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Strooij BT, Blom MT, van Hout HPJ, Maarsingh OR, Elders PJM, van Campen JPCM, van der Heide I, Verheij RA, Joling KJ. Potentially Inappropriate Medication in Older Persons With Dementia: Does a Migration Background Matter? J Am Med Dir Assoc 2024; 25:105150. [PMID: 39009066 DOI: 10.1016/j.jamda.2024.105150] [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: 10/13/2023] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Previous research in the general population shows more potentially inappropriate medications (PIMs) among persons with a migration background compared with persons without a migration background. This study investigated the association between non-Western (nw) migration background (MB) and dementia-specific PIMs in older adults with dementia in the Netherlands. DESIGN Cohort study using routinely recorded electronic health records and administrative data. SETTING AND PARTICIPANTS Electronic health record data of general practitioners from the NIVEL-Primary Care Database, were linked to registries managed by Statistics Netherlands (2013-2014). A total of 9055 community-dwelling older adults with dementia were included, among whom 294 persons had an nw-MB from Africa, South America, or Asia, based on their country of birth. METHODS We determined the presence of dementia-specific PIM prescriptions and compared this between persons with an nw-MB and without an MB, using logistic regression analysis adjusted for follow-up time, age, registered sex, and total number of prescriptions. Interaction effects of potentially relevant covariates were tested. The 3 largest nw-MB groups in the Netherlands were analyzed separately. RESULTS Dementia-specific PIMs were less frequently prescribed to persons with an nw-MB compared to persons without an MB with a dementia diagnosis [30.6% vs 34.4%, odds ratio (OR) 0.71, 95% CI 0.54-0.92], with especially less often a benzodiazepine prescription in the group with an nw-MB, compared to persons without an MB (15.0% vs 19.3%, OR 0.61, 95% CI 0.43-0.84). Dementia duration, living alone, household income, and degree of urbanization did not influence the associations. CONCLUSIONS AND IMPLICATIONS Among older adults with dementia in the Netherlands, persons with an nw-MB had less often a dementia-specific PIM prescription compared to persons without an MB. Whether this difference is a reflection of better quality of care, higher professional uncertainty, or less recognition of (mental) health problems in persons with an nw-MB and dementia, needs further investigation.
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Affiliation(s)
- Bianca T Strooij
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands.
| | - Marieke T Blom
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Petra J M Elders
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, The Netherlands; Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, The Netherlands
| | | | - Iris van der Heide
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Karlijn J Joling
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, The Netherlands
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Chejor P, Atee M, Cain P, Whiting D, Morris T, Porock D. Comparing clinico-demographics and neuropsychiatric symptoms for immigrant and non-immigrant aged care residents living with dementia: a retrospective cross-sectional study from an Australian dementia-specific support service. BMC Geriatr 2023; 23:729. [PMID: 37950203 PMCID: PMC10636936 DOI: 10.1186/s12877-023-04447-3] [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: 04/17/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms of dementia such as agitation and aggression are common in people living with dementia. The presentation of neuropsychiatric symptoms is influenced by the cultural background of people living with dementia. Further, identifying factors contributing to neuropsychiatric symptoms may be complicated if people living with dementia are immigrants or from non-English-speaking backgrounds. Most of what is known about differences in neuropsychiatric symptoms between racial and ethnic groups living with dementia come from community-based samples. This study investigated differences in clinico-demographics and neuropsychiatric symptoms between immigrants and non-immigrants living with dementia in residential aged care homes who were referred to two Dementia Support Australia programs. METHODS This was a retrospective observational cross-sectional study from 2018 to 2022 using data extracted from the Dementia Support Australia database. Immigrant status was identified by documented country of birth. We conducted exploratory subgroup analyses for English-speaking or non-English-speaking immigrants in comparison to non-immigrants. Neuropsychiatric Inventory and PainChek® were used to assess neuropsychiatric symptoms of dementia and pain, respectively. RESULTS Of the 23,889 referrals, 36% were immigrants living with dementia. Immigrants were 0.8 years older than non-immigrants on average. Immigrants had a slightly higher prevalence of mixed dementia (9.5%) than non-immigrants (8.2%). Overall, the groups had no difference in the severity of neuropsychiatric symptoms and associated caregiver distress. However, there was a significant difference in the total number of neuropsychiatric inventory domains (Cohen's d = -0.06 [-0.09, - 0.02], p <.001) between non-English-speaking immigrants and non-immigrants. Immigrants were more likely to present with agitation/aggression, while non-immigrants were more likely to present with hallucinations. Factors contributing to neuropsychiatric symptoms were common between the groups, with language barriers and cultural considerations frequently endorsed for immigrants. CONCLUSION This study reveals a mixed picture of neuropsychiatric symptoms between immigrants and non-immigrants. However, due to the exploratory nature of the hypotheses, our findings need to be replicated in future studies to confirm any conclusions. There is a need for increased awareness on the impact of culture and language on neuropsychiatric symptoms for people receiving residential care. Future studies investigating neuropsychiatric symptoms in different immigrant groups will help increase our understanding of neuropsychiatric symptoms for all people.
