Gali H Weissberger1, S Duke Han2, Lei Yu3, Lisa L Barnes4, Melissa Lamar5, David A Bennett3, Patricia A Boyle5. 1. Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan, Israel 5290002. 2. Department of Family Medicine, USC Keck School of Medicine, 1000 S. Fremont Avenue, Unit 22, HSA Building A-6, 4th Floor, Room 6437A, Alhambra, CA, 91803, USA; Department of Psychology, USC Dornsife College of Letters, Arts, and Sciences, Los Angeles, 90089, CA, USA; USC School of Gerontology, Los Angeles, CA, 90089, USA; Department of Neurology, USC Keck School of Medicine, Los Angeles, 90033, CA, USA. Electronic address: Duke.Han@med.usc.edu. 3. Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison St. Suite 1000, Chicago, IL 60612; Department of Neurological Sciences, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612. 4. Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison St. Suite 1000, Chicago, IL 60612; Department of Psychiatry and Behavioral Sciences; Department of Neurological Sciences, Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612. 5. Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 West Harrison St. Suite 1000, Chicago, IL 60612; Department of Psychiatry and Behavioral Sciences.
Abstract
OBJECTIVES: A growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project. MATERIALS AND METHODS: Cross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy. RESULTS: Early life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029). CONCLUSIONS: Findings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.
OBJECTIVES: A growing body of evidence points to the negative impact of early life socioeconomic status (SES) on health and cognitive outcomes in later life. However, the effect of early life SES on decision making in old age is not well understood. This study investigated the association of early life SES with decision making in a large community-based cohort of older adults without dementia from the Rush Memory and Aging Project. MATERIALS AND METHODS: Cross-sectional data from the Rush Alzheimer's Disease Center Memory and Aging Project was analyzed. Participants were 1044 community-dwelling older adults without dementia (M age = 81.15, SD = 7.49; 75.8% female; 5.4% non-White). Measures of financial and healthcare decision making and early life SES were collected, along with demographics, global cognition, and financial and health literacy. RESULTS: Early life SES was positively associated with decision making (estimate = 0.218, p = 0.027), after adjustments for demographic covariates and global cognition, such that a one-unit increase in early life SES was equivalent to the effect of being four years younger in age as it pertains to decision making. A subsequent model demonstrated that the relationship was strongest in those with low literacy, and weakest for those with high literacy (estimate = -0.013, p = 0.029). CONCLUSIONS: Findings from this study suggest that early life SES is associated with late life decision making and that improving literacy, a modifiable target for intervention, may buffer the negative impact of low early life SES on decision making in older adulthood.
Keywords:
Consortium to Establish a Registry for Alzheimer's Disease, CERAD; Mini-Mental Status Exam, MMSE; National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, NINDCS-ADRDA; Rush Memory and Aging Project, MAP; aging; decision making; early life conditions; financial and health behaviors List of Abbreviations Socioeconomic Status, SES; literacy; socioeconomic status
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