODS This prospective observational study utilized data from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) collected from contributing Alzheimer's Disease Research Centers. Participants were adults aged 55+ years at baseline with at least two visits in NACC UDS (from September 2005 to March 2021) who had a spouse, partner, or companion as a co-participant. Outcome measures included CDR® Dementia Staging Instrument, NACC UDS neuropsychological testing, and the Functional Activities Questionnaire. Multivariable linear mixed-effects models accounted for center clustering and repeated measures by individual. RESULTS Both MSR and SSR groups experienced cognitive decline regardless of baseline diagnosis. In general, MSR and SSR groups did not differ statistically on cross-sectional or longitudinal estimates of functioning, dementia severity, or neuropsychological testing, with two primary exceptions. People in SSR with mild cognitive impairment showed less functional impairment at baseline (FAQ M = 2.61, SD = 3.18 vs. M = 3.97, SD = 4.53, respectively; p < 0.01). The SSR group with dementia had less steep decline in attention/working memory (β estimates = -0.10 versus -0.18; p < 0.01). CONCLUSION Participants in SSR did not show cognitive health disparities consistent with a minority stress model. Additional research into protective factors is warranted.
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Affiliation(s)
- Anthony N. Correro
- Mental Health Service, VA Ann Arbor Healthcare System and Department of Psychiatry, University of Michigan Health, Ann Arbor, MI, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kathryn Gauthreaux
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA, USA
| | | | - Yen-Chi Chen
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA, USA
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Kwun C.G. Chan
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Walter A. Kukull
- National Alzheimer’s Coordinating Center, University of Washington, Seattle, WA, USA
| | - Jason D. Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV, USA
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23
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Kim HJ, Fredriksen-Goldsen K, Jung HH. Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment. J Aging Health 2023; 35:138-150. [PMID: 35766354 PMCID: PMC9771910 DOI: 10.1177/08982643221108658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.
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Affiliation(s)
- Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - Hailey H. Jung
- School of Social Work, University of Washington, Seattle, WA, USA
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Akushevich I, Kravchenko J, Yashkin A, Doraiswamy PM, Hill CV. Expanding the scope of health disparities research in Alzheimer's disease and related dementias: Recommendations from the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" Workshop Series. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12415. [PMID: 36935764 PMCID: PMC10020680 DOI: 10.1002/dad2.12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 03/18/2023]
Abstract
Topics discussed at the "Leveraging Existing Data and Analytic Methods for Health Disparities Research Related to Aging and Alzheimer's Disease and Related Dementias" workshop, held by Duke University and the Alzheimer's Association with support from the National Institute on Aging, are summarized. Ways in which existing data resources paired with innovative applications of both novel and well-known methodologies can be used to identify the effects of multi-level societal, community, and individual determinants of race/ethnicity, sex, and geography-related health disparities in Alzheimer's disease and related dementia are proposed. Current literature on the population analyses of these health disparities is summarized with a focus on identifying existing gaps in knowledge, and ways to mitigate these gaps using data/method combinations are discussed at the workshop. Substantive and methodological directions of future research capable of advancing health disparities research related to aging are formulated.
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Affiliation(s)
- Igor Akushevich
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - Julia Kravchenko
- Duke University School of MedicineDepartment of SurgeryDurhamNorth CarolinaUSA
| | - Arseniy Yashkin
- Social Science Research InstituteBiodemography of Aging Research UnitDuke UniversityDurhamNorth CarolinaUSA
| | - P. Murali Doraiswamy
- Departments of Psychiatry and MedicineDuke University School of MedicineDurhamNorth CarolinaUSA
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Hanes DW, Clouston SAP. Cognitive Aging in Same- and Different-Sex Relationships: Comparing Age of Diagnosis and Rate of Cognitive Decline in the Health and Retirement Study. Gerontology 2022; 69:356-369. [PMID: 36509083 PMCID: PMC9991936 DOI: 10.1159/000526922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/04/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer's disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs). METHODS The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998-2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender. RESULTS Participants in SSRs reported dementia diagnoses (β = -12.346; p = 0.001), crossed the threshold into CIND (β = -8.815; p < 0.001) and possible dementia (β = -13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (β = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (β = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women. CONCLUSION Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories' claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.
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Affiliation(s)
- Douglas William Hanes
- Program in Public Health, Renaissance School of Medicine, Stony Brook University; Stony Brook, New York, United States of America
- Centre for Sexual and Gender Minority Health, Dalla Lana School of Public Health, University of Toronto; Toronto, Ontario, Canada
| | - Sean A. P. Clouston
- Program in Public Health, Renaissance School of Medicine, Stony Brook University; Stony Brook, New York, United States of America
- Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University; Stony Brook, New York, United States of America
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Anderson JG, Flatt JD, Cicero EC, Kittle K, Myers CR, Rose KM, Wharton W. Inclusive Care Practices and Policies Among Sexual and Gender Minority Older Adults. J Gerontol Nurs 2022; 48:6-15. [PMID: 36441066 PMCID: PMC10441248 DOI: 10.3928/00989134-20221107-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [Journal of Gerontological Nursing, 48(12), 6-15.].
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Lin WY. Associations of five obesity indicators with cognitive performance in 30,697 Taiwan Biobank participants. BMC Geriatr 2022; 22:839. [PMID: 36344931 PMCID: PMC9641815 DOI: 10.1186/s12877-022-03457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
Background Obesity adversely influences the central nervous system and cognitive functions. However, the relationship between various obesity indicators and cognitive performance remains controversial. It is unclear which obesity indicator is more relevant to cognitive impairment. Methods The Taiwan Biobank (TWB) administered the Chinese version of the Mini-Mental State Examination (MMSE) to 30,697 participants (12,094 males and 18,603 females) aged 60 to 70 years. A total of 3,454 (11.25%) individuals with MMSE < = 24 were classified as having poor cognitive performance. This cross-sectional study investigates the associations of five obesity indicators with cognitive performance. Five separate logistic regression models were fitted for males and another five for females. Covariates adjusted in all models included age, smoking status, drinking status, regular exercise, chronic disease status (diabetes, cardiovascular diseases, heart diseases, stroke, or Parkinson’s disease), depression status, blood pressure level, total cholesterol, fasting glucose, and educational attainment. The five obesity indicators included body mass index (BMI), body fat percentage (BFP), waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR). Results Abdominal obesity defined by WHR was significantly associated with poor cognitive performance. Male WHR > = 0.90 had a higher risk of poor cognitive performance than male WHR < 0.90 (odds ratio [OR] = 1.233; p = 0.007); female WHR > = 0.85 had an increased risk of poor cognitive performance compared with female WHR < 0.85 (OR = 1.221; p = 3.9E-4). HC and general obesity (defined by BMI and BFP) were not significantly associated with cognitive performance. Conclusion The results consistently agreed that preventing abdominal obesity is associated with better cognitive performance in both males and females. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03457-x.
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Di Lorito C, Bosco A, Peel E, Hinchliff S, Dening T, Calasanti T, de Vries B, Cutler N, Fredriksen-Goldsen KI, Harwood RH. Are dementia services and support organisations meeting the needs of Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers of LGBT people living with dementia? A scoping review of the literature. Aging Ment Health 2022; 26:1912-1921. [PMID: 34842010 DOI: 10.1080/13607863.2021.2008870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES More than 60% of people with dementia live at home, where assistance is usually provided by informal caregivers. Research on the experiences of the Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers is limited. This scoping review of the literature synthesizes international evidence on support provision for the population of LGBT caregivers. METHODS Eight electronic databases and Google Scholar were searched using terms including 'Dementia', 'LGBT' and 'Caregiver' for all types of articles, including empirical studies, grey literature and sources from charity/third sector/lobbying organisations. Article selection was performed by two raters. Data were analysed through deductive thematic analysis, and three themes were established a priori: Distinct experiences of LGBT caregivers; current barriers to support; strategies to overcome the current challenges. RESULTS Twenty articles were included. Distinct experiences of LGBT caregivers included a loss of LGBT identity, the impact of historical events, families of choice, and disclosing LGBT identities. Current barriers to support included poor representation of LGBT caregivers in support services, negative attitudes of staff and reluctance of caregivers to seek support. Strategies to overcome the current challenges included staff awareness training and kite-marking inclusion. CONCLUSION Limited cultural competency of staff and a subsequent reluctance to seek help have an impact on use of support services among LGBT caregivers. Implications for practice include the development of cost-effective, feasible, and acceptable inclusiveness training for services. Implications for policy include implementation in organisations of top-down agendas supporting staff to understand sexuality and non-heteronormative relationships in older age.
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Affiliation(s)
| | - Alessandro Bosco
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Elizabeth Peel
- School of Social Sciences and Humanities, Loughborough University, Loughborough, UK
| | | | - Tom Dening
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Toni Calasanti
- Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Brian de Vries
- School of Social Work, Center for Research and Education on Gender and Sexuality, School of Social Work, San Francisco State University, San Francisco, CA, USA
| | | | | | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Xu C, Zhao L, Dong C. A Review of Application of Aβ42/40 Ratio in Diagnosis and Prognosis of Alzheimer’s Disease. J Alzheimers Dis 2022; 90:495-512. [DOI: 10.3233/jad-220673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The number of patients with Alzheimer’s disease (AD) and non-Alzheimer’s disease (non-AD) has drastically increased over recent decades. The amyloid cascade hypothesis attributes a vital role to amyloid-β protein (Aβ) in the pathogenesis of AD. As the main pathological hallmark of AD, amyloid plaques consist of merely the 42 and 40 amino acid variants of Aβ (Aβ 42 and Aβ 40). The cerebrospinal fluid (CSF) biomarker Aβ 42/40 has been extensively investigated and eventually integrated into important diagnostic tools to support the clinical diagnosis of AD. With the development of highly sensitive assays and technologies, blood-based Aβ 42/40, which was obtained using a minimally invasive and cost-effective method, has been proven to be abnormal in synchrony with CSF biomarker values. This paper presents the recent progress of the CSF Aβ 42/40 ratio and plasma Aβ 42/40 for AD as well as their potential clinical application as diagnostic markers or screening tools for dementia.
