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. 2025 May-Jun;48(3):423-439.
doi: 10.1080/07317115.2024.2375326. Epub 2024 Jul 11.

Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia

Crystal M Glover  1   2   3 , Lei Yu  1   3 , Peter A Lichtenberg  4   5 , S Duke Han  6   7   8   9 , Melissa Lamar  1   2 , Christopher C Stewart  10 , David A Bennett  1   3 , Lisa L Barnes  1   2   3 , Patricia A Boyle  1   2
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Factors Associated With Healthcare and Financial Decision Making Among Older Black Adults Without Dementia

Crystal M Glover et al. Clin Gerontol. 2025 May-Jun.

Abstract

Objectives: The study aims to identify factors associated with health care and financial decision-making among older Black adults without dementia.

Methods: Participants (N = 326) underwent assessments of decision-making and completed measurements of factors from four categories: cognitive, contextual, psychosocial, and personality. We performed separate linear regression models to examine the association between each factor and decision-making and created a fully adjusted model.

Results: Higher global cognition (estimate = 1.92, SE = 0.21, p < .0001) was associated with better decision-making. Contextual factors including higher current annual income (estimate = 0.23, SE = 0.05, p < .0001), higher childhood socioeconomic status (estimate = 0.48, SE = 0.18, p = .006), higher health and financial literacy (estimate = 0.08, SE = 0.01, p < .0001), and lower financial stress (estimate = -0.19, SE = 0.07, p = .01) were associated with better decision-making. More psychological well-being (estimate = 0.07, SE = 0.22, p = .001), a psychosocial factor, and less neuroticism (estimate = -0.06, SE = 0.02, p = .002), a personality factor, were associated with better decision-making. In the fully adjusted model, two factors, higher global cognition and higher literacy (health and financial), remained associated with better decision-making.

Conclusions: Cognitive and contextual factors serve as drivers of decision-making among older Black adults.

Clinical implications: Clinicians may implement strategies to bolster cognition and improve health and financial literacy to facilitate optimal decision-making among older Black adults.

Keywords: Black adults; cognition; decision-making; literacy; psychosocial factors.

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Conflict of interest statement

Declaration of Any Conflict of Interest: The authors report no conflicts with any product mentioned or concept discussed in this article.

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