Epidemiology of racial differences in decision making among older adults

ABSTRACT
Sound decision making is important for maintaining independence and well-being across the lifespan but is
critical in old age, when some of life’s most complex and impactful decisions are made. Recent work from our
group and others has shown that decision making requires cognitive, contextual and psychosocial resources
and that many older persons—even those without cognitive impairment—are vulnerable to poor decision
making in key domains such as finance and health and frequently become victims of fraud. Poor decision
making in aging predicts several adverse health outcomes including Alzheimer’s disease, incident mild
cognitive impairment and mortality and poses a major public health and economic challenge. Importantly,
however, most of the research on decision making to date has involved White participants. Relatively little is
known about decision making among African Americans, despite well documented racial differences in the
cognitive, contextual (e.g., socioeconomic status) and psychosocial (e.g., psychological distress) resources
that influence decision making. Building on our conceptual model of decision making in aging and compelling
preliminary data that suggest racial differences, we hypothesize that racial differences in decision making
contribute to disparities in health outcomes and that contextual and psychosocial factors account for these
differences. The goal of the proposed study, submitted in response to PAR-16-448, is to elucidate the
determinants and adverse health consequences of racial differences in decision making. This study will
leverage the unique resources of an ongoing study of African Americans, the Minority Aging Research Study,
to collect new longitudinal data on multiple aspects of decision making (i.e., financial and health decision
making, temporal discounting, scam susceptibility, fraud victimization) and related contextual and psychosocial
factors in 600 older African Americans without dementia. These newly collected data will be linked with
identical longitudinal decision making data already available from an ongoing study of more than 1,100 Whites
from the Memory and Aging Project to support analyses of: 1) racial differences in decision making among
African Americans and Whites matched on demographics and cognition, 2) the contextual and psychosocial
factors that drive them, and 3) the degree to which racial differences in decision making contribute to
disparities in health. Thus, this study is uniquely poised to efficiently identify the determinants and public health
impact of racial differences in decision making and will facilitate new therapeutic approaches to promote
independence, health and well-being among diverse older persons.

Grant Number: 5R01AG060376-05
NIH Institute/Center: NIH
Principal Investigator: PATRICIA BOYLE