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Affiliation(s)
- Chang Xu
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Li Zhao
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Chunbo Dong
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
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Marshall A, Cahill S. Barriers and opportunities for the mental health of LGBT older adults and older people living with HIV: a systematic literature review. Aging Ment Health 2022; 26:1845-1854. [PMID: 34784488 DOI: 10.1080/13607863.2021.2003300] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE LGBT older adults and older people living with HIV (PLWH) experience a disproportionate burden of behavioral health conditions compared to their heterosexual, cisgender, and HIV-negative peers. This study intends to systematically review the literature regarding accessing mental health care among LGBT older adults and older PLWH. METHODS This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement framework. Three databases were searched using Boolean search strings, and inclusion/exclusion criteria were developed and applied to the search outcomes to appropriately narrow results. Article quality and evidence of bias were evaluated using the National Heart, Lung, and Blood Institute (NHLBI) quality-assessment tool, and the Critical Appraisal Skills Program (CASP) assessment tool, two instruments used to help reviewers in assessing for internal validity of studies. Two independent researchers coded the articles for themes, and consensus was reached on theme grouping through an iterative process. RESULTS Out of 2,031 articles initially screened, 28 met all inclusion criteria and advanced to final analysis. Several key themes emerged, including a lack of provider competency in caring for LGBT patients, lower rates of insurance coverage, greater mental health burden, social and structural determinants of health, policy solutions, and technology and health literacy. CONCLUSION There were several domains identified in the literature as barriers to accessing mental healthcare, as well as opportunities to better attend to the mental health needs of these populations. Provider training, implementing health technology solutions, and enacting public policy changes could improve mental health outcomes.
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Affiliation(s)
- Austin Marshall
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,University of California San Diego School of Medicine, San Diego, CA, USA
| | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
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Fredriksen-Goldsen K, Jen S, Emlet CA, Kim HJ, Jung HH. Key Determinants of Physical and Psychological Health-Related Quality of Life over Time among Midlife and Older LGBTQ and Sexual and Gender Diverse Caregivers. THE GERONTOLOGIST 2022; 63:751-761. [PMID: 35933628 PMCID: PMC10167761 DOI: 10.1093/geront/gnac112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Prior research has shown informal caregiving among older adults can negatively impact the caregiver’s physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers.
Research Design and Methods
Informed by the Health Equity Promotion Model and Caregiver Stress Process Model and utilizing longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this analysis examined modifiable risk and protective factors associated with psychological and physical HRQOL over time among 754 LGBTQ caregivers aged 50-98.
Results
Psychological and physical HRQOL declined over a three-year period. After controlling for background characteristics, mastery, social support, socialization, LGBTQ community engagement, and physical activity were positively associated with psychological HRQOL while day-to-day discrimination, identity stigma, and insufficient food intake were negatively associated. Steeper declines were observed for older and with no physical activity. Mastery, social support, socialization, and physical activity were positively associated with physical HRQOL while day-to-day discrimination and insufficient food intake were negatively associated. Steeper declines were found for those with high mastery and no physical activity.
Discussion and Implications
Although generalized factors including mastery, socialization, and social support, are protective for HRQOL among LGBTQ caregivers, factors including day-to-day discrimination and identity stigma are more unique to historically disadvantaged populations and should be considered in future research and practice. Caregiving interventions incorporating physical activity are promising given its buffering effect for decreased physical and psychological HRQOL over time.
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Affiliation(s)
| | - Sarah Jen
- School of Social Work, University of Washington, Seattle , Washington, USA
| | - Charles A Emlet
- School of Social Work, University of Washington, Seattle , Washington, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle , Washington, USA
| | - Hailey H Jung
- School of Social Work, University of Washington, Seattle , Washington, USA
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Hampel H, Au R, Mattke S, van der Flier WM, Aisen P, Apostolova L, Chen C, Cho M, De Santi S, Gao P, Iwata A, Kurzman R, Saykin AJ, Teipel S, Vellas B, Vergallo A, Wang H, Cummings J. Designing the next-generation clinical care pathway for Alzheimer's disease. NATURE AGING 2022; 2:692-703. [PMID: 37118137 PMCID: PMC10148953 DOI: 10.1038/s43587-022-00269-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/07/2022] [Indexed: 04/30/2023]
Abstract
The reconceptualization of Alzheimer's disease (AD) as a clinical and biological construct has facilitated the development of biomarker-guided, pathway-based targeted therapies, many of which have reached late-stage development with the near-term potential to enter global clinical practice. These medical advances mark an unprecedented paradigm shift and requires an optimized global framework for clinical care pathways for AD. In this Perspective, we describe the blueprint for transitioning from the current, clinical symptom-focused and inherently late-stage diagnosis and management of AD to the next-generation pathway that incorporates biomarker-guided and digitally facilitated decision-making algorithms for risk stratification, early detection, timely diagnosis, and preventative or therapeutic interventions. We address critical and high-priority challenges, propose evidence-based strategic solutions, and emphasize that the perspectives of affected individuals and care partners need to be considered and integrated.
