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BACKGROUND American Indians have excess risk of depression, which can contribute to cerebrovascular and cognitive disability, with effects on memory, processing speed, executive function, and visuospatial ability. However, studies examining depression and cognition in American Indians are limited; this study aims to report associations of depression with general cognition, verbal fluency and memory, and processing speed. DESIGN Cohort study. SETTING The Cerebrovascular Disease and its Consequences in American Indians study was an ancillary examination of Strong Heart Study participants from 3 U.S. regions. PARTICIPANTS All eligible were included in this analysis (N=818). MEASUREMENTS Participants completed evaluations for depressive symptomology, cognition, and physical function—including Center for Epidemiologic Studies Depression (CESD), Modified Mini‐Mental State Examination (3MSE), Wechsler Adult Intelligence Scale‐Fourth Edition coding (WAIS), Controlled Oral Word Association (COWA), California Verbal and Learning Test, Halstead finger tapping, grip strength, and Short Physical Performance Battery (SPPB) tests. Linear mixed models were adjusted for site, age, sex, education, income, marital status, alcohol, smoking, diabetes, hypertension, obesity, cholesterol, stroke, infarct, and hemorrhage. RESULTS: Symptoms of depression were common, with 20% (N=138) endorsing CES‐D scores of 16+. More depressive symptoms were associated with older age, female sex, lower education, lower income, non‐married status, not using alcohol, not smoking, hypertension, diabetes, and stroke. In adjusted analyses, processing speed (WAIS: β −0.13, 95%CI −0.25, −0.03), general cognition (3MSE: β −0.10, 95%CI −0.17, −0.03), verbal fluency (COWA: β −0.10, 95%CI −0.19, −0.01), and motor function (SPPB: β −0.05, 95%CI −0.07, −0.03) were significantly associated with more symptoms of depression. CONCLUSION: These findings maybe informative for health disparities populations, especially those with depressive risk. Clinicians may require particular training in cultural humility. Future studies should validate use of the CES‐D scale in this population; longitudinal studies may focus on causal mechanisms and potential secondary prevention, such as social support. J Am Geriatr Soc 68:1739‐1747, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVES: American Indians experience disproportionately high rates of poor mental health and type 2 diabetes mellitus (T2DM). We examined the association between depressive symptoms and all‐cause mortality in older American Indians with T2DM. DESIGN: We used the Native Elder Care Study survey data from community‐dwelling American Indians aged 55 years or older, linked to data extracted from participants' electronic health records. We focused on those who had an International Classification of Diseases‐Ninth Revision diagnosis of T2DM in their electronic health records. SETTING: The study was conducted with a federally‐recognized tribe with approximately 16,000 enrolled members, most of whom reside on or near tribally‐owned lands that span several rural counties. PARTICIPANTS: Participants were among the Native Elder Care Study participants with a final analytic sample of 222. MEASUREMENTS: We measured depressive symptoms with the Centers for Epidemiologic Studies‐Depression (CES‐D) scale. We used Cox proportional hazard models to examine the association between depressive symptoms and all‐cause mortality in the final analytic sample of 222 subjects. RESULTS: Survival curves revealed that individuals in the third and fourth CES‐D scale categories had higher mortality than those in the first and second categories. Mortality risk was significantly higher for participants with CES‐D scale scores in the third highest compared with the lowest category (hazard ratio = 2.07; 95% confidence interval = 1.07‐4.04), after adjustment for demographic characteristics, health behaviors, obesity, and prevalent T2DM complications. Analyses with the CES‐D scale as a continuous variable also showed a positive association with mortality. CONCLUSION: The impact of mental health on older American Indians with T2DM is often overlooked, yet it is vital to clinical and public health practice. Our findings underscore the importance of addressing the mental health needs of this population, particularly because depression in older patients is often undetected or inadequately treated. J Am Geriatr Soc 67:1940–1945, 2019 [ABSTRACT FROM AUTHOR]

Background/Objectives: Home‐based primary care (HBPC) is a comprehensive, interdisciplinary program to meet the medical needs of community‐dwelling populations needing long‐term care (LTC). The U.S. Department of Veterans Affairs (VA) expanded its HBPC program to underserved rural communities, including American Indian reservations, providing a “natural laboratory” to study change in access to VA LTC benefits and utilization outcomes for rural populations that typically face challenges in accessing LTC medical support. Design: Pretest‐Posttest quasi‐experimental approach with interrupted time‐series design using linked VA, Medicare, and Indian Health Service (IHS) records. Setting: American Indian reservations and non‐Indian communities in rural HBPC catchment areas. Participants: 376 veterans (88 IHS beneficiaries, 288 non‐IHS beneficiaries) with a HBPC length of stay of 12 months or longer. Measurements: Baseline demographic and health characteristics, activities of daily living (ADL), previous VA enrollment, and hospital admissions and emergency department (ED) visits as a function of time, accounting for IHS beneficiary and functional statuses. Results: For HBPC users, VA enrollment increased by 22%. At baseline, 30% of IHS and non‐IHS beneficiaries had 2 or more ADLs impairments; IHS populations were younger (P < .001) and had more diagnosed chronic diseases (P = .007). Overall, hospital admissions decreased by 0.10 (95% confidence interval (CI) = −0.14 to −0.05) and ED visits decreased by 0.13 (95% CI = −0.19 to −0.07) in the 90 days after HBPC admission (Ps < .001) and these decreases were maintained over 1 year follow‐up. Before HBPC, probability of hospital admission was 12% lower for IHS than non‐IHS beneficiaries (P = .02). Conclusion: Introducing HBPC to rural areas increased access to LTC and enrollment for healthcare benefits, with equitable outcomes in IHS and non‐IHS populations. [ABSTRACT FROM AUTHOR]

The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross-sectional study of disability with 505 members of a federally recognized tribe using in-person interviewer administered surveys. Participants who reported difficulty with ADLs, including bathing, dressing, eating, transferring, walking, toileting, grooming, and getting outside, were asked about AT use. Other measures were demographics, living arrangements, receipt of personal care, Medicare and Medicaid beneficiary status, number of chronic conditions, lower body function, and personal mastery. Results indicated that 22.3% of participants aged 55 and older and 26.0% aged 65 and older reported AT use. Toileting had the largest percentage of participants who relied on AT only and getting outside had the largest percentage of participants relying on a combination of AT and personal care. Multiple variable logistic regression analysis identified receipt of personal care, having more chronic conditions, and poorer lower body function as significantly associated with higher odds of AT use. The results suggest that there is greater AT use in this sample than in same-aged adults in national samples. This greater use may be reflective of a combination of higher disability rates, cultural factors, and greater access to AT. Clinicians can use this information to identify the activities with which their patients are experiencing the most difficulty and which ones can be addressed with AT versus personal care. [ABSTRACT FROM AUTHOR]