Commitment to inclusion: The importance of collaboration in gender equity work.

Despite decades of faculty professional development programs created to prepare women for leadership, gender inequities persist in salary, promotion, and leadership roles. Indeed, men still earn more than women, are more likely than women to hold the rank of professor, and hold the vast majority of positions of power in academic medicine. Institutions demonstrate commitment to their faculty's growth by investing resources, including creating faculty development programs. These programs are essential to help prepare women to lead and navigate the highly matrixed, complex systems of academic medicine. However, data still show that women persistently lag behind men in their career advancement and salary. Clearly, training women to adapt to existing structures and norms alone is not sufficient. To effectively generate organizational change, leaders with power and resources must commit to gender equity. This article describes several efforts by the Office of Faculty in the Johns Hopkins University School of Medicine to broaden inclusivity in collaborative work for gender equity. The authors are women and men leaders in the Office of Faculty, which is within the Johns Hopkins University School of Medicine dean's office and includes Women in Science and Medicine. Here, we discuss potential methods to advance gender equity using inclusivity based on our institutional experience and on the findings of other studies. Ongoing data collection to evaluate programmatic outcomes in the Johns Hopkins University School of Medicine will be reported in the future.

Factors Influencing Retirement Decisions of Senior Faculty at U.S. Medical Schools: Are There Gender-Based Differences?

Purpose: Women comprise almost one-third of academic medicine faculty 60 years of age and older. Gender disparities have been documented across many measures in medicine, including salary, promotion rates, and leadership positions and may impact long-term career and retirement decisions. The authors sought to describe gender differences in retirement decisions among late-career, full-time medical school faculty. Materials and Methods: The authors conducted a secondary analysis of cross-sectional survey data from a 2017 survey of faculty 55 years of age and older at 14 U.S. Medical Schools. Responses were compared for differences by gender using bivariate and multivariable analyses. Results: Among the 2,126 respondents (41% response rate), the majority were male (67%) and the average age was 62. Less than half (45%) had current plans to retire and 50% reported that they would consider working part time. Women faculty were less likely to be professors or on a tenure track and more likely to be single and report past and current caregiving responsibilities. Women differed from men in the personal and professional factors influencing retirement decisions with women more likely to identify health insurance, sense of burnout, lack of access to career advancing resources and opportunities, feeling devalued at work, and caregiving responsibilities as important issues. Conclusions: Women late-career faculty report unique and salient factors influencing retirement plans that may reflect cumulative gender-based career differences and disparities. Institutions should be aware of these differences and work to support women during late career and retirement transitions, including creating opportunities for faculty to remain engaged in meaningful work during retirement transitions if they desire to do so.

Prevalence of caregiving and high caregiving strain among late-career medical school faculty members: workforce, policy, and faculty development implications.

BACKGROUND: Nearly one-third of medical school faculty members are age 55 + . As our population ages, the prevalence of family caregiving is increasing, yet we know very little about the caregiving experiences of aging faculty members in academic medicine. Faculty caregiving responsibilities coupled with projected physician shortages will likely impact the future academic medical workforce. We examined the prevalence of caregiving, concomitant caregiving strain, general well-being, and thoughts about retirement for medical school faculty members age 55 and older. METHODS: We analyzed data from a survey of 2,126 full-time medical school faculty 55 + years of age conducted in 2017. Chi-square tests of independence and independent samples t-tests were used to examine statistical differences between subgroups. RESULTS: Of the 5,204 faculty members invited to complete the parent survey, 40.8% participated (N = 2126). Most were male (1425; 67.2%), White (1841; 88.3%), and married/partnered (1803; 85.5%). The mean age was 62.3 years. Of this sample, 19.0% (n = 396) reported providing care on an on-going basis to a family member, friend, or neighbor with a chronic illness or disability, including 22.4% (n = 154) of the female respondents and 17.3% (n = 242) of the male respondents. Among the caregiving faculty members, 90.2% reported experiencing some or a lot of mental or emotional strain from caregiving. Caregivers gave lower ratings of health, social and emotional support, and quality of life, but greater comfort in religion or spirituality than non-caregivers. Both caregiving and non-caregiving faculty members estimated retiring from full-time employment at age 67.8, on average. CONCLUSION: These data highlight caregiving responsibilities and significant concomitant mental or emotional strain of a significant proportion of U.S. medical schools' rapidly aging workforce. Human resource and faculty development leaders in academia should strategically invest in policies, programs, and resources to meet these growing workforce needs.