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Affiliation(s)
| | - Rhoda Au
- Depts of Anatomy & Neurobiology, Neurology and Epidemiology, Boston University Schools of Medicine and Public Health, Boston, MA, USA
| | - Soeren Mattke
- Center for Improving Chronic Illness Care, University of Southern California, San Diego, San Diego, CA, USA
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Depts of Neurology and Epidemiology and Data Science, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Paul Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, San Diego, CA, USA
| | - Liana Apostolova
- Departments of Neurology, Radiology, Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher Chen
- Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Min Cho
- Neurology Business Group, Eisai, Nutley, NJ, USA
| | | | - Peng Gao
- Neurology Business Group, Eisai, Nutley, NJ, USA
| | | | | | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center and the Departments of Radiology and Imaging Sciences, Medical and Molecular Genetics, and Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stefan Teipel
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, University Medical Center Rostock, Rostock, Germany
| | - Bruno Vellas
- University Paul Sabatier, Gerontopole, Toulouse University Hospital, UMR INSERM 1285, Toulouse, France
| | | | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, Beijing, China
| | - Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas (UNLV), Las Vegas, NV, USA
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Fredriksen-Goldsen KI, Jung H, Kim HJ, Petros R, Emlet C. Disparities in Subjective Cognitive Impairment by Sexual Orientation and Gender in a National Population Based Study of U.S. Adults, 2013-2018. J Aging Health 2022; 34:519-528. [PMID: 34645296 PMCID: PMC10484229 DOI: 10.1177/08982643211046466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013-2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results: Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion: Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities.
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Affiliation(s)
| | - Hailey Jung
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Ryan Petros
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Charles Emlet
- School of Social Work, University of Washington, Seattle, WA, USA
- University of Washington, Tacoma, WA, USA
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Lambrou NH, Gleason CE, Obedin-Maliver J, Lunn MR, Flentje A, Lubensky ME, Flatt JD. Subjective Cognitive Decline Associated with Discrimination in Medical Settings among Transgender and Nonbinary Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159168. [PMID: 35954522 PMCID: PMC9368374 DOI: 10.3390/ijerph19159168] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022]
Abstract
Background: Transgender and nonbinary (TNB) individuals report greater subjective cognitive decline (SCD) compared to non-TNB people. SCD involves self-reported problems with memory and thinking and is a potential risk for Alzheimer’s disease and related dementias (ADRD). We explored psychosocial factors, such as discrimination in medical settings, associated with SCD in a sample of TNB older adults. Methods: We utilized cross-sectional data on aging health, SCD (memory complaints and worsening memory in the past year), and discrimination in medical settings from The PRIDE Study for LGBTQ+ adults aged 50+ including TNB adults (n = 115). Associations were tested using multivariate logistic regression. Results: Nearly 16% of TNB participants rated their memory as poor/fair, and 17% reported that their memory was worse than a year ago. TNB older adults with SCD were more likely to report experiencing discrimination in medical settings. After adjustment, those reporting discrimination in medical settings had 4.5 times higher odds of reporting worsening memory than those who did not (OR: 4.5; 95%-CI: 1.5–13.2; p = 0.006), and 7.5 times more likely to report poor/fair memory (OR: 7.49; 95%-CI: 1.7–32.8; p = 0.008); Conclusions: TNB older adults reported high frequencies of SCD and discrimination in medical settings. Further research exploring affirmative cognitive screening and healthcare services is needed.
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Affiliation(s)
- Nickolas H. Lambrou
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (N.H.L.); (C.E.G.)
| | - Carey E. Gleason
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA; (N.H.L.); (C.E.G.)
- Geriatric Research Education and Clinical Center, Wm S Middleton Memorial Veterans Hospital, Madison, WI 53705, USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA 94304, USA; (J.O.-M.); (M.R.L.)
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA 94304, USA; (J.O.-M.); (M.R.L.)
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA 94305, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA; (A.F.); (M.E.L.)
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA 94102, USA
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA 94143, USA; (A.F.); (M.E.L.)
| | - Jason D. Flatt
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA 94143, USA
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
- Correspondence: ; Tel.: +1-702-895-5586
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Young L, D'Aoust RF, Budhathoki C, Casida JM. Proposed Mechanism of Adherence in Caregivers Providing Care to Adults Living with a Left Ventricular Assist Device. Prog Transplant 2022; 32:219-225. [PMID: 35726196 DOI: 10.1177/15269248221107045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The left ventricular assist device (VAD) is commonly used as the bridge-to-transplantation therapy for heart failure patients who are on waitlist of heart transplant. The caregivers' adherence to the homecare regimen plays a vital role in patient outcomes. There is little evidence about the factors related to the caregiver adherence. The purpose of this study was to determine the factors influencing adherence in caring for patients living with a left ventricular device. METHODS The data were collected from 4 online caregiver support groups. Multiple linear regression models were used to determine associations between key variables. The structure equation modeling was used to identify the mediators of caregiver adherence. RESULTS A total of 96 participants' data entered the final analysis. The average age of the participants was 49.8 (SD = 12.88) years, majority were white (84%), female (80%), and married (81%). Caregiver self-efficacy was positively related to their adherence (r = 0.460, P < 0.001). Caregiver knowledge did not mediate the effect of training on self-efficacy. Caregiver self-efficacy did not mediate the effect of knowledge on adherence. There was no interaction between practice hours and knowledge on adherence. DISCUSSION The findings suggest significant association between caregiver self-efficacy and adherence to left ventricular assist home-care regimens. Additional research is needed to identify factors influencing caregiver adherence, leading to the development of evidence-based practice guidelines and to improve the outcomes in advanced heart failure patients living with left VAD.
