Dementia and COVID-19 among Older African American Adults: A Scoping Review of Healthcare Access and Resources

Abstract

African American/Black communities comprise 12.2% of the U.S. population, with a COVID-19 infection rate of more than 18% and marginal access to healthcare services. This scoping review synthesizes the emerging evidence on healthcare accessibility among older African American adult communities with dementia and COVID-19, as well as the resource requirements for this population during the pandemic. Searches of different databases for empirical studies and other sources on dementia and COVID-19 among older African American adults yielded 13 studies that met the following inclusion criteria: (a) focus on dementia and COVID-19, (b) sampled older African American adults,(c) investigated healthcare accessibility and resources, and (d) published between 2019 and 2022. Following the initial selection of the studies, eight were selected for relevance based on the Population, Concept, and Context (PCC) inclusion and exclusion criteria. Thematic analysis indicated that older African Americans with dementia and COVID-19 experienced longer delays in accessing timely healthcare, including transportation, intensive care units (ICUs), and mechanical ventilation. They also had reduced healthcare resources associated with a lack of health insurance, low financial resources, and an increased length of hospital stay, which further aggravated the negative effects of comorbid dementia and COVID-19 infections. Evidence showed that racial and age disparities affected older African American adults with dementia and COVID-19, resulting in lower healthcare access and marginal resources. This is consistent with historical and systemic inequities in meeting the healthcare needs of people of color in the United States, which was compounded for older African Americans during the COVID-19 pandemic.

Understanding stigma of dementia during COVID-19: a scoping review

“…For example, older African American adults with dementia and COVID-19 were described to experience systemic discrimination, increased delays, and reduced access to healthcare resources such as ventilators, technological supports (e.g., cell phones), transportation, health insurance, and access to intensive care units during COVID-19 ( 28 ). Moreover, African American adults often experienced distrust towards the healthcare system and the government due to prejudice, fear, racism, and discrimination ( 28 ). Consequently, a lack of trust was related to the information spread by institutions such as the media and the government ( 21 ).…”

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection

“…For instance, a study by Wang et al found that African American dementia patients have an almost threefold increase in the adjusted odds ratio of becoming infected with COVID-19 [ 8 ], and their prevalence is nearly double compared to white American patients (19% vs. 10%) [ 9 ]. In a scoping review, Udoh et al showed that African American patients with dementia and COVID-19 had longer delays in accessing healthcare services, including ICU access, mechanical ventilation, or transportation [ 10 ]. In Europe, the Roma population has been suggested to have an increased risk of COVID-19 [ 11 ], but clinical results are inconclusive.…”