Mindful Ethical Practice and Resilience Academy: Equipping Nurses to Address Ethical Challenges.

BACKGROUND: Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care. OBJECTIVES: To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses' skills in mindfulness, resilience, confidence, and competence to confront ethical challenges in clinical practice. METHODS: A prospective repeated-measures study was conducted before and after a curricular intervention at 2 hospitals in a large academic medical system. Intervention participants (192) and comparison participants (223) completed study instruments to assess the objectives. RESULTS: Mindfulness, ethical confidence, ethical competence, work engagement, and resilience increased significantly after the intervention. Resilience and mindfulness were positively correlated with moral competence and work engagement. As resilience and mindfulness improved, turnover intentions and burnout (emotional exhaustion and depersonalization) decreased. After the intervention, nurses reported significantly improved symptoms of depression and anger. The intervention was effective for intensive care unit and non-intensive care unit nurses (exception: emotional exhaustion) and for nurses with different years of experience (exception: turnover intentions). CONCLUSIONS: Use of experiential discovery learning practices and high-fidelity simulation seems feasible and effective for enhancing nurses' skills in addressing moral adversity in clinical practice by cultivating the components of moral resilience, which contributes to a healthy work environment, improved retention, and enhanced patient care.

"It's a Little Different for Men"-Sponsorship and Gender in Academic Medicine: a Qualitative Study.

BACKGROUND: Women remain underrepresented in top leadership positions in academic medicine. In business settings, a person with power and influence actively supporting the career advancement of a junior person is referred to as a sponsor and sponsorship programs have been used to diversify leadership. Little is known about how sponsorship functions in academic medicine. OBJECTIVE: To explore perceptions of sponsorship and its relationship to gender and career advancement in academic medicine. DESIGN: Qualitative study using semi-structured, one-on-one interviews with sponsors and protégés. PARTICIPANTS: Twelve sponsors (clinical department chairs) and 11 protégés (participants of a school of medicine executive leadership program [N = 23]) at the Johns Hopkins School of Medicine. KEY RESULTS: All sponsors were men and all were professors, six of the 11 protégés were women, and four of the 23 participants were underrepresented minorities in medicine. We identified three themes: (1) people (how and who): women seek out and receive sponsorship differently; (2) process (faster and further): sponsorship provides an extra boost, especially for women; and (3) politics and culture (playing favorites and paying it forward): sponsorship and fairness. Informants acknowledge that sponsorship provides an extra boost for career advancement especially for women. Sponsors and protégés differ in their perceptions of how sponsorship happens. Informants describe gender differences in how sponsorship is experienced and specifically noted that women were less likely to actively seek out sponsorship and be identified as protégés compared to men. Informants describe a tension between sponsorship and core academic values such as transparency, fairness, and merit. CONCLUSION: Sponsorship is perceived to be critical to high-level advancement and is experienced differently by women. Increased understanding of how sponsorship works in academic medicine may empower individual faculty to utilize this professional relationship for career advancement and provide institutions with a strategy to diversify top leadership positions.

Late-Career Expectations: A Survey of Full-Time Faculty Members Who Are 55 or Older at 14 U.S. Medical Schools.

PURPOSE: The average age of full-time faculty members at U.S. medical schools accredited by the Liaison Committee on Medical Education was 49.5 in 2017, yet the academic medicine community knows little about late-career faculty. The authors sought to characterize full-time faculty members 55 or older and assess their work-life expectations. METHOD: The authors conducted a survey (May-September 2017) of faculty 55+ at 14 U.S. medical schools. RESULTS: Of the 5,204 faculty members invited, 2,126 (40.8%) responded. The average age of respondents was 62.3, and among those responding to the relevant questions, most identified as male (1,425; 67.2%), white (1,841; 88.3%), and married/partnered (1,803; 85.5%). Fewer than half (915; 45.2%) indicated they had begun thinking about full-time retirement, estimating that they would do so at a mean age of 67.8 (standard deviation = 4.3). Half the respondents (1,004; 50.0%) would consider moving to part-time status. The top 3 personal factors likely to affect retirement decisions were health, postretirement plans, and spouse's/partner's plans. The top 3 professional factors were phased retirement or part-time options, changes in institutional leadership, and presence of a successor. Faculty indicated that they would, post retirement, be interested in ongoing work in teaching/education and research/scholarship and that they wanted health insurance, email, and part-time teaching opportunities. CONCLUSIONS: U.S. medical schools employ a rapidly aging workforce. These data indicate that neither faculty members nor institutions are prepared. Faculty affairs and develop ment leaders should champion efforts to engage with late-career faculty to prepare for this changing landscape.

