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Mills MS, Whitehead BR, Howells Wrobel N. Race and Personal Exposure to AD Influence Projected Memory Failure Attributions and Help-Seeking Behaviors. Clin Gerontol 2023; 46:53-65. [PMID: 32274979 DOI: 10.1080/07317115.2020.1751765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Examine race and personal exposure to Alzheimer's Disease (AD) on projected memory failure attributions and medical help-seeking thresholds of pre-morbid adults. The goal is to better understand race discrepancies in help-seeking for those potentially at risk for early-onset AD. METHODS 498 adults aged 40 to 65 (M = 52.27), screened for current memory failure, completed an online questionnaire exploring their help-seeking intentions and threshold, attributions of hypothetical memory failures, and level of AD concern. RESULTS Non-Hispanic Whites (n = 248) were significantly more concerned about AD than African Americans (n = 250) (p =.027). Personal exposure to AD moderated the impact of race on memory failure attributions (p =.036), so that personal exposure was more influential for African Americans. Those who were more likely to attribute hypothetical memory failures to AD had lower projected thresholds for seeking a medical evaluation (p =.010). Memory failure attribution emerged as a potential mediator of the impact of race on projected help-seeking behaviors (p =.057). CONCLUSIONS African Americans were more influenced by personal experience when considering the causes of hypothetical memory failures. CLINICAL IMPLICATIONS Healthcare providers should emphasize to African American families the value of early AD detection and treatment in terms of quality of life for both patient and caregiver.
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Affiliation(s)
- Marisa S Mills
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Brenda R Whitehead
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, USA
| | - Nancy Howells Wrobel
- Department of Behavioral Sciences, University of Michigan-Dearborn, Dearborn, Michigan, USA
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Epps F, Foster K, Alexander K, Brewster G, Chester M, Thornton J, Aycock D. Perceptions and Attitudes Toward Dementia in Predominantly African American Congregants. J Appl Gerontol 2021; 40:1511-1516. [PMID: 33487058 PMCID: PMC8302664 DOI: 10.1177/0733464820987350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to identify the perceptions and attitudes of African American congregants toward dementia before and after attending a dementia-focused workshop. Six churches in Metropolitan Atlanta, Georgia, hosted the workshops. Attendees (N = 171) participated in a free association exercise to evaluate their perceptions and attitudes toward dementia. Before and after the workshop, participants wrote words and phrases that occurred to them when they thought of dementia. Content analysis was used to identify themes. Before the workshop, participants' responses tended to include negative language (e.g., fear, memory loss, sadness). After the workshop, participants expressed more positive words (e.g., support, hopefulness, caring). These findings suggest that education can change congregants' perceptions about dementia and potentially reduce dementia-associated stigma. This change will allow families to feel comfortable both interacting with and seeking help from those in their faith communities.
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Lind KE, Hildreth K, Lindrooth R, Morrato E, Crane LA, Perraillon MC. The effect of direct cognitive assessment in the Medicare annual wellness visit on dementia diagnosis rates. Health Serv Res 2021; 56:193-203. [PMID: 33481263 DOI: 10.1111/1475-6773.13627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the relationship between direct cognitive assessment introduced with the Medicare Annual Wellness Visit (AWV) and new diagnoses of dementia, and to determine if effects vary by race. DATA SOURCES Medicare Limited Data Set 5% sample claims 2003-2014 and the HRSA Area Health Resources Files. STUDY DESIGN Instrumental Variable approach estimating the relationship between AWV utilization and new diagnoses of dementia using county-level Welcome to Medicare Visit rates as an instrument. DATA COLLECTION/EXTRACTION METHODS Three hundred twenty-four thousand three hundred and eighty-five fee-for-service Medicare beneficiaries without dementia when the AWV was introduced in 2011. PRINCIPAL FINDINGS Annual Wellness Visit utilization was associated with an increased probability of new dementia diagnosis with effects varying by racial group (categorized as white, black, Hispanic/Latino, or Asian based on Social Security Administration data). Hazard ratios (95% confidence intervals) for new dementia diagnosis within 6 months of AWV utilization were as follows: 2.34 (2.13, 2.58) white, 2.22 (1.71, 2.89) black, 4.82 (2.94, 7.89) Asian, and 6.14 (3.70, 10.19) Hispanic (P < .001 for each). Our findings show that estimates that do not control for selection underestimate the effect of AWV on new diagnoses. CONCLUSIONS Dementia diagnosis rates increased with AWV implementation with heterogenous effects by race and ethnicity. Current recommendations by the United States Preventive Services Task Force state that the evidence is insufficient to recommend for or against screening for cognitive impairment in older adults.
