Language, Immigration, Race and Cognitive Health: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study

Few large cohort studies of dementia have successfully recruited cohorts that reflect the diversity of the aging population. We aim to describe the complex racial/ethnic, immigration, linguistic histories of a United States (US)-based cohort to describe the complexity of operationalizing identity and describing health disparities.

The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study enrolled 1,892 participants ages 65 and older. Participants self-reported race/ethnicity (Asian, Black, Latino, White, Native American), immigration status (US-born/non-US-born), and languages spoken (monolingual, bilingual, and unascertained) via questionnaire. Participants were screened using NIH Toolbox and those suspected of impairment underwent a neurological exam. Descriptive statistics included means, standard deviations, counts, and percentages of cohort demographics across race/ethnicity, immigration status, and language as well as by cognitive status.

Participants had a mean age of 76 (SD ± 7) and 60% were women. Approximately equal proportions of Asian (24%), Black (26%), Latino (22%), Native American (0.1%), and White (29%) participants were enrolled. 46% of participants were monolingual, 31% bilingual, and 23% unascertained. Of the 25% of participants who reported being non-US-born, most identified as Asian or Latino. Bilingualism was most common among non-US-born men and those reporting multiple racial/ethnic identities. Alcohol consumption, cigarette use, and self-rated health varied across language, race/ethnicity, and immigration status. Cognitive impairment was most prevalent among U.S.-born Black and non-U.S.-born Latino participants.

Highlighting the diversity of older Americans illustrates the need for recruitment of populations that reflect the cultural and linguistic diversity of older adults in the US at risk of dementia.