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Affiliation(s)
- Lufei Young
- College of Nursing, 1421Augusta University, Augusta, GA, USA
| | - Rita F D'Aoust
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jesus M Casida
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Bailey D, Calasanti T, Crowe A, di Lorito C, Hogan P, de Vries B. Equal but different! Improving care for older LGBT+ adults. Age Ageing 2022; 51:6615425. [PMID: 35751872 DOI: 10.1093/ageing/afac142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
International human rights movements have improved the visibility and equality of lesbian, gay, bisexual and transgender+ (LGBT+) communities and their members. Health outcomes for LGBT+ people remain, however, worse than for their non-LGBT+ peers. Older LGBT+ people have experienced fewer positive changes, in part due to their lived experience of discrimination and their ongoing, unintentional invisibility in medical and social care. This article highlights the impacts of societal structure, health and social care on the lives of older LGBT+ people including physical and mental health, End of Life, Dementia, Housing and Care Settings, and a focus on the experiences of trans-people. We look at the existing improvements developed by LGBT+ communities (and their allies) and propose refreshing Person-Centred Care to improve inclusivity. Finally, we provide a framework for looking at the areas in which service challenges arise and suggest ways to address these to make health and social care services more ready to meet the needs of older LGBT+ people.
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Affiliation(s)
- Dan Bailey
- Department of Clinical Gerontology, King's College Hospital, London SE5 9RS, UK
| | - Toni Calasanti
- Department of Sociology, Virginia Tech, Blacksburg, VA 24061, USA
| | - Andrew Crowe
- Department of Acute Medicine, Croydon University Hospital NHS Trust, London, UK
| | | | - Patrick Hogan
- Department of Medicine for Elderly People, Whipps Cross University Hospital, London E11 1NR, UK
| | - Brian de Vries
- Gerontology Program, San Francisco State University, San Francisco, CA, USA
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37
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Investigating the lived experience of LGBT+ people with dementia and their care partners: a scoping review. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Dementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about their experiences, the ways in which their lives have been investigated, to inform future research, policy and practice. Using an established scoping review methodology, we identified seven papers that reported empirical research on the lived experience of LGBT+ people with dementia and their care partners. Only a single study reported on in two of the papers included people who were trans. This in itself reveals how rarely LGBT+ people are asked to speak about how dementia has shaped their lives in academic research. Our reflexive thematic analysis indicates that LGBT+ people with dementia and their care partners endure overlapping forms of disadvantage. This results in heightened experiences of fear and discrimination, lack of services and compounded social isolation. Importantly, while dementia was embodied as interference and loss by LGBT+ people, it was their gender and sexuality differences that provided solace, even in the face of disadvantage. Importantly, people's relationships with LGBT+ identities were framed as fundamental for safety, resilience and wellbeing, rather than a complicating or confounding factor in living with dementia.
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38
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Vorobyova A, Marante A, Cardinal C, Magagula P, Lyndon S, Braley M, Inglis K, Parashar S. Finding the Balance: Embracing the Two-Eyed Seeing Approach to Understand what Cultural Safety in Care Means to Older Adults Living with HIV. J Appl Gerontol 2022; 41:2063-2073. [PMID: 35582747 DOI: 10.1177/07334648221100803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes-Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles-indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).
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Affiliation(s)
- Anna Vorobyova
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Antonio Marante
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Claudette Cardinal
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Patience Magagula
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Sharyle Lyndon
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - McKenzie Braley
- Department of Psychology, Faculty of Arts and Social Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Kathleen Inglis
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Surita Parashar
- Division of Epidemiology and Population Health, 198129BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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40
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Anderson JG, Jabson Tree JM, Flatt JD, Gross AL, Williams IC, Rose KM. A Comparative Analysis of Family Quality of Life Between Heterosexual and Sexual Minority Caregivers of People with Dementia. J Appl Gerontol 2022; 41:1576-1584. [PMID: 35343304 DOI: 10.1177/07334648221079496] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Providing care for someone with Alzheimer's disease or related dementias (ADRD) is associated with significant physical and mental strain affecting quality of life among caregivers. However, little attention has been given to sexual minority (SM; lesbian, gay, bisexual, queer) people caring for those with ADRD. In this cross-sectional study, we used psychosocial measures to describe the characteristics and family quality of life of SM and heterosexual caregivers for people with ADRD. SM caregivers were significantly younger and more frequently reported full or part-time employment compared with their heterosexual counterparts. Lesbian and bisexual caregivers reported more difficulty in paying for everyday basics. After controlling for demographic covariates, SM caregivers had significantly higher family quality of life scores compared with heterosexual caregivers. This study is among the first to compare family quality of life between SM and heterosexual caregivers. Findings can guide development of targeted interventions for SM caregivers.
