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Rahemi Z, Shalhout SZ, Bacsu JDR, Petrovsky DV, Zanwar PP, Adams SA. Social Determinants of Health and Healthcare Utilization Disparities among Older Adults with and Without Cognitive Impairment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.14.24310385. [PMID: 39040173 PMCID: PMC11261929 DOI: 10.1101/2024.07.14.24310385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
The purpose of this study was to determine the healthcare utilization patterns in a national sample of older adults across several social determinants of health factors (ethnicity, gender, race, education) with normal and dementia/impaired cognition. We used datasets from the Health and Retirement Study (HRS, 2018) to evaluate healthcare utilization, including metrics such as hospital and nursing home stays, hospice care, and number of visits to the doctor. Logistic models were used to predict healthcare utilization separately in those with normal cognition and dementia. Our final sample comprised 15,607 adults (mean age: 65.2 normal cognition, mean age 71.5 dementia). Hispanics with normal cognition were less likely to stay in a hospital than non-Hispanic respondents (OR: 0.52-0.71, p<0.01). Being female was associated with a higher risk for shorter nursing home days (OR: 1.41, p<0.01) and doctor visits (OR: 1.63-2, p<0.01) in cognitively normal older adults. Being female was associated with a lower risk for hospital stay in those with dementia (OR: 0.50-0.78, p<0.01). Respondents identifying as Black or other races with dementia were less likely to experience nursing home days (OR: 0.42, p<0.04). Black respondents with normal cognition were less likely to experience doctor visits (OR: 0.32-0.37, p<0.01). Those with more than a high school education in both groups were more likely to experience doctors' visits. The study points to the continued disparities in healthcare utilization linked to participants' social determinants of health factors and cognition.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Clemson, SC, 29634-0743
| | - Sophia Z. Shalhout
- Division of Surgical Oncology, Department of Otolaryngology- Head and Neck Surgery, Mass Eye and Ear, Boston, MA
- Mike Toth Cancer Center, Mass Eye and Ear, Boston, MA
- Department of Otolaryngology- Head and Neck Surgery Harvard Medical School, Boston, MA
| | | | - Darina V. Petrovsky
- Duke University School of Nursing, Division of Women, Children and Families, 307 Trent Drive, Box 3322 Durham, NC 27710
| | | | - Swann Arp Adams
- College of Nursing, University of South Carolina, Columbia, SC 29208
- Department of Epidemiology & Biostatistics, University of South Carolina, Columbia, SC 29208
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Snowball E, Aiken C, Norman M, Hykaway W, Dempster Z, Itzhak I, McLellan E, McGilton KS, Bethell J. Engaging people with lived experience of dementia in research meetings and events: insights from multiple perspectives. FRONTIERS IN DEMENTIA 2024; 3:1421737. [PMID: 39081602 PMCID: PMC11285645 DOI: 10.3389/frdem.2024.1421737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/21/2024] [Indexed: 08/02/2024]
Abstract
This perspective article describes the experiences of engaging people with lived experience of dementia in research meetings and events from the perspectives of people with lived experience, researchers, trainees, audience members and others. We outline examples of engagement from different events and describe a video project, initiated by people with lived experience, conveying diverse views about becoming integral collaborators in the Canadian Consortium on Neurodegeneration in Aging (CCNA) annual Partners Forum and Science Days. We also report evaluation data from audiences and present a series of tips and strategies for facilitating this engagement, including practical considerations for supporting people with lived experience.
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Affiliation(s)
- Ellen Snowball
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Christine Aiken
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Myrna Norman
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Wayne Hykaway
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Zoe Dempster
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Inbal Itzhak
- Knowledge Translation and Exchange Program, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Emily McLellan
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
| | - Katherine S. McGilton
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jennifer Bethell
- Knowledge, Innovation, Talent, Everywhere (KITE) Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Engagement of People with Lived Experience of Dementia Program/Advisory Group, Canadian Consortium on Neurodegeneration in Aging, Montreal, QC, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Jacobsen E, Lucas H, Moran C, Dixon RG, Ganguli M. Recruitment of a Diverse Community-based Older Adult Cohort for a Longitudinal Aging Study: The 15104 Seniors Project. Alzheimer Dis Assoc Disord 2024; 38:160-167. [PMID: 38748658 PMCID: PMC11178142 DOI: 10.1097/wad.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/07/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Enrolling individuals from underrepresented ethnoracial groups in aging research is often a challenge. METHODS We sought a diverse sample of older adults from a small-town area for a longitudinal aging study. We employed an intensive community engagement approach encompassing a range of recruitment strategies. RESULTS Over 4 years a steady trickle of individuals, 66% self-identifying as Black, signed up for study information; the proportion of those who eventually enroll in the study has been rising each year, from 68% to 94%. Community events, word-of-mouth referrals, and mailed postcards brought in the most contacts. The highest percentage of contacts who ultimately enrolled were from postcards, flyers, and word-of-mouth. Significantly more word-of-mouth referrals were endorsed by Black individuals than White and by Black men than other race/sex groups. CONCLUSIONS We have had some success in building relationships and trust with the local community, enrolling Black study participants in a proportion equal to their representation in the target community using a variety of recruitment methods. Patience, immersion in the community, and partnerships with key community members alongside traditional advertisements, and the utilization of study participants as recruiters are critical to designing optimal, targeted, recruitment strategies.
