Socioeconomic status across the life course and dementia-status life expectancy among older Americans

Cha, Hyungmin; Farina, Mateo P.; Hayward, Mark D.

doi:10.1016/j.ssmph.2021.100921

Cited by 12 publications

(17 citation statements)

References 42 publications

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“…Children in poverty are more likely to have developmental delay, worse performance on cognitive and achievement tests than their more fortunate peers and their SES is associated with educational accomplishment, psychological welfare, and health decades later, as reviewed in Johnson et al (2016) . Socioeconomic difficulties, education in preschool years, in childhood and adolescence, and financial resources have been associated with both cognitive development and cognitive impairment in the life course ( Cha et al, 2021 ). This evidence supports the downstream effects of the SES and ADI throughout life on cognitive reserve.…”

Section: Mechanisms Through Which Area Deprivation Index May Influenc...mentioning

confidence: 99%

Area Deprivation Index as a Surrogate of Resilience in Aging and Dementia

2022

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Area deprivation index (ADI), a tool used to capture the multidimensional neighborhood socioeconomic disadvantage across populations, is highly relevant to the field of aging and Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD). ADI is specifically relevant in the context of resilience, a broad term used to explain why some older adults have better cognitive outcomes than others. The goal of this mini-review is three-fold: (1) to summarize the current literature on ADI and its link to cognitive impairment outcomes; (2) suggest possible mechanisms through which ADI may have an impact on AD/ADRD outcomes, and (3) discuss important considerations when studying relations between ADI and cognitive as well as brain health. Though difficult to separate both the upstream factors that emerge from high (worse) ADI and all the mechanisms at play, ADI is an attractive proxy of resilience that captures multifactorial contributors to the risk of dementia. In addition, a life-course approach to studying ADI may allow us to capture resilience, which is a process developed over the lifespan. It might be easier to build, preserve or improve resilience in an environment that facilitates instead of hindering physical, social, and cognitively beneficial activities. Neighborhood disadvantage can adversely impact cognitive impairment risk but be at the same time a modifiable risk factor, amenable to policy changes that can affect communities.

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Section: Mechanisms Through Which Area Deprivation Index May Influenc...mentioning

confidence: 99%

Area Deprivation Index as a Surrogate of Resilience in Aging and Dementia

2022

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“…Components of SES have been identified as modifiable risk factors for the development of dementia and dementia-related mortality. For example, when comparing individuals with higher SES to those with lower SES, higher SES people should anticipate to live a much longer amount of time without dementia ( Cha et al, 2021 ). In addition, lower SES with low income and financial stress is associated with increased risk of dementia in older persons, and the correlations are similar to those found in older adults with lower education in the United States ( Samuel et al, 2020 ).…”

Section: Health Disparities For Preventionmentioning

confidence: 99%

“…Many regions within Alabama suffer from low SES creating the challenge to adopt healthy eating and exercise habits that might prevent or delay onset of ADRD. Diagnosis of dementia tends to be earlier in individuals with high SES, when interventions may have an impact, than people with low SES ( Cha et al, 2021 ; Petersen et al, 2021 ). Many areas in Alabama, both urban and rural, have limited access to healthcare and healthy food, making it more difficult to initiate crucial lifestyle changes to slow AD progression.…”

Section: Introductionmentioning

confidence: 99%

Neurovascular Dysfunction in Diverse Communities With Health Disparities—Contributions to Dementia and Alzheimer’s Disease

et al. 2022

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Alzheimer’s disease and related dementias (ADRD) are an expanding worldwide crisis. In the absence of scientific breakthroughs, the global prevalence of ADRD will continue to increase as more people are living longer. Racial or ethnic minority groups have an increased risk and incidence of ADRD and have often been neglected by the scientific research community. There is mounting evidence that vascular insults in the brain can initiate a series of biological events leading to neurodegeneration, cognitive impairment, and ADRD. We are a group of researchers interested in developing and expanding ADRD research, with an emphasis on vascular contributions to dementia, to serve our local diverse community. Toward this goal, the primary objective of this review was to investigate and better understand health disparities in Alabama and the contributions of the social determinants of health to those disparities, particularly in the context of vascular dysfunction in ADRD. Here, we explain the neurovascular dysfunction associated with Alzheimer’s disease (AD) as well as the intrinsic and extrinsic risk factors contributing to dysfunction of the neurovascular unit (NVU). Next, we ascertain ethnoregional health disparities of individuals living in Alabama, as well as relevant vascular risk factors linked to AD. We also discuss current pharmaceutical and non-pharmaceutical treatment options for neurovascular dysfunction, mild cognitive impairment (MCI) and AD, including relevant studies and ongoing clinical trials. Overall, individuals in Alabama are adversely affected by social and structural determinants of health leading to health disparities, driven by rurality, ethnic minority status, and lower socioeconomic status (SES). In general, these communities have limited access to healthcare and healthy food and other amenities resulting in decreased opportunities for early diagnosis of and pharmaceutical treatments for ADRD. Although this review is focused on the current state of health disparities of ADRD patients in Alabama, future studies must include diversity of race, ethnicity, and region to best be able to treat all individuals affected by ADRD.

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“…However, whether such a system is generous enough to guarantee care equity is an empirical question that we aim to answer in this study. People with dementia have a higher level of care needs and a lower socioeconomic status than those without dementia (Østbye et al, 1997;Giebel et al, 2015;Cha et al, 2021). If the means-tested system is highly restrictive so that many people have no access to government support, it is expected that, for people with a similar level of care needs, the distribution of formal care will be in favour of richer people and that poorer people either rely more on informal care or are more likely to have unmet care needs.…”

Section: Literature Reviewmentioning

confidence: 99%

“…This will outpace the projected rise of 106 per cent in the LTC costs for the older population in general (Hu et al, 2020a). Older people with dementia have a higher level of care needs (Østbye et al, 1997;Giebel et al, 2015) and a lower socioeconomic status than those without dementia (Cha et al, 2021). This means that people with dementia have limited financial resources to meet their needs through privately funded care and may be especially vulnerable to unequal distribution of LTC.…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequality of long-term care for older people with and without dementia in England

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Wittenberg

et al. 2022

Ageing and Society

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Ensuring distributive fairness in the long-term care sector is vitally important in the context of global population ageing and rising care needs. This study, part of the DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) programme, investigates socioeconomic inequality and inequity in the utilisation of long-term care for older people with and without dementia in England. The data come from three waves of the English Longitudinal Study of Ageing (ELSA, Waves 6–8, N = 16,458). We find that older people with dementia have higher levels of care needs and a lower socioeconomic status than those without dementia. The distribution of formal and informal care is strongly pro-poor. When care needs are controlled for, there is no significant inequality of formal or informal care among people with dementia, nor of informal care among people without dementia, but there is a significant pro-rich distribution of formal care among people without dementia. Unmet care needs are significantly concentrated among poorer people, both with and without dementia. We argue that the long-term care system in England plays a constructive role in promoting socioeconomic equality of long-term care for people with dementia, but support for older people with lower financial means and substantial care needs remains insufficient. Increased government support for older people is needed to break the circle between care inequality and health inequality.

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Socioeconomic status across the life course and dementia-status life expectancy among older Americans

Cited by 12 publications

References 42 publications

Area Deprivation Index as a Surrogate of Resilience in Aging and Dementia

Area Deprivation Index as a Surrogate of Resilience in Aging and Dementia

Neurovascular Dysfunction in Diverse Communities With Health Disparities—Contributions to Dementia and Alzheimer’s Disease

Socioeconomic inequality of long-term care for older people with and without dementia in England

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