Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in Older African American and White Veterans

Cheng, Yan; Ahmed, Ali; Zamrini, Edward; Tsuang, Debby W.; Sheriff, Helen; Zeng‐Treitler, Qing

doi:10.3233/jad-191188

Cited by 18 publications

(27 citation statements)

References 38 publications

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“…These findings are similar to those from an earlier systematic review by Mehta and Yeo [10]. A further recent study conducted among US Veterans and published after the time period of our search supports our findings [34]. We also showed a similar increase in dementia incidence among those of Black ethnicity in a post-stroke population Shiekh et al [11].…”

Section: Discussionsupporting

confidence: 92%

Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis

Shiekh

Cadogan

Lin

et al. 2021

JAD

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Background: Globally around 50 million people have dementia. Risk factors for dementia such as hypertension and diabetes are more common in Black, Asian, and other ethnic minorities. There are also marked ethnic inequalities in care seeking, likelihood of diagnosis, and uptake of treatments for dementia. Nevertheless, ethnic differences in dementia incidence and prevalence remain under-explored. Objective: To examine published peer-reviewed observational studies comparing age-specific or age-adjusted incidence or prevalence rates of dementia between at least two ethnic groups. Methods: We searched seven databases on 1 September 2019 using search terms for ethnicity, dementia, and incidence or prevalence. We included population-based studies comparing incidence or prevalence of dementia after accounting for age of at least two ethnic groups in adults aged 18 or more. Meta-analysis was conducted for eligible ethnic comparisons. Results: We included 12 cohort studies and seven cross-sectional studies. Thirteen were from the US, and two studies each from the UK, Singapore, and Xinjiang Uyghur Autonomous Region in China. The pooled risk ratio for dementia incidence obtained from four studies comparing Black and White ethnic groups was 1.33 (95% CI 1.07–1.65; I-squared = 58.0%). The pooled risk ratio for dementia incidence comparing the Asian and White ethnic groups was 0.86 (95% CI 0.728–1.01; I-squared = 43.9%). There was no difference in the incidence of dementia for Latino ethnic group compared to the White ethnic group. Conclusion: Evidence to date suggest there are ethnic differences in risk of dementia. Better understanding of the drivers of these differences may inform efforts to prevent or treat dementia.

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Section: Discussionsupporting

confidence: 92%

Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis

Shiekh

Cadogan

Lin

et al. 2021

JAD

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“…African Americans and Hispanics are more likely to suffer from dementia than Whites and to have higher morbidity burdens. [29][30][31][32] African Americans and Hispanics may have comparable rates of polypharmacy to that of Whites, 33 but lower income minorities have higher rates of polypharmacy and PIM use. 34 Population-based studies suggest that African Americans have significantly less trust in providers and the health care system; poor communication with White providers may cause members of minority groups to be less willing to accept deprescribing recommendations.…”

Section: Discussionmentioning

confidence: 99%

Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study

et al. 2020

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BACKGROUND: Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. OBJECTIVES: To elucidate patient, family, and physician perspectives on medication discontinuation and recommended language for deprescribing discussions in order to inform an intervention to increase awareness of deprescribing among individuals with dementia and MCC, family caregivers and primary care physicians. We also explored participant views on culturally competent approaches to deprescribing. DESIGN: Qualitative approach based on semi-structured interviews with patients, caregivers, and physicians. PARTICIPANTS: Patients aged ≥ 65 years with claimsbased diagnosis of dementia, ≥ 1 additional chronic condition, and ≥ 5 chronic medications were recruited from an integrated delivery system in Colorado and an academic medical center in Maryland. We included caregivers when present or if patients were unable to participate due to severe cognitive impairment. Physicians were recruited within the same systems and through snowball sampling, targeting areas with large African American and Hispanic populations. APPROACH: We used constant comparison to identify and compare themes between patients, caregivers, and physicians. KEY RESULTS: We conducted interviews with 17 patients, 16 caregivers, and 16 physicians. All groups said it was important to earn trust before deprescribing, frame deprescribing as routine and positive, align deprescribing with goals of dementia care, and respect caregivers' expertise. As in other areas of medicine, racial, ethnic, and language concordance was important to patients and caregivers from minority cultural backgrounds. Participants favored direct-to-patient educational materials, support from pharmacists and other team members, and close follow-up during deprescribing. Patients and caregivers favored language that explained deprescribing in terms of altered physiology with aging. Physicians desired communication tips addressing specific clinical situations. CONCLUSIONS: Culturally sensitive communication within a trusted patient-physician relationship supplemented by pharmacists, and language tailored to specific clinical situations may support deprescribing in primary care for patients with dementia and MCC.

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“…The study population included adults with a diagnosis of dementia who were hospitalized in New York State between 2008 and 2014. A diagnosis of dementia was defined as having an ICD‐9 code of: 290.0, 290.1, 290.4, 291.2, 291.82, 294.1*, 294.2*, 294.8, 331.0, 331.19, 331.2, 331.7, 331.82, 331.89, and 331.9 18 . Smaller hospitals with less than 100 beds and rural hospitals were excluded to reduce heterogeneity in hospital characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…A diagnosis of dementia was defined as having an ICD-9 code of: 290.0, 290.1, 290. 4 18 Smaller hospitals with less than 100 beds and rural hospitals were excluded to reduce heterogeneity in hospital characteristics. Hospitals that implemented a palliative care program in 2008, 2013, or 2014 were excluded as there would not be enough baseline or follow-up data available.…”

Section: Exposuresmentioning

confidence: 99%

Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

Lackraj

Kavalieratos

Murali

et al. 2021

J American Geriatrics Society

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Background In patients with serious illness, use of specialist palliative care may result in improved quality of life, patient and caregiver satisfaction and advance care planning, as well as lower health care utilization. However, evidence of efficacy is limited for patients with dementia, particularly in the setting of an acute hospitalization. Objective To determine whether implementation of hospital‐based specialist palliative care was associated with differences in treatment intensity outcomes for hospitalized patients with dementia. Design Retrospective cohort study. Setting Fifty‐one hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. Participants Hospitalized patients with dementia. Measurements The primary outcome of this study was discharge to hospice from an acute hospitalization. Secondary outcomes included hospital length of stay, use of mechanical ventilation and dialysis, and days in intensive care. Difference‐in‐difference analyses were performed using multilevel regression to assess the association between implementing a palliative care program and outcomes, while adjusting for patient and hospital characteristics and time trends. Results During the study period, 82,118 patients with dementia (mean (SD) age, 83.04 (10.04), 51,170 (62.21%) female) underwent an acute hospitalization, of which 41,227 (50.27%) received care in hospitals that implemented a palliative care program. In comparison to patients who received care in hospitals without palliative care, patients with dementia who received care in hospitals after the implementation of palliative care were more 35% likely to be discharged to hospice (adjusted odds ratio (aOR) = 1.35 (1.19–1.51), P < .001). No meaningful differences in secondary outcomes were observed. Conclusion Implementation of a specialist palliative care program was associated with an increase in discharge to hospice following acute hospitalization in patients with dementia.

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Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias in Older African American and White Veterans

Cited by 18 publications

References 38 publications

Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis

Ethnic Differences in Dementia Risk: A Systematic Review and Meta-Analysis

Designing a Primary Care–Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study

Implementation of Specialist Palliative Care and Outcomes for Hospitalized Patients with Dementia

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