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Affiliation(s)
- Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Heather Lucas
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | - Catherine Moran
- University of Pittsburgh, School of Medicine, Department of Psychiatry
| | | | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry
- University of Pittsburgh, School of Medicine, Department of Neurology
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology
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Vidoni ED, Swinford E, Barton K, Perales‐Puchalt J, Niedens CM, Lewandowski T, Schwasinger‐Schmidt T, Peltzer J, Wurth J, Berkley‐Patton J, Townley RA, Moore WT, Shaw AR, Key MN, Andrade E, Robinson M, Sprague S, Bondurant A, Brook D, Freund J, Burns JM. A service-oriented approach to clinical trial recruitment for dementia and brain health: Methods and case examples of MyAlliance for Brain Health. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2024; 10:e12475. [PMID: 38903984 PMCID: PMC11187743 DOI: 10.1002/trc2.12475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Recruitment of sufficient and diverse participants into clinical research for Alzheimer's disease and related dementias remains a formidable challenge. The primary goal of this manuscript is to provide an overview of an approach to diversifying research recruitment and to provide case examples of several methods for achieving greater diversity in clinical research enrollment. METHODS The University of Kansas Alzheimer's Disease Research Center (KU ADRC) developed MyAlliance for Brain Health (MyAlliance), a service-oriented recruitment model. MyAlliance comprises a Primary Care Provider Network, a Patient and Family Network, and a Community Organization Network, each delivering tailored value to relevant parties while facilitating research referrals. RESULTS We review three methods for encouraging increased diversity in clinical research participation. Initial outcomes reveal an increase in underrepresented participants from 17% to 27% in a research registry. Enrollments into studies supported by the research registry experienced a 51% increase in proportion of participants from underrepresented communities. DISCUSSION MyAlliance shifts power, resources, and knowledge to community advocates, promoting brain health awareness and research participation, and demands substantial financial investment and administrative commitment. MyAlliance offers valuable lessons for building sustainable, community-centered research recruitment infrastructure, emphasizing the importance of localized engagement and cultural understanding. Highlights MyAlliance led to a significant increase in the representation of underrepresented racial and ethnic groups and individuals from rural areas.The service-oriented approach facilitated long-term community engagement and trust-building, extending partnerships between an academic medical center and community organizations.While effective, MyAlliance required substantial financial investment, with costs including infrastructure development, staff support, partner organization compensation, and promotional activities, underscoring the resource-intensive nature of inclusive research recruitment efforts.
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Affiliation(s)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Emma Swinford
- Institute for Human DevelopmentUniversity of Missouri Kansas CityKansas CityMissouriUSA
| | - Kelli Barton
- Institute for Human DevelopmentUniversity of Missouri Kansas CityKansas CityMissouriUSA
| | - Jaime Perales‐Puchalt
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - C. Michelle Niedens
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Tina Lewandowski
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | | | - Jill Peltzer
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - JoEllen Wurth
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Jannette Berkley‐Patton
- Department of Biomedical and Health InformaticsUniversity of Missouri Kansas City School of MedicineKansas CityMissouriUSA
| | - Ryan A. Townley
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - W. Todd Moore
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Ashley R. Shaw
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Mickeal N. Key
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | | | | | | | - Aiden Bondurant
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Debra Brook
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Jennifer Freund
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
| | - Jeffrey M. Burns
- University of Kansas Alzheimer's Disease Research CenterUniversity of Kansas Medical CenterFairwayKansasUSA
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Hill-Jarrett TG, Choi M, Buto PT, Miramontes S, Thomas MD, Yang Y, Kim MH, Sims KD, Glymour MM. Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. Neurology 2024; 102:e208005. [PMID: 38266219 DOI: 10.1212/wnl.0000000000208005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing. METHODS In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs). RESULTS Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants. DISCUSSION Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials.
