Racial and Ethnic Differences in Knowledge About One's Dementia Status

Abstract

OBJECTIVES:To examine racial and ethnic differences in knowledge about one's dementia status DESIGN: Prospective cohort study SETTING: 2000-2014 Health and Retirement Study PARTICIPANTS: Our sample included 8,686 person-wave observations representing 4,065 unique survey participants age ≥70 with dementia, as identified by a well-validated statistical prediction model based on individual demographic and clinical characteristics. MEASUREMENTS: Primary outcome measure was knowledge of one's dementia status as reported in the survey. Patient characteristics included race/ethnicity, age, gender, survey year, cognition, function, comorbidity, and whether living in a nursing home.RESULTS: Among subjects identified as having dementia by the prediction model, 43.5%-50.2%, depending on the survey year, reported that they were informed of the dementia status by their doctor. This proportion was lower among Hispanics (25.9%-42.2%) and non-Hispanic blacks (31.4%-50.5%) than among non-Hispanic Whites (47.7%-52.9%). Our fully-adjusted regression model indicated lower dementia awareness among non-Hispanic blacks (OR=0.74 95% CI: 0.58-0.94) and Hispanics (OR=0.60; 95% CI: 0.43-0.85), compared to non-Hispanic whites. Having more IADL limitations (OR=1.65, 95% CI: 1.56-1.75) and living in a nursing home (OR=2.78, 95% CI: 2.32-3.32) were associated with increased odds of subjects reporting being told about dementia by a physician.

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

“…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.…”

Clinician approaches to communicating a dementia diagnosis: An interview study

“…Some studies suggest that individuals identifying as Hispanic or black have missed or delayed dementia diagnoses and are often diagnosed at later stages (e.g., with worse cognitive function and more functional impairments) compared to individuals who identified as non-Hispanic white [ 49 ]. Additionally, while fewer than half of individuals with dementia reported being told their diagnosis by a physician regardless of background, proportions were lower for Hispanics and blacks than non-Hispanic whites [ 50 ]. Reasons for this are likely complex and include a lack of guidance on how to disclose a dementia diagnosis in a manner that is culturally relevant in different racial and ethnic groups.…”

Acceptability and preliminary effectiveness of a remote dementia educational training among healthcare professionals

“…Despite the potential of healthcare professionals to improve the lives of families with ADRD, care remains under-implemented. Approximately 49.2%-56.5% of Americans with ADRD are unaware of their condition and remain potentially undiagnosed (Lin et al, 2020). In the clinic, only 16% of people 65 and older receive regular cognitive assessments during routine health check-ups (Alzheimer’s Association, 2019).…”

“…In addition, Latino, non-Latino Black, and rural individuals have a higher ADRD risk and are disproportionately underserved in care outcomes (Alzheimer’s Association, 2019; Bédard et al, 2004; Koller et al, 2016; Lin et al, 2020; Scharlach et al, 2008; Weden et al, 2018). For example, the likelihood of non-Latino Black and Latino individuals with ADRD to be undiagnosed is 34-40% higher than non-Latino Whites (Lin et al, 2020). If diagnosed, Latinos with ADRD experience a delay in their diagnosis of eight months compared to non-Latino Whites (Barker et al, 2005).…”