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BACKGROUND AND OBJECTIVES: To examine the role of probable dementia on changes in living arrangements and mortality among very old Mexicans and Mexican Americans in 2 different nations. RESEARCH DESIGN AND METHODS: We employ the Hispanic Established Population for the Epidemiologic Study of the Elderly and the Mexican Health and Aging Study, 2 comparable longitudinal data sets, to identify predictors of changes in living arrangements using multinomial logistic regression, controlling for cognitive status, demographic characteristics, and resources. RESULTS: In Mexico, women with dementia who lived alone at baseline were more likely to become part of an extended family household than men with similar levels of cognitive impairment. A similar pattern emerges for the oldest Mexican-American women. Spousal loss increases the likelihood of living alone for women in the United States regardless of dementia. Although dementia elevates the risk of mortality for men living alone in the United States, in both countries, women in their 90s who lived alone with dementia had a lower risk of mortality relative to men. DISCUSSION AND IMPLICATIONS: Longer life spans increase the risk of living alone with dementia in both countries, especially for women. Older individuals in both countries face financial hardships. Mexicans have limited formal options in dementia care. Mexican Americans with dementia continue to live alone despite low income although, unlike the Mexicans, they have access to Medicaid long-term care. For Mexico and the United States, the growing number of older individuals with dementia represents a growing public health concern.

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OBJECTIVE: To estimate the prevalence of dementia among American Indian and Alaska Native (AIAN) Medicare beneficiaries and compare the prevalence of dementia in AIANs and other racial and ethnic minority groups-non-Hispanic Blacks (NHBs) and Hispanics-with non-Hispanic Whites (NHWs) Medicare beneficiaries. METHODS: We used survey data from Round 5 of the National Health and Aging Trends Study (NHATS, 2015) (N = 7,449), a nationally representative study of Medicare beneficiaries ages 65 years and older. We used logistic regression to estimate the age- and sex-adjusted prevalence of dementia with 95% confidence intervals by race/ethnicity as well as prevalence differences between groups. RESULTS: The majority of participants were between 65 and 74 years old. Approximately half of them were female. NHWs had a prevalence of 5% for dementia, and AIAIs had a prevalence of 9%, four percentage points higher than NHWs (95%CI 1%, 11%). We estimated a similar difference in the prevalence of dementia in AIAN Medicare beneficiaries compared to NHBs. CONCLUSION: While previous research has reported that AIANs share a similar or lower prevalence of dementia than NHWs, our findings suggest a potentially higher prevalence of dementia among AIAN Medicare beneficiaries. A relatively small number of AIAN resulted in wide confidence intervals for many of our associations. Future research should focus on recruiting a larger sample and on dementia prevalence and unique risk factors within and among AIAN tribes.

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OBJECTIVE: The study estimates the number of years after age 65 that Mexican Americans live with likely dementia and the impact of dementia on community-based services (CBS) use by nativity. METHODS: Using the Hispanic Established Populations for the Epidemiologic Studies of the Elderly Sullivan methods are employed to predict duration of dementia and logistic regressions identify the predictors of service utilization. RESULTS: Foreign-born women spend more years than other groups with dementia. The foreign-born are more likely to use out-of-home services, whereas U.S.-born are more likely to use in-home services. The foreign-born with dementia of relatively recent onset had the highest probability of service use. DISCUSSION: Given the high cost of institutional care and availability of family caregivers, community-based services are a potentially useful alternative for the growing Mexican-American population living with dementia. Expanded Medicaid and CBS programs could be an equitable and cost-effective alternative that should be investigated.

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OBJECTIVES: Given racial disparities in both dementia and coronavirus disease 2019 (COVID-19), non-Hispanic Black (Black) dementia caregivers (CGs) may be at greater risk for care burden during the COVID-19 pandemic than non-Hispanic White (White) CGs. This study investigates the impact of dementia care provision on CGs' quality of life by race using the 2020 National Health and Aging Trends Study Family Members and Friends COVID-19 data (FF). METHODS: This study features a secondary analysis of FF data (2020-2021), including 216 Black and 1,204 White CGs. We used ANOVA to determine differences in caregiving stressors (i.e., changes in providing help with activities of daily living [ADL], instrumental ADL [IADL], and emotional support). Ordinary least square regression was used to investigate the moderating effects of dementia care on the associations of race with perceived well-being, care burden, and self-reported health and to conduct subgroups analyses of Black and White dementia CGs. RESULTS: Black dementia CGs provided significantly more help with ADL before and during the COVID-19 pandemic than Black nondementia, White dementia, and White nondementia CGs. Dementia care status did not moderate the associations between race and CG outcomes. For Black dementia CGs, changes in objective stressors (assistance with ADL and IADL) were associated with care burden and well-being. For White CGs, the provision of emotional support was associated with care burden and well-being. DISCUSSION: This study highlights that increased caregiving demands during the pandemic amplified racial differences in CG stress. Findings suggest that outreach to reduce CG stress and burden is critical for Black dementia CGs.