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Affiliation(s)
- Tanisha G Hill-Jarrett
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Minhyuk Choi
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Peter T Buto
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Silvia Miramontes
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Marilyn D Thomas
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Yulin Yang
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Min Hee Kim
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - Kendra D Sims
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
| | - M Maria Glymour
- From the Department of Neurology (T.G.H.-.J), Memory and Aging Center; Department of Epidemiology and Biostatistics (M.C., P.T.B.); Bakar Computational Health Sciences Institute (S.M.); Department of Psychiatry and Behavioral Sciences (M.D.T.), Weill Institute for Neurosciences; Department of Epidemiology and Biostatistics (Y.Y., K.D.S., M.M.G.); and Institute for Health Policy Studies (M.H.K.), University of California San Francisco
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Di Lorito C, Griffiths S, Poole M, Kaviraj C, Robertson M, Cutler N, Wilcock J. Patient and public involvement and engagement with underserved communities in dementia research: Reporting on a partnership to co-design a website for postdiagnostic dementia support. Health Expect 2024; 27:e13992. [PMID: 38376077 PMCID: PMC10877991 DOI: 10.1111/hex.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Despite the advancements in Patient and Public Involvement and Engagement (PPIE), the voices of traditionally underserved groups are still poorly reflected in dementia research. This study aimed to report on a PPIE partnership between academics and members of the public from underserved communities to co-design Forward with Dementia-Social Care, a resource and information website supporting people receiving a dementia diagnosis. METHODS The PPIE partnership was set up in four stages: 1-identifying communities that have been under-represented from PPIE in dementia research; 2-recruiting PPIE partners from these communities; 3-supporting PPIE partners to become confident to undertake their research roles and 4-undertaking research co-design activities in an equitable fashion. RESULTS To address under-representation from PPIE in dementia research we recruited seven PPIE partners from Black, Asian and other minority ethnic groups; lesbian, gay, bisexual, transgender, queer+ communities; remote/rural area; religious minorities and partners living with rare forms of dementia. The partners met regularly throughout the project to oversee new sections for the study website, refine existing content and promote the website within their communities. CONCLUSION Strategies can be used to successfully recruit and involve PPIE partners from underserved communities in co-design activities. These include networking with community leaders, developing terms of reference, setting out 'rules of engagement', and investing adequate resources and time for accessible and equitable involvement. These efforts facilitate the co-design of research outputs that reflect the diversity and complexity of UK contemporary society. PATIENT OR PUBLIC CONTRIBUTION This study received support from seven members of the public with lived experience of dementia from communities that have been traditionally underserved in dementia research. These seven members of the public undertook the role of partners in the study. They all equally contributed to the study design, recruitment of participants, development and revision of topic guides for the interviews and development of the website. Three of these partners were also co-authors of this paper. On top of the activities shared with the other partners, they contributed to write independently of the academic team the section in this paper titled 'Partners' experiences, benefits and challenges of the partnership'. Further, they provided input in other sections of the paper on a par with the other (academic) co-authors.
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Affiliation(s)
- Claudio Di Lorito
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Sarah Griffiths
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Marie Poole
- Faculty of Medical Sciences, Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Chandrika Kaviraj
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Martin Robertson
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Neil Cutler
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
| | - Jane Wilcock
- Research Department of Primary Care and Population HealthCentre for Ageing Population StudiesUniversity College LondonLondonUK
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Roche L, Longacre ML. Nonpharmacological interventions in dementia and diversity of samples: A scoping review. Geriatr Nurs 2024; 55:311-326. [PMID: 38142547 DOI: 10.1016/j.gerinurse.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND A public health priority is the increasing number of people with dementia (PwD), and nonpharmacological interventions (NPIs) might offer support. We sought to synthesize types of NPIs tested among PwD and explore sample characteristics. METHODS This study was a scoping literature review. Eligible articles were identified using the search terms "nonpharmacological intervention" and "dementia". RESULTS 36 articles were included. Psychosocial NPIs were implemented the most (n=24) and music-based interventions were found to be the most effective. Gender, race, and ethnicity were not consistently reported (n=30, n=24, and n=6, respectively). White PwD had higher representation, with only 62.5% of studies including Black participants and 25% including Hispanic/Latino participants. Women made up a majority (>50%) of the sample in a greater number of studies (n=20). CONCLUSION Findings suggest that future studies need to be intentional about improving diversity of the sample, particularly with respect to including persons identifying as Black or Hispanic/Latino.
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Affiliation(s)
- L Roche
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States
| | - M L Longacre
- College of Health Sciences, 241 Easton Hall, Arcadia University, 450 S. Easton Rd., Glenside, PA 19038, United States.
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Heng NYW, Rittman T. Understanding ethnic diversity in open dementia neuroimaging data sets. Brain Commun 2023; 5:fcad308. [PMID: 38025280 PMCID: PMC10667030 DOI: 10.1093/braincomms/fcad308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/22/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
Ethnic differences in dementia are increasingly recognized in epidemiological measures and diagnostic biomarkers. Nonetheless, ethnic diversity remains limited in many study populations. Here, we provide insights into ethnic diversity in open-access neuroimaging dementia data sets. Data sets comprising dementia populations with available data on ethnicity were included. Statistical analyses of sample and effect sizes were based on the Cochrane Handbook. Nineteen databases were included, with 17 studies of healthy groups or a combination of diagnostic groups if breakdown was unavailable and 12 of mild cognitive impairment and dementia groups. Combining all studies on dementia patients, the largest ethnic group was Caucasian (20 547 participants), with the next most common being Afro-Caribbean (1958), followed by Asian (1211). The smallest effect size detectable within the Caucasian group was 0.03, compared to Afro-Caribbean (0.1) and Asian (0.13). Our findings quantify the lack of ethnic diversity in openly available dementia data sets. More representative data would facilitate the development and validation of biomarkers relevant across ethnicities.