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Affiliation(s)
- Kimberly E Lind
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kerry Hildreth
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Richard Lindrooth
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Elaine Morrato
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Lori A Crane
- Colorado School of Public Health, University of Colorado, Aurora, Colorado, USA
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Abramsohn EM, Jerome J, Paradise K, Kostas T, Spacht WA, Lindau ST. Community resource referral needs among African American dementia caregivers in an urban community: a qualitative study. BMC Geriatr 2019; 19:311. [PMID: 31727000 PMCID: PMC6857299 DOI: 10.1186/s12877-019-1341-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND African American caregivers of community-residing persons with dementia are mostly unpaid and have high rates of unmet basic and health needs. The National Alzheimer's Project Act (NAPA) mandates improved coordination of care for persons with dementia and calls for special attention to racial populations at higher risk for Alzheimer's Disease or related dementias (ADRD) to decrease health disparities. The purpose of this study is to describe the perceptions of African American caregivers of people with dementia about community resources needed to support caregiving as well as their own self-care. METHODS Using a qualitative study design, in-depth, semi-structured qualitative interviews were conducted with caregivers (N = 13) at an urban geriatric clinic to elicit community resource needs, barriers to and facilitators of resource use and how to optimize clinical referrals to community resources. Caregivers were shown a community resource referral list ("HealtheRx") developed for people with dementia and were queried to elicit relevance, gaps and insights to inform delivery of this information in the healthcare setting. Data were iteratively coded and analyzed using directed content analysis. Results represent key themes. RESULTS Most caregivers were women (n = 10, 77%) and offspring (n = 8, 62%) of the person with dementia. Community resource needs of these caregivers included social, entertainment, personal self-care and hospice services. Main barriers to resource use were the inability to leave the person with dementia unsupervised and the care recipient's disinterest in participating in their own self-care. Facilitators of resource use included shared caregiving responsibility and learning about resources from trusted sources. To optimize clinical referrals to resources, caregivers wanted specific eligibility criteria and an indicator of dementia care capability. CONCLUSIONS African American caregivers in this study identified ways in which community resource referrals by clinicians can be improved to meet their caregiving and self-care needs.
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Affiliation(s)
- Emily M Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 S Maryland Ave., MC2050, Chicago, IL, 60637, USA.
| | - Jessica Jerome
- Department of Health Sciences, DePaul University, Chicago, USA
| | - Kelsey Paradise
- Department of Obstetrics and Gynecology, The University of Chicago, 5841 S Maryland Ave., MC2050, Chicago, IL, 60637, USA
| | - Tia Kostas
- Department of Medicine, Section of Geriatrics & Palliative Medicine, The University of Chicago, Chicago, USA
| | | | - Stacy Tessler Lindau
- Departments of Obstetrics and Gynecology and Medicine-Geriatrics, The University of Chicago, Chicago, USA
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Bonds K, Lyons KS. Formal Service Use by African American Individuals With Dementia and Their Caregivers: An Integrative Review. J Gerontol Nurs 2018; 44:33-39. [PMID: 29846740 DOI: 10.3928/00989134-20180509-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/23/2018] [Indexed: 11/20/2022]
Abstract
Dementia is a predominant problem in older adults, affecting African American individuals at higher rates than other ethnic groups; yet, African American older adults use fewer formal services. To identify factors influencing formal service use by African American individuals with dementia and their caregivers, an integrative review of the literature was performed using four databases from 1990 to July 2017. Fourteen articles (nine quantitative, five qualitative) describing formal service use were included in the review. Three main themes were identified: Formal Service Need, Expectations of Formal Service Providers, and Formal Service Use. Recommendations to improve formal service use are suggested. [Journal of Gerontological Nursing, 44(6), 33-39.].