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Affiliation(s)
- Joel G Anderson
- College of Nursing, University of Tennessee-Knoxville, Knoxville, TN, USA
| | | | - Jason D Flatt
- School of Public Health, 14722University of Nevada-Las Vegas, Las Vegas, NV, USA
| | - Alden L Gross
- 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ishan C Williams
- School of Nursing, 2358University of Virginia, Charlottesville, VA, USA
| | - Karen M Rose
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, 2647The Ohio State University, Columbus, OH, USA
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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42
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Jett S, Malviya N, Schelbaum E, Jang G, Jahan E, Clancy K, Hristov H, Pahlajani S, Niotis K, Loeb-Zeitlin S, Havryliuk Y, Isaacson R, Brinton RD, Mosconi L. Endogenous and Exogenous Estrogen Exposures: How Women's Reproductive Health Can Drive Brain Aging and Inform Alzheimer's Prevention. Front Aging Neurosci 2022; 14:831807. [PMID: 35356299 PMCID: PMC8959926 DOI: 10.3389/fnagi.2022.831807] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/07/2022] [Indexed: 01/14/2023] Open
Abstract
After advanced age, female sex is the major risk factor for late-onset Alzheimer's disease (AD), the most common cause of dementia affecting over 24 million people worldwide. The prevalence of AD is higher in women than in men, with postmenopausal women accounting for over 60% of all those affected. While most research has focused on gender-combined risk, emerging data indicate sex and gender differences in AD pathophysiology, onset, and progression, which may help account for the higher prevalence in women. Notably, AD-related brain changes develop during a 10-20 year prodromal phase originating in midlife, thus proximate with the hormonal transitions of endocrine aging characteristic of the menopause transition in women. Preclinical evidence for neuroprotective effects of gonadal sex steroid hormones, especially 17β-estradiol, strongly argue for associations between female fertility, reproductive history, and AD risk. The level of gonadal hormones to which the female brain is exposed changes considerably across the lifespan, with relevance to AD risk. However, the neurobiological consequences of hormonal fluctuations, as well as that of hormone therapies, are yet to be fully understood. Epidemiological studies have yielded contrasting results of protective, deleterious and null effects of estrogen exposure on dementia risk. In contrast, brain imaging studies provide encouraging evidence for positive associations between greater cumulative lifetime estrogen exposure and lower AD risk in women, whereas estrogen deprivation is associated with negative consequences on brain structure, function, and biochemistry. Herein, we review the existing literature and evaluate the strength of observed associations between female-specific reproductive health factors and AD risk in women, with a focus on the role of endogenous and exogenous estrogen exposures as a key underlying mechanism. Chief among these variables are reproductive lifespan, menopause status, type of menopause (spontaneous vs. induced), number of pregnancies, and exposure to hormonal therapy, including hormonal contraceptives, hormonal therapy for menopause, and anti-estrogen treatment. As aging is the greatest risk factor for AD followed by female sex, understanding sex-specific biological pathways through which reproductive history modulates brain aging is crucial to inform preventative and therapeutic strategies for AD.
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Affiliation(s)
- Steven Jett
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Niharika Malviya
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Schelbaum
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Grace Jang
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Eva Jahan
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Katherine Clancy
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Silky Pahlajani
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Kellyann Niotis
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Susan Loeb-Zeitlin
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States
| | - Richard Isaacson
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Roberta Diaz Brinton
- Department of Pharmacology, University of Arizona, Tucson, AZ, United States
- Department of Neurology, University of Arizona, Tucson, AZ, United States
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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43
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James T, Mukadam N, Sommerlad A, Pour HR, Knowles M, Azocar I, Livingston G. Protection against discrimination in national dementia guideline recommendations: A systematic review. PLoS Med 2022; 19:e1003860. [PMID: 35015760 PMCID: PMC8752020 DOI: 10.1371/journal.pmed.1003860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND National dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. METHODS AND FINDINGS We searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country's official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded. CONCLUSIONS National guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world's countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.
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Affiliation(s)
- Tiffeny James
- Division of Psychiatry, University College London, London, United Kingdom
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Melanie Knowles
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Ignacia Azocar
- Division of Psychiatry, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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44
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Liu H, Hsieh N, Zhang Z, Zhang Y, Langa KM. Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study. J Gerontol B Psychol Sci Soc Sci 2021; 76:1388-1399. [PMID: 33211882 PMCID: PMC8499509 DOI: 10.1093/geronb/gbaa202] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States. METHODS We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment. RESULTS The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001). DISCUSSION The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.