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Affiliation(s)
- Nicholas Yew Wei Heng
- Department of Neurosciences, University of Cambridge, Herchel Smith building, Cambridge Biomedical Campus, Robinson Way, Cambridge CB2 0SZ, UK
| | - Timothy Rittman
- Department of Neurosciences, University of Cambridge, Herchel Smith building, Cambridge Biomedical Campus, Robinson Way, Cambridge CB2 0SZ, UK
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Mitchell S, McCarthy E, Hinton L, Nkimbeng M, Peak KD, Quiñones AR. Best Practice Recommendations for Integrating Health Equity into Pragmatic Clinical Trials for Dementia Care. Ethn Dis 2023; 33:84-90. [PMID: 38845735 PMCID: PMC11145731 DOI: 10.18865/ed.33.2-3.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Context Minoritized populations experience higher rates of dementia and worse health outcomes than non-Hispanic white people, but they are vastly underrepresented in pragmatic clinical trials embedded in health care systems (ePCTs). Little guidance is available to consider health equity-relevant issues in ePCTs. Objective This report describes the development, structure, and content of a guidance document developed by the National Institute on Aging Imbedded Pragmatic AD/ADRD Clinical Trials (IMPACT) Collaboratory to help investigators systematically assess the integration of health equity into all aspects of ePCT design. Design Led by a task force of IMPACT investigators, a literature review of existing frameworks for health equity considerations in clinical trials was conducted. Next, priority health equity-relevant recommendations in the domains of ePCT design were solicited from Collaboratory experts. The 50 submitted recommendations were reduced to 36 nonoverlapping best practices and categorized into 6 domains, as follows: Getting Started, Community Stakeholder Engagement, Design and Analysis, Intervention Design and Implementation, Health Care System and Participant Selection, and Selecting Outcomes. Each domain had 6 best practice recommendations consisting of a succinctly worded main sentence, with 1 to 2 explanatory sentences. The content was finalized through an iterative process of editing and revision. Conclusions Although specifically focused on ePCTs involving dementia care, the best practices are applicable to any ePCT and can be useful to advance health equity in traditional clinical trials. This guidance document provides a first step toward promoting holistic, structured integration of health equity into the design and conduct of ePCTs as a matter of good science.
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Demographic recruitment bias of adults in United States randomized clinical trials by disease categories between 2008 to 2019: a systematic review and meta-analysis. Sci Rep 2023; 13:42. [PMID: 36593228 PMCID: PMC9807581 DOI: 10.1038/s41598-022-23664-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 11/03/2022] [Indexed: 01/03/2023] Open
Abstract
To promote health equity within the United States (US), randomized clinical trials should strive for unbiased representation. Thus, there is impetus to identify demographic disparities overall and by disease category in US clinical trial recruitment, by trial phase, level of masking, and multi-center status, relative to national demographics. A systematic review and meta-analysis were conducted using MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov, between 01/01/2008 to 12/30/2019. Clinical trials (N = 5,388) were identified based on the following inclusion criteria: study type, location, phase, and participant age. Each clinical trial was independently screened by two researchers. Data was pooled using a random-effects model. Median proportions for gender, race, and ethnicity of each trial were compared to the 2010 US Census proportions, matched by age. A second analysis was performed comparing gender, race, and ethnicity proportions by trial phase, multi-institutional status, quality, masking, and study start year. 2977 trials met inclusion criteria (participants, n = 607,181) for data extraction. 36% of trials reported ethnicity and 53% reported race. Three trials (0.10%) included transgender participants (n = 5). Compared with 2010 US Census data, females (48.3%, 95% CI 47.2-49.3, p < 0.0001), Hispanics (11.6%, 95% CI 10.8-12.4, p < 0.0001), American Indians and Alaskan Natives (AIAN, 0.19%, 95% CI 0.15-0.23, p < 0.0001), Asians (1.27%, 95% CI 1.13-1.42, p < 0.0001), Whites (77.6%, 95% CI 76.4-78.8, p < 0.0001), and multiracial participants (0.25%, 95% CI 0.21-0.31, p < 0.0001) were under-represented, while Native Hawaiians and Pacific Islanders (0.76%, 95% CI 0.71-0.82, p < 0.0001) and Blacks (17.0%, 95% CI 15.9-18.1, p < 0.0001) were over-represented. Inequitable representation was mirrored in analysis by phase, institutional status, quality assessment, and level of masking. Between 2008 to 2019 representation improved for only females and Hispanics. Analysis stratified by 44 disease categories (i.e., psychiatric, obstetric, neurological, etc.) exhibited significant yet varied disparities, with Asians, AIAN, and multiracial individuals the most under-represented. These results demonstrate disparities in US randomized clinical trial recruitment between 2008 to 2019, with the reporting of demographic data and representation of most minorities not having improved over time.