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Howell JC, Parker MW, Watts KD, Kollhoff A, Tsvetkova DZ, Hu WT. Research Lumbar Punctures among African Americans and Caucasians: Perception Predicts Experience. Front Aging Neurosci 2016; 8:296. [PMID: 27994549 PMCID: PMC5133251 DOI: 10.3389/fnagi.2016.00296] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/21/2016] [Indexed: 12/21/2022] Open
Abstract
African Americans are under-represented in Alzheimer's disease (AD)-related biomarker studies, and it has been speculated that mistrust plays a major factor in the recruitment of African Americans for studies involving invasive procedures such as the lumbar puncture (LP). We set out to determine factors associated with non-participation in a biomarker study aiming to explore cerebrospinal fluid (CSF) AD biomarker differences between older African Americans and Caucasians. We also surveyed participants' procedure-related perception (a standard medical procedure vs. a frightening invasive procedure) and reluctance, as well as the rate and type of post-procedure discomfort and complications. Among 288 subjects approached for study participation, 145 (50.3%) refused participation with concerns over LP being the most commonly reported reason. Relatively more African Americans than Caucasians reported concerns over LP as the main reason for non-participation (46% vs. 25%, p = 0.03), but more African Americans also did not provide a specific reason for non-participation. Among those who completed study participation (including the LP), African Americans and Caucasians were similar in pre-LP perceptions and reluctance, as well as post-LP rates of discomfort or complication. Perceiving LP as a frightening invasive procedure, not race, is associated with increased likelihood of post-LP discomfort or complication (RR 6.2, 95% confidence interval 1.1-37.0). Our results indicate that LP is a well perceived procedure in a cohort of African American and Caucasian research participants, and is associated with few serious complications. The pre-procedure perception that the LP is a frightening invasive procedure significantly increases the risk of self-reported discomfort of complications, and African Americans may be more likely to turn down study participation because of the LP. Future studies will need to address factors associated with negative LP perceptions to further assure participants and reduce complication rates.
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Affiliation(s)
- Jennifer C Howell
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Monica W Parker
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Kelly D Watts
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Alexander Kollhoff
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
| | - Dobromira Z Tsvetkova
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA
| | - William T Hu
- Department of Neurology, Emory University School of MedicineAtlanta, GA, USA; Center for Neurodegenerative Diseases Research, Emory University School of MedicineAtlanta, GA, USA; Alzheimer's Disease Research Center, Emory University School of MedicineAtlanta, GA, USA
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Desin PJ, Caban-Holt AM, Abner EL, Van Eldik LJ, Schmitt FA. Factors Associated with Unmet Needs among African-American Dementia Care Providers. JOURNAL OF GERONTOLOGY & GERIATRIC RESEARCH 2016; 5. [PMID: 27182464 PMCID: PMC4864855 DOI: 10.4172/2167-7182.1000267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Racial and ethnic minorities currently comprise 20% of the U.S. population; in 2050, this figure is expected to rise to 42%. As a result, Alzheimer’s disease (AD), the 5th leading cause of death for people aged 65 and older, is likely to increase in these groups. Most dementia caregiving for these populations comes from family and friends, especially among families with lower socioeconomic status. A convenience sample of 30 African-American dementia caregivers was interviewed to determine unmet needs. Participants expressed a limited desire for formal services, such as support groups, legal advice, case management, and homemaker services. Instead, commonly expressed needs were daytime respite care and especially a desire for family and social support. Many caregivers expressed a need for other family members to share responsibility in the process; therefore, methods for caregiver support that address multiple family members in care provision may be beneficial for this group.