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Background and Objectives: The growing population of adults surviving past age 85 in the United States and Mexico raises questions about the living arrangements of the oldest old and those living with dementia. This study compares Mexican and Mexican American individuals aged 85 and older to identify associations with cognitive status and living arrangements in Mexico and the United States. Research Design and Methods: This study includes 419 Mexican Americans in 5 southwestern states (Hispanic Established Population for the Epidemiologic Studies of the Elderly) and 687 Mexicans from a nationally representative sample (Mexican Health and Aging Study). It examines characteristics associated with living alone using logistic regression and describes the living arrangements of older adults with probable dementia in each country. Results: Older adults with dementia were significantly less likely to live alone than with others in the United States while there were no relationships between dementia and living arrangements in Mexico. However, a substantial proportion of older adults with dementia lived alone in both nations: 22% in the United States and 21% in Mexico. Among Mexican Americans with dementia, those living alone were more likely to be women, childless, reside in assisted living facilities, and less likely to own their homes. Similarly, Mexican individuals with dementia who lived alone were also less likely to be homeowners than those living with others. Discussion and Implications: Contextual differences in living arrangements and housing between the United States and Mexico pose different challenges for aging populations with a high prevalence of dementia.

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This study explores coping strategies and barriers to dementia care experienced by African American dementia caregivers in Kentucky. Utilizing a convergent mixed-method design integrating focus group and survey data on African American dementia caregivers recruited through churches in Kentucky (N = 28), we elucidate three coping strategies: love-based coping, religion-based coping, and family support. Results from survey data supported these themes, with over 90% of participants reporting that they provide care to give back to family members and for religious reasons. However, over half of the caregivers' reported strain due to three barriers identified by focus group data: time constraints, low support, and the high cost of formal care. This exploratory study highlights the importance of intervention tactics for African American dementia caregivers that focus not only on individual and family support but also community-based outreach and support.

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ObjectivesMexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010-2011, 2012-2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

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In this article, we report on the recommendations of a binational conference that examined the institutional capacities and future ability of Mexico and the United States to address the need for affordable and sustainable dementia care that results from growing older adult populations. These recommendations reflect the large difference in resources between the two nations and each country's political and institutional capacity. Progress in both countries will require an expansion of programs or the generation of new ones, to meet the needs of older adults, including improving access to services and actively managing the dementia care burden. A comprehensive federal health care safety net will be required in both nations, but economic realities will constrain its implementation. Both nations suffer from a persistent shortage of geriatric primary care physicians and geriatricians, especially in rural areas. Advances in diagnosis, treatment, and care management require additional knowledge and skills of general and specialized staff in the health care workforce to deliver evidence-based, culturally and linguistically appropriate long-term care, and human rights-oriented services. We conclude with a discussion of recommendations for binational dementia care policy and practice.

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OBJECTIVE: To study the effects of disability, cognitive impairment, and neuropsychiatric disturbance among older Mexican Americans on depressive symptoms in their children caregivers. METHODS: This study utilizes data from Wave 7 (2010-2011) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE). The final sample included 200 adult children caregivers that provided direct personal care with activities of daily living (ADL) (e.g. bathing, toileting, dressing, etc.) to their older parents (average age = 87). We analyzed the influence of ADL disability, cognition (MMSE), and neuropsychiatric symptoms (NPI) of the care recipient on depressive symptoms of the adult child caregiver. A cross-sectional multivariable linear regression analysis was conducted to examine the effect of neuropsychiatric disturbance on caregiver depressive symptoms. RESULTS: Presence of care recipient NPI symptoms was associated with higher depressive symptoms for caregivers. Additional characteristics associated with caregiver depressive symptoms were not being married, and higher perceived social stress. ADL disability of the care recipient, cognitive functioning of the care recipient, or caregiver health status alone did not have a significant effect on depressive symptoms of the caregiver. CONCLUSIONS: In a Mexican American familistic culture, disability and cognitive impairment might be better tolerated by families but neuropsychiatric behavioral symptoms related to dementia may take an increased toll on family member caregivers. The need to provide respite services, mental health resources and community services for caregivers of care recipients with neuropsychiatric symptoms is of paramount importance to alleviate depressive symptoms and burden among caregivers.