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Affiliation(s)
- Hui Liu
- Department of Sociology, Michigan State
University, East Lansing
| | - Ning Hsieh
- Department of Sociology, Michigan State
University, East Lansing
| | - Zhenmei Zhang
- Department of Sociology, Michigan State
University, East Lansing
| | - Yan Zhang
- Department of Sociology, Michigan State
University, East Lansing
| | - Kenneth M Langa
- Department of Internal Medicine, Institute for Social
Research and VA Center for Clinical Management Research, University of
Michigan, Ann Arbor
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Infurna FJ. Utilizing Principles of Life-Span Developmental Psychology to Study the Complexities of Resilience Across the Adult Life Span. THE GERONTOLOGIST 2021; 61:807-818. [PMID: 34387342 DOI: 10.1093/geront/gnab086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 02/01/2023] Open
Abstract
Life-span developmental psychology includes a broad array of principles that have wide application to studying adult development and aging. Three principles have guided my past, current, and future research: (a) development being a cumulative, lifelong process with no one period taking precedence; (b) multiple processes influence development (e.g., age-, pathology-, nonnormative, and mortality-related processes); and (c) development is multidirectional and multidimensional. This paper elaborates on how these principles have guided my research studying resilience to adversity across the adult life span and how my research aligns with guiding elements of resilience across definitions and literatures. I also discuss my current and future research of applying these principles to studying resilience in midlife, which emphasizes how the defining features of midlife lend themselves to examining resilience, midlife continues to not be well understood, midlife health foreshadows health in old age, and the experience of midlife will evolve in the context of an increasingly diverse society. The last section elaborates on additional directions for future research, such as the promise of intensive longitudinal research designs that incorporate qualitative approaches and examining historical changes in midlife health and well-being. In conclusion, a life-span developmental psychology framework has wide application for elucidating the nature of resilience across the adult life span through the integration of its principles with existing paradigms and research designs that blend contemporary methods with mixed methodology.
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Affiliation(s)
- Frank J Infurna
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
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46
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Flatt JD, Cicero EC, Lambrou NH, Wharton W, Anderson JG, Bouldin ED, McGuire LC, Taylor CA. Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015-2018. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12197. [PMID: 34337136 PMCID: PMC8319657 DOI: 10.1002/trc2.12197] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Subjective cognitive decline (SCD) represents self-reported problems with memory, a possible early sign of dementia. Little is known about SCD among sexual and gender minority (SGM) adults who identify as lesbian, gay, bisexual, and/or transgender or gender non-binary. METHODS Data were weighted to represent population estimates from 25 states' 2015-2018 Behavioral Risk Factor Surveillance System to describe SCD in adults ≥45 years by SGM status. Logistic regression tested associations between demographic and health conditions. RESULTS SCD prevalence was higher in SGM (15.7%; 95% confidence interval [CI]:13.1-18.2) than in non-SGM adults (10.5%; 95% CI:10.1-10.9; P < .0001). SGM adults with SCD were also more likely to report functional limitations due to SCD than non-SGM adults with SCD, 60.8% versus 47.8%, P = .0048. Differences in SCD by SGM status were attenuated after accounting for depression. DISCUSSION Higher prevalence of SCD in SGM adults highlights the importance of ensuring inclusive screenings, interventions, care services, and resources for SGM adults.
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Affiliation(s)
- Jason D. Flatt
- School of Public HealthUniversity of Nevada Las VegasLas VegasNevadaUSA
| | - Ethan C. Cicero
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | - Nickolas H. Lambrou
- Department of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgiaUSA
| | | | - Erin D. Bouldin
- Division of Population HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
- Department of Health and Exercise ScienceAppalachian State UniversityBooneNorth CarolinaUSA
| | - Lisa C. McGuire
- Division of Population HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Christopher A. Taylor
- Division of Population HealthNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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van Heesewijk JO, Dreijerink KMA, Wiepjes CM, Kok AAL, van Schoor NM, Huisman M, den Heijer M, Kreukels BPC. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021; 18:1434-1443. [PMID: 37057450 DOI: 10.1016/j.jsxm.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population. AIM We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences. METHODS In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed. OUTCOMES Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected. RESULTS Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups. CLINICAL IMPLICATIONS The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT. STRENGTHS & LIMITATIONS As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study. CONCLUSION Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;18:1434-1443.