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11
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Eliacin J, Hathaway E, Wang S, O'Connor C, Saykin AJ, Cameron KA. Factors influencing the participation of Black and White Americans in Alzheimer's disease biomarker research. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12384. [PMID: 36505397 PMCID: PMC9728547 DOI: 10.1002/dad2.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
Introduction Alzheimer's disease (AD) is a public health priority. AD biomarkers may vary based on race, but the recruitment of diverse participants has been challenging. Methods Three groups of Black and White participants with and without prior research advocacy or participation were interviewed individually or in focus groups to better understand perspectives related to AD biomarker research participation. A rapid qualitative data analytic approach was used to analyze the data. Results Identified barriers to AD biomarker research participation included hesitancy due to fear, distrust of research and researchers, lack of relevant knowledge, and lack of research test results disclosure. Drivers for engagement in biomarker research procedures included knowledge about research, AD, and related clinical procedures, perceived benefits of participation, and outreach from trusted sources. Discussion Participants' comments related to the need for diversity in research and desire for results disclosure suggest opportunities to engage Black individuals. Highlights Black Americans experience more salient barriers to Alzheimer's disease (AD) biomarker research participation.Concerns about research diversity influence research participation decisions.Research test disclosure may affect research participation and retention.
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Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and CommunicationRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA,Regenstrief InstituteIndianapolisIndianaUSA,National Center for PTSDBoston VA Healthcare SystemBostonMassachusettsUSA,Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA
| | - Elizabeth Hathaway
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sophia Wang
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA,Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Caitlin O'Connor
- VA HSR&D Center for Health Information and CommunicationRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Andrew J. Saykin
- Indiana Alzheimer's Disease Research CenterIndiana University School of MedicineIndianapolisIndianaUSA,Center for NeuroimagingDepartment of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA,Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kenzie A. Cameron
- Department of MedicineDivision of General Internal MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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12
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Ashford MT, Raman R, Miller G, Donohue MC, Okonkwo OC, Mindt MR, Nosheny RL, Coker GA, Petersen RC, Aisen PS, Weiner MW. Screening and enrollment of underrepresented ethnocultural and educational populations in the Alzheimer's Disease Neuroimaging Initiative (ADNI). Alzheimers Dement 2022; 18:2603-2613. [PMID: 35213778 PMCID: PMC9402812 DOI: 10.1002/alz.12640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An analysis of the ethnocultural and socioeconomic composition of Alzheimer's Disease Neuroimaging Initiative (ADNI) participants is needed to assess the generalizability of ADNI data to diverse populations. METHODS ADNI data collected between October 2004 and November 2020 were used to determine ethnocultural and educational composition of the sample and differences in the following metrics: screening, screen fails, enrollment, biomarkers. RESULTS Of 3739 screened individuals, 11% identified as being from ethnoculturally underrepresented populations (e.g., Black, Latinx) and 16% had <12 years of education. Of 2286 enrolled participants, 11% identified as ethnoculturally underrepresented individuals and 15% had <12 years of education. This participation is considerably lower than US Census data for adults 60+ (ethnoculturally underrepresented populations: 25%; <12 years of education: 4%). Individuals with <12 years of education failed screening at a higher rate. DISCUSSION Our findings suggest that ADNI results may not be entirely generalizable to ethnoculturally diverse and low education populations.