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Nativity status is related to stress, health and well-being, but the literature is scant concerning whether these effects differ by race/ethnicity for older adults. We examined direct and indirect effects of nativity status on stress, coping resources, health, and depression/anxiety for the three largest racial/ethnic groups [Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic] in the U.S. using the Transactional Model of Stress and Coping. We obtained the data from Round 1 of the National Health and Aging Trends Study (NHATS; U.S.-born Medicare beneficiaries = 4093, foreign-born Medicare beneficiaries = 382, N = 4475). We used the multi-group analysis function in structural equation modeling to examine similarities and differences in the stress coping processes for the three racial/ethnic groups. The results indicated there are multiple pathways from nativity status to depression or self-rated health. For all three groups, being foreign-born was directly associated with higher stress and indirectly associated with lower self-rated health via stress. Only for Hispanic older adults was being foreign-born directly associated with higher depression/anxiety. For NHWs, being foreign-born was indirectly associated with higher depression/anxiety via less coping resources. Nativity status may have similar effects on self-rated physical health but may exert very different effects on depression/anxiety, depending on race/ethnicity. Nativity status will require special attention for both assessment and management of depression/anxiety as well as self-rated health among older adults of all racial/ethnic backgrounds and especially for older Hispanics.

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BACKGROUND AND OBJECTIVES: In the next few decades, the number of Mexican American older adults with Alzheimer's disease and related disorders will increase dramatically. Given that this population underutilizes formal care services, the degree of care responsibilities in Mexican American families is likely to increase at the same time. However, little is known about the changing need for assistance with instrumental day-to-day activities and emotional support by long-term patterns of cognitive impairment. RESEARCH DESIGN AND METHODS: We use 7 waves of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (1992/1993-2010/2011) and trajectory modeling to describe long-term patterns of perceived emotional and instrumental support, and dementia. RESULTS: Results revealed 2 latent classes of both emotional and instrumental support trajectories: low and high support. Specifically, those living alone were more likely to belong to the group with low support than to that with high support. Three latent classes for likely dementia were also revealed: likely dementia, increasing impairment, and no impairment. Those living alone were more likely to belong to the increasing impairment and likely dementia groups. The dual trajectory of emotional and instrumental support with likely dementia revealed that the probability of belonging to the low-support group was highest for those with increasing impairment. DISCUSSION AND IMPLICATIONS: These findings highlight the risk and vulnerability of those who live alone concerning perceived social support and dementia. Implications of the findings for the potential dependency burden on Latino caregivers are discussed.

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OBJECTIVES: This study uses the life course perspective to explore the role of key midlife factors (occupation and number of children) for gender- and nativity-based pathways to cognitive aging for older Mexican Americans. METHOD: Using the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE, 1993/1994-2016, n = 2,779), this study presents (a) cognitive impairment trajectories over 20 years of data and (b) multinomial logistic regression analyses of trajectory group membership by lifetime occupation and number of children, controlling for educational attainment. RESULTS: For older Mexican American men, lifetime employment in agricultural occupations is associated with elevated risk for late-life cognitive impairment. Delayed risk for impairment is observed for U.S.-born men who were employed in factory work (e.g., production and repair) and in Mexican-born men who were employed in occupations with skilled or supervisory requirements. For all women, labor force participation, especially in skilled occupations, is related to a delayed risk of cognitive impairment. Number of children is unrelated to impairment for men; however, women with five or more children (compared to women with two to four children) are at risk for consistent and rapid cognitive impairment in late life. DISCUSSION: Late-life cognitive health disparities that disproportionately impact the Mexican American population can be addressed by improving access to educational and occupational opportunities in early and midlife. This study points to key areas of intervention within work and the home for the Mexican-origin population.