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Affiliation(s)
- Jason O van Heesewijk
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Almar A L Kok
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martijn Huisman
- Amsterdam University Medical Centers, location VUmc, Department of Epidemiology and Data Science, , Amsterdam, the Netherlands
| | - Martin den Heijer
- Amsterdam University Medical Centers, location VUmc, Department of Endocrinology, , Amsterdam, the Netherlands
- Amsterdam University Medical Centers, location VUmc, Center of Expertise on Gender Dysphoria, , Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam University Medical Centers, location VUmc, Department of Medical Psychology, , Amsterdam, the Netherlands
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48
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Rosendale N, Wong JO, Flatt JD, Whitaker E. Sexual and Gender Minority Health in Neurology: A Scoping Review. JAMA Neurol 2021; 78:747-754. [PMID: 33616625 DOI: 10.1001/jamaneurol.2020.5536] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Little is known about the neurologic health needs of sexual and gender minority (SGM) individuals, and existing research indicates health care disparities for this group. Objective To describe the current state of science in SGM neurology and highlight areas of knowledge and gaps to guide future research. Evidence Review All articles published before April 12, 2020, in PubMed, Embase, Web of Science, PsycInfo, CINAHL, and BIOSIS Previews were searched using a search string encompassing SGM descriptors and neurologic disorders. A total of 8359 items were found and entered into EndNote, and 2921 duplicates were removed. A blind title and abstract review was performed followed by full-text review in duplicate, with conflicts settled through consensus, to identify 348 articles eligible for data abstraction. Articles presenting primary data about an identified adult SGM population addressing a clinical neurology topic were included. Descriptive statistics were used for abstracted variables. Findings Of 348 studies, 205 (58.9%) were case reports or series, 252 (72.4%) included sexual minority cisgender men, and 247 (70.9%) focused on HIV. An association was found between autism spectrum disorder and gender dysphoria in 9 of 16 studies (56.3%), and a higher risk of ischemic stroke in transgender women was shown in other studies. Literature in neuroinfectious disease, the most common topic, largely focused on HIV (173 of 200 studies [86.5%]). Findings in other neurologic topics were limited by lack of data. Conclusions and Relevance In this rigorous compendium of SGM neurology literature, several deficiencies were found: most studies focused on a limited breadth of neurologic pathology, included only a portion of the overall SGM community, and did not assess other aspects of sociodemographic diversity that may contribute to disparities in health care access and outcomes among SGM individuals. Expanding neurologic research to include broader representation of SGM individuals and incorporating sociodemographic factors, like race/ethnicity and socioeconomic status, are essential steps toward providing equitable neurologic care for this community.
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Affiliation(s)
- Nicole Rosendale
- Department of Neurology, University of California, San Francisco Medical Center, San Francisco.,Weill Institute for Neurosciences, University of California, San Francisco
| | | | - Jason D Flatt
- School of Public Health, University of Nevada, Las Vegas
| | - Evans Whitaker
- Health Science Library, University of California, San Francisco
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Expanding sexual and gender minority research in movement disorders: More than awareness and acceptance. Parkinsonism Relat Disord 2021; 87:162-165. [PMID: 34088617 DOI: 10.1016/j.parkreldis.2021.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022]
Abstract
Culturally competent and inclusive care is slowly becoming the standard throughout healthcare institutions. Awareness, acceptance, and inclusion of the sexual and gender minority (SGM) groups in medicine and neurology are progressing. Research in SGM health, although increasing, remains remarkably scant in parkinsonism and other movement disorders, a community whose patient population is on the rise. Most SGM health research in movement disorders only focuses on the symptoms associated with infection by the human immunodeficiency virus and the acquired immunodeficiency syndrome. Multiple clinical and epidemiological research questions remain unaddressed when considering the intersection of movement disorders and SGM health. In this article, we highlight gaps in the care of SGM individuals with movement disorders. First, the prevalence and phenomenology of movement disorders could be different, considering the different rates of risk factors and the use of gender-affirming hormones. Also, the effect of creating a safe environment in healthcare institutions to disclose sexual orientation and gender identity on seeking care, access to resources, and quality of services remains unknown. Moreover, many individuals with movement disorders would require services from multidisciplinary teams or long-term care facilities, which might not consider the needs of SGM patients in their models of care. Last, the effect of social isolation and self-perception (or misperceptions) in the SGM populations on the non-motor and motor symptoms of movement disorders and the treatment plans is not understood.
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50
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Anderson JG, Flatt JD, Jabson Tree JM, Gross AL, Rose KM. Characteristics of Sexual and Gender Minority Caregivers of People With Dementia. J Aging Health 2021; 33:838-851. [PMID: 33998313 DOI: 10.1177/08982643211014767] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Given what little is known about the experiences of sexual and gender minority (SGM) caregivers of people with Alzheimer's disease and related dementias (ADRD), the aim of the current study was to describe psychosocial measures among these caregivers. Methods: We used an online survey and social media recruitment strategies. Results: Of 286 caregivers, the majority were gay men. Most respondents were white, with a third identifying as Latino American. The plurality of caregivers identified as a spouse/partner and were providing care for someone who identified as a sexual minority; one-fifth cared for someone transgender. Sexual orientation, perceived stress, caregiver stigma, and microaggressions were psychosocial factors associated with family quality of life and depressive symptoms in the caregivers. Discussion: This study is the first to provide a focused description of the characteristics and psychosocial needs of SGM caregivers of someone with ADRD, supporting development of targeted interventions for this population.
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Affiliation(s)
- Joel G Anderson
- College of Nursing, University of Tennessee-Knoxville, Knoxville TN, USA
| | - Jason D Flatt
- School of Public Health, 14722University of Nevada-Las Vegas, Las Vegas, NV, USA
| | | | - Alden L Gross
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen M Rose
- Center for Healthy Aging, Self-Management and Complex Care, College of Nursing, 2647The Ohio State University, Columbus, OH, USA
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