Interracial and Intraracial Differences in Neuropsychiatric Symptoms, Sociodemography, and Treatment Among Nursing Home Patients With

Abstract

Using an adaptation of George's (1989) social antecedent model of psychopathology, this article examines interracial and intraracial differences in neuropsychiatric symptoms, sociodemography, and treatment among nursing home patients with dementia. The final sample consisted of 164 U.S.-born African Americans, 54 African Caribbeans, and 68 Caucasians. Although there were appreciable interracial differences in sociodemographics, there were minimal clinical differences. This finding may reflect both racial differences in pathways to institutionalization and the homogenization of clinical characteristics created by new governmental standards for nursing homes. There were no substantial differences between African Americans and African Caribbeans. Use of medication to treat neuropsychiatric symptoms was low, and may have reflected difficulties in diagnosis and concerns about the abuse of medications.

Late-Life Depression Among Black and White Elderly Homecare Patients

“…Also, the results may be confounded by unmeasured differences between black and whites. We did observe significant differences in poverty level, education, and MMSE scores that are consistent with findings of Murden et al 19 and other previous studies; 20,21 our findings indicate that controlling for these variables did not change the observed similar prevalence of MDD in black and white patients. Finally, the results reflect patients from a single agency serving a specific region of the country.…”

Prevalence and pharmacological management of behavioural and psychological symptoms amongst dementia sufferers living in care environments

“…In the largest study, Cohen et al (1998) identi®ed psychosis in 22% of nursing home residents, whereas Shah (1999) from a literature review concluded that aggression occurs in 30% of residents. Other symptoms have received little attention, and previous studies have not compared the frequency of BPSD symptoms between social and nursing care facilities.…”

Ethnicity and dementia

“…Studies that have focused on blacks have shown prevalence rates of 6% to 44% for depression [13][14][15]17 [13,39,[42][43][44][45], and 4% to 26% for hallucinations [13,39,42,44,45]. Three additional studies that reported on the frequency of psychosis (delusions or hallucinations) among black patients with dementia found prevalence rates of 22% [40], 42% [15], and 77% [17], respectively. In terms of behavioral problems among blacks, prevalence rates have varied from 37% to 82% for agitation or aggression [43,44,46] and 37% to 79% [15,17] for activity disturbance.…”

“…In terms of affective symptom clusters in AD, Harwood et al [50] found greater ideational disturbance (suicide, self-deprecation, pessimism, and mood congruent delusions) and mood symptoms (anxiety, sadness, lack of reactivity to pleasant events, and irritability) among Hispanics compared with non-Hispanic whites. Further, Hispanic [37] and black [13,17,43,49,51] patients with dementia show greater rates of psychosis in comparison with whites, although the results have not been uniformly consistent [40,42,45]. Black and white ethnic differences have been negligible with respect to agitation [13,17,42,45], although one study found a higher intensity of difficult behaviors among Mexican-American patients with dementia relative to non-Hispanic whites [4].…”

“…Among blacks, agitation has been associated with increased cognitive impairment and greater psychosis, depression has been linked with increased psychosis and more education, and psychosis has been related to increased cognitive impairment, more visitors per week, and depression [15,40]. In Hispanics, mood disturbance has been correlated with less education, fewer years in the United States (a measure of acculturation), and psychosis [47•].…”