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Affiliation(s)
- Miriam T. Ashford
- Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center - San Francisco (United States)
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Garrett Miller
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael C. Donohue
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research Center and The Department of Medicine, University of Wisconsin School Of Medicine And Public Health - Madison (United States)
| | - Monica Rivera Mindt
- Psychology & Latin American Latino Studies Institute, Fordham University, Joint Appointment in Neurology, Icahn School of Medicine at Mount Sinai - New York (United States)
| | - Rachel L. Nosheny
- Department Of Psychiatry, University of California San Francisco - San Francisco (United States)
| | - Godfrey A. Coker
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | | | - Paul S. Aisen
- Alzheimer's Therapeutic Research Institute, University of Southern California - San Diego (United States)
| | - Michael W. Weiner
- Department Of Radiology and Biomedical Imaging, University of California San Francisco - San Francisco (United States)
| | - Alzheimer’s Disease Neuroimaging Initiative
- Data used in preparation of this article were obtained from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (adni.loni.usc.edu). A complete listing of ADNI investigators can be found at:http://adni.loni.usc.edu/wp-content/uploads/how_to_apply/ADNI_Acknowledgement_List.pdf
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13
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Gillis C, Montenigro P, Nejati M, Maserejian N. Estimating prevalence of early Alzheimer's disease in the United States, accounting for racial and ethnic diversity. Alzheimers Dement 2022; 19:1841-1848. [PMID: 36322470 DOI: 10.1002/alz.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Updated estimates of the US Alzheimer's disease (AD) population, including under-represented populations, are needed to improve clinical trial diversity. METHODS A step-wise approach calculating prevalent numbers from clinical syndrome to biomarker-positive mild cognitive impairment (MCI) due to AD and mild AD was developed, using age-and-race/ethnicity-stratified data where available. RESULTS The estimated percentage of Americans aged ≥ 65 years with MCI due to AD was 9.2% of non-Hispanic Whites, 13.6% of non-Hispanic Blacks, 11.1% Hispanics, and 9.7% other race/ethnicities. The estimated percentage of Americans aged ≥ 65 years with mild dementia due to AD among non-Hispanic Whites was 3.7%, non-Hispanic Blacks 7.0%, Hispanics 5.3%, and 3.9% other race/ethnicities. Of these early-stage AD cases, few are likely diagnosed, ranging from 13% of prevalent non-Hispanic Black cases to 27% of non-Hispanic White cases. DISCUSSION Under-representation in clinical trials may be improved by setting recruitment goals reflecting the diversity of the AD patient population and supporting efforts toward timely diagnosis.
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14
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Ashford MT, Camacho MR, Jin C, Eichenbaum J, Ulbricht A, Alaniz R, Van De Mortel L, Sorce J, Aaronson A, Parmar S, Flenniken D, Fockler J, Truran D, Mackin RS, Rivera Mindt M, Morlett-Paredes A, González HM, Mayeda ER, Weiner MW, Nosheny RL. Digital culturally tailored marketing for enrolling Latino participants in a web-based registry: Baseline metrics from the Brain Health Registry. Alzheimers Dement 2022; 19:1714-1728. [PMID: 36193827 PMCID: PMC10070578 DOI: 10.1002/alz.12805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/20/2022] [Accepted: 07/22/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION This culturally tailored enrollment effort aims to determine the feasibility of enrolling 5000 older Latino adults from California into the Brain Health Registries (BHR) over 2.25 years. METHODS This paper describes (1) the development and deployment of culturally tailored BHR websites and digital ads, in collaboration with a Latino community science partnership board and a marketing company; (2) an interim feasibility analysis of the enrollment efforts and numbers, and participant characteristics (primary aim); as well as (3) an exploration of module completion and a preliminary efficacy evaluation of the culturally tailored digital efforts compared to BHR's standard non-culturally tailored efforts (secondary aim). RESULTS In 12.5 months, 3603 older Latino adults were enrolled (71% of the total California Latino BHR initiative enrollment goal). Completion of all BHR modules was low (6%). DISCUSSION Targeted ad placement, culturally tailored enrollment messaging, and culturally tailored BHR websites increased enrollment of Latino participants in BHR, but did not translate to increased module completion. HIGHLIGHTS Culturally tailored social marketing and website improvements were implemented. The efforts enrolled 5662 Latino individuals in 12.5 months. The number of Latino Brain Health Registry (BHR) participants increased by 122.7%. We failed to adequately enroll female Latinos and Latinos with lower education. Future work will evaluate effects of a newly released Spanish-language BHR website.