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INTRODUCTION: Substantial gaps in research remain across oldest-old ethnic populations while the burden of dementia increases exponentially with age among Mexican and Mexican American older adults. METHODS: Prevalence and correlates of dementia among individuals ≥82 years of age were examined using two population-based cohort studies: The Mexican Health and Aging Study (MHAS, n = 1078, 2012) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, n = 735, 2012-2013). The analytic MHAS and HEPESE samples had an average age of 86.4 and 88.0 years, 1.2 and 1.8 women to men, and 2.7 and 5.1 average years of education, respectively. RESULTS: We identified 316 (29.2%) and 267 (36.3%) cases of likely dementia in the MHAS and HEPESE cohorts, respectively. For Mexicans but not Mexican Americans, age-adjusted prevalence rates of likely dementia were higher in women than men. For both populations prevalence rates increased with age and decreased with education for Mexican Americans but not for Mexicans. In both populations, odds of likely dementia increased with age. Health insurance for the low-income was significantly associated with higher odds of likely dementia for Mexican American men and women and Mexican women but not men. Living in extended households increased the odds of likely dementia in women, but not in men for both studies. Multiple cardiovascular conditions increased the odds of likely dementia for Mexicans but not for Mexican Americans. DISCUSSION: Our study provides evidence of the high burden of dementia among oldest-old Mexicans and Mexican Americans and its association with health and social vulnerabilities.

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BACKGROUND AND OBJECTIVES: Despite growing diversity among the aging population and extensive previous research on racial/ethnic minority caregivers, little research has been conducted on the potentially unique experiences and outcomes of informal caregivers of foreign-born care recipients. Using nationally representative data and the Stress Process Model, the current study examined the differences in caregiver outcomes (care burden, psychological well-being, and self-rated health) by care recipient nativity status (U.S.-born vs. foreign-born) and the extent to which caregiver outcomes vary by care recipient nativity status and caregiver race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Others). RESEARCH DESIGN AND METHODS: The current study used Round 5 of the National Health and Aging Trends Study and the National Study of Caregiving (N = 1,436). We conducted ordinary least squares regression to analyze the differences in caregiver's outcomes by care recipient nativity status and caregiver race/ethnicity and to investigate the impacts of the inclusion of caregiving factors (background factors, primary stressors, secondary stressors, and resources). RESULTS: Regression analyses showed that only care burden significantly varied by care recipient nativity status after controlling for covariates. Caregivers of foreign-born care recipients reported a higher burden. However, when interactions of care recipient nativity status × caregiver race/ethnicity were introduced, non-Hispanic black and Hispanic caregivers of foreign-born care recipients were more likely to report better psychological well-being and self-rated health compared to their counterparts. Across caregiver groups, better caregiver-care recipient relationship quality and less caregiver chronic conditions were associated with less burden and better caregiver psychological well-being and self-rated health. DISCUSSION AND IMPLICATIONS: Care recipient nativity status and caregiver race/ethnicity may have complex effects on caregiving experiences. Given the observed significant interaction effects for caregiver psychological well-being and self-rated health, cultural factors may affect the extent to which these caregivers appraise their caregiving. Future research should delve into the appropriate ways to assess care stress as well as resilience among each caregiver group. Our results indicate the need for research, education, and practice that assess cultural and within-group differences among caregivers and inform needed changes to structural barriers.

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OBJECTIVES: Although research suggests that religious involvement tends to favor longevity, most of this work has been conducted in the United States. This article explores the association between religious participation and all-cause mortality risk in Mexico. METHODS: We used data from the 2003-2015 Mexican Health and Aging Study (n = 14,743) and Cox proportional hazard regression models to assess the association between religious participation and all-cause mortality risk. RESULTS: Our key finding is that older Mexicans who participate once or more per week in religious activities tend to exhibit a 19% reduction in the risk of all-cause mortality than those who never participate. This estimate persisted with adjustments for health selection (chronic disease burden, activities of daily living, instrumental activities of daily living, cognitive functioning, and depressive symptoms), several potential mediators (social support, smoking, and drinking), and a range of sociodemographic characteristics. Although we observed considerable health selection due to physical health and cognitive functioning, we found no evidence of mediation. DISCUSSION: Our results confirm that religious participation is associated with lower all-cause mortality risk among older adults in Mexico. Our analyses contribute to previous research by replicating and extending the external validity of studies conducted in the United States, Israel, Denmark, Finland, and Taiwan.

