Psychosocial Pathways to Racial/Ethnic Inequalities in Late-Life Memory Trajectories

Zahodne, Laura B; Sol, Ketlyne; Kraal, Zarina · 2019 · Crossref

DOI: 10.1093/geronb/gbx113

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Summary

This study investigates the psychosocial mechanisms underlying racial and ethnic disparities in late-life memory trajectories, specifically comparing non-Hispanic Black and Hispanic older adults to non-Hispanic Whites. While existing research establishes that Black and Hispanic populations face higher dementia risks independent of socioeconomic and vascular factors, the specific pathways linking psychosocial experiences to cognitive decline remain unclear. Prior studies were largely cross-sectional, preventing the distinction between factors affecting initial memory levels versus rates of decline, and often failed to model the interrelationships among correlated psychosocial variables. This research addresses these gaps by testing a comprehensive model where perceived discrimination influences depressive symptoms and external locus of control, which in turn affect memory outcomes. The analysis utilized longitudinal data from 10,173 participants aged 65 and older from the Health and Retirement Study, spanning six years (2006–2012). Researchers employed structural equation modeling to examine associations among race/ethnicity, perceived discrimination, depressive symptoms, external locus of control, and memory trajectories. Episodic memory was assessed via immediate and delayed word recall tasks. The models controlled for age, sex, education, income, wealth, chronic disease burden, and stroke history. Missing data were handled using full information maximum likelihood estimation. The results revealed distinct pathways for Black and Hispanic participants. For Black participants, greater perceived discrimination was associated with lower initial memory levels through two independent mediators: increased depressive symptoms and increased external locus of control. Additionally, perceived discrimination was linked to a third pathway where discrimination led to depressive symptoms, which then increased external locus of control, further lowering initial memory. Crucially, perceived discrimination among Black participants was also directly associated with faster memory decline over the six-year period. In contrast, Hispanic ethnicity was not associated with perceived discrimination. However, greater depressive symptoms and external locus of control among Hispanics were each independently associated with lower initial memory levels. No pathways from Hispanic ethnicity to memory decline were identified. These findings indicate that depression and external locus of control partially mediate racial/ethnic differences in memory trajectories, but the drivers of these psychosocial factors differ by group. Perceived discrimination is a significant driver of psychosocial distress and subsequent cognitive disadvantage for Black older adults, affecting both baseline performance and the rate of decline. For Hispanic older adults, psychosocial factors affect initial memory levels but are not linked to ethnicity via discrimination in this model, nor do they predict decline. The study highlights the importance of distinguishing between initial cognitive status and longitudinal change, suggesting that interventions aimed at reducing cognitive morbidity must address the specific psychosocial stressors, such as discrimination, that disproportionately affect Black populations.

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• demographic disparities