Age trajectories of everyday cognition in African American and White older adults under prompted and unprompted conditions

Abstract

We investigated how race and verbal prompting interacted with age to predict age trajectories on a performance-based measure of everyday cognition. African American (n = 727) and White (n = 2052) older adults from the ACTIVE clinical trial were given the Observed Tasks of Daily Living (OTDL; a performance-based measure of medication management/finances/telephone use) at baseline and 1-, 2-, 3-, 5-, and 10-year follow-ups. When participants said "I don't know" or did not respond, they received a standardised verbal prompt, which served only as a cue to initiate the first step. At each occasion, unprompted (sum of items correct without prompting) and prompted (sum of correct prompted and unprompted items) scores were derived for each participant. Mixed effects models for change were used to determine the age trajectories of OTDL performance by race. When not prompted, African Americans demonstrated more rapid decline in OTDL performance than Whites, especially after age 80. When prompted, both groups had improved performance and evinced shallower decline, although African Americans continued to demonstrate a slightly more rapid decline. Simple prompting attenuated age-related changes of African Americans and Whites on a measure of everyday cognition. Prompting may be especially helpful for older African Americans.

Keywords: Cognitive ageing; Ecologically validity; Everyday cognition; Racial disparities; Verbal prompting.

Figure 1

Age trajectories of prompted and unprompted Observed Task of Daily Living (OTDL) performance by race. Note: The Y-axis shows the model–implied values of the OTDL variable in standardised (Z-score) metric. This figure illustrates that the linear and quadratic age effects show more rapid effects of age at higher ages, prompting boosts the performance of both White and African American participants, and also reduces the more rapid (quadratic) trend, particularly in African Americans.