IMPACT OF CULTURE & EDUCATION ON COGNITIVE AGING

Transcription

1 IMPACT OF CULTURE & EDUCATION ON COGNITIVE AGING Presented by Dr. Peggye Dilworth- Anderson Department of Health Policy & Management University of North Carolina Gillings School of Global Public Health University of North Carolina-Chapel Hill IOM COMMITTEE ON THE PUBLIC HEALTH DIMENSIONS OF COGNITIVE AGING APRIL 10, 2014

2 AGENDA Life course and cognitive functioning Impact of education level and quality on cognitive functioning Cultural issues and cognition Interpretation of dementia in a cultural context Gaps and recommendations

3 THE LIFE COURSE PERSPECTIVE Emphasizes the importance of time, context, process, and meaning on human development Analyzes the relationship among psychosocial, behavioral, political, economic, and biological processes as they develop across the lifespan and assesses their effect on disease in later life

4 THE LIFE COURSE PERSPECTIVE The effects of the accumulation of advantages and disadvantages in early life provide evidence for understanding social, psychological, educational and cognitive abilities through the life course. Childhood socioeconomic position (higher SES) is associated with higher cognitive functioning in later life, as well as higher levels of health, income and education. Both early cognitive ability and educational achievement/quality impact cognitive functioning in later life.

5 IMPACT OF EDUCATION LEVEL AND QUALITY ON COGNITIVE DEVELOPMENT Education Level Impacts cognitive functioning Worse measure than literacy Quality of Education Better predictor of cognitive function than education level Aligns most closely to literacy level, which is a better predictor of cognitive function Different effects across races/ethnic groups

6 FROM EDUCATION TO CULTURE THE ROLE OF CUTURE ON COGNITIVE FUNCTIONING: WHAT DO WE KNOW?

7 DEFINING CULTURE Culture is a set of shared symbols, beliefs, and customs that shape individual and group behavior. Provides guidelines for speaking, doing, interpreting and evaluating actions Developed through experiences, interactions, and thoughts of the perception of others Different cultural frames allow people to be a member of a cultural group and not share all of the group s values (Source: Goodenough, 1981 & 1999)

8 COGNITION AND CULTURE Social networks Importance of education Approaches to healthy living Diet and exercise habits Religious beliefs Language preferences Cognitive decline is affected by the strength of our social networks and the amount of social engagement across the lifespan. (Barnes et al, 2004)

9 IMPLICATIONS FOR PUBLIC HEALTH HOW DO WE ENGAGE AND EDUCATE THE PUBLIC TO UNDERSTAND COGNITIVE FUNCTIONING & DEMENTIA in LATER LIFE?

10 CULTURAL ISSUES AND COGNITION Neuropsychology needs to continue to move away from a universalistic approach to cognition and testing, even within seemingly homogenous ethnic groups. Clinical vs. Cultural Interpretation CLINICAL = diagnosis CULTURAL = interpretation of diagnosis (Mindt et al, 2010)

11 INTERPRETATION OF DEMENTIA IN A CULTURAL CONTEXT Ethnic/Racial Group African-American Anglo-European Asian-American Latino Interpretation Normal aging; mental illness; faith healing Mental illness; stigmatization Mental illness; normal aging; stigmatization Bad blood ; mental illness; normal aging; faith healing Source: Hinton et al, 2005; Dilworth-Anderson et al, 2012; Lui et al, 2008; Gallagher-Thompson et al, 1997; Teng et al, 2002

12 DEMOGRAPHICS OF CAREGIVERS (N=200) Race 47% American Indians, 45% African Americans, 8% Whites Average Age : 59 years Gender: Female (88.5%) 80% of American Indians, 90% of African Americans, 100% of Whites Employment: Full-time (33.3%) Full: 13.8 % of American Indians, 48.8% of African Americans, 56.3% of White Education: >High School (67.5%) 46.8% American Indians, 84.5% of African Americans, 99% of White Perceived Health: Excellent (13.5%), Good (63%) Excellent: 13% of American Indians, 12% of African American, 19% of White Good: 53.2 % of American Indians, 71% of African American, 75% of White

13 ALZHEIMER S DISEASE KNOWLEDGE SCALE (ADKS) 30 True/False dichotomous items Assessment of individuals knowledge about Alzheimer s disease (i.e., etiology, risk factors, assessment, diagnosis, symptomatology, course, treatment and management, and caregiving) Cronbach s α tests Pre-test total sample =.764; American Indians =.709; African Americans =.770; Whites =. 627 Post-test total sample =.656; American Indians =.635; African Americans =.612, Whites=.413. Sources: Carpenter, Balsis, Otilingam, Hanson & Gatz, 2009; Carpenter et al., 2011

14 RESULTS: THE MOST INCORRECTLY ANSWERED QUESTIONS ON PRE-TEST ON THE ALZHEIMER S DISEASE KNOWLEDGE SCALE Correct Answer (%) Item # Item 52.5% 3. After symptoms of Alzheimer s disease appear, the average life expectancy is 6 to 12 years. 49% 6. When people with Alzheimer s disease begin to have difficulty taking care of themselves, caregivers should take over right away. 48.5% 16 Once people have Alzheimer s disease, they are no longer capable of making informed decisions about their own care. 56% 18. Having high cholesterol may increase a person s risk of developing Alzheimer s disease.

15 RESULTS: THE MOST INCORRECTLY ANSWERED QUESTIONS ON POST-TEST ON THE ALZHEIMER S DISEASE KNOWLEDGE SCALE Correct Answer (%) Item# Item 40.2% 6. When people with Alzheimer s disease begin to have difficulty taking care of themselves, caregivers should take over right away. 31% 16. Once people have Alzheimer s disease, they are no longer capable of making informed decisions about their own care. 51% 19. Tremor or shaking of the hands or arms is a common symptom in people with Alzheimer s disease.

16 RESULTS: THE EFFECT OF TRAINING ABOUT DEMENTIA & THE ALZHEIMER S DISEASE KNOWLEDGE SCALE A significant difference between the pretest and posttest scores Pretest Note Significant difference was calculated using a pared t-test Mean Scores Posttest

17 RESULTS: THE ASSOCIATION OF RACE AND CAREGIVER S KNOWLEDGE Significant Differences on Mean Pretest and Posttest Scores among Three Groups Black White American Indian Mean Pretest Scores Black White American Indian Mean Posttest Scores Note Significant difference was calculated using a one-way analysis of variance.

18 GENERAL SUMMARY Gaps in knowledge for certain aspects of AD (e.g., disease course, caregiving, risk factors) Significant group differences in knowledge of AD at the pre-test and the post-test Overall, significant improvement on dementia caregivers AD knowledge across ethnic groups

19 GAPS & RECOMMENDATIONS Develop and use conceptual models that incorporate life course issues to understand cognitive aging in diverse cultural populations. Create approaches that support recruiting and retaining inclusive samples to understand cognitive aging diverse cultural populations.

20 GAPS & RECOMMENDATIONS Increase cultural competency within the cognitive testing process through more research on diverse populations Educate and empower clinicians about the diverse range of cultural interpretations of illness diagnoses and their correlation to treatment behaviors

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22 ACKNOWLEDGEMENTS Research reported in this presentation supported by GlaxoSmithKline Community Partnership Program of NC Train the Trainer A Dementia Care Program and Caregiver Intervention Project. Assistance provided by: Amanda Thompson, MHA candidate, Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina- Chapel Hill Heehyul Moon, PhD, post-doctoral fellow, Carolina Program on Health and Aging Research, Institute on Aging, University of North Carolina- Chapel Hill