Late-Career Faculty: A Survey of Faculty Affairs and Faculty Development Leaders of U.S. Medical Schools.

PURPOSE: Individuals 55 or older constitute 28.5% of the U.S. population but 32% of full-time faculty at U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). The academic medicine community knows little about the policies, programs, and resources for faculty in pre- and post-retirement stages. The authors sought to inventory the range of institutional resources for late-career faculty development and retirement planning in U.S. LCME-accredited medical schools. METHOD: The authors surveyed 138 medical school faculty affairs deans and leaders in May 2017 to ascertain (1) priorities around retirement, succession planning, and workforce development/support; (2) retirement policies; (3) late-career and retirement resources; and (4) perceived factors impacting faculty retirement. RESULTS: Of those invited, 84 (60.9%) responded to the survey, and of these, 44 (52.4%) disagreed or strongly disagreed that retirement planning and support was a top priority in their offices. Less than half (n = 35 [41.7%]) reported that their institution had a retirement policy. The 5 most common late-career and retirement-related resources offered were emeriti or honorific appointments, academic benefits for retirees, phased retirement, retirement counseling, and financial planning. More than half the respondents noted that the following factors impact faculty retirements: physician burnout (43/75 respondents [57.3%]), decreased grant funding (42/75 [56.0%]), and changes in productivity requirements (38/75 [50.7%]). CONCLUSIONS: These data highlight a distinct, startling gap between the needs of a fast-growing population of late-career faculty and the priorities of their institutions. Faculty affairs/faculty development offices must meet these growing needs.

The Health of America's Aging Prison Population.

Older incarcerated individuals comprise the fastest growing demographic in the US prison system. Unhealthy lifestyles among incarcerated individuals and inadequate health care lead to earlier onset and more rapid progression of many chronic conditions that are prevalent among community-living older adults. There are limited peer-reviewed epidemiologic data in this area; however, there is growing interest in identifying strategies for housing aging incarcerated individuals, delivering appropriate health care in prisons, and coordinating after-release health care. In this systematic review, we summarize the epidemiologic evidence of the health challenges facing the aging US prison population. Our comprehensive literature search focused on health outcomes, including diseases, comorbid conditions, mental health, cognition, and mobility. From 12,486 articles identified from the literature search, we reviewed 21 studies published between 2007 and 2017. All the studies were observational and cross-sectional, and most (n = 17) were based on regional samples. Sample sizes varied widely, ranging from 25 to 14,499 incarcerated people (median, 258). In general, compared with their younger counterparts, older incarcerated individuals reported high rates of diabetes mellitus, cardiovascular conditions, and liver disease. Mental health problems were common, especially anxiety, fear of desire for death or suicide, and depression. Activities of daily living were challenging for up to one-fifth of the population. We found no empirical data on cognition among older incarcerated individuals. The findings of this review reveal few empirical data in this area and highlight the need for new data to drive policy and practice patterns that address critical health issues related to the aging prison population.

Perceived discrimination and health-related quality-of-life: gender differences among older African Americans.