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Affiliation(s)
- Pelden Chejor
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Mustafa Atee
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
- The Dementia Centre, HammondCare, Osborne Park, Western Australia, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Cain
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
| | - Daniel Whiting
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Thomas Morris
- The Dementia Centre, HammondCare, St Leonards, New South Wales, Australia
| | - Davina Porock
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia
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Lewis A, Gupta A, Oh I, Schindler SE, Ghoshal N, Abrams Z, Foraker R, Snider BJ, Morris JC, Balls-Berry J, Gupta M, Payne PRO, Lai AM. Association Between Socioeconomic Factors, Race, and Use of a Specialty Memory Clinic. Neurology 2023; 101:e1424-e1433. [PMID: 37532510 PMCID: PMC10573139 DOI: 10.1212/wnl.0000000000207674] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/06/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The capacity of specialty memory clinics in the United States is very limited. If lower socioeconomic status or minoritized racial group is associated with reduced use of memory clinics, this could exacerbate health care disparities, especially if more effective treatments of Alzheimer disease become available. We aimed to understand how use of a memory clinic is associated with neighborhood-level measures of socioeconomic factors and the intersectionality of race. METHODS We conducted an observational cross-sectional study using electronic health record data to compare the neighborhood advantage of patients seen at the Washington University Memory Diagnostic Center with the catchment area using a geographical information system. Furthermore, we compared the severity of dementia at the initial visit between patients who self-identified as Black or White. We used a multinomial logistic regression model to assess the Clinical Dementia Rating at the initial visit and t tests to compare neighborhood characteristics, including Area Deprivation Index, with those of the catchment area. RESULTS A total of 4,824 patients seen at the memory clinic between 2008 and 2018 were included in this study (mean age 72.7 [SD 11.0] years, 2,712 [56%] female, 543 [11%] Black). Most of the memory clinic patients lived in more advantaged neighborhoods within the overall catchment area. The percentage of patients self-identifying as Black (11%) was lower than the average percentage of Black individuals by census tract in the catchment area (16%) (p < 0.001). Black patients lived in less advantaged neighborhoods, and Black patients were more likely than White patients to have moderate or severe dementia at their initial visit (odds ratio 1.59, 95% CI 1.11-2.25). DISCUSSION This study demonstrates that patients living in less affluent neighborhoods were less likely to be seen in one large memory clinic. Black patients were under-represented in the clinic, and Black patients had more severe dementia at their initial visit. These findings suggest that patients with a lower socioeconomic status and who identify as Black are less likely to be seen in memory clinics, which are likely to be a major point of access for any new Alzheimer disease treatments that may become available.
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Affiliation(s)
- Abigail Lewis
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Aditi Gupta
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Inez Oh
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Suzanne E Schindler
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Nupur Ghoshal
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Zachary Abrams
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Randi Foraker
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Barbara Joy Snider
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - John C Morris
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Joyce Balls-Berry
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Mahendra Gupta
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Philip R O Payne
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO
| | - Albert M Lai
- From the Division of Computational and Data Sciences (A.L.), Washington University in St. Louis; Institute for Informatics (A.L., A.G., I.O., Z.A., R.F., P.R.O.P., A.M.L.), Department of Neurology (S.E.S., N.G., B.J.S., J.C.M., J.B.-B.), and Department of Psychiatry (N.G.), Washington University School of Medicine, St. Louis; and Olin Business School (M.G.), Washington University in St. Louis, MO.
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