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An extensive body of research documents marital status differences in health among older adults. However, few studies have investigated the heterogeneity in depressive symptomatology among older married adults living in developing countries. Our study investigates the interplay of gender and marital power dynamics for mental health among older Mexican adults. Our sample includes older married couples in the 2015 Wave of the Mexican Health and Aging Study (n=3,621 dyads). We use seemingly unrelated regression to model the association between self-reported distributions of decision-making power within marriages and depressive symptoms for husbands and wives. For approximately 41 per cent of couples, the husband and wife both reported an equal distribution of power in the marriage. Compared to those who reported an equal power distribution, husbands and wives who reported an imbalance of power (having more power or less power than their spouse) reported more depressive symptoms. Levels of depressive symptoms were higher in marriages characterised by an unequal balance of power. The relationship between equality in power and depressive symptoms is not explained by health care needs or living arrangements. Marital quality is an important factor for understanding depressive symptoms among older Mexican adults.

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BACKGROUND AND OBJECTIVES: The current study employs population-based data to determine the extent to which stress and coping factors are related to self-rated health and distress for informal caregivers (CGs) from the 3 largest racial/ethnic groups in the United States (non-Latino White, African American, and Mexican American). RESEARCH DESIGN AND METHODS: Data on primary, informal CGs are obtained from the 2015 National Study of Caregiving (NSOC) (n = 667) and the 2016 Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE) CG supplement (n = 287). Logistic regression models of health are presented for all CGs and specifically for dementia CGs. RESULTS: Caregiving intensity is related to health for non-Latino White CGs and African American dementia CGs. Support from family and friends is related to better self-rated health, but only for African American dementia CGs. While better relationship quality is related to better health for African American CGs and White dementia CGs, formal support utilization is related to worse CG health for Mexican American dementia CGs. DISCUSSION AND IMPLICATIONS: Findings emphasize the importance of earlier detection and intervention with CGs at the beginning in the caregiving career, the interplay of formal and informal support, and appropriate ways to intervene with dementia CGs. Culturally tailored home- and community-based care options are needed to supplement the low levels of CG support, especially for the Mexican American population.

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The purpose of this study is to explore variations in family support for Latino dementia caregivers and describe the role of the family in dementia caregiver stress processes. Content analysis is utilized with themes derived inductively from 16 in-depth interviews with Latino caregivers recruited in California from 2002 to 2004. Three types of family support are described: extensive (instrumental and emotional support from family, n = 3), limited (instrumental support from one family member, n = 7), and lacking (no support from family, n = 6). Most caregivers report limited support, high risk for burnout and distress, and that dementia-related neuropsychiatric symptoms are obstacles to family unity. Caregivers with extensive support report a larger family size, adaptable family members, help outside of the family, and formalized processes for spreading caregiving duties across multiple persons. Culturally competent interventions should take into consideration diversity in Latino dementia care by (a) providing psychoeducation on problem solving and communication skills to multiple family members, particularly with respect to the nature of dementia and neuropsychiatric symptoms, and by (b) assisting caregivers in managing family tensions - including, when appropriate, employing tactics to mobilize family support.

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The rising number of immigrants to the United States and other western countries has been accompanied by rising interest in the characteristics of immigrants including their mortality risk and health status. In general, immigrants to the United States, Canada, and Australia enjoy a health advantage over the native populations, which has been coined the healthy immigrant effect. The purpose of this review is to summarize findings on aging and the immigrant health effect in the 3 most common immigrant destinations the United States, Canada, Australia, as well as in Europe. Much of the research in the United States has focused on the so-called Hispanic Paradox or the favorable health of Hispanics relative to non-Hispanic whites despite lower average socioeconomic status as well as other risk factors, with recent research beginning to pay attention to dietary and genetic factors. In all 3 countries, there is evidence of a health convergence of immigrants relative to the native-born population over approximately 10-20 years. By the time they reach old age, immigrants experience high rates of comorbidity and disability. Immigrant health selection appears to be the key reason explaining the immigrant health advantage. Immigrants to Europe also appear to be health selected but not as consistently as in the United States, Canada, and Australia. Immigrant enclaves appear to confer health advantages in the United States among older Hispanics but appear to have negative consequences in Europe. More attention needs to be given to the health and health care needs of the rising numbers of refugees to Europe as well as refugees in the Middle East, Africa, and elsewhere.

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