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Affiliation(s)
- P J Desin
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky, USA
| | - A M Caban-Holt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
| | - E L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA
| | - L J Van Eldik
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, Kentucky, USA
| | - F A Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA; Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
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Howe E. Clinical implications of the new diagnostic guidelines for dementia. INNOVATIONS IN CLINICAL NEUROSCIENCE 2013; 10:32-8. [PMID: 23882439 PMCID: PMC3719461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
New criteria have been proposed for diagnosing Alzheimer's disease. These emphasize that this illness exists on a continuum and begins early on. This article reviews the pros and cons of these criteria. It also provides practical guidelines for psychiatrists whose patients may be affected by these new criteria. Particular attention is given to patients who, as opposed to their wanting to know whether they are likely to have AD, want to deny this possibility.
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Affiliation(s)
- Edmund Howe
- Dr. Howe is Professor, Department of Psychiatry, Director, Programs in Medical Ethics, and Senior Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Abstract
BACKGROUND Many minority ethnic (ME) older adults face several culturally associated and systemic barriers to timely dementia diagnoses that may result in delays to dementia care-seeking. We aimed to develop and propose a model illustrating variables that influence dementia care-seeking among ME older adults. METHODS We conducted a literature review on the effects of these barriers on diagnostic delays and impairment levels at initial evaluation. We also strived to provide a basis for the Sociocultural Health Belief Model (SHBM) to guide future research and service planning pertaining to culture and dementia care-seeking. RESULTS There was consistent evidence that ME older adults with dementia tended to have greater diagnostic delays and higher levels of cognitive impairment and behavioral and psychological symptoms of dementia at initial evaluation than their non-Hispanic White counterparts. We also found several barriers to dementia care-seeking among ME groups. These barriers included lower levels of acculturation and accurate knowledge about dementia, more culturally associated beliefs about dementia, such as the perception of memory loss as normal aging and stigma associated with dementia, and health system barriers. CONCLUSIONS The SHBM provides an empirically based conceptual framework for examining cross-cultural differences in dementia care-seeking among diverse groups. We provide recommendations for future research, such as the need for research with more diverse ethnic subgroups and the examination of group-specific cultural values. We conclude with a discussion of the clinical and service implications of our review, including potential interventions aimed at facilitating timely dementia diagnoses among ME older adults.
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Logue MW, Schu M, Vardarajan BN, Buros J, Green RC, Go RCP, Griffith P, Obisesan TO, Shatz R, Borenstein A, Cupples LA, Lunetta KL, Fallin MD, Baldwin CT, Farrer LA. A comprehensive genetic association study of Alzheimer disease in African Americans. ACTA ACUST UNITED AC 2012; 68:1569-79. [PMID: 22159054 DOI: 10.1001/archneurol.2011.646] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the association of genetic variation with late-onset Alzheimer disease (AD) in African Americans, including genes implicated in recent genome-wide association studies of whites. DESIGN We analyzed a genome-wide set of 2.5 million imputed markers to evaluate the genetic basis of AD in an African American population. SUBJECTS Five hundred thirteen well-characterized African American AD cases and 496 cognitively normal African American control subjects. SETTING Data were collected from multiple sites as part of the Multi-Institutional Research on Alzheimer Genetic Epidemiology (MIRAGE) Study and the Henry Ford Health System as part of the Genetic and Environmental Risk Factors for Alzheimer Disease Among African Americans (GenerAAtions) Study. RESULTS Several significant single-nucleotide polymorphisms (SNPs) were observed in the region of the apolipoprotein E gene (APOE). After adjusting for the confounding effects of APOE genotype, one of these SNPs, rs6859 in PVRL2, remained significantly associated with AD (P = .0087). Association was also observed with SNPs in CLU, PICALM, BIN1, EPHA1, MS4A, ABCA7, and CD33, although the effect direction for some SNPs and the most significant SNPs differed from findings in data sets consisting of whites. Finally, using the African American genome-wide association study data set as a discovery sample, we obtained suggestive evidence of association with SNPs for several novel candidate genes. CONCLUSIONS Some genes contribute to AD pathogenesis in both white and African American cohorts, although it is unclear whether the causal variants are the same. A larger African American sample will be needed to confirm novel gene associations, which may be population specific.
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Affiliation(s)
- Mark W Logue
- Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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NIA Outreach to Minority and Health Disparity Populations. Alzheimer Dis Assoc Disord 2010. [DOI: 10.1097/wad.0b013e3181f14a75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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