Disparities in Self-Rated Memory By Occupation Among Native Hawaiian and Other Pacific Islander Older Adults

Background/Purpose. Minority older adults are at high risk of cognitive impairment. There is a growing literature linking work with cognitive health, yet few have focused on Native Hawaiian and other Pacific Islander (NHPI) older adults. The use-it-or-lose-it hypothesis and the environmental complexity hypothesis suggest the cognitive health benefits of mentally demanding jobs. Guided by these hypotheses, the present study explores 1) the association between occupation types and self-rated health and 2) the moderating role of occupation length in this association among NHPI older adults.

Methods. Data and sample: Data from the 2014 Native Hawaiian and Pacific Islander National Health Interview Survey (n = 1,045 with respondents aged 50+) were analyzed with logistic regression models. To address missing data, chained multiple imputation methods were used with Stata, Version 15 (StataCorp, 2017). As a result, ten imputed data sets were created.

Measures: Following the previous literature, the occupation types were categorized into blue-collar, clerical/sales/services, and professional/managerial (the reference group). The length of jobs was measured by the number of years. Self-rated memory was measured using a single survey question that asked: Do you have difficulty remembering or concentrating? 1 = no difficulty, 2 = some difficulty, 3 = a lot of difficulty, or 4 = unable to do this. The responses were dichotomized as 1 = unable to do this or a lot of difficulty or some difficulty remembering/concentrating and 0 = no difficulty. Variables including age, gender, education, marital status, labor force status, income, smoking status, physical activity, and self-rated health were controlled in multivariate models.

Results. People with blue-collar occupations were twice as likely to have memory problems compared to people with professional/managerial occupations (OR = 2.011, p < .05). Occupation types and occupation length interactions significantly predicted self-rated memory. People with blue-collar occupations were at higher risk of memory problems than people with professional/managerial occupations when the occupation length increased. On the other hand, working in occupations that may be more mentally engaging was associated with lower odds of memory problems as the occupation length increased.

Conclusions and Implications. The present study supports the use-it-or-lose-it hypothesis and the environmental complexity hypothesis by highlighting the importance of mentally stimulating work environments and the need to address disparities in cognitive health. The implications are discussed for promoting cognitive health equity for minority older adults in the United States.