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Affiliation(s)
- Miriam T Ashford
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Monica R Camacho
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Chengshi Jin
- University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, USA
| | - Joseph Eichenbaum
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Aaron Ulbricht
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | | | | | | | - Anna Aaronson
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Shivam Parmar
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Derek Flenniken
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - Juliet Fockler
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA
| | - Diana Truran
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA
| | - R Scott Mackin
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
| | - Monica Rivera Mindt
- Psychology & Latin American Latino Studies Institute, Fordham University, Joint Appointment in Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alejandra Morlett-Paredes
- University of California, San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center in the School of Medicine, San Diego, California, USA
| | - Hector M González
- University of California, San Diego, Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center in the School of Medicine, San Diego, California, USA
| | - Elizabeth Rose Mayeda
- University of California, Los Angeles, Department of Epidemiology, Los Angeles, California, USA
| | - Michael W Weiner
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Northern California Institute for Research and Education (NCIRE), Department of Veterans Affairs Medical Center, San Francisco, California, USA.,University of California, San Francisco Department of Radiology and Biomedical Imaging, San Francisco, California, USA.,Department of Neurology, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Rachel L Nosheny
- VA, Advanced Imaging Research Center, San Francisco Veteran's Administration Medical Center, San Francisco, California, USA.,Department of Psychiatry, University of California San Francisco, San Francisco, California, USA
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15
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Bothongo PL, Jitlal M, Parry E, Waters S, Foote IF, Watson CJ, Cuzick J, Giovannoni G, Dobson R, Noyce AJ, Mukadam N, Bestwick JP, Marshall CR. Dementia risk in a diverse population: A single-region nested case-control study in the East End of London. THE LANCET REGIONAL HEALTH. EUROPE 2022; 15:100321. [PMID: 35558994 PMCID: PMC9088197 DOI: 10.1016/j.lanepe.2022.100321] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Shaw AR, Perales-Puchalt J, Moore T, Weatherspoon P, Robinson M, Hill CV, Vidoni ED. Recruitment of Older African Americans in Alzheimer's Disease Clinical Trials Using a Community Education Approach. J Prev Alzheimers Dis 2022; 9:672-678. [PMID: 36281671 PMCID: PMC9514712 DOI: 10.14283/jpad.2022.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022]
Abstract
Alzheimer's disease and related dementias (ADRD) is two times more prevalent among compared to non-Hispanic Whites. Despite the higher prevalence of ADRD among older African Americans, recent estimates suggest research enrollment by those who identify as African American remains limited. The purpose of the study is to 1) explore how a culturally tailored community education program impacts clinical trial interest and enrollment in ADRD research studies and to 2) identify how applicable the African American community perceived the culturally tailored curriculum. Using a community-engaged research approach, we collaborated with predominately African American serving community-based organizations to support content development and delivery of Aging with Grace (AWG), a culturally tailored ADRD educational curriculum. A total of five AWG presentations were given to 66 attendees. Most attendees (67%) expressed interest in participating in clinical trials after attending AWG. Enrollment increased within an observational study (84%) and lifestyle prevention clinical trials (52%) from 2018 to 2019. Attendees (32%) also perceived an increase in ADRD knowledge from attending AWG and 89.1% believed more African Americans should participate in research. Our work demonstrates the effectiveness of a culturally tailored community education program to enhance knowledge, clinical trial interest, and recruitment into observational studies and lifestyle ADRD clinical trials among older African Americans. Education programs developed in partnership with the community can serve as bridge to research participation for underrepresented minorities in clinical research. Future studies should assess long-term retention of knowledge and research readiness.
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Affiliation(s)
- A R Shaw
- Eric Vidoni, PhD, 4350 Shawnee Mission Parkway, Fairway, KS, 66205, USA, Phone: 913-588-5312; Fax: 913-945-5035,
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Brijnath B, Croy S, Sabates J, Thodis A, Ellis S, de Crespigny F, Moxey A, Day R, Dobson A, Elliott C, Etherington C, Geronimo MA, Hlis D, Lampit A, Low L, Straiton N, Temple J. Including ethnic minorities in dementia research: Recommendations from a scoping review. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12222. [PMID: 35505899 PMCID: PMC9053375 DOI: 10.1002/trc2.12222] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/18/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Introduction Ethnicity influences dementia etiology, prognosis, and treatment, while culture shapes help‐seeking and care. Despite increasing population diversity in high‐income settlement countries, ethnic minorities remain underrepresented in dementia research. We investigated approaches to enhance the recruitment, and consistent collection and analysis of variables relevant to, ethnic minorities in dementia studies to make recommendations for consistent practice in dementia research. Methods We did a scoping review, searching Embase, PsycINFO, Medline, CENTRAL, and CINAHL between January 1, 2010 and January 7, 2020. Dementia clinical and cohort studies that actively recruited ethnic minorities in high‐income countries were included. A steering group of experts developed criteria through which high‐quality studies were identified. Results Sixty‐six articles were retrieved (51 observational; 15 experimental). Use of interpreters and translators (n = 17) was the most common method to facilitate participant recruitment. Race and ethnicity (n = 59) were the most common variables collected, followed by information on native language (n = 14), country of birth (n = 9), and length of time in country of settlement (n = 8). Thirty‐three studies translated or used a culturally validated instrument. Twenty‐three articles conducted subgroup analyses based on ethnicity. Six high‐quality studies facilitated inclusion through community engagement, collected information on multiple aspects of ethnic diversity, and adjusted/substratified to analyze the impact of ethnicity on dementia. Discussion We make recommendations for consistent recruitment, collection, and reporting of variables relating to ethnic and cultural diversity in dementia research.
