Tamara A. Baker - US grants

The objective of the proposed study is to systematically examine the relationship between arthritic disability and the psychological and physical health among older African Americans. Compared to elderly Caucasians, older African Americans are disproportionately diagnosed with more chronic diseases, are more likely to be diagnosed earlier in life, and are more incapacitated from the disease. Considering the increase in chronic illnesses, it is important to examine the concomitant relationship between the physical and mental health constructs among older African Americans. In understanding this relationship, several research questions have been proposed: 1) Is there an association between demographic factors (e.g. age, gender, and SES) and perceptions of disease severity, pain, and functional impairment due to arthritis among older African Americans?; 2) Do arthritic adults report more depressive and somatic symptoms compared to non arthritic adults?; and 3) Does location and type of arthritic disorder influence reports of depressive and somatic symptoms? Five specific aims are planned to examine these research questions: 1) To collect data from 150 African Americans 50 years of age and older; 2) To examine the intercorrelations between demographic factors, depressive symptoms, functional impairment, and pain and disease severity; 3) To assess the direction of the relationship between demographic factors and physical and psychological health; 4) To examine the type of arthritic disability and location; and the relationship between disease severity, pain perception, functional impairment, and depressive symptoms; and 5) To assess the amount of individual variance associated in disease severity, pain perception and depressive symptoms. This research addresses the importance of acknowledging that different life experiences, health, and comorbidity experienced by minority elderly may create sources of individual variation in their experience of arthritic disability.

The objective of the proposed study is to systematically examine the relationship between arthritic disability and the psychological and physical health among older African Americans. Compared to elderly Caucasians, older African Americans are disproportionately diagnosed with more chronic diseases, are more likely to be diagnosed earlier in life, and are more incapacitated from the disease. Considering the increase in chronic illnesses, it is important to examine the concomitant relationship between the physical and mental health constructs among older African Americans. In understanding this relationship, several research questions have been proposed: 1) Is there an association between demographic factors (e.g. age, gender, and SES) and perceptions of disease severity, pain, and functional impairment due to arthritis among older African Americans?; 2) Do arthritic adults report more depressive and somatic symptoms compared to non arthritic adults?; and 3) Does location and type of arthritic disorder influence reports of depressive and somatic symptoms? Five specific aims are planned to examine these research questions: 1) To collect data from 150 African Americans 50 years of age and older; 2) To examine the intercorrelations between demographic factors, depressive symptoms, functional impairment, and pain and disease severity; 3) To assess the direction of the relationship between demographic factors and physical and psychological health; 4) To examine the type of arthritic disability and location; and the relationship between disease severity, pain perception, functional impairment, and depressive symptoms; and 5) To assess the amount of individual variance associated in disease severity, pain perception and depressive symptoms. This research addresses the importance of acknowledging that different life experiences, health, and comorbidity experienced by minority elderly may create sources of individual variation in their experience of arthritic disability.

DESCRIPTION (from applicant): Epidemiological evidence shows that elderly minority adults are less likely to have their cancer pain recorded, are at an increased risk for the misdiagnosis and under-treatment of their cancer pain, and report less relief or analgesic treatment for their pain. This project proposes two phases, a descriptive survey and an educational pain management intervention, to assess if such disparities are influenced by identified social, cultural, or psychological constructs. The primary objective for phase I (descriptive) is to elucidate existing social, cultural, and psychological sources that may influence the experience of cancer pain, satisfaction with cancer pain care and management in elderly Blacks and Whites diagnosed with lung, colon, breast, or prostate cancer. The aims to support this objective are to: 1) assess whether elderly Black and White cancer patients differ in social (discrimination, SES), cultural (cultural heritage, ethnic identity), and psychological (depression, physician mistrust, symptom distress) variables, and to determine if these factors serve as potential mediators explaining differential health outcomes, 2) determine the relationship between identified psychosocial and cultural factors, and 3) assess the utility of a proposed theoretical model in explaining individual differences in identified health outcome variables both within and between race groups of elderly cancer patients. Guided by phase I's conceptual model, the objective for phase II (intervention) is to: 1) determine the feasibility and acceptability of a cancer pain management education intervention among elderly Black and White cancer patients, and 2) evaluate patients'reactions to and satisfaction with the program, while identifying potential psychological, social, and cultural constructs that present as barriers to effective pain management. To date, we have identified no studies that have examined the impact identified psychosocial and cultural factors (e.g., discrimination, ethnic identity) have on optimal cancer pain management. In addition, there are few interventions designed to address these constructs as they relate to cancer pain care and management among the elderly. Examining these factors will prove pivotal in potentially reducing disparities and eliminating barriers to cancer pain care and management.