PURPOSE: Emerging data suggest that African-American women may fare worse than African-American men in health-related quality-of-life (HRQOL). Perceived discrimination is an important contributor to poor health overall among African Americans, but few studies examined the intersecting effects of perceived discrimination and gender in explaining HRQOL disparities. We investigated gender differences in HRQOL and tested whether perceived discrimination accounted for these differences. METHODS: We examined data from the Chicago Health and Aging Project in which 5652 African-American adults aged 65 and older completed structured questionnaires about demographic and socioeconomic characteristics, HRQOL, perceived discrimination, and health-related variables. Logistic regression models were used to identify associations between perceived discrimination and gender differences in poor HRQOL outcomes (defined as 14+ unhealthy days in overall, physical, or mental health over the past 30 days) when controlling for the other variables. RESULTS: More women reported poor overall HRQOL than men (24 vs. 16% respectively). Higher perceived discrimination was significantly associated with worse overall HRQOL (OR 1.11; 95% CI 1.08, 1.15), with stronger effects for women in overall and mental HRQOL. These gender disparities remained significant until controlling for potentially confounding variables. Perceived discrimination did not account for gender differences in poor physical HRQOL. CONCLUSIONS: Perceived discrimination is associated with poor HRQOL in older African Americans, with this association appearing stronger in women than men for mental HRQOL. These findings warrant further investigation of effects of perceived discrimination in gender disparities in overall health, and such research can inform and guide efforts for reducing these disparities.

Junior Investigators Thinking About Quitting Research: A Survey.

OBJECTIVE: Junior tenure-track faculty report high levels of stress and low satisfaction; the increasingly competitive funding environment compounds this discontent. We examined factors associated with junior investigators who were thinking about quitting research. METHOD: Data were collected as part of a program evaluation of an interdisciplinary research mentoring program in an academic medical center. RESULTS: Of the 62 mentees, 44 responded to the survey (71%). When asked "In the past year, have you considered quitting research?" 39 mentees answered the question; 17 (44%) answered in the affirmative. Those who had considered quitting had lower scores on the Clinical Research Appraisal Inventory-12 (CRAI-12) and job satisfaction and higher scores on burnout. In a regression model, we found that only CRAI-12 scores were significantly, inversely associated with thinking about quitting. CONCLUSION: Factors associated with thinking about quitting included lower confidence in research skills, reduced job satisfaction, and higher levels of burnout.

Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study.

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.

Do Local Social Hierarchies Matter for Mental Health? A Study of Neighborhood Social Status and Depressive Symptoms in Older Adults.

OBJECTIVES: Despite a well-established association between relative social position and health, stratification at smaller levels of social organization has received scant attention. Neighborhood is a localized context that has increasing relevance for adults as they age, thus one's relative position within this type of mesolevel group may have an effect on mental health, independent of absolute level of social and economic resources. We examine the relationship between an older adult's relative rank within their neighborhoods on two criteria and depressive symptoms. METHOD: Using data from the Chicago Health and Aging Project, neighborhood relative social position was ascertained for two social domains: income and social reputation (number of neighbors one knows well enough to visit). Using multilevel models, we estimated the effect of relative position within the neighborhood on depressive symptoms, net of absolute level for each domain and average neighborhood level. RESULTS: Higher neighborhood relative rankings on both income and visiting neighbors were associated with fewer depressive symptoms. Although both were modest in effect, the gradient in depressive symptoms was three times steeper for the relative rank of visiting neighbors than for income. Men had steeper gradients than women in both domains, but no race differences were observed. DISCUSSION: These findings suggest that an older adult's relative position in a local social hierarchy is associated with his/her mental health, net of absolute position.

The association of adverse childhood experiences with mid-life depressive symptoms and quality of life among incarcerated males: exploring multiple mediation.

OBJECTIVES: To explore the association of experiencing death, trauma, and abuse during childhood with depressive symptoms and quality of life at mid-life among incarcerated men and to understand how current social support and coping strategies mediate the impact of childhood trauma histories on mental health. METHODS: Study participants were 192 male inmates in a maximum security prison. Participants completed measures of adverse childhood experiences related to death, trauma, and abuse, and depressive symptoms and quality of life. Data were analyzed using multiple mediation modeling. RESULTS: Men who reported having experienced adverse childhood experiences reported more depressive symptoms and lower quality of life than their counterparts. The results showed that in models both unadjusted and adjusted for age, race, education, number of years served, and whether the inmate had a life sentence, the association between adverse childhood experiences and quality of life were partially explained by the total of the indirect effects (point estimate = -.5052; CI.95 = -1.0364, -.0429 and point estimate = -.7792; CI.95 = -1.6369, -.0381), primarily via social support. However, the associations between adverse childhood experiences and depressive symptoms were not explained by social support and coping. CONCLUSION: Adverse childhood experiences are associated with deleterious mental health effects in later life. Social support and coping partially mediate the association between adverse childhood experiences and quality of life. The high prevalence of childhood trauma among aging prison inmates warrants attention to increasing social support mechanisms to improve mental health.

