Members of racial and ethnic minority groups living with dementia are less likely to receive an accurate and timely diagnosis, they have reduced access to treatments, and they are less likely to live in long-term care facilities that have specialized memory care units, new research finds.
Researchers from University of California-Davis Health and Oregon Health & Science University said that members of minority groups fall victim to systemic oppression that leads to a higher risk of hospitalization and more aggressive life-sustaining treatment in end-of-life care.
Their research, published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, analyzed 71 studies between 2000 and 2022 that examined healthcare access and quality for people living with dementia and their caregivers.
“Reducing disparities in Alzheimer’s disease and related dementias, and receiving timely, high-quality healthcare services, is essential to advance health equity, “ first author Ladson Hinton, MD, a professor in the UC Davis Department of Psychiatry and Behavioral Sciences, said in a press release. “Our review provides timely and compelling evidence of disparities in healthcare quality and access for people living with dementia from minoritized populations.”
Some of the key findings from the analysis were that members of minority groups received less optimal care and experienced delays in receiving a diagnosis. In one study, it took 11% longer for Black Americans and 40% longer for Hispanic Americans to access care.
The analysis also found that Asian older Americans were less likely to receive a diagnostic work-up for cognitive impairment, and Black and Hispanic Americans were less likely to be referred for neuropsychological testing. Minority populations also had lower rates of prescriptions for dementia-related medications.
Hinton told McKnight’s Senior Living that the review was broadly inclusive of older adults in various settings and that the finding would apply to assisted living communities.
“The overarching message is that people living with cognitive impairment and their families need to be proactive and informed as they navigate their way through the healthcare system,” Hinton said. “This is particularly important for people of color, but is good advice for everyone.”
End-of-life care more aggressive for minorities
Black Americans living with dementia were more likely to experience increased hospital admission rates, longer lengths of stay at hospitals and higher costs.
The researchers also found that Black Americans living with dementia were less likely to receive hospice care and more likely to have feeding tubes and mechanical ventilation during end-of-life care.
“The results of our study highlight the importance of granular data collection on race and ethnicity,” Oanh Meyer, PhD, a study co-author and associate professor in the UC Davis Department of Neurology, said in a statement. “Understanding where the disparities exist will help us address why they occur and how to remedy them at the individual clinical and health system level.”
Creating equity in dementia care
The researchers recommended monitoring for disparities in care at the local level, educating and training clinicians to reduce racial bias and improve communication, and enhancing the cultural and linguistic competence of clinical care.
They also supported the development of targeted initiatives to empower people with dementia and family caregivers as they navigate the healthcare system.
“Ultimately, it’s critical that the best available dementia care is attainable and offered to all Americans, particularly those who are left out of novel research innovations because of their race, social standing or place of residence,” Ana R. Quinones, PhD, the senior author of the study and an associate professor at Oregon Health & Science University, said in a statement. “To make real progress in achieving equity and closing the gaps in outcomes for Alzheimer’s disease and related dementias, we must do more to ensure the most promising interventions are aimed at those who need them most.”
