Growing reluctance of households to participate in surveys has led to a variety of methodological efforts to combat this phenomenon. Several organizations employ case prioritization in a responsive survey design framework, dedicating increased effort to specific subgroups of sampled cases during certain data collection phases. For example, some surveys may prioritize subgroups defined by age and/or race/ethnicity if balanced response rates across these subgroups are important for minimizing nonresponse bias. Unfortunately, no methodological studies to date have identified optimal approaches for applying this increased effort to prioritized cases. This study experimentally examined three alternative methods for case prioritization in the National Survey of Family Growth: simply flagging the cases to receive increased effort in the sample management system (a “standard” method), developing tailored approaches to working the prioritized cases, and no prioritization (a “control” method). In the “tailored” method, which was designed to provide the interviewers with more guidance than simple “flagging,” interviewers worked with their supervisors to develop tailored strategies for how to best work each case within the prioritized subgroup. We find that both prioritization methods improved response rates and led to significant reductions in calling effort per completed case, with the “flagging” approach working particularly well. Given the additional costs associated with the “tailored” method, the results of our experiment provide support for a “hybrid” case prioritization approach that combines optimal features of these two methods.
BackgroundBilingualism is increasingly common in older adults in the US and may impact the expression and course of Alzheimer’s Disease and related dementias (ADRD). Optimal methods for assessing cognition in population‐based studies of bilingual older adults are not established. Given that declines in semantic fluency are associated with declines in episodic memory in ADRD, we examined the degree to which animal naming in English and Spanish is associated with memory performance in a sample of bilingual Mexican American (MA) older adults.MethodThe Brain Attack Surveillance in Corpus Christi‐Cognitive study is a population‐based study of cognition in MA and non‐Hispanic white adults 65+ in south Texas. We included US‐born, bilingual MA participants who completed in‐person neuropsychological assessment in their preferred language (English) with the Harmonized Cognitive Assessment Protocol. We added a Spanish animal naming trial to the standard animal naming trial in English. We used the delayed recall score from a word list as the indicator of memory performance. We performed a series of regression analyses with delayed recall as the dependent variable and the English and Spanish animal naming scores as the independent variables, with age, sex, years of education, and a self‐reported bilingualism index score to account for level of bilingualism (range 0–1; 0 indicates monolingual Spanish; 1 indicates monolingual English) as covariates.ResultNinety‐six participants were included (Mage = 73yrs±6; Meducation = 11±4; 60% women; Table 1). In separate regression models including covariates, English animal naming (b = 0.25, p<.0001) and Spanish animal naming (b = 0.20, p <.05) were each associated with delayed recall. When considered together, English animal naming (b = 0.24, p = <.0001) and not Spanish animal naming (b = 0.03, p = .69) was associated with delayed recall, after accounting for age, sex, years of education, and level of bilingualism (Table 2). Results were consistent when the analysis was restricted to balanced bilinguals (Table 3).ConclusionSemantic fluency in English and Spanish were each related to episodic memory among bilingual MA older adults assessed in English, although the Spanish trial did not add unique information in its association with episodic memory. Future studies should evaluate how bilingual semantic fluency is associated with longitudinal cognitive decline in ADRD.
Background: We studied the association of stroke history with dementia in a population-based cohort study in Nueces County, Texas, USA, a bi-ethnic community with a large and primarily non-immigrant Mexican American population. Methods: Nueces County households were randomly identified and community-dwelling residents aged 65 years or older were recruited using door-to-door case ascertainment. Demographics, educational history, and medical history were obtained, and participants completed the Montreal Cognitive Assessment (MoCA), a screening scale that scores multiple domains of cognitive performance with aggregate scores ranging from 0 to 30 (lower scores worse). Using an inverse propensity weighting methodology, the 2015-2019 American Community Survey (ACS) data for the 65+ population of Nueces County were used to develop a population weight for each case in the analysis sample based on age, sex, race, ethnicity, and education level. A logistic regression model was developed to assess the relationship between stroke and dementia (defined as MoCA <20), controlling for age, ethnicity, education, and history of diabetes. Results: A total of 1226 participants completed MoCA screening, of whom 435 scored <20 (35.5%), and 154 (12.6%) reported a history of stroke. Stroke prevalence was higher among those with MoCA <20 than those with MoCA 20-30 (17.8% vs 10.3%; p < 0.001). Table 1 shows the final multivariable model demonstrating a 129% increase in the odds of MoCA <20 for those with stroke history. Conclusions: History of stroke was associated with more than double the odds of dementia after controlling for other factors. Aggressive stroke prevention is needed to reduce cognitive impairment.
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