Physical and Cognitive Activities as Deterrents of Cognitive Decline in a Biracial Population Sample.

OBJECTIVE: Physical and cognitive activities are associated with slower cognitive decline. Few studies have examined racial differences in these associations, however. The aim of this study was to examine the association of physical and cognitive activities with level and change in cognitive function among black and white participants. A secondary aim was to explore observed differences between black and white participants using post hoc analyses based on education and cognitive function levels. METHODS: Data came from a longitudinal study of 7,742 (63% black and 61% female) participants assessed three times over an average of 9.5 years. At baseline, each participant reported number of hours of leisure time physical activity (categorized using quartiles) and rated frequency of participation in cognitively stimulating activities (range: 0-4). A standardized measure of cognition was derived from tests of memory, perceptual speed, and orientation. RESULTS: Of the 7,742 participants, 2,322 (30%) reported no physical activity. Cognitive decline was slower by about 20% (95% CI: 13%-27%) among whites with physical activity above 1.25 hours compared with those with no physical activity, but showed no significant decrease in cognitive decline relative to those with no physical activity among blacks. Further post hoc analysis revealed cognitive decline to be slower by about 29% (95% CI: 20%-38%) among blacks and whites with higher education and above average baseline cognition. A 1-point increase in cognitive activity frequency decreased cognitive decline by 8% (95% CI: 3%-14%) among blacks and by 14% (95% CI: 7%-20%) among whites. CONCLUSIONS: The benefits of higher physical activity on cognitive decline was observed among whites, and among blacks with higher education and above average baseline cognitive function. Nevertheless, the protective effect of cognitive activity seems to be independent of education and baseline cognitive function among both blacks and whites.

Implementation and evaluation of the Johns Hopkins University School of Medicine leadership program for women faculty.

BACKGROUND: Women continue to be underrepresented in top leadership roles in academic medicine. Leadership training programs for women are designed to enhance women's leadership skills and confidence and increase overall leadership diversity. The authors present a description and evaluation of a longitudinal, cohort-based, experiential leadership program for women faculty at the Johns Hopkins University School of Medicine. METHODS: We compared pre- and post-program self-assessed ratings of 11 leadership skills and specific negotiation behaviors from 3 cohorts of leadership program participants (n=134) from 2010 to 2013. RESULTS: Women reported significant improvements in skills across 11 domains with the exceptions of 2 domains, Public Speaking and Working in Teams, both of which received high scores in the pre-program assessment. The greatest improvement in rankings occurred within the domain of negotiation skills. Although women reported an increase in their negotiation skills, we were not able to demonstrate an increase in the number of times that women negotiated for salary, space, or promotion following participation in the program. CONCLUSIONS: The Johns Hopkins School of Medicine Leadership Program for Women Faculty has demonstrable value for the professional development of participants and addresses institutional strategies to enhance leadership diversity and the advancement of women.

Gene-behavior interaction of depressive symptoms and the apolipoprotein E {varepsilon}4 allele on cognitive decline.

OBJECTIVE: Depressive symptoms and the apolipoprotein E (APOE) ε4 allele are independent risk factors for cognitive decline. However, it is not clear whether the presence of both depressive symptoms and the APOE ε4 allele increases cognitive decline. METHODS: A prospective study of a population-based sample of 4150 (70% African American and 63% women) participants 65 years and older who were interviewed at 3-year intervals was conducted. Depressive symptoms were measured using the 10-item version of the Center for Epidemiologic Studies Depression scale, with each item coded as presence or absence of a symptom. The APOE genotype was ascertained by DNA samples collected during follow-up. Cognitive function was assessed at the initial and follow-up interviews (average follow-up of 9.2 years), using a standardized global cognitive score. RESULTS: There were 1405 (34%) participants with one or more copies of the APOE ε4 allele. In participants with no depressive symptoms, cognitive function decreased by 0.0412 unit per year among those with no copies and 0.0704 unit per year among those with one or more copies of the APOE ε4 allele. For each additional symptom of depression, cognitive decline increased by 0.0021 unit per year among those with no copies and 0.0051 unit per year among those with one or more copies of the APOE ε4 allele. The three-way interaction of depressive symptoms, APOE ε4 allele, and time was significant (p = .021). CONCLUSIONS: The association of depressive symptoms on cognitive decline was increased among participants with one or more copies of the APOE ε4 allele compared with those without the allele.