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Affiliation(s)
- Bianca Brijnath
- National Ageing Research Institute Parkville Victoria Australia
- School of Social Sciences University of Western Australia Western Australia Perch Australia
| | - Samantha Croy
- Centre for Population Genomics Murdoch Children's Research Institute Melbourne Victoria Australia
| | - Julieta Sabates
- Academic Unit for Psychiatry of Old Age University of Melbourne Parkville Victoria Australia
| | - Antonia Thodis
- National Ageing Research Institute Parkville Victoria Australia
| | - Stephanie Ellis
- ACT Health Directorate Australian Capital Territory Australia
| | - Fleur de Crespigny
- Australian Institute of Health and Welfare Canberra Australian Capital Territory Australia
| | - Annette Moxey
- Dementia Australia Research Foundation Griffith Australian Capital Territory Australia
| | - Robert Day
- Australian Government Department of Health Canberra Australian Capital Territory Australia
| | - Annette Dobson
- School of Public Health University of Queensland Herston Queensland Australia
| | | | - Cathy Etherington
- Australian Bureau of Statistics Belconnen Australian Capital Territory Australia
| | - Mary Ann Geronimo
- Federation of Ethnic Community Councils of Australia Deakin Australian Capital Territory Australia
| | - Danijela Hlis
- Consumer Representative Buderim Queensland Australia
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age University of Melbourne Parkville Victoria Australia
| | - Lee‐Fay Low
- Sydney School of Health Sciences University of Sydney Camperdown New South Wales Australia
| | - Nicola Straiton
- NHMRC Clinical Trials Centre Sydney New South Wales Australia
| | - Jeromey Temple
- School of Population and Global Health University of Melbourne Parkville Victoria Australia
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Aranda MP, Kremer IN, Hinton L, Zissimopoulos J, Whitmer RA, Hummel CH, Trejo L, Fabius C. Impact of dementia: Health disparities, population trends, care interventions, and economic costs. J Am Geriatr Soc 2021; 69:1774-1783. [PMID: 34245588 PMCID: PMC8608182 DOI: 10.1111/jgs.17345] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The dementia experience is not a monolithic phenomenon-and while core elements of dementia are considered universal-people living with dementia experience the disorder differently. Understanding the patterning of Alzheimer's disease and related dementias (ADRD) in the population with regards to incidence, risk factors, impacts on dementia care, and economic costs associated with ADRD can provide clues to target risk and protective factors for all populations as well as addressing health disparities. METHODS We discuss information presented at the 2020 National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers, Theme 1: Impact of Dementia. In this article, we describe select population trends, care interventions, and economic impacts, health disparities and implications for future research from the perspective of our diverse panel comprised of academic stakeholders, and persons living with dementia, and care partners. RESULTS Dementia incidence is decreasing yet the advances in population health are uneven. Studies examining the educational, geographic and race/ethnic distribution of ADRD have identified clear disparities. Disparities in health and healthcare may be amplified by significant gaps in the evidence base for pharmacological and non-pharmacological interventions. The economic costs for persons living with dementia and the value of family care partners' time are high, and may persist into future generations. CONCLUSIONS Significant research gaps remain. Ensuring that ADRD healthcare services and long-term care services and supports are accessible, affordable, and effective for all segments of our population is essential for health equity. Policy-level interventions are in short supply to redress broad unmet needs and systemic sources of disparities. Whole of society challenges demand research producing whole of society solutions. The urgency, complexity, and scale merit a "whole of government" approach involving collaboration across numerous federal agencies.
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Affiliation(s)
| | - Ian N. Kremer
- LEAD Coalition (Leaders Engaged on Alzheimer’s Disease)
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Vidoni ED, Szabo-Reed A, Kang C, Shaw AR, Perales-Puchalt J, Grove G, Hamill M, Henry D, Burns JM, Hillman C, Kramer AF, McAuley E, Erickson KI. The IGNITE trial: Participant recruitment lessons prior to SARS-CoV-2. Contemp Clin Trials Commun 2020; 20:100666. [PMID: 33052319 PMCID: PMC7544598 DOI: 10.1016/j.conctc.2020.100666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/20/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022] Open
Abstract
Full and diverse participant enrollment is critical to the success and generalizability of all large-scale Phase III trials. Recruitment of sufficient participants is among the most significant challenges for many studies. The novel SARS-CoV-2 coronavirus pandemic has further changed and challenged the landscape for clinical trial execution, including screening and randomization. The Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) study has been designed as the most comprehensive test of aerobic exercise effects on cognition and brain health. Here we assess recruitment into IGNITE prior to the increased infection rates in the United States, and examine new challenges and opportunities for recruitment with a goal of informing the remaining required recruitment as infection containment procedures are lifted. The results may assist the design and implementation of recruitment for future exercise studies, and outline opportunities for study design that are flexible in the face of emerging threats.
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Affiliation(s)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | - Ashley R. Shaw
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | | | | | - Jeffrey M. Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | - Arthur F. Kramer
- Northeastern University, Boston, MA, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Edward McAuley
- University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
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20
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Low LF, Barcenilla-Wong AL, Brijnath B. Including ethnic and cultural diversity in dementia research. Med J Aust 2019; 211:345-346.e1. [PMID: 31559640 DOI: 10.5694/mja2.50353] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | | | - Bianca Brijnath
- National Ageing Research Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
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