S Duke Han1,2,3,4,5,6,7, Lisa L Barnes5,6,7, Sue Leurgans6,7, Lei Yu6,7, David A Bennett6,7, Patricia A Boyle5,6. 1. Department of Family Medicine, University of Southern California, Los Angeles, California. 2. Department of Neurology, University of Southern California, Los Angeles, California. 3. Department of Psychology, University of Southern California, Los Angeles, California. 4. School of Gerontology, University of Southern California, Los Angeles, California. 5. Department of Behavioral Sciences and Psychiatry, Rush University Medical Center, Chicago, Illinois. 6. Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois. 7. Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.
Abstract
BACKGROUND/ OBJECTIVES: Decision making in financial and healthcare matters is of critical importance for well-being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making. DESIGN: Community-based epidemiologic cohort study. SETTING: Communities in northeastern Illinois. PARTICIPANTS: Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision-making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276). MEASUREMENTS: All participants completed clinical assessments, a decision-making measure that resembles real-world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare). RESULTS: In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (β = -8.20; SE = 1.34; 95% CI = -10.82 to -5.57; P < .01) and separately on decision making (β = -.80; SE = .23; 95% CI = -1.25 to -.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (β = -.45; SE = .24; 95% CI = -.93 to .02; P = .06), but literacy remained significantly associated with decision making (β = .04; SE = .01; 95% CI = .02-.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making. CONCLUSIONS: Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well-being for diverse populations. J Am Geriatr Soc 68:1279-1285, 2020.
BACKGROUND/ OBJECTIVES: Decision making in financial and healthcare matters is of critical importance for well-being in old age. Preliminary work suggests racial differences in decision making; however, the factors that drive racial differences in decision making remain unclear. We hypothesized literacy, particularly financial and health literacy, mediates racial differences in decision making. DESIGN: Community-based epidemiologic cohort study. SETTING: Communities in northeastern Illinois. PARTICIPANTS: Nondemented Black participants (N = 138) of the Rush Alzheimer's Disease Center Minority Aging Research Study and the Rush Memory and Aging Project who completed decision-making and literacy measures were matched to White participants (N = 138) according to age, education, sex, and global cognition using Mahalanobis distance (total N = 276). MEASUREMENTS: All participants completed clinical assessments, a decision-making measure that resembles real-world materials relevant to finance and healthcare, and a financial and health literacy measure. Regression models were used to examine racial differences in decision making and test the hypothesis that literacy mediates this association. In secondary analyses, we examined the impact of literacy in specific domains of decision making (financial and healthcare). RESULTS: In models adjusted for age, education, sex, and global cognition, older Black adults performed lower than older White adults on literacy (β = -8.20; SE = 1.34; 95% CI = -10.82 to -5.57; P < .01) and separately on decision making (β = -.80; SE = .23; 95% CI = -1.25 to -.34; P < .01). However, when decision making was regressed on both race and literacy, the association of race was attenuated and became nonsignificant (β = -.45; SE = .24; 95% CI = -.93 to .02; P = .06), but literacy remained significantly associated with decision making (β = .04; SE = .01; 95% CI = .02-.06; P < .01). In secondary models, a similar pattern was observed for both financial and healthcare decision making. CONCLUSIONS: Racial differences in decision making are largely mediated by literacy. These findings suggest that efforts to improve literacy may help reduce racial differences in decision making and improve health and well-being for diverse populations. J Am Geriatr Soc 68:1279-1285, 2020.
Authors: Mengchi Li; Hyejin Kim; Susan M Sereika; Trevor J Nissley; Jennifer H Lingler Journal: Res Gerontol Nurs Date: 2022-02-11 Impact factor: 1.643
Authors: Sukriti Nag; Lisa L Barnes; Lei Yu; Robert S Wilson; David A Bennett; Julie A Schneider Journal: Neurology Date: 2020-08-05 Impact factor: 9.910
Authors: Sukriti Nag; Lisa L Barnes; Lei Yu; Aron S Buchman; David A Bennett; Julie A Schneider; Robert S Wilson Journal: Neurology Date: 2021-06-04 Impact factor: 11.800
Authors: S Duke Han; Lisa L Barnes; Sue Leurgans; Lei Yu; Christopher C Stewart; Melissa Lamar; Crystal M Glover; David A Bennett; Patricia A Boyle Journal: Front Psychol Date: 2021-07-12