Depression, Cognition, & Social Determinants of Health: Assessing Associations in Older African Americans with Diabetes

Social determinants of health have been widely identified as characteristics of one’s social and economic climate that affect one’s health outcomes1. (see Graphic 1) The Alzheimer’s Association indicates that rates of Alzheimer’s disease (AD) and other forms of dementia are two times higher in older African Americans than their white counterparts2. People who have diabetes are also at an increased risk. The prevalence and co-morbidity of depression among older Americans with diabetes (both with and without cognitive impairment) has been well established3. Understanding the effect that social determinants of health have on the onset and progression of dementia and depression in older African American diabetics is important as such an understanding may better inform future health policy and government spending on healthcare intervention(s).https://jdc.jefferson.edu/cwicposters/1038/thumbnail.jp

Determinants of Activity Levels in African Americans With Mild Cognitive Impairment.

Engaging in cognitive, social, and physical activities may prevent cognitive decline. In a sample of older African Americans with mild cognitive impairment (MCI; N=221), we investigated the cross-sectional relationships between activity levels and participants\u27 demographic, clinical, and neuropsychological characteristics. The average age of participants was 75.4 years (SD, 7.0); 177 (80.1%) were women. Participation in cognitive/social activities was positively associated with education, depression, literacy, mobility, instrumental activities of daily living (IADL), verbal learning, and subcomponents of executive function. A linear regression identified IADLs, education, depression, and verbal learning as independent predictors. Participation in physical activities was positively associated with sex, depression, IADLs, and subcomponents of executive function. An ordinal regression identified executive function and depression as independent correlates. These data suggest that unique characteristics are associated with cognitive/social and physical activities in older African Americans with MCI. These characteristics, coupled with low activity levels, may increase the risk of progression from MCI to dementia. Culturally relevant behavioral interventions to reduce cognitive decline in this high-risk population are needed

Diabetes distress, daily functioning, and hemoglobin A1c in older Black individuals with diabetes and mild cognitive impairment

Objective: The purpose of the cross-sectional study was to identify associations between diabetes distress, physical functioning, and cognition with hemoglobin A1c in older Black individuals with diabetes and mild cognitive impairment. Methods: The investigators analyzed previously collected data from 101 older Black individuals with diabetes and mild cognitive impairment. Participants were administered surveys at baseline to assess diabetes distress, physical functioning, and cognitive functioning, and had hemoglobin A1c testing. Results: Participants with higher hemoglobin A1c showed worse self-reported daily function (r = -0.279, p \u3c .01). Three of four diabetes distress factors were positively correlated with hemoglobin A1c – emotional (r = .276, p \u3c .01), regimen-related (r = .330, p \u3c .01), and interpersonal distress (r = 0.266, p \u3c.01). In a multivariate regression with hemoglobin A1c as the dependent variable, only regimen-related diabetes distress (beta = .282, p = .012) and self-reported daily function (beta = -0.294, p = .027) were significant. Conclusion: The main finding of this study is that regimen-related diabetes distress and self-reported daily functioning compromise glycemic control in Black individuals with mild cognitive impairment and diabetes. This finding suggests that diabetes interventions should be multi-faceted to improve glycemic control in Black individuals with diabetes, a high-risk population

Depression and Risk Perceptions in Older African Americans with Diabetes

Introduction: The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes. Methods: The authors analyzed data on depression, risk perceptions, diabetes self-management, and hemoglobin A1C in African Americans with type 2 diabetes.T tests, chi square, and multivariate regression were used to analyze the data. Results: The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty four (19.2%) participants met criteria for depression. Compared to non-depressed participants, depressed participants scored significantly higher on Personal Disease Risk (the perception of being at increased risk for various medical problems), Environmental Risk (i.e., increased risk for environmental hazards), and Composite Risk Perception (i.e., overall perceptions of increased risk), adhered less to diabetes self-management practices, and had marginally worse glycemic control. Depression and fewer years of education were independent predictors of overall perception of increased health risks. Conclusion: Almost 20% of older African Americans with type 2 diabetes in this study were depressed. Compared to non-depressed participants, they tended to have fewer years of education, perceived themselves at higher risk for multiple health problems, and adhered less to diabetes self-management practices. It is important for diabetes educators to recognize the impact of low education and the fatalistic perceptions that depression engenders in this population