Gene-environment interaction of body mass index and apolipoprotein E ε4 allele on cognitive decline.

Genetic variation alone may not account for common chronic disease susceptibility. Rather, an interaction between genetic and environmental factors may clarify the underlying disease mechanism. Hence, we tested whether body mass index (BMI) modified the genetic association of the apolipoprotein E ε4 allele with cognitive decline. The data came from a longitudinal population-based sample of 4055 participants interviewed at 3-year intervals from 1993 to 2012. Cognitive function was assessed using a standardized global cognitive score and BMI was assessed at baseline and classified as normal, overweight, and obese. There were 1374 (34%) participants with the ε4 allele. In normal BMI participants, cognitive decline was 0.048 units/y without the ε4 allele, and increased by an additional 0.031 units/y with the ε4 allele. In overweight participants, cognitive decline was 0.038 units/y without the ε4 allele, and increased by an additional 0.026 units/y with the ε4 allele. Finally, in obese participants, cognitive decline was 0.038 units/y without the ε4 allele, and increased by an additional 0.014 units/y with the ε4 allele. The association of ε4 allele with cognitive decline was significantly lower in obese participants compared with normal BMI participants (P=0.003), thereby suggesting significant gene-environment interaction on cognitive decline.

Race differences in the association of spiritual experiences and life satisfaction in older age.

OBJECTIVES: The primary objective of this study was to examine an African American 'faith advantage' in life satisfaction. Specifically, we sought to test the hypothesis that the positive relationship between spiritual experiences and life satisfaction is stronger among older African Americans than among older Whites. METHOD: The data came from 6864 community-dwelling persons aged 65+ (66% African American) who participated in the Chicago Health and Aging Project. Life satisfaction was measured using a five-item composite and we used a five-item version of the Daily Spiritual Experiences scale. RESULTS: In a regression model adjusting for age, sex, marital status, education, income and worship attendance, we found that African American race was associated with lower life satisfaction. We also found a positive association between spiritual experiences and life satisfaction. In an additional model, a significant race by spiritual experiences interaction term indicates that spiritual experiences are more positively associated with life satisfaction among African Americans. CONCLUSION: The data suggest that at higher levels of spiritual experiences, racial differences in life satisfaction are virtually non-existent. However, at lower levels of spiritual experiences, older African Americans show modestly lower levels of life satisfaction than do older Whites. This pattern suggests that spiritual experiences are a positive resource - distinct from worship attendance - that enable older African Americans to overcome decrements in life satisfaction and, in fact, that lower spiritual experiences may be especially harmful for older African American's life satisfaction.

Worship attendance and the disability process in community-dwelling older adults.

OBJECTIVES: We examined the contribution of religious involvement to age-related declines in health by examining the association of worship attendance with measures of different stages in the disability continuum. METHOD: Participants included 5,863 Black and White older adults from the Chicago Health and Aging Project. Worship attendance was coded in 3 levels: very frequent (several times a week or more), frequent (several times a month), and infrequent (several times a year or less). Measures of disability included self-reported instrumental activities of daily living (IADL) and activities of daily living (ADL) disability as well as observed physical function. RESULTS: In multiple regression models adjusted for demographic factors, compared with those with infrequent worship attendance, those with frequent or very frequent attendance had lower levels of IADL and ADL disability and higher levels of physical performance at baseline. These associations remained significant in models that adjusted for health and cognitive status. There was no association between frequency of worship attendance and change in disability or physical function over time. DISCUSSION: These results suggest that more frequent worship attendance does not contribute to slowing the progress of disability in late life. Future research is needed to better understand the development of the differences in disability associated with worship attendance observed at baseline.