Impediments to timely diagnosis of Alzheimer's disease in African Americans

2010 Alzheimer's disease facts and figures

Alzheimer's disease (AD) is the seventh leading cause of all deaths in the United States and is virtually tied with the sixth leading cause of death-diabetes. AD is the fifth leading cause of death in Americans aged 65 and older. Although other major causes of death have been on the decrease, deaths because of AD have been rising dramatically. Between 2000 and 2006, heart disease deaths decreased 11.1%, stroke deaths decreased 18.2%, and prostate cancer-related deaths decreased 8.7%, whereas deaths because of AD increased 46.1%. Older African-Americans and Hispanics are more likely than older white Americans to have AD or other dementia. Current estimates are that African-Americans are about 2 times more likely, and Hispanics about 1.5 times more likely, than their white counterparts to have these conditions. However, the relationship of race and ethnicity to the development of AD and other dementias is complex and not fully understood. In 2009, nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to persons with AD and other dementias; this care is valued at nearly $144 billion. Medicare payments for services to beneficiaries aged 65 years and older with AD and other dementias are three times higher than for beneficiaries without these conditions. Total payments for 2010 for health care and long-term care services for people aged 65 and older with AD and other dementias are expected to be $172 billion (not including the contributions of unpaid caregivers). An estimated 5.3 million Americans have AD; approximately 200,000 persons under age 65 with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050 the time of every 70 seconds is expected to decrease to every 33 seconds. Over the coming decades, the baby boom population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11-16 million people. Dramatic increases in the numbers of "oldest old" (aged 85 years and older) across all racial and ethnic groups will also significantly affect the numbers of people living with AD. This report provides information to increase understanding of the public health effect of AD, including incidence and prevalence, mortality, costs of care, and effect on caregivers and society in general. This report also sets the stage for better understanding the relationship between race and ethnicity and the development of AD and other dementias.

Rural African American clergy: an exploration of their attitudes and knowledge of Alzheimer's disease

Rural African American clergy's ability to recognize Alzheimer's Disease (AD) and their capacity to provide support to elders with this illness has been neglected in the literature. Using a mental health literacy framework, the purpose of this research was to explore rural African American clergy knowledge and beliefs of AD. In-depth interviews were conducted with 9 African American clergy who oversaw churches in central Kentucky. Although few had direct experience with providing pastoral care to elders with AD, all clergy were literate and aware of the need for additional training. This study seeks to further clarify the role of African American clergy and their understanding of AD to inform the future development of appropriate interventions and establish better collaborative community treatment relationships.

Black and white adult family members' attitudes toward a dementia diagnosis

OBJECTIVES

To examine potential benefits of and barriers to diagnosis from the perspective of black and white adults directly affected by Alzheimer's disease (AD).

DESIGN

Telephone survey.

SETTING

Convenience sample recruited from two U.S. metropolitan areas.

PARTICIPANTS

One hundred seventy-eight family members of people with AD, including current and former AD caregivers and immediate blood relatives of someone with AD.

MEASUREMENTS

Respondents were asked to rate the importance of eight benefits of and 16 barriers to obtaining a diagnosis.

RESULTS

Family members strongly endorse several benefits of obtaining a diagnosis, including getting information, finding out what is wrong with their relative, and prompting future planning. A majority of survey respondents did not endorse any barriers examined. Lack of a cure for AD and the belief that little can be done for someone with AD were the most frequently endorsed barriers. Black respondents endorsed five of the eight benefits more frequently than white respondents.

CONCLUSION

Black and white adults with a family member who has received an diagnosis of AD perceive a range of benefits and few barriers to the diagnostic process examined in this study. Their positive experiences might be instructive to families considering pursuing a diagnosis and to physicians who may be reluctant to offer screening or referral because of the belief that families have little to gain.

African American caregivers

Despite the significance of an early diagnosis of Alzheimer's disease (AD), African Americans are diagnosed in later stages of the disease and present with greater cognitive impairment at the time of diagnosis when compared to Euro-Americans. To this end, there exists a paucity of research on diagnostic pathways among African Americans with dementia. More specifically, few studies have explored help-seeking pathways from the initial manifestation of symptoms until an actual diagnosis of Alzheimer's disease was received from the perspective of African American caregivers. Thus, the present study examined the retrospective experiences of 17 African American caregivers who were given a diagnosis of Alzheimer's disease for a family member with dementia. Participants completed face-to-face semi-structured interviews. Study findings revealed a complex interplay between the patient with dementia, entities that comprise their social support network, and clinicians.

Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries

OBJECTIVES

Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia.

METHODS

Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey.

RESULTS

After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR=0.73, 95% confidence interval [CI]=0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR=0.75, 95% CI=0.57, 0.99) and non-Hispanic others (PR=0.50, 95% CI=0.26, 0.96) but were attenuated for Hispanics (PR=0.84, 95% CI=0.59, 1.20).

DISCUSSION

Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors.